HomeMy WebLinkAboutIowa Economic Development Authority-4/18/2016sconnmic d veicii_:
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Debi V. Durham, Director
Iowa Economic Development Authority
Business Financial Assistance Application
Business Finance - Business Development Division
Iowa Economic Development Authority
200 East Grand Avenue
Des Moines, Iowa 50309-1819
www.iowaeconomicdevelooment.com
Telephone: 515.725.3134 Email: businessfinance(ciliowa.00v
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)
® 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,leais.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:OOpm on the fourth Monday of the month.
Applications will be reviewed by the IEDA Board on the third Friday of the following month.
v.2,22.16
Public Records Policies
During the application process, the information submitted by you to IEDA is exempt from disclosure under
the "industrial prospects" exemption found in Section 22.7(8). However, once you receive an award, the
industrial prospects exemption no longer applies and all documents submitted and generated during the
application and negotiation process become public records under Iowa's Open Records Law (Iowa Code,
Chapter 22) unless
1) The information belongs to one of the classes of records automatically treated as confidential; or
2) You have applied for and received written notice that your information will be treated as confidential,
Automatically Confidential Records
IEDA automatically treats the following records as confidential and will withhold them from public inspection
even without a request for confidential treatment:
• Tax Records and Tax Liability Information
• Quarterly Iowa Employer's Contribution and Payroll Report prepared for the Iowa Workforce
Development Department
• Payroll Registers
• Business Financial Statements and Projections (unless those statements are already publicly
available elsewhere, e.g., 10-K filings)
Personal Financial Statements
Exemptions to the Open Records Law
If you wish to have additional information treated as confidential, you must fill out the confidential treatment
request form. Under the Open Records Law, IEDA may lawfully treat certain information as confidential if
that information falls within an exemption to the Open Records Law. The following exemptions represent
records which may lawfully be treated as confidential under the Open Records law and which are most often
applicable to the information submitted to IEDA:
• Release of information would give an unfair advantage to competitors — Iowa Code Sec. 15.118
Trade secrets — See Iowa Code section 22.7(3), see also Iowa Code Ch. 550
Information on an industrial prospect with which the IEDA is currently negotiating — See Iowa
Code section 22.7(8)
Communications not required by law, rule or regulation made to IEDA by persons outside the
government to the extent that IEDA could reasonably believe that those persons would be
discouraged from making them to IEDA if they were made available for general public
examination — Iowa Code section 22.7(18)
Non-Confidentlal 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.2.22.16
SECTION A
Applicant Information Date Application Submitted: 3/24/2016
1. Name of Business: Hydrite Chemical Co.
2. Entity Name (for contracting purposes): same
3. Address: 300 North Patrick Blvd.
4. City, State & Zip Code: Brookfield, WI 53045
5. Contact Person: Bob Hintz Title: Corporate Controller
6. Phone: 262-792-8708 Fax: 262-792-7895 Email: bob.hintz@hydrite.com
7. FEIN: 39-0364390
8. NAICS Code for primary business operations: 325100
9. US DOT Number: 100011
10. Does the Business file a consolidated tax return under a different tax ID number?
❑ Yes Of 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 Waterloo
13. Official Contact (e.g. Mayor, Chairperson, etc.): Mayor Quentin Hart Title: Mayor
14. Address: City Hall, 715 Mulberry Street
15. City, State & Zip Code: Waterloo, IA 50703
16. Phone: Fax: Email:
17. If IEDA needs to contact the sponsor organization with questions, should we contact the person
listed above?
❑ Yes ® No, please contact the following person:
Name: Lisa Skubal Title: CEcD
Address: Great Cedar Valley Alliance & Chamber
City, State & Zip Code:
Phone: 319-232-1156 Fax:
Email: LSkubal@CedarValleyAlliance.com
If necessary, please list information on additional sponsors in an attachment.
IEDA — Business Financial Assistance Application
3 v.2.22.16
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 andlor customers.
Hydrite Chemical Co. was established in 1929, We are one of the largest manufacturers and distributors of
chemical products in the United States. To date, we have locations in California, Illinois, Indiana, Iowa and Wisconsin.
We offer expertise in chemical distribution, food and dairy sanitation, food ingredients, organic processing, liquid sulfur
salts, water treatment, foam control, and compliance management.
2. Business Structure:
❑ Cooperative ❑ Corporation ❑ Limited Liability Company
0 Partnership ® S -Corporation 0 Sole Proprietorship
3. State of Incorporation: Wisconsin
4. Identify the Business' owners and percent ownership: Honkamp Family 100%
5. Does a woman, minority, or person with a disability own the Business? 0 Yes ® No
6. List the Business' Iowa locations and the most current number of employees at each location. Waterloo location
has 88 employees (86 full-time and 2 part-time). Address is: 2815 WCF & N Drive, Waterloo, IA 50703
7. What is the Business' worldwide employment? (Please include employees of parent company, subsidiaries, and
other affiliated entities in this figure.) 840
Project Information
8. Project Street Address: 2815 WCF & N Drive
Project City & Zip Code: Waterloo, Iowa 50703 Project County: Black Hawk County
9. Type of Business Project:
0 Startup ® Expansion of Iowa Company ❑ New Location in Iowa
10. Does the project site qualify as a "Brownfield" or "Grayfield" site? 0 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.)
Hydrite Chemical is increasing its manufacturing capabilities in Waterloo, IA in order to expand our product line
primarily in the food, as well as agriculture and sulfur industries. Beyond expansion of manufacturing capabilities, the
project includes construction of a building, improvements for operations throughput, and additional infrastructure related
requirements. The estimated start date is April 25, 2016,
12.
Project Timeline (add additional rows as needed)
Beginning Activity Date
June 2016
Activity Completion Date
July 2016
Site Preparation
Land and Building Construction
July 2016
July 2017
Mfg. Machinery &Equipment
April 2016
March 2019
13. Has any part of the project started*?
If yes, please explain.
'For IEDA's purposes, starting the project includes: the start of construction or rehabilitation, the purchase of a building, the execution of a lease, or
the installation of equipment to be used in the project.
14. Identify the Business' competitors. If any of these competitors have Iowa locations, please explain the nature of
the competition (e.g. competitive business segment, estimated market share, etc.) and explain what impact the
proposed project may have on the Iowa competitor.
Envirotech, Peroxychem, TKI, PVS, Brenntag North America, Inc., Harcros Chemicals, Inc., K.A. Steel Chemicals,
Inc.
IEDA — Business Financial Assistance Application 4 v.2.22.16
0 Yes
® No
15. Will any of the current Iowa employees lose their jobs if this project does not proceed?
0 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 0 No
If yes, where and what assistance is being offered? Other locations are evaluated based on return on investment
and high level strategy. Other locations include Hydrite operations in Wisconsin, California, Illinois and Indiana.
Assistance in these states has not yet been explored for this project.
17. Please identify the company project management for the project location and experience. Hydrite Chemical
Co. internal Engineering department will manage the Waterloo project and source local vendors as appropriate.
SECTION C
Applicant's Project Budget
1. Does the Business plan to lease the facility? 0 Yes ® No
If yes, please provide the Annual Base Rent Payment (lease payment minus property taxes, insurance, and
operating/maintenance expenses) for three years in the budget below, and only major renovation costs your
company expects to incur. Administrative rules require that the lease be in place for a minimum of five years.
2. Please complete the budget below. Include only costs the company plans to incur directly:
Use of Funds
Cost..-.
Source A
Source B
Source C
Source D
Source E
Source F
Base Rent (3 years)
Include when funds will be
disbursed; If loan, whether
payments are a level term,
balloon, etc
Source A. IEDA (see #4 below)
$
Source B: Local Government
Tenant Improvements
Source C: Business
$
Land Acquisition
1 1 1, 4 0 0
Source D: Other Source
(Hydrite will fund)
$15,893,400
.$
Site Preparation
1,433,000
Source F: Other Source
$
Building Acquisition
$15,893,400
Building Construction
3,709,000
Building Remodeling
1-00r,000,1
Mfg. Machinery & Equip.
10,510,000
Other Machinery & Equip.
Racking, Shelving, etc.'.r
Computer Hardware
Computer Software
�s:=
Furniture & Fixtures,.
Working Capital
Research & Development
Other (Lab Upgrades)
3 0, 0 0 0
TOTAL. ,...
$15,893,400,
' $
$
$
$ '
$
$
Racking, shelving and conveyor equipment used in distnbution center protects only
3. Please complete the chart below with proposed financing for the p oject (tax benefits should be reflected as indirect
•
,,,,a,,.,,,,y.,.,,...,, ,.., ...,,.,..f..
PROPOSED FINANCING
Source of Funds
Amount
Form of Funds
Rate and
Term
Commitment
Status
Conditions/Additional
Information
Add additional lines as needed
(Loan, Grant, In-
Kind, Donation, etc.)
Include when funds will be
disbursed; If loan, whether
payments are a level term,
balloon, etc
Source A. IEDA (see #4 below)
$
Source B: Local Government
$
Source C: Business
$
Source D: Other Source
(Hydrite will fund)
$15,893,400
.$
Source E: Other Source
Source F: Other Source
$
TOTAL
$15,893,400
IEDA — Business Financial Assistance Application
v.2.27.16
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. *
5,
No collateral, funding disbursed at the end of the 5 -year contract
0
Explain:
Description
Irrevocable letter of credit
0
Dedicated certificate of deposit (CD)
0
Surety bond
0
Mortgage on real estate
0
Corporate guaranty
Personal. guarantee
0
- - -
* The IEDA Board has the final discretion on what collateral will be accepted.
TAX CREDITS AND INDIRECT FINANCING
Source of Funds
Amount
Description
Investment Tax Credit
$634,535
Sales, Service & Use Tax Refund
$157 260
Research Activities Credit (3%/10%)
Local Property Tax Exemption
Tax Increment Financin•
260E Job Training Funds
In-kind Contribution
Other
TOTAL
$791,795;".
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 internal rate of return (IRR) is marginal given this significant investment. Investment tax credits and use tax
refunds allow this capital expansion plan to be acceptable financially.
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 3
Option 1
Option 2
80% single Coverage
50% Family coverage
Monetary Equivalent
Total Number of
Employees in
US
Pay 80% of premium costs
for a standard medical plan,
single coverage.
Pay 50% of premium costs for
a standard medical plan,
family coverage.
Provide medical and pay the
monetary equivalent of Option
1 or Option 2 in supplemental
IEDA—Business Financial Assistance Application
6 v.2,22.16
250+
$1250maximum deductible
$2500 maximum deductible
50-249
$2250 maximum deductible
$4500 maximum deductible
0-50
$2000 maximum deductible
$4000 Maximum deductible
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.? 840
2, What is the total premium cost for a standard medical plan for single employee coverage? .$1,514/vr
a. What portion of this cost is paid by the business? 75%
b. What is the deductible associated with this plan? $500
3. What is the total premium cost for a standard medical plan for family coverage? $4,709/vr
a. What portion of this cost is paid by the business? 75%
b. What is the deductible associated with this plan? $1,500
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
$
Health Savings Account (HSA) contribution
$
TOTAL
$
5. Does the Business offer a pension plan, 401(k) plan, and/or retirement -plan? ❑ Yes 0 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
employ
Year Ending
Average Actual Match per
Employee ($)
$
$
$
Three-year Average:
$
6. Does the Business offer a profit-sharing plan? ❑ Yes 0 No
If yes, p ease indicate total amount paid out each year for the past three years and then, determine the average annual
bonus o
Year Ending
Average Actual Share per
Employee ($)
$
$
IEDA — Business Financial Assistance Application r v.2.22.16
Three-year Average:
Notes:
1. A qualified plan must be offered to all full-time permanent employees.
2. If you have multiple health insurance plans, please provide information on each plan.
IEDA — Business Financial Assistance Application 8 v.2.22.16
SECTION E
Project Jobs
1. List the jobs that will be created and/or retained as the result of this project. (A retained job is an existing job that
would be eliminated or moved to another state if the project does not proceed in Iowa.) For jobs to be created,
include the starting and final hourly wage rate. For retained jobs, include the current hourly wage rate.
Full -Time CREATED Jobs
(Add additional rows as needed)
Job Title
Number of
CREATED Jobs
Starting
Hourly Wage
$21.63
Wage at 36 months
following the award
$22.60
Supervisor
1
Production
10
$18.50
$19.47
Total Full -Time CREATED Jobs
11
Full -Time RETAINED Jobs
(Add additional rows as needed)
Job Title (AT -RISK jobs only)
Number of
RETAINED
Jobs
Current Hourly
Wage
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.2.22.16
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
Year 3
Year 4
Year 5
State Corporate Income Tax*
40,000
75,000
110,000
145,000
180,000
State Business Sales and Use Tax
50,000
50,000
50,000
0
0
* Insurance Companies: Provide State Insurance Premium Tax
Local Business Taxes
Year 1
Year 2
Year 3
Year 4
Year 5
Local Real Estate Property Tax
15,000
0
0
0
0
Local Option Sales Tax
0
0
0
0
0
CONFIDENTIAL
IEDA— Business Financial Assistance Application
10 v.2.22.16
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 found at
http://www.lowaeconomicdevelopment,com/Business/application
A3 Affidavit that states the Business has not, within the last five years, violated state or federal statutes, rules,
and regulations, including environmental, worker safety regulations and antitrust laws or If such violations
have occurred, that there were mitigating circumstances or such violations did not seriously affect public health
or safety or the environment. A sample affidavit can be found at
http://www.iowaeconomicdevelopment.com/Business/application
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.2.22.16
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? 0 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? 0 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.
I understand that all information submitted to IEDA related to this application is subject to Iowa's Open Record Law (Iowa Code,
Chapter 22), unless specifically marked as confidential section.
I understand that IEDA reserves the right to negotiate the financial assistance.
I understand this application is subject to final approval by IEDA and the Project may not be initiated until final approval is secured.
Furthermore, I am aware that funds will not be disbursed until a contract has been executed and the appropriate terms have been
met.
I 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: For the Sponsor(s):
/1'yl sorb L sA-t-za— `YI
tgnature Date Signature Date
Rost ' KA2- Go qoy-gte, Co, ( U -VA -i -\r) 1,1 LV4
Name and Title (typed or printed) Name and Title (typed or printed)
is r
IEDA will not provide assistance in situations where it is determined that any representation, warranty, or statement made
in connection with this application is incorrect, false, misleading or erroneous in any material respect. If assistance has
already been provided prior to discovery of the incorrect, false, or misleading representation, IEDA may initiate legal action
to recover Incentives and assistance awarded to the Business.
IEDA — Business Financial Assistance Application
12 v.2,22.16
Attachment A3
Affidavit
State of Iowa
County of Black Hawk
I, Mark Minsky, depose and say that I have examined the following statement and have found it to
the best of my knowledge to be accurate and true.
Hydrite Chemical Co. has not, within the last five years, violated state or federal statutes, rules, and
regulations, including environmental and worker safety regulations, 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,
I have submitted a report detailing the circumstances of all such violations to the Economic
Development Authority and such report represents a full and complete description of such
circumstances.
I hereby certify that the information presented to the Iowa Economic Development Authority on
March 24, 2016 is fully complete, true, and correct. 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, as provided in Iowa Code section 15A.3 and other applicable law.
Furthermore, I understand that providing false, misleading, or fraudulent information to the Board
may result in civil and/or criminal liabilities and penalties against the Recipient and its
representatives.
I further depose that the signature below is my own proper signature.
Dated: March 24, 2016
Subscribed and sworn to before me on
this 24Th day of March. 2016
aaa ct • co eat (Notary Public)
W auK2 ha. County
My commission expires on\212.4 Jzotq
7/18/12
Signature