Issuance of Industrial Revenue Bonds (IRB) Application

General Information

Date of request*

Firm address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Firm phone number*

Name/title of responsible officer*

Phone*

Names & addresses of all persons or corporations who would be obligated as either applicant or personal guarantors of the bond documents:

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Names & addresses of the principal officers and directors of the applicant:

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Nature of applicant's business*

The products to be assembled or manufactured or service to be rendered*

Applicant's attorney*

First Last

Phone*

Applicant's bond counsel*

First Last

Phone*

Applicant's bond underwriter*

First Last

Phone*

Estimated amount of issue*

Number of years to retire bonds*

List all previous industrial revenue bond issues of applicant or parent company or subsidary*

Describe all threatened or pending litigation and legal claims or regulatory issues*

Nature of Improvements

Amount requested for purchase of land ($xxx)*

Amount requested for land improvements (buildings)*

Amount requested for machinery and equipment*

Capitalized debt service*

Underwriting expense*

Cost of issuance*

Other (including refunding of existing IRB's)*

Total request*

IRB Proposal

Will the issue refinance an existing project?*

Is the proposed project an expansion or replacement of another existing facility?*

Is the applicant presently located in the City of Pittsburg?*

Name and address of contractor and/or architect*

What type of equipment will be financed?*

If the applicant will be in competition with local firms, (a) name the firms*

(b) describe nature of the competition*

Marketing of Bonds

Has a bond underwriter submitted an analysis indicating that the tenant's bond are marketable?*

If yes, attach a copy to this application

Will the bonds be sold as a public offering or privately placed?*

Have arrangements for the marketing of the bonds been made?*

Has the tenant investigated conventional financing?*

Does the tenant intend to purchase all or any part of the industrial revenue bonds?*

Proposed Location

Location of the proposed facility*

If facility is a proposed expansion or replacement of another plant, state size and location of current operations

What percentage of the facility will be occupied by the applicant?

Is the prospective location properly zoned?

If a zoning change is pending, cite application number and present status. If application has not been made, briefly describe what change will be needed and plans for submitting application

If unusual demands for water or sewer will be made, specify the demands

Ownership & Management

Describe the organixzational structure of applicant (proprietorship, partnership, subsidiary, corporation, etc.)*

Note relationship to a parent company

Financial Responsibility

How many years has the applicant been in business?*

What amount is the applicant to deposit in a reserve account for payment of debt service?*

What portion of the project is being financed from other company funds (in addition to bond issue)?*

Please explain*

Describe all threatened or outstanding litigation*

Attach proforma statements for the first five (5) years of operation after issuance of the bonds, including revenue projections, operating expense projections, and a debt amortication schedule

Tax Exemption/Payment

Will the applicant request an ad valorem tax exemption?*

If yes, what does applicant intend to propose as an annual payment in lieu of taxes?*

Measure of Economic Growth and Benefit

What dollar amount of sales is contemplated?*

What percentage of sales wil be sold locally?*

What is the estimated amount of merchandise and services purchased locally, per year?*

How many people will the project employ?*

Professional*

Technical

Clerical

General Labor

Number of current full-time employees at applicant's present location

In order to facilitate the timely processing of the application, please attach as part of the proposal the following items

Certified copies of applicant's financial audits for the past three (3) years*

Applicant's most recent annual or quarterly financial report.*

Interim financial statements, to date, for the current fiscal year.*

A financial audit, current to date, for each personal guarantor certified by a certified public accountant and the guarantor.*

Applicant's tax returns as well as the tax return of each guarantor for the past three years.*

Applicant should be aware that additional financial data shall be required if requested by the City Manager, City Attorney, Bond Counsel, or the Bond Underwriter.

Attached hereto is a copy of the GUIDELINES OF THE CITY OF PITTSBURG, KANSAS, RELATING TO THE ISSUANCE OF INDUSTRIAL REVENUE BONDS for informational purposes. However, the applicant acknowledges and agrees that said document, as well as this application, is a set of guidelines and an of the provisions stated therein may be waived or added to at the discretion of the Pittsburg City Commission. IRB Guidelines