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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 /> Qualify <br /> Please complete the table below with the appropriate information. If Earned Points Available Points <br /> (Yes or No) -- -- - _ <br /> you qualify for the points,please enter the full amount of available <br /> points. <br /> 1 Construction Related(Contractors): <br /> A. Employ Local Companies(75%) N/A 20 <br /> B. Purchase Materials from Local Companies(75%) NiA 20 <br /> C. Require Employees vs.Independent Contractors 10 <br /> D. Require Prevailing Wage(Davis Bacon) .. . 22 <br /> Require Health Benefits 22 <br /> F. Require Pension Benefits 14 <br /> G. Maintain Affirmative Action Plan 20 <br /> Sub-total Construction Related: 0 <br /> 2 Wage&Benefit Related(Owner): <br /> A. Pay Target Wage Levels YES 33 <br /> B. Provide Health Benefits YES 34 <br /> C. Provide Pension Benerrts SES 29 29 <br /> D. Provide Training YES 28 28 <br /> E. Provide Child Care NO 0 <br /> F. Provide Transportation Assistance NO 3 <br /> G. Provide Employer Assisted Housing program <br /> Sub-total Wage&Benefit Related: '24 .._ <br /> 3 Workforce Related: <br /> A. Create New Jobs ,ES ••. <br /> B. .Retain Existing Jobs <br /> C. Maintain Affirmative Action Plan 'ES _- <br /> D. Provide Targeted Hiring Preference Y E S • <br /> Sub-total Workforce Related: 1'7 <br /> 4 Support a Municipal Facility: <br /> Support a SB Municipal Facility(donations to the N O <br /> A. <br /> zoo,conservatory,museum,etc.) <br /> Name of Facility <br /> [Sub-total Municipal Facility: <br /> Subtotal from Above: <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: 1 `.✓Lim � �=�✓-1 Date: '.// L/ )C -Z <br />