City of San Dimas
COVID-19 Emergency Small Business Grant Program
Special Economic Development Activities
Job Retention/Creation Certification – Form B
Small Businesses that do not qualify as microenterprise may be assisted as a Special Economic
Development Activity. To qualify as a Special Economic Development Activity, the business must meet a
public benefit:
• This means jobs made available to low/moderate persons are created or retained.
• In a
ccordance with 24 CFR 570.209(b) one full time equivalent, permanent job must be created
or retained. This will be documented.
• If a business applicant has laid off some or all employees, but reports they intent to hire once
this crisis ends – this can be job creation.
• If a business applicant has not laid off employees but reports they will have to; they need to
document that BUT FOR this assistance, they will have to lay off employees. This can be
accomplished through a self-certifying letter, included with the application.
Legal Business Information:
1.Name:
Address:
2.Number of Employees – full-time: Part time:
3.
Estimate of the number of jobs retained by this grant:
4.Estimate of the number of layoffs this grant prevents (ie. number of jobs saved):
5.In order to document that an FTE job is retained or created, the following section will need to
be completed for each full-time job
retained or created: (If part-time only employees, the # of
employees must add up to full-time employee in hours)
Job Retained – Employee A
Name:
DOB:
Home Address:
Phone: Email:
Household Size: Annual Household Income:
Job Title/Duties:
Regular Hours worked of (___________): Hours per___day; ___week; or ___month
Rate of Pay as of (___________): $_______hourly;$ _______monthly; or $_________annually
