Cottingham & Butler Application to IEDA for Business AssistanceCopyrighted
November 6, 2017
City of Dubuque Consent Items # 18.
ITEM TITLE: Cottingham & Butler Application to IEDAfor Business
Assistance
SUMMARY: City Manager recommending approval of a resolution
authorizing the submission of an Iowa Economic
Development Assistance Application by Cottingham &
Butler, Inc. to the Iowa Economic Development Authority.
RESOLUTION Authorizing the filing of an application for
State Business Financial Assistance on behalf of
Cottingham & Butler, Inc.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Adopt
Resolution(s)
ATTACHMENTS:
Description Type
Cottingham & Butler Business Financial Assistance City Manager Memo
Application -MVM Memo
Staff Memo Staff Memo
1EDA Application Supporting Documentation
Resolution of Approval Resolutions
THE CITY OF
Masterpiece on the Mississippi
Dubuque
�.nw,.rnxirxz�
�111F
2007.2012
2013.2017
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: November 2, 2017
Economic Development Director Maurice Jones recommends City Council approval of a
resolution authorizing the submission of an Iowa Economic Development Assistance
Application by Cottingham & Butler, Inc. to the Iowa Economic Development Authority.
Cottingham & Butler is in the planning stages of adding another 20 jobs. The company
is proposing to renovate existing space at its 800 Main Street location, at a total
estimated cost of $2.3 million. The company is seeking direct financial assistance from
the Iowa Economic Development Authority in the amount of an $80,000 forgivable loan,
as well as approximately $350,000 in tax credits and job training funds. The local match
will be fulfilled by a $150,000 loan from ECIA. The company will invest the balance of
the project costs at over $2 million.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
17boka
Michael C. Van Milligen
MCVM:jh
Attachment
cc: Crenna Brumwell, City Attorney
Teri Goodmann, Assistant City Manager
Cori Burbach, Assistant City Manager
Maurice Jones, Economic Development Director
Dubuque
Itri 0=1
AIFAnerlee City
JN. CT,
'^M��iI►
Masterpiece on the Mississippi 22::220014
Economic Development Department
50 West 13'h Street
Dubuque, Iowa 52001-4864
Office (563) 589-4393
TTY (563) 690-6678
http://www.cityofdubuque.org
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: October 25, 2017
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 (C&B) was established in 1887 and is the 30th largest insurance
broker in the U.S. and a recognized leader in offering innovative property and casualty
and employee benefit insurance solutions. The company is headquartered in Dubuque,
Iowa, and employs over 800 employees across the U.S. C&B 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.
Beginning in 2015 C&B established a plan to increase employment in Iowa by 90
positions, to be predominantly located in Dubuque at 1000 & 1030 Main Street. That
project is underway and the company proposes to complete the hiring by March of
2018. The project cost is approximately $2.3 million. C&B applied to the Iowa
Economic Development Authority for assistance in the form of grants and loans:
$305,000 in training fund reimbursement for the 90 jobs, as well as direct financial
assistance of $600,000 from the IEDA. The incentives were offered through the State's
High Quality Jobs Program.
Only a year later, C&B added another 90 jobs to downtown Dubuque. The company
applied to the IEDA for direct financial assistance in the amount of $300,000. The
company is leasing approximately 25,000 square feet of space in the Roshek Building
to accommodate these new employees, 75 of which will qualify for the IEDA's
assistance program. The buildout for this expansion took place in 2016, with positions
to be hired before April 2019.
DISCUSSION
C&B is now in the planning stages of adding yet another 20 jobs. The company is
proposing to renovate existing space at its 800 Main Street location, at a total estimated
cost of $2.3 million. The company is seeking direct financial assistance from the IEDA
in the amount of an $80,000 forgivable loan, as well as approximately $350,000 in tax
credits and job training funds. The local match will be fulfilled by a $150,000 loan from
ECIA. The company will invest the balance of the project costs at over $2 million.
RECOMMENDATION
I recommend that the City Council approve the Economic Development Assistance
Application on behalf of Cottingham & Butler, Inc. for the proposed investment of
approximately $2.3 million for the expansion of its operations in 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. 353-17
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 Two Million Three Hundred
Thousand Dollar ($2,300,000.00) investment for tenant improvements 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 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 Cottingham & Butler, Inc.'s proposed improvements at 800 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 6th day of November, 2017.
Attest:
Kin S. Firnstahr; City Clerk
oy D. Buol, Mayor
e; ''/sv A
Debi V. Durharn, Director
Iowa Economic Development Authority
Business �����������"��D Assistance ��0����Q"������~����
N-Nmm�wmm��N��N Application
Business Finance - Business Development Division
lowa Economic Development Authority
200 East Grand Avenue
Des Moines, Iowa 50309-1819
|owoaoonomiodavo|oomenLcoro
Telephone: 515.348.6163 Ema\|:bua}nonofinonoe(aiovvaeda.com
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 Quaty Jobs Program (HQJ)
Tax Credits
Direct Financial Assistance
2. Before filling out this application form, please read all applicable sections of the Iowa Code and Iowa
AdministratCode (rules). kttos://Vm^mv]eqio.iovYa.00V/|avv/adDlinimt[oUVeRV|Ss
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 appUcation fully. If questions are left unanswered or required
attachments are not submitted, an exptanation must be inctuded,
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 to initiate the review process:
• One original, signed application form and alt required attachments
• One electronic copy of the application forrn and alt required attachments
Facsimile cories wifl not be accepted.
Applications must be submitted to IEDA Business Finance before 4:00 p.m. on the fourth Monday of the
month.
Applications will be reviewed by the IEDA Board on the third Friday of the following month.
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 genera! 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 v92517
SECTION A
Applicant Information
Date Application Submitted: 10/2/2017
1. Name of Business: Cottingham & Butler Insurance Services, Inc.; Self Insured Services Company;
Safety Management Services Company
2. Entity Name(s) for contracting (please include all that are involved in proposed project): Cottingham
& Butler Insurance Services, Inc.
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: Email: tberns@cottinghambutler.com
7. FEIN: 42-0198040
8. Please indicate your tax period end date: 12/31
9. NAICS Code for primary business operations: 524210
10. US DOT Number:
11. Does the Business file a consolidated tax return under a different tax ID number?
❑ Yes (If yes, please also provide that tax ID number) Eg No
a. Is the contact person Listed above authorized to obligate the Business?
® Yes flNo If no, please provide the name and title of a company officer authorized to
obligate the Business:
12. 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)
13. Sponsor Organization: City of Dubuque, Iowa
14. Official Contact (e.g. Mayor, Chairperson, etc.): Roy Buol Title: Mayor
15. Address: 50 W. 13th Street
16. City, State & Zip Code: Dubuque, Iowa 52001
17. Phone: 563 589-4100 Fax Email:
18. 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.9.25.17
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.
Cottingham & Butler is the 30th 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 800 employees across the U.S.
Cottingham & Butler provides a full suite of risk management and employee benefits services including:
• Property & Casualty Insurance
• Casualty Claims Administration (TPA)
• Captives & Programs
• Safety and Loss Control Consultina Services
• Employee Benefits Brokerage and Consultina
• Compliance & HR Consultina Services
• Benefit Claims Administration (TPA)
• Medical Management Services
• Wellness and Disease Manaaement Solutions
• Personal insurance Services
2, Business Structure:
❑ Cooperative ❑ Corporation ❑ Limited Liability Company
0 Partnership ® S -Corporation ❑ Sole Proprietorship
3, State of Incorporation: Iowa
4. Identify the Business' owners and percent ownership: Cottingham & Butler Inc. 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. Dubuque 574,
Davenport 27, Other 19
7. What is the Business' worldwide employment? (Please include employees of parent company, subsidiaries, and
other affiliated entities in this figure.) 802
Project Information
8. Project Street Address: 800 Main Street
Project City & Zip Code: Dubuque, Iowa 52001
9. Type of Business Project:
❑ Startup
Project County: Dubuque
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.)
12. The company is proposing an expansion at one of its Dubuque locations. The company is proposing to renovate
existing space at 800 Main Street, and employ an additional 20 persons. These positions are high quality jobs.
Total cost of the expansion is estimated at $2,300,000.
13.
1 Project Timeline (add additional rows as needed) Beginning Activity Date Activity Completion Date
1 Renovation of existing facility. 10/31/2017 04/30/2018
1 Hiring new employees 10/31/2017 10/31/2020
1
IEDA — Business Financial Assistance Application
4 v525-17
14. Has any part of the project started*?
If yes, please explain.
❑ Yes No
* 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
15. 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 the U.S. The insurance industry is a very broad industry. As the
majority of our business is located outside of Iowa (85%), we do not believe this expansion will have any impact on
competitors in Iowa.
16. 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.
17. Is the Business actively considering locations outside of Iowa? ® Yes ❑ No
If yes, where and what assistance is being offered? We also have opportunities to expand in major regional
markets where the company has established locations such as Madison, WI, Rochester MN, and Rosemont (Chicago)
H.
18. Please identify the company project management for the project location and experience. David Becker,
CEO of the company, is the project manager. David is responsible for overseeing sales, marketing, and operations
for Cottingham Butler and its subsidiaries. David has successfully managed the past expansions of the company in
Dubuque.
SECTION C
Applicant's Project Budget
1. Does the Business plan to lease the facility? l Yes ® No
If yes, please provide the Annual Base Rent Payment (lease payment minus property taxes, insurance, and
operatinglmaintenance 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 years)
Tenant Improvements
Land Acquisition
Site Preparation
Building Acquisition
Building Construction
Building Remodeling 1,700,000 8 0,0 0 0 1,620,000
Mfg. Machinery & Equip.
Other Machinery & Equip.
Racking, Shelving, etc.'
Computer Hardware 100,000 100,000
Computer Software
Furniture & Fixtures 500,000 350,000 150,000
Working Capital
Research & Development
Other
TOTAL $2,300,000 $80,000 1 $ $2,070,000 $150,000 $ $
Racking, shelving and conveyor equipment used in distribution center projec.s only
IEDA — t3usiness Financial Assistance Application
5 v.9.25.17
3. Please complete the chart below with proposed financing for the project (tax benefits should be reflected as indirect
financing under #5 below):
Source of Funds
Add additional lines as needed
Source A:
Source 6:
Source C:
Source D:
Source E:
Source F:
TOTAL
Amount
IEDA (see #4 below) $80,000
Local Government $
Business $2,070,000
Other Source $150,000
Other Source $
Other Source $
1$
PROPOSED FINANCING
Form of Funds
(Loan, Grant, In -
Kind, Donation, etc.)
Forgivable Loan
Rate and
Term
Commitment
Status
Pending
Cash Approved
ECIA RLF 4%/7yr Pending
Conditions/Additional
Information
Include when funds will be
disbursed; if loan, whether
payments are a level term,
balloon, etc
Project Completion
November 2017
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 INDI ECT FINANCING
Source of Funds
Investment Tax Credit
Sales, Service & Use Tax Refund
Research Activities Credit (3%/10%)
Local Property Tax Exemption
Tax Increment Financing
260E Job Training Funds
in-kind Contribution
Other
TOTAL
Amount
90,000
51,000
Description
5% of qualified investment
6% sales tax refund
177,660 $8,883,50 per job @ 20 jobs
35,160 New jobs tax credit - $1758 per job
353,820
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 the company has operations. Attracting and hiring employees into
Iowa can require more resources than some of the locations in larger regional metropolitan areas
IEDA — Business Financial Assistance Application
6 v52517
SECTION D
Employee Benefits
There are three options to meeting the sufficient benefit requirement. These o
below. Please complete questions 1-3. If your company meets Option 1 or 2,
required. If you would like to utilize Option 3, please also complete questions
Option 1 Option 2
80% single Coverage 50% Family coverage
Total Number of
Employees in
250+
50-249
0-50
Pay 80% of premium costs
for a standard medical plan,
single coverage.
$1250maximum deductible
$2250 maximum deductible
$2000 maximum deductible
Pay 50% of premium costs for
a standard medical plan,
family coverage,
$2500 maximum deductible
$4500 maximum deductible 1
$4000 Maximum deductible 1
ptions are detailed in the chart
no additional information is
4-6.
Option 3
Monetary Equivalent
Provide medical and pay the
monetary equivalent of Option
1 or Option 2 in supplemental
employee benefits.
Benefits Counted Toward
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.? 802
2. What is the total premium cost for a standard medical plan for single employee coverage? $5,668
a. What portion of this cost is paid by the business? 65%
b. What is the deductible associated with this plan? $ 1350
3. What is the total premium cost fora standard medical plan for family coverage? $14,169
a. What portion of this cost is paid by the business? 65%
b. What is the deductible associated with this plan? $3.000
4.
No additional information required, in this section, if your company meets the requirement for Option 1 or Option 2
Does your company provide additional benefits to full time employees? ['Nes ❑No
If yes, please provide the annual amount offered by the business, per employee in the chart below:
Benefit Annual amount paid by the
business (per emploveei:
Dental Insurance — Single plan
Dental Insurance — Family plan
Pension (Use 3 -year average calculated below)
Retirement Plan - i.e. 401(k) (Use 3 -year average calculated below)
Profit Sharing Plan (Use 3 -year average calculated below)
Childcare Services
Life Insurance coverage
Disability Insurance coverage
Health Savings Account (HSA) contribution
TOTAL
5. Does the Business offer a pension plan, 401(k) plan, and/or retirement -plan? ❑ Yes El No
If yes, please indicate the amount contributed on a per employee basis by the Business to the plan for the last three
years. For 401(k) plans, please provide information on the company match and indicate the average annual match per
employee.
Year Ending
Average Actual Match per
Employee ($)
$)
IEDA — Business Financial Assistance Application
7 v9.251r
1
1 Three-year Average:
6. Does the Business offer a profit-sharing plan? ❑ Yes ❑ No
If yes, please indicate total amount paid out each year for the past three years and then, determine the average annual
bonus or contribution per employee for that three year period.
Year Ending Average Actual Share per
Employee ($)
$
1 Three-year Average:
Notes:
1. A qualified plan must be offered to al! full-time permanent employees.
2. !f you have multiple health insurance plans, please provide information on each plan.
IEDA — Business Financial Assistance Application
8 v.9 25.17
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 starting and final hourly wage rate. For retained jobs, include the current hourly wage rate.
Full -Time CREATED Jobs
Job Title
Service Jobs
Sales
Total Full -Time CREATED Jobs
Full -Time RETAINED Jobs
Job Title (AT -RISK jobs only)
Total Full -Time RETAINED Jobs
(Add additional rows as needed)
Starting Wage at 36 months
Hourly Wage following the award
42,000 46,750
45,000 63,000
Number of
CREATED Jobs
15
5
20
(Add additional rows as needed)
Number of
RETAINED
Jobs
Current Hourly
Wage
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.9.25.17
SECTION F
Business Taxes
IEDA is required to calculate the return on state and local government investments in this project. Data from other parts
of the application will be combined with the estimates requested below to calculate the required return on investment
information. Please read the following directions carefully:
• IEDA is asking for a best estimate on the increase in taxes associated with this project.
• Estimates should only include the expected increase in tax liability resulting from this project.
• At minimum, IEDA needs estimates for the first three years of the project.
• Show data as if no tax abatements or tax credits awarded for this project were taken.
• For partnership forms of ownership (e.g. limited partnerships, s -corporations, LLC, etc.), please
estimate the partners' increase in Iowa tax liability due to this project.
• Sales and use taxes refer to the taxes paid on materials, etc. that the Business purchases, not taxes
you collect from sales to your customers.
• Applicants will not be held to these numbers with respect to any award from or contract with IEDA.
• This page of the application will automatically be treated as confidential.
Increase in Tax Collections Associated with this Project
State Business Taxes
Year 1 Year 2
IState Corporate Income Tax*
State Business Sales and Use Tax
* Insurance Companies: Provide State Insurance Premium Tax
Local Business Taxes
ILocal Real Estate Property Tax
ILocal Option Sales Tax
Year 1
Year 3 Year 4 Year 5 I
Year 2 Year 3 Year 4 Year 5
CONFIDENTIAL
IEDA — Business Financial Assistance Application
10 v 9.25 17
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
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 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.
AS Collateral documentation (If requesting direct financial assistance only)
A6 Brownfield or Grayfield site documentation (if applicable)
IEDA — Business Financial Assistance Application
11 v.92517
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? 0 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? 0 Yes El 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? 0 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.
1 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, 1 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 �1
Tim Berns, CFO
Name and Title (typed or printed)
For the S onsor(s`:
Date Signature
Rov D. Buol , Mayer
Name and Title (typed or printed)
11/6/2017
Date
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 'L1) 25.1 7