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1] <br />12. Does any member of the governing body of the City of South Bend or any public <br />official or employee of the City of South Bend have any direct or indirect <br />personal interest in the Applicant or the development of the land as proposed? <br />❑ Yes <br />a No <br />If yes, explain: <br />13. Is this organization or any of its owners or officers presently delinquent on <br />property taxes or any fee (including, but not limited to, permit fees, license fees <br />and user fees) owed to the State of Indiana, St. Joseph County, Indiana or the City <br />of South Bend. <br />❑ Yes <br />■ No <br />If yes, explain. <br />14. Brief statement regarding Applicant's intent to use local suppliers, contractors and <br />labor. In addition, Applicant shall submit information concerning use of local <br />suppliers, contractors and labor on previous jobs, not limited to projects in St. <br />Joseph County, Indiana. <br />It is the developer's intent to hire an area general contractor who will bid <br />most or all of the work on this development to local subcontractors and <br />suppliers in the South Bend area. <br />Certification <br />I (We), Gameday Centers Southeastern LLC <br />certify that this Statement for Public Disclosure is true and correct to the best of my (our) <br />knowledge and belief. <br />Gar B. S illers <br />e <br />/ Sig ature <br />Managing Member <br />Title <br />11 -30 -05 <br />Date <br />Name <br />Signature <br />Title <br />Date <br />(!f the applicant is an individual, this statement should be signed by such individual, if a partnership, it should be <br />signed by one of the partners; if a corporation or other entity, it should be signed by one of its chief officers having <br />knowledge of the facts required by this statement.) <br />