Agenda - Economic Development Authority - 07/09/2015

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SECTION 4 - BUSINESS ACKNOWLEDGMENT AND CERTIFICATION DATA PRIVACY ACKNOWLEDGMENT: Tennessen Warning Notice: per MN Statutes 13.04, Subd.2, this data is being requested from you to determine if you are eligible for an award under the Job Creation Fund program. You are not required to provide the requested information, but failure to do so may result in the department's inability to determine your eligibility for an award pursuant to the criteria developed under the program's enabling legislation and rules. The data you provide is classified as private or non-public and cannot be shared without your permission except as specified in statute. Data Privacy Notice: per MN Statutes 13.591, Subdivision 1, certain data provided in this application is private or non- public data; this includes financial information about the business, including credit reports, financial statements, net worth calculations, business plans; income and expense projections; balance sheets; customer lists; income tax returns; and design, market, and feasibility studies not paid for with public funds. Per MN Statutes 116J.401, Subd. 3., certain data provided in this application is private data; this includes data collected on individuals pursuant to the operation of the Job Creation Fund Program. BUSINESS CERTIFICATION: Financial Assistance Certification: I hereby certify that the Job Creation Fund program is necessary to my business start- up or expansion and that without the Job Creation Fund my business start-up or expansion project would not happen to the extent outlined in the Job Creation Fund Application. I certify that I will not count any existing positions or employees moved or relocated from another of Minnesota facility where my business conducts operations as new permanent full-time employees for the purposes of fulfilling requirements of the Job Creation Fund Program. I certify I will not terminate, lay-off, or reduce the working hours of an employee for the purpose of hiring an individual to fulfill the requirements of the Job Creation Fund Program. I certify that I will pay prevailing wages as required under the laws of the State of Minnesota if applicable. I certify I will enlist the services of the Workforce Center Business Services and will sign a Job Listing Agreement as a condition to receiving funds in excess of $200,000 from the MN Department of Employment and Economic Development. I have read the above statements and I agree to supply the information requested to the MN Department of Employment and Economic Development, Office of Business Finance with full knowledge of the information provided herein. I certify that all information provided herein is true and accurate and that the official signing this form has authorization to do so. Name/Title of Business Official: Signature of Business Official: Date: LOCAL GOVERNMENT CERTIFICATION: I hereby certify that as the local government contact for the proposed Job Creation Fund project, I have reviewed the application and business information. I agree to work with the Job Creation Fund Program business applicant to supply information requested by the MN Department of Employment and Economic Development, Division of Business and Community Development. Name/Title of Local Government Contact: Signature of Local Government Contact: Date 6 102214