Iowa Economic Development Authority (IEDA) Application - Cottingham & Butler Copyright 2014
City of Dubuque Action Items # 4.
ITEM TITLE: Iowa Economic Development Authority (I EDA) Application - Cottingham &
Butler
SUMMARY: City Manager recommending approval of a resolution authorizing the
submission of an Iowa Economic Development Assistance Application on
behalf of Cottingham & Butler, Inc. for the expansion of its operations in
Dubuque.
RESOLUTION Authorizing the filing of an application for State Business
Financial Assistance on behalf of Cottingham & Butler
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Adopt Resolution(s)
ATTACHMENTS:
Description Type
❑ Cottingham &Butler-IEDA Application-MVM Memo City Manager Memo
❑ Staff Memo Staff Memo
❑ C&B IEDA Application Supporting Documentation
❑ Resolution Resolutions
THE CITY OF Dubuque
UBE I
erica .i
Masterpiece on the Mississippi 2007-2012-2013
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: State of Iowa Business Financial Assistance Application for Cottingham &
Butler, Inc.
DATE: January 27, 2015
Economic Development Director Maurice Jones recommends City Council approval of a
resolution authorizing the submission of an Iowa Economic Development Assistance
Application on behalf of Cottingham & Butler, Inc. for the proposed investment of $1.2
million for the expansion of its operations in Dubuque. The proposed project would add
90 jobs predominantly located in Dubuque at 1000 and 1030 Main Street.
The local match requirement will be met with a $150,000 loan from ECIA.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
Mic ael C. Van Milligen
MCVM:jh
Attachment
cc: Barry Lindahl, City Attorney
Cindy Steinhauser, Assistant City Manager
Teri Goodmann, Assistant City Manager
Maurice Jones, Economic Development Director
Dubuque Economic Development Department
THE CITY OF 50 West 13th Street
All-America City Dubuque,Iowa 52001-4864
D U B3 E1 ' Office(563)589-4393
TTY(563)690-6678
° http://www.cityofdubuque.org
Masterpiece on the Mississippi 200.2012.2013
TO: Michael Van Milligen, City Manager
FROM: Maurice Jones, Economic Development Director
SUBJECT: State of Iowa Business Financial Assistance Application for Cottingham &
Butler, Inc.
DATE: January 26, 2015
INTRODUCTION
This memorandum presents for City Council review and approval a resolution
authorizing the submission of an Iowa Economic Development Assistance Application
by Cottingham & Butler, Inc. to the Iowa Economic Development Authority (IEDA).
BACKGROUND
Cottingham & Butler was established in 1887 and is the 37th largest insurance broker in
the U.S. and a recognized leader in employee benefit insurance solutions. The
company is headquartered in Dubuque, Iowa, and employs over 600 employees across
the U.S. Cottingham & Butler provides a full suite of risk management and employee
benefits services.
The company continues to increase its national footprint in an effort to make certain it is
providing the best service to its clients and has satellite offices in Iowa, Florida, Illinois,
Ohio, Wisconsin, Tennessee, Minnesota, Pennsylvania and California.
DISCUSSION
Beginning in 2015 Cottingham & Butler is establishing a plan to increase employment in
Iowa by 90 positions, to be predominantly located in Dubuque at 1000 & 1030 Main
Street. The company is proposing to enter into a lease agreement for approximately
10,000 square feet of space located in Dubuque; complete tenant improvements; and
purchase furniture, fixtures, software, hardware and phones to accommodate the
increase in employment. The company proposes to start the project in March of 2015,
and complete the hiring by March of 2018. The project cost is more than $1.2 Million.
Cottingham & Butler has applied to the Iowa Economic Development Authority for
assistance in the form of grants and loans.
The company is eligible for an estimated $305,000 in training fund reimbursement for
the 90 jobs. The local match requirement will be met with the $150,000 loan from ECIA
(see Source D listed on page 6 of application). The company is also requesting direct
financial assistance of $600,000 from the IEDA. The incentives are offered through the
State's High Quality Jobs Program.
RECOMMENDATION
I recommend that the City Council approve the Economic Development Assistance
Application on behalf of Cottingham & Butler, Inc. for the proposed investment of $1 .2
Million for the expansion of its operations in Dubuque. The proposed project would add
90 jobs and promote the City's goal of retaining and expanding business to add to the
economic base.
ACTION STEP
The action step for the City Council is to adopt the attached resolution.
Prepared by: Jill Connors, Economic Development, 50 W. 13th Street, Dubuque IA 52001, 563 589-4393
Return to: Jill Connors, Economic Development, 50 W. 13th Street, Dubuque IA 52001, 563 589-4393
RESOLUTION NO. 38-15
AUTHORIZING THE FILING OF AN APPLICATION FOR STATE BUSINESS FINANCIAL
ASSISTANCE ON BEHALF OF COTTINGHAM & BUTLER, INC.
Whereas, Cottingham & Butler, Inc. has proposed making a One Million Two Hundred
Thousand Dollar ($1,200,000.00) investment for tenant improvements of a ten thousand
square foot (10,000 sq. ft.) office facility in the City of Dubuque, Iowa ; and
Whereas, the City Council of the City of Dubuque, Iowa has considered the proposal
and has determined that the proposed project will contribute to the local economy through
the creation of ninety (90) full-time jobs in the City; and
Whereas, financial assistance from the Iowa Economic Development Authority is
designed to assist in the economic development efforts of local jurisdictions; and
Whereas, the Iowa Economic Development Authority has requested execution of an
Economic Development Assistance Contract in order to finalize incentives and document
associated terms for the tenant improvements of Cottingham & Butler, Inc.'s proposed
location at 1000 & 1030 Main Street in the City.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
DUBUQUE, IOWA:
Section 1. That the filing of an Application for participation in the Iowa Economic
Development Authority's Financial Assistance Program on behalf of Cottingham & Butler,
Inc., a copy of which is attached hereto, is hereby approved.
Section 2. That the Mayor is hereby authorized to execute and the City Manager is
hereby directed to submit the Application to the Iowa Economic Development Authority
together with such other documents as may be required.
Passed, approved, and adopted this 2"d day of February, 2 15.
t(
Attest:
dirt
Kevin
Firnstahl, City Clerk
Roy Duol, Mayor
economic t� �l AO
Debi V. Durham, Director
Iowa Economic Development Authority
Business Financial Assistance Application
Business Finance - Business Development Division
Iowa Economic Development Authority
200 East Grand Avenue
Des Moines, Iowa 50309-1819
wwwiowaeconomicdevelopment.com
Telephone. 5157253134 Email. businessfinance(dliowa boy
Application Instructions
To Complete Electronic Form: Click on TEXT BOX to add text Double click on YES/NO boxes and select"Checked".
1. Al applicants must complete the Business Financial Assistance Application and attach only those
additional sections for the components to which the applicant is applying.
STATE of IOWA— Financial Assistance Proaram
High Quality Jobs Program (HQJP)
❑ Tax Credits
® Direct Financial Assistance
2. Before filling out this application form, please read all applicable sections of the Iowa Code and Iowa
Administrative Code (rules). www.leais.state.ia.us/lowaLaw.html
3. Only typed or computer-generated applications will be accepted and reviewed. Any material change to
the format, questions, or wording of questions presented in this application will render the application
invalid and it will not be accepted.
4. Complete the applicable sections ofthe application fully. If questions are left unanswered or required
attachments are not submitted, an explanation must be included.
5. Use clear and concise language.Attachments should only be used when requested or as supporting
documentation.
6. Any inaccurate information of a significant nature may disqualify the application from consideration.
7. The following must be submitted to Business Finance at IEDA in order to initiate the review process:
• One original, signed application form and all required attachments
• One electronic copy of the application form and all required attachments
Facsimile copies will not be accepted.
Applications must be submitted to IEDA Business Finance before 4:00pm on the fourth Monday of the month.
Applications will be reviewed by the IEDA Board on the third Friday of the following month.
v 0 06 2014
Public Records Policies
During the application process, the information submitted by you to IEDA is exempt from disclosure under
the "industrial prospects" exemption found in Section 22.7(8). However, once you receive an award, the
industrial prospects exemption no longer applies and all documents submitted and generated during the
application and negotiation process become public records under Iowa's Open Records Law (Iowa Code,
Chapter 22), unless
1) The information belongs to one of the classes of records automatically treated as confidential; or
2) You have applied for and received written notice that your information will be treated as confidential.
Automatically Confidential Records
IEDA automatically treats the following records as confidential and will withhold them from public inspection
even without a request for confidential treatment:
• Tax Records and Tax Liability Information
• Quarterly Iowa Employer's Contribution and Payroll Report prepared for the Iowa Workforce
Development Department
• Payroll Registers
• Business Financial Statements and Projections (unless those statements are already publicly
available elsewhere, e.g., 10-K filings)
• Personal Financial Statements
Exemptions to the Open Records Law
If you wish to have additional information treated as confidential, you must fill out the confidential treatment
request form. Under the Open Records Law, IEDA may lawfully treat certain information as confidential if
that information falls within an exemption to the Open Records Law. The following exemptions represent
records which may lawfully be treated as confidential under the Open Records law and which are most often
applicable to the information submitted to IEDA:
• Release of information would give an unfair advantage to competitors — Iowa Code Sec. 15.118
• Trade secrets —See Iowa Code section 22.7(3), see also Iowa Code Ch. 550
• Information on an industrial prospect with which the IEDA is currently negotiating —See Iowa Code
section 22.7(8)
• Communications not required by law, rule or regulation made to IEDA by persons outside the
government to the extent that IEDA could reasonably believe that those persons would be
discouraged from making them to IEDA if they were made available for general public
examination — Iowa Code section 22.7(18)
Non-Confidential Information
Information that is submitted to IEDA as part of the application process or that is contained in a contract for
program benefits is generally considered material to the eligibility requirements of the program or to the
amount of incentives or assistance to be provided. Such information is generally not given confidential
treatment. Such information includes but is not limited to, the number and type of jobs incented, the wage
levels for the incented jobs, your company's employee benefit information, and your project budget.
Additional Information Available. Copies of Iowa's Open Record law and IEDA's administrative rules
relating to public records are available from the IEDA upon request.
IEDA—Business Financial Assistance Application 2 v.08.06.2014
SECTION A
Applicant Information Date Application Submitted: 1/26/15
1. Name of Business: Cottingham & Butler, Inc
2. Entity Name (for contracting purposes): Tim Berns
3. Address: 800 Main Street
4. City, State & Zip Code: Dubuque, Iowa 52001
5. Contact Person: Tim Berns Title: CFO
6. Phone: 563 587-5301 Fax: 563-587-5881 Email: tberns@cottinghambutler.com
7. FEIN: 42-1490886
8. NAICS Code for primary business operations: 524210
9. US DOT Number:
10. Does the Business file a consolidated tax return under a different tax ID number?
❑ Yes (If yes, please also provide that tax ID number) ® No
a. Is the contact person listed above authorized to obligate the Business?
® Yes ❑No If no, please provide the name and title of a company officer authorized to
obligate the Business:
11. If the application was prepared by someone other than the contact person listed above, please
complete the following:
Name of Business:
Address:
City, State & Zip Code:
Contact Person: Title:
Phone: Fax: Email:
Sponsor Information (A sponsor organization is a city or county)
12. Sponsor Organization: City of Dubuque, Iowa
13. Official Contact (e.g. Mayor, Chairperson, etc.): Roy Buol Title: Mayor
14. Address: 50 W. 13th Street
15. City, State & Zip Code: Dubuque, Iowa 52001
16. Phone: 563 589-4100 Fax: Email:
17. If IEDA needs to contact the sponsor organization with questions, should we contact the person
listed above?
❑ Yes ® No, please contact the following person:
Name: Maurice Jones Title: Economic Development Director
Address: 50 W. 13th Street
City, State & Zip Code: Dubuque, Iowa 52001
Phone: 563 589-4393 Fax: 563.589.1733 Email:
mjones@cityofdubuque.org
If necessary, please list information on additional sponsors in an attachment.
IEDA—Business Financial Assistance Application 3 v.08.06.2014
SECTION B
Business Information
1. Provide a brief description and history of the Business. Include information about the Business'
products or services and its markets and/or customers.
Cottingham & Butler was established in 1887 and is the 37th largest insurance
broker in the U.S. and a recognized leader in offering innovative property & casualty
and employee benefit insurance solutions. The company is headquartered in
Dubuque, Iowa, and employs over 600 employees across the U.S. Cottingham &
Butler provides a full suite of risk management and employee benefits services.
Our central location in the heart of the U.S. gives us the distinct advantage of easily
reaching many major metropolitan cities and, more importantly, remote locations
around the country. We continue to increase our national footprint in an effort to
make certain we are providing the best service to our clients and have satellite
offices in Iowa, Florida, Illinios, Ohio, Wisconsin, Tennessee, Minnesota,
Pennsylvania and California.
2. Business Structure:
❑ Cooperative ❑ Corporation ❑ Limited Liability Company
❑ Partnership ® S-Corporation ❑ Sole Proprietorship
3. State of Incorporation: Iowa
4. Identify the Business' owners and percent ownership: Confidential
5. Does a woman, minority, or person with a disability own the Business? ❑ Yes ® No
6. List the Business' Iowa locations and the most current number of employees at each location.
a. Dubuque-445
b. Davenport-23
c. Cther-8
7. What is the Business' worldwide employment? (Please include employees of parent company, subsidiaries, and
other affiliated entities in this figure.) Over 600.
Project Information
8. Project Street Address: 1000 & 1030 Main Street
Project City&Zip Code: Dubuque, 52001 Project County: Dubuque
9. Type of Business Project:
❑ Startup ® Expansion of Iowa Company ❑ New Location in Iowa
10. Does the project site qualify as a"Brownfield"or"Grayfield" site? ❑Yes ® No
If yes, please explain and document as Attachment A6.
11. Describe the proposed project for which assistance is being sought. (Include project timeline with dates,
facility size, infrastructure improvements, proposed products/services, any new markets, etc.)
The company is proposing to increase employment in Dubuque by 90 positions. The company is proposing to
enter into a lease agreement for approximately 10,000 square feet of space at the above address, complete tenant
improvements, and purchase furniture, fixtures, software, hardware and phones to accommodate the increase in
employment. The company proposes to start the project in March of 2015, and complete the hiring by March of
2018.
IEDA—Business Financial Assistance Application 4 v.08.06.2014
12.
Project Timeline (add additional rows as needed) Beginning Activity Date Activity Completion Date
Lease Space 3/2015 4/2015
Tenant Improvements Hardware/software etc 4/2015 5/2015
Job creation 3/2015 3/2018
13. Has any part of the project started*? ❑Yes ® No
If yes, please explain.
*For IEDA's purposes, starting the project includes:the start of construction or rehabilitation, the purchase of a building, the execution of a
lease, or the installation of equipment to be used in the project.
14. Identify the Business' competitors. If any of these competitors have Iowa locations, please explain the nature of
the competition (e.g. competitive business segment, estimated market share, etc.) and explain what impact the
proposed project may have on the Iowa competitor. We compete with other insurance brokers in Iowa. The
insurance industry is a very broad industry. We do not believe that the expansion of our business will have any
impact on our competitors in Iowa.
15. Will any of the current Iowa employees lose their jobs if this project does not proceed?
❑ Yes ® No
If yes, please explain why and identify those jobs as "retained jobs" in the Project Jobs Section E.
16. Is the Business actively considering locations outside of Iowa? ® Yes ❑ No
If yes, where and what assistance is being offered? We continually evaluate the growth of other locations in C&B's
network of offices. We have not pursued any financial assistance in other locations at this time.
17. Please identify the company project management for the project location and experience. David Becker is
the project manager. David is the CEO and is responsible for overseeing sales, marketing, and most of the
operations for Cottingham & Butler and its subsidiaries. Prior to joining C&B in 2004, David spent 8 years with
McKinsey &Company in Chicago, where he was a Partner specializing in issues related to strategy and marketing
SECTION C
Applicant's Project Budget
1. Does the Business plan to lease the facility? ® Yes ❑ No
If yes, please provide the Annual Base Rent Payment(lease payment minus property taxes, insurance, and
operating/maintenance expenses) for three years in the budget below, and only major renovation costs your
company expects to incur. Administrative rules require that the lease be in place for a minimum of five years.
2. Please complete the budget below. Include only costs the company plans to incur directly:
Use of Funds Cost Source A Source B Source C Source D Source E Source F
Base Rent 3 ears 400, 000 400,000
Tenant Improvements 335, 000 200,000 135,000
Land Acquisition
Site Preparation
Building Acquisition
Building Construction
Building Remodeling
Mf,q. Machinery & Equip.
Other Machinery& Equip.
Racking, Shelving, etc.'
Computer Hardware 105, 000 105,000
Computer Software 180, 000 180,000
Furniture & Fixtures 150, 000 150,000
Working Capital
Research & Development
Other: Phones 65 , 000 1 165 , 000
TOTAL $1,235,000 1 $600,000 1 JL 1 $485,000 $150,000 $ $
' Racking,shelving and conveyor equipment used in distribution center projects only
IEDA-Business Financial Assistance Application 5 v.08.06.2014
3. Please complete the chart below with proposed financing for the project (tax benefits should be reflected as indirect
financing under#5 below):
PROPOSED FINANCING
Source of Funds Form of Funds Conditions/Additional
Information
Amount (Loan,Grant, In- Rate and Commitment Include when funds will be
Add additional lines as needed Kind, Donation,etc.) Term Status disbursed; If loan,whether
payments are a level term,
balloon,etc
Source A: IEDA (see#4 below) $600,000 50% loan/50% 0% Syr
forgivable loan
Source B: Local Government $
Source C: Business $485,000 Yes
Source D: Other Source $150,000 Loan from ECIA 4% 10 Yr In process June 2015 estimate
RLF
Source E: Other Source $
Source F: Other Source $
TOTAL $1,235,000
4. Direct financial assistance(loans/forgivable loans) must be secured with acceptable collateral. Please
select the type of collateral your company will pledge to secure the IEDA financing, and document its value
in Attachment A5.
Explain:
No collateral, funding disbursed at the end of the 5-year contract ❑
Irrevocable letter of credit ❑
Dedicated certificate of deposit CD ❑
Surety bond
Mortgage on real estate ❑
Corporate guaranty ❑
Personal guarantee ❑
*The IEDA Board has the final discretion on what collateral will be accepted.
5. Please complete the chart below with tax credits and other indirect financing expected for the project:
TAX CREDITS AND INDIRECT FINANCING
Source of Funds Amount Description
Investment Tax Credit
Sales, Service& Use Tax Refund
Research Activities Credit 3%/10%
Local Property Tax Exemption
Tax Increment Financing
260E Job Training Funds $305,000 Estimate from NICC
In-kind Contribution
Other
TOTAL $305,000
6. There are three justifiable reasons for providing assistance. Check the box next to the reason why
assistance is needed to complete this project.
❑ Financing Gap- A gap exists between the financing required and the financing on-hand and the provision of
tax incentives or assistance is necessary to fill the gap.
❑ Rate of Return Gap—The likely returns of the project are inadequate to motivate a company decision maker to
proceed with the project even if sufficient debt or equity can be raised to finance the project, and the project's risks
outweigh its rewards, making the provision of tax incentives or assistance necessary to reduce the project's risks.
® Location Disadvantage(Incentive)—The business is deciding between a site in Iowa ("Iowa site") and a site
in another state ("out-of-state site") for its project and the cost of completing the project at the out-of-state site is
demonstrably lower, making tax incentives or assistance necessary to equalize the cost differential between the
two sites. Note: The authority will attempt to quantify the cost differential between the sites.
7. Please provide a brief explanation of the need for assistance.
The State of Iowa is one of many states in which we are located. Attracting and hiring employees in/to Iowa
requires more resources than many of our other locations.
IEDA—Business Financial Assistance Application 6 v.08.06.2014
SECTION D
Employee Benefits
There are three options to meeting the sufficient benefit requirement. These options are detailed in the chart
below. Please complete questions 1-3. If your company meets Option 1 or 2, no additional information is
required. If you would like to utilize Option 3, piease also complete questions 4-6.
Option 1 Option 2 Option 3
80% single Coverage 50% Family coverage Monetary Equivalent
Total Number of Pay 80% of premium costs Pay 50% of premium costs for Provide medical and pay the
Employees in for a standard medical plan, a standard medical plan, monetary equivalent of Option
Iowa single coverage. family coverage. 1 or Option 2 in supplemental
250+ $750 maximum deductible $1,500 maximum deductible employee benefits.
50-249 $1250 maximum deductible $2500 maximum deductible Benefits Counted Toward
0-50 $1750 maximum deductible $3500 Maximum deductible Monetary Equivalent: Medical
coverage, Dental coverage,
Vision insurance, Life
insurance, Pension, 401(k)
(company's Average
contribution, Short-/long-term
disability insurance, Child care
services, Other nonwage
compensation
1. How many full-time, permanent employees does your company currently employ within the State of Iowa? 476
2. What is the total premium cost for a standard medical plan for single employee coverage? $5,486
a. What portion of this cost is paid by the business? $ 3.566
b. What is the deductible associated with this plan? $ 1.300
3. What is the total premium cost for a standard medical plan for family coverage? $ 14.743
a. What portion of this cost is paid by the business? $ 9.583
b. What is the deductible associated with this plan? $ 3.000
No additional information required, in this section, if your company meets the requirement for Option 1 or Option 2
4. Does your company provide additional benefits to full time employees? [-]Yes [-]No
If yes, please provide the annual amount offered by the business, per employee in the chart below:
Benefit Annual amount paid by the
business (Der employee):
Dental Insurance—Sin le plan $
Dental Insurance—Family Ian $
Pension Use 3-year average calculated below $
Retirement Plan - i.e. 401 k Use 3-year average calculated below) $
Profit Sharing Plan (Use 3-year average calculated below) $
Childcare Services $
Life Insurance coverage $
Disability Insurance coverage $
Health Savings Account HSA contribution $
TOTAL $
IEDA—Business Financial Assistance Application 7 v.08.06.2014
5. Does the Business offer a pension plan, 401(k) plan, and/or retirement-plan? ❑ Yes ❑ No
If yes, please indicate the amount contributed on a per employee basis by the Business to the plan for the last three
years. For 401(k) plans, please provide information on the company match and indicate the average annual match per
employee.
Year Ending Average Actual Match per
Employee $
Three-year Average: $
6. Does the Business offer a profit-sharing plan?❑ Yes ❑ No
If yes, please indicate total amount paid out each year for the past three years and then, determine the average annual
bonus or contribution per employee for that three year period.
Year Ending Average Actual Share per
Employee $
Three-year Average: $
Notes:
1. A qualified plan must be offered to all full-time permanent employees.
2. If you have multiple health insurance plans, please provide information on each plan.
I EDA—Business Financial Assistance Application 8 v.08.06.2014
SECTION E
Project Jobs
1. List the jobs that will be created and/or retained as the result of this project. (A retained job is an existing job that
would be eliminated or moved to another state if the project does not proceed in Iowa.) For jobs to be created,
include the starting and final hourly wage rate. For retained jobs, include the current hourly wage rate.
Full-Time CREATED Jobs Add addltlonal rows as needed
Job Title Number of Starting Wage at 36 months
CREATED Jobs Hourly Wage following the award
Service Jobs 15 $34,000 $36,000
Service Jobs 50 $41,800 $45,000
Sales 20 $42,000 $60000
Management 5 $60,000 $75,000
Total Full-Time CREATED Jobs 90
Full-Time RETAINED Jobs Add addltlonal rows as needed
Number of Current Hourly
Job Title (AT-RISK jobs only) RETAINED Wage
Jobs
Total Full-Time RETAINED Jobs
2. Is the hourly wage rate based on a 40 hour work week, 52 weeks per year? ® Yes ❑ No
If no please explain:
IEDA—Business Financial Assistance Application 9 v.08.06.2014
SECTION G
Attachments
Please attach the following documents:
Al Project Plan
Please provide an executive summary for your project. This information should include, at a minimum,
expanded information about the company's products and services and any other project related information
that has not already been described in the application for financial assistance.
The company is proposing to increase employment in Dubuque by 90 positions. The company is proposing to enter
into a lease agreement for approximately 10,000 square feet of space at the above address, complete tenant
improvements, and purchase furniture, fixtures, software, hardware and phones to accommodate the increase in
employment. The company proposes to start the project in March of 2015, and complete the hiring by March of 2018.
A2 Payroll Information (Confidential)
• Copies of the Business' Quarterly Iowa Employer's Contribution and Payroll Report for the past
year. This report should include the monthly employment totals.
• A copy of the most recent payroll report for one pay period. The copy of the most recent payroll
report for one pay period must be in Excel format and include the following information:
o Company name, date of payroll and source of payroll information
o Employee name and/or employee identification number
o Current hourly wage - do not include bonuses or other benefit values
o Indicate if the employee is full time (40 hours per week, 52 weeks per year) or part time.
o A sample Excel spreadsheet can be found at
http://iowaeconomicdevelopment.com/BusinessDev/application
A3 Affidavit that states the Business has not, within the last five years, violated state or federal statutes, rules,
and regulations, including environmental, worker safety regulations and antitrust laws, or, if such violations
have occurred, that there were mitigating circumstances or such violations did not seriously affect public health
or safety or the environment. A sample affidavit can be found at
httip:Hiowaeconomicdeveloipment.com/BusinessDev/aiDiDlication
A4 Financial Information (Confidential, unless already publicly available) (Existing Businesses Only)
• Profit and loss statements and balance sheets for past three year-ends,
• Current YTD profit and loss statement and balance sheet,
• Schedule of aged accounts receivable,
• Schedule of aged accounts payable, and
• Schedule of other debts.
AS Collateral documentation (If requesting direct financial assistance only)
A6 Brownfield or Grayfield site documentation (if applicable)
IEDA—Business Financial Assistance Application 11 v.08.06.2014
SECTION H
Certification & Release of Information
1. Are there any judgments or court actions completed or pending against the applicant entity, or any current or
prospective officer, principal, director, or owner? ❑ Yes ® No
2. Has any current or prospective officer, principal, director, or owner been accused or convicted of any wrongdoing or
crime, other than a simple misdemeanor? ❑ Yes ® No
3. Have there been any current or past bankruptcies on the part of the applicant entity (or predecessor entities), or on
the part of any current (or prospective) officer, principal, owner or in any business dealings of current (or
prospective) officers, principals, or owners of the applicant entity? ❑ Yes ® No
4. In the last five years have there been, or are there currently any investigations of potential violations of public
health, safety (including workplace safety) or environmental laws by the applicant entity, or any current or
prospective officer, principal, director, or owner? ❑ Yes ® No
5. In the last five years have there been, or are there currently any violations of antitrust laws by the applicant entity,
or any current or prospective officer, principal, director, or owner? ❑ Yes // No
6. If yes to any of the above, please provide additional explanation: While the Company does not have any
judgments or court actions completed or pending against it, the Company is occasionally named in lawsuits in the
normal course of business.
I hereby give permission to the Iowa Economic Development Authority (IEDA) to research the Business' history, make credit checks,
contact the Business' financial institutions, insurance carriers, and perform other related activities necessary for reasonable
evaluation of this application. I also hereby authorize the Iowa Department of Revenue to provide to IEDA state tax information
pertinent to the Business' state income tax, sales and use tax, and state tax credits claimed.
I understand that all information submitted to IEDA related to this application is subject to Iowa's Open Record Law (Iowa Code,
Chapter 22), unless specifically marked as confidential section.
I understand that IEDA reserves the right to negotiate the financial assistance.
I understand this application is subject to final approval by IEDA and the Project may not be initiated until final approval is secured.
Furthermore, I am aware that funds will not be disbursed until a contract has been executed and the appropriate terms have been
met.
I hereby certify that all representations, warranties, or statements made or furnished to IEDA in connection with this application are
true and correct in all material respect. I understand that it is a criminal violation under Iowa law to engage in deception and
knowingly make, or cause to be made, directly or indirectly, a false statement in writing for the purpose of procuring economic
development assistance from a state agency or subdivision.
For the Business:
A) 6 l3
hwie17-1v 3C2>5/ CFO
Name and Title (typed or printed)
For the Sponsor(s):
L;
2/2/2015
Date Signature Date
Roy D. Buol, Mayor
Name and Title (typed or printed)
IEDA will not provide assistance in situations where it is determined that any representation, warranty, or statement made
in connection with this application is incorrect, false, misleading or erroneous in any material respect. If assistance has
already been provided prior to discovery of the incorrect, false, or misleading representation, IEDA may initiate legal action
to recover incentives and assistance awarded to the Business.
IEDA — Business Financial Assistance Application
12 v.08.06.2014