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1 City of Kalispell West Side Urban Renewal District-Core Area Tax Increment Financing (TIF) Application (Application must be completed in full with all required documents attached) APPLICANT INFORMATION Name of Mailing Phone PROJECT INFORMATION Business Name: Business/Project Physical Business Insurance Co: Tax ID Business Type (Corp, LLC, Partnership, etc.): Date business was Date of property Shareholders Name Address % Owned *A current financial statement for each shareholder involved in the project may be required as well as documentation of financial capacity. (This information will be kept confidential, subject to challenge in a court of law.) Description of business (product or service provided etc.): Annual amount of property taxes: Current on all property taxes: ____Yes ___No If no, explain Employment: Number of retained positions: ; Full Time:_____ Part Number of new positions to be created: Full Time:_____ Part ---PAGE BREAK--- 2 Average wage per hour Attachment: Attach an Excel spreadsheet briefly listing and describing the job classifications with the average wage noted by each job classification. Provide a schedule of when the positions are anticipated to be created and filled. Provide a summary of the fringe benefits provided to Project Architectural Firm: Project Has such contractor or architect ever failed to qualify as a responsible bidder, refused to enter into a contract after an award has been made, or failed to complete a construction or development contract within the last 10 years? No Yes If yes, STATEMENT OF QUALIFICATION AND FINANCIAL RESPONSIBILITY Has the applicant or any individual or entity affiliated with the development of this project been adjudged bankrupt, either voluntarily or involuntarily, within the past ten years? No Yes if yes, list date, place, and under what name: Has the applicant or any individual or entity affiliated with the development of this project been indicted for or convicted of any felony within the past 10 years? No Yes if yes, list the date, charge, place, court and action taken for each case: ---PAGE BREAK--- 3 PROJECT EXPENSE WORKSHEET Proposed project Proposed Construction/Rehabilitation Costs: (If additional room is needed, provide an Excel sheet of expenses) Cost: Cost: Cost: Cost: Cost: Cost: Cost: Cost: Architectural Design/Supervision: Cost: Permitting Fees: Cost: Additional Cost: Additional Cost: Total Project Expense: Attachment: Attach bids for each proposed project expense Proposed project schedule with start date and completion ---PAGE BREAK--- 4 PROJECT FINANCING WORKSHEET Project Financial Lending Institution: Total Project Cost: Land and Building if recently purchased (5 years): Cash invested in recent improvements (5 years): Subtotal: Total ‘Project Expense’ from page 3: Total Project Cost: Lender Commitments (Include letters of credit or other documentation.) Lender Loan Amount Interest Term Payment/Period ---PAGE BREAK--- 5 TIF FUNDING REQUESTED (Refer to West Side Urban Renewal – Core Area TIF District Policies for more information) Public Impact Categories: Shared Utilities Extension: Eligible for a matching grant up to 50% of the project cost, not to exceed $50,000. Sidewalk Improvement: Eligible for 50% grant match. Tree Placement/Replacement: Up to 100% grant. Private Investment Categories: Private investment grant categories, in aggregate, may not exceed 10% of the total project cost. Private investment loan categories, in aggregate, may not exceed $150,000. Loan Programs: Façade Improvement: Eligible for loan dollars not to exceed $50,000 Rehabilitation/Code Compliance: Eligible for loan dollars not to exceed $50,000 Grant Programs: Historic Façade Improvement: Eligible for a matching grant up to 50% of project cost not to exceed $50,000 Site Preparation and Demolition: Eligible for a matching grant up to 50% of the project cost not to exceed $50,000. (Additional grant or loan dollars may be available through the Kalispell Brownfields Program) Technical Assistance: Eligible for grant funding not to exceed $5,000 ---PAGE BREAK--- 6 CERTIFICATION I (we), (please print), certify that the statements and estimates within this application as well as any and all documentation submitted as attachments to this application under separate cover are true and correct to the best of my (our) knowledge and belief. Name: Name: Signature: Signature: Title: Title: Date: Date: Return to: City of Kalispell Community & Economic Development Department 201 1st Avenue East, Kalispell, MT 59901 [PHONE REDACTED] [EMAIL REDACTED] Required attachments: • Excel spreadsheet briefly listing and describing the job classifications with the average wage noted by each job classification. Provide a schedule of when the positions are anticipated to be created and filled. • Bids for each proposed project expense listed on page 3. • Letters of commitment or documentation from any project lender commitment listed on page 4.