COVID-19 Hardship Small Business Grant Application
To access and download our COVID-19 Hardship Small Business Grant Guidelines click the link provided below.
https://drive.google.com/file/d/1zaFUOWmtjn2Q-I4nCzCR0achjpu7wBpg/view?usp=sharing
Grant program materials are available in the following languages: Portuguese, Spanish, French, Arabic, Somali, and Vietnamese.
Date
*
-
Month
-
Day
Year
Date
Legal Business Name:
*
DBA (Doing Business As) if different from legal name:
Principal Place of Business (in South Portland) *
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
*If your Principal Place of Business is not in South Portland, please list your Principal address below.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Owner/Applicant Name:
*
First Name
Last Name
Title/Relationship to the Business (I.e. Owner, Manager, Etc.)
*
Business Phone Number
*
-
Area Code
Phone Number
Cell Phone
-
Area Code
Phone Number
Email
*
example@example.com
Is your business located in your home?
*
Yes
No
Business Structure NOTE: Non-Profit/Not for Profit businesses are NOT eligible for this grant program.
*
Sole Proprietorship
General Partnership
Limited Partnership
Limited Liability Company (LLC)
Corporation
If a Sole Proprietorship, have you applied for and received Pandemic Unemployment Assistance?
Yes
No
If you answered yes to the previous question, please enter the amount you have received.
Number of Full-Time Employees as of March 15, 2020:
*
Number of Full-Time Employees as of Today:
*
Number of Part-Time Employees as of March 15, 2020:
*
Number of Part-Time Employees as of Today:
*
Number of Employees you plan to hire or rehire in the next 6 months:
*
Did you provide employee benefits to employees before the COVID pandemic?
Health Insurance
Paid Time Off (sick, vacation, etc.)
Other
Funding Requested
Total Amount Being Requested ($):
*
Maximum Grant: Up to Two Thousand and 00/100 U.S. Dollars ($2,000.00).
Use of Funds:
*
If awarded, how would your business use and benefit from the City of South Portland’s COVID-19 Hardship - Small Business Hardship Grant?
Question 1: Please provide a short statement of how the COVID-19 crisis has negatively impacted your business (e.g. EE layoffs, closure, loss of income >50%, etc.). Please justify your need for public assistance.
*
Question 2: If not awarded the funding amount requested, what is your contingency plan(s)?
*
Question 3: Is there any other information the Review Team should be aware of to aid in determining eligibility and/or hardship?
*
Tax Payer ID (EIN):
*
Please attach: Completed IRS W-9 Tax Form below.
*
Browse Files
To access a copy of the W-9 tax form: https://drive.google.com/drive/folders/1k2mI3CoNGym3mrxX3wyDYmFmohgZ2PLM
Cancel
of
Please attach: Copy of 2019 Business Tax Return (typically 1120,1120S, or Schedule C)
*
Browse Files
To access a copy of the personal financial statement: https://drive.google.com/file/d/1P3uxDrJ-924TYeQnN7dHWR5G--IkIMx8/view?usp=sharing
Cancel
of
Please attach: Payroll Summary of number of employees, salaries/wages, and positions prior to March 15, 2020.
*
Browse Files
Cancel
of
Please attach: Current Payroll Summary with number of employees, salaries/wages, and positions (must be dated no less than 30 days prior to application submittal).
*
Browse Files
Cancel
of
Please include Payroll Forecast for number of rehire(s)/new hires(s), positions, salaries/wages, and estimated date of rehires/new hires.
*
Browse Files
Cancel
of
Certification
(Owner) in requesting the funds certifies as follows:
*
1. The Business has no more than 100 employees. 2. The Business has business operations in South Portland and has been negatively impacted by the COVID -19 circumstances. 3. The Business needs funds in order to assist it in preserving its business operations and/or employees. 4. The funds provided pursuant to this program will be used by the Business directly in the Business to assist the Business in preserve its business operations and/or employees.
Signature of Authorized Representative
*
Date:
*
Print Name:
*
All statements contained in the Application are truthful and accurate. If statements are subsequently determined to be false or inaccurate. The Applicant may forfeit any Grant award and be required to repay the City any funds that have been received. For questions and/or program clarifications, please contact: William Mann, Economic Development Director, at: wmann@southportland.org
Submit
Should be Empty: