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Complete below for Real or Personal Property Tax Abatement only. <br />Please sign for all requested incentives. <br />Public Benefit Item: <br />Information is required on both the construction companies and the <br />companies which will provide materials purchased for this project. <br />QualifyPleasecompletethetablebelowwiththeappropriateinformation. If Earned Points Available Points <br />you qualify for the points,please enter the full amount of available ( <br />Yes or No) <br />points. <br />1 Construction Related(Contractors): <br />A. Employ Local Companies(75%) N/A <br />B. Purchase Materials from Local Companies(75%) N/A 37) <br />C. Require Employees vs.Independent Contractors N/A <br />D. Require Prevailing Wage(Davis Bacon) NIA <br />E Require Health Benefits NIA <br />F. Require Pension Benefits N/A IR <br />G. Maintain Affirmative Action Plan N/A Ti) <br />Sub-total Construction Related: G 1-it <br />2 Wage&Benefit Related(Owner): <br />A. Pay Target Wage Levels YES 33 <br />B. Provide Health Benefits ES 34 <br />C. Provide Pension Benefits ES 29 79 <br />0. Provide Training YES 28 28 <br />E. Provide Child Care NO C 55 <br />F. Provide Transportation Assistance NO C <br />G. Provide Employer Assisted Housing program NO 0 9 <br />Sub-total Wage&Benefit Related: 124 <br />3 Workforce Related: <br />A. Create New Jobs ES 42 d: <br />B. Retain Existing Jobs ii ES 41 Ii <br />C. Maintain Affirmative Action Plan CS 35 35 <br />D. Provide Targeted Hiring Preference YES 34 <br />Sub-total Workforce Related; 152 1.' <br />4 Support a Municipal Facility: <br />Support a SB Municipal Facility(donations to the <br />A. <br />zoo,conservatory,museum,etc.) IN Q d4 <br />Name of Facility <br />Sub-total Municipal Facility: SI <br />Suh•total from Above: 3 <br />The undersigned owner(s)of real property,located within the City of South Bend,herby petition the Common Council of the City <br />of South Bend for a real and/or personal property tax abatement consideration and pursuant to I.C.,6-1.1-12.1-1,et seq.,and <br />South Bend Municipal Code Sec.2-76 et seq.,fcr this petition state the above. <br />Submitted By: I 1_ ,;,..,__ L x-c-i <br />Date: lt;1C/ ;?C.i;-e