Fillable CARES Act Relief Funds Small Business Application Instructions (City of Belen)

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CARES Act Relief Funds Small Business Application Instructions (City of Belen)

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BROWSE CITY OF BELEN (NM) FORMS

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1
CARES Act Relief Funds – Small Business Application Instructions
STATE OF NEW MEXICO SMALL BUSINESS CONITNUITY GRANT
APPLICATION PERIOD OPENS ________________, 2020 AND CLOSES _______________, 2020
A maximum of $10,000.00 may be approved per application. The city has been allocated up to a
total of $117,150 for Small Business Grants so funds are limited.
The CARES Act provides that payments from the Fund may only be used to cover costs that—
1. Are necessary expenditures incurred due to the public health emergency with respect to the
Coronavirus Disease 2019 (COVID–19);
2. Were not accounted for in the budget most recently approved as of March 27, 2020 (the date of
enactment of the CARES Act) for the State or government; and
3. Were incurred during the period that begins on March 1, 2020, and ends on December 30, 2020.
The State of New Mexico is providing Coronavirus Aid Relief funds to reimburse costs for expense due
to COVID-19.
***IMPORTANT: PLEASE READ ALL OF THE CORONAVIRUS RELIEF FUND GUIDANCE FOR
STATE, TERRITORIAL, LOCAL, AND TRIBAL GOVERNMENTS INFORMATION.
APPLICATIONS ARE FINAL UPON SUBMISSION INCLUDING ADDITIONAL INFORMATION
AND DOCUMENTS LISTED BELOW.
Who can apply?
• This grant is available to qualifying small businesses with 50 or fewer full-time equivalent
employees in Belen, New Mexico
as long as funding remains for the program. The grant
proceeds must be spent on eligible “business continuity” expenses. In addition, you may
qualify for additional funding for “business redesign” expenses necessary to adopt COVID Safe
Practices, and eligible expenses for both portions of this grant program outlined below.
• To be eligible, your company must be headquartered in Belen, New Mexico and either have been
forced to close or severely curtail business operations as a result of closure orders from the state
and have an annual revenue of $2 million or less prior to the impact of COVID-19. The business
must have also had a start date of March 1, 2019 or prior.
Who is not eligible to apply?
• Businesses headquartered outside of Belen, New Mexico
• Businesses exceeding 50 full-time equivalent employees
• Businesses with annual revenue exceeding $2 million
• Businesses that started after March 1, 2019
• Businesses that were not forced to close or did not have severely curtailed business operations
as a result of closure orders from the state
What documents are required?
• Completed application form and required supportive documents
submitted to the contact email address below or hand delivered at
Belen City Hall.
All required documentation is listed below:
September 18
November 20th
2
• Certificate of good standing (Up to date and active City Busin
ess Licence, Non-profit
certification, e
tc).
• Copy
of your payroll
to include March 1, 2020
• Most recent payroll at time of application
• Documentation of March and April 2019 total gross receipts
• Most recent taxes documenting net taxable income
• Unemployment insurance tax documentation for the fourth quarter of 2019
• Completed W9 Form
• Voided Check or Bank Letter with Account/Routing Info (if applicable). Payments will be made
directly into the small business bank account. By providing us this information, you certify that
the information provided is correct and you authorize the county or municipality to initiate credits
for corrections to the financial institution.
What expenses will be covered?
Business Continuity:
• Non-owner employee payroll - – Limited to costs associated with Covid response services
• Ren
t
• Scheduled mortgage payments
• Insurance
• Utilities
• Marketing
Business Redesign:
• Reconfiguring physical space
• Installing plexiglass barriers
• Purchasing web-conferencing or other technology to facilitate work-at-home
• PPE for employees
• Temporary structures to mitigate the spread of Covid-19• Exterior features/
structures (tents, tables, signage, etc) must be temporary only
Contact information:
For questions regarding this application, please email _____________________. After submitting the
application, you will be notified of your award amount. Again, applications can be submitted to the
email address above or hand delivered to the Belen City Hall.
Applicants must be aware that applying for this grant may result in not being eligible to apply for other
federal grants.
Funds will be provided on a reimbursement basis. (Grantees must submit clear copies of invoices and
proof of payment. This is required for federal audit purposes.) (Documentation regarding payroll
expenses will be required.)
caresactsubmittals@belen-nm.gov
3
IMPORTANT NOTE: PLEASE ANSWER ALL QUESTIONS. FAILURE TO DO SO
WILL DELAY THE PROCESSING OF YOUR APPLICATION AND MAY FURTHER
RESULT IN YOUR APPLICATION BEING DENIED IF INFORMATION REQUESTED
IS NOT PROVIDED TO THE CITY WITH THE APPLICATION.
New Mexico Small Business Continuity Grant Application Form
1. Please type the legal name of your business.
2. Please enter y
our New Mexico taxpayer ID number. ________________________________
3. Please en
ter your local business license number. ___________________________________
4. Do you have a current certificate of good standing? ☐Yes ☐No
5. Only the owner, CEO or other authorized representative of the business may apply for this grant.
Please enter your full first and last names.
Business Owner: ______________________________________________________________
CEO or other authorized representative: ____________________________________________
6. Is your bu
siness headquartered in New Mexico? ☐Yes ☐No
7. What are the coun
ty and zip code for the company’s primary place of business?
County ________________________________ Zip Code _______________________
8. What type of bus
iness do you have? ☐C-Corp ☐LLC ☐Partnership ☐Sole Proprietorship
☐ Nonprofit
9. What was your
employee headcount for full-time (32 hours/week or more) and part-time employees
on March 1, 2020?
32 Hours/week or more ___________ Part-time__________
10. What is your current employee headcount for full-time (32 hours/week or more) and part-time
employees?
32 Hours/week or more ___________ Part-time__________
11. What were y
our total gross receipts for March 2019 and for April 2019?
March 2019 $____________________ April 2019 $____________________
12. What were y
our estimated total gross receipts for March 2020 and for April 2020?
March 2020 $____________________ April 2020 $____________________
4
13. Was your bus
iness included in the New Mexico orders to shut down or severely curtail business
operations? ☐Yes ☐No
14. Did you
shut down or severely curtail your business activities as a result of closure orders?
☐Yes ☐No If so, what date did you close or curtail your business? ____________________
a. If you curtailed rather than closed your business, please describe the nature of the
curtailment.
b. What is
your best estimate of what month you did or will reopen? ____________________
c. When you
reopen, what percent of capacity to you expect to operate at? May – December
listed for reopen, 0-25% / 26-50% / 51-75% / 76-100% for capacity
May _______________ June _______________ July _______________
Aug. ______________ Sept. _______________ Oct. _______________
Nov. ______________ Dec. _______________
15. What was
your net taxable income in the most recent complete tax year? $ ___________________
16. What imp
act do you anticipate the COVID-19 crisis and related effects will have on your revenues
for 2020 as a whole?
☐ No effect ☐10% ☐20% ☐30% ☐40% ☐50% ☐60% ☐70% ☐80% ☐90% ☐100%
17. If you pay
withholding, have you delayed or plan on delaying withholding tax? ☐Yes ☐No
18. How many
years has your business been in continuous operation through March 1, 2020? ________
19. How many e
mployees and what total payroll did you report to the state for unemployment insurance
taxes for the fourth quarter of 2019?
# Employees ____________
Taxes Reported $_____________
20. Have you
been approved for an SBA Paycheck Protection Program loan or Economic Injury
Disaster Loan? (check all that apply)
☐SBA Paycheck Protection Program Loan
☐Economic Injury Disaster Loan
21. Is your bus
iness owned by a socially disadvantaged group? (check all that apply)
☐No
☐Woman
☐Veteran
☐Minority
☐Tribal
5
22. Please provi
de a list of items to be purchased for COVID-19 prevention and/or mitigation and the
estimated cost for each item. Use the list of items under “What expenses will be covered?” in the
instructions above as a guide.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
I understand that knowingly making a false statement to obtain this grant or providing expenditures that
do not qualify may result in the applicant refunding all reimbursed expenditures to the Department of
Finance & Administration.
Applicant:_______
________________________
By:___________________________________ Date:_______________________
Upon submitting my application form, I certify that the information
provided in this application is true and that the expenses will not be reimbursed through other CARES Act
funds. I understand this grant is for expenses incurred between March 1, 2020 and December 30, 2020 as
specified above.
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CARES Act Relief Funds Small Business Application Instructions (City of Belen)

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Completed 15 February 2021

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