Company Name:

Project ID:

Section #1: Employment Information

A. Employment at time of ECIDA Application

    Indicate the number of full and part-time employees by job category and indicate the average hourly or annual wages and the value of the fringe benefits (health insurance, vacation, sick, personal, 401K, etc.).

Category	# Full time, Part-time	Average Hourly/Annual Wage	Average Fringe Benefits
Management
Professional
Administrative
Production
Other
Other
Other

B. Jobs created during 2018

    If your company hired any new full and/or part-time employees during 2018, indicate the number by job category and indicate the average hourly or annual wages and the value of the fringe benefits (health insurance, vacation, sick, personal, 401K, etc.).

Category	# Full time, Part-time	Average Hourly/Annual Wage	Average Fringe Benefits
Management
Professional
Administrative
Production
Other
Other
Other

C. Total FTE Employees as of December 31, 2018

    Indicate the total number of full and part-time employees by job category and indicate the average hourly or annual wages and the value of the fringe benefits (health insurance, vacation, sick, personal, 401K, etc.).

Category	# Full time, Part-time	Average Hourly/Annual Wage	Average Fringe Benefits
Management
Professional
Administrative
Production
Other
Other
Other

***Attach a copy of your NYS 45 form.  If the NYS 45 form is not available for the specific project location or the form does not accurately reflect the full-time jobs created, please provide an internal report verifying the total jobs by employment category as outlined above.

NYS 45 Form:


D. Construction Jobs

    If your project was in the construction phase in 2018, indicate the number of full-time construction employees who worked on your project in 2018. Complete this section if you submitted local labor reports in 2018.

Number of construction employees who worked on the project in 2018:


E. Independent Contractors

    If any full or part-time independent contractors or employees of independent contractors worked at your facility in 2018, indicate the number by job category and indicate their wage information (if known).

Category	# Full time, Part-time	Average Hourly/Annual Wage
Management
Professional
Administrative
Production
Other
Other
Other

Section #2: Bond Information

If you have a bond through the ECIDA or the ILDC, please complete the following:

Date of  bond issue:

Bond amount at date of issue:

Principal amount paid in 2018:

Principal balance as of 12/31/18:

Final maturity date:

Bank trustee (trustee name, bank, address, cite, state & zip):


Section #3: Sales Tax Savings (if you purchased goods with an ECIDA issued sales tax letter in 2018)

Total sales tax exemptions received from 1/1/18 through 12/31/18 (actual sales tax savings, NOT total purchases):

***Attach your New York State ST-340 form for the sales tax exemptions referenced above

NYS ST-340:


Section #4: Mortgage Record Tax Savings

Mortgage tax exemption amount (0.75% of the mortgage amount):

Section #5: Unpaid Real Property Tax Re-Certification

By checking this box, individuals who hold at least a 25% ownership interest in the applicant (the entity that is receiving ECIDA benefits) certify that they do not have any unpaid taxes on any property located within Erie County.


If any individuals who hold at least a 25% ownership in the applicant owes taxes on any property located within Erie County, please explain:



Section #6: Certification

I certify that to the best of my knowledge, the information on this form is correct. I also understand that failure to report completely and accurately may result in enforcement of the provisions of my agreement, including but not limited to voidance of the agreement and potential recapture of benefits.

Name:

Title:

Date:

Phone:

E-mail:

If any contact information is incorrect, please provide the updated information below:


Additional comments:


Please submit your completed survey and the requested documents on or before Friday, February 15, 2019.