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CERTIFICATION
I, the undersigned, acting on behalf of the Company named below, hereby certify and agree to the following:
The information submitted by the Company to DED in connection with the Project is true and correct and such information is consistent with
documents provided to lenders, other government programs, or investors. The Company hereby authorizes DED to verify such information
from any source;
Neither the Company nor any person identified in the application:
a) Has committed a felony, is currently under indictment for a felony, or is currently on parole or probation;
b) Is delinquent with respect to any non-protested federal, state or local taxes or fees;
c) Has filed (or is about to file) for bankruptcy, unless otherwise disclosed to DED; or
d) Has failed to fulfill any material obligation under any other state or federal program;
There are no pending or threatened liens, judgments, or material litigation against the Company or any person identified on the application
which is likely to have a material impact on the Company’s viability;
Neither the operations of the Project itself nor the receipt of incentives for the Project would violate any existing agreement;
The Company has obtained or is capable of obtaining all necessary federal, state and local permits and licenses for the Project;
I certify that the applicant does NOT knowingly employ any person who is an unauthorized alien and that the applicant has complied with
federal law (8 U.S.C. § 1324a) requiring the examination of an appropriate document or documents to verify that each individual is not an
unauthorized alien.
I certify that the applicant is enrolled and will participate in a federal work authorization program as defined in Section 285.525(6), RSMo.,
with respect to employees working in connection with the activities that qualify applicant for this program. I certify that the applicant will
maintain and, upon request, provide the Department of Economic Development documentation demonstrating applicant’s participation in a
federal work authorization program with respect to employees working in connection with the activities that qualify applicant for this
program.
I understand that, pursuant to section 285.530.5, RSMo, a general contractor or subcontractor of any tier shall not be liable under section
285.525 to 285.550 when such general contractor or subcontractor contracts with its direct subcontractor who violates section 285.530.1, if
the contract binding the contractor and subcontractor affirmatively states that the direct subcontractor is not knowingly in violation of
section 285.530.1 and shall not henceforth be in such violation and the contractor or subcontractor receives a sworn affidavit under the
penalty of perjury attesting to the fact that the direct subcontractor’s employees are lawfully present in the United States.
I understand that if the applicant is found to have employed an unauthorized alien, applicant maybe subject to penalties pursuant to
Sections 135.815, 285.025, and 285.535, RSMo.
I understand that if the applicant is found to have employed an unauthorized alien in Missouri and did not, for that employee, examine the
document(s) required by federal law, the applicant shall be ineligible for any state-administered or subsidized tax credit, tax abatement or
loan for a period of five years following any such finding.
I attest that I have read and understand the Small Business Incubator Tax Credit Program guidelines.
I hereby agree to allow representatives of the Department of Economic Development access to the property and applicable records as may
be necessary for the administration of this program.
I certify under penalties of perjury that the above statements and information contained in the application and attachments are complete,
true, and correct to the best of my knowledge and belief.
I hereby agree to allow DED, Department of Revenue, or either of their designated representatives, access to the property and applicable
records as may be necessary for the administration of this program.
I certify that I have the proper authority to execute this document on behalf of the Company and that I am authorized to make the statement of
affirmation contained herein. I also realize that failure to disclose material information regarding the Company, any owners or individuals
engaged in the management of the Company, or other facts may result in criminal prosecution.
REQUIRED ATTACHMENT:
Copy of the executed Memorandum of Understanding between the Applicant and the United States Citizenship and Immigration Services
(USCIS).
Applicant Signature Print Name Title Date
Appeared before me this _________ day of _______________, 20____, ____________________________ to me personally known to be the
person who executed the above certification, and acknowledged and states on his/her oath to me that he/she executed the same for the purpose
therein stated.
State of County (or City of St. Louis)
Notary Public Name My Commission Expires Use Rubber Stamp in Area Below
Notary Public Signature
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