HomeMy WebLinkAboutApplication for business financial assistanceBusiness Financial Assistance
Application for Iowa City CDBG Economic Development Funds
Prior to submitting your Business Financial Assistance Application, please make sure to do the
following:
Fill out the application completely. If any questions are left unanswered or required attachments are not submitted, an explanation for the omission must be included.
Should
you have any questions while completing the application contact Neighborhood Services staff at 319.356.5230 or by email at neighborhoods@iowa-city.org.
Sign the application.
All
application materials are subject to the Open Records Law (1994 Iowa Code, Chapter 22). Confidentiality may not be guaranteed. Please review the applicant guide to review what specific
information is considered proprietary and what information is available to the public.
Recipients must receive pre- and post-award technical and management assistance from local non-profit
providers such as the Small Business Development Center and/or from participating lenders. If necessary, assistance may be paid through loan proceeds. Please review the applicant guide
for specifics.
Please be aware that the funds available are federal funds; as such various federal requirements may apply. Each applicant is encouraged to speak with Neighborhood
Services staff about the requirements that will apply to your specific business prior to submitting an application.
Applicants must be a US Citizen or a “qualified alien” and may
be required to provide proof of citizenship or immigration status per 8 USCA section 1642.
Application Deadlines: Applications will be accepted throughout the year until funding is
depleted.
Iowa City CDBG Economic Development Funds
Application for Business Financial Assistance
Business Requesting Financial Assistance:
Individual
Home Address
Name of Applicant
Business
Full Street Address of Business
Phone Number & Email Address
DUNS Number (If awarded funds, applicant must obtain a DUNS number):
Type of Business
Date Business
Established
Commercial Lender’s Name, Address and Contact Person’s Phone and Email Address:
Current residency status (please check one):
( U.S. Citizen or Permanent Resident
Alien
( Other
NOTE: The City will not provide assistance in situations where it is determined that any repre sentation, 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 by the City prior to discov ery of the incorrect, false or misleading representation,
the City may initiate legal action to recover City funds.
Section 1: Description of Business and Proposed Project
Describe the proposed "project" (for example, company relocation, building expansion, remodel ing, new product line, number of
new jobs, amount of investment in machinery and equipment) and the expected benefits it will receive from the financial assistance requested:
Provide a brief history of your company:
Descri
be the organizational structure of the business:
Management
(Proprietor, partners, officers, directors, all holders of outstanding stock, 100% of ownership must be shown)
Name
& Position/Title
Complete Address
%
Owned
Attach a brief description similar to a resume of the education, technical and business background
for all the people listed under Management.
Will the project involve a transfer of operations or jobs from any other Iowa City or Johnson County facility or replace operations or
jobs currently being provided by another Iowa City or Johnson County company? If yes, please indicate the facility(s) and/or company(s) affected.
Section 2: Financial Contributions to the Proposed Project
Use of Proceeds
USE OF Proceeds
Activity
Loan Requested (Enter gross dollar amount rounded to the nearest hundreds)
Land
acqui si ti on
$
New Construction/Expansion Repair
$
Acquisition and/or Repair of Machinery and Equipment
$
Inventory Purchase
$
Working Capital (including accounts payable)
$
Acq
uisition of Existing Business
$
All Other (provide description)
$
Total Loan Requested (All Uses):
$
Terms of Proposed Financing (Sources)
Proposed Financing
Amount
Monthly
Payment
Type(1)
Rate
Term
Financial Institution:_________________
$
Financial Institution : ________________
$
Other : ___________________________
$
Io
wa City CDBG Economic Dev. Fund
$
TOTAL SOURCES:
$
(1)For example: forgivable loan, direct loan, or grant.
NOTE: Total Loan Requested - Uses (2.1) and Total
Sources (2.2) should be equal.
Explain why assistance is needed from the City, and why it cannot be ob tained elsewhere. If the applicant did not apply for a loan through a private
financial institution, please explain why. If denied assistance through a financial institution, please attach the letter of denial.
Indicate the owner’s contribution (cash, assets for the operation of the business, etc.) to this project. (This amount should not be included in questions 2.1 and 2.2)
Identify
all agencies or institutions involved in the project (financial, technical assistance, etc.) and what their involve ment is:
What type of security will the assisted business provide
the City? If no security or less than the dollar amount requested is offered, an explanation must be provided.
Corporate Guaranty
UCC Financing Statement
Irrevocable Letter of Credit
Personal
Guarantee
Mortgage on Real Estate
Other: ___________________
Before execution of a CDBG agreement, if the collateral consists of machinery and equipment, inventory, or other, the applicant
must provide an itemized list that contains serial and identification numbers for all articles that had an original value of greater than $5,000. Include a legal description of real
estate offered as collateral.
2.7 If the City did not provide financial assistance, could the project proceed?
Section 3: Jobs to Be Created/Retained
Special Note: The Community
Development Block Grant (CDBG) program requires that at least 51% of the jobs created or retained must be held by or made available to low-moderate income persons. The business acknowledges
that if it fails to create and/or retain the jobs identified below by the end of the project period and maintain them for a period of time (usually 12 months from the date of the award);
it may be required to reimburse City funds for the employment shortfall.
If an existing business, how many employees are currently employed at your Iowa City location? Please attach
a copy of the company's quarterly Iowa "Employer's Contribution and Pay roll Report" for the most recent quarter.
Complete the following chart identifying the number of jobs to be
created and/or retained based on this specific project.
Type of Job and Hourly Rate for Created and/or Retained Positions in First 12 Months of Project Award (please see attached Job Category Definitions)
# of Jobs Cre ated
# of Jobs
Re tained
Type
of Job
No. Hours
Per Week
Hourly Rate of Pay
Fringe Benefits*
Officials & Managers
Professional
Technicians
Sales
Office
& Clerical
Craft Wokers (Skilled)
Operatives (semi-skilled)
Laborers (unskilled)
Service Workers
*If fringe benefits are
provided, please attach a description of all employee benefits provided by and paid for (in full or in part) by the business.
What is the estimated annual payroll for the new employees
resulting from this project?
If an existing business, will any of the current employees lose their jobs if the project does not proceed? If yes, how many? Explain why:
Section
4: Economic & Environmental Impact
What other Johnson County companies could be considered to be your competitors?
Please describe the energy and resource efficiency programs, waste
reduction, waste exchange, and recycling programs at your Iowa City operation.
Section 5: Community Involvement, Compliance with Law
In addition to your normal business activities, does your business contribute or have plans to contribute to the community through
volunteer work, financial contributions, or through other means? Please describe.
Has the business been cited or found to violate any federal or state statute or regulation within
the last five years (including, but not limited to environmen tal regulations, payroll taxes, Occupational Safety and Health Administration laws, Fair Labor Standards, the National Labor
Relations Act, the Americans with Disabilities Act)? If yes, please explain the circum stances of the violation(s).
Has the company or any officer of your company been involved in
bankruptcy or insolvency proceedings during the past 7 years from the date of this application? If so, provide the details.
Are you or your business involved in any pending lawsuits?
If yes, provide the case name of the lawsuit, docket number, and city and state where it is pending.
Section 6: Summary of Required Attachments
Check off each attachment submitted.
If not submitted, ex plain why.
[ ]
Business plan (if start-up business)
[ ]
Balance Sheet (3 year historical if an existing business. Start-ups must provide a pro-forma
balance sheet)
[ ]
Profit and loss statements (3 year historical if an existing business, 3 year projection for start-ups)
[ ]
12 month cash flow statement (if the business
does not expect to turn profitable within the first 12 months, provide a cash flow statement extended to the year the business expects to turn profitable)
[ ]
Description of fringe
benefits provided to employees, if applicable
[ ]
Brief description of the education, technical and business background for all the persons listed under Management (Question #1.4)
[ ]
Please provide the social security numbers for all the persons listed under Management (Question #1.4)
[ ]
If an existing company, copy of the company's quarterly Iowa
"Employer's Contribution and Pay roll Report" for the most recent quarter.
[ ]
Construction loans only: Cost estimates for construction and a statement of the source of any additional
funds
[ ]
Include a list of any machinery or equipment or other non-real estate assets to be purchased with the financial assistance and the cost of each item as quoted by the
seller. Include the seller’s name and address.
Upon review of a submitted application, the City reserves the right to request additional information in order to assist the City
with its evaluation of an application.
Release of Information and Certification
NOTE: Please read carefully before signing
I hereby give permission to the City of Iowa City (the
City) to research the company's history, make credit checks, contact the company's financial institution, and perform other related activities necessary for reasonable evaluation of
this proposal. I understand that all information submitted to the City relating to this application is subject to the Open Records Law (1994 Iowa Code, Chapter 22) and that confidentiality
may not be guaranteed. I hereby certify that all repre sentations, warranties or statements made or furnished to the City in connection with this application are true and correct in
all material respects. 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 develop ment assistance from a state agency or political subdivision.
If applicant is a proprietor or general partner, sign below.
By:
___________________________________________ Date: ______________________
If applicant is a Corporation, sign below:
_______________________________________________
Corporate Name
and Seal Date
By: ____________________________________________
Signature of President
Attested by: ___________________________________________
Signature of Corporate Secretary