Fillable City of Thorne Bay Grant Application To Benefit (City Of Thorne Bay)

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City of Thorne Bay Grant Application To Benefit (City Of Thorne Bay)

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CITY OF THORNE BAY
P.O. BOX 19110
THORNE BAY, ALASKA 99919
(907) 828-3380
FAX (907) 828-3374
www.thornebay-ak.gov
City of Thorne Bay Grant Application
To Benefit Small Businesses and Non-Profit Organizations
The City of Thorne Bay is receiving relief funding from the State of Alaska CARES
program to help mitigate the effects of COVID 19. Each municipality is receiving
funding based on population.
A portion of the funds will be available as grants to small businesses and non-profits in
Thorne Bay that have been impacted by the pandemic. As grant money, these funds
will not need to be paid back.
The funds are not intended to provide extensive support, however they will provide
some relief for weathering economic conditions that may last a much longer time than
the close of this supplemental funding (Dec. 30, 2020). The City will provide other
resources for businesses and non-profits to pursue additional funding as information
becomes available. (Please check our website – www.thornebay-ak.gov)
Allowable costs for these funds must be documented:
• Payroll
• Rent
• Utilities
WARNING: If a small business applies for and receives money from the City of Thorne Bay
CARES grant program, then the business will NOT be eligible for the other much more
comprehensive government programs such as the Payroll Protection Plan, EIDL or the Credit
Union 1 grants.
It is in your best interests to pursue these other funds first because the amount of funding
is so much bigger. If your business has already received money from one of these programs,
you can still be eligible for The City of Thorne Bay’s CARES grant. Also, if your business is
waiting for funds from one of these other programs, the city can retain funding from this
application and disburse it to you after you have received relief money from one of the other
programs. The City can retain the funding no later than October 1
st
.
Please contact Priscilla Goulding for more information or questions – 907-321-
5462 or email gouldingpri2020@gmail.com
1) The application process will be open until July10th to allow all applicants time to
complete and submit applications. Paper applications will be accepted via mail to:
The City of Thorne Bay
P.O. BOX 19110
Thorne Bay, AK 99919
Email: gouldingpri2020@gmail.com
In person:
Thorne Bay City Hall
120 Freeman Drive
Thorne Bay, AK 99919
Applications must be submitted by 4PM on July 10. Only complete applications will be
considered – W9 REQUIRED with application.
2) Businesses must have paid city sales tax for the last calendar year (2019).
3) Nonprofit organizations must have been established by December 2018.
4) Applicants will be notified by preferred contact (email or phone) when their applications
have been received.
5) All qualified applicants will receive a set amount of funding figured by a percentage of
the amount of sales tax paid to the city 2019, or in the case of non-profits a flat amount.
This is not a competitive process. The grant award will be determined based on the
number of applications received.
6) The grantee will be required to submit a final report to the City by November 15, 2020
detailing how funds were used. Use of funds must comply with allowable expenses.
7) Grantee will be required to submit a W9 along with this application PRIOR to receiving
funds.
8) All business information will be kept strictly confidential and will not be shared or used
for any purpose other than evaluation of the grant award.
9) For more information, contact Priscilla Goulding, contracted COVID 19 Response and
Crisis Preparedness grants manager at gouldingpri2020@gmail.com or 907-321-5462
CITY OF THORNE BAY
P.O. BOX 19110
THORNE BAY, ALASKA 99919
(907) 828-3380
FAX (907) 828-3374
www.thornebay-ak.gov
THORNE BAY SMALL BUSINESS CARES FUNDING GRANT APPLICATION
Name of business or nonprofit organization: ________________________________________
Name of contact: ______________________________________________________________
Contact telephone: ___________________ Contact email: _____________________________
Address of business or nonprofit: __________________________________________________
_____________________________________________________________________________________
Type of business: ☐ Sole proprietorship ☐ Partnership ☐ LLC ☐ S Corporation ☐ C Corporation
☐ nonprofit corporation ☐ other, please list: ______________________________________________
If your organization is a nonprofit, check which type:
☐ 501(c)(3) Charitable Organization
☐ 501(c)(5) Labor, Agricultural, or Horticultural Organization
☐ 501(c)(6) Trade/Professional Organization
☐ 501(c)(19) or (23) Veterans Organization
☐ Other, please list: _________________________________________
IRS Employer Identification Number: _____________________________________________________
Sole proprietors may provide a Social Security Number OR Individual Tax Identification Number (whichever your
business uses)
If your organization is a business, list all individuals* and organizations that own 50% or more:
Name: ________________________________________________________________________
Name: ________________________________________________________________________
THORNE BAY SMALL BUSINESS CARES FUNDING GRANT APPLICATION
1. Does your business/nonprofit have a physical location in the city limits of Thorne Bay?
(This could be an office, store, restaurant, food truck, farmers market stand, home-based business or space that
depends on foot traffic).
☐ Yes
☐ No
2. What type of business do you operate?
☐ Non-essential public facing business (i.e. bookkeeper)
☐ Retail business
☐ Restaurant
☐ Non-essential non-public facing business (i.e. engineer, road work)
☐ Fishing charters
☐ Lodging
☐ Other -Please specify.
____________________________________________________________
3. Did your business close as a result of COVID 19?
☐ Yes
☐ No
4. If open, how have you modified operations?
☐ Restricted access
☐ Utilized protective equipment
☐ Take-out and delivery only
☐ Curbside service
☐ Appointment only
☐ On-line business only
☐ Other (please explain)
______________________________________________________________________
5. How has your business/nonprofit been harmed by the COVID-19 pandemic? Check all that apply:
☐ Full or partial closure due to city or state emergency order
☐ Forced to lay off or not pay one or more employees
☐ A loss of monthly revenue of 25% or more
☐ Probable closure if we do not get federal or state assistance
☐ Other. Please explain
___________________________________________________________________________
5a Are your losses related to the COVID-19 pandemic?
☐ Yes
☐ No*
6. Does the nonprofit, business, or a listed owner have an outstanding judgment, tax liens, pending
or threatened bankruptcy proceedings, pending or threatened lawsuits against them, or criminal
proceedings?
☐ Yes
☐ No.
If yes, please explain. * ____________________________________________________________
7. Is the organization, business, or a listed owner delinquent on any federal, state, or local taxes or
assessments, direct or guaranteed loans, leases, contracts, grants, child support payments, or any
other obligations?
☐ Yes
☐ No.
If yes, please explain. * _______________________________________________________________
8. Does any owner, owner’s spouse, or household member work for or serve in an official capacity
for local or state government?
☐ Yes
☐ No.
If yes, please explain. * _______________________________________________________________
9. Is your business restricted to patrons over age 18 or 21?
☐ Yes
☐ No
For example, liquor store, bar, smoke shop, marijuana dispensary, and adult entertainment
10. Nonprofits only, please confirm that your organization:
☐ Is directed by a volunteer board or local advisory board with a majority of members who are Alaska
residents
☐ Has provided aid or services in Thorne Bay during 2019
☐ Issued an IRS determination letter of nonprofit status in 2019 or earlier
DISCLAIMERS * Please confirm your understanding of these disclaimers ☐Yes ☐No
Application for the grant DOES NOT GUARANTEE award of funding.
The total amount awarded will be based on funds available.
All businesses receiving funding MUST complete a W-9 prior to receipt of funding.
It is the sole responsibility of the applicant to determine or to seek independent advice to
determine the tax implications to the grant funds received by the applicant.
CERTIFICATION *
As an official signer for my nonprofit/business, I certify that all of the information provided in
this application is true and accurate. I am agreeing to assist in the verification of information
provided in this application and to provide additional information, if requested.
Signature: __________________________________________________________
Date: ______________________________________
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City of Thorne Bay Grant Application To Benefit (City Of Thorne Bay)

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Completed 5 August 2020

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