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APPLICANT CERTIFICATION
I, the undersigned, acting on behalf of the Applicant named below, hereby certify and agree to the following:
The information submitted by the Applicant 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 Applicant hereby authorizes DED to verify such information from
any source;
Neither the Applicant, nor any person actively engaged in the management of the Applicant:
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 Applicant or any person identified on the application which is
likely to have a material impact on the Applicant’s viability;
Neither the operations of the Project itself nor the receipt of incentives for the Project would violate any existing agreement;
The Applicant 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 certify that the Applicant shall include in any contract it enters with a subcontractor in connection with the activities that qualify applicant for this
program, an affirmative statement from the subcontractor that such subcontractor is not knowingly in violation of Section 285.530.1, RSMo, and
shall not be in violation during the length of the contract. In addition the Applicant will receive a sworn affidavit from the subcontractor under the
penalty of perjury, attesting that the subcontractor’s employees are lawfully present in the United States. I certify that the Applicant will maintain
and provide the Department of Economic Development and Department of Revenue access to documentation demonstrating compliance with this
requirement
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 Business Facility Headquarters Credit guidelines;
I will inform DED if, at any time before project completion, there is any change to any of the certifications made herein;
I hereby agree to allow representatives of the Department of Economic Development (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; and,
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 certify that I am a Corporate Officer/Member of the Applicant and have the proper authority to execute this document on behalf of the Applicant. I am
authorized to make the statement of affirmation contained herein. I realize that failure to disclose material information regarding the Applicant, any
owners or individuals engaged in the management of the Applicant, or other facts may result in criminal prosecution.
Applicant Signature Print Name Title Date
STATE OF_______________________________________ )
ss.
COUNTY OF ____________________________________ )
On this ___ day of _______________in the year 20___ before me, ________________________, a Notary Public in and for said state, personally
appeared ___________________________ [name of Corporate Officer/ Member], ____________________________ [Official Title],
_____________________________ [Name of Corporation/ Limited Liability Corporation], known to me to be the person who executed the within
Agreement in behalf of said company and acknowledged to me that he or she executed the same for the purposes therein stated.
________________________________
Notary Public
My commission expires ___________________________________
1If more than one representative signs use a copy of this page for each signatory.
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