Rapid Response COVID-19 Business Support Initiative
Employer Application and Agreement
The Capital Region Workforce Board has been awarded a $201,000 grant from the Commonwealth of Virginia to assist
small businesses (fewer than 250 at a site) with certain costs related to the COVID 19 crisis that might help them meet
certain needs and/or divert expenses in other areas as a form of assistance. The source of funding is the US Department of
Labor Employment and Training Administration Workforce Innovation and Opportunity Act, Title I. Examples of uses
include paying for cleaning services so companies can stay open, paying for cleaning supplies, or purchasing items that
can assist employees in teleworking. Other COVID19 related items can be considered on a case-by-case. (Note that
“equipment” with a per unit value over $5,000 is not allowed; nor are wage reimbursements for employees). Another
condition is that these funds are only available on a reimbursement basis, meaning the business must first incur the cost
and present proof of payment to get reimbursed. Reimbursement is available for allowable costs incurred March 1, 2020
August 31. 2020.
There is a locally-set cap of funding available for each jurisdiction in our region based on proportional shares of the labor
force. Our region includes Charles City, Chesterfield, Goochland, Hanover, Henrico, New Kent, Powhatan and
Richmond. Funds are being made available on a first-come-first basis, in order of applications received by jurisdictional
basis by Brian Davis at dav113@henrico.us
. Questions welcome by email or 804-652-3228.
Business Name
Business Address
Business Contact Information
Phone and Email
Projected Start and End Date
Locality Name
Industry Sector (2 Digit NAICS)
Number of Employees Impacted
and Estimated Annual Wages
Brief Project Description
Description of Leveraged
Resources if applicable
Total Cost
(Use form at Attachment A for
line item detail)
Signatures and Certifications
BY MY SIGNATURE I VERIFY: (1) THAT THE INFORMATION IN THIS APPLICATION IS ACCURATE TO THE
BEST OF MY KNOWLEDGE AND FURTHER, THAT ONLY COSTS INCURRED AFTER MARCH 1, 2020 WILL
BE SUBMITTED FOR REIMBURSEMENT FOR ACTIVITES APPROVED IN THIS APPLICATION (2) THAT I
HAVE THE AUTHORITY TO SUBMIT THIS APPLICATION ON BEHALF OF THE NAMED BUSINESS AND (3) I
CERTIFY THAT THE BUSINESS (CONTRACTOR) IS AWARE OF AND WILL COMPLY WITH THE FEDERAL
WORKFORCE INNOVATION AND OPPORTUNITY ACT ASSURANCES AND CERTIFICATIONS THAT ARE
POSTED AT THIS SITE, https://vcwcapital.com/wp-content/uploads/assurances.pdf
AND INCORPORATED HEREIN
BY REFERENCE.
Typed Name
Signature
Title
Date
For the Capital Region Workforce Partnership:
_______________________________________________________ __________________________
Brian K. Davis, Executive Director Date
Attachment A Line Item Budget
LINE ITEMS
Amount
Provide a detailed explanation and the basis for the budget
amount requested
GRAND TOTAL