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available in order to determine the amount of Sales Tax Revenue generated for the reporting <br /> period. <br /> Personal Property Tax Portion of Chapter 380 Payment = % X Amount <br /> Personal Property Taxes (To be provided annually only with Grant <br /> Payment request following 4th Quarter) <br /> Sales Tax Portion of Chapter 380 Payment = % X Sales Tax Amount <br /> Revenues <br /> Total Chapter 380 Payment Request Total <br /> • Total Jobs at beginning of Reporting Period: <br /> • Total Jobs at end of Reporting Period: <br /> • Please list any final judicial determinations or administrative decisions that Company <br /> unlawfully discriminated in violation of Section 3.05 of the Chapter 380 Agreement: <br /> [attach separate sheet] <br /> The City Manager may agree to an amendment to this form from time to time, provided such <br /> amended form shall be substantially similar in reporting the information necessary to confirm <br /> compliance with the Chapter 380 Agreement and to calculate the Chapter 380 Payments. <br /> Upon request of the City Manager, Company shall permit the City to conduct an audit and <br /> inspection of Company's records in accordance with the terms of the Chapter 380 Agreement. <br /> The City Manager may designate one or more persons to act or receive information on the City's <br /> behalf under this certificate and the Chapter 380 Agreement. <br /> I, [Insert name and title], certify that the foregoing <br /> information is true and correct and that Company has materially complied with all terms and <br /> conditions of the Chapter 380 Agreement. <br /> [Name and Title] <br /> Date <br /> 20 <br />