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

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

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State of Oregon COVID-19
Emergency Business Supplemental Grant Application
The 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.
Recognizing that recovery from the COVID-19 pandemic has lengthened and that many Oregon
businesses continue to suffer from economic harm due to decreased revenues and increased
operating expenses, the Oregon Legislature, in partnership with the Governor, increased the
limits for this program effective October 1, 2020, and to ensure that all businesses are treated
equitably, those that had received funding under the previous terms of this program are eligible
for a supplemental award.
COVID-19 Emergency Business Grant awards are also now available to eligible businesses that
have received less than $100,000 in federal funding. Businesses may use the proceeds for any
business-related operating expenses.
This application is only for businesses that have already received funding through the State of
Oregon COVID-19 Emergency Business Grant Program. Businesses that have not previously
received funding through the State of Oregon COVID-19 Emergency Business Grant program
should complete the State of Oregon COVID-19 Emergency Business Grant Application.
As past recipients of grant awards have already provided verification of economic injury due to
the COVID-19 pandemic, they will not be required to provide financial information again. Eligible
businesses must continue to meet the following program 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 following businesses remain 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.
• Businesses 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.
Awards to eligible businesses will be made as a grant. The amount of the grant, at a minimum,
will be equal to the previous award to the business. The awards will be processed based on
documentation previously provided.
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/
)
4
Section 2: Prior State of Oregon Financial Assistance Information
Amount of State of Oregon COVID-19 Emergency Business Assistance Received:
How much was your previous award through this program?
The State of Oregon has allocated funding to Cities, Counties, Certified Development Financial
Institutions (CDFIs), Credit Unions and Economic Development Districts. This information is
required for verification purposes. It may be helpful to review your correspondence from the
previous award that included the original application and supporting documentation, W-9,
Demographic Questionnaire and Award Certifications. What entity did you receive your previous
award from?
If your award was made by a city, identify which city:
If your award was made by a county, identify which county:
If your award was made by an entity other than a city or county, identify which entity:
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Section 3: Required Documentation
To qualify for a supplemental award through this program, documentation may be required. An
application will not be considered complete until all required documentation is provided.
Complete the following checklist and attach the required documentation as required.
(a) Federally Administered CARES Act Funding Verification.
Has your business received federal CARES Act funding through the SBA's PPP or EIDL program
after receiving assistance through the State of Oregon 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
(b) 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 (c)
Yes, provide the following information
Small Business Relief Award Amount
(c) Other CARES Act Funding Program Verification.
Has your business applied for funding from the Oregon Cares Fund for Black Relief + Resiliency?
No, Proceed to (Section 4)
Yes, provide the following information
Oregon Cares Fund Award Amount
6
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 50% 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 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
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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 Supplemental Grant (Columbia Gorge Community College)

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Completed 1 November 2020

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