Fillable City of San Dimas COVID-19 Emergency Small Business (City of San Dimas)

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City of San Dimas COVID-19 Emergency Small Business (City of San Dimas)

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City of San Dimas
COVID-19 Emergency Small Business Grant Program
Grant Application
Purpose: The City of San Dimas proposes to use CDBG funds to develop an Emergency Small Business
Grant Program that can issue cash grants (not loans) to San Dimas businesses impacted by COVID-19.
Grants can be issued based on the demonstrated need up to a maximum of $5,000.
Business Owner Contact Information:
Name: Title:
Email: Phone:
Home Address:
Legal Business Information:
Name:
Address:
Phone: Website:
FEIN/Tax ID Number: Date Founded/Incorporated:
Please check your business organization type:
a. Partnership c. Cooperative
d. Limited Liability Company
b. Corporation
e. Other__________________
Eli
gible Businesses:
Business applicants must be eligible as either Microenterprise or Special Economic Development, and
meet the following eligibility criteria, please check all that apply:
Small Businesses (25 employees or less. Multi-national or publicly traded businesses are not
eligible for this program.)
Commercial Business
Must be located in the City of San Dimas
Business was impacted by COVID-19 (required to close as non-essential)
Eligible Business Types – The following is an exhaustive list of eligible business types, please check the
box next to your business type:
Restaurants, bars, coffee shops, bakeries, etc.
Salons, barbers, and other grooming businesses
Gyms, day spas, and fitness studios
Retail and Commercial stores (such as consumer goods, electronics and appliances, health and
sporting goods, furniture, clothing and shoes, kitchen equipment, books and entertainment stores,
music and audio/visual equipment, etc.)
Disqualifying Criteria – Any of the following events or actions will disqualify the owner of a business
from consideration for grant funding; please check all that apply.
Poor Credit History
Bankruptcy in the last 5 years
San Dimas Code Enforcement Violations
Questionable criminal record
Special Economic Development Activities – 24 CFR 570.203(b) if you are seeking assistance under the
Special Economic Development category, please complete and attach the following forms:
Form B
Form B1
Please share a b
rief description of your company, including your industry, the product and/or services
you offer:
Have you received any other financial resources in 2020 response to COVID-19 impacts?
(i.e. SBA Disaster Fund, PPP, other loans)
If yes, please describe:
Do you want us to share your information with LACDA or other county departments for grants, loans, or
other resources?
Yes No
Eligible Activities – Small Business Grant Assistance can be provided under one of the following eligible
activity categories as defined by HUD, please check one:
Microenterprise assistance – 24 CFR 570.201 (o)(1)(i) – If you are seeking assistance under the
Microenterprise category, please complete and attach the following forms:
Form A
Form A1
Form A2
Statement of Need – Please describe how COVID-19 has impacted your business:
Employees
How many full-time and
part-time employees (including yourself ) are employed at your business
PT:
FT:
Have you laid off staff?
If yes, how many full-time?
Part-time?
If you have not had to lay off staff, how many employees does this grant help you retain?
FT: PT:
Please provide an estimate of the number of layoffs this grant will help you prevent (ie. Number of
jobs saved):
Business Recovery Plan – You will need to create a simple but specific document that describes
how you will spend the requested grant amount. The plan should include a response to the
following questions or the attachment of the requested document:
• How do you intend to use the funds?
• Attach: Financial and/or organizational documentation that supports demonstration of
significant economic hardship as a result of COVID-19. Example: Last October sales
compared to this October sales numbers
• Attach: Budget Sheet for use of funds
• Attach: Year-End 2019 Financial Statement w/ monthly expense sheet
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City of San Dimas COVID-19 Emergency Small Business (City of San Dimas)

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Completed 24 January 2021

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