Fillable Buffalo Housing & Redevelopment Authority Small Business Emergency (Minnesota Department of Revenue)

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Buffalo Housing & Redevelopment Authority Small Business Emergency (Minnesota Department of Revenue)

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  • 17 check-boxes
  • 75 other fields

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Buffalo Housing & Redevelopment Authority
Small Business Emergency Grant Application
Program Information
All grants (ranging from $10,000 - $20,000) awarded are for the purpose of working capital and
intended to replace cash flow used for operating costs that existed at the time of the peacetime
emergency declaration made through Executive Order 20-01. Eligible costs, between 3/1/2020 and
11/15/2020, may include paying fixed debts; payroll costs; lease or mortgage payments; accounts
payable; utility payments; inventory costs; property taxes; and other critical business expenses that
can’t be paid as a result of the current emergency. This program is subject to applicable state and local
peacetime emergency executive orders.
Refer to the COVID-19 Emergency Grant Program Policy for additional details.
Eligible Businesses
Eligible small businesses which may apply for the COVID-19 Emergency Grant Program include:
1. Businesses and Non-profits which have experienced adverse impacts on operations due to the
COVID-19 Health Pandemic
2. Businesses and Non-profits which have been deemed non-essential by the State of Minnesota
3. Businesses and Non-profits which have faced mandated closures per State of Minnesota orders
All applicants must meet the following criteria:
1. Have been “in business by March 1, 2020” (The HRA shall determine “been in business”)
2. Have no more than 100 FTE (full-time equivalent) employees at the Buffalo location. Consideration
may be given to businesses which utilize independent contractors and sole proprietors
3. The small business must have a physical address within the City
4. All small business applicants must be an allowed use through zoning of the property or be a legally
non-conforming use
5. The small business must be a legal entity registered with the Minnesota Secretary of State, and be
in good standing
6. Any applicant must not have delinquent taxes, bills, or charges due to the City from February 1,
2020 or prior
2
Application Checklist
The following documents must accompany an application for it to be deemed complete:
☐ Completed and signed Small Business Emergency Grant Application (Pages 3-7)
☐ Evidence of occupancy in Buffalo (e.g. that you own or lease the space your business is
located). Example documentation includes copy or statement of lease including terms,
mortgage statement, property tax statement or other document to show proof of occupancy
within City of Buffalo. This could also include photograph or web map street image of the
business location with evidence of business signage, if applicable.
☐ Proof of eligible expenses to be paid with grant funds. This includes, but is not limited to,
payroll, rent/mortgage/utility/ property tax statements, accounts payable, and other critical
business expenses that cannot be paid as a direct result of the current health emergency.
☐ A copy of the most recent federal tax return submitted for the business (with signature).
☐ A copy of a W-9 Form (with signature).
Please do not submit any original documents, only copies. The HRA is not responsible for returning any
original documents submitted. The HRA may request additional documentation as deemed necessary
for the applicant’s situation.
Application Process and Deadlines
Deadline for application submission is Monday, August 31
st
. All applications submitted will be
reviewed beginning September 1
st
, and business will be notified of their award status by September
9
th
. Applications submitted after August 31
st
will be considered on a rolling basis if funds are available.
Applications must include all supporting documentation listed in the checklist above to be considered.
Submit applications via email to Alison Matthees, Assistant City Administrator at
Alison.Matthees@ci.buffalo.mn.us or mail / drop-off applications to:
Buffalo Housing & Redevelopment Authority
Attn: Alison Matthees, Assistant City Administrator
212 Central Ave
Buffalo, MN 55313
For any questions regarding the Small Business Emergency Grant Application, please contact:
Alison Matthees –763-684-5406 or 763-682-1181 | Alison.Matthees@ci.buffalo.mn.us
3
I. Applicant Information
1. Business legal name: ______________________________________________________
(Name should be the officially registered name of the business entity.)
Business operating name ______________________________________________________
(if different)
Type of Business: ______________________________________________________
NAICS Code (if available): ______________________________________________________
Business street address: ______________________________________________________
City: ______________________ State: __________ Zip Code: _____________
Mailing address (if different): ______________________________________________________
City: _____________________ State: __________ Zip Code: _____________
Telephone: _____________________________ Email: ___________________________________
Business website (if applicable): ______________________________________________________
2. Individual completing the application:
Name: _________________________________________________________________________
Title: ________________________________________________________________________
(Owner, Founder, CEO, General Manager, Partner, etc.)
Telephone: _____________________________ Email: ____________________________________
3. Is your business registered with the Minnesota Secretary of State?
☐ Yes ☐ No
4. Do you own the building where your business is located or have a lease for the space?
☐ Own ☐ Lease ☐ Other (Explain) ________________________________________
5. What year did this business begin operating in Buffalo? ________________________
a. Does the business have a physical presence in another city?
☐ No ☐ Yes. If yes, specify other location: _________________________
4
6. Business description (product, hours, customers, clients, number of locations, etc.), type (industry)
and brief history of business:
7. Employment (please include all W-2 employees):
On March 1, 2020:
# Full-time employees: ______________ # Part-time employees: _____________________
Current:
# Full-time employees: ______________ # Part-time employees: _____________________
II. Financial Information
8. Calculate estimated revenue loss due to COVID-19:
Average monthly gross revenue prior to March 2020: $_______________
Actual and Projected monthly gross revenue March through October 2020? — $_______________
(ex. Average of March – July and average of next two months) __________________
Estimated monthly gross revenue loss due to COVID-19: = $______________
9. List any other COVID-19 related grants, loans, or insurance claims you have applied for.
Program Applied For
(e.g. Paycheck Protection Program, State Aid Lottery, etc.)
Amount Awarded / Received
$
$
$
$
5
III. COVID-19 Impact
10. Was your business ordered to close or had to significantly reduce its operations by a State of
Minnesota Emergency Executive Order in 2020?
☐ Yes ☐ No
11. Current operating status of business:
☐ Open for business and/or operating online
☐ Open for business but with reduced hours
☐ Reduced operations and/or operating online
☐ Closed but still operating onsite, online or remotely
☐ Closed but products and or services redeployed to assist current health crisis
☐ Completely closed
☐ Other: please explain current status of business if none of the above apply.
12. Briefly explain how the business has been impacted by COVID 19 health pandemic and/or related
Executive Orders and what challenges it is facing.
6
13. What are your plans to reopen and/or resume operations during / following the COVID-19 crisis?
14. Please list specific intended uses for awarded grant funds to support your business during the
COVID-19 crisis. Eligible expenses include current payroll obligations (may not include employees
who have been laid off), lease or mortgage payments, utilities, accounts payable, property taxes
and other critical business expenses that can’t be paid as a direct result of the current health
emergency. Include proposed expenses requested to be paid using total amount of grant. For
example: Payroll – 2 employees, 2 weeks: $3,000, May Rent - $2,000.
$ Amount
Proof (invoice
or statement)
attached?
The grant amount awarded may be less than the total amount requested, but not less than
$10,000. The HRA will determine final distribution amounts based on the number of applications.
15. Is there anything else that we should be aware of in relation to your application or business?
7
Applicant Acknowledgements
1. The Applicant shall hold the City of Buffalo HRA, its officers, consultants, attorneys, and agents
harmless from any and all claims arising from or in connection with the Grant Program or its
Application, including but not limited to, any legal or actual violations of any State or Federal laws.
2. The Applicant recognizes and agrees that the City of Buffalo HRA retains absolute authority and
discretion to decide whether or not to accept or deny any particular Grant Application, and that all
expenditures, obligations, costs, fees, or liabilities incurred by the Applicant in connection with the
Grant Application are incurred by the Applicant at its sole risk and expense.
3. The Applicant acknowledges that it has read the COVID-19 Emergency Grant Program guidelines and
understands that if the application is approved for funding, grant funds awarded must only be used
to pay eligible expenses and a Post Award Report must be submitted to the City of Buffalo HRA.
4. The Applicant has reviewed the Application Checklist to ensure completeness of application and
supporting documentation required.
5. Financial Assistance Certification: I hereby certify that the Small Business Emergency Assistance is
necessary due to direct and adverse effects related to Executive Orders 20-04 and 20-08.
The undersigned, a duly authorized representative of the Applicant, hereby certifies the foregoing
information is true, correct, and complete as of the date hereof; and agrees that:
• All proceeds from the grant will be used for eligible business expenses under the COVID-19
Emergency Grant Program.
• Applicant will file a report with the City of Buffalo within three months of receiving a grant
stating how awarded funds were spent.
• Applicant shall be bound by all terms and provisions of the COVID-19 Emergency Grant
Program.
Name/Title of Authorized Business Representative
Signature of Authorized Business Representative
Date
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Buffalo Housing & Redevelopment Authority Small Business Emergency (Minnesota Department of Revenue)

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Completed 19 July 2021

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