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HomeMy WebLinkAboutIowa Department of Economic Development-Grant Agreement-10.13.2008 �� , 4t.. ao o 9°° IOWA DEPARTMENT OF ECONOMIC DEVELOPMENT Jumpstart Small Business Assistance Program Grant Agreement This Grant Agreement (the "Agreement") is between the Iowa Department of Economic Development and the Grantee (collectively, the "Parties") identified below as of the Effective Date stated: The Parties: GRANTEE IDED GRANTEE: City of Waterloo Iowa Department of Economic Development 200 East Grand Avenue GRANTEE ADDRESS: Des Moines, IA 50309 City Hall 715 Mulberry Street Waterloo, IA 50703 GRANTEE CONTACT IDED CONTACT: Stoney Harris, Program Mayor Tim Hurley Manager E-mail: mayor@waterloo-ia.org Email: Phone: (319)291-4301 Stoney. Harris@iowalifechanging.com Fax: (319)291-4286 Phone: (515)242-4735 Fax: (515)242-4918 The Grant: GRANT AGREEMENT EFFECTIVE DATE: # 09-JMPST-09 September 17, 2008 MAXIMUM GRANT AMOUNT: INITIAL ALLOCATION OF FUND: $ 341,884 $ 113,961 MAXMIMUM ADMININSTRATION FEE: PROJECT COMPLETION DATE: June 30, $ 6,837 2009 In consideration of the promises and mutual covenants and agreements contained herein, the Parties agree as follows: ARTICLE 1 AGREEMENT DURATION This Agreement shall be in effect as of the Effective Date first stated and shall remain in effect until the Project Completion Date or until all of Grantee's obligations and liabilities under this Contract have been satisfied, whichever occurs later. ARTICLE 2 FUNDING 2.1 Funding Source. The source of funding for this Grant is a reallocation of state funds to the Department's Small Business Disaster Recovery Financial Assistance Program (the "Program"). 2.2 Reduction, Discontinuance or Alteration of Funding. Any termination, reduction, or delay of funds available due, in whole or in part, to (i) lack of, reduction in, or a deappropriation of funds, or (ii) any other reason beyond the IDED's control may, in the IDED's discretion, result in the termination, reduction or delay of funds to the Grantee. ARTICLE 3 DEFINITIONS; DOCUMENTS INCORPORATED BY REFERENCE; AND ORDER OF PRIORITY 3.1 Definitions. The following terms apply to this Agreement: "Project"means the description of the work and activities to be provided by the Grantee as outlined in Exhibit A, Work Statement. "Project Completion Date"means the date stated above and is the date by which all Project activities shall be satisfactorily completed by Grantee. 3.2 Documents Incorporated by Reference. The following documents are incorporated by reference and considered an integral part of this Agreement Exhibit A - Work Statement Exhibit B - Letter of Application from Grantee. 3.4 Order of Priority. In the case of any inconsistency or conflict between the specific provisions of this document and the exhibits, the following order of priority shall control: (a) Agreement, Articles 1-9. (b) Exhibit A—Work Statement. ARTICLE 4 AWARD TERMS 4.1 Description of the Protect and Grant Award. The IDED has approved an Award to the Grant in the total amount identified in the chart on page one of this Agreement. Grant funds have been awarded to the Grantee to administer the Program within its service area to provide assistance to businesses impacted by the 2008 natural disasters. 4.2 Terms of the Grant. The terms of this Grant are as follows: (a) Administration obligations. Grantee shall provide the work and services described in Exhibit A, Work Statement. These services include application review and processing, contracting, reporting, and Program oversight. The Grantee shall have the primary responsibility for the Project and shall be the fiscal agent. Grantee shall ensure that the Program is administered in compliance with IDED's administrative rules for the Program (261 Iowa Administrative Code Chapter 78). The Grantee shall have the operational, oversight and fiscal responsibility for the Project. If consultant(s) are to be hired in association with the Project, the Grantee is responsible for recruiting, selecting, and contracting (e.g. terms and conditions, scope of work, payment) with consultant(s). (b) Administration fee. Grantee shall receive an amount equal to 2% of the initial disbursement of Grant funds. Thereafter, Grantee shall receive 2% of the funds actually loaned by the Grantee to eligible businesses under the Program from subsequent disbursements. The administrative fee shall be paid from the allocation made to the Grantee, not in addition thereto. 2 (c) Redistribution of Unused Funds. If by April 30, 2009, the Grantee has not obligated funds to eligible businesses for allowable activities, IDED will reallocate funds to entities that have demonstrated additional unmet need for financial assistance. 4.2 Acknowledgement of Obligations. Grantee acknowledges and agrees that: a) this Grant is made in consideration of Grantee's representations and warranties described in this Agreement, and b) upon violation of such covenants and warranties, Grantee is obligated to immediately repay any amounts IDED determines Grantee received without fulfillment of Grantee's obligations under this Agreement, plus applicable interest and costs described in Article 8. ARTICLE 5 CONDITIONS TO DISBURSEMENT OF FUNDS; DISBURSEMENT TERMS The obligation of IDED to make, continue or disburse funds under this Agreement shall be subject to the following conditions precedent: 5.1 Documents Submitted. IDED shall have received each of the following documents, properly executed and completed, and approved by IDED as to form and substance: (a) Grant Agreement. Fully executed Grant Agreement. (b) Requests for Disbursement. All disbursements of Grant funds shall be subject to receipt by the IDED of requests for disbursement, in form and content acceptable to IDED, submitted by the Grantee. All requests shall include documentation of costs that have been paid or costs to be paid immediately upon receipt of Grant funds. The Grantee shall submit to IDED such supporting evidence as may be reasonably requested by IDED to substantiate all payments which are to be made out of any requisition and/or to substantiate all payments then made with respect to the Project. 5.2 Prior Costs. No expenditures made prior to the Effective Date may be included as Project costs. 5.3 Suspension of Disbursement. Upon the occurrence of an Event of Default (as defined in Article 8) IDED may suspend payments to Grantee until such time as the default has been cured to IDED's satisfaction. Notwithstanding anything to the contrary in this Agreement, upon a termination of this Agreement on account of an Event of Default, Grantee will no longer have the right to receive any disbursements after the effective date of default. 5.4 Investment of Grant Funds. (a) In the event that Grant Funds are not immediately utilized, temporarily idle Grant Funds held by the Grantee may be invested provided such investments shall be in accordance with State law, including but not limited to the provisions of Iowa Code chapter 12C concerning the deposit of public funds. Interest accrued on temporarily idle Grant funds held by the Grantee shall be credited to and expended on the Project prior to the expenditure of other Grant funds. (b) All proceeds remaining, including accrued interest, after all allowable Project costs have been paid or obligated shall be returned to the IDED within thirty (30) days after the Project Completion Date. Within ten (10) days of receipt of a written request from IDED, Grantee shall inform the IDED in writing of the amount of unexpended Grant funds in the Grantee's possession or under the Grantee's control, whether in the form of cash on hand, investments, or otherwise. 3 ARTICLE 6 REPRESENTATIONS AND WARRANTIES Grantee represents and warrants to IDED as follows: 6.1 Authority and Validity of Obligations. Grantee has full right and authority to enter into this Agreement. The person signing this Agreement has full authority to: (a) Sign this Agreement: on behalf of the Grantee, and (b) Obligate the Grantee to the performance of each and all of the obligations under the Agreement. 6.2 Approvals received. This Agreement delivered by the Grantee has been duly authorized, executed and delivered by the Grantee and constitutes the valid and binding obligations of the Grantee and enforceable against it in accordance with their terms. Grantee has secured all necessary authorizations and approvals with any governmental, regulatory or governing board that may be necessary to permit Grantee to execute this Agreement and comply with its terms. 6.3 Use of Proceeds. The Grantee hereby agrees to use Grant funds only for the Project and for the activities described in Exhibit A, Work Statement. 6.4 Governmental Authority and Licensing. Grantee has received all licenses, permits, and approvals of all Federal, state, local, and foreign governmental authorities, if any, necessary to conduct its business, in each case where the failure to obtain or maintain the same could reasonably be expected to have a material adverse effect. No investigation or proceeding which, if adversely determined, could reasonably be expected to result in revocation or denial of any material license, permit, or approval is pending or, to the knowledge of the Grantee threatened. 6.10 Litigation and Other Controversies. There is no litigation or governmental proceeding pending, nor to the knowledge of the Grantee threatened, against the Grantee which if adversely determined would adversely impact Grantee's ability to perform under this Agreement. 6.11 Compliance with Laws. Grantee is in compliance with the requirements of all federal, state and local laws, rules and regulations applicable to or pertaining to the operations of Grantee. 6.12 Effective Date of Representations and Warranties. The warranties and representations of this Article are made as of the Contract Effective Date and shall be deemed to be renewed and restated by the Grantee at the time each request for disbursement of funds is submitted to the IDED. ARTICLE 7 COVENANTS 7.1 Performance Obligations. By the Project Completion Date, Grantee shall complete the Project in accordance with the Work Statement as detailed in Exhibit A and comply with all other performance requirements described in this Agreement. Grantee shall promptly provide IDED with written notice of any major changes that would impact the success of the Project. 7.2 Repayment Obligations. Upon the occurrence of an unremedied Event of Default as described in Article 8 Grantee agrees to immediately repay such amounts determined by IDED as due and payable. 7.3 Required Reports. For the duration of this Agreement Grantee shall provide IDED with required reports to assist in evaluation of the Program's effectiveness and to determine compliance with this Agreement. Grantee shall: (a) Disbursement Requests. Grantee shall prepare, sign and submit disbursement 4 requests and reports as specified in this Agreement in the form and content required by IDED. Grantee shall review all disbursement requests and verify that claimed expenditures are allowable costs. Grantee shall maintain documentation adequate to support the claimed costs. (b) Reports. Grantee shall prepare, sign and submit required reports to the IDED. The Grantee shall submit a written report to the IDED on a quarterly basis for IDED's review to verify that the terms of this Agreement have been met. Reports shall be completed in the manner and form provided by IDED. IDED may request more frequent reports or additional information, if deemed necessary. Grantee shall promptly comply with all such requests. 7.4 Inspection and Audit. Grantee shall permit the IDED and its duly authorized representatives to visit and inspect any of the Grantee's properties, books and financial records related to the Project, to examine and make copies of the books of accounts and other financial records, and to discuss the affairs, finances and accounts with, and to be advised as to the same by, its officers, and independent public accountants (and by this provision Grantee authorizes such accountants to discuss with the IDED and the IDED's duly authorized representatives the finances and affairs of the Grantee) at such reasonable time and reasonable intervals as the IDED may designate. 7.5 Compliance with Laws. (a) Grantee will comply in all material respects with the requirements of all federal, state and local laws, rules, regulations and orders (b) Grantee shall comply in all material respects with all applicable federal, state, and local laws, rules, ordinances, regulations and orders applicable to the prevention of discrimination in employment, including the administrative rules of the Iowa Department of Management and the Iowa Civil Rights Commission which pertain to equal employment opportunity and affirmative action. (c) Grantee shall comply in all material respects with all applicable federal, state and local laws, rules, ordinances, regulations and orders applicable to worker rights and worker safety. (d) Grantee shall comply with IDED's administrative rules for the Small Business Disaster Recovery Financial Assistance Program (261 IAC - Chapter 78). 7.6 Use of Grant Funds. Grantee shall use Grant funds extended under this Contract solely for the purposes set forth in Exhibit A. 7.7 Notice of Proceedings. Grantee shall promptly notify IDED of the initiation of any claims, lawsuits, or other proceedings brought against Grantee which would adversely impact the Project. 7.8 Accounting Records. Grantee is required to maintain its books, records and all other evidence pertaining to this Agreement in accordance with generally accepted accounting principles and such other procedures specified by IDED. These records shall be available to IDED, its internal or external auditors, the Auditor of the State of Iowa, the Attorney General of the State of Iowa and the Iowa Division of Criminal Investigations at all times during the Agreement duration and any extensions thereof, and for three (3) full years from this Agreement is closed out by IDED. 7.9 Indemnification. Grantee shall indemnify, defend and hold harmless the IDED, the State of Iowa, its departments, divisions, agencies, sections, commissions, officers, employees and agents from and against all losses, liabilities, penalties, fines, damages and claims (including taxes), and all related costs and expenses (including reasonable attorneys' fees and disbursements and costs of investigation, litigation, settlement,judgments, interest and penalties), arising from or in connection with any of the following: a) Any claim, demand, action, citation or legal proceeding arising out of or resulting from 5 the Project; b) Any claim, demand, action, citation or legal proceeding arising out of or resulting from a breach by Grantee of any representation or warranty made by the Grantee in this Agreement; c) Any claim, demand, action, citation or legal proceeding which results from an act or omission of Grantee or any of their agents in its or their capacity as an employer of a person. ARTICLE 8 EVENTS OF DEFAULT AND REMEDIES 8.1 Events of Default. Any one or more of the following shall constitute an "Event of Default"hereunder: (a) Noncompliance with Agreement. Default in the observance or performance of any other provision of this Agreement; or (b) Material Misrepresentation. Any representation or warranty made by the Grantee in this Agreement or in any statement or certificate furnished by it pursuant to this Agreement, or made in its request to receive an allocation as an administrative entity (as defined in Program rules), or in connection with any of :he above, proves untrue in any material respect as of the date of the issuance or making thereof; or (c) Adverse Change in Financial Condition. Any change shall occur in the financial condition of the Grantee which would have a material adverse effect on the ability of the Grantee to perform under this Agreement; or (d) Bankruptcy or Similar Proceedings Initiated. Either the Grantee shall (1) have entered involuntarily against it an order for relief under the United States Bankruptcy Code, as amended, (2) not pay, or admit in writing its inability to pay, its debts generally as they become due, (3) make an assignment for the benefit of creditors, (4) apply for, seek, consent to, or acquiesce in, the appointment of a receiver, custodian, trustee, examiner, liquidator or similar official for it or any substantial part of its Property, (5) institute any proceeding seeking to have entered against it an order for relief under the United States Bankruptcy Code as amended, to adjudicate it insolvent, or seeking dissolution, winding up, liquidation, reorganization, arrangement, adjustment or composition of it or its debts under any law relating to bankruptcy, insolvency or reorganization or relief of debtors or fail to file an answer or other pleading denying the material allegations of any such proceeding filed against it, or (6) fail to contest in good faith any appointments or proceeding described below; or (e) Appointment of Officials. A custodian, receiver, trustee, examiner, liquidator or similar official shall be appointed for either the Grantee or any substantial part of any of its respective property, or a proceeding described above shall be instituted against the Grantee and such appointment continues undischarged or such proceeding continues undismissed or unstayed for a period of sixty (60) days; or (f) Failure to Submit Required Reports. The Business fails to submit complete reports by the required due dates as outlined in Article 7.2. 8.2 Default Remedies. When an Event of Default has occurred and is continuing, the IDED may, by written notice to the Grantee (a) terminate this Agreemen'.: and all of the obligations of IDED under this Agreement on the date stated in such notice, and (b) suspend pending disbursements and terminate further disbursements of Grant funds, and (c) declare the total amount of Grant funds disbursed to be forthwith due and payable, including any and fees, charges and other amounts payable under this Agreement. The total 6 amount due shall be and become immediately due and payable without further demand, presentment, protest or notice of any kind. 8.3 Expenses. Grantee agrees to pay to the IDED all expenses reasonably incurred or paid by IDED including reasonable attorneys' fees and court costs, in connection with any Default or Event of Default by the Grantee or in connection with the enforcement of any of the terms of this Agreement. 8.4 Notice of Default and Opportunity to Cure. If IDED has reasonable cause to believe that an Event of Default has occurred under this Agreement IDED shall issue a written Notice of Default to the Grantee, setting forth the nature of the alleged default in reasonable specificity, and providing therein a reasonable period time, which shall not be fewer than twenty (20) days from the date of the Notice of Default, in which the Grantee shall have an opportunity to cure, provided that cure is possible and feasible. ARTICLE 9 MISCELLANEOUS 9.1 Timely Performance. The Parties agree that the dates and time periods specified in this Agreement including the timelines established for the Project and more fully described in Exhibit A, are of the essence to the satisfactory performance of this Agreement. 9.2 Choice of Law and Forum. (a) In the event any proceeding of a quasi-judicial or judicial nature is commenced in connection with this Agreement, the proceeding shall be brought in Des Moines, Iowa, in Polk County District Court for the State of Iowa, if such court has jurisdiction. If however, such court lacks jurisdiction and jurisdiction lies only in a United States District Court, the matter shall be commenced in the United States District Court for the Southern District of Iowa, Central Division. (b) This provision shall not be construed as waiving any immunity to suit or liability, in state or federal court, which may be available to the IDED, the State of Iowa or its members, officers, employees or agents. 9.3 Governing Law. This Agreement and the rights and duties of the Parties hereto shall be governed by, and construed in accordance with the internal laws of the State of Iowa without regard to principles of conflicts of laws. 9.4 Agreement Amendments. The Agreement may only be amended if done so in writing and signed by the Grantee and IDED. 9.5 Notices. All notices hereunder shall be in writing and shall be given to the relevant party at its address, or e-mail address or fax number as set forth on the first page of this Agreement. Each such notice, request or other communication shall be effective (i) if given by facsimile, when such facsimile is transmitted to the facsimile number specified and a confirmation of such facsimile has been received by the sender, (ii) if given by e-mail, when such e-mail is transmitted to the e-mail address specified and a confirmation of such e-mail has been received by the sender, (iii) if given by mail, five (5) days after such communication is deposited in the mail, certified or registered with return receipt requested, addressed as aforesaid or (iv) if given by any other means, when delivered at the addresses specified. 9.6 Headings. Article headings used in this Agreement are for convenience of reference only and are not a part of this Agreement for any other purpose. 9.7 Final Authority. The IDED shall have the authority to reasonably assess whether Grantee has complied with the terms of this Agreement. Any IDED determinations with respect to compliance with the provisions of this Agreement shall be deemed to be final determinations pursuant to Section 17A of the Code of Iowa (2007). 7 9.8 Waivers. No waiver by IDED of any default hereunder shall operate as a waiver of any other default or of the same default on any future occasion. No delay on the part of the IDED in exercising any right or remedy hereunder shall operate as a waiver thereof. No single or partial exercise of any right or remedy by IDED shall preclude future exercise thereof or the exercise of any other right or remedy. 9.10 Counterparts. This Agreement may be executed in any number of counterparts, each of which shall be deemed to be an original, but all of which together shall constitute but one and the same instrument. 9.11 Survival of Representations. All representations and warranties made herein or in any other Agreement document or in certificates given pursuant hereto or thereto shall survive the execution and delivery of this Agreement and the other Agreement documents and shall continue in full force and effect with respect to the date as of which they were made until all of Grantee's obligations or liabilities under this Agreement have been satisfied. 9.12 Severability of Provisions. Any provision of this Agreement which is unenforceable in any jurisdiction, shall, as to such jurisdiction, be ineffective to the extent of such unenforceability without invalidating the remaining provisions hereof or affecting the validity or enforceability of such provision in any other jurisdiction. All rights, remedies and powers provided in this Agreement or any other Agreement document may be exercised only to the extent that the exercise thereof does not violate any applicable mandatory provisions of law, and all the provisions of this Agreement and any other Agreement document are intended to be subject to all applicable mandatory provisions of law which may be controlling and to be limited to the extent necessary so that they will not render this Agreement or any other Agreement document invalid or unenforceable. 9.13 Assignment. This Agreement may not be assigned by Grantee without prior written consent of IDED. 9.14 Termination. This Agreement may be terminated in the following circumstances: a) As a result of the Grantee's default under this Agreement; b) As a result of the termination or reduction of funding to IDED; c) upon written mutual, written agreement of IDED and Grantee. 9.15 Integration. This Agreement contains the entire understanding between the Grantee and IDED relating to the Project and any representations that may have been made before or after the signing of this Agreement which are not contained herein, are nonbinding, void and of no effect. Neither of the Parties has relied on any such prior representation in entering into this Agreement. IN WITNESS WHEREOF in consideration of the mutual covenants set forth above and for other good and valuable consideration, the receipt, adequacy and legal sufficiency of which are hereby acknowledged, the Parties have entered into this Agreement and have caused their duly authorized representatives to execute this Agreement, effective as of the Agreement Effective Date first stated. FOR IDED: FOR THE GRANTEE: BY: BY: Michael L. Tramontina, Director Si mature /lAA / Ir2 NJLC1iey ety®r Typed Name and Title 8 EXHIBIT A WORK STATEMENT [9-17-08] Grantee shall provide the following work under this Agreement: 1. Program Administration and Oversight. a. Grantee shall use Grant funds received to administer the State's Small Business Disaster Recovery Financial Assistance Program within its designated service area. b. Grantee shall provide oversight and contract administration to ensure that the recipients of Program funds are meeting contract requirements. c. Grantee shall enter into a contract with the business to provide assistance under the Program. The contract shall include terms and conditions that meet Program requirements, including requiring repayment if funds are not used in compliance with the Program. The contract shall provide that the loan will be forgiven if the business re- opens within 12 months of the Award Date and if applicable, upon receipt of documentation that the business has purchased and installed the energy-efficient equipment 2. Award Forgivable Loans to Eligible Businesses. a. Grantee shall process applications for assistance from the Program and award forgivable loans to eligible businesses. b. Awards will be made to businesses meeting the following criteria: • The business sustained physical damage or economic loss due to the 2008 disasters. • The business has executed loan documents for a disaster loan from an eligible lender. • The business commits to re-open business within 12 months of receipt of assistance. c. Assistance will be provided n the form of a forgivable loan, totaling 25% of the amount of approved by an eligible lender, up to $50,000. 3. Additional Funds for Energy-Efficient Purchases. a. Up to $5,000 per eligible business is available to reimburse the business for the full cost of purchasing energy-efficient equipment, including but not limited to, furnaces and boilers, appliances, air conditioners, hot water heaters, windows, and insulation. b. The cost that is eligible for reimbursement is the amount of the purchase price and installation less any utility rebates received. c. To be eligible for reimbursement, documentation must be provided to verify that the energy-efficient equipment meets the standards established by the Iowa office of energy independence (OEI). 4. Total Program Assistance Capped at $55,000. The Grantee shall ensure that an eligible business does not receive more than $55,000, including the Program funds available for energy-efficient purchases and installation (maximum of $5,000). 9 5. Additional Requirements. a. Grantee will acknowledge in award documents that Program funds are State funds awarded by IDED through the "Jumpstart Small Business Assistance Program". b. Grantee shall comply with all Program rules and reasonable directives or requests from IDED. c. Grantee shall utilize forms, online applications, and other materials provided by IDED for the administration of the Program. 10 ,ttach supporting documentation /a the back c'this form STATE OF IOWA GAX BUDGET FY General Accounting Expenditure DOCUMENT NUMBER 200^ DATE ACCTG PERIOD(mm/yy) (v{ VENUUR C UE AGENCY NAME VENDOR NAME AND ADDRESS BILL TO ADDRESS(ORDERING AGENCY) SHIP TO ADDRESS City of Waterloo Iowa Department of Economic Development City Hall 200 E. Grand Ave. 715 Mulberry Street Des Moines, Iowa 50309 Waterloo, IA 50703 I tKMJ hUtS UKUtK HPPKUVtU on UUUUJ KtI.tIVtU/JLKVIUOJ PERFORMED VENDORS INVOICE NUMBER DATE INITITALS QUANTITY ORDERED RECEIVED UNIT OF UNIT PRICE TOTAL PRICE MEASURE Initial allocation of Jumpstart Small 113,961.00 Business Program Funds DOCUMENT TOTAL 113,961.00 CLAIMANT'S CERTIFICATION AGENCY CERTIFICATION I CERTIFY THAT THE ITEMS FOR WHICH PAYMENT IS CLAIMED WERE FURNISHED FOR STATE I CERTIFY THAT THE ABOVE EXPENSE WERE INCURRED AND THE AMOUNTS ARE BUSINESS UNDER THE AUTHORITY OF THE LAW AND THAT THE CHARGES ARE REASONABLE, CORRECT AND SHOUD BE PAID FROM THE FUNDS APPROPRIATED BY: PROPER,AND CORRECT,AND NO PART OF THIS CLAIM HAS BEEN PAID. CODE OR CHAPTER SECTION(S) DATE TITLE CLAIMANT'S SIGNATURE AUTHORIZED SIGNATURE _ THE FOLLOWING FIELDS ARE FOR STATE ACCOUNTING USE ONLY DOC TYPE DOC NUMBER DOC DATE ACCTG PRD BUDGET ACTION PO SHIP INT INT SELLER INT SELLER (GAX) FY NEW/MOD INSTR IND FUND AGCY GAX 09 VEN OR CODE ADDR OVERRIDE F/A INDICATOR -EF I`IND TEXT-po's only(Y/N) EXT(po's only) REF DOC TYPE REF DOC NUMBER REF DOC LINE COM LN VEND INVOICE# COMMODITY CODE GS CONTRACT LINE FUND AGCY ORG SUB ACTV FUNC OBJT SUB JOB NUMBER REP CAT QUANTITY/ I/D DESCRIPTION AMOUNT I/D P/F ORG OBJT 01 269 UNITS 02 03 04 05 C16 07 DOCUMENT TOTAL GAX WARRANT# AUDITED BY PAID DATE ELECTRONIC FUNDS TRANSFER(EFT)AUTHORIZATION FORM DEPARTMENT OF ADMINISTRATIVE SERVICES,STATE ACCOUNTING ENTERPRISE VENDOR NAME(Business Name,Governmental Unit Name,or Individual Name): VENDOR IDENTIFICATION NUMBER(Federal ID Number): VENDOR CONTRACT NUMBER: (09-JMPST-XX) DIRECT DEPOSIT INFORMATION: Financial Institution Name Address ABA Routing Number(9 Digits) Account Number at Financial Institution Checking Account or Savings Account (Mark One) I hereby authorize the State of Iowa to initiate a deposit entry and to initiate, if necessary, any adjustments or debit entries for any deposit made in error to the Account Number specified above. If each project or contract needs to be deposited into specific accounts,then a new EFT form will need to be provided for each project or contract. AUTHORIZED BY: SIGNATURE NAME TITLE TELEPHONE NUMBER DATE Mail or Fax Completed Form to: Iowa Department of Economic Development ATTN: Katie Caggiano 200 East Grand Avenue Des Moines,Iowa 50309 Telephone Number: (515)242-4802 Fax Number: (515)242-4809 NOTE: This form will be forwarded to the Iowa Department of Administrative Services, State Accounting Enterprise, for financial information input.