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FINAL CHECKLIST (please mark and enclose the following items before submitting): <br />TAB 1 TAB 4 <br />® <br />Signed Application Form <br />® <br />Line Item Budget <br />® <br />Proposal Narratives <br />® <br />Detailed Cost Estimates <br />Reuse Project Description <br />TAB 5 <br />Company & Job Description <br />® <br />Site Control Documents <br />Building Description <br />® <br />Building Assessments <br />Description of the Renovation Project <br />Statement of Tax Value <br />Weekly Wage Computation Work <br />Sheet <br />Article of Incorporation if a Start-up <br />business <br />TAB 2 <br />TAB 6 <br />® <br />Job Commitment LetterE <br />® <br />Photographs <br />❑ <br />NC Unemployment Insurance 101 <br />® <br />Project Contacts <br />Forms <br />TAB 3 <br />® <br />Proof of Funding Availability Letters <br />Notes: <br />® <br />Local Govt Letter Resolution <br />CERTIFICATION BY CHIEF ELECTED OFFICIAL <br />The attached statements and exhibits are hereby made part of this application, and the undersigned <br />representative of the applicant certifies that the information in this application and the attached statements and <br />exhibits is true, correct, and complete to the best of his/her knowledge and belief. He/She further certifies: <br />1 as Authorized Representative, he/she has been authorized to file this application by Formal action of the <br />governing body; <br />2 that the governing body agrees that if a grant and/or loan is awarded, the applicant will provide proper <br />and timely submittal of all documentation requested by the Grantor Agency; <br />3 that the applicant has substantially complied with or will comply with all federal, state, and local laws, <br />rules, regulations, and ordinances as applicable to this project; <br />4 that the applicant has analyzed the participating companies' financial and organizational strength in <br />regard to the to the ability to successfully meet the terms of the job creation and maintenance <br />requirements, carry out the renovation project, as well as, the ability to meet the potential for repayment <br />of loan funds; and <br />5 that the project is in accordance with the applicant's economic development plan and that the <br />applicant has investigated any impact that the project may have on existing businesses within the <br />applicant's jurisdiction. <br />SIGNATURE OF CHIEF ELECTED OFFICIAL/AUTHORIZED REPRESENTATIVE <br />Amy Dalrymple <br />TYPED NAME <br />11/07/2016 <br />DATE <br />Chair <br />TYPED TITLE <br />(188 <br />Page 14 of 14 <br />Building Reuse Program - North Carolina Department of Commerce February 1, 2016 <br />