Cherokee Area Economic
Development Corporation
Checklist
Listed below are the required documents and fees for completion of the IRP/RLF application.
_____ Completed Application
_____ Packaging Fee
_____ Deposit Fee
_____ Proof of Key-man Life Insurance
_____ Proof of Hazard Insurance
_____ Guide for Racial/Ethnicity and Gender Data Collection
_____ Assurance Agreement (form RD 400-4)
_____ Request for Environmental Information (form RD 1940-20)
Cherokee
Area Economic Development Corporation
Revolving
Loan Fund
Application for Financial
Assistance
Business Name:
_________________________________________________________________
Address:
______________________________________________________________________
Contact Person:
_________________________________________________________________
I
hereby give permission to the Cherokee Area Economic Development Corporation to
research the company's history, make credit checks, contact the company's
financial institution, and perform other related activities necessary for the
reasonable evaluation of the proposal.
Signature of Company
Officer:
_____________________________________________________
The following information is
requested by the Federal Government in order to monitor compliance with Federal
Laws prohibiting discrimination against applicants seeking to participate in
this program. You are not required to furnish this
information, but are encouraged to do so.
This information will not be used in evaluating your application or
to discriminate against you in any way.
However, if you choose not to furnish it, we are required to note the
race/national origin of individual applicants on the basis of visual observation
or surname.
Ethnicity:
Hispanic or Latino:
_____
Not Hispanic or Latino:
_____
Race: (Mark one or
more):
White: _____, Black or
African American: _____, American Indian/Alaska Native: _____, Asian: _____,
Native Hawaiian or Other
Pacific Islander: _____
Gender: Male: _____ Female:
_____
_____ I do not wish to
furnish the above information
Add additional pages as
necessary when completing the application
1.
Description and history of
business:
2.
Describe in detail the
proposed project being undertaken (e.g. Company relocation, new business
start-up, plant expansion or remodeling, new product line,
etc.)
3.
What percentage of the
company's sales will be outside Cherokee County?
_______________
4.
What percentage of the
company's total operating expenditures (including wages and salaries)
will be spent within Cherokee County?
___________________________
5.
What date will the project
begin? _______________________
be completed? _______________________
6.
Has any part of the project
been started yet?
_____
Yes
_____
No
If Yes, please
describe:
7.
How many employees are
currently employed by the company? _______________________
If this company has more
than one facility, how many full-time employees are there at the facility
affected by this proposal?
________________________________________________
8.
How many new, full-time
employees will you add to the payroll within 24 months, if this project is
accomplished? ________________________ Part-time?
_____________________
9.
What is the estimated annual
payroll for the new employees resulting from this project?
______________________________________________________________________
10. What is the average wage
rate projected to be for the new employees?
__________________
11. Will any of the current
employees lose their jobs if the project does not proceed?
_______
Yes
_______
No
12. If yes, how many?
_______________ Explain
why:
13. How will this project
benefit the city/county, etc.?
14. Summary of project costs and
proposed financing sources:
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Uses |
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Sources |
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Activity |
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$
Amount |
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$
Amount |
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Provided
by |
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1 |
Land
Acquisition |
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________ |
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________ ________ ________ ________ |
____________ ____________ ____________
____________ | |
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2 |
Site
Preparation |
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________ |
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________ ________ ________ ________ |
____________ ____________ ____________
____________ | |
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3 |
Building
Acquisition |
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________ |
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________ ________ ________ ________ |
____________ ____________ ____________
____________ | |
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4 |
Building
Construction |
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________ |
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________ ________ ________ ________ |
____________ ____________ ____________
____________ | |
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5 |
Building
Remodeling |
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________ |
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________ ________ ________ ________ |
____________ ____________ ____________
____________ | |
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6 |
Machinery
& Equipment |
________ |
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________ ________ ________ ________ |
____________ ____________ ____________
____________ | ||
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7 |
Furniture
& Fixtures |
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________ |
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________ ________ ________ ________ |
____________ ____________ ____________
____________ | |
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8 |
Working
Capital:
*Receivables *Inventory
*Marketing *Other |
________ ________ ________ ________ ________ |
________ ________ ________ ________ ________ |
____________ ____________ ____________ ____________
____________ | |||
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9 |
Other |
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________ ________ ________ ________ $_______ |
________ ________ ________ ________ $_______ |
____________ ____________ ____________ (2 columns must be
equal) | ||
15. Terms of proposed
financing
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Amount |
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Type (Grant/Loan/Etc.) |
Rate |
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Term | |
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CAED
RLF Fund |
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Conventional
Financing |
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Job
Training |
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Community
Participation |
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State
Assistance |
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Other |
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16. Explain what the form of the
business contribution to the project is (i.e. cash, loan, equity,
etc.)
17. Identify all agencies or
institutions involved in the project and what their involvement
is:
18. Is there any potentially
adverse environmental impact from this project?
______
Yes
______
No
If yes,
explain:
19. Explain request for a low
interest loan. If market rate loan
is not sufficient, why not?
20. What type of security and in
what amount will the assisted business provide the Cherokee Area Economic
Development Corporation?
Mortgage ________
$_____________ What seniority or
position? __________
Lien on __________
$_____________ What seniority or
position? __________
Personal Guarantee
_________________________
$_______________________________
Other
____________________________________
$_______________________________
None
____________________________________
21. Generally, a recommendation
by the CAEDC loan Review committee and a decision by the CAEDC Board of
Directors on this application can be expected within 30 to 45 days of receipt of
the application. Is there an urgent
need for a more immediate decision on this application?
_________
Yes
_________ No
If so,
why?
22. Is this company willing to
give preference in hiring to low and moderate-income
people?
________
Yes
________
No
23. Is the company willing to
give hiring preference to Iowa residents or residents of Cherokee
County?
_______
Yes
_______
No
24. Required attachments. Check off each one submitted. If not submitted, explain why
not.
_______ Capital equipment
list or current depreciation schedule
_______ List of positions or
jobs to be created (i.e. 5 welders, 3 assemblers, etc.)
_______ Business
plan
_______ Marketing plan (may
be part of business plan)
_______ Profit and loss
statements (3 year historical and 2 year projections)
_______ Balance sheets or
financial statements (3 year historical and 2 year
projections)
_______ Business tax returns
(3 year historical)
_______ Letters of
commitment of funds (from banks, applicant, etc.)
_______ Description of
standard fringe benefits provided to employees
_______ Market demand
summary/purchase orders
_______ Resume of principals
with personal financial statements
_______ Company's federal
identification number
_______ Copies of company's
quarterly Iowa "Employers Contribution Payroll Report" for the past year and a
copy of the most recent monthly payroll register
_______ Copies of personnel
lift insurance policy
_______ Copies of hazard
insurance policy
_______ A list of any civil
or criminal violations of state or federal law which the company has been
charged with or convicted of during the last five years. Please include the violations and date,
the agency that charged the violation, the outcome or resolution, and any
penalties or settlement terms.
_______ Will the project
involve a transfer of operations or jobs from any other Iowa facility or replace
operations or jobs currently being provided by another Iowa company? If yes, please indicate the facility(s)
and/or company affected.
25. Explanation/ Other
comments: