Section 130.APPENDIX A   Renewable Fuels Development Program Application Cover Sheet

Illinois Department of Commerce & Economic Opportunity

Bureau of Energy & Recycling – Alternative Energy Development Section

Renewable Fuels Development Program

Application Cover Sheet

Applicant Name

FEIN No.

Applicant Address (including 9 digit zip code)

Project Address (if different from above)

County of Project

Project Manager (Please Type)

Phone

Fax

Type of Biofuels Project:  New Construction   Alteration   Modification   Retrofit

Legal Organizational Status

Applicant Certifications – The applicant certifies that:

• This project complies with all applicable State, federal, and local environmental and zoning laws, ordinances and regulations and that all required licenses, permits, etc., have either been obtained or will be obtained no later than 90 days following the grant award from DCEO;

• It is not in violation of the prohibitions against bribery of any officer or employee of the State of Illinois as set forth in 30 ILCS 505/10.1;
• It has not been barred from contracting with a unit of State or local government as a result of a violation of Section 33E-3 or 33E-4 of the Criminal Code of 1961 [720 ILCS 5/33E-3 and 33E-4];
• It is not in violation of the Educational Loan Default Act [5 ILCS 385];
• As of the submittal date, the information provided in this application is accurate and the individuals signing below are authorized to submit this application;
• It will enter into a Project Labor Agreement covering the project that is compliant with the provisions of the Renewable Fuels Development Program;
• It will commit to securing all debt and equity financing necessary to complete the project; and
• It will commit to using Illinois agricultural products as the primary source in the renewable fuels production process.