Resolution - #09-01-009 - 01/13/2009

Home

PJl$si"ltj .'vv.~. y.Ii~r\iDenjalEmP1Oyment l::?vtlnneslil;; . _ Please fill in date agreement signed (same as question 21) 2008 Minnesota Business Assistance Form for Non-JOBZ Projects . The Minnesota Business Assistance Form (MBAF) online is available at www.deed.state.mn.us/Communitv/subsidies/MBAFForm.h1m to report each business subsidy and financial assistance agreement signed fromAurrnst 1. 199Uhrouf!h December 31. 2007unIess goals have been achieved and reported on a MBAFper Minn. Stat ~Il6J.993 to ~Il6J.995, . The following government agencies must submit a MBAF: 1) any local government/agency that signed a business subsidy agreement sirice January 1,2003, or represents a population of more than 2,500; 2) all state government agenCies authorized to provide biIsiness subsidies. . Executive Order 08-01 at http://www.govemor.state.l1111.us/priorities/govemorsorderslexecutiveorders/PROD008598.html requires that recipients for all business subsidy agreements signed on or after January 29, 2008, to comply with the ImmigrationAct of 1986, as . amended. The recipient of business assistance must certifY that it is currently participating in the E-VerifY program located at http://W\vw.uscis.gov and that all newly hired employees hired on or after January 29, 2008 are eligible for employment in the United States throughout the term of the business assistance. . DEED will contact any local or state government agency that is required to report but has not done so by May 1. Business assistance may not be awarded after June 1 of each year until a report has been submitted. . Questions? Call (651) 259-7179. Information on where to mail or fax your completed MBAF(s) is on page 5. Section 1: (Grantor Information) 1. Name of grantor (funding entity) 2. Name of person completing this form 3. Street address 4. City 5. Zip Code 6. County 7. Phone number 8. Fax number 9. E-mail address. 10. Please indicate who in your organization should receive the MBAF if different from the person in Question 2. . NamelTitle Phone number Street address City Zip Code 11. Classification of grantor (Mark one. If grantor is entity created. 12. Has your organization held a public hearing on and adopted by gov 't agency, please indicate affiliation. For example, a city criteria for awarding business subsidies in compliance with EDA would check "City government. ") Minn. Stat ~ Il6J.994? (Mark one.) o City goveinment 0 Yes, in 2008 (attach criteria) 0 Yes, in 2008 but have not yet adopted criteria o County government 0 Yes, prior t02008 o Regional government If Yes: Hearing Date: Year Criteria Submitted: o State government 0 No o Other (please specify) 0 Other (Please attach exDlariation.) 13. Has your organization. signed any agreements to award a business subsidy or financial assistance from August 1,1999 through December 31, 2007 unless goals have been achieved and reported in a previously filed MBAF? (Mark one.) DYes (Complete the remainder of the form unless goals have been achieved and o No (Stop here. go to section 5 011 page 4.) reported in a previo~slv filedMBAF per Minn. Stat. g1l6J. 993 and S 116J. 994.) Section 2: Reci ient Information 14. Name of business or organization receiving subsidy or flnancialassistance 15. Address where business subsidy or fmancial assistance will be used . Street address Ci State ZIP Code 16. Does the recipient have a parent corporation? (Mark one.) o Yes (Indicate name and address of parent corporation below; If more than one, indicate ultimate owner.) o No Name of Street address Ci State ZIP Code Minnesota Business Assistance Form (3/25/08) Page 1 of5 Dept. of Employment and Economic Development