Grant Application

APPLICATION INSTRUCTIONS

We will provide a full description as soon as we determine the due date of application with the City of Firebaugh. We will provide general instructions on application submission. Please keep this text as a place holder at the moment.

HOW DID YOU HEAR ABOUT THIS GRANT?*

City of Firebaugh
Facebook
Fresno Business Service Center (BSC)

Other (Please specify:)

BUSINESS INFORMATION

BUSINESS NAME*

IS THIS A FOR-PROFIT BUSINESS?*

YES
NO

HAS YOUR BUSINESS BEEN NEGATIVELY IMPACTED AS A RESULT OF THE COVID-19 PANDEMIC?*

YES
NO

BESIDES FINANCIAL ASSISTANCE, WHAT OTHER AREAS DOES YOUR BUSINESS NEED SUPPORT WITH?*

Business Resources in Spanish
Hiring
Marketing
Business Support Webinars
Human Resources

Other (Please specify:)

IS YOUR BUSINESS LOCATED AND OPERATING WITHIN THE CITY OF FIREBAUGH?*

YES
NO

BUSINESS ADDRESS*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

MAILING ADDRESS IF DIFFERENT THAN BUSINESS ADDRESS

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

TYPE OF BUSINESS (i.e. Restaurant, Salon, etc.)*

BUSINESS STRUCTURE*

Corporation
LLP
Sole Proprietor
LLC
Partnership

Other (Pleases specify:)

BUSINESS LICENSE NUMBER*

EXPIRATION DATE*

DATE OF BUSINESS ESTABLISHMENT IN FIREBAUGH?(MM/DD/YYYY)

NUMBER OF EMPLOYEES ON PAYROLL AS OF MARCH 15, 2020?*

NUMBER OF EMPLOYEES ON PAYROLL AS OF DATE OF APPLICATION?*

HAVE YOU RECEIVED ANY FORM OF ASSISTANCE TO PAY FOR BUSINESS OVERHEAD AND OPERATING EXPENSES?*

YES
NO

If YES, please download and fill out the funding form, listing all previous COVID-19 relief funding you have received. You can turn this in with the additional documentation required.

CARES ACT ELIGIBILITY: TO QUALIFY FOR CARES ACT FUNDS, A BUSINESS MUST PROVIDE DOCUMENTATION OF HOW THE BUSINESS WAS NEGATIVELY IMPACTED BY THE CORONAVIRUS PANDEMIC. PLEASE CERTIFY THE BUSINESS ELIGIBILITY (BACKUP DOCUMENTATION REQUIRED).

2020 or 2021 Profit loss of 10% or more, compared to 2019?
Temporary Closure? (i.e. provide dates when business was closed 30 days or more)
Layoffs/Retention of employees?
Other (Please provide a detailed description).

Other (Please specify:)

BUSINESS OWNER CONTACT INFORMATION

Title

Name*

First Last

Home Phone

Work Phone

Mobile

Email

APPLICANT ETHNICITY (CORRESPONDING BOX FOR EACH ONE):

Do you identify yourself as Hispanic/Latino?

Yes
No

REQUIRED DOCUMENTATION

SHOULD YOU BE SELECTED AS A GRANT RECIPIENT, FOR WHICH OF THE FOLLOWING AREA(S) ARE YOU PLANNING TO USE THE FUNDS?*

Inventory
Rehire
Utilities
Payroll
Rent
Personal Protective Equipment (PPE)

Other (i.e. expenses incurred by operating outside)

Total CDBG-CV Fund Request

PLEASE BE PREPARED TO FAX THE FOLLOWING REQUIRED DOCUMENTATION AS PART OF YOUR GRANT APPLICATION TO 559.230.4045. YOU WILL ALSO BE ABLE TO PROVIDE DOCUMENTS TO ASSIGNED FIREBAUGH CITY HALL STAFF FOR SUPPORT WITH PROVIDING DOCUMENTATION.

COVID-19 Impact Back Up Documentation
Current Payroll Documenting Number of Employees
Copy of Driver’s License
Legal Documentation Reflecting Authority to Sign on Behalf of Applicant Business
Profit & Loss Statement Documenting Owner’s Net Operating Income
Proof or registration on WWW.SAM.GOV
W-9 Form

ONLINE APPLICATION CERTIFICATION

By submitting this application, I certify that this information is complete and accurate to the best of my knowledge. I agree to provide by request, documentation on all income sources to HCD or Program Administrator. I understand that if a "duplication of benefits" is later found, I may be required to pay these funds back.

I understand and agree to the Online Application Certification above.*

YES

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Date

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CITY OF FIREBAUGH MICRO BUSINESS PROGRAM

APPLICATION INSTRUCTIONS

BUSINESS INFORMATION

BUSINESS OWNER CONTACT INFORMATION

REQUIRED DOCUMENTATION

ONLINE APPLICATION CERTIFICATION