Wave Reaction, Inc._State of Iowa Application for Business Financial Assistance Copyrighted
May 15, 2017
City of Dubuque Action Items # 4.
ITEM TITLE: State of Iowa Application for Business Financial Assistance
-Wave Reaction, Inc.
SUMMARY: City Manager recommending authorization to submit an
Iowa Economic Development Assistance Application by
Wave Reaction, Inc. to the Iowa Economic Development
Authority for the proposed investment of approximately
$1.98 million for the relocation of its Illinois operations to
downtown Dubuque.
RESOLUTION Authorizing the filling of an application for
State Business Financial Assistance on behalf of Wave
Reactions, Inc.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Adopt
Resolution(s)
ATTACHMENTS:
Description Type
State of Iowa Business Financial Assistance Application City Manager Memo
for Wave Reaction-MVM Memo
Staff Memo Staff Memo
IEDAApplication Supporting Documentation
Resolution Resolutions
THE CITY OF Dubuque
DUB TENWinrkaCky
1111.
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 Wave
Reaction, Inc.
DATE: May 10, 2017
Economic Development Director Maurice Jones recommends City Council authorization
to submit an Iowa Economic Development Assistance Application by Wave Reaction,
Inc. to the Iowa Economic Development Authority for the proposed investment of
approximately $1.98 million for the relocation of some of its Illinois operations to
downtown Dubuque. The proposed project would add 20 jobs to downtown Dubuque.
Local government match is coming from East Central Intergovernmental Association in
in the form of a $25,000 loan.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
Mic ael C. Van Milligen
MCVM:jh
Attachment
cc: Crenna Brumwell, 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 Wave
Reaction, Inc.
DATE: May 8, 2017
INTRODUCTION
This memorandum presents for City Council review and approval a resolution
authorizing the submission of an Iowa Economic Development Assistance Application
by Wave Reaction, Inc. to the Iowa Economic Development Authority (IEDA).
BACKGROUND
Wave Reaction is a software company with products designed to encourage the use of
environmentally friendly reusable containers instead of disposable packaging. The
primary product of the company is called WAVE reusables. This product tracks,
manages, and helps automate large reusable container programs. WAVE reusables
received the 2016 Innovation of the Year Award from John Deere, which was presented
April 18, 2017. Besides the agricultural and construction markets Wave Reaction's
customer base includes automotive suppliers, container manufactures and logistics
companies.
DISCUSSION
Wave Reaction is considering the City of Dubuque, Dubuque County for the relocation
of the company. This project would include the purchase and renovation of a building to
support a new venture aimed at providing distribution and freight optimization services
marketed toward companies with large reusable programs. They intend to be
operational by Summer 2017. The project would add twenty (20) high quality jobs to
downtown Dubuque.
Local government match is coming from ECIA, in the form of a $25,000 loan.
RECOMMENDATION
I recommend that the City Council approve the Economic Development Assistance
Application on behalf of Wave Reaction, Inc. for the proposed investment of
approximately $1 .98 million for the relocation of its Illinois operations to downtown
Dubuque. The proposed project would add 20 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. 184-17
AUTHORIZING THE FILING OF AN APPLICATION FOR STATE BUSINESS FINANCIAL
ASSISTANCE ON BEHALF OF WAVE REACTIONS, INC.
Whereas, Wave Reactions, Inc. has proposed making a One Million Nine Hundred
Eighty Thousand Dollar ($1,980,000.00) investment for the purchase and improvement of
an 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 twenty (20) full-time jobs in the City, all of which qualify for the Iowa
Economic Development Authority Business Financial Assistance Program; 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 acquisition and improvements of Wave Reaction, Inc.'s proposed
location at 703 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 Wave Reaction, 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
e.eby u•recaeu to
submit the Application
ppl'caa°on a o the Iowa Economic Development Authority
together with such other documents as may be required.
Passed, approved, and adopted this 15th day of May, 2017.
Roy D. BSI, Mayor
Attest:
Ke in S. Firnstah , City Clerk
1 ( )WAO
Debi V. Durham, Director
Iowa Economic Development Authority
Business Financial Assistance mApplication
Business Finance - Business Development Division
Iowa Economic Development Authority
200 East Grand Avenue
Des Moines, Iowa 50309-1819
www.iowaeconomicdevelopment.com
Telephone: 515.725.3134 Email: businessfinanceaiowa.gov 1
Application Instructions
To Complete Electronic Form:Click on TEXT BOX to add text. Double click on YES/NO boxes and select"Checked"
1. All 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 Program
High Quality Jobs Program (HQJP)
Z 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). https://www.legis.iowa.gov/law/administrativeRules
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 of the 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.3.1.17
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. This form is available by request. 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.3.1.17
SECTION A
Applicant Information Date Application Submitted:
1. Name of Business: Wave Reaction, Inc.
2. Entity Name (for contracting purposes): Wave Reaction, Inc.
3. Address: 11470 Industrial Drive
4. City, State &Zip Code: Galena, IL 61036
5. Contact Person: Karl Malik Title: President
6. Phone: 815.733.2496 Fax: none Email:
karl.malik@wavereaction.com
7. FEIN: 26-3214928
8. NAICS Code for primary business operations: 541511
9. US DOT Number: none
t
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
13. Official Contact (e.g. Mayor,
Chairperson, etc.): Roy Buol Title: Mayor
14. Address: 50 West 13th Street
15. City, State &Zip Code: Dubuque, Iowa 52001
16. Phone: 563.564.5455 Fax: None Email:rdbuol@cityofdubuque.org
17. If IEDA needs to contact the sponsor organization with questions, should we contact the person
listed above? -1
F-1 Yes ® No, please contact the following person:
Name: Dan McDonald Title: Greater Dubuque Development Corporation
Address: 900 Jackson
City, State &Zip Code: Dubuque, Iowa 52001
Phone: 563-557-9049 Fax: None
Email: DanielM@greaterdubuque.org
If necessary, please list information on additional sponsors in an attachment.
IEDA—Business Financial Assistance Application 3 v.3.1.17
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.
Wave Reaction is a software company with products designed to encourage the use of environmentally friendly reusable
containers instead of disposable packaging.The primary product of the company is called WAVE reusables,this product
tracks, manages,and helps automate large reusable container programs. WAVE reusables received the 2076 Innovation of
the YearAwardfrom John Deere, presented April 18,2017, Besides the agricultural and construction markets Wave Reaction's
customer base includes automotive suppliers,container manufactures and logistics companies.
2. Business Structure:
❑ Cooperative ❑ Corporation ❑ Limited Liability Company
❑ Partnership ® S-Corporation ❑ Sole Proprietorship
3. State of Incorporation: Illinois
4. Identify the Business'owners and percent ownership: Karl Malik 100%
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. No Iowa Locations
7. What is the Business'worldwide employment? (Please include employees of parent company, subsidiaries, and
other affiliated entities in this figure.) 7
Project Information
i
8. Project Street Address: Main Street Dubuque Iowa
Project City&Zip Code: Iowa, 52001 Project County: Dubuque County
9. Type of Business Project: !I
❑ 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 project is an expansion of the services in the reusable container management market. The proposed project
would include the purchase of a 2 story approximate 20,000 sqft office building. Infrastructure inside the building
would need to be added to support an enterprise warehouse control center to remotely manage large worldwide
container management warehouses.
12.
Project Timeline add additional rows as needed Beginning Activity Date Activity Completion Date
Purchase Building June 2017 July 2017
Move into Building July 2017 July 2017
Improve Building July 2017 June 2018
Hire Sales Staff July 2017 Dec 2017
Hire Software Developers July 2017 Dec 2017
Hire Project Managers July 2017 Dec 2017
Start First Project Dec 2017 Dec 2017
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.
IEDA—Business Financial Assistance Application 4 v.3.1.17
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. Competitors: Surgere,lnc(Ohio), TrackX(Canada)
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?Wisconsin, No assistance has been investigated yet.
17. Please identify the company project management for the project location and experience.
Karl Malik, Galena, IL: Civil Engineer, MBA Previously owned construction company
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 u
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.
I
2. Please complete the budget below. Include only costs the company plans to incur directly:
Use of Funds Cos ,, y Source A Source B Source C Source D Source E Source F
Base Rent 3 ears
Tenant Improvements
Land Acquisition
Site Preparation
Building Acquisition ROOM $1,312,500 $437,500
Building Construction
Building Remodeling 45,000
$5,000
Mfg. Machinery&Equip.
Other Machinery&Equip.
Racking, Shelving, etc.'
Computer Hardware $20,000
Computer Software '1C7� 0 $10,000
Furniture & Fixtures SIMON $25,000 $25,000
Working Capital
Research &Development 1Oy0 r0 0 0 $100,000
Other '2y50 0 0
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 ❑
*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 $72,000 j
Sales,Service&Use Tax Refund $1,500
Research Activities Credit 3%/10% $5,000
Local Property Tax Exemption
Tax Increment Financing
260E Job Training Funds $66,348
In-kind Contribution
Other h
TOTAL $144,848
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6. There are three justifiable reasons for providing assistance. Check the box next to the reason why f
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. u
❑ 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.
Wave Reaction would like to move closer to a denser employee pool ie Dubuque, Iowa. If Wave Reaction decides
to move forward with the proposed project and hire additional employees, it would incur substantial expenses that it
is not currently paying.
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, please 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
US single coverage. family coverage. 1 or Option 2 in supplemental
250+ $1250maximum deductible $2500 maximum deductible employee benefits.
50-249 $2250 maximum deductible $4500 maximum deductible Benefits Counted Toward
IEDA—Business Financial Assistance Application 6 v.3.1.17
0-50 $2000 maximum deductible 1 $4000 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 U.S.?4
2. What is the total premium cost for a standard medical plan for single employee coverage? $500/month
a. What portion of this cost is paid by the business? 100%
b. What is the deductible associated with this plan? $1,500
3. What is the total premium cost for a standard medical plan for family coverage? $1,600(estimated family of 4)
a. What portion of this cost is paid by the business?(Pays for single only, $500)
b. What is the deductible associated with this plan? $4000
u
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 (per employee):
Dental Insurance—Single plan $
Dental Insurance— Family plan $
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 $1,700
Health Savings Account HSA contribution $
TOTAL $
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($)
2016 $1010
2015 $1064
2014 $1010
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: $
IEDA—Business Financial Assistance Application 7 v.3.1.17
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.
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IEDA—Business Financial Assistance Application 8 v.3.1.17
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 startinq and final hourly wage rate. For retained jobs, include the current hourly wage rate.
Full-Time CREATED Jobs Add additional rows as needed
Job Title Number of Starting Wage at 36 months
CREATED Jobs Hourly Wage following the award
Software Engineer 5 $38.46 $40.86
Support Engineer 3 $26.44 $27.88
Project Manager 3 $28.85 $30.77
Graphic Designer 1 $20.19 $22.00
Support Technician 6 $17.00 $17.79
Inbound Sales With Commission 2 $12.00 $27.88
I
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Total Full-Time CREATED Jobs 20 s411
,.
Full-Time RETAINED Jobs Add additional rows as needed
Number of Current Hourly
Job Title(AT-RISK jobs only) RETAINED Wage
Jobs
it
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.3.1.17
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Business Financial Assistance Application
Wave Reaction, Inc.
Page 10, Section F—original redacted from City Council copy, as it contained confidential
information
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IIS
4
IEOA—Business Financial Assistance Application 10 v.3.1.17
9
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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.
Please note, a traditional business plan, including an executive summary, market analysis, organization and
management structure, marketing and sales management, service and product line narrative, financial
projections, feasibility study and patent status, as well as any other relevant information, may be requested by
the Iowa Economic Development Authority to evaluate the feasibility of this project.
A2 Payroll Information (Confidential)
• Copies of the Business' Quarterly Iowa Employer's Contribution and Payroll Report for the past l
year. This report should include the monthly employment totals.
• A copy of the most recent payroll report for one payperiod. 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 provided by IEDA staff
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 provided by IEDA staff.
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.
A5 Collateral documentation (If requesting direct financial assistance only)
A6 Brownfield or Grayfield site documentation (if applicable)
IEDA—Business Financial Assistance Application 11 v.3.1.17
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:
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.
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 understand that upon execution of the contract and prior to the issuance of a tax credit number or the disbursement of Award
Funds, a recipient shall pay IEDA a one-time compliance cost fee in the amount of $500. In addition, if tax benefits are greater than
$100,000, the Recipient shall remit to IEDA a compliance cost fee 0.5% of the value of the Tax Incentives claimed pursuant to the
contract. The fee will be due and payable upon filing the Recipient's annual tax return for each tax year in which tax credits are
claimed under the contract.
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:
Signature
Karl Malik, President
Name and Title (typed or printed)
For the Sponsor(s):
4/24/2017 (lAi,„5/15/17
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.
Business Financial Ass'ss13