Are you submitting an "Intent to Propose" application seeking funding through the Upstate Revitalization Initiative?

Project City

Project county or counties.

Project ZIP Code. (please use ZIP+4 if known)

Project Street Address: Please input the project street address (Street Number and Street Name only).

If the project has multiple locations, please input the primary street address of the project. If the project does not have a definite street address, please input the approximate street address of the project (Street Number and Street Name only).

Project State

Project Latitude (This question's value will be filled automatically, based on the project address, when the application is finalized.)

Project Longitude (This question's value will be filled automatically, based on the project address, when the application is finalized.)

US Congressional District where the project is located. (This question's value will be filled automatically, based on the project address, when the application is finalized.)

NYS Assembly District where the project is located. (This question's value will be filled automatically, based on the project address, when the application is finalized.)

NY Senate District where the project is located. (This question's value will be filled automatically, based on the project address, when the application is finalized.)

Type of Applicant (select all that apply)

Is the applicant a DBA?

What is the applicant's DBA name?

Select an applicant ID type from the list below that you normally use to identify your organization on application forms.

Based on your selection from the previous question, enter your applicant ID number. (Please do not provide your social security number).

If you are a business, have you been certified as a New York State Minority or Women-owned Business Enterprise (MWBE)?

Organization Legal Name

Applicant Street Address

Applicant City

Applicant State

Applicant ZIP Code. (please use ZIP+4 if known)

Applicant Telephone Number (please include area code)

Applicant Email Address

Contact First Name

Contact Last Name

Contact Title

Contact Street Address

Contact City

Contact State

Contact ZIP Code (please use ZIP+4 if known)

Primary Contact Phone Number. (please include area code)

Contact Email

Contract Salutation

Contract First

Contract Last

Contract Title

Authorized Organization

Contract Street

Contract City

Contract State

Contract Zip (please use ZIP+4 if known)

Contract Phone (please include area code)

Contract Email

Additional Project Contact First Name

Additional Project Contact Last Name

Additional Contact Title

Additional Contact Street Address

Additional Contact City

Additional Contact State

Additional Contact ZIP (please use ZIP+4 if known)

Additional Contact Telephone Number (please include area code)

Additional Contact Email Address

Please select the primary sector or characterization that best defines this project.

Please select the secondary sector or characterization that best defines this project.

Does this project require State and/or Federal Environmental Review?

What is the status of State and/or Federal Environmental Review?

Has a National Environmental Policy Act (NEPA) Record of Decision been issued?

Please explain decision and include date of Record of Decision.

Has the applicant or project been awarded funding in prior CFA rounds?

What were the CFA numbers for which funding was awarded? (separate multiple CFA numbers with commas)

Project Description. Concisely describe the project, indicating the location, what will be planned, designed, acquired, and/or constructed, the issues/opportunities to be addressed, and expected outcomes and deliverables. Additional details will be collected later in the application process.

Statement of need: Provide a brief summary of the need for the project in the geographic area proposed and the project's financing needs, including funding gaps of the proposed project.

How does your project align with the Regional Economic Development Council’s Strategic Plan/Upstate Revitalization Initiative Plan? (strategic plans are located at https://regionalcouncils.ny.gov/ )

Explain what makes your project a regional economic priority - for example creates jobs, economic investment, sustainability and community revitalization, government efficiency or consolidation etc.

Current State of Project Development (i.e. planning, preliminary engineering, final design, etc. You may enter N/A for non-project related applications)

Estimated Project Timeline: include project start/completion dates, estimates for design, permitting and construction or other major steps.

Provide a list of all federal, state, and local reviews, approvals, or permits needed or completed, including the dates when they are expected to be completed or were completed. If Not Applicable, indicate "NA".

For each program to which you are applying under the CFA, explain your strategy for proceeding if the full amount of requested funding, required matching funds, and temporary financing are not secured as expected, or committed sources become unavailable.This explanation must address any proposed project phases, and both CFA and non-CFA sources of funds.

Indicate how many existing full-time equivalent jobs the applicant employs in all NYS LOCATIONS.

Indicate the average annual wage for existing full-time equivalent employees the applicant employs in all NYS Locations as of the date this application is finalized.

Indicate how many of the total existing full-time equivalent employees in New York State are contract employees.

Indicate how many existing full-time equivalent jobs the applicant employs at all PROJECT LOCATION(S).

Indicate the average annual wage for the employees at the Project Location as of the date this application is finalized.

Indicate how many of the total existing full-time equivalent employees at the Project Location are contract employees.

How many of the full-time existing jobs at the project location(s) are at risk if the project does not go forward.

What percentage of the project's employees are/will be residents of New York State?

Will any other non-construction jobs result from the project? For example, this could include jobs created by tenants at an incubator or mixed-use development or as a result of the creation of a job training center. If so, please estimate how many jobs, explain how these jobs will be created, and explain the method used to determine the job number estimate.

Will the proposed project result in the creation of construction jobs? If so, estimate the number of construction jobs to be created.

Enter zero if not applicable.

Definition of full-time equivalent employee: (1) a full-time, permanent, private-sector employee on the Recipient's payroll, who has worked at the Project Location for a minimum of 35 hours per week for not less than four consecutive weeks and who is entitled to receive the usual and customary fringe benefits extended by Recipient to other employees with comparable rank and duties; or (ii) two part-time, permanent, private-sector employees on Recipient's payroll, who have worked at the Project Location for a combined minimum of 35 hours per week for not less than four consecutive weeks and who are entitled to receive the usual and customary fringe benefits extended by Recipient to other employees with comparable rank and duties.

For the Excelsior Jobs Program: a full-time permanent employee must be on the payroll for at least six months of a year in order to qualify for benefits. Jobs transferred from employment with another business located in the State including from a related person in this State are not net new jobs for purposes of the employment commitment.

Indicate the year employment begins under Year 1 for your project here:

Indicate how many new full-time equivalent employees (using the definition in the question above) the company will create over 5 years.

If awarded, your company or entity will be held to the job creation commitments as outlined in this question and table below. For grants, should you fail to meet the job creation commitments, recapture provisions may apply. For Excelsior, each years job commitment is evaluated separately to determine if tax credits can be issued.

Net New Job Information (Enter Cumulatively) 1. Enter the type of job by general category.
2. Enter the gross annual wages for each job type.
3. List the number of net new jobs. Please enter CUMULATIVE job totals, i.e. if there are 10 jobs being created each year for 5 years, enter as 10, 20, 30, 40, 50.

Please note that if you are completing the URI Phase 1 - Intent to Propose, you are not required to complete the table below at this time as this information will be available to enter in during phase 2 of the application.

Net New Job Information

Net New Job Information

Net New Job Information

Net New Job Information

Net New Job Information

Net New Job Information

Attach 2019 financial documents

For privately owned companies, IDAs, not-for-profits, educational institutions, start-ups, municipalities, or any business or organization other than publicly traded companies, please provide audited or reviewed financials, or compiled financials with signed tax returns, for 2019. For-publicly traded companies, please provide Form 10-K for 2019.

Attach 2020 financial documents.

For privately owned companies, IDAs, not-for-profits, educational institutions, start-ups, municipalities, or any business or organization other than publicly traded companies, please provide audited or reviewed financials, or compiled financials with signed tax returns, for 2020. For publicly traded companies please provide Form 10-K for 2020.

Attach 2021 financial documents.

For privately owned companies, IDAs, not-for-profits, educational institutions, start-ups, municipalities, or any business or organization other than publicly traded companies, please provide audited or reviewed financials, or compiled financials with signed tax returns, for 2021. For publicly traded companies please provide Form 10-K for 2021.

Attach interim financials for 2022

For privately owned companies, IDAs, not-for-profits, educational institutions, start-ups, municipalities, or any business or organization other than publicly traded companies, please provide interim financials for 2022, certified by a company officer. For publicly traded companies, please provide the most recent Form 10-Q.

Please provide any documentation or letters of support for the project.

Please provide Letters of Support for your project (if applicable). All letters should be scanned into a single PDF file and their total size cannot exceed 30 Megabytes (MB).

For Start-up companies, in addition to the documents listed above provide: 1) Financial projections (5 years) 2) Personal financial statements from a personal guarantor(s) of the start-up company 3) Principal resumes

Attach an organizational chart and/or description of ownership structure including the percentage of ownership for each individual entity.

Attach a short or long Environmental Assessment Form

Project review pursuant to the State Environmental Quality Review Act (SEQRA) must be completed prior to the award of any state funds. For projects classified as Type I or Unlisted actions, submit a short or long Environmental Assessment Form. See "Scoring Tips" for links to forms.

If review of the project has been completed pursuant to State Environmental Quality Review Act (SEQRA) or National Environmental Policy Act (NEPA), please submit the Negative Declaration or Findings Statement, or Finding of No Significant Impact or Record of Decision.

Provide a list of all other federal, state, and local reviews, approvals, or permits needed or completed, including the dates when they are expected to be completed or were completed. If Not Applicable, please upload an attachment that indicates "NA".

In the first phase of the Application, you were asked to describe your overall project including the location, what will be planned, designed acquired, and/or constructed, the issues/opportunities to be addressed, and expected outcomes and deliverables. Please indicate if any of these items have changed since your original submission.

Please identify which key URI concepts/indicators the project will advance and describe the efforts in which those concepts will be addressed. See help for additional information.

Please describe the readiness of the project and identify when state funding would need to be made available.

Should the full amount of the Applicant's ESD funding request not be awarded, at what minimum level of ESD funding does the project become unfeasible?

Please provide a concise narrative describing the applicant’s history and current operations. Include information about company/organization size, products, services, market share, position within the industry, competitors and the year in which the company was formed, etc.

Please identify the project partners including the project leader and others involved in the implementation of the project. See the help section for format.

Please enter the amount of funding you are requesting through the URI.

Briefly describe the activity that the project involves in terms of product(s) or services(s) that will be provided at the project location.

Please enter the amount of private funding that will be provided for this project.

Indicate the Primary North American Industrial Classification System (NAICS) Code associated with the activity of the business at the project location.

Please enter the amount of additional funding that will be provided to this project.

Describe how the capital investment for which you are seeking funding will make it possible to reach your business or organizational goals, such as changes to profitability, productivity, market share, product offerings, or other results relevant to your goals.

A third party completing this application is required to disclose their name, company and contact name. Is a third party completing this application?

Provide the third party name and contact info.

Please enter the total project cost from all sources.

Please enter the number of net new permanent private sector jobs that will be created.

Please enter the number of retained jobs associated with the project.

What tasks and steps need to be completed before the project can begin (e.g. obtaining permits, licenses, hiring staff, etc.)

What is the first project year? (e.g. the year equipment will be ordered or when first expenditures are expected to be made)

Please enter the number of construction jobs associated with the project.

Please enter the number of ancillary or other jobs associated with the project.

Is the proposed project located in a highly distressed area? If so, please provide information that will help ESD confirm that the area is highly distressed.

Have you ever formally presented this project or components of this project to the Regional Economic Development Council where the project is located?

Provide any other information in support of the project or pertinent to the request.

Qualified Investments Building Acquisition Year 1

Qualified Investments Building Acquisition Year 2

Qualified Investments Building Acquisition Year 3

Qualified Investments Building Acquisition Year 4

Qualified Investments Building Acquisition Year 5

Qualified Investments Year 1

Qualified Investments Year 1

Qualified Investments Year 1

Qualified Investments Year 1

Qualified Investments Year 1

Qualified Investments Year 1

Qualified Investments Year 1

Qualified Investments Building Renovation Year 2

Qualified Investments New Construction Year 2

Qualified Investments Production Machinery Year 2

Qualified Investments Furniture, fixtures Year 2

Qualified Investments Land Acquisition* Year 2

Qualified Investments Demolition Year 2

Qualified Investments Year 2

Qualified Investments Building Renovation Year 3

Qualified Investments New Construction Year 3

Qualified Investments Production Machinery Year 3

Qualified Investments Furniture, fixtures Year 3

Qualified Investments Land Acquisition* Year 3

Qualified Investments Demolition Year 3

Qualified Investments Year 3

Qualified Investments Building Renovation Year 4

Qualified Investments New Construction Year 4

Qualified Investments Production Machinery Year 4

Qualified Investments Furniture, fixtures Year 4

Qualified Investments Land Acquisition* Year 4

Qualified Investments Demolition Year 4

Qualified Investments Year 4

Qualified Investments Building Renovation Year 5

Qualified Investments New Construction Year 5

Qualified Investments Production Machinery Year 5

Qualified Investments Furniture, fixtures Year 5

Qualified Investments Land Acquisition* Year 5

Qualified Investments Demolition Year 5

Qualified Investments Year 5

Net New Job Information Job Type/Category

Net New Job Information 2 Avg Gross Wages/Job Type

Net New Job Information 2 Year 1 -

Net New Job Information 2 Year 2 -

Net New Job Information 2 Year 3 -

Net New Job Information 2 Year 4 -

Net New Job Information 2 Year 5 -

Net New Job Information (Enter Cumulatively) Job Type/Category

Net New Job Information (Enter Cumulatively) 3 Avg Gross Wages/Job Type

Net New Job Information (Enter Cumulatively) 3 Year 1 -

Net New Job Information (Enter Cumulatively) 3 Year 2 -

Net New Job Information (Enter Cumulatively) 3 Year 3 -

Net New Job Information (Enter Cumulatively) 3 Year 4 -

Net New Job Information (Enter Cumulatively) 3 Year 5 -

Net New Job Information (Enter Cumulatively) Job Type/Category

Net New Job Information (Enter Cumulatively) 4 Avg Gross Wages/Job Type

Net New Job Information (Enter Cumulatively) 4 Year 1 -

Net New Job Information (Enter Cumulatively) 4 Year 2 -

Net New Job Information (Enter Cumulatively) 4 Year 3 -

Net New Job Information (Enter Cumulatively) 4 Year 4 -

Net New Job Information (Enter Cumulatively) 4 Year 5 -

Net New Job Information (Enter Cumulatively) Job Type/Category

Net New Job Information (Enter Cumulatively) 5 Avg Gross Wages/Job Type

Net New Job Information (Enter Cumulatively) 5 Year 1 -

Net New Job Information (Enter Cumulatively) 5 Year 2 -

Net New Job Information (Enter Cumulatively) 5 Year 3 -

Net New Job Information (Enter Cumulatively) 5 Year 4 -

Net New Job Information (Enter Cumulatively) 5 Year 5 -

Does the project site involve or is it substantially contiguous to a property listed or recommended for listing in the NY State or National Registers of Historic Places? Consult the National Register Information System at http://www.nps.gov/history/nr/research/ to find out if a property is listed. The Cultural Resource Information System (CRIS) tool is located here . Indicate Yes, No, N/A. Click "Scoring Tips" for more information.

If Yes, please identify the name of the resource.

Is the project site wholly or partially included within an identified archeologically sensitive area? The Geographic Information System for Archeology and National Register tool can be used to identify archeologically sensitive areas. Indicate Yes, No, N/A. Click "Scoring Tips" for more information.

If Yes, please list the geographic information for the archeologically sensitive areas.

Does the proposed project use, maintain, or improve existing infrastructure?

Explain how the proposed project will use, maintain, or improve existing infrastructure.

Is the proposed project located in a municipal center?

Please explain how the proposed project is located in a municipal center.

Is the proposed project located in a developed area or an area designated for concentrated infill development in a municipally approved comprehensive land use plan, local waterfront revitalization plan and/or brownfield opportunity area plan?

Please explain how the proposed project is located in a developed area or an area designated for concentrated infill development in a municipally approved comprehensive land use plan, local waterfront revitalization plan and/or brownfield opportunity area plan.

Will the proposed project protect, preserve and enhance the State’s resources, including agricultural land, forests, surface and groundwater, air quality, recreation and open space, scenic areas, and significant historic and archeological resources?

Please explain how the proposed project will protect, preserve and enhance the State's resources, including agricultural land, forests, surface and groundwater, air quality, recreation and open space, scenic areas, and significant historic and archeological resources.

Will the proposed project foster mixed land uses and compact development, downtown revitalization, Brownfield redevelopment, the enhancement of beauty in public spaces, the diversity and affordability of housing in proximity to places of employment, recreation and commercial development and the integration of all income and age groups?

Please explain how the proposed project will foster mixed land uses and compact development, downtown revitalization, Brownfield redevelopment, the enhancement of beauty in public spaces, the diversity and affordability of housing in proximity to places of employment, recreation and commercial development and the integration of all income and age groups.

Will the proposed project provide mobility through transportation choices including improved public transportation and reduced automobile dependency?

Please explain how the proposed project will provide mobility through transportation choices including improved public transportation and reduced automobile dependency.

Will the proposed project involve coordination between state and local government and inter-municipal and regional planning?

Please explain how the proposed project will involve coordination between state and local government and inter-municipal and regional planning.

Will the proposed project involve participation in community based planning and collaboration?

Please explain how the proposed project will involve participation in community based planning and collaboration.

Will the proposed project ensure predictability in building and land use codes?

Please explain how the proposed project will ensure predictability in building and land use codes.

Will the proposed project promote sustainability by strengthening existing and creating new communities which reduce greenhouse gas emissions and do not compromise the needs of future generations, by among other means encouraging broad based public involvement in developing and implementing a community plan and ensuring the governance structure is adequate to sustain its implementation?

Please explain how the proposed project will promote sustainability by strengthening existing and creating new communities which reduce greenhouse gas emissions and do not compromise the needs of future generations, by among other means encouraging broad based public involvement in developing and implementing a community plan and ensuring the governance structure is adequate to sustain its implementation.

By entering your name in the box below, you certify, under penalty of perjury, that the information given herein is true and correct in all respects for the company or organization applying for funding (the "Company"), presently and for the past five years: -the Company is not a party to any litigation or any litigation is not pending or anticipated that could have an adverse material effect on the company's financial condition;

-the Company does not have any contingent liabilities that could have a material effect on its solvency;

-the Company, its affiliates or any member of its management or any other concern with which such members of management have been officers or directors, have never been involved in bankruptcy, creditor's rights, or receivership proceedings or sought protection from creditors;

-the Company is not delinquent on any of its state, federal or local tax obligations;

-No principal, officer of the Company, owner or majority stockholder of any firm or corporation, or member of the management has been charged or convicted of a misdemeanor or felony, indicted, granted immunity, convicted of a crime or subject to a judgment, or the subject of an investigation, whether open or closed, by any government entity for a civil or criminal violation for: (i) any business-related activity including, but not limited to, fraud, coercion, extortion, bribe or bribe receiving, giving or accepting unlawful gratuities, immigration or tax fraud, racketeering, mail fraud, wire fraud, price fixing or collusive bidding; or (ii) any crime, whether or not business related, where the underlying conduct relates to truthfulness, including but not limited to, the filing of false documents or false sworn statements, perjury or larceny;

-the Company or any of the Company's affiliates, principal owners or Officers has not received a violation of State Labor Law deemed "willful";

-the Company or any of its affiliates has never been cited for a violation of State, Federal, or local laws or regulations with respect to labor practices, hazardous wastes, environmental pollution or other operating practices;

-there are not any outstanding judgments or liens pending against the Company other than liens in the normal course of business.

-the Company or any of its affiliates, principal owners or officers the company has not been the subject of any judgments, injunctions, or liens including, but not limited to, judgments based on taxes owed, fines and penalties assessed by any governmental agency, or elected official against the Company.

- the Company or any of its affiliates, principal owners or officers the company has not been investigated by any governmental agency, including, but not limited to, federal, state and local regulatory agencies

-the Company or any of its affiliates, principal owners or officers the company has not been debarred from entering into any government contract; been found non-responsible on any government contract; been declared in default ore terminated for cause on any government contract; been determined to be ineligible to bid or propose on any contract; been suspended from bidding on any government contract; received an overall unsatisfactory performance rating from any government agency on any contract; agree to a voluntary exclusion from bidding or contracting on a government contract.

- the Company or any of its affiliates, principal owners or officers the company has not failed to file any of the required forms with any government entity regulating the Company. By entering your name in the box below, you agree to allow the Department of Taxation to share the Company tax information with ESD. By entering your name in the box below, you agree to allow the Department of Labor to share tax and employer information with ESD. Note: If any of the statements above are not true, in addition to entering your name, also include an explanation in the box below, indicating which issue you are addressing.

By entering your name in the box below, you certify that you are authorized on behalf of the applicant and its governing body to submit this application. You further certify that all of the information contained in this Application and in all statements, data and supporting documents which have been made or furnished for the purpose of receiving assistance for the project described in this application, are true, correct and complete to the best of your knowledge and belief. You acknowledge that offering a written instrument knowing that the written instrument contains a false statement or false information, with the intent to defraud the State or any political subdivision, public authority or public benefit corporation of the State, with the knowledge or belief that it will be filed with or recorded by the State or any political subdivision, public authority or public benefit corporation of the State, constitutes a crime under New York State Law.

By entering your name in the box below, you are acknowledging that ESD’s Contractor & Supplier Diversity policy will apply to this project. You are further acknowledging that you are aware of ESD’s agency-wide Minority and Women Business Enterprise (‘MWBE’) utilization goal of 30%. Please note that each project will be assigned an individual contract-specific goal, which may be higher or lower than 30%. Furthermore, you understand that, should this project receive a funding award, the Applicant shall be required to use good faith efforts to achieve the prescribed MWBE goals assigned to this project and failure to attain MWBE goal could result in grant amount being reduced.

By entering your name in the box below, you certify and agree that you are aware that your award will be reduced in proportion to the reduction of jobs and/or total project costs. Furthermore, you understand that, should this project receive a funding award, the Applicant will maintain such records and take such actions necessary to demonstrate such compliance throughout the completion of the project.

Management

Computer and Mathematical

Production

Community and Social Services

Construction and Extraction

Life, Physical, and Social Science

Healthcare Practitioners and Technical

Installation, Maintenance, and Repair

Building and Grounds Cleaning and Maintenance

Food Preparation and Serving Related

Arts, Design, Entertainment, Sports, and Media

Protective Service

Legal

Sales and Related

Architecture and Engineering

Personal Care and Service

Healthcare Support

Transportation and Material Moving

Farming, Fishing, and Forestry

Business and Financial Operations

Education, Training, and Library

Office and Administrative Support

1st Most Common Recruitment Method

1st Most Common Recruitment Method - Other

1st Most Common Recruitment Method - Percentage of Use

2nd Most Common Recruitment Method

2nd Most Common Recruitment Method - Other

2nd Most Common Recruitment Method - Percentage of Use

3rd Most Common Recruitment Method

3rd Most Common Recruitment Method - Other

3rd Most Common Recruitment Method - Percentage of Use