Section 130.APPENDIX B Application Form For Renewable Fuels Development Program

Illinois Department of Commerce & Economic Opportunity

Application Form For Renewable Fuels Development Program

Name and Mailing Address of Organization:

List Type of Organization (Cooperative, LLC, Corporation, etc.)

Type of Renewable Fuels Production Facility: Biodiesel Ethanol

New Construction Expansion Retrofit or Upgrade

Capacity (gallon/year):

New:
Existing:
Total:

Feedstock – Type & Quantity

Facility Location:

1.	Nearest city or town:
2.	Estimated population:
3.	County:
4.	Proposed site location:

Total costs of project:
Total construction jobs:
Total permanent jobs created:
Estimated start date of construction:
Estimated completion date of construction:

Financial Structure:

1.	Cooperative (# of Members):
2.	Cost/share:
3.	Total equity:
4.	List other equity partners & amount of investment:





5.	Debt:

List primary lender:
Design company:
Construction management company:
List other incentives received or applied for:

List of required attachments:

1. Completed Appendix A (Application Cover Sheet)

2. Completed Appendix B (Grant Application Form)

3. Completed Appendix C (Projected Energy Use By Type Information Form)

4. Copy of Prospectus for Shareholders (Either Cooperative or Other)

5. Copy of Business Plan

6. Organizational Structure

7. Copy of budget for construction, including materials, labor hours and total costs, and management/engineering (please indicate if confidential)

8. Copy of Project Labor Agreement

PROJECT NARRATIVE

The Project Narrative should concisely address all topics set forth below:

1) Plant description. A description of the proposed construction or expansion project, including a description of the scope and nature of the plant; a description of equipment, technologies and processes used; a description of the renewable fuels production capacity; a description of the amounts, types and sources of Illinois agricultural products used as feedstock in the project; a location map showing project site and connections to existing transportation routes; and a description of all permits, contracts or other agreements necessary to complete the project. If the applicant does not have all relevant or necessary operating permits, identification of the status of any permit applications and anticipated date of permit issuance should be included in the narrative, in addition to the date that any required contracts or agreements will be executed.

2) Project benefits. Economic justification for the project that includes a summary of the social or economic benefits of the project to Illinois; identification of those communities, businesses, and other entities likely to benefit from the project; identification of employment impacts, such as number and type of permanent jobs created or retained by the project itself (i.e., non-construction jobs) and projected payrolls; and the existing and/or new agricultural commodity and renewable fuel markets that would be affected by the project.

3) Project costs and schedule. A gross project budget and time schedule for completion of the project and for major project components; include cost estimates and anticipated completion dates.

4) Ownership disclosure. Identification by name of those individuals or entities with 10% or more ownership of the plant that is the subject of the project.

5) Performance disclosure. As asserted against the owner, or any parent organization or holding company, identification of all pending or unresolved violations of State or federal laws or regulations that could result in legal or regulatory impact on the operation of the project.