State of Washington Registered Business/Organization Name:
Business License #:
Date of Application:
Business/Organization Physical Address: (Must be within city limits)
Business/Organization Mailing Address: (If different from physical)
Phone Number:
Website Address:
Primary Contact:
Grant Amount Requested: (from $1,000 to a maximum of $10,000)
pplications will be accepted from June 4 through June 12, 2020 by 5 p.m.
The grant may be used to leverage funding from a public or private financing program provided the total of the funding
does not exceed the amount on the Economic Injury Worksheet.
The small business or community organization must have no more than twenty-five (25) full-time equivalent
employees (FTEs). Unique circumstances will be considered as exemptions to this requirement.
Based on the information submitted on the City of North Bend Economic Injury Worksheet, grants may not exceed
$10,000. There will be limited consideration given to grants greater than $10,000 for small businesses or
community organizations that play a significant role in the broader cultural, retail, and economic vitality of North
Bend. The City of North Bend may choose to give full or partial funding of the requested amount at its sole
The small business or community organization must have experienced a significant loss of income in 2020 (more
than 25% per month) due to COVID-19 or the Governor’s related “Safe Start Washington order, as compared to
thecomparable period during 2019. Small businesses and community organizations that qualify as an “essential
business and remained open to the public or worked under normal operating conditions during February-May
2020 do not qualify. Revenue loss must be documented with federal tax or North Bend Business & Occupation
(B&O) tax returns and/or or similar financial documentation.
Alternatively, the small business or community organization must demonstrate that it will incur significant new
costs for personal protective equipment or physical improvement to its processes or location to comply with social
distancing or other directives or recommendations issued by the county or state due to COVID-19.
The small business or community organization must be current on all state licensing and other regulatory
The small business or community organization must be a current North Bend business or organization and have
had a North Bend business license and not been delinquent in payment on any taxes or fees owed to the City of
North Bend as of December 31, 2019.
The small business or community organization must have had a physical location in North Bend city limits on or
before March 1, 2020 and had a consistent or growing level of business for at least one (1) year prior to that date.
Home occupation businesses operated from the owner’s primary residence may qualify if the residence is
physically located in North Bend city limits, although priority will be given to brick-and-mortar businesses.
If it is a small business, the small business must be engaged in a type of business eligible to receive funding by
the U.S. Small Business Administration (SBA)
If it
is a non-profit corporation or community organization, it must be located within North Bend city limits or if not
located within North Bend city limits provides essential human/social services to North Bend residents or plays
ignificant economic, social, or cultural role for North Bend
If it is a human/social services organization, it must show that public demand in North Bend for its services have
significantly increased due to COVID-19 but that increased revenue needed to meet the demand is not available.
1. Payment of rent or required monthly loan payments.
2. Payments of regular wages, taxes, and typical benefits to employees (for example, health insurance, and/or paid
vacation/sick leave essential to maintain operations), but only to the extent those wages, taxes, and typical
benefits have not been reimbursed by other federal, state, county, or regional grants or loans.
3. Payment for personal protective equipment (such as masks), sanitizer, disinfectant, or other supplies, equipment,
or physical changes (for example, plastic/acrylic barriers) necessary for the protection of public health or the
health of business or organization owners or employees.
4. Typical operating costs and expenses, including those set forth on an income statement, as a regular, ongoing
ost of operating the business or organization
5. Typical draws or wages on a regular interval to owner, provided such draws or wages are consistent with thos
paid in pr
evious intervals, quarters, or years.
I, (print name) ___________________________, the (print title) ___________________________
of (print business name) ___________________________, have approved the submission of this proposal.
If I/we receive a grant, I/we agree to enter into a contract with the SnoValley Chamber of Commerce and promise to:
1. use the grant funds in the intended manner; and
2. provide all documentation necessary for the SnoValley Chamber of Commerce to verify the use of the funds.
ignature: ______________________________________ Date: _________
(If document is filled digitally, please sign digitally in order to retain document details.)
mail completed and signed application and Economic Injury Worksheet to the SnoValley Chamber of Commerce at
. Include “Rapid Relief Program” in the email subject line.
f necessary, the completed and signed application and Economic Injury Worksheet may be sent via U.S. Mail to
SnoValley Chamber of Commerce, PO Box 357, North Bend, WA 98045. It must be postmarked no later than June 12,
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