OR InC Job Creation Report-No BIN# (Business Identification Number) #2

Please fill out this form if there is not a Business Identification Number (BIN#) for the company/entity.

Business Name and Address
Contact Person / Phone
1. Report information
a.  a. Period of Reporting / to
b. Estimated Number of Jobs Created (Estimate the number of jobs that are expected to be created because of the funding)
c. Estimated Number of Jobs Retained (Estimate the number of jobs that are expected to be retained because of the funding)
*If project is fully funded by the initiative please only answer #2 and #3. If project is partially funded by the initiative please only answer #4 and #5.
2. *Total number of hours worked by employees during the period in 1.a. above. Hours worked does not include vacation or sick leave or any other hours where work was not performed.
3. *Total wages paid to employees who worked during the period in 1.a. above.
4. * Total hours worked on the project funded by the intiative during the period in 1.a
5. *Total amount of wages paid to employees while working on initiative funded project during the period in 1.a
6. Attach a copy of the summary report from the payroll system or spreadsheet, for each pay period in the period in 1.a. above, for all employees:
a. total hours worked
b. total wages
7. Subcontractor Information
Were any of the funds received used to engage Oregon subcontractors? / YES / NO
If YES, have you included Oregon subcontractor jobs information with this report? / YES / NO
If you did engage Oregon subcontractors and were unable to obtain job creation information from them, please fill out the section(s) below.
Subcontractor #1 Name and Address
Contact Person / Phone
Performance Period of the Contract / TO
Subcontractor #2 Name and Address
Contact Person / Phone
Performance Period of the Contract / TO
Subcontractor #3 Name and Address
Contact Person / Phone
Performance Period of the Contract / TO
8. I certify and affirm that all statements and information contained herein and attached hereto are true and complete to the best of my knowledge.
Preparer Signature / Printed Name & Title / Date
Company Signature / Printed Name & Title / Date

Confidentiality of information: Information submitted to the State of Oregon Business Development Department marked as PROPRIETARY is exempt from disclosure to the extent allowed by the Oregon Public Records Law (ORS 192.410 to 192.505). Specifically, this law conditionally exempts trade secrets, as defined in ORS 192.501(2), from disclosure if the following tests are met: (a) the information must not be patented; (b) the information must be known only to certain individuals within an organization and used in a business the organization conducts; (c) the information must have actual or potential commercial value; and (d) the information must give its users an opportunity to obtain a business advantage over competitors who do not know or use it. Additionally, ORS 192.502(16) exempts from disclosure the following services: (a) personal financial statements; (b) financial statements of applicants; (c) customer lists; (d) certain information pertaining to litigation; (e) production, sales and cost data; and (f) marketing strategy information that relates to company’s plan to address specific markets and company’s strategy regarding specific competitors. Finally, ORS 192.502(4) allows information submitted to the State of Oregon Business Development Department to be exempt from disclosure if: (a) the information is submitted voluntarily; (b) the information is of the type that should reasonably be kept confidential; (c) the State of Oregon Business Development Department has obligated itself to keep the information confidential; (d) the information is submitted in confidence; and (e) disclosure of the information would harm the public interest. The above statements are a recitation of the law as it presently exists. Changes in the law may affect the ability of State keep information provided pursuant to this report confidential.