Fillable Form -1815: PURPOSE EMERGENCY DISASTER RELIEF FUNDING PROGRAM (City of Winchester)

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Form -1815: PURPOSE EMERGENCY DISASTER RELIEF FUNDING PROGRAM (City of Winchester)

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BROWSE CITY OF WINCHESTER (VA) FORMS

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City of Winchester
33 East Boscawen Street
Suite 100
Winchester, VA 22601
(540) 667
-1815
www.developwinchesterva.com
EMERGENCY DISASTER RELIEF FUNDING PROGRAM
PURPOSE
The purpose of the Disaster Relief Funding Program (DRF) is to assist Winchester city businesses that are being
affected by mandatory closures and changed operational policies brought upon by the COVID-19 Pandemic.
TERMS AND CONDITIONS
Loan terms and conditions shall be structured on the basis of need and ability to repay. The Disaster Relief
Funding Program has a limited amount of funding, so not every loan will be approved.
Minimum standards include the following.
Loan Amount: The maximum amount of Disaster Relief Funding available for any single business enterprise shall
be $5,000. No payment will be required for the first six (6) months, or 180 days after the loan is disbursed.
Interest Rate: The interest rate shall be zero percent (0%) for the first twenty-four (24) months of the loan with a two
percent (2%) interest rate being applied to the remaining additional thirty-six (36) months of the loan term. Please
note, the Winchester EDA will reevaluate this interest rate policy after the first eighteen (18) months of the
Program's existence.
Loan Term and Repayment: The EDA wishes to keep the loan term at 5 years or less so that the Disaster Relief
Funding can be replenished.
Prepayment: There are no penalties for prepaying the loan in whole or in part at any time during the loan term.
ELIGIBLE AREAS
The area served by the DRF program shall be within the corporate limits of the City of Winchester, Virginia.
ELIGIBLE APPLICANTS
Eligible businesses are defined to be “small businesses” operating at a full-time commercial location within the City
of Winchester corporate limits. Small businesses are those that generate under $2.5 million in annual revenue and
employ under twenty-five (25) employees. Applicants shall not be disqualified based on age, race, religion, color,
handicap, sex, physical condition, development disability, sexual orientation or national origin. Eligible businesses are
those that have been operating within the City of Winchester for at least six (6) months before the date of the
application.
DEMONSTRATION OF NEED
Applicants will be asked to demonstrate their need for working capital as a result of a reduction of business due to
the COVID-19 Pandemic.
USE OF FUNDS
Funds may be used for costs associated with rent, utilities, payroll, inventory, etc.
INELIGIBLE APPLICANTS
Disaster Relief Funds will not be eligible for any member of the Winchester City Council; the EDA; or any other
official, employee, or agent of the City who exercises decision-making functions or responsibilities in connection
with the implementation of the DRF program is eligible for financial assistance under this program. No member
of Winchester City Council; the EDA, or any other official, employee, or agent of the City may financially benefit
from this program. Applicants who utilize a business address that is a home office, or operate inside of a
residential property may not apply for funds. Non-for profit entities may not apply.
2
DISASTER RELIEF FUNDING PROGRAM APPLICATION
Name of Business:
Tax ID#:
Address:
Telephone #:
Website:
Date Established:
Applicant:
Telephone #:
Address:
Email:
Co-Applicant:
Telephone #:
Address:
Email:
Structure of Borrower (Check One)
Sole Proprietorship:
S-Corporation:
Limited Liability Company:
C-Corporation:
Limited Partnership: Other:
Months of Operation
More than 6 months:
Less than 6 months:
MANAGEMENT & OWNERSHIP
(Proprietor, partners, key personnel, officers, directors and all shareholders 100% ownership must be shown). Use
separate sheet if necessary.
Name:
Title:
# Years with Business:
Address
% Owned:
Telephone #:
Name:
Title:
# Years with Business:
Address
% Owned:
Telephone #:
Name:
Title:
# Years with Business:
Address
% Owned:
Telephone #:
ADDITIONAL CONTACT INFORMATION
Name of Primary Bank:
# of years:
Contact Name:
Telephone #:
Address:
Name of Accountant/Bookkeeper:
# of years:
Contact Name:
Telephone #:
Address:
3
BUSINESS OPERATIONS
Describe your business and the products and services that you provide and who your target market is (customer
base). Please include number and type of employees (full-time/part-time), and wage ranges and your current
annual sales.
DEMONSTRATION OF NEED & AMOUNT OF FUNDS REQUESTED
Describe your need for working capital as
a result of a reduction of business due to the COVID-19 Pandemic.
Please include amount of loan funding requested and documentation showing what funds will be spent on.
If more space is needed, please continue on separate sheet:
BUSINESS EXPENSES
Please include a breakdown of monthly business expenses to include rent, mortgage, payroll, utilities, inventory,
etc.)
COLL
ATERAL
Collateral is preferred but not required as part of this application. Please describe existing assets that may be
available for collateral.
4
DIS
CLOSURES
1.
Have you or any officers of the company ever declared bankruptcy or defaulted on any
financial or contractual obligation? YES NO
2.
Are you or your business involved in any pending litigation? YES NO
3.
Are you or your business delinquent on any federal, state or local taxes? YES NO
4.
Have any of the individuals listed in the “Management & Ownership” section been convicted of
a felony? YES NO
If the answer is YES to any of the above questions, please explain.
CRED
IT REPORT
Please submit your most recent credit report. Loan applicants must obtain, review,
and submit a free copy of their credit report at the time of the loan application. Free
reports are available for download at www.annualcreditreport.com.
CE
RTIFICATION AND CONSENT TO RELEASE OF INFORMATION
I certify the above information and statements contained in the attachments are true
and accurate as of the stated date(s). These statements are
made for the purpose of
obtaining a loan. I understand that incomplete applications may be rejected and at the
very least will delay the decision on the requested loan. I authorize the Economic
Development Authority of the City of Winchester to investigate the applicant’s and
affiliated companies’ credit and financial records including banking records. As part of
the investigation, I authorize the EDA to request and obtain consumer credit reports on
the applicant and affiliated companies’ in connection with the opening, monitoring,
renewal and extension of this and other loan requests with the EDA.
Si
gned: Title:
Date:
Mail completed application package to the Economic Development Office, 33 Eas
t Boscawen
Street, Suite 100, Winchester, Virginia 22601, or email to staff at
shirley.dodson@winchesterva.gov. Call with any questions to the Economic Development
Office Staff: (540) 247-1826
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Form -1815: PURPOSE EMERGENCY DISASTER RELIEF FUNDING PROGRAM (City of Winchester)

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Completed 17 July 2020

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