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HomeMy WebLinkAbout04-12-2007 Council Economic Development CommitteeAGENDA City of Iowa City City Council Economic Development Committee Thursday, April 12, 2007 10:00 a.m. City Hall Lobby Conference Room 410 E. Washington St. 1. Call to Order 2. Prep Sports Online application for CEBA and HQJC funds through IDED 3. Committee time 4. Adjournment OWE Michael Tramontina, Interim Director P, C h a rl I n Iowa Department of Economic Development Application for Financial Assistance Section A — Applicant &Project Information Business Development Division Iowa Department of Economic Development 200 East Grand Avenue Des Moines, Iowa 50309 www.iowalifechanging.com January 22, 2007 Instructions 1. All applicants shall complete Section A of the Application for Financial Assistance and attach only those section(s) for the program(s) to which the applicant is applying. Program Download and Complete Community Economic Bettermeant Account (CEBA) Section B Enterprise Zone Program (EZ) Section C High Quality Job Creation Program (HQJC) Section D Entrepreneurial Ventures Assistance Program (EVA) Section E Value Added Agricultural Products & Processes Financial Assistance Program (VAAPFAP) Section F Economic Development Set -Aside Program (EDSA) Section G 2. Please visit the IDED Web site, http://www.iowalifechanging.com/applications/bus dev/index.html or contact IDED at (515) 242-4819 to see if this version of the application is still current. 3. Before filling out this application form, please read all applicable sections of the 2005 Iowa Code and Iowa Administrative Code (rules). http://www4.legis.state.ia.us/IAChtml/261.htm 4. Only wed 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. 5. Complete the applicable sections of the application fully; if questions are left unanswered or required attachments are not submitted, an explanation must be included. 6. Use clear and concise language. Attachments should only be used when requested or as supporting documentation. 7. Any inaccurate information of a significant nature may disqualify the application from consideration. 8. Upon completion of the application, please submit the following to the Business Finance Team at IDED: • The original, signed application form and all required attachments • One copy of the application form and all required attachments from which additional copies can easily be made. If electronic copies of the application and required attachments are available, please e-mail these documents to bus inessfinance()iowalifechanging.com in addition to submitting the original plus one copy. Business Finance Team Iowa Department of Economic Development 200 East Grand Avenue Des Moines IA 50309 Application Due Dates IDED Board Meeting Application Due Date A ril 20, 2006 March 27, 2006 May 18, 2006 Aril 24, 2006 June 15, 2006 Ma 22, 2006 July 20, 2006 June 26, 2006 August 17, 2006 Jul 24, 2006 September 21, 2006 Au ust 28, 2006 October 19, 2006 September 25, 2006 November 16, 2006 October 23, 2006 December 21, 2006 November 27, 2006 * EVA applications will be acted upon every other month starting in March. Section A —Applicant & Project Information Public Records Policies Information Submitted to IDED. The Iowa Department of Economic Development (IDED) is subject to the Open Records law (Iowa Code, Chapter 22). Treatment of information submitted to IDED in this application is governed by the provisions of the Open Records law. All public records are available for public inspection. Some public records are considered confidential and will not be disclosed to the public unless ordered by a court, the lawful custodian of the record, or by another person duly authorized to release the information. Confidential Records. IDED automatically treats the following records as confidential and they are withheld from public disclosure: • Tax Records • Quarterly Iowa Employer's Contribution and Payroll Report prepared for the Iowa Workforce Development Department • Payroll Registers • Business Financial Statements and Projections • Personal Financial Statements Other information supplied to IDED as part of this application may be treated as confidential under Iowa Code section 22.7. Following are the classifications of records which are recognized as confidential under Iowa law and which are most frequently applicable to business information submitted to IDED: • Trade secrets [Iowa Code §22.7(3)] • Reports to governmental agencies which, if released, would give advantage to competitors and serve no public purpose. [Iowa Code §22.7(6)] • Information on an industrial prospect with which the IDED is currently negotiating. [Iowa Code §22.7(8)] • Communications not required by law, rule or regulation made to IDED by persons outside the government to the extent that IDED could reasonably believe that those persons would be discouraged from making them to the Department if they were made available for general public examination. [Iowa Code §22.7(18)] Information supplied to IDED as part of this application that is material to the application and/or the state program to which the applicant is applying including, but not limited to the number and type of jobs to be created, wages for those jobs, employee benefit information, and project budget, are considered open records and will not be treated as confidential. Additional Information Available. Copies of Iowa's Open Record law and IDED's administrative rules relating to public records are available from the Department upon request or at httD://www.iowalifechanaina.com/downloads/chaDl69ooenrecords.doc. Section A — Applicant & Project Information 3 ADDlicant Information 1. Name of Business: Prep Sports Online Address: 1900 W. Lefevre Road City: Sterling State: IL Zip: 61081 Contact Person: Tom Brandt Title: Director of External Partnerships Phone: 815 625-3005 Fax: 815 625-0366 Email: tombrandt@presportsonline.com 2. SIC or NAICS Code: 54-2113015 Federal ID Number: Does the Business file a consolidated tax return under a different tax ID number? ❑ Yes X No If yes, please also provide that tax ID number: Is the contact person listed above authorized to obligate the Business? ❑ Yes X No If no, please provide the name and title of a company officer authorized to obligate the Business: Nyle F. Anderson, CEO If the application was prepared by someone other than the contact person listed above, please complete the following: Joe Raso assisted Tom Brandt with the completion of this application Name: Joe Raso Title: President Organization: Iowa City Area Development Group Address: 325 E. Washington Street, Suite 101 City, State, & ZIP Code: North Liberty, Iowa 52240 Phone: 319-354-3939 Fax: 319-338-9958 Email: JRaso@lowaCityArea.com Sponsor Information Please review the following table to determine who needs to sponsor this application. Depending on the programs being applied for, more than one sponsor may be necessary. Program Acceptable Sponsor CEBA City or County or Community College in which the Project Site is Located EZ Local Enterprise Zone Commission HQJC City or County in which the Project Site is Located EVA City or County in which the Project Site is Located; Local Development Entity; John Pappajohn Entrepreneurial Center; a Small Business Development Center; Business Accelerator; or similar entity VAAPFAP City or County in which the Project Site is Located or Local Development Entity EDSA City or County in which the Project Site is Located 1. Sponsor Organization: City of Iowa City Official Contact (e.g. Mayor, Chairperson, etc.): Wendy Ford Title: Economic Development Coordinator Address: 410 E. Washington Street City, State & ZIP Code: Iowa City, Iowa 52240 Phone: 319-356-5248 Fax: 319-356-5009 E-mail: Wendy-Ford@Iowa-City.org 2. If IDED needs to contact the sponsor organization with questions, should we contact the person listed above? X Yes ❑ No, please contact the following person: Name: Title: Address: City, State & ZIP Code: Phone: Fax: E-mail: If necessary, please list information on additional sponsors in an attachment. Section A — Applicant & Project Information Certification & Release of Information I hereby give permission to the Iowa Department of Economic Development (IDED) 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 IDED 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 IDED related to this application is subject to Iowa's Open Record Law (Iowa Code, Chapter 22). I understand this application is subject to final approval by IDED and the Project may not be initiated until final approval is secured. (High Quality Job Creation Program applications may be submitted up to 12 months following the completion of the project.) I understand that IDED reserves the right to negotiate the financial assistance. Furthermore, I am aware that financial assistance is not available until an agreement is executed within a reasonable time period following approval. I hereby certify that all representations, warranties, or statements made or furnished to IDED 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 he B 7,.7 Signature Date 3'Z O-- 07 Tous- ( a-440 — - Dot. w r✓ xwpk4�L. Name and Title (typed or printed) For the Sponsor(s): 3 -fig -0-7 Signature Date inlr✓Qb� Fog E or►a '� Dev. �o v- Name and Title (typed or printed) Please use the following if more than one sponsor is required. (For example, use this if a signature from the local Enterprise Zone Commission is required in addition to the signature from the Mayor of the sponsoring city.) Signature Date Name and Title (typed or printed) IDED 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, IDED may initiate legal action to recover incentives and assistance awarded to the Business. Section A —Applicant & Project Information Project Information Provide a brief description and history of the Business. Include information about the Business' products or services and its markets and/or customers. PSO was founded in 2002, by Nyle Anderson in Sterling, IL. By publishing high school athletic websites, a unique fund raising opportunity for high schools was created. Through the PSO 501-c-3, not -for -profit, a portion of all revenue is given back to the school's athletic department. The current PSO model, implemented in August, 2006, has proven to be the proper fit for the market. The "operational proof of concept" has allowed PSO to partner with Wasserman Media Group, LLC based in Los Angeles, CA. The strategic, long term partnership entered into in February, 2007 will assure PSO the resources required to grow its network and operation substantially over the next 3 years. www.prepsportsonline.com www.wmgllc.com 2. Business Structure: ❑ Cooperative ❑ Corporation X Limited Liability Company ❑ Not for Profit ❑ Partnership S-Corporation ❑ Sole Proprietorship State of Incorporation: Illinois 3. Identify the Business' owners. Nyle Anderson 50%; Casey Wasserman 50% Does a woman, minority, or person with a disability own the Business? ❑ Yes X No If yes, is the business certified as a Targeted Small Business? ❑ Yes X No 4. List the Business' Iowa Locations and the Current Number of Employees at each Location. The company has no employees in Iowa at this time. Should the project proceed in Iowa it is projected to create nearly 80 jobs. 5. What is the Business' worldwide employment? (Please include employees of parent company, subsidiaries, and other affiliated entities in this figure.) PSO will employ 29 professional in year 1. PSO will also have independent contracts with over 50 Content Coordinators, all in Iowa; over 750 Media Providers, 20 in Iowa and 10 Network Development Managers across the US. 6. Briefly 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.) Considering relocation of corporate office from Sterling, IL to Iowa City, IA. Complete corporate management, including Network Development, Content Acquisition, Content Aggregation, Website publishing and IT support will be based in Iowa City, IA. Currently looking at 10,000 square foot facility in SW Iowa City. The space will allow us to expand another 5,800 square feet in year 2. PSO provides high school athletic websites free of charge to high schools across the US. PSO shares in the revenue with the high schools from the monetization of ad space, content licensing and multi media sales. Timeline attached Project Address (Street Address, City, and County): Gateway One Center 2nd Floor Hwy 1 West Iowa City, IA 52246 Section A — Applicant & Project Information 8. Type of Business Project: ❑ Startup ❑ Expansion of Iowa Company ❑ New Location in Iowa X Relocation from another State Please identify the management at the project location and his/her/their experience. Nyle Anderson - Founder Nyle had a very successful career in the financial services business for 25 plus years. He specialized in group benefits and was able to secure some of the biggest accounts in Chicago and western Illinois. Nyle also owns two other business, Medical Claim Services and is a franchise owner of Dippin' Dots. A father of five, he and his wife have always been philanthropic. It was through that passion of giving that Prep Sports Online was created. By capturing the essence of high school athletics through recoginition and giving, Nyle has been able to create a model that will benefit thousands of young people for years to come. Tom Brandt - Director of External Partnerships Tom owned and operated River City Sport for 8 years before closing its doors in 2002. Specializing in market specific, sport promotions for retailers across the US, River City Sport became a leader in retailing licensed goods. Staying in the licensed athletic world, Tom became partners in Logo America and worked with many universities and colleges across the US by bringing corporations interested in supporting inter -collegiate athletics to them. It was through this avenue that Tom was introduced to Nyle Anderson. Since January of 2006, Tom has been involved with the daily evolution of PSO. Phil Dowson - CTO Phil has a vast background in software development and IT system creation. He built the proprietary software used by PSO to manage all content for the websites. He worked for 6 years with the Davenport School District in Iowa before joining PSO in 2004. 10. Has any part of the project started? ❑ Yes X No If yes, please explain. Section A — Applicant & Project Information 11 Project Budget: AMOUNT BUDGETED Use of Funds Cost Source A Source B Source C Source D Source E Source F Soul Acquisition $ $ $ $ $ $ $ $ 'reparation $ $ $ $ $ $ $ $ ing Acquisition $ $ $ $ $ $ $ $ ing Construction $ $ $ $ $ $ $ $ ing Remodeling $250000 $ $ $ $ $250000 $ $ Machinery & Equip. $ $ $ $ $ $ $ $ Machinery & Equip. $ $ $ $ $ $ $ $ in , Shelving, etc.' $ $ $ $ $ $ $ $ )uter Hardware $500,000 $400,000 $ $100,000 $ $ $ )uter Software $ $ $ $ $ $ $ $ ture & Fixtures $50000 $ $ $ $ $50,000 $ $ ing Capital $3,250,000 $ $ $ $ $3,250,000 $ $ arch & Development $ $ $ $ $ $ $ $ raining $612,000 $ $612,000 $ $ $ $ $ AL $4,662,000 $400,000 $612,000 $1001000 $ $3,550,000 $ $ " Racking, Shelving and Conveyor Equipment used in Warehouse or Distribution Center Projects Does the Business plan to lease a facility? X Yes ❑ No If yes, please provide the Annual Base Rent Payment (lease payment minus property taxes, insurance, and operating/maintenance expenses) and the length of the lease agreement. Lease agreement is as follows: Total lease costs, minus triple net over 5-year lease period is approximately $725,500 Year 1 - $8,166 / month Year 2 - $12,650 / month Year 3 - $12,903 / month Year 4 - $13,166 / month Year 5 - $13,573 / month PROPOSED FINANCING Source of Funds Amount Form of Funds Rate Term Conditions 1 Addit (Loan, Grant, In -Kind Donation, etc.) Include when funds will be payments are a leve ;e A: IDED $400,000 CEBA Grant ;e B: Other State (e.g. $612,000 260E Job Training -nunity College, DOT, etc. ;e C: Local Government $100,000 City of Iowa City Economic 0% 3 year Job creation at wages indicate Development General Funds Loan ;e D: Business $ :e E: Other Private Sources $3,550,000 Fully funded by Wasserman M ;e F: $ ;e G: $ ;e H: $ AL $4,662,000 Please list below anv tax benefits (e.a. Investment Tax Credit. Sales Tax Refund. R&D Tax Credit. New Jobs Tax Credit. Property Tax Exemption/Abatement, etc.) that the Business is seeking and include the estimated value of each tax benefit: Prep Sports Online is also requesting investment tax credits and sales tax refunds via the High Quality Job Creation Program and New Jobs Investment Tax Credit Program. 12. Employee Benefits: Please identify all employee benefits provided by and paid for (in full or in part) by the Business. Employee Benefits Total Annual Cost Portion of Total Plan Provisions Provided by the (show on a per Annual Cost Paid (Include deductibles, coinsurance %, office visit Business employee basis) by the Business* co -payments, annual out-of-pocket maximums, face amounts, com2anX match, etc. Employee Family Employee Family 4500 4500 See attached file Medical/Health Insurance 750 750 Dental Insurance 600 600 Vision Insurance 150 150 See attached file Life Insurance 900 900 See attached file Short Term Disability (STD) See attached file Long Term Disability (LTD) * If the business's plan is self -insured, please use the amount paid by the business for costs associated with employee and family coverage during the past three years and then, determine the business' average annual contribution per employee for that three year period. Does the Business offer a pension plan, 401(k) plan, and/or retirement -plan? X Yes ❑ No If yes, please indicate the amount contributed on a per employee basis by the Business to the plan. For 401(k) plans, please provide information on the company match and indicate the average annual match per employee (show average as a percentage of salary). This is being finalized as part of the partnership agreement between PSO and WMG. That agreement will be dated 4/1/07 Does the Business offer a profit-sharing plan? X Yes ❑ No If yes, please indicate total amount paid out each year for the past three years and then, determine the average annual bonus or contribution per employee for that three year period. This is being finalized as part of the partnership agreement between PSO and WMG. That agreement will be dated 4/1/07 Does the Business offer child care services? ❑ Yes X No Child care services include child care services on -site at the facility in which the project will occur or off -site child care subsidized by the business at the rate of 50% or more of the costs incurred by an employee. 13. 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. PSO currently has no competitors in the state of Iowa that we are aware of. There are 3 competitors in the US we have identified but none have the 501-c-3 status we believe provides us a competitive advantage in this market space. 14. Will any of the current Iowa employees lose their jobs if this project does not proceed in Iowa? ❑ Yes X No If yes, please explain why and identify those jobs as "retained jobs" in the following question. This questions is not applicable because the company currently has all its employees located in Illinois 15. List the jobs that will be retained and/or created 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 retained jobs, include the current hourly wage rate. For jobs to be created, including the startin hourly wage rate. Job Title Skills, Education, or Experience Required Number of Jobs Retained (R) or Created C Starting or Current Wage Rate Year 1 of the Project Director, HS Associations 1 C 60,000 Director, Network Development 1 C 100,000 Supervisor, Network Development 2 C 75,000 Manager, Media 3 C 50,000 Director, Content 1 C 50,000 Manager, Content 4 C 35,000 C00 1 C 150,000 Clerical Assistant 2 C 40,000 Developer 3 C 60,000 Director, Video 1 C 100,000 Supervisor, Video 1 C 100,000 Manager, Video 3 C 50,000 Controller 1 C 75,000 Manager, IT 1 C 60,000 Manager, HR 1 C 45,000 CEO 1 C Assistant, CEO 1 C 50,000 CTO 1 C 100,000 Year Subtotal 29y." Year 2 of the Project Manager, Network Development 5 C 50,000 Manager, Content 5 C 40,000 Manager, Video 5 C 50,000 Year 2 Subtotal 15 4,, Year 3 of the Project Manager, Network Development 5 C 55,000 Associate, Network Development 5 C 35,000 Manager, Content 5 C 45,000 Manager, Video 5 C 55,000 Associate, Video 5 C 35,000 Manager, Media 5 C 55,000 Associate, Media 5 C 35,000 Year Subtotal 35 77 MR!, 11W W,��,�Z Total Number of Retained Jobs: Total Number of Created Jobs: 79 Average hourly wage for all positions, excluding the CEO, is $24.75/hour, or more than 160% of the average county private sector wage. 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Co Q¢¢¢Qaa a a a ¢ �aaagaaaaaa .0 ;WXzzzzzz z z z z z 3 zzzzzzzzz 0 U o O U Q (CS CU C6 CO T CCS C O X X X X Q Q X-6 (n .V O C N .V O C US.V O O N .V O C N .0 O C Q a a g a g a a a g z z 0 m 2-5 O .a 2-0 O z Z Z Z z Z Z z z z N CU O O a) O 42 O CL C O cn O N CU N Z Q a CD N -0 N C co v N z O U U •_ O 05 CU N C O Q) Z " O N O u = N cn ca a) V co Cn co > a) N a' c m co aLf ' a) C N C Ch N O a) C .O m C CU N C6 p O.. O cu O C .� N O U y i C 0 U_mU) 3 �� p 06 cu Of d = g L'aa)i.�as"= J ' N E 7 c > > O O �- C N N rn O C> on O ..�-. W dj E O O GO cn IZ Q O U O O i N_ ..-. a) 15 V Q U Q — CU � cn U -= 0 0 N E 00 t a�i a�i c 'y a cu 5 •� o E E C G J O T cn U d a) N N a :2 E 0 0 O Cn Cn m O U Q CL U Q Q Cn w J 2� H m W U U LO r U N U C 0 .0 O_ a Q a¢ z 'z zz zz ¢¢ zz ¢a zz zz E 0 T Medical/Rx Page 1 of 1 Medical/Rx Benefit Overview MBRS INSIDE PPO SERVICE AREA PPO Non-PPO $20 copay $1,000 calendar year Primary Physician deductible Office/Clinic Services PLUS 40.0% of covered charges Specialist Physician $20 copay $1,000 calendar year Office/Clinic Services deductible PLUS 40.0% of covered charges Outpatient Hospital $1,000 calendar year $1,000 calendar year Services deductible deductible PLUS 20.0% of covered PLUS 40.0% of covered charges charges Emergency Room $1,000 calendar year $100 copay Services deductible PLUS $1,000 calendar year PLUS 20.0% of covered deductible charges PLUS 40.0% of covered charges Inpatient Hospital $1,000 calendar year $500 copay Services deductible PLUS $1,000 calendar year PLUS 20.0% of covered deductible charges PLUS 40.0% of covered charges Outpatient Physician $1,000 calendar year $1,000 calendar year Hospital Services deductible deductible PLUS 20.0% of covered PLUS 40.0% of covered char es charges Inpatient Physician $1,000 calendar year $1,000 calendar year Hospital Services deductible deductible PLUS 20.0% of covered PLUS 40.0% of covered charges charges For information regardinq pre -authorization of services, please refer to the ID card. The above benefits are for other than Mental Health, Behavioral, Alcohol or Drug Abuse Treatment Services. Please refer to the benefit booklet for details on benefits for those conditions. Return to top Plan Maximums PPO Non-PPO Individual Calendar Year Deductible $1,000 $1,000 Family Calendar Year $3,000 $3,000 Deductible Individual Out -of- $1,500 $3,000 Pocket Expense Limit Family Out -of -Pocket $3,000 $6,000 Expense Limit Return to top hiss t,e"sc ,i.,u, h = MBRSM"le, .- INSIDE PPO SERVICE AREA • Administered by: Caremark • Tier 1 Copay: $10.00 • Tier 2 Copay: $25.00 • Tier 3 Copay: $40.00 • The above Copays apply if filled at a participating pharmacy. Please refer to your benefit booklet -certificate for benefits if a non -participating Rharmacy is used. • Administered by: Caremark Mail Service • Tier 1 Copay: $25.00 • Tier 2 Copay: $62.50 • Tier 3 Copay: $100.00 • The above Copays apply if filled at a participating pharmacy. Please refer to your benefit booklet -certificate for benefits if a non -participating pharmacy is used. Disclaimer: The information and summaries shown here are intended for employer use only and are not for employee distribution. These summaries do not include all of the benefits, provisions, restrictions, and limitations that apply to the coverage and may not reflect current benefits. Please refer to the policy or benefit booklets for more complete benefit information. Disclaimer: Not all transactions needed to administer your company's employee benefits with The Principal are available through the Employee Benefits Service Centers"'. Only the services currently available over the Internet will be found here. The information displayed may not reflect the most current transactions. Security Information: To ensure confidentially of your information, either select Logout, exit the browser, or turn off the PC when you are finished. Home Page I Contact us I Privacy & Security I Help Copyright © 1995- 2007 Principal Financial Group. All Rights Reserved. Principal Life Insurance Company, Des Moines, IA 50392-0001, USA. Long -Term Disability Page 1 of 1 Class Description Benefit Percent Maximum,Amount ALL MEMBERS 66 2/3% $5,000 Monthly Minimum $50 Elimination Period 6 month(s) Maximum Duration Social Security Normal Retirement Age (SSNRA) Own Occupation Period 2 Years Definition of Disability Residual Disclaimer: The information and summaries shown here are intended for employer use only and are not for employee distribution. These summaries do not include all of the benefits, provisions, restrictions, and limitations that apply to the coverage and may not reflect current benefits. Please refer to the policy or benefit booklets for more complete benefit information. Short -Term Disability Page 1 of 1 ALL MEMBERS Elimination Period Class Description Benefit Percent Minimum Amount Maximum Amount 0% $0 $500 Benefits will begin: - 1 day(s) if the disability is due to injury; or - 8 day(s) if the disability is due to sickness Maximum Duration 26 week(s) Occupational/ Non -Occupational Non -Occupational - Provides benefits only for non -work related illnesses/injuries Definition of Disability Residual First Day Hospital No Disclaimer: The information and summaries shown here are intended for employer use only and are not for employee distribution. These summaries do not include all of the benefits, provisions, restrictions, and limitations that apply to the coverage and may not reflect current benefits. Please refer to the policy or benefit booklets for more complete benefit information. Dependent Life Page 1 of 1 Class Description ALL MEMBERS Spouse Benefit 0 Days to 6 Months 6 Months to Age 25 $5,000 $1,000 $2,000 Disclaimer: The information and summaries shown here are intended for employer use only and are not for employee distribution. These summaries do not include all of the benefits, provisions, restrictions, and limitations that apply to the coverage and may not reflect current benefits. Please refer to the policy or benefit booklets for more complete benefit information. Life/AD&D Page 1 of 1 Class Description Benefit Percent Minimum Amount Maximum Amount ALL MEMBERS $25,000 Non-Med Maximum Age Range Employee Under 65 $50,000 65 to 69 $25,000 70 or older $10,000 Reduction Schedule Active 25% at 65 Additional 25% at 70 AD&D Benefits AD&D Coverage Occupational Disclaimer: The information and summaries shown here are intended for employer use only and are not for employee distribution. These summaries do not include all of the benefits, provisions, restrictions, and limitations that apply to the coverage and may not reflect current benefits. Please refer to the policy or benefit booklets for more complete benefit information. IOWA /�p I changing- 1. Which program component is the Business applying for? ❑ Small Business Gap Financing X New Business Opportunity ❑ New Product Development ❑ Modernization Component 2. Funding Information: Total Amount Requested: $ 400,000 Loan Amount: $ Forgivable Loan Amount: $ 400,000 Section B - CEBA See Chapter 53, Section 261 in the CEBA Administrative Rules for maximum funding amounts. The CEBA program is not designed to provide 100% funding for any project and limits assistance based on the type of project submitted. 3. Security: ❑ Corporate Guaranty ❑ Surety Bonds ❑ UCC Financing Statement ❑ Mortgage on Real Estate ❑ Irrevocable Letter of Credit ❑ Escrow Account X Personal Guarantee ❑ Other: All awards secured by Personal Guarantees will require a current financial statement from each of the personal guarantors, which must be attached to the application. 4. Does the business certify that at least 10% of the positions to be created will be made available to qualified Promise Job Participants? X Yes ❑ No 5. Are underground tanks (whether or not in current use) for the storage of petroleum products, agricultural or other chemicals, waste oil or other liquid waste or any other inflammable, corrosive, reactive or explosive liquid or gas located on the project site? ❑ Yes X No If yes, please explain: Will the Business be storing above -ground, on or about the project site, in tanks or otherwise, any liquid or gas (as described above) or any inflammable, corrosive, reactive or explosive solid, for any length of time or any purpose? ❑ Yes X No If yes, please specify: Will the Business be treating, transporting or disposing of any liquid, gas, or solid (described above) either on or about the project site or at a landfill or other treatment facility or upon any public street or highway, or on any waterway or body of water, or in any aircraft? ❑ Yes X No Section B — CEBA 2/4/2005 If yes, please specify the substance and what the Business will be doing with it. Does the Business generate solid or hazardous waste? ❑ Yes X No If yes, please describe and provide a copy of the Business' solid and hazardous waste reduction plans. Attachments Please attach the following documents: B3 Community resolution authorizing the submission of the application. City of Iowa City City Council will be meeting in full session on Tuesday, April 17 to approve the City's support and the Resolution of Support for the CEBA application. Section B — CEBA 2/4/2005 changing - Section D - High Quality Job Creation Program The Business must meet at least 4 of the following required elements to be eligible for the High Quality Job Creation Program. Please indicate which 4 required elements the business meets. (If the business is a start-up, please indicate which 4 required elements the business will meet when its operation commences.) X The business shall offer a pension or profit sharing plan to all full-time employees. For purposes of this requirement, a retirement program offered by the business, such as a 401(k) plan, and to which the business makes a monetary contribution shall be considered the equivalent of a pension plan. X The business shall produce or manufacture high value-added goods or services or be engaged in one of the following industries*: X The business shall provide and pay at least eighty percent of the cost of a standard medical and dental insurance plan for all full-time employees working at the facility in which the new qualifying investment occurs. For purposes of this requirement, single or employee -only medical and dental coverage will be what the department considers in determining if the business meets this required element. ❑ The business shall make child care services available to its employees. The business shall satisfy this required element if it provides child care services on -site at the facility in which the project will occur or if it subsidizes 50% or more of off -site child care service costs incurred by an employee. ❑ The business shall invest annually no less than one percent of pretax profits, from the facility located to Iowa or expanded or modernized under the program, in research and development in Iowa. The business must be able to demonstrate, using generally accepted accounting principles, the facility's history of pretax profits or a reasonable expectation of pretax profits from the facility in order to utilize this element. ❑ The business shall invest annually no less than one percent of pretax profits, from the facility located to Iowa or expanded or modernized under the program, in worker training and skills enhancement. The business must be able to demonstrate, using generally accepted accounting principles, the facility's history of pretax profits or a reasonable expectation of pretax profits from the facility in order to utilize this element. X The business shall have an active productivity and safety improvement program(s). The program(s) will involve both management and workers and have benchmarks for gauging compliance. ❑ The business shall purchase and occupy an existing facility that includes at least one vacant building which is at least 20,000 square feet. * State's targeted industries include, value-added agricultural products, insurance and financial services, plastics, metals, printing paper or packaging products, drugs and pharmaceuticals, software development, instruments and measuring devices and medical instruments, recycling and waste management, telecommunications and trucking and warehousing. Attachments Please attach the following documents: For projects of $10 million or more, include the following: D1 Resolution by the sponsoring County Board of Supervisors/City Council approving this application For projects of $10 million or more and when a local value-added property tax exemption is being offered, include the following: D2 Legal description of the project site. Include the size, in acres. D3 Detailed map (no larger than 8"x14") showing the boundaries of the project site. Section D — HQJC 6/24/2005 lu ,S r3m N L L L O O O N Cmw C C W in W ui r- a LL O N N N LL LL C) Lo N = = o L a m `0 0 (L) m c > U O �p O N O N h U U- N 0 2 V O O L U) LL O 11 OLO N > N N O d 2 S H LL O no C C E O O O_ O C O - N f N 7 > U 6 U m Q Q Y Q C C C 3 a CO) c 0 0 Z U U> U U N N O O O O L C U U N N O O O O 11'3 �fJ O L Y Y C) N o y E O d L 0 C_ O J O is CM 0 c n O N O 0 F- LL 0