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Minnesota Business Assistance Form-View Form Page 1 of 4 34 • ) i ok - - .711 _ _ _ _ DEPARTMENT OF EMPLOYMENT AND ECONOMIC DEVEOP ENI Section 1 Grantor Information Date submitted:4/15/2010 8:51:00 AM Note:Modified by DEED on 7/1512010 9:54:11 AM 1.Name of grantor(funding entity):Elk River City of 2.Name of person completing this form:Catherine Mehelich 3.Street Address:13065 Orono Parkway 4.City:Elk River 5.Zip code:55330 6.County:Sherburne 7.Phone number:7636351041 9.E-mail address:cmeheiich @cielk-river.mn.us 10.Is the person who should receive the MBAF different from the person in Question 2?No 11.Classification of grantor(If grantor is entity created by government agency,please indicate affiliation,For example,a city EDA would check"City Government"):City government 12.Has your organization held a public hearing on and adopted criteria for awarding business subsidies in compliance with Minn,Stat, 116J.994?:Yes,prior to 2004 Hearing Date:5/16/2006 Year Criteria Submitted:2006 13.Has your organization signed any agreements to award a business subsidy or financial assistance from August 1,1999 through December 31,2006,unless goals have been achieved and reported in a previous filed MBAF that is required to be reported under Minn. Stat.0116J,993 and J116.1.994?:Yes Section 2 Recipient Information 14.Name of business or organization receiving subsidy or financial assistance:Bank of Elk River 15.Address where business subsidy or financial assistance will be used. Street Address:630 Main St City:Elk River State:MN Zip Code:55330 16.Does the recipient have a parent corporation?:No 17.Industry of recipient's facility:Finance,Insurance,Real Estate 18.Did the recipient relocate as a result of signing this agreement?No 19.What would the recipient have done without business subsidy or financial assistance?:Relocate to different Minnesota location 19A.Was the project a result of eminent domain?No Section 3-Agreement Information 20.Total dollar value of business subsidy or financial assistance:$300000 21.Date agreement signed:4/17/2006 • 22.Benefit date(Indicate the date the recipient receives the business subsidy or improvements were finished,equipment was placed into service,or the recipient occupied the property,whichever is earlier.):9/13/2007 https://apps,deed.state.nui.us/Annual_MBAF_Reports/fetch_report.asp 11/7/2013