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Small Business Relief Grant Application

2. 

4. The Small Business Relief Program will provide Zanesville City small businesses (30 or fewer employees are considered Small Businesses) with expenses due to business interruption caused by the COVID-19 pandemic. Eligible small businesses may apply for up to $2,500 in grant funds to be used for the reimbursement of eligible expenses.

6. Type of Entity:

7. Corporation:

9. Minority Owned:

10. Limited Liability Entity:

12. Veteran Owned:

13. Limited Partnership:

15. Woman Owned Partnership:

16. Sole Proprietor:

18. Business "dba" Name (if applicable):

19. Business Owner/Applicant Email:

21. Business Owner/Applicant Phone:

22. Year Business Was Founded:

24. Business Address:

26. Federal Employee ID #:

28. Note - Applicants seeking rent/lease, or mortgage assistance must also upload or include with the application verification (e.g. copies of invoices or previous transactions) or rent/lease or mortgage expenses.

30. Applications can be submitted starting 8:00 am on October 21, 2020 FIRST COME, FIRST QUALIFIED & COMPLETED. Applications will be processed once all support documentation is subbmitted.

32. Business Real Property Type:*

    1. Own
    2. Rent

34. Business' Primary Industy:

    1. Retail
    2. Service
    3. Restaurant
    4. Manufacturing
    5. Agriculture
    6. Other

35. Number of Full Time Employees:

    Based on last questers Wage and Tax Form

37. Describe how your business has been impacted due to COVID-19.

39. Requested Amount?

41. Describe how funds will be used - Dollar amounts and timelines

43. Category (example Rent, Electric, Water)

44. Amount

45. Date

47. Has this business applied for or received other types of assistance? (select as many as applicable)

    1. Paycheck Protection
    2. Economic Impact Disaster Loan
    3. Other SBA Loan

    1. Shared Work Ohio Loan
    2. Business Loan
    3. Other Grants or Assistance

49. REQUIRED DOCUMENTATION

51. Have been operational since at least January 2019. This can be evidenced at a minimum by; a) filing(s) with the Ohio Secretary of State, such as articles of incorporation or other registration documents along with an Ohio Secretary of State Certificate of Good Standing; b)an Ohio's vendor's license; c) Federal Schedule C - Profit or Loss from Business (Sole Proprietorship, etc); or any other documents that demonstrate that the business has been in operation as a for-profit entity since January 2019?

    1. Yes
    2. No

53. Does the business or business owner have any outstanding judgements, tax liens, pending or threatened bankruptcy proceedings, pending or threatened lawsuits against them, or criminal proceedings?

    1. Yes
    2. No

55. Does the business owner, owner's spouse, or other relative or household member work for or serve in any State government or any other entity associated with the City of Zanesville Small Business Relief Program?

    1. Yes
    2. No

57. If you answered yes to the previous question, please indicate the person(s) and affliations:

59. Can the business attest it is in good standing with all applicable government regulations related to building code or property maintenance issues?

    1. Yes
    2. No

61. Is the business or business owner delinquent on any Federal, State or Local taxes or assessments, payments, direct or guaranteed loans; leases, contracts, grants, child support payments, or any other financial obligations?

    1. Yes
    2. No

63. Does the business or business owner have any outstanding judgements, tax liens, pending or threatened bankruptcy proceedings, pending or threatened lawsuits against them, or criminal proceedings?

    1. Yes
    2. No

65. CERTIFICAITON : By signing your name below and submitting this application, you are certifying that all of the information provided is true. You agree to provide additional information, if requested The applicant indemnify, defend, release and hold harmless the Zanesville City, and its members, officials, employees and representatives from and against any and all claims, liabilities, losses and expenses (including reasonable attorney's fees) directly or indirectly arising from or in connection with any act, omission or conduct of the Zanesville City Small Business Relief Program. Applicant understands that all applications will be uniformly considered based on compliance with eligibility and criteria as established in this document. Awards will not be given, nor considered, on the basis of race or ethnicity, color, sex, gender, national origin, age, religion, creed, disability, veteran's status, sexual orientation, gender identity or gender expression, marital status, family/parental status, genetic information, immigration status, political belief or affiliation Applicant understands that the information provided in this application or during resulting transactions may be considered public record and may be subject to public disclosure through the Ohio Public Records Act. The grantor will endeavor to retain all submitted information on a confidential basis to the extent allowed by law. If submitted information is considered by the applicant to be confidential or protected as a trade secret, the information must clearly be marked as such.

67. Signature of Applicant

68. Date and Time
    Date and Time

    Date and Time

Leave This Blank:


70. 1. Receive an email copy of this form.
71. Email address

    This field is not part of the form submission.

72. Submit Submit and Print

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