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BK:00025 P&0030 <br />FINAL CHECKLIST (please mark and enclose the following items before submitting): <br />TAB 1 <br />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 />Building Description <br />® <br />Site Control Documents <br />Company & Job Description <br />® <br />Building Assessments <br />Description of the Renovation Project <br />Statement of Tax Value <br />TAB 2 <br />Environmental Assessment <br />® <br />Job Commitment Letters <br />TAB 6 <br />® <br />INC Unemployment Insurance 101 Forms <br />® <br />Photographs <br />TAB 3 <br />® <br />Project Contacts <br />® <br />Funding Commitment Letters <br />® <br />Local Govt Letter of Commitment <br />Notes: <br />Submit to: Rural Economic Development Center, Inc. <br />Building Reuse Grants Program <br />4021 Carya Drive <br />Raleigh, NC 27610 <br />CERTIFICATION BY CHIEF ELECTED OFFICIAL <br />The attached statements and exhibits are hereby made part of this application, and the undersigned representative of the applicant certifies <br />that the information in this application and the attached statements and exhibits is true, correct, and complete to the best of his/her <br />knowledge and belief. He /She further certifies: <br />as Authorized Representative, he /she has been authorized to file this application by formal action of the governing body; <br />that the governing body agrees that if a grant from the Building Reuse and Restoration Grants Program as funded by the General <br />Assembly through the North Carolina Economic Infrastructure Fund, the applicant will provide proper and timely submittal of all <br />documentation requested by the Grantor Agency (Rural Center); <br />that the applicant has substantially complied with or will comply with all federal, state, and local laws, rules, regulations, and <br />ordinances as applicable to this project; <br />that the applicant has analyzed the participating companies' financial and organizational strength in regard to the to the ability to <br />successfully meet the terms of the job creation and maintenance requirements, carry out the renovation project, as well as, the <br />ability to meet the potential for repayment of loan funds; and <br />that the project is in accordance with the applicant's economic development plan and that the applicant has investigated any impact <br />that the project may have on existing businesses within the applicant's jurisdiction. <br />Linda Shook Chairman <br />TYPED NAME TYPED TITLE <br />DATE <br />Vacant Building Category July 2011 10 <br />