HomeMy WebLinkAbout31. 15-513NOVEMBER 24, 2015 15-513 RESOLUTION
(CARRIED__7-0____LOST______LAID OVER______WITHDRAWN______)
PURPOSE: AUTHORIZE SUBMITTING APPLICATION TO WISCONSIN
ECONOMIC DEVELOPMENT CORPORATION FOR IDLE
INDUSTRIAL SITES REDEVELOPMENT GRANT ON BEHALF OF
THE MORGAN DISTRICT LLC FOR FORMER JELDWEN
PROPERTY IN SOUTH SHORE REDEVELOPMENT AREA;
ACCEPT FUNDS; APPROVE AGREEMENT WITH THE MORGAN
DISTRICT LLC FOR CITY’S ADMINISTRATION OF IDLE
INDUSTRIAL SITES REDEVELOPMENT GRANT
INITIATED BY: COMMUNITY DEVELOPMENT DEPARTMENT
WHEREAS, the Wisconsin Economic Development Corporation (WEDC) has
grant funds available for implementation of redevelopment plans for large industrial sites
that have been idle, abandoned, or underutilized for at least five years; and
WHEREAS, local municipalities are an eligible applicant and can apply for said
grant funds on behalf of a local property owner; and
WHEREAS, The Morgan District LLC approached the City about applying for
said grant funds for the proposed redevelopment of the former JeldWen/Morgan Doors
th
property at Oregon Street and West 6 Avenue in the South Shore Redevelopment
Project Area.
NOW, THEREFORE, BE IT RESOLVED by the Common Council of the City of
Oshkosh that the proper City officials are hereby authorized to submit an Idle Industrial
Sites Redevelopment grant application to Wisconsin Economic Development
Corporation to obtain funds for said purpose.
BE IT FURTHER RESOLVED that if said grant funds are awarded, the proper
City officials are hereby authorized and directed to accept said funds, pursuant to the
terms of the grant application, and to execute any and all documents and assurances
which may be required for purposes of same.
BE IT FURTHER RESOLVED that the attached Agreement with The Morgan
District LLC relative to the City’s administration of an Idle Industrial Sites
Redevelopment grant for the former JeldWen/Morgan Doors property on Oregon Street
th
and West 6 Avenue is hereby approved contingent upon receiving said grant funds
from Wisconsin Economic Development Corporation for this project.
NOVEMBER 24, 2015 15-513 RESOLUTION
CONT’D
BE IT FURTHER RESOLVED by the Common Council of the City of Oshkosh
that the proper City officials are hereby authorized and directed to execute and deliver
the agreement in substantially the same form as attached, any changes in the execution
copy being deemed approved by their respective signatures, and said City officials are
authorized and directed to take those steps necessary to implement the terms and
conditions of the Agreement.
NOVEMBER 24, 2015 15-513 RESOLUTION
CONT’D
BE IT FURTHER RESOLVED by the Common Council of the City of Oshkosh
that the proper City officials are hereby authorized and directed to execute and deliver
the agreement in substantially the same form as attached, any changes in the execution
copy being deemed approved by their respective signatures, and said City officials are
authorized and directed to take those steps necessary to implement the terms and
conditions of the Agreement.
�
O.fHKO.IH
ON THE WATEP
TO: Honorable Mayor and Members of the Common Council
FROM: Allen Davis
Community Development Director
DATE: November 24, 2015
RE: Authorize Submitting Application to Wisconsin Economic Development
Corporation for ldle Industrial Grant on Behalf of The Morgan District LLC for
Former Jeld-Wen Property in South Shore Redevelopment Area; Accept Funds;
Approve Agreement with the Morgan District LLC for City's Administration of
Idle Industrial Grant
BACKGROUND
Staff is proposing to submit an Idle Industrial Sites Redevelopment grant application to
WEDC on behalf of The Morgan District LLC, the developers of the former Jeld-Wen
riverfront site. The grant amount shall not exceed $500,000 and the funds will be used for site
improvements to prepare the property for development.
The Morgan District LLC is proposing a mixed-use development which will be completed in
multiple phases over a number of years. Before any building construction can start, specific
site improvements such as roadways and utilities will need to be installed. The Morgan
District LLC will be investing approximately $40 million dollars in the entire project in the next
five to ten years. If WEDC awards the grant, the City would administer the grant funds and
ensure compliance for use of funds.
ANALYSIS
The Morgan District LLC, the developers of the former Jeld-Wen site, are starting the
infrastructure site work for their redevelopment. The general schedule is:
Start infrastructure improvements in summer of 2016.
Start construction of mixed-use development in fall 2016.
Complete construction in late 2017 to early 2018.
The WEDC funds and investor funds will be used largely in 2016-17 for:
• Infrastructure improvements necessary for a mixed-use development.
City staff has worked with representatives of The Morgan District LLC in preparing the grant
application and agreement that will transfer the grant match fund requirements and other
WEDC grant requirements from the City to The Morgan District LLC.
FISCAL IMPACT
There are no City funds included in the Idle Industrial Sites Redevelopment grant application
or the implementation. The Morgan District LLC will be paying for the City's staff time for
grant administration, namely the grant draws.
RECOMMENDATION
The City Council approves the submission of the WEDC Idle Industrial Sites Redevelopment
grant application, the agreement with The Morgan District LLC for their redevelopment, and
accepts the WEDC Idle Industrial Sites Redevelopment grant funds should they be awarded
to the City.
Approved,
��a---���" 1
City Manager
AGREEMENT
WHEREAS, The Morgan District, LLC has purchased and has a desire to redevelop the
property commonly known as the former Morgan Door Company, located at 42'f Oregon
Street, 0 Oregon Street, 228 W 6�' Ave, 0 W 4�h Ave and encompassing the parcel
identification numbers 90900010000, 90300010100, 90900010100 located in the City of
Oshkosh ("the Property") as shown an the at#ached Exhibit "A" to this Agreement; and
WHEREAS, The Morgan District, LL.0 will be building a mixed use development; and
WHEREAS, the City of Oshkosh (the "Cit�') desires to work with The Morgan District,
LLC to facili#ate the redevelopment af the Property; and
WHEREAS, it is desirable to prepare and submit an application for a Wisconsin
Economic Development Corporation {WEDC) Idle Industriai Sites Redevelopment Grant
Program to assist with certain of the costs associated with the redevelopment o# the Property.
NOW, THEREFORE, the City of Oshkosh, hereinafter referred to as the "City", and The
Morgan District, LLC hereinafter referred to as "The Morgan Partners", agree as follows:
1. The City shall submi# an application for a WEDC ldfe Indus#rial S[tes
Redevelopment Grant to assist with the redevelopment of ihe Property. The application shall
be for the purposes identified in and substantially in the same form as the attached Exhibit B to
this Agreement.
2. The City shali be responsible to complete all necessary requirements in relation
to this WEDC Idle Incius#ria( Sites Redevelopment grant Agreemeni and the WEDC Idle
Industrial Sites grant, if awarded.
3. The Morgan District, LLC shall be responsible for obtaining all required permits
and approvals for all work to be perFormed on the Praper#y in relation to this Agreement and
the WEDC Idle Industrial Sites Redevelopment grant, if awarded, including but not limited to
permits and approvals from other state and federal agencies.
4. The Morgan District, LLC shall be responsible for the Match Investment identified
in the WEDC Idle Industrial Sites Redevelopment applicatian and directly pay for all project
costs including but not limited to any permit or approval costs and fees, and any contractors'
fees and consuftants' fess, relating to the performance of responsibilities under the WEDC ldie
lndustrial Sites Redevelopment grant, if awarded.
5. The Morgan District, LLC sha!! use WEDC ldle Indus#rial Sites Redevelopmenfi
funds under the terms of the ac#ivities outlined in Exhibit B. Failure to use the WEDC Idle
Industrial Sites Redevelopment funds on the terms of Exhibit B will result in payment requests
being denied.
6. The Morgan District, LLC sha11 submit to the City payment requests with all
necessary supporting documentation to allow the City to reques# reimbursement under the
terms of the WEDC Idle Industrial Sites Redevelopment gran#.
I
7. The Morgan District, LLC shall pay to the City a fee of $500 per payment request
to reimburse the City for the City's costs of administering the WEDC Idle Industrial Sites
Redevelapment grant.
8. The Margan District, LLC shall comply with the requirements listed in the
agreement between the WEDC and the City.
9, The Morgan District, LLC shall fully and completely cooperate with the City, the
City's attorneys, the City's Auditors or other representative of the City (collectively, the "City")
in connection with any internal or governmental Audit, with respect to matters relating to this
Agreemen#. Such coopera#ion may include, but shall not be limited to, responding to requests
for documents and/or other records, and making Contractar's employees available ta the City
(or their respective attorneys or auditors) upon reasonable notice for: (i) interviews, facival
investigations, and providing dec{arations or affidavits that provide truthful information in
connection with any Audit; (ii) volunteering to the City all pertinent information related to any
Litigation or Audit; and (iii} providing information and legal representations to auditors in a form
and within a timeframe requested.
10. The agreement between The Margan District, LLC and the City shalf expire once
the project is completed and upon completion of the grant requirements.
19. Subject to any limitations contained in Sec 893.80 and any similar statute, of the
Wisconsin Statutes, the City agrees to hold The Morgan District, LLC, its afficers, officials,
employess, and agents harmless from any and all liabi3ity, including claims, demands, losses,
costs, damages, and expenses of every kind and descripiion (including death}, or damages to
person or property arising out af the terms of this Agreement where such iiability is #ounded
upon or grows out of the acts of omission of any City's officers, employees, or agents while
acting within the scope of their employment.
The Morgan District, LLC agrees to hold the City, its officers, officials, employees, and agents
harmless from any and a11 liability, including claims, demands, losses, costs, damages, and
expenses of every kind and description (including death), or damages to person or property
arising out of the terms of this Agreement where such liability is founded upon or graws out of
the acts of omission of any The Morgan District, LLC's officers, employees, or agents while
acting within the scope of their employment.
Nothing in this Agreement is intended as a waiver af the City's right or opportunity to rely upon
the governmental limitations and immunities contained within Wisconsin iaw. Municipal
immunities and limitations include, but are not limited to, Sections 345.05, 893.8Q, and 893.83,
Wisconsin Statutes. Such damage iimits, caps and immunities are intended to be preserved
and are incorporated into this agreement and shall govern ali disputes, contractual or
otherwise, as they apply to the parties and their agents, o#ficers, and employees.
The intention of this paragraph is that each party sha11 be responsible for its own actions and
inactions related to this Agreement.
Notwithstanding any other provision of this Agreement, it is further agreed that to the fullest
extent permitted by law The Morgan Districf, LLC shall indemnify and hold harmless the City,
its employees, agents, contractors and consultants from and against all claims, damages,
losses and expenses, direct and indirect, or consequential damages, including but not limited
2
to attorneys' fees and ali Court, arbitration or other dispute resolution costs, arising out of,
resulting from, or reiated to the presence and/or involvement of hazardous substances or
constituents, including hazardaus waste, at or contiguous to the project site or contained in
samples collected by or received by the City or its contractors and/or consultants fram the site.
This indemnification extends to claims against the City or any of its employees, agents,
contractors or consultan#s which arise out of, are related to, or are based upon, the d�sposal,
discharge, escape, release, spillage or saturation of smoke, vapors, soot, fumes, acids, alkalis,
toxic chemicals, liquids, gases or any other ma#erial, irritant, contaminant or pollution in or into
the atmosphere, or on, onto, upon, in or into the surface or subsurtace of soil, water or
watercourses, objects, or any tangible or intangible matter, whether such event or
circumstance is sudden or not. Nothing in this paragraph is intended to indemnify, or sha(I be
construed as indemnifying fhe City, ifs employees, agents, contractors or consultants with
respecf to claims, losses, expenses or damages to the extent caused by the City or its
employees', agents', contractors' or consuftants' awn negligent acts ar omissions.
12. This Agreement shali be construed under the {aws af the State of Wisconsin.
13. This Agreement, and all other documents or instruments that may be required by
this Agreement, may be executed in several caunterparts, each of which shall be deemed an
original, but all of which shall const'stute the same insfrument.
3
IN WITNESS WHEREOF, the City of Oshkosh, Wisconsin, and The Morgan District, LLC have
respectively caused this Agreement to be duly executed on this day of Nvvember,
2015.
C{TY OF OSHKOSH
:
Mark Rohloff, City Manager
And:
Pamela R. Ubrig, City Cierk
And:
Trena Larson, Finance Director
Approved as to form:
Lynn Lorenson, City Attorney
STATE �F WISCONSIN )
} ss.
WiNNEBAGO COUNTY )
The Morg D' trict C
By_
Gr , egistered Agent
Personally came before me this 1� day of November, 2015, the above named
Grant Schwab, registered agent of The Morgan District, LLC to me known to be the persons
who executed the foregoing instrument and acknowledged same as and for said company, by
its authority.
STATE OF WISC�NSIN)
) ss.
WINNEBAGO COUNTY }
��
Not Public, Winneba a County, WI
My Commission Expires: /l — / � —� "�
Personally came before me this day of November, 2015, the above named
Mark Rohloff, City Manager, Pamela R. Ubrig, City Clerk, and Trena L.arson, �inance Director,
of the City of Oshkosh, to me known to be the persons who executed the foregoing instrument
and acknowledged same as and for said Corporation, by its authority.
Notary Public, Winnebago Caunty, WI
My Commission Expires:
�
Exhibit A
The City of Oshkash rxeates and maintains GIS maps and cata for its c:vn use. They n�ay sh�w the
approximate relative E�ratier� of property, houndaries antl other fe2ture `�om a•���riety o1 scurces.
These map(s)idatasets are pretirided for infonnet€on pu�poses on:y and rray not be su�cier: o�
appropriate for legai: engineering, or surveying purpcses. They are prov�ded "iaS-ES" witheut
warranties of any kind an� tFe Ciry of Oshkosh assur�es n� Iiability for us2 or misuse.
O.f HKOlH
ON iHE WATFA
H'jef`nlFianr�i�:g Basa !,1aP - Jei 2u':4.iritid Us�r: je»�
WISCONSIN ECONOMIC DEVELOPMENT CORPORATION
Idle Industrial Sites Redevelopment Prospect Data Sheet
(All application materials must be received by WEDC no later than November 21, 2014)
A. GRANT REQUEST
Grant Request: $$375,000 Applicant Match: $$1,050,000 Total Project Cost: $$40M+
Project Size:
� Contiguous site is greater than 5 acres, but less than 10 acres
❑ Contiguous site exceeds 10 acres
Name of WEDC Communitv Account Mana�er: Natetta Burr
B. APPLICANT INFORMATION
Legal Name: City of Oshkosh NAICS: 999300
Applicant Type: �City ❑Town ❑Viilage ❑County ❑Other Public Body:
FEIN #:39-6005563 (Submit Completed W-9 as a separate document)
Addl'eSS: 215 Church Ave, PO Box 1130
City, State, Zip: Oshkosh, WI 54903
Tele. #:(920) 236-5055 Fax #: (920) 236-5053
Internet Address: www. ci.oshkosh.wi.us
C. LOCAL GOVERNMENT CONTACTS
Primary Contact:
Name: Allen Davis Title: Director of Community Development
Address (if different):
Phone: (920)236-5055 Email: adavis@ci.oshkosh.wi.us
Highest Elected Official:
Name: Steve Cummings Title: Mayor
Address (if different): 1124 Bay Shore Drive Oshkosh, WI 54901
Phone: (920) 410-8545 Email: scummings�a ci.oshkosh.wi.us
Official Authorized to Sign Contracts:
Name: Mark Rohloff Title: City Manager
Address (if different):
Phone: (920) 236-5002 Email: mrohloff@ci.oshkosh.wi.us
Individual to Receive Grant Payments:
Name: Allen Davis Title: Director of Community Development
Address (if different):
Phone: (920) 236-5055 Email: adavis@ci.oshkosh.wi.us
Reporting Contact:
Name: Kelly Nieforth Title: Economic Development Specialist
Address (if different):
Phone: (920) 236-5045 Email: knieforth@ci.oshkosh.wi.us
D. SECONDARY CONTACT (e.g. consultant, developer, partner, as applicable):
Name: Ed Bowen Title:
Organization: The Morgan District, LLC
Explain Role: Development Coordinator
Address: 601 Oregon Street Suite B
City, State, Zip: Oshkosh, WI 54902
Rev.10/15/2014
Tele. #:(920) 267-2558
Email Address: ed@themorganpartners.com
Fax #:(920) 233-7363
E. INITIAL ELIGIBILITY
Please answer the following to demonstrate eligibility:
Yes No
� ❑ 1. ❑ The property is larger than 5 acres and has had over 25 years of industrial usage.
-OR-
� The property is larger than 10 acres and has had over 25 years of commercial usage.
� ❑ 2. The property has been vacant or underutilized for more than five years.
� ❑ 3. The applicant owns the targeted site or can demonstrate the legal ability to access the property and
perform the work proposed in the application.
� ❑ 4. Grant funds will not be used for environmental work occurring on properties in which the current
owner is also a causer who possessed or controlled the contaminant(s) on the site.
� ❑ 5. I certify that WEDC financial assistance is needed to ensure the project will happen in Wisconsin.
Explain:
Contact
Account Manager for eligibilitv information if anv answers in Section C
F. SITE DETAILS
PTOjeCt LoCatlon: � City ❑ Town ❑ Village Of: Oshkosh County: Winnebago
Project Street Address: 421 Oregon St/424 Oregon St Site Size (Acres): 27
Current Zoning: C-3PD Proposed Zoning: TBD
Is the project located in a TID? � Yes ❑ No If yes, creation date: 4/1/2016
The party that likely caused environmental contamination on the subject property is unknown, cannot be
located or is financially unable to pay for the cost of the cleanup. � Yes ❑ No
Does the applicant currently own the site? � Yes ❑ No
If no, how do you have or expect to obtain ownership or access to the property?
❑ Condemnation
❑ Tax Delinquency
❑ Purchase (attach purchase agreement or option)
❑ Development Agreement
❑ Other:
Timeframe:
Timeframe:
Timeframe:
Timeframe:
Timeframe:
If applicant will not own the property, what entity will/does?
Current Site Ownership: The Morgan Districc, phone: (920) 267-2558 Email:
LLC ed(a�themor�andistrict.com
G. REDEVELOPMENT NARRATIVES (reference Required Supporting Documentation as needed)
1. Project Objectives: Provide a clear, accurate, and concise summary of the project, the project goals
and objectives, and how the project will directly or indirectly promote economic development of the
area and support community revitalization. The summary should include the needs to be addressed, the
proposed scope of work, total investment, projected impact on jobs and tax base and any other factors
of significant impact. Supporting documentation may be referenced as to precise location in the
application materials and attached (e.g. letters of support, testimonials from concerned interests,
summaries of market and/or planning study data, demographic date). (Two page limit)
2. Need for Assistance: Describe the nature and scope of the site's challenges (physical, social, financial,
institutional, and/or other). Clearly and concisely justify the need for grant funding that cannot be met
by the private sector alone (e.g., traditional financing, equity investment or donor support), local public
2
Rev.10/15/2014
sector support (e.g. RLF financing, TIF financing and/or public borrowing) ar a reduction in the scope
of the project. (Two page limit)
3. Site Background: Describe the site location, history and significance of the site, past and current
ownership and usage, any known contamination and causers, reasons for underutilization, and area and
people to be impacted by the proposed project. Describe how this project aligns with any planning
processes that have been completed relating to this site and include any redevelopment plans
specifically referencing the site as Supporting Documentation. (Two page limit)
4. Project Implementation: This section should provide a clear overview of the redevelopment strategy
and project vision, and a well-conceived overall approach to the project, including details
demonstrating that the project will be implemented in a way that will achieve the program's goals and
objectives. Information provided should include the following (four page limit):
• An implementation plan and quarterly schedule that details past and planned activities through one
year past completion, including milestones and factors that might affect the schedule (e.g.
permitting, planning, site control actions, site assessments, environmental cleanup), including
strategies to address potential obstacles.
• A description of the means by which the applicant has or expects to obtain ownership or access to
the property, as well as descriptions of intended property transactions that will occur over the next
five years.
• Evidence of market viability (e.g. market data from a published source), marketing plans and
descriptions of how the project is positioned for continued success after the end of the grant period.
5. Project Viability: Provide information that includes the following (two page limit):
• Describe and demonstrate that the applicant is able to implement project activities consistent with
the project's scope, scale and projected outcomes, and sustain the project as described in the
application.
� Include name, role and qualifications of key individuals responsible for implementation of the
project, including ownership percentage for any individual owning more than 20% of the project.
• Describe the partnerships developed and demonstrate that the partner has sufficient and relevant
experience and success in development and/or business operation similar to that being conducted
under the proposed project. Include a partnership or other agreement between the applicant and the
project partner that includes a description of the roles and the relationship between the applicant
and the project partner in Supporting Documentation. The agreement should address topics such as
ensuring that: detailed records documenting long-term job creation, appropriate expenditures of
grant funds will be provided regularly; the grantee will play a substantive role in the project and
will actively monitor the partner(s)' activities to ensure compliance with WEDC program
requirements; and all parties will cooperate with WEDC monitoring efforts. As evidence of the
project partner's financial viability, individuals owning 20% or more of the project may be required
to submit a signed and dated personal financial statement and may be subject to credit check.
WEDC funding shall not exceed 30% of eligible project costs.
6. Project Financing: The applicant must include an acceptable financial plan for the project that
demonstrates that the project has all financing needed to complete construction and to sustain the
project for at least 1 year after completion. Supporting documentation that clearly demonstrates
financial feasibility includes iirm iinancial commitment letters from a lending institution or
government entity. Financial statements consisting of income statements, balance sheets and cash flow
projections may support project viability. Describe each line item in Section N, Proposed Project
Budget, itemized by funding source. The financial plan should also demonstrate that the financial
estimates are grounded in solid assumptions, attaching any cost estimates or bidding conducted for
costs listed in the project budget, or an explanation of the basis for all costs as Supporting
Documentation. (Two page limit)
Rev.10/15/2014
H. PROJECTED ECONOMIC DEVELOPMENT
How many full-time jobs will likely be created at the Average wage: 11.00+/hr
ro�ect site: 75-100
ProjeCt S1te: 421/424 Oregon (27 AC redevelopment)
Current Assessed Value: $876,600 Projected Assessed Value: $301�+
A detailed justification of these estimates should be provided in the Economic Development Potential narrative
requested above.
I. LEGAL INFORMATION YES/NO
Has the applicant, or any owner, officer, subsidiary or affiliate, been involved in a lawsuit � yes � No
in the last 5 years?
Has the applicant, or any project owner, officer, subsidiary ar affiliate, ever been involved � yes � No
in a bankruptcy or insolvency proceeding or are any such proceedings ending?
In the last 5 years, has the applicant, or any owner, ofiicer, subsidiary or affiliate, been
charged with a crime, ordered to pay or otherwise comply with civil penalties imposed, or ❑ Yes � No
been the subject of a criminal or civil investigation?
Does the applicant, or any project owner, officer, subsidiary or affiliate, have any � yes � No
outstanding tax liens?
Applicant certifies that they have completed a similar background review of the developer � yes ❑ No
or any pass through recipient
Please attach a detailed explanation of any YES responses.
J. REGULATORY INFORMATION (if applicable)
DNR Project Manager Name and Address: Telephone Number: (920) 424-7890
Kevin McKnight
625 E County Rd Y#700, Oshkosh, WI 54903 Fax Number: (920) 424-4404
Email Address: kevin.mcknight@wisconsin.gov
Indicate the various WDNR case numbers or BRRTS #'s that have been assigned to the project site:
1) See Attachments 2) See attachments 3) See attachments
K. STATE REQUESTS FOR BID OR PROPOSAL
Are you aware of any State of Wisconsin request for bid or request for proposal to which the
applicant or any project owner intends to respond or to which the applicant or has recently
responded? ❑ Yes � No
If yes, please provide the following:
a. Identify the bid or request for proposal (e.g., bid number, or general description or
title).
b. Identify the state agency or public entity to which you are submitting the bid or
proposal.
c. Explain the status of the bid or proposal (e.g., recently submitted; considering
submission; in current negotiations).
Please note that if you answer "yes", WEDC may not be able to discuss potential financial
assistance until the reauest for bid or reauest for proposal nrocess has been comnleted.
Rev.10/15/2014
L. REQUIRED SUPPORTING DOCUMENTATION CHECKLIST
Please include the following attachments in the appendix and clearly identify each Included Attachment
document: ✓ #
1. A map and aerial image indicating the project location within its municipal
jurisdiction and any specially designated federal, state or local economic or �
t�ation zone encompassing the project site. Photographs of the site and
surrounding area.
2. List of previous site owners/occupants from a Phase I Assessment or a title �
search.
3. Statement declaring that a search was conducted to determine if the parties
that caused contamination are unknown, or if known, are no longer in
existence or have no ownership interest in the property, or that state funds ❑
will not be used for environmental remediation on the site if there is a
known viable causer.
4. Copies of all Phase I and II Environmental Assessments performed on the �
project property.
5. Also identify and provide copies of any subsequent environmental reports
or correspondence produced that are relevant in demonstrating the progress ❑
of any environmental activities at your project site.
6. A copy of the redevelopment plan for the site. ❑
7. A copy of any cost estimates or bidding conducted for costs listed in the �
roject budget, or an ex lanation of the basis for all costs.
8. A copy of the agreement or document under which the applicant has or �
expects to obtain ownership ar access to the property.
9. Documentation that demonstrates the success of obtaining firm financing
(e.g. commitment letters from lending institutions, municipal resolutions for ❑
fnancing or TID creation).
10. Partnership or other agreement between the applicant and project partner(s)
that includes a description of the roles and the relationship between the ❑
applicant and the project partner.
11. Individuals owning 20% or more of the project may be required to submit �
signed and dated personal iinancial statement.
12. Statements from community, public and economic development leaders that �
support the project proposed for funding.
13. Please list any other relevant documentation you have provided with your
application, along with the page number:
a) �
b) �
c) ❑
d) �
e) ❑
Rev.10/15/2014
M. CERTIFICATION STATEMENT
This npplication, nnd the information being sicbmitted to WEDC, is true and correct to the best of my (our)
knowlecige. This also certifies that:
1. The applicant certifies that to the best of its knowledge and belief, the information being submitted to
WEDC is true and correct.
2. The applicant understands submitting false or misleading information in connection with an
application may result in the applicant being found ineligible for financial assistance under the funding
program, and the applicant or its representative may be subject to civil and/or criminal prosecution.
3. The applicant certiiies that it is in compliance with all laws, regulations, ordinances and arders of
public authorities applicable to it.
4. The applicant certiiies that it is not in default under the terms and conditions of any grant or loan
agreements, leases, or financing arrangements with its other creditors.
5. The applicant understands this application and other materials submitted to WEDC may constitute
public records subject to disclosure under Wisconsin's Public Records Law, § 19.31 et seq. The
applicant will mark documents "coniidential" where appropriate for iinancial and other sensitive
materials that should be, to the extent possible, be kept in confidence. WEDC will notify the applicant
if it receives a public records request for materials marked confidential.
6. The applicant certifies that WEDC is authorized to obtain a credit check and Dun and Bradstreet on
the applicant, the business and/or the individual(s).
7. The recipient of the Idle Industrial Sites Grant funds shall enter into a contract with WEDC that may
require, at the discretion of WEDC, a personal or business guarantee from any private owner of the
site with more than 20% ownership interest.
8. The recipient of Idle Industrial Sites Grant funds shall provide WEDC with semi-annual performance
reports, iinancial reports, and schedules of expenditures compiled by a qualified independent third
P�Y•
9. Funds received for remediation under the Idle Industrial Sites program shall not replace funds from
any other source including Agri-Chemical, Petroleum Environmental Cleanup Act and the Superfund.
10. Funds received under the Idle Industrial Sites program shall not be used for environmental remediation
costs where there is a known viable causer of contamination with ownership interest in the property.
11. The applicant certified that it has disclosed and will continue to disclose any occurrence or event that
could have an adverse material impact on the project. Adverse inaterial impact includes but is not
limited to lawsuits, criminal or civil actions, bankruptcy proceedings, regulatory interventions or
inadeauate caqital to complete the qroiect.
Signature:
(Authorized Representative)
Date:
Printed Name: Title: - -
Rev.10/15/2014
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State of Wisconsin
Departrnent of Administration
DOA-6448 (R08/2001) Subsdtute W-9
Division of Executive Budget and Finance
State Controller's Office
DO NOT SEND TO IRS
W-9 TAXPAYER IDENTIFICATION NUMBER (TIN) VERIFICATION
Print or Type
This form can be made available in alternative formats to qualified individuals upon request.
_ _ . _ _ --- — — _
Legal Name: (as encered wich ntS) i Entity Designation: (check only one)
Individuals: Enter Last Name, First Name, Middle Initial
Sole Proprietorships: Enter Last Name, First Name, Middie Initial ❑ Individual / Sole Proprietor
All Others: Enter Lega] Name of Business ❑ Corporation (includes service corporations)
Trade Name:
Individuals: Leave Blank
Sole Proprietorships: Enter Business Name
All Others: Complete only if doing business as a DB/A
Remit Address: Address where awarded funds check should be sent if
different from primary address PO Box or Number and Street, City, State,
ZIP+4
Order Address: Address where order should be mailed
PO Box or number and street, City, State, ZIP+4
[NOT APPLICABLE]
Primary Address: Address where 1099 should be sent if different from
remit address
PO Box or nuinber and street, City, State, ZIP+4
❑ Lirruted Liab�hty Partnership
❑ Limited Liability Corporation
❑ Government Entity
❑ Hospital Exempt from Tax or Government
Owned
❑ Long Term Care Facility Exempt from Tax or
Government Owned
❑ All Other Entities
Taxpayer ldentification Number (TIN):
If you are a sole proprietor and you have an EIN, you may
enter either your SSN or EIN. However, using your EIN
may result in unnecessary notices to the Requester.
Check Only One
❑ Social Security Number (SSN)
❑ Employer ldentification Number (EIN)
❑ Individual Taxpayer ldentification Number
for U.S. Resident Aliens (ITIN)
--- _ --- _ — -- ---- — -- _— ---
Certification: Under penalties of perjury, I certify that:
1. The number shown on this form is my conect taxpayer identification number, AND
2. I am not subject ro back up withholding because (a) I am exempt from backup withholding, or (b) I have not beei� notified by the Internal
Revenue Service (IRS) that I am subject to back up withholding as a result of a failure to report all interest or dividends, or (c) the IRS has
notified me that I am no longer subject to backup withholding.
3. I am a U.S. person (induding a US resident alien).
---- __----- -- -- __ — --- —
� ---
Printed Name � Printed Title , Telephone Number
li )
Sig�ature
For Agency Use
Agency Nutnber
Contact
Date (mm/dd/ccyy)
Phonc Number
_ - -- — — ------
___ __ _ —
Chan�,e ❑ Name ❑ Address ❑ Other (explain) � � �
For all projects approved by WEDC, this forni is used as a reference for issuing checks to Recipients. WEDC will file with the IIZS appropriate income tax forms
for award Recipients b�sed on information that appears on this form. Failure ro provide this information may result in delayed payments. This request is being
made at the direcUOn of the Wisconsin State Controller. We are required to inform you that failure to provide the correct Taxpayer ldentification Number (TIN) /
Name combination may subject you to a$50 penalty assessed by the Internal Revenue Service under section 6723 of the Intemal Revenue Code. Section 6109
requires you to furnish your correct TIN to persons who must file information returns with the Il2S to report interest, dividends, and certain other income paid to
you, mortgage interest you paid, the acquisition or abandonment of secured property, or contributions you made to an IRA. The IRS uses the numbers for
identification purposes and to help verify the accuracy of your ta�c return. You must provide your TIN whether or not you are required to file a tax return. Payers
must generally withhold 31 °/a of ta�cable interest, dividend, and certain other pay�nents to a payee who does not furnish a TIN to a payer. Certain penalues may also
apply.
DOA-6448 (R08/2001) REV for PDS 12/04