1 Tax Incremental Financing Program NOTE: 1. Do not complete this Application before discussing your business opportunity with a CDA Public Finance Officer. 2. The Applicant may wish to be designated a High Performance Work Organization. If so, the appropriate form is attached. Completing the form is optional. 3. The Applicant is required to complete the attached Threshold Projects form if the requested assistance is $1 million or more and the Applicant has 100 or more full-time employees in Connecticut. CONNECTICUT DEVELOPMENT AUTHORITY 999 West Street, Rocky Hill, CT Telephone: (860) Fax: (860) ctcda.com
2 Overview Page 2 of 11 Legislative Mandate: Connecticut encourages the location of significant economic projects within the state through the issuance of bonds in which debt service is paid from the collection of project-related incremental sales, admission, cabaret and dues taxes. CGS Section governs this program. Assistance: Eligible Applicants: Eligibility Criteria: Eligible Uses: Bond Term: Interest Rate: Bond Amount: Fees: may issue tax-exempt and taxable bonds, payable entirely or in part from incremental taxes allocated and deemed appropriated from the state s General Fund, to help finance, on a self-sustaining basis, significant economic projects located in the state. Any person, firm or corporation with an eligible economic development project, or any municipality seeking to support such a project. Only large-scale Economic Development Projects, approved by the Authority and State Bond Commission prior to 7/1/01, are eligible. Each project must be determined, with the aid of an independent financial assessment, to be self-sustaining through supplemental financing resources and the generation of incremental taxes to the state collected under: Sales and Lodging Tax (CGS, Chapter 219) and Admissions, Cabaret and Dues Tax (CGS, Chapter 225). Consideration will be given to projects that: A. add substantial new economic activity and employment in the project community and surrounding areas, and generate significant additional tax revenues B. require the use of TIF bonds to attract such a project to the state C. are economically viable and self-sustaining D. provide direct and indirect benefits to the state and municipality that outweigh costs of the project E. are consistent with the strategic development priorities of the state Generally between 10 and 30 years Negotiated sale or competitive bid with bond purchasers developed in conjunction with the State Treasurer. Determined by the net incremental taxes to be generated by the Economic Development Project. (Legislative approval is required when the aggregate State assistance exceeds $10 million within a two-year period.) Application: A $25,000 deposit shall be paid with the application, to be credited against the cost of the independent financial assessment study, plus a non-refundable fee based on the proposed bond amount: $5 million or less (one time fee at closing).$1,000 More than $5 million (one time fee at closing)...$2,500 Bond Closing: $5 million or less (At closing and on each anniversary.)...1/2 of 1% of bond amount More than $5 million (At closing and annually.)..1/8 of 1% of balance outstanding
3 Business Profile - 1 Page 3 of Applicant: Principal operating company. Check one or more: Project Owner Developer Municipality Operator 2. Address: Attach sheet listing other business location(s) and/or project site(s). Street P.O. Box Town State Zip 3. Contact: Title: Phone: Fax: 4. Company Website: 5. Co-Applicant, Sponsor or Borrower: If different than the Applicant, provide the requested information for each. Use additional sheets if necessary: A. Entity: B. Check one or more: Project Owner Developer Municipality Operator C. Address: Attach sheet listing other business location(s) and/or project site(s). Street P.O. Box Town State Zip D. Contact: Title: E. Phone: Fax: 6. Applicant data: SIC and/or NAICS CT tax registration Federal employer ID 7. Type of business: Manufacturing e-commerce Service Retail Wholesale Other 8. Product or service:
4 Business Profile - 2 Page 4 of Sales for the fiscal year ending:, 20 Net sales $ Approximate net sales outside Connecticut $ Approximate net sales outside the U.S. $ Approximate net sales to Africa $ 10. Ownership: Date established, State of incorporation/partnership filing, Date acquired by present owners, Date qualified to do business in CT.. Proprietorship Limited Liability (LLC) S Corporation Partnership C Corporation Other (please specify) Publicly held. Listed on Exchange, symbol Not publicly held List principals, guarantors and other persons owning 10% or more of the Applicant. Please list additional shareholders, principals and guarantors on a separate sheet of paper Name Title Street address Town, state, zip % Ownership Social Security The majority company shareholder is: A minority A woman Physically disabled 11. Three largest customers: Include percentage of total annual sales made to each. Customer Contact Address Street PO Box Street PO Box Street PO Box City State Zip City State Zip City State Zip Phone % of sales
5 Business Profile - 3 Page 5 of Connecticut employment: Full-time Part-time Total Current CT employment Effect of project on CT employment Total jobs % Minority Retained jobs New jobs 13. Connecticut wages & benefits: Please include the most recent UC-5 (a) payroll report filed with the CT Department of Labor. Current Annual payroll at project completion Retained jobs New jobs Gross annual payroll $ $ $ Non-executive payroll $ $ $ Gross annual fringe benefits $ $ $ 14. Health insurance provided for: All employees Executives Full-time only None % Paid by employer. 15. Past due taxes: If there are any, please provide details and any payment arrangements. Federal Federal State State Real Unemployment Personal withholding income sales income property insurance property $ $ $ $ $ $ $ 16. Three largest trade creditors: Creditor Contact Street PO Box Street PO Box Street PO Box Address City State Zip City State Zip City State Zip Phone
6 Business Profile - 4 Page 6 of Professional Relationships: A. Principal bank bank name, address, contact officer, phone B. Accountant firm name, address, accounting officer, phone C. Attorney firm name, address, attorney, phone D. Insurance agent company name, address, agent, phone 18. Other obligations: Are there obligations not listed on this Application or on the financial statements submitted with this Application for which the Applicant is obligated? No Yes. If yes, please provide details: 19. Litigation: Is the Applicant, any individual owning 10% or more of the Applicant, any guarantor, or any company related to the Applicant, a party to any claim or lawsuit? No Yes. If yes, please provide details: 20. Defaults: Is the Applicant, any individual owning 10% or more of the Applicant, any guarantor or any company related to the Applicant, in default under any loan agreement? Are any assessments due and unpaid? No Yes. If yes, please provide details:
7 Business Profile - 5 Page 7 of Environmental compliance: Does the Applicant have any outstanding orders or citations from either the CT Department of Environmental Protection or the Federal Environmental Protection Agency? No Yes. If yes, please provide details. EPA contact & phone number: 22. OSHA compliance: Does the Applicant have any outstanding orders or citations from the federal Occupational Safety and Health Administration? No Yes. If yes, please provide details. OSHA contact & phone number: 23. Bankruptcy: Has the Applicant, any individual owning 10% or more of the Applicant, any guarantor, or any company related to the Applicant ever filed a voluntary or involuntary petition of bankruptcy or had a petition of bankruptcy filed against it? No Yes. If yes, please attach copies of filings including schedules of assets & liabilities. 24. Applicant s Threshold Project determination: Please check boxes that apply to borrower. Operations in Connecticut 100 or more employees in Connecticut Requesting $1 million or more in assistance Checking all three boxes constitutes a Threshold Project. Please complete and return the attached one-page form. 25. Public disclosure: A. Has the Applicant included community and employee participation in preparing its request for financial assistance? Yes No Yes No B. If no, would informing community representatives and employees of the request for financial assistance prior to final approval be a disclosure of confidential or proprietary information? If yes, please explain.
8 Project Description - 1 Page 8 of High Performance Work Organization: A. The Connecticut General Statutes , direct the Authority to give priority to High Performance Work Organizations in the event that funds for lending become limited. If the Applicant wishes to be considered a High Performance Work Organization it must incorporate six or more of twelve selected work environment attributes. If yes is checked, please complete and return the attached form. B. Does the company wish to be designated a High Performance Work Organization? Yes No 27. Project name: 28. Project costs: Please include any pertinent information in the space provided. Acquire land $ Machinery & equipment $ Acquire building $ Working capital $ Renovate building $ Refinancing $ Leasehold improvements $ Relocation $ Refinancing existing debt $ Site remediation $ Other $ Infrastructure Total uses/project costs $ 29. Sources of funds: Please identify each source including phone, address & name of contact. Owner s equity $ Investor(s) $ From business $ CDA $ Commercial lender(s) $ DECD $ Municipality $ TIF bond issue Leasing company(s) $ Total sources $
9 Project Description - 2 Page 9 of Project description: Attach additional sheets if necessary. 31. Project location: If different than the Applicant, include full address and/or PO Box. 32. Economic benefits resulting from the project: Include sales, payroll, corporate, real property and personal property taxes paid as a result of this project. Also include sales taxes paid that relate to the construction of a building, the acquisition of equipment or those paid by others for products or services related to operations financed by this loan. Please list assumptions on a separate sheet. Estimated tax payments: CT corporate CT payroll CT sales Town property Town personal property Current Actual Projected 1 st Year Projected 2 nd Year Projected 3 rd Year Projected 4 th Year Projected 5 th Year 33. Prior government assistance: Has the Applicant received financing assistance from any state or federal organization for this project or any other project? If so, please indicate organization, amount, and type of assistance, date of transaction, balance outstanding and use of proceeds. CDA DECD CT Innovations SBA Other 34. State assistance requested: TIF bond issue: Tax supportable amount: Term: indicate years or months: Estimated interest rate: Estimated debt service in stabilized year $ mos./ yrs. % $
10 Request for Assistance Page 10 of Bond repayment sources: (in stabilized year 20 ) Sales & lodging incremental tax* $ Admissions, cabaret & dues incremental tax $ Total state incremental tax revenue $ Property tax increment from municipality $ Other public revenue source $ Total public revenue source $ Direct revenue from project $ Other private revenue sources $ Total revenue available $ *For retail shopping projects, allocated sales for computation of tax cannot exceed 30% of gross sales directly associated with project. 36. Project area: Please attach: A. Geographic description of incremental tax area surrounding site B. Number and type of existing firms doing business in area 37. Economic impact on municipality: Attach description of effects of project on municipality: A. Include analysis of necessary infrastructure development to support project and indicate available sources of financing B. Discuss potential for adverse impact on existing businesses in area C. Provide assumptions and basis for projection of # of additional businesses to be created in project area and associated jobs 38. Private capital Investment: Attach description of nature and amount of private investment capital to be generated. Include assumptions and basis for such projections with regard to: A. Direct private investment B. Indirect private investment stimulated by project 39. Tourism: Attach description of expected impact, if any, project will have on tourism: Include assumptions and basis for such projection. 40. Financial viability: Attach Feasibility Study and/or Business Plan that demonstrates the financial viability of project: A. Show how bonds will be self-sustaining from incremental taxes collected and any amounts made available by the municipality B. Discuss how project will provide net benefit to State s economy and employment opportunities
11 Applicant s Certification Page Certification by Applicant, Co-Applicant and/or Sponsor 11 of 11 We hereby apply for tax increment financing pursuant to Connecticut General Statutes , as amended, and confirm that we have read and are familiar with said Statute. The accompanying information is being submitted pursuant to and in satisfaction of the requirements of in order to induce the Connecticut Development Authority ( Authority ) to issue its bonds under said Statute. We hereby represent and warrant to the Authority that to the best of our knowledge the information contained herein and attached hereto is complete, true and correct. To the extent such information represents predictions as to future events, it represents good faith estimates based on our experience. We further represent and warrant that we have fully disclosed herein any matters involving the Applicant(s) with regard to either outstanding orders or citations for environmental and OSHA related compliance issues, and the existence of any delinquent tax payments owed. In extension of the foregoing, we hereby agree to indemnify the Authority of, and from, and to hold the Authority harmless against, any and all loss, cost, liability and expense, including without limitation, attorneys fees and consulting fees and the like arising in any way out of this application, or the use by the Authority of any information contained herein and/or in any of the materials now or hereafter submitted herewith. We also acknowledge that the Authority may act solely upon the information provided in connection with this application, and that should the project so described change in any material way, this application and any approvals, grants, loans and the like shall be null and void and of no force and effect, and the project as so changed must be resubmitted in accordance with the then applicable requirements of the Authority. In such event the Authority shall have no obligation to provide any form of approval, notwithstanding any prior approvals. As more particularly set forth in , we acknowledge that final approval of this application may only occur after the State Bond Commission has approved it. Any prior approvals, including that of the Authority, are interim only and are of no force or effect. Upon final approval, we acknowledge that the mechanism and/or format for the advance of funds for the Project shall be in the sole discretion of the Authority. Further, we acknowledge that we shall reimburse the Authority for all costs and expenses incurred by it in connection with the processing of this application. We, the undersigned, further agree that bank, credit agencies, the Connecticut Department of Labor ( DOL ), the Connecticut Department of Revenue Services and other references are hereby authorized now, or anytime in the future, to give the Authority any and all information in connection with matters referred in this application, including the payment of taxes by the undersigned (when not a municipality). In addition, the undersigned agree that the assistance provided pursuant to this application will be utilized exclusively for the purposes represented in this application, as may be amended, and further agree that individual company data from DOL may be used for reporting purposes to the Connecticut General Assembly to comply with the Authority s statutory requirements. APPLICANT: CO-APPLICANT/SPONSOR: (strike one) By By ITS DATE ITS DATE Please Note: 1. A $25,000 Deposit plus Application Fee, payable to the Connecticut Development Authority, must be enclosed with this Application. 2. An Affirmative Action Plan does not need to be submitted at this time, but must be prepared by the Applicant and approved by the Authority prior to closing. Please call for the form and assistance. FALSE STATEMENTS MADE HEREIN ARE PUNISHABLE AS A CLASS A MISDEMEANOR UNDER CGS 53a-157b.
12 High Performance Work Organization Note: Completing this form is optional Name of Company Address The Applicant is a: sole proprietorship limited liability company partnership trusteeship corporation government entity Public Act directs the Connecticut Development Authority to give priority to High Performance Work Organizations when providing financial assistance. The Applicant will be deemed to be a High Performance Work Organization if six or more of the twelve attributes listed below are checked. If appropriate, attach descriptions of actions the Applicant has taken that illustrate its commitment to being a High Performance Work Organization. Demonstrate a commitment to continuous improvement of products and services and cost reductions for such products and services. Encourage decentralized decision-making, worker participation at all levels and greater reliance on front line workers. Adopt an organizational structure that includes flexible, cross functional teams responsible for training, customer service, operational problemsolving, and product design and development. Cultivate an environment that permits management to assume motivational and leadership functions, including, but limited to, long-range planning, coaching and facilitation, rather than serving only as enforcers Demonstrate a commitment to ongoing training of all workers, including front-line staff, and training to enable the company to meet appropriate ISO standards. Implement a flexible benefits program and innovative compensation schemes, such as profitsharing, gain-sharing skill-based pay or pay-forperformance systems. Demonstrate a commitment to a safe and healthful workplace. Solicit suggestions from customers and suppliers in designing and developing products and services. Demonstrate a commitment to delivering a greater variety of high quality products at a lower cost through manufacturing innovations such as concurrent engineering, flexible manufacturing and just-in-time production. Provide wages and benefits that meet or exceed industry average. Participate in a state approved school-to-career education program leading to the Connecticut Career Certificate Program. Develop a worker-management relationship based on consideration of mutual interests and concerns. Is the applicant willing to participate in a Connecticut Career Certificate Program established by a local or regional board of education, regional vocational-technical school, or regional education service center and approved by the Commissioner of Education and the Labor Commissioner? No Yes Certification: I certify that the representations made on this form and its attachments are true and accurate to the best of my knowledge. Authorized Signature Telephone Print Name and Title Date FALSE STATEMENTS MADE HEREIN ARE PUNISHABLE AS A CLASS A MISDEMEANOR UNDER CGS 53a-157b.
13 THRESHOLD PROJECTS This form must be filed with the Application if the requested assistance is $1 million or more and the Applicant has 100 or more full-time employees in CT. Page 1 of 2 CGS defines as a Threshold Project those projects for which a business having 100 or more full-time employees working in Connecticut seeks financial assistance of $1 million or more. If both of these criteria are met, CGS requires the Applicant to: 1. Submit this completed form along with the Application for financial assistance. 2. Consult with the local municipality (page 2, Sec. 2) and the Applicant s employee representative(s) (page 2, Sec. 3) regarding the project for which assistance has been requested unless the reasons for not consulting are specified as required by the instructions on page File an Annual Progress Report on the Applicant s achievement of the Public Policy Objectives checked in Section 1 below. A specific form will be provided by CDA to facilitate this reporting. Applicant Project Location (Name of Company) (Street, Town, Zip include mailing address if different) this box if any information included with this form is confidential or proprietary. On a separate sheet that you label Exhibit #1 please specifically identify such information and explain the basis for your conclusion that it is confidential or proprietary. 1 Public Policy Objectives. CDA has established the following Public Policy Objectives (PPOs) for Threshold Projects. On the list below, please check all PPOs that will be realized should the attached Application be approved. 1. Retain and expand employment opportunities for CT workers. 2. Retain and expand CT s base of economic activity. 3. Increase business investment in CT. 4. Create jobs for unemployed & underemployed workers and public assistance recipients. 5. Provide other benefits of value to the state, municipalities, residents and taxpayers. # 6. Attract new business and new jobs to CT that will create increased economic activity. 7. Expand CT s intellectual capital and the technology-based skills of CT workers. 8. Increase state and municipal tax revenues. 9. Increase and expand CT s base of information technology and e-commerce businesses. 10. Return unproductive or underutilized brownfields sites to economic viability. Please insert same PPO number(s) in the left column as you checked above (# 1 through #10). Please discuss & quantify how the requested financial assistance and will advance each PPO objective, including the number of jobs to be retained, the number of jobs to be created and the wage and benefit levels of such jobs. Attach additional sheet(s) if necessary and label them Exhibit #2 Number of Employees Amount of assistance requested $ # # #
14 THRESHOLD PROJECTS 2 3 No This form must be filed with the Application if the requested assistance is $1 million or more and the Applicant has 100 or more full-time employees in CT. Page 2 of 2 Contact with Municipality Please the appropriate box. Has the Applicant consulted with the municipality in which the Threshold Project is located regarding this request for financial assistance and the PPOs that will be fulfilled by approval of the Application? Yes Please attach a separate statement labeling it Exhibit 3 indicating: A. Name, title and address of municipal official, agency or department contacted. B. Is the municipality in support of the proposed project? C. Were there commitments made by the municipality related to the requested financial assistance? Describe the commitments? How do they relate to the achievement of the PPOs? D. Has the Applicant made any commitments to the municipality that relate to this request for financial assistance? Describe the commitments and the relationship between the commitments and the requested financial assistance. E. Has a copy of Exhibit 3 been forwarded to chief elected official of the municipality? No Applicant has attached a separate statement marked Exhibit 4 explaining why the Applicant has not consulted with the municipality in which the project is located, noting whether the Applicant intends to consult with the municipality in the future. Contact with Employee Representative(s) Please the appropriate box. Has the Applicant consulted with its employee representative(s) regarding this request for financial assistance and the PPOs that will be fulfilled by approval of the Application? For this purpose, employee representative(s) means representatives of any certified or recognized bargaining agents for the employees of a business. Yes Please attach a separate statement which should be a statement prepared jointly or separately by the Applicant and the employee representative(s) labeling it Exhibit 5 indicating: A. Name, title and capacity of employee representative(s) contacted. B. Is (are) the employee representative(s) in support of the proposed project? C. Did the employee representative(s) offer commitments related to the requested financial assistance? Describe those commitments. How do they relate to the Applicant s achievement of the PPOs? D. Has the Applicant made any commitments to the employee representative(s) that relate to the requested financial assistance? Describe the commitments and the relationship between the commitments and the requested financial assistance. E. Has Applicant developed a plan for on-going cooperation with its employees through labor management committee or other mechanism for the purpose of promoting such PPOs? Applicant has attached a separate statement marked Exhibit 6 explaining why the Applicant has not consulted with an employee representative and whether the Applicant intends to consult with a representative in the future. Note: If the Applicant has no employee representative(s), the Applicant and its employees may submit either a joint statement or separate statements containing the information called for in Exhibit 5. I certify that the information contained in this form and attachments is accurate and correct. I have attached (please which ones) Exhibit(s) #1, #2, #3, #4, #5, #6, as required by CGS Signature Title Date Print Name If Not Executive Officer, Relationship to Applicant FALSE STATEMENTS MADE HEREIN ARE PUNISHABLE AS A CLASS A MISDEMEANOR UNDER CGS 53a-157b.