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DocuSign Envelope ID: DBF1C726- DE7142B2- AE61-AD6D18F646AD <br />CITY OF SOUTH BEND, INDIANA <br />WORKONE NORTHERN INDIANA FORM <br />Pursuant to Section 2 -83.2 of the South Bend Municipal Code, the <br />Petitioner referred to herein agrees to work with WorkOne Northern <br />Indiana, 851 South Marietta Street, South Bend, Indiana 46601, or its <br />successor agency as a condition of receiving property tax abatement. <br />Great Lakes Capital Development <br />Petitioners Name <br />Agent's Name Acting on Behalf of the Petitioner <br />Brad Toothaker <br />Contact Person <br />112 W. Jefferson Blvd. <br />Street Address <br />South Bend, IN 46601 <br />City, State, Zip Code <br />574- 251 -4400 <br />Business Telephone Number <br />btoothakeroegreatlakescapital .com <br />E -mail Address <br />Signature of Petitioner <br />cc: WorkOne Northern Indiana <br />Chairperson, Community and Economic Development Comml <br />Department of Community and Economic Development piled In C S& Of�l <br />City Clerk's Office — 1 <br />(Rev. 5/13/11) <br />puc, 7 <br />•IJOFDBEND, n+ <br />Cr" CLERK,_ED <br />