Business Incentive Request

BUSINESS INCENTIVE REQUEST

Parties and Recitals

Applicant Name:   Agency Name:

WHEREAS, the Agency has authority to consider and grant financial and non-financial incentives to support private business investment that demonstrably advances local economic development and public policy objectives; and

WHEREAS, Applicant has submitted a proposal describing a business project for which Applicant requests certain incentives from the Agency, and has represented that the project will create specified public benefits, including new employment opportunities and capital investment; and

WHEREAS, the parties intend to record the terms, conditions and performance obligations applicable to any incentive provided by Agency to Applicant pursuant to this Business Incentive Request and any subsequent award or agreement.

Applicant Information

Project Summary and Scope of Work

Incentive Requested

Select requested incentive types (check all that apply):

Tax Abatement    Grant/Rebate    Low-Interest Loan    Infrastructure Assistance    Workforce Training Support

Payment Terms

Payment of any awarded incentive shall be made to Applicant only upon satisfaction of the conditions set forth in the disbursement schedule and subject to Agency approval of required documentation. Applicant acknowledges that funds may be subject to repayment or clawback in accordance with the terms of any award agreement.

Term and Termination

The term of any incentive award shall commence on Start Date and continue through End Date, unless earlier terminated in accordance with this section.

Start Date:    End Date:

Either party may terminate an awarded incentive for material breach after providing Notice Period days' written notice and a reasonable opportunity to cure. Notice Period (days):

Termination for cause shall entitle Agency to all remedies available at law or equity, including recovery of disbursed funds where Applicant has materially failed to perform or has made material misrepresentations.

Performance, Reporting and Remedies

Confidentiality

Confidential Business Information submitted with this request will be treated in accordance with applicable law. Applicant shall clearly identify materials believed to be confidential at time of submission. Agency may disclose information where required by law or as necessary to evaluate the request, subject to applicable confidentiality protections.

Governing Law

This request and any resulting award or agreement shall be governed by the laws of the State of without regard to its conflict of laws principles.

Entire Agreement

This Business Incentive Request, together with any written award, agreement, schedules and attachments, constitutes the entire understanding between the parties with respect to the subject matter and supersedes all prior or contemporaneous oral or written agreements. No modification shall be effective unless in writing and signed by both parties.

Certifications and Acknowledgements

By signing below, Applicant certifies that all information provided in this request is true, complete and accurate to the best of Applicant’s knowledge, that Applicant has authority to submit this request, and that Applicant understands that submission of this request does not create any obligation on the part of Agency to provide incentives.

Authorized Representative Name:

Authorized Representative Title:

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