Fillable BUSINESS ASSISTANCE PROGRAM Small Business Assistance Grant ROUND (City of Beaumont)

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BUSINESS ASSISTANCE PROGRAM Small Business Assistance Grant ROUND (City of Beaumont)

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BUSINESS ASSISTANCE PROGRAM
Small Business Assistance Grant
ROUND 2
Date Submitted: ___________________________________
Business Name: _____________________________________________________________________________________
Type of Business: ___________________________________________________________________________________
Physical Business Address: __________________________________________________________________________
Business Phone: ____________________________ Email: ________________________________________________
BUSINESS OWNERSHIP
Name of Owner: ____________________________________________________________________________________
Address of Owner: __________________________________________________________________________________
__________________________________________________________________________________
Owner Phone: _______________________________ Email: ________________________________________________
QUESTIONS
Please reply to each question below. By providing an affirmative response to any of these
questions you signify that you can verify the corresponding information for the City of Beaumont
Business Assistance Program.
What is the current status of your business?
Open – no restrictions
Open with restrictions
Closed
Please explain: __________________________________________________________________________________
What date was the business established? ___________________________________________________________
What date did the business establish a physical location within Beaumont? _______________________
Does the business have a valid Beaumont Business License? Yes No
Is the business in good standing with the City of Beaumont?
(No outstanding code violations, compliance orders, etc.) Yes No
Did the business have fewer than 15 employees as of March 1, 2020? Yes No
How many full-time employees does the business have as of the date of the application? __________
Page 2 of 2
Since March 2020, has the business received assistance from any other County, State, or Federal
program? Yes No
If yes, please explain: ________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Did you receive City of Beaumont Business Assistance Grant Round 1 funds? Yes No
Can verification be provided that demonstrates the business was negatively impacted by the
coronavirus pandemic? Yes No
If yes, please explain: ________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Is the business home-based? Yes No
Is the business engaged in any illegal activities, the adult entertainment, gambling, or cannabis
industries? Yes No
What are the sources of revenue for the business? __________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Is the business willing to participate in the City of Beaumont Safe Business Pledge Program?
Yes No (If yes, please register online at BeaumontCa.gov/Pledge)
Is the business willing to complete a Grant Agreement with the City of Beaumont obligating the
use of the grant funds for the intended purpose? (An executed copy of the agreement is required with this
application.) Yes No
APPLICATION CERTIFICATION
I declare that I am the owner of the business applying for this grant. I have read the foregoing City of
Beaumont Business Assistance Program Small Business Assistance Grant Application and understand the
questions and requirements. I declare under penalty of perjury under the laws of the State of California that
the foregoing is true and correct. I acknowledge that the completion of this application does not in any way
indicate eligibility or approval. I acknowledge that, due to the limited funds available for the program, some
qualifying applications including this one may not be funded.
Name: ________________________________________________ Title: _______________________________________
Signature: ________________________________________________________________ Date: ___________________
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BUSINESS ASSISTANCE PROGRAM Small Business Assistance Grant ROUND (City of Beaumont)

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Completed 9 February 2021

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