SAMPLE LETTER TO BE SIGNED AFTER CITY COUNCIL APPROVES by tommyadams

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									                              ** SAMPLE LETTER **
             TO BE SIGNED AFTER CITY COUNCIL APPROVES APPLICATION




January 14, 2009

Mr. Jack Lavin
Illinois Department of Commerce
  and Economic Opportunity
620 East Adams Street
Springfield, Illinois 62701

Dear Director Lavin:

The City of Galesburg is submitting an application for a technical assistance grant under “Flexible
Funds” Pilot Program of the Community Development Assistance Program. The funds which are
deobligated/returned grant funds in the amount of $78,750 will be used to operate an
Entrepreneurship Center that will provide technical assistance and support for entrepreneurs, start-
up businesses, and existing business. The benefit to low-to-moderate income individuals will not
be less than 51% of clients served by this program.

Respectfully,




Gary C. Smith
Mayor




                                                1 of 18
                CDAP SUBMISSION CHECKLIST AND TABLE OF CONTENTS

All CDAP applications will be screened for completeness. Applicants must complete and submit
this checklist with the application. All pages of the application must be sequentially numbered.
Use the right-hand column, labeled "Page Number" to indicate the page for each item.

       One original and one copy of the application
       One Partial Packet: project information form, problem statement/project strategy, project
       budget form, location map, and local government certification form.
n/a    One Annual Audit (Under separate cover)
PROJECT INFORMATION                                                            PAGE NUMBER
____ Letter of Transmittal from Chief Elected Official                              __1___
____ Completed Submission Checklist/Table of Contents                               __2___
____ CDAP Applicant Project Information                                             __3___
____ Problem Statement/Project Strategy                                             __6___
n/a   Project Maps                                                                  ______
____ Budget Narrative                                                               __8___
n/a   Project Readiness                                                             ______
____ Project Budget                                                                 __10__
____ List of Previous CDAP Grants                                                   __11__
n/a   Analysis of Low-to-Moderate Benefit                                           ______
n/a   Low-to-Moderate Income Survey Summary, if applicable                          ______
n/a   Income Survey Worksheets and Income Survey, if applicable                     ______
n/a   Income Survey map, if applicable                                              ______
n/a   DCEO Approval and Request to Conduct Random Sample Survey, if applicable      ______
n/a _ Minority Benefit/Affirmative Housing Statement                                ______
____ Administrative Budget Detail                                                   __12__
n/a   Financial Checklist                                                           ______

DOCUMENTATION, CERTIFICATIONS, RESOLUTIONS
____ Council Resolution of Support                                                             __13__
____ Citizen Participation/Public Hearings - 7 day notice, newspaper clipping,
        publisher's certification, certified minutes, attendance sheet(s)                      __14__
____ Local Government Certifications                                                           __15__
____ Applicant/Grantee/Recipient Disclosure Certification                                      __16__
n/a  Intergovernmental Cooperation Agreement, if applicable                                    ______

ATTACHMENTS
n/a   Supporting documentation of threat to health and safety                                  ______
n/a   Council resolution committing local government funds, if applicable                      ______
n/a   Firm letters of commitment from other leveraging sources, if applicable                  ______
n/a _ Construction Cost Estimate                                                               ______
      147C Letter                                                                              __18__




                                               2 of 18
                                         CDAP APPLICANT PROJECT INFORMATION
                            TYPE OF CDAP REQUESTED:                         Flexible Funding

I.     GENERAL INFORMATION
       (Information applies only to the governmental entity. DO NOT include the name/address of the administrator.)
          APPLICANT TYPE:          ⌧ City              County             Village            Town          Township

          APPLICANT NAME (Entity):                                                  POPULATION (from most recent U.S. Census)

                   City of Galesburg                                                          33,706 (2000 Census)

          CHIEF ELECTED OFFICIAL:                                                   TITLE:
                   Gary C. Smith                                                              Mayor

          BUSINESS ADDRESS:

          Street Address    55 W. Tompkins Street
                            Galesburg, IL 61401-4408                                E-Mail:         gcs@ci.galesburg.il.us
                                       (include + 4)                                          (required)
          EXPIRATION DATE OF CURRENT TERM: May 2, 2009
          DAYTIME PHONE: (309) 343-0704                               HOME PHONE: (309)


          APPLICANT FEDERAL EMPLOYER IDENTIFICATION NUMBER:                                            37-6001160
                                                                                                       (required)
II.       GEOGRAPHICAL PROJECT INFORMATION
          This information is required for the project benefit area, not necessarily the applicant.
          COUNTY:           Knox                TOWNSHIP (OR PRECINCT NAME/NUMBER): Galesburg City Tw

          CENSUS TRACT(S): 17095-0002 to 0014               ZIP CODE FOR PROJECT BENEFIT AREA:                           61401

          STATE SENATE DISTRICT(S): 37th                              STATE HOUSE DISTRICT(S):                  74th

          U.S. CONGRESSIONAL DISTRICT(S):                  17th

III.      PROJECT INFORMATION
          AMOUNT OF CDAP FUNDING REQUESTED                            $             78,750     (Whole Dollars ONLY)

          TOTAL AMOUNT OF LEVERAGE                                    $                  0

          TOTAL COST OF PROJECT                                       $             78,750
          LEVERAGE SOURCE (if applicable):                      LOCAL (see local council resolution)
                                                                USDA Rural Development
            NOT APPLICABLE                                      IEPA           IHDA
                                                                BANK           PRIVATE
                                                                IRBB           OTHER ____________________

          PROJECT DESCRIPTION: Sustain the operation of an Entrepreneurship Center that will provide business
          planning and technical assistance to entrepreneurs, start-up enterprises, and existing business.
          NAME OF ENTITY THIS APPLICATION IS IN SUPPORT OF:                         Galesburg Regional Development Association




                                                                3 of 18
IV.      PROJECT BENEFIT INFORMATION
           Provide the following information if needed:

           TOTAL NUMBER                     NUMBER OF LMI                       PERCENT BENEFIT
           PERSONS SERVED                   PERSONS SERVED
                 90                         Total               46                        51%

                                   80% of Median                46
                                   50% of Median
                                   30% of Median


                 Number of persons by specific ethnic group benefiting from the project

                               Ethnic Category                            Total Persons         # Also Hispanic
      White                                                              75
      Black/African American                                             15
      Asian
      American Indian/Alaskan Native
      Native Hawaiian/Other Pacific Islander
      American Indian/Alaskan Native and White
      Asian and White
      Black/African American and White
      American Indian/Alaskan Native and Black/African American
      Other Individuals Reporting more than One Race

         # of female headed households              20
         # of elderly                               5



V.       GRANT APPLICATION WRITER

         CONTACT PERSON:                                               TITLE:

           Cesar Suarez                                                         Economic Development Director

         ADDRESS AND PHONE NUMBER:
         Legal Name of Agency               City of Galesburg

         Street Address            55 W. Tompkins Street                        P.O. Box______________________
                                           (required)                                    (Only if no street address)
         City    Galesburg          State   IL   Zip Code 61401-4408            E-Mail csuarez@ci.galesburg.il.us
                                                         (include + 4)                         (required)

         BUSINESS PHONE: (309) 345-3680                         FAX PHONE: : (309) 345-5703




                                                          4 of 18
VI.      GRANT ADMINISTRATOR (or CITY ADMINISTRATOR)
         (If not using an administrative agency, please complete for Local Government Contact.)
         AGENCY TYPE:           Private Firm       Regional Planning Commission ⌧ Government Agency
                                     Applicant

         AGENCY CONTACT PERSON:                                         TITLE:
           Cesar Suarez                                                           Economic Development Director

         AGENCY ADDRESS AND PHONE NUMBER:
         Legal Name of Agency                City of Galesburg

         Street Address             55 W. Tompkins Street                         P.O. Box______________________
                                            (required)                                     (Only if no street address)
         City     Galesburg          State   IL   Zip Code 61401-4408             E-Mail csuarez@ci.galesburg.il.us
                                                          (include + 4)                          (required)

         BUSINESS PHONE: (309) 345-3680                          FAX PHONE: : (309) 345-5703


         ADMINISTRATIVE AGENCY FEDERAL EMPLOYER IDENTIFICATION NUMBER:                              37-6001160
                                                                                                    (required)

VII.     PROJECT ENGINEER - NOT APPLICABLE

         NAME:                                                          TITLE:
         _____________________________________________                  ______________________________________

         Legal Name of Agency       ___________________________________________________________________

         Street Address    __________________________________ P.O. Box______________________________
                                   (required)                                  (Only if no street address)

         City _______________ State _________ Zip Code _______________ E-Mail ________________________
                                                          (include + 4)                 (required)

         BUSINESS PHONE: (______)___________________                    FAX PHONE: (______)__________________

         PROJECT ENGINEER FEDERAL EMPLOYER IDENTIFICATION NUMBER: ____________________
                                                                     (required)

GRANTEE CERTIFICATE: To the best of my knowledge and belief, the information and data provided are true and
correct. I realize that regardless of the elections made, we the grantee, are responsible to ensure compliance with all
provisions of the grant agreement and to respond to official correspondence/notifications as required within allowable
times. Further, I understand that the submission of changes to the information certified above is a grantee responsibility
and that DCEO will use information from the latest certification on file based on the date of signature. I have full
signature authority to sign on behalf of this grantee.


           __________________________________________                             ______________________
           Signature - Chief Elected Official                                            Date


This state agency is requesting disclosure of information that is necessary to accomplish the statutory purpose as
outlined under Ill. Comp. Statutes, 20 ILCS 605/46.1. Disclosure of this information is VOLUNTARY. No penalties
attach for failure to respond. This form has been approved by the State Forms Management Center.


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PROBLEM STATEMENT/PROJECT STRATEGY

PROBLEM TO BE ADDRESSED
(What is the specific problem the application seeks to address?)

The Galesburg region has experienced the loss of over 2,000 jobs since the closing of the Maytag
and Butler facilities in 2004 and 2005 respectively. The closing of these plants coupled with the
national trends of manufacturing jobs moving to Mexico or overseas to Asia has put into question
whether jobs creation through business attraction will make up for the job losses already
experienced in Galesburg. The current financial crisis and economic recession has exacerbated the
problem of replacing lost jobs and dealing with the unemployed and the underemployed in the
Galesburg region and the Counties of Knox, Warren, and Henderson. All three counties in the West
Central Region have suffered severe job losses with the latest unemployment rates of November
2008 for Henderson, Knox, and Warren Counties being 7.1%, 7.2%, and 6.5% respectively.


PROBLEM IMPACT ON COMMUNITY
(Who is most affected by the problem? and how severely?)

Job losses in the Galesburg region has caused many who previously had jobs in manufacturing to:
a) move away to large metropolitan areas such as St. Louis or Chicago to find similar paying jobs,
b) remain unemployed c) become underemployed by taking lower paying, lower skilled jobs
without benefits, or d) go back to school to relearn a new career. Such job losses as a whole have
lead to an overall population loss, loss of discretionary income, dip in new housing starts, and
increase in poverty rates. Those most severely affected have been those who lack the needed skills
or education to shift into higher skilled service jobs or open their own business.


PROBLEM RECOGNITION AND CONSEQUENCES OF INACTION
(When did the problem first became apparent? What are the long-term consequences, if no action is
taken?)

After the closure of both Maytag and Butler in 2004 and 2005, respectively, it was apparent that
local economic development resources were not sufficient to assist those who lost their jobs and
wanted to find local employment or open their own business. There wasn’t an established network
of providers or a dedicated person to assist entrepreneurs in the region to grow small businesses or
help start-up businesses.

The lack of entrepreneurial development resources in the long-term would be a loss of future
economic growth for the Galesburg region. It is well documented that small business growth and
start-ups account for 80% to 95% of new jobs created in any given year. The long-term opportunity
costs for inaction would be loss of new jobs, economic growth, population sustainability, and
community quality of life.




                                                6 of 18
PROBLEM STATEMENT/PROJECT STRATEGY (continued)

PROBLEM RESOLUTION & INADEQUACIES
(What local efforts have taken place to resolve the project? and, why have they been inadequate?)

To address the growing demand for small business and entrepreneurial development services,
various cities and chambers in the Galesburg region provided assistance on an ad hoc or impromptu
basis. While cities and chambers assisted with some preliminary items, they were not positioned to
provide comprehensive nor ongoing services in financing, consulting, and business planning.

In July 2004 a regional Entrepreneurship Center was established to serve Knox, Henderson, and
Warren Counties. The Entrepreneurship Center operated for several years serving as a gateway for
information, technical consulting and referrals for existing small business or start-ups.
Unfortunately, funding was cut on June 31, 2008. Although GREDA has committed financial
support of the Entrepreneurship Center until the end of 2008, a sustainable funding stream has not
been identified in 2009.


PROPOSED PROJECT BENEFIT TO COMMUNITY
(How will the proposed project benefit the community?)

It has become increasingly evident that a sustainable effort to support an entrepreneurial
development program is vitally important for the region’s future economic growth. The
community’s capacity to serve entrepreneurs in small businesses and start-up operations will lead to
greater job creation both in the short-term as well as for the long-term sustainability of the region.
The presence of an Entrepreneurship Center with a dedicated professional along with a supporting
network of partners will allow for: a) quicker establishment of new businesses, b) creation of job
growth for existing businesses, and c) foster a culture of entrepreneurship within the community.

The population served by the Entrepreneurship Center is approximately 77,000 in the counties of
Knox, Warren and Henderson. In any given month, 25% - 40% of Entrepreneurship Center client
flows are people of underrepresented groups: women, minorities and those with disability
challenges. These segments are starting businesses at higher rates than other segments. It is vitally
important to offer them the on-going technical assistance and mentoring for start-ups and for the
continued success of the existing small business.

With flexible office hours and a customer oriented policy of outreach, the Entrepreneurship Center
has had great success in attracting the above populations to discuss their ideas and to help some of
them start or expand their business. The Entrepreneurship Center benefits all sectors of the
community in which it operates by being a liaison to government, education, and financing
institutions for the benefit of the entrepreneur




                                                7 of 18
BUDGET NARRATIVE

PROJECT SCOPE
(What are the specific activities/tasks, timeframes, responsible parties and products/outcome? and
how were they determined?)

GREDA is the regional economic development non-profit agency under which the Entrepreneurship
Center operates. It is responsible for housing the office and providing the administrative and
sundry services for its operations. The Entrepreneurship Center is managed by a full-time
professional staff responsible for the implementation of its activities.

The Entrepreneurship Center provides services in business planning, technical consultation,
outreach activities, and referrals to other resources to help and guide the establishment and growth
of new or existing businesses.

The main activity is to provide professional and individualized consulting services to those that
want to start businesses or to expand their operations. The consulting will focus on market
opportunities, financing, and business growth. Referrals will be made to other agencies where it is
appropriate to do so. Included in the outreach activities are business education workshops that are
sponsored by the Entrepreneurship Center and its partners on a regular basis. The entire community
is invited to attend these workshops to better disburse information and to stimulate an
entrepreneurial mindset. Presentations to service groups, schools and other interested parties will be
an on-going activity to promote the services of the Entrepreneurship Center office. The operations
of the Entrepreneurship Center are continuous with the expectation that the activities will be
sustained as long as there is a need for this resource.

The end result is the facilitation of job creation and business expansion as documented through
client contact and follow-up. Performance measures include: a) number of clients served, b) jobs
assisted, and c) number of low-moderate income clients served and their ethnic profile. Based on
prior experience, it is believed the Entrepreneurship Center will: a) serve 90 clients, b) assist with
the creation/retention of 14 jobs, and c) serve 46 low-moderate income people, or 51%.


PROJECT TIMELINE
(Is the timeframe for completion reasonable and appropriate?)

The Entrepreneurship Center under this grant will operate for an additional year. All activities
proposed will be ongoing activities with consultation occurring monthly, outreach activities
occurring quarterly, and referrals and business planning assistance as needed. These activities and
the cost to operate the Entrepreneurship Center are reasonable and appropriate within the scope of
activities performed in the past.




                                                8 of 18
PROJECT BUDGET
(Is the budget reasonable and appropriate considering the scope, substance and duration of the
proposed project.)

The proposed budget of $78,750 is provided on the following page. Funds of $75,000 would be
used to support the operations of the Entrepreneur Center for over a year and $3,750 would be used
for grant administration cost. Operating costs include: salary, travel, computer and software
upgrades, office supplies, rent & utilizes, along with program marketing and advertising.

The proposed budget along with the support of existing partners will sustain the viability and
effectiveness of the Entrepreneurship Center for an additional year. The budget is reasonable and
appropriate considering the operating cost of the Entrepreneurship Center are taken from actual cost
from the previous year.




                                               9 of 18
                               PROJECT BUDGET



             Budget                                               Leverage
                                      Amount          CDAP       (By source)

(19B) ED Technical Assistance     $ 75,000       $ 75,000




(21a) General Administration      $   3,750      $   3,750


  TOTAL                           $ 78,750       $$ 78,750   $




                                      10 of 18
                              LIST OF PREVIOUS CDAP GRANTS


Has the unit of local government submitting this application received previous CDAP grants?

       Yes              X     No

If yes, please include the following information for all grants received:

    CDAP Grant
     Number                 Amount            Project Description            Status of Project




If this funding request is related to, or an extension of a previously funded CDAP project, please
explain.
_______not applicable___________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________


If this application is related to other applications that are being submitted under this competitive
cycle, please list the applicant(s) and explain the relationship to this project.

_______not applicable___________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________




                                                11 of 18
                     ADMINISTRATION COSTS – BUDGET DETAIL
                        WHICH WILL BE PAID OUT OF CDAP

I.     PERSONNEL COSTS
                                                % OF NUMBER OF
                                                CDAP MONTHS    CDAP
       POSITION                    COMPENSATION TIME           TOTAL
       Economic Dev. Dir.                            12         $ 3,750



II.    GENERAL MANAGEMENT COSTS
       A. COMMUNICATIONS
          PHONE
          POSTAGE
       B. SUPPLIES/MATERIALS
       C. COPYING/PRINTING
       D. EQUIPMENT (LIST)



                                                              SUB-TOTAL

       E. TRAVEL
III.   CONTRACTUAL COST (IDENTIFY)


                                                              SUB-TOTAL
IV.    OTHER (IDENTIFY IN DETAIL)




                                                                       TOTAL* $ 3,750
       *This amount must not exceed the CDAP Administration limits listed on page 10.




                                          12 of 18
                                        ** SAMPLE **

                           COUNCIL RESOLUTION OF SUPPORT

                                  Resolution No. ___________

WHEREAS, the City of Galesburg is applying to the State of Illinois for a Community
Development Assistance Program grant, and

WHEREAS, it is necessary that an application be made and agreements entered into with the State
of Illinois.

NOW, THEREFORE, BE IT RESOLVED as follows:

    1)   that the City of Galesburg apply for a grant under the terms and conditions of the State of
         Illinois and shall enter into and agree to the understandings and assurances contained in
         said application.

    2)   that the Mayor and City Clerk on behalf of the City execute such documents and all other
         documents necessary for the carrying out of said application.

    3) that the City Manager is authorized to provide such additional information as may be
       required to accomplish the obtaining of such grant.

    4) that the Galesburg Regional Economic Development Association serve as a sub-grantee in
       the application to operate an Entrepreneurship Center.


Passed this _______ day of _____________________, 2009.


         (SEAL)




ATTEST: ___________________________               ____________________________
             City Clerk                                   Mayor




                                               13 of 18
                               PUBLIC HEARING DOCUMENTS
                                 TO BE PROVIDED INCLUDE

    1)   7-day notice
    2)   Newspaper clipping
    3)   Publisher’s Certification
    4)   Certified Minutes
    5)   Attendance Sheet/s

               Below is a Public Notice Submitted to the Register Mail for Publication
                                    Saturday, January 10, 2009

                                         PUBLIC NOTICE
                         CONCERNING GRANT APPLICATION OF CDAP FUNDS
                               BY THE CITY OF GALESBURG, ILLINOIS
                          FOR SUPPORT OF AN ENTREPRENEURSHIP CENTER

The City of Galesburg is considering the submittal of an application for federal grant funds administered by
the Illinois Department of Commerce & Economic Opportunity under the Community Development
Assistance Program (CDAP) for the support of an Entrepreneurship Center. The Entrepreneurship Center
will provide business planning and technical assistance to individuals seeking to start or grow their business.
A copy of the application is available for review at the office of the City Clerk located at Galesburg City Hall
located at 55 West Tompkins Street, the Galesburg Public Library located at 40 East Simmons Street and on
the City’s website at www.ci.galesburg.il.us.

Notice is hereby given that:

1. The City will hold a public hearing concerning the CDAP application on Tuesday, January 20,
    2009, at City Hall, 55 West Tompkins Street, Galesburg, Illinois, at 7:15 p.m. in the Council
    Chambers.
2. The Public Hearing will cover: (a) the amount of funds available; (b) the range of activities that
    will be undertaken; (c) the estimated amount of proposed activities that will benefit low-to-
    moderate income individuals; and (d); a detailed prioritized list of community development
    needs.
3. All interested persons will be given an opportunity to be heard at the public hearing.
4. Written comments or questions may also be made in advance of the hearing and should be
    submitted to:
                                             Cesar Suarez
                                     Economic Development Director
                                           City of Galesburg
                                         55 W. Tompkins Street
                                        Galesburg, Illinois 61401
                                             309/345-3680



                                                    14 of 18
                              LOCAL GOVERNMENT CERTIFICATIONS

On this ______ of ___________, 2009, I, Gary C. Smith, Mayor of the City of Galesburg, IL hereby certifies to the
Department of Commerce and Economic Opportunity in regard to an application and award of funds through the
Community Development Assistance Program:

1.      It will comply with the National Environmental Policy Act (NEPA) with the submission of this application and
        it further certifies that no aspect of the project for assistance has or shall commence prior to the award of funds
        to the community and the receipt of an environmental clearance.
2.      It will comply with the Interagency Wetland Policy Act of 1989 including the development of a plan to
        minimize adverse impacts on wetlands, or providing written evidence that the proposed project will not have
        an adverse impact on a wetland.
3.      It will comply with the Illinois Endangered Species Protection Act and the Illinois Natural Area Preservation
        Act by completing the consultation process with the Endangered Species Consultation Program of the Illinois
        Department of Natural Resources, or providing written evidence that the proposed project is exempt.
4.      It will identify and document all appropriate permits necessary to the proposed project, including, but not
        limited to: building, construction, zoning, subdivision, IEPA and IDOT.
5.      No legal actions are underway or being contemplated that would significantly impact the capacity of the City
        of Galesburg to effectively administer the program, and to fulfill the requirements of the CDAP program.
6.      It will coordinate with the County Soil and Water Conservation District regarding standards for surface and
        sub-surface (tile) drainage restoration and erosion control in the fulfillment of any project utilizing CDAP
        funds and involving construction.
7.      It is understood that the obligation of the State will cease immediately without penalty of further payment
        being required if in any fiscal year the Illinois General Assembly or federal funding source fails to appropriate
        or otherwise make available sufficient funds for this agreement.
8.      It acknowledges the applicability of Davis-Bacon prevailing wage rate requirements to construction projects; a
        request for wage rate determination will be submitted prior to commencement of any construction or
        equipment installation; and, it shall discuss these requirements with the contractor.
9.      It will comply with Section 3 of the Housing and Urban Development Act of 1968 to ensure that employment
        and other economic opportunities generated by certain HUD financial assistance shall, to the greatest extent
        feasible, and consistent with existing federal, state, and local laws and regulations, be directed to low and very
        low income persons and businesses.
10.     It certifies that no occupied or vacant occupiable low-to-moderate income dwellings will be demolished or
        converted to a use other than low-to-moderate income housing as a direct result of activities assisted with
        funds provided under the Housing and Community Development Act of 1974, as amended.
11.     It will conduct a Section 504 self-evaluation of its policies and practices to determine whether its employment
        opportunities and services are accessible to persons with disabilities.
12.     Specify whether any of the project activities/area is in a flood plain.    Yes ____ No _X_
        If yes, does it participate in the National Flood Insurance Program?       Yes ____ No _____
        If no, provide an explanation as to why it does not participate: ____________________________________
        ______________________________________________________________________________________



      _________________________________________ ______________________________________________
            Signature of Chief Elected Official       Date




                                                         15 of 18
                   APPLICANT/GRANTEE/RECIPIENT DISCLOSURE CERTIFICATION

 See attached instructions.
PART I. APPLICANT/GRANTEE/RECIPIENT INFORMATION
                                       Indicate whether this is an Initial Report _X____ or an Update Report _____
A. Applicant/Grantee Name, Address and Telephone (include area code)
City of Galesburg
55 W. Tompkins Street
Galesburg, IL 61401
309-345-3680



B. Recipient Name, Address and Telephone (include area code) (for economic development component only)




C. Project Location Address
Galesburg Commerce Center
185 S. Kellogg Street
Galesburg, IL 61401
309-343-1194



D. Type of Assistance Requested/Provided                         Amount of Assistance Requested/Provided
CDAP                                                      $78,750


PART II. THRESHOLD DETERMINATION (Applicant/Grantee only)
Have you received, or can you reasonably expect to receive (including this grant application), an
aggregate amount of CDAP funds in excess of $200,000 for the time period January 1, 2008, to
December 31, 2008                         Yes _____            No _X____
If “yes,” Parts III through V must also be completed.

All applicants must certify that the information provided is true by signing below.


_____________________________________ ___________________________________________
Printed Name of Applicant/Grantee/Recipient              Signature of Authorized Official



_____________________________________ ___________________________________________
Date                                                   Printed Name and Title of Authorized Official


                                                      16 of 18
 Applicant/Grantee/Recipient Disclosure Certification (continued)

PART III. OTHER GOVERNMENT ASSISTANCE
Federal Department/State/Local                                                            Amount
Agency Name & Address          Program                          Type                   Requested/Provided


Not Applicable




PART IV. INTERESTED PARTIES
           List of all persons with a                                                  Financial Interest
          Reportable Financial Interest                  Type of Participation          in Project ($ and %)




Not Applicable




PART V. SOURCES AND USES OF FUNDS
                  Source                                                         Use




Not Applicable




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