Retention and Modernization Program

Pre-Certification Application Form

All data elements are necessary to determine certification awards.

General Information

Pre-certification application filed today will be evaluated and become eligible for award consideration at the end of the 3rd quarter of 2019.

Company name:
Company address:
Company city:
Company state: Company ZIP code:
Company parish/county:
SIC code:  or NAICS code:  
Federal Employer ID No. (FEIN or EIN):
LA Dept of Revenue ID No. (on form LDOL-ES4 Employer’s Wage and Tax Report):
LA Workforce Commission Unemployment Insurance ID No.:
Company contact:
Contact email address:
Contact phone number:
Facility same as above
Facility address:
Facility city:
Facility state: Facility ZIP code:
Facility parish:
Project description (reason for request):
Competing location(s) for capital investment
(city, state, country):
Capital expenditure amount $$$:
Tax credit amount requested $$$:
Parent company name:
Parent company address:
Parent company city:
Outside USA?
Parent company state:
Parent company ZIP code:
Parent company parish:
Number of current jobs
Number of new jobs
Number of retained jobs after modernization
Additional job description information (optional):

Construction Information

Year construction begins:
Construction start date:
Construction end date:
Construction period (__year(s)/__month(s):
Construction employment (FTE):
Total annual construction payroll:
Construction materials:
Equipment purchases:
Date operation begins (month/day/year):

Job Creation/Payroll (Excluding Benefits)

  Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 Year 9 Year 10
Job Creation (net new full-time jobs)
New Job Annual Payroll
Current Jobs Retained
Retention Payroll
Value of first year Louisiana taxable operational purchases (examples: copy paper, shop towels, welding rods, maintenance supplies, non-raw materials):
Value of current annual taxable operational purchases:

Project Budget

Project Funds - Dollar Amount & Source (numeric values only)
Project Cost Categories Local
Private Total Cost
Land Acquisition
Building Acquisition
Building Construction
Building Rehab./Renovation
Capital Equipment
Private Fixed Assets
Project Costs

Supporting documentation (upload files):

In applying for this incentive program, my company understands and accepts that an incentive award would require a public disclosure by LED of our projected job retention (and, if applicable, creation) totals, total retained and new payroll, and total capital investment, as well as a brief summary of the project and how it will impact our company's competitiveness.