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 for funding?

Are you applying for at least $100,000?

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

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 City

Project State

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

Project county or counties.

For more than one project location, please provide full address(es) for each location. If Not Applicable, indicate "NA".

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.)

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.)

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.)

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.

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 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 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 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.

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.

Does the applicant own the property?

Is the cost of acquisition of the property included in the budget?

Does the applicant have site control or written consent from the ownership entity?

Please upload an explanation, including the name of the entity that owns the property/site, and proof of site control or written consent from the ownership entity.

Please upload an explanation of how and when the applicant plans to have site control.

Attach interim financial documents for 2026

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 2025. For-publicly traded companies, please provide Form 10-K for 2026.

Attach 2025 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 2025. For-publicly traded companies, please provide Form 10-K for 2025.

Attach 2024 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 2024. For-publicly traded companies, please provide Form 10-K for 2024.

Attach 2023 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 2023. For-publicly traded companies, please provide Form 10-K for 2023.

Attach an organizational chart along with a brief description of the ownership structure. Please specify the ownership of the applicant’s business including the names of principal owners, include the percentage of ownership for each individual entity (if applicable), and if the company is a parent, subsidiary and/or affiliate of another company, please provide a description of the relationship. Additional financial information may be requested.

Please upload any additional documents relevant to the application such as project renderings, an map of the proposed site, etc.

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.

Have any other entities completed a Climate Impact Statement or other similar form for this project?

Attach a copy of the completed Climate Impact Statement or similar form.

Has an Environmental Impact Statement been prepared for this project?

Attach copy of the Greenhouse Gas Emission section.

Have the greenhouse gas emissions expected from the project been quantified in any other way?

Attach copy of the supporting calculations and other material.

Does this project include funding requests for capital related expenses?

Please list the amount of capital funding being requested.

Does this project include funding requests for working capital related expenses?

Please list the amount of working capital funding being requested.

How does your project align with the NYC ACHIEVE Initiative? (NYC’s ACHIEVE Initiative Proposal is linked below).

The NYC ACHIEVE “Breakthrough Initiative” focuses on co-locating homes and workplaces. Is your project associated with a larger development that incorporates new residential units?

Provide a concise narrative outlining how your project will integrate with the residential development.

Please provide estimated metrics regarding the residential development including: total project budget, net new units created, number of units at market rate, number of affordable/supportive units, and square footage of residential portion.

In the beginning of the Application, you were asked to describe your overall project, which may include multiple phases, such as in the case of a major infrastructure project or redevelopment of a specific geographic area. Please note that this section of the Application is specific to the phase of the project for which ESD funds are being requested through this CFA, NOT the overall project. Is the proposed project a phased project as described above?

Concisely describe ONLY the phase of the project for which ACHIEVE funds are being requested via this CFA, indicating the location, what will be planned, designed and/or constructed, the issues/opportunities to be addressed and expected outcomes and deliverables.

What does the project involve in terms of product(s) or services(s) that will be provided at the project location? Please explain and quantify how the capital investment for which you are seeking funding will make it possible to reach business or organization goals such as changes to efficiency, profitability, productivity, market share, product offerings, or other measurable results relevant to your goals for the product(s) and service(s) that are/will be provided.

Does this project provide training and improvements to the workforce?

Will trainees earn any type of certification?

Indicate the type of certification and length of time to earn, as well as another other relevant information about the certification program.

Will there will be assistance provided for job placement upon completion of training.

Please indicate how assistance will be provided for job placement or advancement upon completion of training.

Please indicated any other relevant information to show how the project provides training and improvements to the workforce.

How many individuals will be trained annually?

How many indirect jobs will the project support?

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.

Applicant website

Indicate the principal North American Industrial Classification System (NAICS) Code of the Company.

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

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.

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.

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.

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 Land Acquisition Year 1

Qualified Investments -Building Acquisition Year 1

Qualified Investments Demolition & environmental remediation 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 Soft Costs Year 1

Qualified Investments Land Acquisition * Year 2

Qualified Investments Building Acquisition Year 2

Qualified Investments Demolition 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 Soft Costs Year 2

Qualified Investments Land Acquisition * Year 3

Qualified Investments Building Acquisition Year 3

Qualified Investments Demolition 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 Soft Costs Year 3

Qualified Investments Land Acquisition * Year 4

Qualified Investments Building Acquisition year 4

Qualified Investments Demolition 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 Soft Costs Year 4

Qualified Investments Land Acquisition * Year 5

Qualified Investments Building Acquisition

Qualified Investments Demolition Year 5

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 Soft Costs Year 5

Working capital for non-profit workforce - Year 1

Working capital for non-profit workforce - Year 2

Working capital for non-profit workforce - Year 3

Working capital for non-profit workforce - Year 4

Working capital for non-profit workforce - Year 5

Training program expenses - Year 1

Training program expenses - Year 2

Training program expenses - Year 3

Training program expenses - Year 4

Training program expenses - Year 5

Working capital for the Network Convener - Year 1

Working capital for the Network Convener - Year 2

Working capital for the Network Convener - Year 3

Working capital for the Network Convener - Year 4

Working capital for the Network Convener - Year 5

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

Is there any additional information you wish to provide that is relevant to your organization or project to be considered? If so, please provide.

Is the project located in or within a half mile of a Disadvantaged Community as identified by the Disadvantaged Communities map maintained by NYSERDA?

Did you answer yes to the any one of the following three questions?

Q_16310: Have any other entities completed a Climate Impact Statement or other similar form for this project?

Q_16312: Has an Environmental Impact Statement been prepared for this project?

Q_16314 Have the greenhouse gas emissions expected from the project been quantified in any other way?

Have you uploaded supporting documentation in the attachments section of this application?

Does the project involve new building construction or renovation of an existing building?

You should select 'Yes' only if the project involves new building construction or the renovation of an existing building. If you answer 'Yes' to less than 4 questions in this section (Part B - The Building), not including this question, and are awarded, you may be contacted to incorporate greenhouse gas mitigation measures into your project.

Is the project an adaptive reuse of an existing building?

Explain briefly:

Explain briefly:

Will the project reuse building materials?

Explain briefly:

Explain briefly:

Will the project recycle rehabbed building materials?

Explain briefly:

Explain briefly:

Will the project incorporate low-carbon building materials into construction?
Some examples of low-carbon materials and products in the market include low-carbon bricks, concrete, tiles and recycled metals.

Explain briefly:

Explain briefly:

Will the project utilize an energy efficient building envelope or improve building weatherization through, for example, insulation, air sealing, and/or replacing poorly performing windows and doors?

Explain briefly:

Explain briefly:

Will the project adopt measures to avoid, reduce or re-use waste?

Explain briefly:

Explain briefly:

Will the project utilize climate friendly refrigerants (those with a Global Warming Potential of less than 10) instead of hydrofluorocarbons?

Explain briefly:

Explain briefly:

Will the project incorporate energy efficiency measures such as smart thermostats, energy efficient lighting, or heat pumps for space heating and cooling?

Explain briefly:

Explain briefly:

Will the project make use of thermal energy networks, such as those that utilize, for example, ground-source heat pumps, waste heat, or industrial process heat to provide space heating, cooling and/or domestic hot water?

Explain briefly:

Explain briefly:

Will the project incorporate infrastructure for charging/fueling zero-emission vehicles?

Explain briefly:

Explain briefly:

Will the project install on-site renewable energy systems and/or on-site battery storage systems to contribute to the project’s energy needs?

Explain briefly:

Explain briefly:

Will the project utilize renewable energy for at least 50% of its electricity?

Explain briefly:

Explain briefly:

Will the building systems be 100% electrified?

Explain briefly:

Explain briefly:

Are there any renewable energy or energy efficiency improvements being made to the building as part of the project that are not reflected in the items above?

Explain briefly:

Explain briefly:

Does the project involve the installation, expansion or renovation of a manufacturing process?

Will the project use innovative measures to reduce emissions such as low-carbon thermal solutions or carbon capture, storage, and utilization?

Explain briefly:

Explain briefly:

Will the project use cleaner fuels, such as hydrogen formed without greenhouse gas emissions through the use of electrolysis powered by renewable electricity, to replace or displace the use of fossil fuels?

Explain briefly:

Please identify the fuels and systems that will be employed in the manufacturing process and explain why cleaner fuels or electrification will not be used.

Will the project incorporate mitigation measures for process emissions?

Explain briefly:

Explain briefly:

Will the project use best available control technology for mitigating and controlling greenhouse gas emissions?

Explain briefly:

Explain briefly:

Are there any renewable energy or energy efficiency improvements being made to the manufacturing process as part of the project that are not reflected in the items above?

Explain briefly:

Explain briefly:

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 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. 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.