Fillable State of Oregon COVID-19 Emergency Business Grant Application (Columbia Gorge Community College)

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State of Oregon COVID-19 Emergency Business Grant Application (Columbia Gorge Community College)

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State of Oregon COVID-19
Emergency Business Grant Application
T
he Oregon Legislature, in partnership with the Governor, allocated $22.5 Million of federal
CARES Act funds for the purpose of providing financial assistance to small businesses adversely
affected by economic conditions as a direct result of the COVID-19 pandemic.
T
o fill gaps not reached by other programs, these federal funds are directed to adversely affected
businesses with 25 or fewer employees. COVID-19 Emergency Business Grant awards will be
made to eligible businesses that have received less than $100,000 in federal funding. Businesses
may use the proceeds for any business-related operating expenses.
Businesses that have previously received funding through the State of Oregon COVID-19
Emergency Business Grant program are eligible to receive additional funding and should
complete and submit the State of Oregon COVID-19 Emergency Business Supplemental Grant
Application.
This application is for a business that meets all of the following eligibility requirements:
• The business is headquartered in Oregon and has its principal operations in Oregon.
• If required by Oregon law to be registered with the Oregon Secretary of State to do business
in Oregon, the Business is so registered.
• The business has 25 or fewer employees.
• The business was adversely affected in either one of the following two ways:
o For-profit and non-profit (limited to 501(c)(3) corporations) businesses that were
prohibited from operation as directed by Executive Order 20-12.
o For-profit and non-profit (limited to 501(c)(3) corporations) businesses that can
demonstrate a one-month decline in sales of 25% or more, incurred by the COVID-19
pandemic, between March 1, 2020 and August 31, 2020 as compared against the same
period of time in 2019.
T
he following businesses are ineligible to apply for or receive funding under the Program:
• Passive real estate holding companies and other entities holding passive investments.
• Non-profit entities that do not have federal 501(c)(3) status.
• Businesses that experience a decline in revenues for reasons other than those caused by the
COVID-19 pandemic (e.g. seasonal or cyclical businesses cycles).
• Businesses that are delinquent on federal, state or local taxes that were due on or before the
date of application.
• Businesses that do not comply with all federal, state and local laws and regulations.
• Businesses that have already received grant funds through the Statewide Business and
Cultural Support Program. The Emergency Board of the Oregon Legislature established this
program in July 2020, to support cultural venues and organizations. Eligible recipients for
this program include, but are not limited to, cultural institutions, children’s museums, county
2
fairgrounds, cultural entities within federally recognized Indian Tribes based in Oregon, and
festivals and community event organizations.
• Bu
sinesses that have received more than $100,000 of federal CARES funding (e.g. PPP, EIDL,
and/or EIDL Advance) as set forth by this program in this application.
• Businesses that do not otherwise meet the eligibility requirements set forth above.
Again, businesses that have previously received funding through the State of Oregon COVID-19
Emergency Business Grant program should not complete this form but should complete and
submit the State of Oregon COVID-19 Emergency Business Supplemental Grant Application.
Awards to eligible businesses will be made as a grant. The amount of the grant will be the greater
of the following figures based upon a calculation for Full Time Equivalent (FTE) employment:
1) Businesses with 2 or fewer FTE – $5,000
2) Businesses with 3 or more FTE – $2,000 per FTE (cap of $50,000)
FT
E will be calculated for applicants in Section 2.
Bu
sinesses not required or that have elected not to file OED Form 132 with the Oregon
Employment Department are still eligible for this program but will have a maximum award of
$5,000.
Business information, ownership information and demographic information will be reported to
the State for all applications submitted, reviewed, approved and/or denied. Information reported
includes, but is not limited to:
• Name of company
• Employer Identification Number (EIN)
• Oregon Business Identification Number (BIN)
• Amount of PPP, EIDL, EIDL Advance, or other CARES Act funding awarded to the applicant
• Address of company
• Industry/NAICS
• Amount of State of Oregon COVID-19 Emergency Business Grant award
• Legal business structure
• Number of employees
• Number of employees expected to be retained as a result of this award
3
Section 1: Business Information
Business Name
Business Owner/Operator Name
Email Address
Business Type
Sole PropPartnership
Corporation LLC
501(c)(3)
Telephone
Street Address
City State Zip Code County
Employer Identification Number (Federal EIN) or Social Security Number (SSN)
Business Identification Number (BIN)
BINs are issued by Oregon Employment Department (OED) and are required for all businesses that have 5 or
more employees and for businesses with fewer than 5 employees that file OED Form 132.
NAICS Code (as listed on the businesses most recent federal tax filing.)
(https://www.census.gov/eos/www/naics/
)
Description of product(s) or service(s) offered:
4
Section 2: Business Details
Company Principals
Name Title
Percent Ownership
Name Title
Percent Ownership
Name Title
Percent Ownership
Name Title
Percent Ownership
Total Percent Ownership
FTE Employment Calculation rounded to nearest whole number (required for all businesses
seeking an award based on 3 or more FTE):
(Input the number of hours reported to the Oregon Employment Department (OED) on Form 132
for Q4 2019, Q1 2020, Q2 2020, or Q3 2020)
Total hours reported on Form 132 ÷ 455 = FTE
Amount of State of Oregon COVID-19 Emergency Business Assistance requested:
(The greater of $5,000 or FTE x $2,000)
How many jobs will be retained at your business as a result of the grant?
(Include jobs lost since February 29, 2020 that can now be retained because of the grant.)
0
0
5
Section 3: Required Documentation
To qualify for a grant through this program, documentation is required. An application will not
be considered complete or be processed until all required documentation is provided. Complete
the following checklist and attach the required documentation as required.
(a) Sales Decline Verification.
Was your business prohibited from operations as directed by Executive Oder 20-12?
Yes – Sales verification is not required – Proceed to (b).
No – For a one-month period between March 1, 2020 and August 31, 2020, and for the
corresponding period in 2019, one of the following must be provided documenting a 25% or
more reduction in sales (e.g. April 2020 and April 2019):
Profit and Loss Statements (like periods in 2019 and 2020)
Income Statements (like periods in 2019 and 2020)
Sales Reports (like periods in 2019 and 2020)
Bank Records (like periods in 2019 and 2020)
(E.g. bank statements, online banking reports, etc.)
(b) Federally Administered CARES Act Program Funding Verification.
Has your business received federal CARES Act funding through the SBA's PPP or EIDL program?
No – CARES Act funding verification is not required – Proceed to (c).
Yes – For each federal CARES Act funding program that financial assistance was received,
provide the following:
PPP Program – Copy of the loan agreement
(This was provided by your financial institution and may have been executed via DocuSign®).
PPP Loan Amount
EIDL Program – Copy of the loan agreement
(This was provided through the SBA portal and was executed via DocuSign®).
EIDL Award Amount
EIDL Advance – Copy of bank statement showing deposit of grant proceeds
EIDLA Award Amount
(c) City administered CARES Act Funding Program Verification.
Has your business applied for CARES Funding from the City of Portland Small Business Relief
Program administered by Prosper Portland?
No, Proceed to (d)
Yes, provide the following information
Small Business Relief Award Amount
6
(d) Other CARES Act Funding Program Verification.
Has your business applied for funding from the Oregon Cares Fund for Black Relief + Resiliency?
No, Proceed to (e)
Yes, provide the following information
Oregon Cares Fund Award Amount
(e) Full Time Equivalent (FTE) employee verification:
Are you applying for a grant award larger than $5,000?
No – FTE verification is not required – Proceed to Section 4.
Yes – Provide Oregon Employment Department From 132 used to complete the FTE
employment calculation in Section 2:
Hours Reported ÷ 455 = FTE
0
7
Section 4: Certifications and Representations
The information in this application, including all attachments and certifications, are, to the best
of the knowledge of the undersigned, complete, current and accurate. The application presents
fairly the conditions of the eligibility of the undersigned. Proceeds of the award are intended to
solely support the operations and reopening expenses of the applicant business. Initial all the
following certifications that apply:
o The applicant business was adversely impacted as a direct result of the COVID-19
crisis.
o The applicant business had 25 or fewer employees as of the date of this application.
o The applicant business:
Was determined to be a non-essential business in accordance with
Governor’s Executive Order 20-12, or
Experienced a 25% or more reduction to sales as a result of the COVID-19
crisis.
o If the applicant has received federal financial funding relief through the CARES Act
of 2020 (e.g. SBA's PPP or EIDL program) or any subsequent federal act that provides
emergency business assistance as of the date of this application, that federal
support has been disclosed in the application.
o The applicant has not received funding from the State of Oregon through COVID-19
Emergency Business Grant Program, or the Statewide Business and Cultural
Support Program as of the date of application.
o The applicant business is current on all federal, state and local taxes as of the date
of application.
o The applicant business is headquartered in and has primary operations in Oregon.
o The applicant business is currently registered with the Oregon Secretary of State to
do business in Oregon if such registration is required.
o The applicant business is compliant with all federal, state and local laws.
o The applicant business agrees to provide business, financial and ownership
information necessary to determine and verify eligibility.
o The applicant business will only use these proceeds to support business-related
expenses to maintain operations and/or reopen and that Oregon COVID-19
Emergency Business Grant Program proceeds will not be used for personal
purposes.
o Unless otherwise directed by Executive Order, the applicant is open, or has
reopened for business or intends to reopen if adversely affected by the 2020 wild
fires
Failure to comply with eligible use of proceeds, or making a material misrepresentation about the
business and its operations to qualify for an award will be a provision of default of the award and
subject the award to recapture. The State of Oregon reserves the right to request additional
documentation from the applicant to verify the accuracy and authenticity of the information
provided.
Should the State determine a misrepresentation exists creating a default, the award may be
forfeited and subject to repayment. Failure to repay or cure a default will result in any and all
collection actions permissible by law, including through third party collection services or the
8
Oregon Department of Revenue. The applicant agrees to allow the State to pursue such collection
actions.
As these funds are being provided by the State of Oregon, Business Oregon and affiliated state
agencies may use your company in future promotions of their programs and services.
General Certification
I certify to the best of my knowledge that all information, contained in this application, including
all attachments and certifications, is valid and accurate. I further certify that, to the best of my
knowledge:
1. The application has been reviewed and approved by the authorized owner(s), managers with
appropriately delegated authority, and/or in accordance with the organization’s articles of
incorporation, articles of organization or bylaws, and
2. Signature authority is verified.
Check one:
Yes, I am authorized to submit on behalf of the applicant within authority granted in the
applicant’s articles of incorporation, articles of organization or bylaws. (e.g., President,
Secretary, Chief Executive Officer, Board Chair, etc.)
No, I am not authorized to submit on behalf of the applicant within authority granted in
the applicant’s articles of incorporation, articles of organization, or bylaws so I have
attached documentation that verifies my authority to sign on behalf of the applicant.
Only applications with proper signature authority documentation will be accepted.
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State of Oregon COVID-19 Emergency Business Grant Application (Columbia Gorge Community College)

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Completed 9 October 2020

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