Section 675 IAC 12-14-5 - Form of applicationAuthority: IC 22-13-2-2
Affected: IC 22-12-1-18.7; IC 36-8-12-2
Sec. 5.
(a) The application shall contain at least the following information: (1) Name, address, telephone number, federal employer identification number, and, where applicable, state nonprofit identification number of the qualified entity.(2) Name, title, address, and telephone number of contact person for the qualified entity.(3) Names of governmental units, if any, with which the qualified entity has contracted to provide fire protection or emergency services.(4) Organizational structure of the qualified entity.(5) Where applicable, the tax exempt status of the qualified entity for both state and federal income tax purposes.(6) Amount of loan requested and purpose.(7) A description of the equipment and/or apparatus to be purchased and whether or not it is new or used.(8) Specific source of repayment revenue.(10) Name of person authorized to execute loan documents.(11) The total assessed property tax value of the qualified entity or the total assessed property tax value of those areas for which the qualified entity actually provides fire protection or other emergency services.(12) The total population of the qualified entity, based on the most recent census performed by the United States Census Bureau, or the total population of those areas for which the qualified entity actually provides fire protection or other emergency services, based on the most recent census performed by the United States Census Bureau.(13) The total amount of the qualified entity's last calendar year budget, or last fiscal year budget if the qualified entity does not operate on a calendar year basis, that was spent on firefighting or emergency equipment or apparatus, including, without limitation, personal protective equipment.(b) Attachments to the loan application shall include the following:(1) Certified copy of the qualified entity's organizational documents, such as its constitution or articles of incorporation, or applicable statute or ordinance or other law creating the qualified entity.(2) If operated by a governmental entity, a copy of the resolution of the legislative body of the unit creating the qualified entity.(3) If the qualified entity is a nonprofit corporation, a copy of its bylaws and a certificate of existence from the corporations division of the office of the secretary of state of Indiana.(4) A resolution of the governing body of the qualified entity authorizing the application for the loan, designation of authorized signatory, and execution of all documents necessary to the consummation of the loan.(5) A verified financial statement of the qualified entity, signed by the chief financial officer, showing the income, expenses, assets, liabilities, and sources of income of the qualified entity as of the date of the application, and for the previous three (3) annual accounting periods.(6) A copy of the contract, bid specifications, or proposal for purchase of the equipment and/or apparatus to be purchased with the loan proceeds.Fire Prevention and Building Safety Commission; 675 IAC 12-14-5; filed May 29, 1997, 2:40 p.m.: 21 IR 397; readopted filed Sep 11, 2001, 2:49 p.m.: 25 IR 530; readopted filed Sep 21, 2007, 9:20 a.m.: 20071010-IR-675070388RFA; readopted filed Oct 10, 2007, 9:16 a.m: 20071031-IR-675070388RFA; readopted filed Aug 8, 2012, 8:08 a.m.: 20120905-IR-675120260RFAReadopted filed 7/3/2018, 2:22 p.m.: 20180801-IR-675180204RFA