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Matching i $10,000+ ‘rr eee Partner Disclosure and Participation Verification and Certification ‘© Wil the partnering organization in this application or any employee or representative of the parreing organization recave a "skec financial benefit" the grant approved? Yes] No | yes, please describe the benefit to be recerved and identify all persons recelving the benefit: © Docother employees or representatives of my partnering organization have any vested intrests in the project? Yes] No yes, please identity the Indlvidual and describe the vested interest he or she may have: © Is my organzation presently in compliance with all state, federal, and local laws, inducing but not limited to, Hotel/Motel tax end ‘or workers’ compensation insurance and Unemployment ‘Compensation? Yes Ed NOL © 1s my organization presently involved in a bankrupiey proceeding? Yes] No D2 Yes flees prove fre nar eas a aphonerumbe of ¢ pean oe ta xenon to be contacted regarding the particulars of the bankruptcy proceeding. By signature hereon, | hereby certify that the information supplied within this disclosure/ certification is {ue and correct and that |, the undersigned, have the authorly to speak for and bind by my signature the ‘below listed partner entty or organization (hereinafter referred to as “The Company’). | cart that | have. Name: Brian Campbell Partner Entity or Organization: Adventure WV LLC Company Address: po Box 78, Lensing, WW 25892 Applicant Organization with which you are partnering: the Greenbrier Project Name: Greenbrier Cli sic Broadcast Advertising Campaign 1 Partner Disclosure Verification Certification rev. 1010— 49 WV Dition f Tourism +60 MacCorke Ave. SW » Sou Charleston, W'V 25903 + 904-958-2200 Fax 304-658-4803, Matching dvertising Figrmershie =e10 00%. Project Dates: April. 12 - December 31, 2013 ‘Amount of My Contribution to this Project: $5000.00 1 “Dict financial benefit” moans that any portion ofthe ttelprofect cost wil be receded by the enplicant or partner organizations, thei representatives or employees or by an ently in which the ‘applicant or pertner their representatives or employees have en ownership interest. ro rate to disciose the above requested information shall result in the cancellaton of any award io {he applicant organization previously approved by the Tourism Commission and the dequalficagen of the ‘spolicant and partner organizations and their representatives from future MAPP awards. W Va Goce 1441-38 2 Partner Disclosure Verification Certification r6v. 9100 — 49 |WV Dhision f Toute - 80 MacCorhe Ave. SW + Sauth Charen, WV 25303 - 304.558-2200 "Fx So ss6-4sas "Rene, ——_s10000- Partner Disclosure and Participation Verification and Certification am tn this eppication or td sr ad ine partnering organization i ppleaton or. sry ernioye ven Nob Fee pees ota aa cL ee el © Do ather employees or representatives of my partnering organization have any vested intrests in eeeres No Bl lease identify the IndlMidual and describe the vested intrest he or she may have: © le my orpantzation a a ee ne Sder,end oa ovs, kang tt rt Tiedt, HotaMotl tx ‘compensation Inurance ond Une Compansaton? Yes not ns mS mateo Is Yes) No. * eemeremencmereee re ee Sienna gece By signature hereon, I heraby cert that the information supplied within thie dcloeure/ certification Is ‘tue and correct and that the undersigned, have the auth sea aoe yea ne bow tad part ery or orperzaton (hereafter refered "The Company’). that have refers fe bev ied MAP appleton Ee bi ate pe dae ieieee mmole lena tat Cope Slee apes eer be est ofry knowadoe. ipany Is to be an active perfcipant in Ths Project, " ray ore emi plone ht others router wi be ina rata ‘other application awarded through this oP watt we, ig] 20 lo Name: Rachae! Stebbins Partner Entity or Organization: Greenbrier County CVB ‘Company Address: 200 W. Washington Steet, Lewisburg, WV 24901 ‘Applicant Organization with which you are partnering: The Greenbrier Project Name: The Greenbrier lasale (Greenbrier Classic Broadcast Advertising Campaign) 1 Partner Disciosurs Vertieation Cersication rw. 00 — 40 ‘WY Dicion of Toure +60 MacOorkis Ave. 67+ South Charocoe, WV 25808 -SO4-E58.2200 uc 30656