Converse, Niobrara, Platte and Natrona Counties Big Horn, Hot Springs, Park, and Washakie Counties Campbell, Sheridan, Johnson, and Weston Counties Kim Rightmer East Central Regional Director 2435 King Blvd, Box 1 Casper, WY Tel: 307.577.6012 Cell: 307.287.2309 kim.rightmer@wyo.gov Amy Quick Northwest Regional Director 1508 Stampede Avenue Cody, WY 82414 Cell: 307.421.0140 Brandi Harlow Northeast Regional Director PO Box 706 Wright, WY 82732 Cell: 307.689.1320 brandi.harlow@wyo.gov Lincoln, Sublette, and Uinta Counties Fremont and Sweetwater Counties Albany, Goshen, Laramie, and Carbon Counties Elaina Zempel Southwest Regional Director 520 Topaz, Suite 110-A Kemmerer, WY 83101 Tel: 307.877.2203 Cell: 307.723.1510 elaina.zempel@wyo.gov Rebecca Briesmaster South Central Region Director 1400 Dewar Drive, Ste 208A Rock Springs, WY 82901 Cell: 307.389.0867 Heather Tupper Southeast Regional Director 214 West 15th Street Cheyenne, WY 82002 Tel: 307.777.2804 Fax: 307.777.2838 Cell: 307.772.1265 heather.tupper@wyo.gov Send 3 hard copies and 1 electronic copy of the completed application to: Karen Fate / Brayden Connour, Project Managers Business Ready Community Grant and Loan Program Wyoming Business Council 214 W. 15th Street Cheyenne, WY Phone: 307.777.2827/ 307.777.2811 Fax: 307.777.2838 Cell: 307.214.0168/ 307.214.0270
(For Business Committed, Managed Data Center Cost Reduction, and Senior Care/Child Care Applications ONLY) Business contact information: Business Name: Contact Person: Mailing Address: Phone: Fax: Email: NAICS: Complete the following job retention and creation table. Jobs must be expressed in Full Time Equivalents (FTEs). Average cost of benefits per hour include medical and retirement benefits provided solely by the employer. Retained jobs are defined as jobs that would otherwise be lost to the state if the business were to cease operations or move from Wyoming.) If the business is simply expanding, existing jobs should not be included as “retained” jobs. Do not include the business owners in the calculations as owners are not typically salaried employees. Year One Job Creation Table Position Type # of Jobs Retained # of Jobs Created Average Wage- per hour Average Cost of Benefits Annual Net Wages (all jobs*wages *2080 hrs) Mgmt/Administrative $ $ $ Technical/Professional $ $ $ Office/Clerical $ $ $ Sales $ $ $ Skilled Crafts $ $ $ Other $ $ $ TOTAL Year One $ $ $ Year Two Job Creation Table
Position Type Original jobs retained & created Year 1 New jobs created Year 2 Average Wage- per hour Average Cost of Benefits Annual Net Wages (all jobs*wages *2080 hrs) Mgmt/Administrative $ $ $ Technical/Professional $ $ $ Office/Clerical $ $ $ Sales $ $ $ Skilled Crafts $ $ $ Other $ $ $ TOTAL Year Two $ $ $ Year Three Job Creation Table Position Type Original jobs retained & created Year 2 New jobs created Year 3 Average Wage- per hour Average Cost of Benefits Annual Net Wages (all jobs*wages *2080 hrs) Mgmt/Administrative $ $ $ Technical/Professional $ $ $ Office/Clerical $ $ $ Sales $ $ $ Skilled Crafts $ $ $ $ $ $ TOTAL Year Three $ $ $ Year Four Job Creation Table Position Type Original jobs retained & created Year 3 New jobs created Year 4 Average Wage- per hour Average Cost of Benefits Annual Net (all jobs*wages *2080 hrs) Mgmt/Administrative $ $ $ Technical/Professional $ $ $ Office/Clerical $ $ $ $ $ $ Skilled Crafts $ $ $ $ $ $ TOTAL Year Four $ $ $
5. Site work $ 6. Demolition and removal $ 7. Construction a. Electrical Systems (*) $ b. Mechanical, Plumbing, HVAC Systems (*) $ c. Landscaping (*) $ d. Foundation and/or Structural Framing System (*) $ e. Interior Finishes (*) $ f. Fire Protection (*) $ g. Remediation (*) $ h. Other (*) – please specify $ 8. (Please explain in detail on additional page(s) $ 9. Subtotal (sum of lines 1 through 8) $ 10. Contingencies $ Total Eligible Project Costs 11. Total Eligible Project Costs Use this amount for Part B, Number 1 and as the Total Eligible Project Costs as listed on the cover sheet. $ (*) = Required for projects involving the construction of a new or existing building Part B: Funding Sources 1. Total Eligible Project Cost This amount will be the same as Part A, Number 11 and will be reflected on the Cover Sheet as the Total Project Cost. $ 1a 2. Local Match a. Cash Match. List cash match funding source(s) and amount. Identify whether the amount has been provided or is being requested. Provide the status and the date funds were approved or the date that funds are expected to be approved. Cash Match Source Status (approved or pending) Date of Approval Cash Amount $ $ $ Total Cash Match $ 2a