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Loan sponsor summary: <br />*If more than one loan sponsor will be participating in the project list all of the loan sponsors and the amount of each loan <br />requested: <br />Loan sponsor #1: <br />Loan sponsor #2: <br />Loan sponsor #3: <br />Loan sponsor #4: <br />Loan sponsor #5: <br />Conflict of Interest <br />Amount: <br />Amount: <br />Amount: <br />Amount: <br />Amount: <br />Total amount requested: <br />A conflict of interest occurs when any of the following conditions is present: <br />(a) An applicant or potential loan awardee uses his/her status to obtain special advantage, benefit, or access to the MPCA's <br />time, services, facilities, equipment, supplies, prestige, or influence. <br />(b) An applicant receives or accepts money or anything else of value from another state loan awardee or loan applicant or has <br />equity or a financial interest in or partial or whole ownership of a competing loan applicant organization. <br />(c) An applicant is an employee of the MPCA or is an immediate family member of an employee of the MPCA. <br />(d) An applicant or potential loan awardee is unable or potentially unable to render impartial assistance or advice to the State <br />due to competing duties or loyalties. <br />(e) A loan awardee's objectivity in carrying out the loan project is or might be otherwise impaired due to competing duties or <br />loyalties. <br />(f) A loan awardee has an unfair competitive advantage through being furnished unauthorized proprietary information or <br />source selection information that is not available to all competitors/applicants. <br />I certify that I have read and understand the description of conflicts of interest above and (check one of the following two boxes): <br />® Based on the criteria and description above, I do not have any conflicts of interest. <br />® Based on the criteria and description above, I have an actual or potential conflict of interest, or the appearance of a conflict <br />of interest, which I am listing immediately below. <br />Name/Relationship and/or Description of the Conflict of Interest (attach additional page if needed): <br />www.pca.state.mn.us 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats <br />wq-cwp7-35e • 9114116 Page 5 of 5 <br />