APPLICATION FOR ENERGY SALES TAX EXEMPTION PROGRAM FOR CERTAIN COUNTIES

New Jersey Commerce Commission ENERGY SALES TAX EXEMPTION PROGRAM FOR CERTAIN COUNTIES (Salem County) Administered by: The New Jersey Commerce Commission (1/8/08) 1 Application for ENERGY SALES TAX EXEMPTION PROGRAM FOR CERTAIN COUNTIES* SUMMARY  The New Jersey Commerce Commission (the "Commission") administers an energy sales tax exemption program (the "Program") for the retail sales of electricity and natural gas and their transport to a business in counties designated for the 50 percent sales tax exemption. That business must employ at least 50 people at that facility, at least 50 percent of whom are directly employed in a manufacturing process. The energy and utility services must be consumed exclusively at that facility. See P.L. 2005, c.374 (the "Act") and Commission Program regulations at N.J.A.C.12A:3.1 et seq. ("Program Regulations"). All application requests shall be made to: New Jersey Commerce Commission, 20 West State Street, PO Box 820, Trenton, New Jersey 08625 Attention: Joseph Constance. Annual renewal applications by applicants satisfying the criteria of the Program Regulations ( N.J.A.C. 12A:3.3) shall be required to be submitted annually within 45 days prior to the expiration date of the energy sales tax exemption.   ELIGIBILITY CRITERIA 1. To qualify for energy sales tax exemption for the retail sale, transmission, or distribution of electricity and natural gas, an applicant shall be required: a. To operate a manufacturing facility in a qualified county*; and b. Employ at least 50 people at that facility, at least 50 percent of whom are directly employed in the manufacturing process. *Currently Salem County is the only qualified county. 2 GENERAL INSTRUCTIONS FOR PREPARATION OF THE "APPLICATION FOR ENERGY SALES TAX EXEMPTION FOR MANUFACTURERS" The Act provides a tax exemption Program in certain counties, currently statutorily limited to Salem County. The accompanying Application form is to be used by Salem County manufacturers. The general instructions are as follows: 1. The preparation and execution of the APPLICATION FOR ENERGY SALES TAX EXEMPTION FOR MANUFACTURERS is the responsibility of the applying manufacturing firm, including all requisite certifications, information and signature by an authorized representative (higher level than a basic "contact"). 2. The APPLICATION FOR ENERGY MANUFACTURERS is submitted to: New Jersey Commerce Commission P.O. Box 820 Trenton, NJ 08625 Attention: Joseph Constance Please be advised, it may be helpful to first send an unexecuted draft of the application to the Commission's Office of Business Advocate by fax (609-292-5509) or e-mail: (joseph.constance@commerce.state.nj.us) for a preliminary overview. 3. Following receipt of the executed application and after an initial review of the application for eligibility and completeness, an appointment will be made to conduct a site visit. The site visit generally involves member(s) of the Commission and applicant management and staff. Other State representatives may be asked to attend. 4. After the site visit and other appropriate due diligence, a recommendation will be made to the Board of the Commission to approve or deny the application and exemption. If approved, the applicant, utilities and appropriate State agencies will be notified, and, in due order, an exemption certificate will be issued by the Division of Taxation, New Jersey Department of Treasury. If formally denied, the applicant will be notified and must wait 90 days to re-apply. 5. There are other requirements, rights, obligations and details in the Program Regulations, which the applicant is urged to read carefully. SALES TAX EXEMPTION FOR 3 NEW JERSEY COMMERCE COMMISSION Application for Energy Sales Tax Exemption Program for Certain Counties (Salem County) I. Business Information 1. 2. 3. 4. Legal Company Name: Trade Name (if different): Street Address(es) (attach a list as necessary) City:_________________________ 5. State NJ 6. Zip Code__________________ 7. Business Contact (Must be an authorized representative of the company.) Mr.  Ms.  Mrs.  8. Title______________________________ 9. Telephone )_____________________ 10. Fax ( )___________ 11. E-mail address__________________________________ 12. Mailing Address (if different) 13. City________________________ 14. State ___ 15. Zip Code________________ 16. N.J. Taxpayer ID# 17. Business Formation:  Corporation  Joint Venture  Limited Partnership  Partnership  Sole Proprietorship  Limited Liability Company Other (please explain) II. Qualifying Information for Manufacturers (attach additional sheets as necessary) 18. Describe the nature of the business and the facility for which this application is being made. 19. Provide the address of the manufacturing facility if different from Part I. 20. List the products manufactured 21. NAICS Code 22. Employee Data: Please provide employee data for the applicant business as requested below and attach a list with the name, title and business location (site address) for these employees. 22a. Total number of employees at the site(s) 22b.Number of these employees directly employed in a manufacturing process 22c. Percent of employees directly employed in a manufacturing process. (22b:-22a=) % III. Energy Providers and Projected Consumption 23. Energy and utility account information at the site. Please provide the following detailed contact information:  Utility name  Account number and applicant's plant location  Contact person 4 (  Address  Telephone number  E-mail address Utility Type: Gas  Electricity Utility Name: Account Number/Plant Location: Contact Person: Street Address: City: State: Phone: E-mail: Utility Type: Gas  Electricity Utility Name: Account Number/Plant Location: Contact Person: Street Address: City: State: Phone: E-mail: Utility Type: Gas  Electricity Utility Name: Account Number/Plant Location: Contact Person: Street Address: City: State: Phone: E-mail: Utility Type: Gas  Electricity Utility Name: Account Number/Plant Location: Contact Person: Street Address: City: State: Phone: E-mail: Zip: Zip: Zip: Zip: [if there are additional utilities/service providers, please list in same format on an attachment.] 24. Energy Consumption Applicant(s) certify and affirm that the energy and utility service is for the exclusive use and consumption at the applicant's listed locations, which are certified and active participants at the site. Baseline consumption for the 12-month period immediately prior to submission of this application Gas: Electricity: Projected consumption in next 12 months (units and dollars) 5 Gas: Electricity: $ $ 25. All Renewal Applicant(s) must include a report summarizing the totals of all exempt purchases of energy and utility service for the prior 12-month period (units and dollars). Applicants may also be called upon to also provide this information on an interim basis. Gas: Electricity: $ $ 26. Each business that receives approval of its application for the energy sales tax exemption shall notify the Commission if it ceases to meet the manufacturing and employment requirements for the energy sales tax exemption for more than a total of three weeks in any two consecutive months. IV. Debarment, Suspension and Disqualification Businesses applying for Energy Sales and Use Tax Exemption Program are subject to the Commission’s Disqualification/Debarment Regulations (the “Regulations”), which are set forth in N.J.A.C. 12A:4-12.1 et seq. Applicants are required to answer the questions, found in Appendix A, pertaining to the commission of certain offenses that can lead to disqualification from eligibility under the Regulations. V. Release Authorization Businesses applying for Energy Sales and Use Tax Exemption Program are required to complete the Release Authorization Form (Appendix B) authorizing the Division of Taxation and the Department of Labor and Workforce Development to conduct a review of their tax filing history and payment history to determine if there are currently any tax deficiencies and/or delinquencies. 6 VI. Certifications and Consent to Site Inspection I certify to the best of my knowledge and belief, that all of the above information is true, correct, complete and that applicant is not in default with any other program administered by the State of New Jersey. I certify that I am an authorized representative of the applicant and hereby permit the State of New Jersey and the New Jersey Commerce Commission and its agents and/or employees to enter the applicant's business and manufacturing premises during reasonable business hours to determine compliance with eligibility requirements. I certify that the applicant will fulfill monitoring and compliance requirements as specified in the regulations governing this energy sales tax exemption program. COMPANY NAME COMPANY AUTHORIZED REPRESENTATIVE, TITLE (type or print name) DATE COMPANY AUTHORIZED REPRESENTATIVE (signature) NOTICE: Applicants are urged to familiarize themselves with N.J.A.C. 12A:2A-3.1 et seq. "Energy Sales Tax Exemption Program for Certain Counties.” 7 APPENDIX A Businesses applying for Energy Sales and Use Tax Exemption Program are subject to the Commission’s Disqualification/Debarment Regulations (the “Regulations”), which are set forth in N.J.A.C. 12A:4-12.1 et seq. Applicants are required to answer the following background questions pertaining to the commission of certain offenses that can lead to disqualification from eligibility under the Regulations. All capitalized terms used in this Questionnaire, except those defined elsewhere herein, shall be defined at the bottom of this form. Has Applicant, any officers or directors of Applicant, or any Affiliates (collectively, the “Controlled Group”) been found guilty, liable or responsible in any Legal Proceeding for any of the following violations or conduct? (Any civil or criminal decisions or verdicts that have been vacated or expunged need not be reported). 1. Commission of a criminal offense as an incident to obtaining or attempting to obtain a public or private contract, or subcontract there under, or in the performance of such contract or subcontract. ____ Yes ____ No Violation of the Federal Organized Crime Control Act of 1970, or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, perjury, false swearing, receiving stolen property, obstruction of justice, or any other offense indicting a lack of business integrity or honesty. ____ Yes ____ No Violation of the Federal or State antitrust statutes, or of the federal Anti-Kickback Act (18 U.S.C. 874). ____ Yes ____ No Violation of any law governing the conduct of elections of the Federal Government, State of New Jersey or of its political subdivision. ____ Yes ____ No Violation of the “Law Against Discrimination” (P.L. 1945, c.169, N.J.S.A. 10:5-1 et seq., as supplemented by P.L. 1975, c127), or of the act banning discrimination in public works employment (N.J.S.A. 10:2-1 et seq.) or of the act prohibiting discrimination by industries engaged in defense work in the employment of persons therein (P.L. 1942, c.114, N.J.S.A. 10:10 et seq.). ____ Yes ____ No To the best of your knowledge, after reasonable inquiry, violation of any laws governing hours of labor, minimum wage standards, prevailing wage standards, discrimination in wages, or child labor. ____ Yes ____ No 2. 3. 4. 5. 6. 8 7. To the best of your knowledge, after reasonable inquiry, violation of any law governing the conduct of occupations or professions of regulated industries. ____ Yes ____ No Debarment by any department, agency, or instrumentality of the State or Federal government. ____Yes ____ No Violation of any of the following prohibitions on vendor activities representing a conflict of interest, or failure to report a solicitation as set forth below: (i) No person shall pay, offer or agree to pay, either directly or indirectly, any fee, commission, compensation, gift, gratuity, or other thing of value of any kind to any Commission officer or employee or special Commission officer or employee, as defined by N.J.S.A. 52:13D-13b and e, with which such person transacts or offers or proposes to transact business, or to any member of the immediate family as defined by N.J.S.A. 52:13D-13i, of any such officer or employee, or partnership, firm, or corporation with which they are employed or associated, or in which such officer or employee has an interest within the meaning of N.J.S.A. 52:13D-13g. The solicitation of any fee, commission, compensation, gift, gratuity or other thing of value by any Commission officer or employee or special Commission officer or employee from any person shall be reported in writing by the person to the Attorney General and the Executive Commission on Ethical Standards. No person may, directly or indirectly, undertake any private business, commercial or entrepreneurial relationship with, whether or not pursuant to employment, contract or other agreement, express or implied, or sell any interest in such person to, any Commission officer or employee or special Commission officer or employee having any duties or responsibilities in connection with the purchase, acquisition or sale of any property or services by or to the Authority, or with any person, firm or entity with which he or she is employed or associated or in which he or she has an interest within the meaning of N.J.S.A. 52:13D-13g. Any relationships subject to this subsection shall be reported in writing to the Executive Commission on Ethical Standards, which may grant a waiver of this restriction upon application of the Commission officer or employee or special Commission officer or employee upon a finding that the present or proposed relationship does not present the potential, actually or appearance of a conflict of interest. No person shall influence, or attempt to influence or cause to be influenced, any Commission officer or employee or special Commission officer or employee in his or her capacity in any manner which might tend to impair the objectivity or independence of judgment of the officer or employee. 8. 9. (ii) (iii) (iv) 9 (v) No person shall cause or influence, or attempt to cause or influence, any Commission officer or employee or special Commission officer or employee to use, or attempt to use, his or her official position to secure unwarranted privileges or advantages for the person or any other person. ___ Yes ___ No (If Yes, specify subsection) 10. Has any member of the Controlled Group been found guilty, liable or responsible for the violation in any Legal Proceedings of any State or Federal law that may bear upon a lack of responsibility or moral integrity, or that may provide other compelling reasons for disqualification? (Your responses to the foregoing question should include, but not be limited to, the violation of the following laws, without regard to whether any monetary award, damages, verdict, assessment or penalty has been made against any member of the Controlled Group, except that any violation of any environmental law in category (v) below need not be reported where the monetary award, damages, etc. amounted to less than $1 million). Laws banning or prohibiting discrimination or harassment in the workplace on the basis of gender, race, age, religion or handicapped status. (i) (iii) Laws prohibiting or banning any form or forced, slave, or compulsory labor. Laws protecting workers who have reported the wrongdoing of their employers to governmental authorities, commonly referred to as “Whistleblower Laws”. Securities or tax laws resulting in a finding of fraud or fraudulent conduct. Environmental laws. Laws banning the possession or sale of, or trafficking in, firearms or drugs. Laws banning anti-competitive dumping of goods. Anti-terrorist laws. Criminal laws involving commission of any felony or indictable offense under State or federal law. Laws banning human rights abuses. Laws banning the trade of goods or services to enemies of the United States. The New Jersey Conflicts of Interest Law, N.J.S.A. 52:13D-1 et seq. ___ Yes ___ No 10 (iv) (v) (vi) (vii) (viii) (ix) (x) (xi) (xii) 11. To the best of your knowledge, after reasonable inquiry, is any member of the Controlled Group a party to pending Legal Proceedings wherein any of the offenses or violations described in questions 1-10 above are alleged or asserted against such entity or person? ___ Yes ___ No The terms set forth below shall be defined as follows: “Affiliates” means entities having an overt or covert relationship such that any one of them directly or indirectly controls or has the power to control another. “Legal Proceedings” means any State or Federal civil, criminal or administrative proceeding in a court or administrative tribunal in the United States or any territories thereof. The Commission reserves the right to require additional clarifying or explanatory information from the applicant (“Applicant”) regarding the answers given. If, at any time prior to board action on this application, or, at any time between the date of such action and the execution of an agreement with the Commission, the Applicant should become aware of any facts that materially alter or change such answers, or that render any of them incomplete, the Applicant shall have a duty to immediately report such facts to the Commission in writing. 11 APPENDIX B COPY AND COMPLETE ONE FOR EACH COMPANY/SUBSIDIARY THAT WILL BE HIRING/RETAINING ELIGIBLE EMPLOYEES AT THE PROJECT SITE RELEASE AUTHORIZATION I, ____________________________________________________________, an officer of hereby authorize the New Jersey Commerce Commission to contact the New Jersey Department of Labor and Workforce Development to conduct a review of our tax filing history to determine if there are currently any tax deficiencies and/or delinquencies. The New Jersey Department of Labor and Workforce Development may release their findings to the New Jersey Commerce Commission, Energy Sales Tax Exemption Program for Certain Counties (Salem County) (N.J.A.C. 12A:4-12.1 et seq). Date Federal Tax ID# Signature/Title Sworn to and subscribed before me this day of , 20 . (seal) (Notary Public) 12 *Applicant must email or fax this Tax Clearance Document to the Division of Taxation. We are not responsible for this portion of the application. Please return this page only with your completed application to NJ Commerce. State of New Jersey Division of Taxation Business Assistance Clearance Section P.O. Box 272 Trenton, NJ 08695-0272 E-Mail = Taxation.BusAssistanceTC@Treas.State.NJ.US Fax # 609-292-9266 APPLICATION FOR TAX CLEARANCE – BUSINESS ASSISTANCE AND INCENTIVES Legal Name of Applicant _________________________________________________________________ Trade Name of Applicant ________________________________________________________________ Mailing Address ________________________________________________________________________ NJ Tax Registration # ____________________________ FID/TIN # _____________________________ Type of Business ______________________________________________________________________ List All Officers or Partners:(On reverse side) Is this entity a parent, subsidiary or other related entity to another business or businesses? □ No □ Yes (If yes, please identify the related business(es) on reverse side.) ==================================================================================================== Name of Issuer State Agency: New Jersey Commerce Commission Due Date: February 26, 2008 Name of Assistance Program: Energy Sales Tax Exemption Program for Certain Counties Agency Contact Person: Joseph Constance Agency Contact Address: PO Box 820, 20 West State Street, 4 Floor, Trenton, NJ 08625 Agency Contact Phone # (609) 292-1636 Agency Contact Fax #: (609) 292-5509 th I certify that I am authorized to complete this tax clearance application; that it is true and complete; and that if any information contained in this tax clearance application is willfully false, I may be subject to penalty. I understand that the Division of Taxation will communicate to the issuer State agency, the status of the tax compliance of the applicant. By signing this tax clearance application, I consent to the release of such general status information by the Division of Taxation. ______________________________________ ____________________________ _________________ (Signature of Authorized Representative) (Title) (Date) (Print Name) 13 Name of Applicant _____________________________ NJ Tax Registration # Effective July 1, 2007, P.L. 2007, c. 101 established a tax clearance program for awards of certain business assistance and incentive programs, including but not limited to a grant, loan, loan guarantee, or other monetary or financial benefit issued by the State and its independent agencies and authorities to assist in the conduct or operation of a business, occupation, trade, or profession in the State. As a precondition to or as a component of the application process, the applicant must provide to the State agency a current tax clearance certificate issued by the Director of the Division of Taxation. This application form is intended to provide the Division of Taxation with the necessary information to conduct its research and determine if the applicant is compliant with New Jersey tax laws such that a tax clearance certificate may be issued. If the Director determines that the applicant has not filed all required tax returns and has not paid all tax, penalties, interest, or fees due, the Director shall issue a notice to the applicant of the particulars to be resolved before a tax clearance certificate may be issued. Questions about the tax clearance process may be directed to: (609) 292-6400. Questions about the award process should be directed to the specific State Agency noted on page 1. List of Officers or Partners: Name Address Social Security # Information on related entities: (Name, Address, Relationship, Taxpayer Identification Number & Type of Business) I certify the information on this page is correct. (Signature of Authorized Representative) (Date) 14