Iowa Project Questionnaire HiddenDate MM slash DD slash YYYY Name of Business Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Contact InformationName First Last PhoneEmail* Enter Email Confirm Email Please check those that are applicable. Expansion of Iowa Company New Location in Iowa 1. Describe the company, its products, and the customer base2. Describe the project including location (city / county), proposed project activities, and estimated start date3. Does the business plan to lease the facility? Yes No If yes, please provide the Annual Base Rent Payment (lease payment minus property taxes, insurance, and operating / maintenance expenses) in the budget below, and the only major renovation costs your company expects to incur.4. Please estimate the project budget to the best of your abilityBase Rent (3 years)AmountBase Rent - Estimated Timeline (over 3 years)Estimated Timeline (over 3 years)Tenant ImprovementsAmountTenant Improvements - Estimated Timeline (over 3 years)Estimated Timeline (over 3 years)Land Acquisition (if not leased)AmountLand Acquisition (if not leased) - Estimated Timeline (over 3 years)Estimated Timeline (over 3 years)Site Preparation (if not leased)AmountSite Preparation (if not leased) - Estimated Timeline (over 3 years)Estimated Timeline (over 3 years)Building Acquisition (if not leased)AmountBuilding Acquisition (if not leased) - Estimated Timeline (over 3 years)Estimated Timeline (over 3 years)Building Construction (if not leased)AmountBuilding Construction (if not leased) - Estimated Timeline (over 3 years)Estimated Timeline (over 3 years)Building Remodeling (if not leased)AmountBuilding Remodeling (if not leased) - Estimated Timeline (over 3 years)Estimated Timeline (over 3 years)Mfg. Machinery & Equip.AmountMfg. Machinery & Equip. - Estimated Timeline (over 3 years)Estimated Timeline (over 3 years)Other Machinery & Equip.AmountOther Machinery & Equip. - Estimated Timeline (over 3 years)Estimated Timeline (over 3 years)Computer HardwareAmountComputer Hardware - Estimated Timeline (over 3 years)Estimated Timeline (over 3 years)Computer SoftwareAmountComputer Software - Estimated Timeline (over 3 years)Estimated Timeline (over 3 years)Furniture & FixturesAmountFurniture & Fixtures - Estimated Timeline (over 3 years)Estimated Timeline (over 3 years)Research & DevelopmentAmountResearch & Development - Estimated Timeline (over 3 years)Estimated Timeline (over 3 years)Other (specify)AmountOther (specify) - Estimated Timeline (over 3 years)Estimated Timeline (over 3 years)TotalTotal5. Employment:Describe the number of employees and the pay scale that would result from this projectJob CategoryNo. of JobsCreated (C) or Retained (R)Starting or Current Wage RateWage at 36 months following the award “Retained job” means an existing full-time, permanent position which is at risk of elimination in Iowa, if the project does not proceed. Verification may be requested during the application process.6. "Sufficient benefits" Financial assistance programs require that companies provide a certain level of medical insurance to full time, permanent employees. Please answer the following questions about your company’s benefits:How many full-time, permanent employees does your company currently employ within the U.S.?b) What percentage of the total premium costs for a standard medical plan for single employee coverage does your company pay?What is the deductible associated with this plan?c) What percentage of the total premium costs for a standard medical plan for family coverage does your company pay?What is the deductible associated with this plan?d) Does your company provide additional benefits to full time employees?Benefits counted toward monetary equivalent could include medical and dental insurance plans, pension, retirement, profit-sharing plans, child care services, life insurance coverage, vision insurance coverage, and disability insurance coverage. Yes No If yes, what benefits?Other Project Information7. Do you have interest in an EB-5 loan?The EB-5 loan is a low-cost form of alternative financing, for qualifying projects over $30 million, through a program with federal oversight. Yes No 8. Is the project located on a Brownfield or Grayfield site? Yes No Not sure If yes, describe here.9. NAICS Code for primary business operations, if known:Locate your NAICS code, here. 10. If known, what other sources of funds have been identified for the project? 11. Have you been in contact with any state or local/community development representatives in the State of Iowa? Yes No If so, whom? 12. Is the Business actively considering locations outside of Iowa? Yes No If yes, please explain. Additional InformationIf direct financial assistance is provided, acceptable collateral will be required to secure the financing. Types of collateral that the Board may require include: an irrevocable letter of credit, escrow account, or dedicated certificate of deposit. As an alternative, your company can elect to pledge no collateral and draw the available funding at the end of the five year contract. The amount of funding at that time will be based on actual contract compliance. The IEDA Board has a local community match policy. If your company proceeds to a full application, participation at the local level should be anticipated.Note: This questionnaire is neither an award nor a contract. It is designed to establish basic program eligibility and provide estimates of potential assistance according to the details provided. The estimates provided are for sample purposes only. All actual assistance amounts will be determined based on completion of a full application, final approval by the board, and satisfactory compliance with all contractual terms. All awards of assistance are ultimately subject to the requirements of the applicable Iowa law authorizing IEDA’s programs.