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Business Information

First Name*
Last Name*
Name of Business *
Business Address*
City*
State*
Zip*
Email Address*
Phone Number*
Business Identification FEIN/EIN*
City of Sheridan Business License Number*
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Business Impact

Type of Business*
How long has your business been in operation?*
What is your estimated decline in revenue due to COVID-19 pandemic?*
1. 50% or greater
2. 25% to 50%
3. 10% to 25%
4. 5% to 10%
5. Less than 5%
Of the choices below which option(s) would best describe the impact of the COVID-19 Pandemic on your business? *
1. Closed due to public health order
2. Closed voluntarily to promote social distancing
3. Decreased customer demand due to COVID-19 pandemic
4. None of the above
5. Other
If you answered "other" please fill in answer here. *
What are the economic impacts of the COVID-19 pandemic on your business?*
1. Tempory business closure
2. Reduced hours of operation
3. Employee layoffs/furloughs
4. Revenue decline
5. Increased operating costs
6. Interruptions in your supply chain
7. Inability to serve customers
8. Unable to set up home delivery / pick up process
9. Reduced access to capital
10. Modifications made to continue operations
11. Other
If you answered "other" please fill in answer here. *
Provide a description of the impact to your business. Please provide your specific amount of loss.*
If asked, can you provide documentation showing your loss? What documentation can you provide?*
Two Grant opportunities are available. Please select one or both.*
Please apply only for the funds needed to support
1. Business Interruption
2. Infrastructure/PPE
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Business Interruption

Business Interruption
Grant can be used to support the operational needs of the business such as lease/mortgage payments, utility expenses, payroll expense, supplies and services, materials. (If grant funding was received within the past 6 months that amount may be deducted from the award) Grant amount up to $10,000.
Total amount requested for Business Interruption*
Provide a detailed explanation of how you will use the Business Interruption Support Funds*
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Infrastructure /PPE

Infrastructure/PPE
Funds can be used to purchase items needed to adapt your business to new processes or items needed to operate in a different manner due to the COVID-19 crisis, including PPE. This grant will reimburse items purchased back to March 1, 2020 used to safely adapt and/or change your business to operate within the COVID-19 pandemic. The program will also allow you to plan future expense and be reimbursed at the time of the expense through November 30, 2020. Maximum amount: $10,000
Total amount requested for Infrastructure/PPE*
Provide a detailed explanation of how you will use the Infrastructure/PPE Support Funds*
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Additional Questions

Have you applied for and/or received funding support through any grant programs in the last 6 months? If yes please state the program(s) you have applied or received funds from.*
Is your business a franchise?*
1. Yes
2. No
Please clearly describe any support you receive from Franchiser*
Will this grant funding enable you to hire, retain, and/or bring back employees?*
1. Yes
2. No
Do you have any additional comments?
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Acknowledgement

Statement of Understanding & Certification by Applicant

I have read the program eligibility criteria for the COVID-19 Small Business Emergency Grant Program on page 1 of this Application. I understand that grant awards will be determined at the discretion of the City based on the program eligibility criteria and the responses provided in this Application. I understand that grant funds are limited, and that submitting an Application does not guarantee a grant award. I further understand the City may terminate the program at any time, for any reason.
I certify that I am authorized to sign this Application as or on behalf of the Applicant. I agree to verify any of the information contained in this Application upon request by the City. If selected to receive a grant, I agree to provide feedback to the City of Sheridan in the form of an online survey on my business’ use and impact of the grant.
I agree that my business is fully responsible for determining and understanding the effect that my receipt of grant funds, if awarded, may have on any other applications for, my business’ eligibility for, or awards from, other economic aid or relief programs from any other entity whatsoever. I further agree that by submitting this Application, I and my business release and hold harmless the City of Sheridan from any responsibility or liability for any effect the receipt of grant funds from the City may have on such applications, eligibility, or awards from such other programs. All Applications will become property of the City of Sheridan, and all Applications are subject to the Colorado Open Records Act, C.R.S. § 24-72-200.1 et seq., provided that the City will use its best efforts to maintain the confidentiality of any confidential financial information submitted, as permitted by law.
By signing below, I certify that all information in this application, and all information furnished in support of this application, is given for the purpose of obtaining a City of Sheridan COVID-19 Small Business Impact Assistance Grant and that the information provided is true, correct, and complete to the best of my knowledge.
By entering my name and title below, I am electronically signing my application.
Legal Name*
Applicant must enter legal first and last name.
Title*
Review process can take up to 60 days.
Please be on the lookout for emails from the City of Sheridan requesting additional information or supporting documentation.

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1. Receive an email copy of this form.
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City of Sheridan COVID-19 Business Impact Assistance Grant Program

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Business Information

Business Impact

Business Interruption

Infrastructure /PPE

Additional Questions

Acknowledgement

Statement of Understanding & Certification by Applicant

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