HomeMy WebLinkAbout04-12-2007 Council Economic Development Committee
AGENDA
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
IOWA
It I changingll
Michael Tramontina, Interim Director
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.iowalifechanglrJ.g.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.
Proqram
Community Economic Bettermeant Account (CEBA)
Enterprise Zone Program (EZ)
High Quality Job Creation Program (HQJC)
Entrepreneurial Ventures Assistance Program (EVA)
Value Added Agricultural Products & Processes
Financial Assistance Program (VAAPFAP) Section F
Economic Development Set-Aside Program (EDSA) Section G
2. Please visit the IDEO Web site, http://www.iowalifechanqinq.com/applications/busdev/index.htmlor contact IDEO 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.leqis.state.ia.us/IAChtml/261.htm
4. Only typed or computer-qenerated 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 IDEO:
. 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
businessfinance@iowalifechanqinq.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
Download and Complete
Section B
Section C
Section 0
Section E
Application Due Dates
IDED Board Meeting Application Due Date
April 20, 2006 March 27, 2006
May 18, 2006 April 24, 2006
June 15, 2006 May 22, 2006
July 20, 2006 June 26,2006
August 17, 2006 July 24, 2006
September 21, 2006 Auaust 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
2
Public Records Policies
Information Submitted to IDEO. The Iowa Department of Economic Development (IDEO) is subject to the Open Records law
(Iowa Code, Chapter 22). Treatment of information submitted to IDEO 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. IDEO 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 IDEO 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 922.7(3)]
. Reports to governmental agencies which, if released, would give advantage to competitors and serve no public purpose.
[Iowa Code 922.7(6)]
. Information on an industrial prospect with which the IDEO is currently negotiating. [Iowa Code 922.7(8)]
. Communications not required by law, rule or regulation made to IDEO by persons outside the govemment to the extent that
IDEO 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 922.7(18)]
Information supplied to IDEO 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 IDEO's administrative rules relating to public
records are available from the Department upon request or at
http://www.iowalifechanqinq.com/down loads/chap 1690pen records .doc.
Section A - Applicant & Project Information
3
Applicant 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: 815625-3005 Fax: 815625-0366 Email: tombrandt@presportsonline.com
2.
3.
SIC or NAICS Code: 54-2113015
Federal 10 Number:
Does the Business file a consolidated tax return under a different tax 10 number?
If yes, please also provide that tax 10 number:
Is the contact person listed above authorized to obligate the Business? DYes
If no, please provide the name and title of a company officer authorized to obligate the Business:
Nyle F. Anderson, CEO
XNo
DYes
XNo
4.
5. 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.
Pro ram
CEBA
EZ
HQJC
EVA
VAAPFAP
EDSA
1.
Sponsor Organization: City of Iowa City
Official Contact (e.g. Mayor, Chairperson, etc.): Wendy Ford
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@lowa-City.org
Title: Economic Development Coordinator
2. If IDEO needs to contact the sponsor organization with questions, should we contact the person listed above?
X Yes D 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
4
Certification & Release of Information
I hereby give permission to the Iowa Department of Economic Development (IDEO) 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 IDEO related to this application is subject to Iowa's Open Record Law (Iowa Code,
Chapter 22).
I understand this application is subjectto final approval by IDEO 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 IDEO 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 IDEO 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.
Fmetif
~~re ~
j;IAL Brz..AtJt>T"' - D,'iL. tP- G".16r4UL PMZ-T1oL~tfIP~
Name and Title (typed or printed)
3rl.~-07
~ -~?5-07
Signature
We~Di..f rOB-I), ~CD~"m('c- DeV. Cllov-dlno.,:-6r
Name and Title (typed or printed)
Date
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)
IDEO 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
5
Proiect Information
1. 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.wmqllc.com
2.
Business Structure:
D Cooperative
D Partnership
D Corporation
S-Corporation
X limited Liability Company
D Sole Proprietorship
D Not for Profit
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?
If yes, is the business certified as a Targeted Small Business?
DYes
DYes
X No
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
7. Project Address (Street Address, City, and County):
Gateway One Center
2nd Floor
Hwy 1 West
Iowa City, IA 52246
Section A - Applicant & Project Information
6
8. Type of Business Project:
D Startup D Expansion of Iowa Company D New Location in Iowa
X Relocation from another State
9. 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 westem 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?
If yes, please explain.
DYes
XNo
Section A - Applicant & Project Information
7
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 $ $ $ $ $ $ $ $
inq Construction $ $ $ $ $ $ $ $
inq Remodelinq $250000 $ $ $ $ $250000 $ $
Machinerv & Equip. $ $ $ $ $ $ $ $
. Machinery & Equip. $ $ $ $ $ $ $ $
inq, Shelvinq, etc.' $ $ $ $ $ $ $ $
)uter Hardware $500,000 $400,000 $ $100,000 $ $ $
)uter Software $ $ $ $ $ $ $ $
ture & Fixtures $50000 $ $ $ $ $50,000 $ $
inq Capital $3,250,000 $ $ $ $ $3,250,000 $ $
arch & Development $ $ $ $' $ $ $ $
"raininq $612,000 $ $612,000 $ $ $ $ $
$ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $
AL $4,662,000 $400,000 $612,000 $100,000 $ $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 D 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
Source of Funds
Amount
PROPOSED FINANCING
Form of Funds Rate
(Loan, Grant, In-Kind Donation, etc.)
Term
Conditions I Addil
Include when funds will be
payments are a levE
$400,000
$612,000
$100,000
CEBA Grant
260E Job Training
;e A: IDED
;e B: Other State (e.g.
nunit Colle e, DOT, etc.
;e C: Local Government
City of Iowa Cily Economic 0%
Develo ment General Funds Loan
3 year
Job creation at wages indicate
;e D: Business
;e E: Other Private Sources
;e F:
;eG:
;e H:
AL
$
$3,550,000
$
$
$
$4,662,000
Please list below any tax benefits (e.g. 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.
: l r.:: '. '!., ,L'" ' !'" ~ , > "lj~ 'I !~~ ~'-'''..." f~ ,\,,; i :~ '1\'; ", ~:;;-\.~.., jt.~ J r" "',,~ \ :" 1"," , '
""~-W"'{.{'oI!Ia.... ~.~;j,j.""'~,,~ ...,_., ..~_, ~~'I~.'...~~~ ,.,1.._'.. ~A;';'r" _t._ ......':l~t":6<.tJ~~oltr\..'-~'~.r,) . .
12. Employee Benefits: Please identify all employee benefits provided by and paid for (in full or in part) by the Busin
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
co-payments, annual out-of-pocket maximums,
Business employee basis) by the Business* face amounts, company match, etc.)
Employee Family Employee Family ,"", '1. " ; <C,," ,01
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
(L TO)
ess.
* 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 D 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 D 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? D 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.
2
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?
D 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
3
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 startinq hourly wage rate.
Job Title Skills, Education, or Experience Number of Retained (R) or Starting or Current Wage
Required Jobs Created (Cl Rate
Year 1 of the Proiect
Director, HS Associations 1 C 60,000
Director, Network Develooment 1 C 100,000
Supervisor, Network Develooment 2 C 75,000
Manaqer, Media 3 C 50,000
Director, Content 1 C 50,000
Manaaer, Content 4 C 35,000
COO 1 C 150,000
Clerical Assistant 2 C 40,000
Develooer 3 C 60,000
Director, Video 1 C 100,000
Supervisor, Video 1 C 100,000
Manaqer, Video 3 C 50,000
Controller 1 C 75,000
Manaqer, IT 1 C 60,000
Manaqer, HR 1 C 45,000
CEO 1 C
Assistant, CEO 1 C 50,000
CTO 1 C 100,000
Year 1 Subtotal 29 .
Year 2 of the Proiect
Manaqer, Network Develooment 5 C 50,000
Manaqer, Content 5 C 40,000
Manaaer, Video 5 C 50,000
Year 2 Subtotal 15
Year 3 of the Proiect
Manaaer, Network Develooment 5 C 55,000
Associate, Network Develooment 5 C 35,000
Manaqer, Content 5 C 45,000
Manaaer, Video 5 C 55,000
Associate, Video 5 C 35,000
Manaqer, Media 5 C 55,000
Associate, Media 5 C 35,000
Year 3 Subtotal 35 I
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. All 79 positions pay above the 130% of the average county wage.
4
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Medical/Rx Page 1 of 1
Medical/Rx Benefit Overview
-~~-~:-~~1~--,.'~~~~~~:i~~~~~~:~' ~.-~~;.~".-:t~t~~~
~~~..~...;'Il!,tl... ;R,...!. .,"!.'t....~...._~:.t....(~~~~,.;,.Q!~~~'\:ilt~j.l"j}:. ,,,W.;jJ,., ""'_"4"..(1 .~;:.~~,y~it~:l-,.~~
MBRS INSIDE PPO SERVICE AREA
Primary Physician
Office/Clinic Services
Specialist Physician
Office/Clinic Services
Outpatient Hospital
Services
Emergency Room
Services
Inpatient Hospital
Services
Outpatient Physician
Hospital Services
Inpatient Physician
Hospital Services
PPO
$20 copay
$20 copay
$1,000 calendar year
deductible
PLUS 20.0% of covered
charqes
$1,000 calendar year
deductible
PLUS 20.0% of covered
charges
$1,000 calendar year
deductible
PLUS 20.0% of covered
charges
$1,000 calendar year
deductible
PLUS 20.0% of covered
charges
$1,000 calendar year
deductible
PLUS 20.0% of covered
charges
Non-PPO
$1,000 calendar year
deductible
PLUS 40.0% of covered
charqes
$1,000 calendar year
deductible
PLUS 40.0% of covered
charges
$1,000 calendar year
deductible
PLUS 40.0% of covered
charqes
$100 co pay
PLUS $1,000 calendar year
deductible
PLUS 40.0% of covered
charges
$500 copay
PLUS $1,000 calendar year
deductible
PLUS 40.0% of covered
charqes
$1,000 calendar year
deductible
PLUS 40.0% of covered
charges
$1,000 calendar year
deductible
PLUS 40.0% of covered
charges
For information regarding 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.
Retu rn to to P
Individual Calendar
Year Deductible
Family Calendar Year
PPO
$1,000
$3,000
Non-PPO
$1,000
$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
1-'._!l
Class Descri tion
MBRS INSIDE PPO SERVICE AREA
. Administered by: Caremark
. Tier 1 Copay: $10.00
. Tier 2 Copay: $25.00
. Tier 3 Copay: $40.00
. The above Co pays apply if filled at a participating pharmacy. Please
refer to your benefit booklet-certificate for benefits if a non-participating
harmac is used.
. Administered by: Caremark Mail Service
. Tier 1 Copay: $25.00
. Tier 2 Copay: $62.50
. Tier 3 Copay: $100.00
. The above Co pays apply if filled at a participating pharmacy. Please
refer to your benefit booklet-certificate for benefits if a non-participating
harmac 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
CenterSM. 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 Loqout, exit the
browser, or turn off the PC when you are finished.
Home Paoe I Contact Us I Privacv & Securitv I Help
Copvrioht (C) 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,
provisi"ons, 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
Class Description
Benefit Percent
Minimum Amount
Maximum Amount
ALL MEMBERS
0%
$0
$500
Elimination Period
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 weekes)
Occupationall
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
o 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
AD8r.D Benefits
AD8r.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 b'enefits. Please refer to the policy or benefit booklets for more
complete benefit information.
IOWA
li~fi:? Ie h an gi n g"
Section B - CEBA
1, Which program component is the Business applying for?
D Small Business Gap Financing
X New Business Opportunity
D New Product Development
D Modernization Component
2. Funding Information:
Total Amount Requested:
Loan Amount:
Forgivable Loan Amount:
$ 400,000
$
$ 400,000
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
D
D
D
Mortgage on Real Estate
Escrow Account
D
D
D
X Personal Guarantee D 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.
Surety Bonds
UCC Financing Statement
Irrevocable Letter of Credit
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 D 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?
DYes
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?
DYes
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?
DYes
X No
Section B - CEBA
2/4/2005
If yes, please specify the substance and what the Business will be doing with it.
6, Does the Business generate solid or hazardous waste? D 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
2
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Section D - High Quality
Job Creation Program
1. 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,
D 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,
D 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,
D 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,
D 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:
01 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 beinq offered, include the following:
02 Legal description of the project site, Include the size, in acres,
03 Detailed map (no larger than 8Ix14") showing the boundaries of the project site,
Section D - HQJC
6/24/2005
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