2. PORTLAND INDUSTRIAL DEVELOPMENT BOARD

   100 SOUTH RUSSELL STREET, PORTLAND, TN 37148

4. LOCATION OF PROJECT

6. Is the project located in the City of Portland?*
   -- Select One --YesNo
7. What county is the project located in?*
   -- Select One --Sumner CountyRobertson County
8. What IDB Board will you be using as the primary?*
   -- Select One --Sumner County IDBRobertson County IDB

10. APPLICANT

12. Company Name*
14. Type of Entity and State of Organization*
16. Federal Employer Identification Number*
18. City, State, and Country of all additional locations*
20. Company Representative*
21. Title
23. Address*
25. City*
26. State*
27. Zip Code*
29. Phone Number*
30. Fax Number
32. Email Address*
34. Description of Principal Business*
36. Does the Entity own other businesses?*
    -- Select One --YesNo
37. If so, under what name(s)?
39. City, State, and Country of all locations
41. Name & Address of any of the following involved in the project
43. Legal Counsel*
44. Adress*
46. Engineer*
47. Address*
49. Architect*
50. Address*
52. General Contractor*
53. Address*

55. Project Overview

57. Type of Project*
    -- Select One --Project ExpansionRetention/ExpansionNew Location
59. Does the project involve a plant/ facility closing?*
    -- Select One --YesNo
61. If “yes,” where is plant/facility moving from and where is it going?
63. Project Location and Ownership*
65. Address*
67. City*
68. State*
69. Zip Code*
71. Phone Number*
72. Fax Number
74. Current Property Owner*
76. Current Property Use*
78. Is there a brownfield agreement on the site*
    -- Select One --YesNo
79. Are there any historic buildings on the site?*
    -- Select One --YesNo
80. Is the property located in a Portland redevelopment area?*
    -- Select One --YesNo
82. If yes, please describe the history and recognition:
84. Project Description: Provide a brief description of the intended use for the property after the project is completed.*

86. Include latest property tax statement from Sumner and/or Robertson County Assessor’s Office (Include both real and existing tangible personal property).  All outstanding city and county taxes must be paid in full prior to development assistance requests being approved. 

88. Tax parcel ID number(s)*
89. Current assessment(s)*
91. Current tax bill*
93. City*
95. County*
97. Estimated assessment after the project is completed:*
99. City*
100. County*
102. Estimated Tax Bill after the project is completed:*
104. City*
105. County*
107. Current Sales Tax Generation (if applicable)
108. Estimated Sales Tax Generation (if applicable)

110. INVESTMENT OVERVIEW

     New Capital Investment

112. 
     

     Year One

114. Real Property $*
115. Equipment $*
116. Other Personal Property $*

118. Year Two

120. Real Property $*
121. Equipment $*
122. Other Personal Property $*

124. Year Three

126. Real Property $*
127. Equipment $ *
128. Other Personal Property $*
130. Financing plan description including a statement of sources and use of funds: *

132. CONSTRUCTION TIMELINE ESTIMATE

134. Start Date*
135. Completion Date*

137. LABOR NEEDS

139. 
     

     Year One

141. Full-Time*
142. Estimated Wages*
144. Part-Time*
145. Estimated Wages*
147. Seasonal*
148. Estimated Wages*
150. Management*
151. Estimated Wages*

153. Year Two

155. Full-Time*
156. Estimated Wages*
158. Part-Time*
159. Estimated Wages*
161. Seasonal*
162. Estimated Wages*
164. Management*
165. Estimated Wages*

167. Year Three

169. Full-Time*
170. Estimated Wages*
172. Part-Time*
173. Estimated Wages *
175. Seasonal*
176. Estimated Wages*
178. Management*
179. Estimated Wages*

181. Year Four

183. Full-Time*
184. Estimated Wages*
186. Part-Time*
187. Estimated Wages*
189. Seasonal*
190. Estimated Wages*
192. Management*
193. Estimated Wages*

195. Year Four

197. Full-Time*
198. Estimated Wages*
200. Part-Time*
201. Estimated Wages*
203. Seasonal*
204. Estimated Wages*
206. Management*
207. Estimated Wages*

209. Year Five

211. Full-Time*
212. Estimated Wages*
214. Part-Time*
215. Estimated Wages*
217. Seasonal*
218. Estimated Wages*
220. Management*
221. Estimated Wages*

223. Number of New Jobs

225. Production*
226. Maintenance*
227. Office*
228. Management*
230. Describe any public benefit not outlined above
232. Financial Information

     Attach copies of the most recent, preferably audited financial statements.  

235. Certifications

     This application is made in order to induce the City of Portland, Sumner and/or Robertson County and the Industrial Development Board of the City of Portland to grant financial incentives to the applicant and sponsor. Applicant and sponsor represent and warrant that the statements contained herein or attached hereto are true and correct to the best of their knowledge and include all information materially significant to the board and its consideration of this application. 

     Applicant agrees to pay all reasonable costs, fees and expenses incurred by the Board in connection with the project described herein and this application, whether or not the financial incentives are granted or the project built. 

237. Electronic Signature Agreement*

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
239. First Name*
240. Last Name*
242. Electronic Signature*
243. Date*
Leave This Blank:


245. 1. Receive an email copy of this form.
246. Email address

     This field is not part of the form submission.

247. Submit

* indicates a required field