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APPLICATION FOR ASSISTANCE (monroe county)

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BROWSE MONROE COUNTY (NY) FORMS

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MONROE COUNTY INDUSTRIAL DEVELOPMENT CORPORATION
I. APPLICANT DATA D. Current Legal Owner of property
A. Applicant Name
Address
E. Who are the principal user(s) of the facility (the "company")? If there are
City/State/Zip multiple users, please indicate on attached sheet. If same as applicant
B Applicant's Officer Responsible for Completing this Application indicate "same" below.
Name Company Name
Title Address
Mailing Address City/State/Zip
City/State/Zip SIC/NAICS Code
Telephone Contact Person
Fax Telephone
E-Mail E-Mail
Applicant's Tax ID No. % of facility to be
C. State of Incorporation occupied by company
D.
Applicant's Legal Counsel F. Are other facilities or related companies located within New York State?
Firm Name
F Yes F No
Address Location
City/State/Zip
Telephone
G. Description of project (check one or more)
Attorney's Name F New construction
Fax F Addition to existing facility
E-Mail F Renovation and modernization of existing facility
F Acquisition and modernization of existing facility
II. PROJECT & OCCUPANCY DATA F New machinery and equipment
A.
Location of proposed project facility (address if available) F Other (specify)
H. Attach a general narrative description of the project and background
B.
Tax Map Parcel Number on user(s) of the facility. Provide Confidential Information Form
C. Indicate municipal jurisdiction (Appendix A) for user(s) of the facility.
Town
Village
City of Rochester
School District
(585) 753-2000  Fax (585) 753-2002  monroecounty.gov 
Each applicant seeking assistance must complete the accompanying application material which includes the Application for Assistance, Appendix A, Appendix B,
Appendix C, Appendix D and Environmental Assessment form. A non-refundable application fee of $350.00 must be included with this application. Make check
payable to MCIDC.
In the absence of a waiver permitting otherwise, every project seeking MCIDC assistance must use all local labor for the construction of new, expanded or renovated
facilities. "Local" is defined as residing in Monroe, Genesee, Livingston, Ontario, Orleans, Seneca, Wayne, Wyoming or Yates Counties. See Appendix B.
Please answer all questions. Use "None" or "Not Applicable" where necessary. Information in this application may be subject to public review under New York State
Law, except for information that is considered deniable by the Freedom of Information Law. This form is available online at monroecounty.gov.
8100 CityPlace  50 West Main Street  Rochester, New York 14614 
APPLICATION FOR ASSISTANCE
for Not-for-Profit Corporations
REV 02-16-2010
2
III. COMPANY EMPLOYMENT INFORMATION
V
II. PROJECT CONSTRUCTION INFORMATION
A.
Total current employment within Monroe County is
A. What is the proposed commencement date of construction or
Full-Time Part-Time acquisition of the project?
B. Projected Employment:
Applicant or principal user(s) must complete Appendix A.
B. Outline the timetable for the project, indicating when project will
IV. ALL-LOCAL LABOR REQUIREMENT be in full use.
C. Contractor(s)
V. PROJECT COMPLIANCE
V
III. ENVIRONMENTAL ASSESSMENT
VI. PROJECT COSTS AND FINANCING
New York State law requires that an Environmental Assessment
A. Estimate the costs necessary for the construction, acquisition, rehabilitation, Form (EAF) must be completed and submitted along with this
improvement and/or equipping of the project. application. Attach the EAF which was submitted to the
Estimated Costs Eligible municipality.
a. Building Construction or Renovation Cost a. $
b, Sitework b. $
c. Non-manufacturing equipment c. $
Name of Applicant's Officer Responsible for Completing Application:
d. Furniture, Fixtures d. $ (Please print)
e. Other (specify) e. $ Signature
f. Subtotal f. $ Date of Application
g. Land and/or Building Purchase g. $
h. Soft Costs (Legal, Architect, Engineering) h. $
i. Other (specify) i. $
j. Subtotal j. $
Total Project Costs f. + j. $
B. Indicated how the project will be financed
a. Tax-Exempt Civic Facility Bond a. $
b. Equity b. $
TOTAL SOURCES $
Estimated Amount of Mortgage $
C. Has the applicant made any arrangements for the financing of the project?
F Yes F No
If so, please specify bank, underwriter, etc.
In the absence of a waiver permitting otherwise, every project seeking
MCIDC assistance must use all local labor for the construction of new,
expanded or renovated facilities. (Read and Sign Appendix B.)
P
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comp
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mon
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local labor/supplier commitment, employment requirements and
incentive verification. The cost of this monitoring will be paid for by
MCIDC.
REV. 02-16-2010
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deposes and says that he/she is the
of , the corporation
named in the attached application; that he/she has read the foregoing application and knows the contents thereof; that the same is true to his/her knowledge.
Deponent further says the reason this verification is made by the deponent and not by
, (company name)
is because the said company is a corporation. The grounds of deponent's belief relative to all matters in the said application which are not stated upon his/her own personal
knowledge are investigations which deponent has caused to be made concerning the subject matter of this application as well as information acquired by deponent in the
course of his/her duties as an officer of and from the books and papers of said corporation.
As officer of said corporation (thereinafter referred to as the "applicant") deponent acknowledges and agrees that applicant shall be and is responsible for all costs incurred by
the nonprofit Monroe County Industrial Development Corporation (hereinafter referred to as the "Agency") acting on behalf of the attached application whether or not
the application, the project it describes, the attendant negotiations and ultimately the necessary issue of bonds and/or completion of the lease/leaseback transaction are
ever carried to successful conclusion. If, for any reason whatsoever, the applicant fails to act within a reasonable or specified period of time to take reasonable, proper,
or requested action or withdraws, abandons, cancels, or neglects the application or if the Agency or applicant are unable to identify buyers willing to purchase the total
bond issue required or facilitate the lease/leaseback transaction, then upon presentation of invoice, applicant shall pay to the Agency, its agents, or assigns all actual costs
involved in conduct of the application, up to that date and time, including but not necessarily limited to fees of bond counsel for the Agency and fees of general counsel
for the Agency. Upon successful conclusion and sale of the required bond issue or completion of the lease/leaseback transaction, the applicant shall pay to the Agency
an administrative fee set by the Agency. The cost incurred by the Agency and paid by the applicant, including bond counsel and the Agency's general counsel's fees
and the administrative fee, may be considered as a cost of the project and included as part of the resultant bond issue or lease/leaseback transaction.
Print Name of Chief Executive
Signature
CERTIFICATION
name of chief executive of the company submitting application
REV. 02-16-2010
MONROE COUNTY INDUSTRIAL DEVELOPMENT CORPORATION
Full-Time Part-Time Total
Total number of employees within
Monroe County at the date of application: + =
Estimated average annual salary:
Total number of employees to be directly
IMPACTED by the project:
+=
A
DD: Number of new jobs to be created
during the first year after completion: + =
Total end of first year: +=
A
DD: Number of new jobs to be created
during the second year after completion: + =
Total end of second year: +=
A
DD: Number of new jobs to be created
during the third year after completion: + =
Total end of third year: +=
Estimated average annual salary
of new
jobs to be created:
Expected high salary of new
jobs to be created:
Expected low salary of new
jobs to be created:
*Applicant or principal user(s) as noted in Section II.E of application.
Print Name Signature Date
(585) 753-2000  Fax (585) 753-2002  monroecounty.gov 
PROJECTED EMPLOYMENT*
8100 CityPlace  50 West Main Street  Rochester, New York 14614 
APPENDIX A
REV 02-16-2010
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MONROE COUNTY INDUSTRIAL DEVELOPMENT CORPORATION
1. Requirement for use of All-Local Labor for all projects involving the construction of new,
expanded or renovated facilities:
A
ll project employees of the general contractor, subcontractor, or sub to a subcontractor (contractors
)
working on the project must reside within the following counties in the State of New York: Monroe,
Genesee, Livingston, Ontario, Orleans, Seneca, Wayne, Wyoming or Yates. The All-Local Labor criterio
n
will be verified based on employment, payroll and related records
.
MCIDC understands that at certain times local labor may not be available within the local area.
Under this condition, applicants are required to contact MCIDC in writing to request waiver of the
A
ll-Local Labor requirement. Contractors do not have to be local companies as defined herein, but mus
t
employ local people to qualify under the All-Local Labor criterion
.
2. Additional Requirement for use of All-Local Suppliers as applicable, per the Uniform Tax
Exemption policy:
A
ll material suppliers and providers to projects must be companies located within the following countie
s
in the State of New York: Monroe, Genesee, Livingston, Ontario, Orleans, Seneca, Wayne, Wyoming or Yates.
A
ll non-labor costs will be included in this calculation for All-Local Supplier compliance.
MCIDC understands that in some cases suppliers of specialty items are not available within the local
area. Under this condition, applicants are required to contact MCIDC in writing to request waiver o
f
the All-Local Supplier requirement.
The foregoing terms have been read, reviewed and understood by the Applicant, to wit
:
(Applicant)
and all appropriate personnel. Furthermore, the undersigned agrees and understands that the informatio
n
contained herein must be transmitted and conveyed in a timely fashion to all applicable subcontractors
,
suppliers and materialman. Furthermore, the undersigned agrees to post and maintain a sign
,
provided by MCIDC, in a prominent, easily accessible location, identifying the project as a recipien
t
of MCIDC assistance and the local labor requirements associated with this assistance. Furthermore,
the undersigned realizes that failure to abide by the terms herein could result in MCIDC revoking
all or any portion of benefits it deems reasonable in its sole discretion for any violation hereof
.
(APPLICANT)
, title
REQUIREMENTS FOR CONSTRUCTION PROJECTS
8100 CityPlace  50 West Main Street  Rochester, New York 14614 
(585) 753-2000  Fax (585) 753-2002  monroecounty.gov 
APPENDIX B
REV. 02-16-2010
MONROE COUNTY INDUSTRIAL DEVELOPMENT CORPORATION
OCCUPATIONAL CATEGORIES/PAY RANGES ASSOCIATED WITH PROJECT
Current and Planned Categorized Salary/Pay Range
of Occupations
1. Application Fee - Send with Completed Application
A
non-refundable application fee of Three Hundred Fifty Dollars (
$
350.00) shall be charged each applicant
.
2. Administrative Fee - Paid at Closing
a. For projects
$
20 million and under: 1% of project cost.
b. For projects over
$
20 million: 1% of project up to
$
20 million plus 1/4% fee on amount over
$
20 million
.
3. Counsel Fee-Paid at Closing
a. Counsel fee is one-third of administrative fee on projects up to
$
50 million.
b. For projects over
$
50 million, the counsel fee is included in the administrative fee.
4.
Bond Counsel
Designated Bond Counsel fee is based on the complexity and amount of transaction.
Print Name of Chief Executive
Signature Date
CONFIDENTIAL INFORMATION
APPENDIX C
REV. 02-16-2010
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