Fillable MITCHELL COUNTY CDBG-CV GRANT APPLICATION (Mitchell County, Kansas)

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MITCHELL COUNTY CDBG-CV GRANT APPLICATION (Mitchell County, Kansas)

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MITCHELL COUNTY CDBG-CV
GRANT APPLICATION
Businesses in Mitchell County who are facing financial difficulties due to the COVID-19 pandemic are eligible
to receive assistance through the Mitchell County CDBG-CV Grant Funds. This is a grant for those facing
impending income losses or other stresses due to the COVID-19 pandemic. The purpose of the program is to
help our businesses retain jobs to low-to-moderate income families.
Eligibility: Any for profit business in existence as of March 1, 2020 that is retaining jobs and benefiting 51% or more
low to moderate income families and not owned by an elected official of this city/county.
Use of grant funds: Operational relief, including payroll, utilities, rent, inventory (limited to 60 days), and other
monthly expenditures. Cost cannot be incurred prior to 03/1/2020. Cannot be used to pay back loans.
Amount:
-1-5 Employees: Up to $25,000 per Full Time Equivalent (FTE) jobs retained based on need for businesses
with a maximum funding of $30,000.00 per company.
-6-50 Employees: Up to $35,000 per FTE jobs retained based on the need of a business with a maximum
funding of $50,000.00 per company.
***PLEASE NOTE THESE MAXIMUMS ARE SUBJECT TO AVAILABILITY OF FUNDS***
Application: The application must be submitted by July 23, 2020 at noon to the following address:
Heather Hartman
Mitchell County Economic Development
209 E. Main St.
Beloit, KS 67420
The application will be considered complete if the following information is provided:
1. CDBG-CV Application Form-note the number of employee certifications included must equal the
total number of jobs retained on page 1 of the application
2. Grant Budget - Excel Sheet
3. Employee Certification Form for retained employees
4. Current Payroll Report including last name, hours worked, rate of pay, pay period weekly, bi-
weekly, monthly; asterisk current employees from date of application-signed and dated by owner
5. Letter (signed and dated by business owners) from business explaining that the effects of
COVID-19 has shut down or will shut down the business if funding is not secured
Additional Information:
-If awarded, the business will be required to supply invoices, receipts and proof of payment for funds seeking
to be reimbursed. Please note the invoices must be dated 3-1-2020 or later including check number and paid
date written on each invoice.
Note: Amount of request may decrease based on availability of funds.
Questions please contact:
Heather Hartman at hhartman@beloitks.org 785-738-3000
Keegan Bailey, NCRPC kbailey@nckcn.com 785-738-2218
CDBG-CV Business Application
Date:
COMPANY INFORMATION
Legal Name of Business:
Type of Business:
Primary Contact Person:
Mobile Phone:
Email:
Business Phone:
Website:
Social Media:
Home Address of Owner:
Number of Owners:
Project Site Address:
Duns #:
Business Structure (LLC, Sole Proprietorship, Inc.):
Is the business located in the same city as the
mailing address above? Yes No
Date Business Established:
Does the applying business have a related
operating or holding company? Yes No
GENDER
Male
Female
VETERAN
Yes
No
RACE/ETHNICITY:
White
Black/African American
Asian
American Indian/Alaskan Native
Native Hawaiian/Other Pacific Islander
American Indian/Alaskan Native & White
Asian & White
Black/African American & White
American Indian/Alaskan Native & Black/African
American
Other Multi Racial
Hispanic
Non-Hispanic
Total Working Capital Need:
List any and all other funding you
are currently seeking, including but
not limited to, bank loans, SBA
loans, public or private loans, grant
funding, etc.
SBA
City
Network Kansas/HIRE
Chamber of Commerce
Main Street
Community Foundation
E-Community
MCAC
Banker/Financing
Other:
Jobs Retained: Full-time: Part-time:
Will full or part-time jobs be retained as a result of the funds? Yes No Unknown
Does the business owner have a tax liability in arrears with
the Kansas Department of Revenue or the IRS?
Yes No Unknown
Please provide a description of the
services provided by your business:
Please provide a short description of
how COVIC-19 is negatively
impacting the business (e.g. weekly
sales average drop for restaurants,
occupancy rate drop for hotels, etc.)
Describe how the use of the CDBG
grant fund enhances the ability of
this business to survive.
What types of working capital will
the funds be used for (e.g. utilities,
payroll, inventory)?
Please list any other business
resource partners that the business
is working with, if any, (e.g. small
business development centers,
economic development
organization, industry or trade
services).
Rev. 6/15/2020
Mitchell County CDBG-CV Grant Application
Due to the Mitchell County Economic Development Office by noon on July 23, 2020
1. Are you an immediate family member of an employee of Mitchell County? Yes No
2. Business revenue decrease month of April 2020 compared to month of April 2019. (Please Circle)
less than 10% 10 to 25% 25 to 50% 50 to 75% 75 to 90% >90%
3. How did you respond to reduce the negative impact of Covid-19? ___________________________
___________________________________________________________________________________
___________________________________________________________________________________
4. Were you denied for, or received minimal, PPP or EIDL funds because you did not show enough net
income in 2019? Yes No
If yes, was your 2019 net income less than your 2018 net income? Yes No
If yes, by how much__________ and why _______________________________
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MITCHELL COUNTY CDBG-CV GRANT APPLICATION (Mitchell County, Kansas)

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Completed 17 August 2021

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