The City of Tallahassee

* Applicant Name:

* Applicant Role in Business:

* Business Name:

* Business Address:

* City:

* State:

* Zip Code:

* Business Phone Number:

* Business Email Address:

* Number of Employees:

Note: An employee is defined as an individual who receives a paid wage or salary which employment taxes (e.g. FICA, FUTA) and income taxes are withdrawn and remitted to the IRS, as evidenced by business tax returns filed, i.e. IRS Form 940, Employer's Annual Federal Tax Return, IRS Form 941, Employer's Quarterly Federal Tax Return or IRS Form W-3, Transmittal of Wage and Tax Statements. For purposes of eligibility, independent contractors (also known as 1099 employees) do qualify as employees for this program.

* Estimated Annual Revenue:

* Number of Locations:

* Is your business currently operational?
YesNo

* Briefly describe your business services/product:

* Briefly describe the negative impact COVID-19 has had on your business: (you will also need to provide documentation below in Upload #2):

* Pre-COVID Weekly Revenue (As of February 2020):

* March 2019 Average Weekly Revenue:

* Average Weekly Revenue Since March 18, 2020:

* By checking "Yes", I certify the business described in this application is an active business located in or operating from within the boundary of the Greater Frenchtown/Southside Community Redevelopment Area. Verify you are in the GFS District.

Yes

* By checking "Yes", I certify no person and/or firm will be paid out grant funds, if approved, to help complete this application.

Yes

* By checking "Yes", I certify the business described in this application will remain open and retain employment at the highest possible pre-COVID-19 levels to the best of its ability for 45 days from receipt of the CRA disaster assistance grant funding.

Yes

* By checking "Yes", I certify the business described in this application did not receive COVID-19 Economic Development Relief (CEDR) funds from the Tallahassee/Leon County Office of Economic Vitality (OEV).

Yes

Required Uploads (.PDF, .JPG, .PNG)
* Upload #1: Proof of Business in Leon County (Articles of Incorporation, Bill to Business Address or other documentation)

* Upload #2: Documentation demonstrating the negative impact COVID-19 has had on your business between March 2019 and May 2020. This could include, but is not limited to, a comparison of monthly sales tax returns to the Florida Department of Revenue, IRS quarterly business tax forms (Form 941 and/or 720), bank statements, payroll information or signed statements from a certified public accountant.

* Upload #3: The Property Information Sheet from the Leon County Property Appraiser Website confirming the business is located within the GFS District or other documentation acceptable to the CRA verifying the business is located in the GFS District.

Upload #4: For tenants: please provide a copy the lease with the GFS District property owner or other documentation acceptable to the CRA (such as a certified letter from owner of the property where your business is located) that shows your business is located in the GFS District.

* Signature (click "Save Signature" when done signing)

By signing my full name, I certify that all information is valid and complete and hereby authorize the City of Tallahassee Community Redevelopment Agency (CRA), the City of Tallahassee and their affiliated offices and agencies to verify any of the above information as deemed necessary. I certify that I have reviewed the CRA disaster assistance grant eligibility requirements and selection criteria and that, to the best of my knowledge, the above-mentioned recipient is eligible to receive a grant from the CRA. I understand that. in the event the CRA awards a grant to the above-mentioned recipient, I may be required to provide subsequent documentation regarding the use of the grant funds. I agree to return to CRA any funds received for intentionally submitting false information to receive CRA funds, and agree to pay CRA's attorney's fees and costs associated with any action to recover CRA funds.

Version: 3537 (6/11/2020 12:50 PM) |