Have any of the expenses for this project (or, in the case of a multi-phase project, the phase of the project for which funds are being requested) been incurred or are expected to be incurred prior to an award of funding?

Does the proposed project budget include a 10% cash equity contribution from the Applicant?

Type of Applicant (select one)
Applicants will first select a single applicant type from the categories below and then a subtype based on their initial selection. Applicants should review the selections below which provides a list of subtypes by main applicant type.

1. For Profit entity options:
Limited Liability Corporation (LLC)
Limited Liability Partnership (LLP)
Sole Proprietorship
S Corporation
C Corporation
Limited Partnership (LP)
Other- applicant will be required to list their other for-profit designation.

2. Not-for profit entity options:
501(c)(1) Any corporation that is organized under an act of Congress that is exempt from federal income tax;
501(c)(2) Corporations that hold a title of property for exempt organizations;
501(c)(3) Corporations/funds/foundations that operate for religious/ charitable/ scientific/ literary/ educational purposes;
501(c)(4) Nonprofit organizations that promote social welfare;
501(c)(5) Labor, agricultural, or horticultural associations;
501(c)(6) Business leagues/chambers of commerce/etc. that are not organized for profit;
501(c)(7) Recreational organizations; and
Other- applicant will be required to list their other not-for-profit designation.

3. Government entity options:
Federal
State
County
City
Town
Village
Tribal
School District
County or Town Improvement District
District Corporation
Public Authority
Business Improvement District
Fire District
Board of Cooperative Education Services (BOCES)
Public Library
Association Library
Other- applicant will be required to list their other government designation.

Does the project align with the Regional Economic Development Council's Strategic Plan?

Explain how the project aligns with the Regional Economic Development Council's Strategic Plan.

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

Is this project subject to National Environmental Policy Act (NEPA)?

Type of Applicant (select one)
Applicants will first select a single applicant type from the categories below and then a subtype based on their initial selection. Applicants should review the selections below which provides a list of subtypes by main applicant type.

1. For Profit entity options:
Limited Liability Corporation (LLC)
Limited Liability Partnership (LLP)
Sole Proprietorship
S Corporation
C Corporation
Limited Partnership (LP)
Other- applicant will be required to list their other for-profit designation.

2. Not-for profit entity options:
501(c)(1) Any corporation that is organized under an act of Congress that is exempt from federal income tax;
501(c)(2) Corporations that hold a title of property for exempt organizations;
501(c)(3) Corporations/funds/foundations that operate for religious/ charitable/ scientific/ literary/ educational purposes;
501(c)(4) Nonprofit organizations that promote social welfare;
501(c)(5) Labor, agricultural, or horticultural associations;
501(c)(6) Business leagues/chambers of commerce/etc. that are not organized for profit;
501(c)(7) Recreational organizations; and
Other- applicant will be required to list their other not-for-profit designation.

3. Government entity options:
Federal
State
County
City
Town
Village
Tribal
School District
County or Town Improvement District
District Corporation
Public Authority
Business Improvement District
Fire District
Board of Cooperative Education Services (BOCES)
Public Library
Association Library
Other- applicant will be required to list their other government designation.

Select the for-profit entity of the applicant applying for funding:

Enter the applicant's 'Other' for-profit entity designation.

Select the not-for-profit entity of the applicant applying for funding:

Enter the applicant's 'Other' not-for-profit entity designation.

Select the government entity of the applicant applying for funding:

Enter the applicant's 'Other' government entity designation.

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 the associated ID 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 First Name

Applicant Last 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 Salutation

Contact First Name

Contact Last Name

Contact Title

Primary Organization

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 Salutation

Additional Project Contact First Name

Additional Project Contact Last Name

Additional Contact Title

Additional Organization

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.

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.

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".

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

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

Please indicate the lead agency (if applicable).

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)

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.

List all entities and their EIN that the employment is being reported to DOL under.
ALL NYS Locations

List all entities and their EIN that the employment is being reported to DOL under.
Project location only

A. Total Employees / Jobs
(this should add up to the sum of Total Full Time Employees + Total Part Time Employees + Total Contract Employees)

A. Total Employees / Jobs (Project Location Only)
(this should add up to the sum of Total Full Time Employees + Total Part Time Employees + Total Contract Employees)

B. Total Full Time Employees / Jobs Only
All NYS Locations

B. Total Full Time Employees / Jobs Only
Project Location Only

C. Total Part-time Employees/Jobs Only

C. Total Part-time Employees/Jobs Only Project Location Only

D. Total Contract Employees/Jobs Only ALL NYS Locations

D. Total Contract Employees/Jobs Only Project Location Only

E. Total Full Time Equivalents (FTEs)
(this should be calculated from part-time employees only (C) using the FTE definition from the top of the page)
ALL NYS Locations

E. Total Full Time Equivalents (FTEs)
(this should be calculated from part-time employees only (C) using the FTE definition from the top of the page)
Project location only

F. Total Full Time Employees + Total FTEs (B+E) All NYS LOCATIONS.

F. Total Full Time Employees + Total FTEs (B+E) PROJECT LOCATION Only

G. Average Annual Wage (Full Time Employees and FTEs) All NYS Locations as of the date this application is finalized

G. Average Annual Wage (Full Time Employees and FTEs) Project Location Only as of the date this application is finalized.

H. At Risk Positions (From Existing Full Time Employees and FTEs)
How many of the existing jobs at the project location(s) are at risk if the project does not go forward.

I. Average Annual Wage of at Risk Employees/Jobs (Full Time Employees and FTEs)
project location only

J. Percentage of Employees that are residents of New York State
ALL NYS locations

J. Percentage of Employees that are residents of New York State Project Location Only

K. Construction Jobs: Estimate the number of construction jobs to be created by the proposed project.

Will any other non-construction jobs result from the project? 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.

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.

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

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 -

Indicate how many net new full-time jobs the company will create over 5 years. Please ensure this number is the same as the cumulative total number of jobs you entered for year 5 from the Net New Job Infromation table above.

The number of net new jobs should be consistent with the definitions from the top of the page, where total new full-time employees/jobs are added to total new full-time equivalent employees/jobs to get the total number of net new jobs that can counted.

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.

Indicate the average annual salary for the net new jobs created as a result of this project.

What percentage of the project’s net-new employees will work remotely (in part or fully)?
If none, then enter 0(zero).

Indicate the year employment begins under Year 1 for your project for the Net New Job table above.

Indicate what the average percentage is of the applicants' total employees' gross wages paid in benefits (exclude mandated benefits such as Federal Insurance Contributions Act (FICA), Medicare tax, unemployment insurance or workers' compensation insurance.

For the developer, please provide audited or reviewed financials, or compiled financials with signed tax returns, for 2023. For publicly traded companies please provide Form 10-K for 2023.

For a start-up company with no operating history for this year, attach personal financial statements from a personal guarantor(s) of the start-up company for 2023.

For the developer, please provide audited or reviewed financials, or compiled financials with signed tax returns, for 2024. For publicly traded companies please provide Form 10-K for 2024.

For a start-up company with no operating history for this year, attach personal financial statements from a personal guarantor(s) of the start-up company for 2024.

For the developer, please provide audited or reviewed financials, or compiled financials with signed tax returns, for 2025. For publicly traded companies please provide Form 10-K for 2025.

For a start-up company with no operating history for this year, attach personal financial statements from a personal guarantor(s) of the start-up company for 2025.

For the developer, please provide interim financials for 2026, certified by a company officer. For publicly traded companies, please provide the most recent Form 10-Q.

For a start-up company with no operating history for this year, attach personal financial statements from a personal guarantor(s) of the start-up company for interim 2026.

Is the development company also the entity that will be providing the guarantee on the proposed ESD award?

Please attach a list of affiliated corporate entities or individuals that will be providing the guarantee on the ESD award, if selected for award.

For the corporate entities or individuals providing the guarantee, 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.

For a start-up company with no operating history for this year, attach personal financial statements from a personal guarantor(s) of the start-up company for 2021.

For the corporate entities or individuals providing the guarantee, please provide audited or reviewed financials, or compiled financials with signed tax returns, for 2022. For publicly traded companies please provide Form 10-K for 2022.

For a start-up company with no operating history for this year, attach personal financial statements from a personal guarantor(s) of the start-up company for 2022.

For the corporate entities or individuals providing the guarantee, please provide audited or reviewed financials, or compiled financials with signed tax returns, for 2023. For publicly traded companies please provide Form 10-K for 2023.

For a start-up company with no operating history for this year, attach personal financial statements from a personal guarantor(s) of the start-up company for 2023.

For the corporate entities or individuals providing the guarantee, please provide interim financials for 2024, certified by a company officer. For publicly traded companies, please provide the most recent Form 10-Q.

For a start-up company with no operating history for this year, attach personal financial statements from a personal guarantor(s) of the start-up company for interim 2024.

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).

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 "View Help" 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.

Pro Forma Workbook – Please email nys-longisland@esd.ny.gov requesting a standard pro forma template. Please populate the model with the details of the project and attach a completed template to this question. Let us know if you encounter any issues. Please populate the sources with all planned permanent financing sources.

Equity Breakdown – Sources of equity funds, terms and conditions with partners, and/or proof of sufficient cash on hand

Term Sheets – Please provide signed term sheets for any debt facilities that will serve as permanent funding sources on the project.

Ownership Chart – Please provide a chart that clarifies the structure of all stakeholding entities involved in this transaction/development, including all ownership percentages.

For all organizations and entities, provide financial projections for 10 years.

Please attach bios and resumes for all principals in the project in PDF format.

Is the applicant a city, town, or village that is applying for capital funding?

Is the applicant organization a subsidiary?

Parent Company name:

Parent Company Street Address:

Parent Company City:

Parent Company Zip:

Parent Company County:

Is the applicant applying on behalf of another organization or entity that will be the recipient of, or that will benefit from, the award if funds are awarded to the project?

Beneficiary Legal Organization Name:

Is the beneficiary a DBA?

Beneficiary DBA Name:

Beneficiary Street Address:

Beneficiary City:

Beneficiary Zip:

Beneficiary County:

Beneficiary Contact First Name:

Beneficiary Contact Last Name:

Beneficiary Contact Job Title:

Beneficiary Contact Phone:

Beneficiary Contact Email:

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 the associated ID number.

Is the Beneficiary company a subsidiary?

Beneficiary Parent Company Name:

Beneficiary Parent Company Street Address:

Beneficiary Parent Company City:

Beneficiary Parent Company Zip:

Beneficiary Parent Company County:

Will the funds be used by the recipient (applicant) to create a program to disburse funds to sub-recipients?

Please describe in detail the sub-recipient organizations, anticipated services to be rendered and anticipated disbursement amounts.

Please select the type of business that will enter into a contract, if funding is awarded.

Is the organization or entity New York State certified as minority-owned or woman-owned?

Please enter the New York State certification number.

Is the organization a manufacturer?

Provide all the North American Industrial Classification (NAICS) numbers used to classify each type of the organization's business activity. If more than one NAICS code, separate by commas.

Describe in detail the qualifications of the organization to undertake this project, including the organization's experience with projects of similar size and scope.

Has the applicant applied for and/or been awarded funding from other New York State or local entities for this project?

Please detail the funding applied to for this project and the entity administering the funding. Do not include funding that has been awarded.

Please detail the funding awarded to this project and the entity administering the funding.

Has the applicant applied to and/or been awarded funding from a local IDA?

Please detail the funding applied for this project and the entity administering the funding. Do not include funding that has been awarded.

Please detail the funding awarded to this project and the entity administering the funding.

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

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 to find out if a property is listed. Or use the Cultural Resource Information System (CRIS) tool .
See question requirements for more information on SHPO consultation.

Please identify the name of the resource, explain the status of the SHPO consultation, and if consultation is complete, please provide a link to SHPO's Letter of Determination of No Adverse Effect or Letter of Resolution to Mitigate Adverse Effect.

Does the project site contain or is it substantially contiguous to buildings that are more than 50 years old and/or buildings/lands that are known to be historically, architecturally, or culturally significant?

Is the project site wholly or partially included within an identified archeologically sensitive area?
Consult the National Register Information System to find out if a property is listed. Or use the Cultural Resource Information System (CRIS) tool to identify archeologically sensitive areas.
See question requirements for more information on SHPO consultation.

Please list the geographic information for the archeologically sensitive areas, explain the status of SHPO consultation, and if consultation is complete, please provide a link to SHPO's Letter of Determination of No Adverse Effect or Letter of Resolution to Mitigate Adverse Effect.

Does your application contain 1) trade secrets, (2) information that, if disclosed, would cause substantial injury to the competitive position of your organization, or (3) critical infrastructure information? (All efforts should be made to provide such Information in the questions marked as “restricted.”)

Please identify the Question # and specific language for those portions of your application and accompanying documents you believe fall under these exemptions, and provide a detailed justification for the exemption from disclosure. See 'Click Here for Question Requirements' for formatting and additional information.

Qualified Investments -Building Acquisition Year 1

Qualified Investments Building Renovation Year 1

Qualified Investments New Construction Year 1

Qualified Investments Production Machinery & Equipment Year 1

Qualified Investments Furniture, fixtures & equipment Year 1

Qualified Investments Land Acquisition Year 1

Qualified Investments Demolition & environmental remediation Year 1

Qualified Investments Soft Costs Year 1

Qualified Investments Building Acquisition Year 2

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 Soft Costs Year 2

Qualified Investments Building Acquisition Year 3

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 Soft Costs Year 3

Qualified Investments Building Acquisition year 4

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 Soft Costs Year 4

Qualified Investments Building Acquisition

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 Soft Costs Year 5

Salaries - Year 1

Salaries - Year 2

Salaries - Year 3

Salaries - Year 4

Salaries - Year 5

Consulting Fees - Year 1

Consulting Fees - Year 2

Consulting Fees - Year 3

Consulting Fees - Year 4

Consulting Fees - Year 5

Marketing - Year 1

Marketing - Year 2

Marketing - Year 3

Marketing - Year 4

Marketing - Year 5

Lease Expenses - Year 1

Lease Expenses - Year 2

Lease Expenses - Year 3

Lease Expenses - Year 4

Lease Expenses - Year 5

Other Facility Operational Costs - Year 1

Other Facility Operational Costs - Year 2

Other Facility Operational Costs - Year 3

Other Facility Operational Costs - Year 4

Other Facility Operational Costs - Year 5

Programming/Training - Year 1

Programming/Training - Year 2

Programming/Training - Year 3

Programming/Training - Year 4

Programming/Training - Year 5

Other - Year 1

Other - Year 2

Other - Year 3

Other - Year 4

Other - Year 5

Did you enter a dollar values greater than $0 for the "Other" row in the above "Working Capital Investments" table?

Please specify the "Other" costs

The NYS Smart Growth Public Infrastructure Policy Act requires that a public infrastructure project meet the relevant smart growth criterion to the extent practicable. Public Infrastructure projects consist of construction or reconstruction of transportation, sewer, wastewater treatment, water, education, housing and other publicly supported infrastructure.Does the proposed project build new public infrastructure, expand public infrastructure or use, maintain, or improve existing public infrastructure?

If you are maintaining or improving existing public infrastructure, please answer “YES”. If you are building new public infrastructure or expanding public infrastructure, please answer "YES".

If this this is not applicable to your project, answer “NO”.

Please explain the need to build new infrastructure instead of using or improving existing infrastructure. If n/a, please type N/A.

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

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

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. Specifically, explain how your project advances infill development or redevelopment in existing developed areas consistent with an approved plan.  Infill development includes redevelopment, rehabilitation and new development between existing buildings on vacant or under-utilized sites.

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. Beyond simply avoiding or minimizing negative environmental impacts, please indicate the resources that may be impacted by your project and how your project will preserve and enhance these resources.

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. Specifically, explain how your project advances these objectives and improves the quality of life in your community.

Please explain how the proposed project will provide mobility through transportation choices including improved public transportation and reduced automobile dependency. There are many alternatives to automobile transportation.  Please explain how your project provides or complements alternatives to automobile travel such as bikes, pedestrians, public transit, air travel or rail travel.

Please explain how the proposed project will involve coordination between state and local government and inter-municipal and regional planning. Identify any interaction between the applicant and any municipal and county governments, planning boards, regional planning associations or similar organizations. Document any outreach by the applicant to these organizations regarding the project and any relevant correspondence.

Please explain how the proposed project will involve participation in community-based planning and collaboration. Specifically, explain how the project results from an inclusive, multi-stakeholder (including traditionally underserved populations) process of community-based planning and collaboration.  To assist with your explanation, identify any affected community groups or organizations with an interest in the proposed project and if the planning process involved outreach to citizens and stakeholders at all stages of development of the project.

Please explain how the proposed project will ensure predictability in building and land use codes. Provide any additional relevant information.

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. Specifically, explain how your project promotes sustainability.  For example, does your project include buildings and plans that seek to minimize consumption of fossil fuels (coal, petroleum), reduce water usage / consumption, and encourage the use of renewable energy (wind, solar, and geo-thermal).

Please explain how the proposed project will mitigate future physical climate risk due to sea-level rise, and/or storm surges and/or flooding, based on available data predicting the likelihood of future extreme weather events, including hazard risk analysis data.

Specifically, explain how your project demonstrates that future physical climate risk due to sea-level rise, storm surge and flooding have been considered. For example, have you demonstrated consideration of the flood risk applicable to your specific structure type? Explain how the siting and design have evaluated flood-risk considerations, including, but not limited to, human health and safety, environmental effects, cost, funding-source requirements, feasibility and community impact.

For information on the State Climate Impacts Assessment visit:
https://nysclimateimpacts.org/about-the-assessment/what-is-the-assessment/

For information on implementation of the Community Risk and Resiliency Act visit:
https://dec.ny.gov/environmental-protection/climate-change/new-york-response/crra

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 Pursuant to New York State Executive Law Articles 15-A and Article 3 of New York State Veterans’ Services Law, ESD recognizes its obligation under the law to promote opportunities for maximum feasible participation of certified New York State minority and women-owned business enterprises (MWBEs) and service-disabled veteran-owned businesses (SDVOBs) in the performance of ESD projects. The Recipient shall be required to use Good Faith Efforts (pursuant to 5 NYCRR §142.8 and 9 NYCRR § 252.2(n) to achieve MWBE and SDVOB Participation. In addition, ESD’s MWBE and SDVOB Participation/Equal Employment Opportunity Policy will apply to this program. Specific goals related to the total value of ESD’s funding will be established on a grant-by grant basis. ESD has an agency-wide goal of 30% for MWBE participation, 15% for New York State-certified Minority-owned Business Enterprise (“MBE”) participation and 15% for New York State-certified Women-owned Business Enterprise (“WBE”) participation (based on the current availability of MBEs and WBEs). ESD has an agency-wide goal of 6% for SDVOB participation, based on the current availability of qualified SDVOBs.

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, and not meeting and maintaining affordable housing requirements. 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.

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 acknowledge that you will pay a 1% commitment fee to ESD and be responsible for out-of-pocket costs at the time of board approval.