Fill - Free fillable MEAT AND POULTRY PROCESSING GRANT APPLICATION (Missouri) PDF form

MISSOURI DEPARTMENT OF AGRICULTURE

MEAT AND POULTRY PROCESSING GRANT APPLICATION

SECTION 1 - MEAT AND/OR POULTRY PROCESSING FACILITY INFORMATION

SECTION 2 - PROGRAM INFORMATION

NAME OF MEAT AND/OR POULTRY PROCESSING FACILITY

CONTACT NAME COUNTY

911 ADDRESS MAILING ADDRESS (IF NOT THE SAME AS 911 ADDRESS)

CITY STATE ZIP CODE

TELEPHONE NUMBER NUMBER OF EMPLOYEES AT THIS FACILITY E-MAIL ADDRESS

DATE FIRST IN OPERATION NAICS/SIC CODE IS THE COMPANY HEADQUARTERED IN MISSOURI?

Date: ____________ Not yet in operation Yes No If not Missouri, where? ____________________

MISSOURI STATE REPRESENTATIVE DISTRICT # MISSOURI SENATORIAL DISTRICT #

ARE THERE MULTIPLE PROCESSING FACILITY LOCATIONS ASSOCIATED WITH THE PRINCIPAL OPERATOR? LIST ALL LOCATIONS AND INCLUDE NUMBER OF EMPLOYEES AT EACH FACILITY.

PROCESSOR IS

INDIVIDUAL PARTNERSHIP S-CORPORATION CORPORATION TRUST LIMITED LIABILITY COMPANY

If member is a Partnership, S-Corporation, Trust, or Limited Liability Company, identify the names and proportionate share of

ownership of each beneciary, partner or shareholder below. Aggregate proportionate shares or percent of ownership may not

exceed 100%.

Total Funds: The Missouri General Assembly appropriated $20 million in federal funds to support Missouri meat and poul

processors, available under section 601(a) of the Social Security Act, as added by 5001 of the Coronavirus A

Relief, and Economic Security Act (“CARES Act”).

Grant Purpose: The Meat and Poultry Processing Grant was created to support Missouri meat and poultry processing faciliti

with fewer than 200 employees, to address supply chain disruptions and mitigate health and environmental impa

as a result of the COVID-19 public health emergency. Projects should aim to improve food supply resilience throu

increasing livestock or poultry slaughter, expanding meat or poultry processing capacity, or promoting wor

safety. Grants may reimburse workforce assistance, equipment, capital improvements and other eligible co

incurred from March 1, 2020 through November 15, 2020.

Reimbursement Grant: Award maximum determined by Applicant’s demonstrated Level of eligibility achieved no later than November

2020 (Level 1, Level 2, or Level 3)

Due Date: Applications must be received by the Department no later than August 31, 2020

Award Date: Anticipated September 15, 2020

Project Completion: Reimbursable costs shall be incurred from March 1, 2020 through November 15, 2020. Facilities must provi

required documentation, including proof of a federal grant of inspection, state grant of inspection,

application of state grant of exemption, no later than November 30, 2020.

Final Report: A final report is required detailing the activities and project goals completed at the time the reimbursement requ

is submitted, no later than November 30, 2020.

The Department will review applications for eligibility, demonstrated need in response to the ongoing COVID-19 public health emergency, a

project impact on increased livestock and poultry slaughter, expanded meat and poultry processing capacity, or promotion of worker safe

Applicants will receive written approval and notice of award amount from the Department once the review process is complete and applic

eligibility is verified.

THE DEPARTMENT RESERVES THE RIGHT TO MODIFY GRANT AWARDS IF TOTAL ELIGIBLE APPLICANT

REIMBURSABLE EXPENSES EXCEED THE APPROPRIATED $20 MILLION PROGRAM CAP.

I, the undersigned, understand that grant awards may be modified based upon funding availability. I attest that a reduced award amount

not result in project termination.

Yes No

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SECTION 3 - APPLICANT ELIGIBILITY

SECTION 4 - APPLICANT SIGNATURE

CURRENT MEAT AND/OR POULTRY PROCESSING FACILITY INSPECTION STATUS

The Meat and Poultry Processing Grant provides funding for meat and poultry processing facilities located in Missouri who employ fewer than

200 employees in the state. Both existing facilities and new facilities that will soon be in operation are eligible to apply. All facilities must provide

proof of their federal grant of inspection, state grant of inspection, or application of state grant of exemption no later than November 30, 2020.

What is the facility’s current inspection status?

Federal Inspection - Establishment Number ____________ Does the facility currently conduct livestoc y slaughter? k or poultr Yes No

State Inspection - Establishment Number ____________ Does the facility currently conduct livestock or poultry slaughter? Yes No

Custom Exempt - Date of application ____________

Facility not yet in operation. ____________ When do you anticipate receiving a grant of inspection or exemption? ____________

MAXIMUM REIMBURSEMENT GRANT AWARD

The maximum reimbursement grant amount will be determined by the Applicant’s demonstrated Level of eligibility achieved no later than

November 30, 2020. Applicants may apply for a Level which they do not currently qualify for, but must demonstrate qualifications for the higher

Level no later than November 30, 2020. The three Levels are intended to incentivize facilities to increase livestock or poultry slaughter and/

or become an inspected or exempted facility in the near term. Increased Missouri meat and poultry slaughter and processing facility capacity

will add resilience to food supply chain disruptions and mitigate health and environmental impacts as a result of the COVID-19 public health

emergency.

Level 1 - Maximum $200,000 Reimbursement Grant

• Federal or state inspected meat and/or poultry slaughter and processing facility

• Facility must conduct livestock or poultry slaughter

• Applications will be accepted from prospective facilities that are not yet inspected or that do not yet conduct slaughter. However, no funds

will be disbursed until proof of a grant of inspection for slaughter is provided to the Department.

Level 2 - Maximum $100,000 Reimbursement Grant

• Federal or state inspected meat and/or poultry processing facility

• Facility does not conduct livestock or poultry slaughter, but does provide further processing under inspection

• Applications will be accepted from prospective facilities that are not yet inspected. However, no funds will be disbursed until proof of a

grant of inspection is provided to the Department.

Level 3 - Maximum $20,000 Reimbursement Grant

• Custom exempt processing and/or slaughter facility

• Applications will be accepted from prospective facilities that do not have a grant of exemption yet. However, no funds will be disbursed

until proof of a grant of exemption is provided to the Department.

Which Level of funding is the facility applying for, with proof of inspection/exemption delivered no later than November 30, 2020?

Level 1 Level 2 Level 3

Pursuant to the “Guidelines” document for the “Meat and Poultry Processing Grant” issued by the Missouri Department of Agriculture

(Department), the applicant (signing below) hereby certifies, subject to penalties of perjury, the following:

1. Signing this document does not constitute an approved grant by the Department.

2. I have received and read the Meat and Poultry Processing Grant Guidelines.

3. I am not (i) a commissioner or employee of the Missouri Department of Agriculture, (ii) a member of the Missouri General Assembly,

(iii) a state-wide elected official, (iv) a director of a state department, or (v) a spouse or dependent child of any of the above who has a

substantial interest in the Meat and/or Poultry Processing Facility entity shown in Section 1. Substantial interest is defined as ownership

by the individual, the individual’s spouse, or the individual’s dependent children, whether singularly or collectively, of ten percent or more

of the Meat and/or Poultry Processing Facility.

4. I, the undersigned, to the best of my knowledge, information and belief declare that the information submitted is true, correct, and

complete, and I hereby agree to comply with the requirements of the program as specified herein.

5. The applicant understands that submitting false or misleading information in connection with this application may result in the applicant

being found ineligible for participation in the Meat and Poultry Processing Grant.

6. The applicant or owner of the applicant is not presently suspended, debarred, proposed for debarment, declared ineligible, voluntarily

excluded from participation in this transaction by any Federal or State department or agency, or presently involved in any bankruptcy.

MO 350-1599 (7-2020) 2

E-mail completed application form and supporting documents to grants@mda.mo.gov no later than August 31, 2020.

Completed application

All Trust, Partnership, S-Corporation, or Limited Liability Company Information included in Section 1 (provide attachment if necessary)

Proof of Enrollment in E-verify

Form 943 to obtain a tax clearance certificate completed and submitted to Missouri Department of Revenue

EXECUTIVE SUMMARY: (200 Word Limit: Brief summary of the project, suitable for dissemination to the public)

MO 350-1599 (7-2020) 3

7. To my knowledge, there is no person who is actively engaged in the management of the Applicant who has been convicted of a felony,

is currently under indictment for a felony, or is currently on parole or probation.

8. There are no pending or threatened liens, judgements, or material litigation against the Applicant or any person who is engaged in the

management of the Applicant that would have a material impact on the viability of the applicant.

9. I understand the Meat and Poultry Processing Grant funds will be provided as reimbursement only and the Department reserves the

right to modify award amounts based upon funding availability.

10. I understand that expenses that have been or will be reimbursed by insurance or federal, state, or local dollars are not eligible expenses

for the Meat and Poultry Processing Grant.

11. Successful applicants must complete the project or phase(s) of the project detailed in the application and submit all documentation by

November 30, 2020. Required documentation includes: final report detailing the activities and project goals completed, detailed listing

of expenses, all paid invoices/detailed receipts/proof of payment, photograph(s) of the completed project, and proof of inspection status

(federal grant of inspection, state grant of inspection, or application of state grant of exemption).

12. The project described in the application must be completed and ready for inspection by Department staff no later than November 30,

2020.

13. Reimbursements will only be completed once all required documentation has been received. Failure to submit the required documentation

by November 30, 2020 will result in the forfeiture of funds.

14. The Meat and/or Poultry Processing Facility will retain all documentation relating to the program for at least five years from the date of

program closeout, and will allow the Department to audit such information within that five-year period.

15. The eligible Meat and/or Poultry Processing Facility agrees that Department staff will be allowed to visit the facility at any time during

the project period and/or throughout the records retention time period, and will provide to the Department information relating to: 1)

expansion progress 2) most recent financial information, and 3) verification of current number of employees.

I, the undersigned, declare that I have examined the application submitted to the Department for the Meat and Poultry Processing Grant,

including accompanying exhibits, and to the best of my knowledge, information and belief, it is true, correct, and complete, and I hereby agree

to comply with the requirements of the program as specified above.

SIGNATURE TITLE DATE

SECTION 5 - APPLICATION SUBMISSION CHECKLIST

SECTION 6 - PROJECT IMPACT

PROJECT DESCRIPTION: (500 Word Limit: Identify the project need and outline the project work plan)

IMPACT POTENTIAL AND METRICS FOR RESULTS:

Due to meat and poultry processing supply chain disruptions caused by the COVID-19 public health emergency, did you increase or do you

anticipate increasing livestock or poultry slaughter compared to March 1, 2020? If so, please explain and provide information estimating

livestock or poultry slaughter (either by (1) species and number of animals harvested, or (2) species and pounds of meat or poultry) before and

after March 1, 2020. If applicable, provide projections for how this grant will assist with further increasing livestock or poultry slaughter capacity.

If you have no intention of slaughtering, please proceed to the next question.

Due to meat and poultry processing supply chain disruptions caused by the COVID-19 public health emergency, did you increase or do

you anticipate increasing meat or poultry processing capacity compared to March 1, 2020? If so, please explain and provide information

estimating meat processing capacity (type and pounds of meat or poultry processed) before and after March 1, 2020. If applicable, provide

projections for how this grant will assist with further increasing meat or poultry processing capacity.

Due to meat and poultry processing supply chain disruptions caused by the COVID-19 public health emergency, did you create or do you

anticipate creating any new jobs since March 1, 2020?

_____ NO _____ YES, if yes # of full-time permanent _____ # of part-time permanent _____

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SECTION 6 - PROJECT IMPACT CONTINUED

List all costs requested for reimbursement. Breakdown expenses by categories listed below and explain why the request is necessary and how

it will address supply chain disruptions and mitigate health and environmental impacts as a result of the COVID-19 public health emergency.

Projects should aim to improve food supply resilience through increasing livestock or poultry slaughter, expanding meat or poultry processing

capacity, or promoting worker safety.

Grants may reimburse eligible costs incurred from March 1, 2020 through November 15, 2020. For costs not yet incurred, provide a budget

projection. The Department will need copies of all paid invoices and proof of payment, including but not limited to: cancelled checks, receipts

of payment, and/or paid contracts for all money spent through the project period for which you are applying for the reimbursement grant.

Eligible Expenses Reimbursement grant request amount

Capital improvements to expand capacity (including expansion and modifications to existing $

buildings and/or construction of new buildings at existing facilities)