2020-130C - Laserfiche WebLink

Home Browse Search

SEOF BASMAN HOME OF PEU"CM ISMD COVID-19 RECOVERY & STIMULUS PLAN FOR SMALL BUSINESSES GRANT APPLICATION I Name of Small Business: Business Phone Number: Fictitious Business Name (Doine Business As Business Email Address: Business Property Address: I Business Mailing Address: Describe Your Business and the Services/Products Offered: Describe the Economic Loss Suffered: (Either Forced Reduction of Services or Documented 25% Loss of Income). Number of Workers (Only Include Part Time Employees That Worked Over 20 Hours per Week): Full Time Employees: Part Time Employees: Independent Contract Workers: As Of March 1, 2020: Current Number: As Of March 1, 2020: Current Number: As Of Current March 1, 2020: Number: Primary Owner's Signature: Date: By signature of this application, the applicant(s) agree that this application and other relevant documents are subject to verification by the City and may be shared with internal and external stakeholders and hereby certify that my Business has been negatively impacted by the COVID-19 Pandemic: Primary Owner's Name: (If Primary Owner has less than 51% of Equity, Attach List with Names, Primary Owner's Title Signatures and Titles of Collective Owners Equaling at least 51%). Primary Owner's Signature: Date: Documentation Required With This Application: 1. Unless Business was mandated to reduce or eliminate serves, provide: (1.) Certified Point of Sale or QuickBooks Report(s), (2.) Certified Income Statements or (3.) Sales Tax Returns, which demonstrate a comparison of the current month sales revenues versus the same month the previous year. 2. Documentation of Workers with either: (1.) the 2019 IRS Form W-3, (2.) the IRS Form 941 or (3.) the Summary filed with IRS of 1099s issued to individual independent contractual workers for that time period. 3. A Copy of the Primary Applicants Current Driver's License, Current Passport or Other Photographic Identification. 4. A Completed and Signed IRS Form W-9. 5. All COVID-19 Small Business Worker Grant Application(s).