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					                                                                           CERTIFIED SITES FORM

 Site ID                  Certified Site Information Request                              Clarification on Requested Information               Checklist / Comments
 1                                                                                   OWNERSHIP INFORMATION
 1.1.          Provide the name, address and phone number of the legal                   In a letter, provide the name(s), address and
               property owner of record;                                                 phone number of legal owners of the proposed
                                                                                         site to be certified. Please provide e-mail address
                                                                                         if appropriate. Please state in the letter if the
                                                                                         proposed certified site property is in the city
 1.2.          Include a letter from the property owner stating fixed sale price;        This sale price should be listed in dollars and
                                                                                         should be consistently referenced throughout the
 1.3.          Provide evidence of clear title to the property through certificate
                                                                                         Provide a letter from a licensed attorney stating
               of title prepared by a Title Company, licensed abstractor, or
                                                                                         clear title. Review committee is looking for a "fee
               lawyer.; or
                                                                                         simple title" here. This is not needed if applicant
 1.3.1.            A copy of the title insurance or a title opinion from a licensed
                                                                                         can provide a title insurance policy.
                   attorney can also show evidence of clear title;
 1.4.          Provide documentation of all easements, liens, rental contracts,
               or other physical or legal encumbrances associated with the               Documentation required.
               property; and
 1.5.          Indicate if site is in existing city limits and, if not, are plans
                                                                                         Documentation required.
               underway to annex into the city.
 1.6.          Provide a voluntary real property disclosure form from the
                                                                                         This requirement is optional.
               owner. (Optional)
 2                                                                                    PROPERTY INFORMATION
 2.1.       Provide the following about the parcel to be listed:
 2.1.1.     Location information including:              Name of site, if applicable;              Address of site (street number if it exists or best available
                                                                                         Provide a plat map that shows (section, township,
                                                                                         and range). Clearly identify proposed site. Also              Section;
                                                                                         include longitude and lattitude of the site.              Township;              Range;              Plat map
 2.1.2.            Parcel size in square feet and acres as recorded by local
                                                                                         Documentation required.
                   assessor; and
 2.1.3.            Provide site specific aerial photo (should cover a half mile
                                                                                         Provide area photo that shows additional half mile
                   radius around the property).
                                                                                         radius around the property which clearly identifies
                                                                                         the site's boundaries, structures, wooded areas,
                                                                                         creeks (wetland or flood plain possiblilities), and
                                                                                         road system. Google Earth or ML 1 may work;
                                                                                         might check with county courthouse may have
                                                                                         photos in tax department.            Must include date of capture; and                                 Must include on map.            Sufficient detail to show large existing surface features
                                                                                       Make sure map is of sufficient size.
                     such as homes, outbuildings, tree and brush lines, etc.
 2.1.4.           Topography Map                                                       May be taken from ML 1.
 2.1.5.           Include record of the current taxes paid and current tax rate
                                                                                       Provide record of millage rate and parcel
                  and parcel identification number.
                                                                                       identification number with description. This can
                                                                                       be shown by providing most recent tax bill by the
                                                                                       assesor, make sure all taxing districts are
                                                                                       represented. Property identification must meet
                                                                                       other legal descriptions of the property referenced
                                                                                       in the application. If proposed property has
                                                                                       multiple tax numbers, place tax numbers on map
                                                                                       differentiating number with each parcel.

 2.2.       Provide the following about the sale or lease of the property:
 2.2.1.           Price (or rent) per square foot or acre;
                                                                                       Information should have been provided in Section
 2.2.2.           Total asking price (or annual rent and term of lease) for the
                                                                                       1.2 of the application.
                  parcel being listed;
 2.2.3.           Copy of realtor listing and name of licensed broker with listing     Realtor agreement should include contact
                  or leasing agreement                                                 information of realtor, terms and dates in the
                                                                                       agreement, along with signatures.
 2.2.4.           Copy of an option to purchase the property , listing
                  agreement, or leasing agreement; and                                 Provide a copy of Option to Purchase Property or
                                                                                       Right of First Refusal. Should be provided by local
 2.2.5.           Documentation of right of first refusal.
                                                                                       economic development group or if not entered
                                                                                       into with the local ED group, copies of documents
                                                                                       by property owner entered into with another
                                                                                       party. Review committee is looking for terms,
                                                                                       dates, conditions, and signatures.

 2.2.6.           Any additional information regarding required easements,
                                                                                       In a letter, identify any other claims against the
                  leases or licenses necessary to develop or use the site.
                                                                                       property or conditional uses by property owner,
                                                                                       private citizen or governmental entities.

 3                                                                ENVIRONMENTAL AND CULTURAL INFORMATION
 3.1.       Phase 1 Environmental Assessment (ASTM)
 3.1.1.          Provide name and contact information of entity conducting
                                                                           Documentation required.
                 Phase I Environmental Assessment;

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                                                                         CERTIFIED SITES FORM

 Site ID                   Certified Site Information Request                          Clarification on Requested Information                   Checklist / Comments
 3.1.2.                Provide a copy of the Phase I Environmental Assessment OWNERSHIP INFORMATION
                       Report developed by a qualified professional in the       To complete a Phase I Environmental site
                       environmental field. The report shall have been completed assessment, the community may either hire a
                       within the last 180 days and in conformance with ASTM     qualified environmental professional or the
                       standard E1527-05. The Phase I needs to include at        community can enroll in the MODNR Brownfield
                       minimum, the following:                                   Voluntary Cleanup Program. For questions regarding
                                                                                 the MODNR program, please contact Missouri
                                                                                 Department of Natural Resources, Hazardous Waste
                                                                                 Program, P.O. Box 176, Jefferson City, Missouri 65102-
                                                                                 0176 (1-800-361-4827 or 573-526-8913)                  Performance of on-site visit to view present conditions
                           (chemical spill residue, die-back vegetation, etc.);                  Hazardous substances or petroleum products usage
                           (presence of above or underground storage tanks,
                           storage of acids, etc.); and                  Evaluate any likely environmentally hazardous site
                           history;                  Evaluation of risks of neighboring properties upon the
                           subject property;                  Documentation of interviews with person
                           knowledgeable regarding the property history (past
                           owners, present owner, key site manager, present
                           tenants, neighbors);
                                                                                    Documentation required, pursuant to ASTM                  Develop a history of parcel back to first developed used
                                                                                    standard. Enrollment in the Brownfield/VCP program
                           or 1940 using a combination of,
                                                                                    is not required for certification.                   Municipal or county planning records to check prior
                              land owner usage and permits granted;                   Historic aerial photography of the vicinity;                   Examine chain of title for Environmental Liens and/or
                              Activity and Land Use Limitations (AULs);                    Review current and past city directories; and                   Conduct file searches with appropriate public
                              agencies (Soil and Water Conservation Commission,
                              fire department, county health department, etc)
                              having oversight relative to water quality and soil
                              contamination issues.
 3.1.3.            Examine current USGS maps to scrutinize drainage patterns
                   and topography.
 3.1.4.            Submit the Phase I Environmental Assessment to the Missouri
                   Department of Natural Resources, Hazardous Waste Program,
                   P.O. Box 176, Jefferson City, Missouri 65102-0176 (1-800-361-
                                                                                        Documentation reguired.
                   4827 or 573-526-8913) and provide the MDNR "Letter of No
                   Further Action". If no such letter is offered, proceed to Phase
                   II Environmental Assessment.
 3.2.         Phase II Environmental Assessment (ASTM) (Phase II only applicable if DNR does not offer a "Letter of No Further Action" for the property.)
 3.2.1.            If the Phase I ESA indicated the possible presence of
                   contamination on the site, provide the name and contact
                   information of the entity conducting the Phase II
                   Environmental Assessment;
 3.2.2.            Provide a copy of the Phase II Environmental Assessment
                   Report developed by a qualified professional in the
                   environmental field. The Phase II ESA shall indicate, at
                   minimum, the following:               The results of investigation of the identified contaminants If a Phase II is recommended, or further remediation
                        and recommendation for further assessment;                  is necessary, this will not prohibit a successful               A detailed remediation plan for monitoring, removal or      application to DED. However, it will be noted on ML1
                        mitigation of contaminants, as necessary. The remediation that further action is required before the site is ready
                        plan shall conform to state requirements. Remediation       for development.
                        plans shall have been submitted to the appropriate
                        agencies for review and approval. Provide copies of
                        correspondence with the governing agency and approvals
                        of proposed plans.
 3.2.3                  Perform remediation necessary to clear the site in
                        accordance with the Voluntary Cleanup Program
 3.2.4                  Gain "Letter of No Further Action" from Department of
                        Natural Resouces and include copy with application
 3.3.         Regional Air Quality
 3.3.1.            State whether the site is in an ambient air quality non-
                                                                                        EPA-designated non-attainment areas in Missouri:
                   attainment or maintenance area and if so, list pollutants and
                   criteria of compliance;
 3.3.2.             Document prevailing wind direction associated with property
                                                                                     Information can be obtained from local airport.

 3.4.         Wetland or Waters of the U.S. Boundaries (if applicable)
 3.4.1.            Provide a copy of a map showing the limits of any wetlands or
                                                                                     To make a wetlands map, access the US Fish &
                   other environmentally sensitive areas on the parcel.
                                                                                     Wildlife National Wetlands Inventory Mapper:
 3.4.2.             Provide a wetlands determination and delineation and             NRCS Wetlands Determination Contacts:
                    functional assessment completed by a qualified wetland 
                    biologist.                                                       etland_reponsibility0708.pdf

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                                                                            CERTIFIED SITES FORM

 Site ID                  Certified Site Information Request                                 Clarification on Requested Information               Checklist / Comments
 3.4.3.           Provide documentation that the U.S. Corps of Engineers and OWNERSHIP INFORMATION
                  applicable agencies have reviewed and concur with the         US Army Corps of Engineers District Map &
                  findings.                                                     Contacts:

 3.5.       Floodplain Boundaries (if applicable)
 3.5.1.          Provide documentation that the city is a member in good
                 standing of the National Flood Insurance Program (NFIP);                  NFIP Community Status Book (scroll to MO & click
                                                                                           PDF , print page listing community):

 3.5.2.           Provide a copy of an updated Federal Emergency                           If a FEMA FIRM Map is not available, a FEMA
                  Management Agency (FEMA) Flood Insurance Rate Map                        Firmette Map may be created at the following
                  (FIRM) for the parcel and surrounding areas.                             website.
 3.6.       Threatened or Endangered Species Review
 3.6.1.           Provide information from the U.S Fish and Wildlife and the               U.S. Fish & Wildlife Service
                  Missouri Department of Conservation identifying both the                 Columbia Ecological Services Field
                  presence and species of state and federal threatened and                 Charlie Scott, Field Supervisor
                  endangered species and their habitat within the boundary of              101 Park DeVille Drive, Suite A
                  the parcel, or absence thereof.                                          Columbia, MO 65203-0057
                                                                                           Phone: 573-234-2132
                                                                                           * MO Dept. of Conservation online Heritage
                                                                                           Review Report :

 3.7.       Archeological and Cultural Resources
 3.7.1.          Provide a letter from the Department of Natural Resources              Submit to the SHPO the "Section 106 Project
                 State Historic Preservation Office (SHPO) regarding the likely         Information Form" found at the following link, along
                 presence of significant archeological or historic resources at or      with relevant attachments. Reviews may take 30
                 on the site;                                                           days or longer.
 3.8        Soil Conditions
 3.8.1.     Provide a copy of the soils investigation report performed by a
            qualified Missouri geo-technical or engineer based on preliminary
            site and grading plans. The report should contain at a minimum;    Location of soil borings (3 borings for site requirement plus 1 for
                                                                                           Documentation required. For clarification on
            every additional 20 acres)
                                                                                           qualified firm or engineer to conduct this study,    Indication of presence of suitable soils for construction
                                                                                           please contact either Joel McNutt or Jo Ann Dent    BPI - soils compatibility statement
                                                                                           at 573-751-9045.    Any anticipated cut and fill factors    Recommendations for paving thickness in parking and driveway
            areas    And any other pertinent information to the development of the site

 3.9        Seismic Activity
 3.9.1      Provide intensity rating based on Mercali Scale as measured by the
                                                                                           SEMA Mercalli Scale:
            State Emergency Management Agency
 4                                                                                      ACCESS INFORMATION
 4.1.       Site Access
 4.1.1.           Provide a summary that includes the following:            Width of roadway;                                                     In a concise manner, address all of these questions            Type (i.e. Interstate, 4 - Lane Highway, etc.);                       as thoroughly as you can. Review committee is            Construction Type (asphalt, gravel, concrete, etc.);                  specifically looking for how vehicles, large and            Is access controlled by stoplight or other means;                     small, have access to and from the site for            Condition of perimeter streets or roads and available of              industrial purposes.
                     access to the site from each of these streets.            Traffic impact study and findings                                     Documentation required.            Scheduled improvements                                                Documentation required.
 4.1.2.           Provide the name and contact information of agencies                     Provide the contact information of the chief
                  responsible for the review and permitting of access to the site.         administrative person in charge of zoning for the
                                                                                           proposed certified site.
 4.2.       Rail Access
 4.2.1            If a Class 1 railroad or short line railroad serves site, provide a
                  letter from them detailing their services and capabilities at the        Provide a letter from the rail representative
                  site (trans-loading, switching, offloading, warehousing, etc.)           stating capabilities at the site and answer if
                                                                                           switching is done by the class I rail provider or a
 4.2.2            If rail opportunities are accessible to your community's site,           short-line railroad provider. On a map, show how
                                                                                           the rail serves the site and draw spur if one is not          Provide a map detailing how rail can be brought into the site;           shown. Review committee wants to see if the
                  and                                                                      proposed spur has a long curve on the property, if          A cost estimate (when estimating rail spur extensions, please            the spur is not present, identify proposed route,
                  use one-quarter mile as a standard length of a rail spur and             cost of spur and the amount of time needed to
                  cost of switch).                                                         build the spur. If this information is being
                                                                                           provided by the local economic development
                                                                                           professional, provide name of railroad and contact
                                                                                           information for railroad representative.

 4.3.       Airport Access
 4.3.1.           Name of nearest airport
 4.3.2.           Provide details on the type of airport, including:            Miles to site;
                                                                                           Information can be obtained from local airport.            Length of runway; and

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                                                                                CERTIFIED SITES FORM

 Site ID                     Certified Site Information Request                            Clarification on Requested Information                Checklist / Comments
Number                                                                                   Information can be obtained from local airport.             Night landing capability.                                OWNERSHIP INFORMATION              Fuel type sold
 4.4.       Parcel Boundary Survey
 4.4.1.            Provide a sealed copy of the boundary survey performed in
                   accordance with the 2005 Minimum Standard Detail               Provide contact information for the engineer or
                   Requirements for ALTA/ACSM Land Title Surveys.                 land surveryor, the scale used, and their registered
 4.4.2.            Provide the name and contact information for a land surveyor   stamp.
                   conducting boundary survey.
 4.5.       Fire Insurance Rating
 4.5.1.            Provide the name and contact information for the local fire
                                                                                  Provide the name and contact information for the
                   department or district;
                                                                                  chief fire official and corresponding fire district.
 4.5.2.            Provide the Fire Insurance Rating (ISO) for the site; and             Provide actual ISO rating.
 4.5.3.            Provide the distance measured to the nearest fire station.            Provide this measurement in miles. Also include
                                                                                         the type and size of fire trucks at the nearest fire
 4.6.       Utilities
 4.6.1                  Provide a single map of all existing utilities with line sizes   Provide a map of all existing utilities with line
                        noted                                                            sizes, capacities, and pressures. This will likely
                                                                                         require GIS mapping capabilities.
 4.6.2                  Electric Service, please provide the following:                Provider name and contact information;                           Provide the name of electric provider, company                A map of the lines noting the line(s) size at site               contact, and information on the size of available
                                                                                         electric line(s) serving the site. Provide map that
                                                                                         shows location of existing line(s) and capacity in
                                                                                         Kilovolts (kV). Please make distinction between
                                                                                         operating capacity and available capacity.

 4.6.3.     Natural Gas, please provide the following:            Provider name and contact information;                              Provide the name of the company, company            Line(s) size at site;                                               contact, and contact information for natural gas at            Psi at site.                                                        the site. Information should state size of line             Capacity of gas system (cubic feet);                                pounds per square inch (p.s.i). Please state             Excess capacity of gas system (cubic feet)                          capacity of the system at the site. Show location
                                                                                         of line at site as well as excess capacity of gas
                                                                                         system at the site expressed in cubic feet(c.f).
                                                                                         Natural gas is not required at site. However, if
                                                                                         property has propane tank or other, please
 4.6.4.     Water, please provide the following:            Provider name and contact information;            Capacity of water system (gallons per day);            Amount of excess capacity (gallons per day);                        Provide name of local government, wastewater            Line(s) size and psi at site;                                       district, or company serving the site. Contact
                                                                                         information for their representative, size of the
                                                                                         line (expressed in inches), pounds per square inch
                                                                                         (p.s.i.). Please identify current usage expressed
                                                                                         and excess capacity in gallons per day (g.p.d).
                                                                                         Also, indicate total system capacity by (g.p.d) and
                                                                                         current operating capacity. Feel free to include a
                                                                                         copy of the latest report sent to any governmental
                                                                                         regulatory agency such as MODNR.

 4.6.5.     Phone/Fiber, please provide the following:           Provider name and contact information;           Statement of whether there is currently fiber optics at the          Provide name of telephone companyand its
                    site and if not, provide the distance to nearest fiber optic         representative's contact information. Include the
                    point in feet or miles;                                              size and type of lines. Identify what company has
                    Name of POP provider, if one exists;                                 the point of presence (POP) serving the site and
                    Other attributes - T1 or T2 lines;                                   how far it is from the site. Include in description
                    Line(s) size at site and capacity.                                   what type of line is present (T1 or T2), and indicate
                                                                                         available capacity. If fiber is not at the site,
                                                                                         indicate the nearest fiber line and distance to it.

 4.6.6.     Solid Waste, please provide the following:            Collection provider name and contact information;            Name of landfill servicing community;                               Identify local or regional company, or local            Life of landfill servicing community;                               government responsible for operation of the most            Statement of whether the nearest landfill provider is               likely landfill and refuse hauler a company would
                     publicly or privately owned;                                        use to service the site. Identify the contact            Statement of whether there are any restrictions on the              information for the Landfill's representative and
                     type of waste that can be deposited in the landfill, and if so      permitted life of the landfill. Describe the type of
                     explain.                                                            refuge that can and cannot be deposited. Also,
                                                                                         provide a copy of the latest report sent to any
                                                                                         governmental regulatory agency (MODNR/EPA).

 4.6.7      Sanitary Sewer, please provide the following:             Provider name and contact information;             Capacity of sewer system (gallons per day);                        Provide the name of the local government,             Excess capacity of sewer system (gallons per day);                 wastewater district, or company serving the site,             Size of line and psi at the site;                                  contact information for their representative, and
                                                                                         size of the line (p.s.i). Identify current usage
                                                                                         expressed and excess capacity expressed in
                                                                                         gallons per day (g.p.d). Feel free to include a copy
                                                                                         of the latest report sent to any governmental
                                                                                         regulatory agency (MODNR/EPA).

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                                                                           CERTIFIED SITES FORM

 Site ID                  Certified Site Information Request                               Clarification on Requested Information               Checklist / Comments
 4.6.8.     Storm Sewer, please provide the following:                               OWNERSHIP INFORMATION           Provider name and contact information;           Size of line at the site.                                            Identify the name of entity responsible for storm
                                                                                         sewers at the site and their representative's
                                                                                         contact information. Provide a map depicting
                                                                                         their location and any on-site storm water
                                                                                         retention areas in relation to the site.

 5                                                                                   COMMUNITY INFORMATION
 5.1.       Post Office
 5.1.1.           Provide classification of Local post office as prescribed by the       State the services and capabilities of the post
                  Federal Post Office. This is a number system that describes            office that would servie the site such as are office
                  the capabilities of the post office.                                   delivery or pick-ups available, size of packages or
                                                                                         boxes that can be handled by postal personnel.
                                                                                         Also identify how far the post office is from the
 5.2.       Freight Service
 5.2.1.           Provide name and relevant information regarding all freight            Identify the freight companies that serve your
                  services from site.                                                    area. Please identify mileage from freight
                                                                                         provider's place of business to site.
 5.3.       Emergency Medical Response
 5.3.1.          Provide the name the entity that would provide emergency                Provide name and contact information for
                 medical services, such as the name and size of hospital and             company(s) or other entities that would provide
                 services they provide such as trauma services.                          emergency medical services to the site. Identify
 5.3.2           Provide the name of the public or private ambulance provider            closest hospital and the trauma services they can
                                                                                         provide. Also address how far the site is from the
 5.4.       Planning Agency
 5.4.1.           Provide documentation that the site and proposed
                                                                                         Provide documentation that reflects utilization of
                  development is consistent with the most recent city
                                                                                         the certified site in the city or county's most
                  comprehensive plan, if applicable.
                                                                                         recent strategic plan. If possible, documentation
                                                                                         should be provided by the chief elected official.

 5.5.       Building Department
 5.5.1.           Provide the name and contact information for the building
                                                                                         Provide the name and contact information for
                  department or agency responsible for plan approval and
                                                                                         person and/or agency responsible for
                  permitting for construction purposes, if applicable.
                                                                                         desseminating and receiving building permits, plan
                                                                                         approval and permitting. Provide a sample
                                                                                         building permit for the application.

 5.6.       Zoning Designation
 5.6.1.          Provide the name of the zoning district
 5.6.2.          Provide a copy of the zoning regulations detailing                      Provide the contact information of the chief
                 development requirements for the parcel; or                             administrative person in charge of zoning and the           If there is no zoning district, provide a copy of any                name of the zoning district (if applicable). Also,
                    applicable development requirements. This may include                provide the zoning map, site designation and
                    Conditions, Covenants and Restrictions (CC&R's),                     section of the ordinance that defines the site
                    Conditional Use Permit (CUP), Planned Unit Development               designation. If the locality does not have zoning
                    (PUD), etc. (The property must be appropriately zoned to             and the site is publicly owned or the local
                    successfully complete the requirements.)                             economic development group owns the site,
                                                                                         provide industrial covenants that have been filed
 5.6.3.           Provide a copy of any special overlay district regulations or          with the county clerk. DED is looking for allowable
                  requirements if applicable.                                            uses and prohibitions of uses for the site. Also
                                                                                         identify if zoning requirements require buffer
                                                                                         areas or special districts.

 5.7.       Police Protection
 5.7.1.           Provide distance (miles) to police/sheriff to site.                    Provide the distance from the site to the closest
 5.7.2            Provide a statement regarding the capacity of the police force;        police station or sheriff's department facility, the
                  officers per capita; officers per square mile.                         number of patrol officers and detectives
                                                                                         employed, officers per capita and officers per
                                                                                         square miles of local entity.
 5.8.       Local Support
 5.8.1.           Provide a letter of support from the Mayor and City Council
                                                                                         Provide a letter from the local government
                  supporting the marketing and development of the property.
                                                                                         supporting certified site status for the property,
                                                                                         marketing and development of the property.

 5.9        Missouri Location One
 5.9.1      Provide evidence that the site is located on Missouri Location One
            and that the community information has been updated to the most              Provide a printout of the site from ML1.
            recent information
 5.10       Miscellaneous
 5.10.1     Provide any other data that would offer potential investors with a           Provide any additional information that investors
            complete backround of the parcel. These include research on the              of business locators should know about the site
            availability of Tax Increment Financing or Tax Abatement Programs,           (special attributes) and community. Also identify
            and other information pertinent to the sale of the property.                 any incentives (financial or other) specific to the

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