Chesapeake Small Business COVID-19 Recovery Grant Application Reimbursement

RECOVERY GRANT REIMBURSEMENT APPLICATION

If you have applied for and received a Chesapeake Small Business COVID-19 Recovery Grant, you are eligible to apply for additional reimbursement of up to $2,500. All businesses with 50 employees or less, who are previous grant recipients, even those that have received funding from the Paycheck Protection Program and Economic Injury Disaster Loan (EIDL), can apply below. Our sole stipulation is that the grant funds must be used only on reimbursable business expenses dated on or after March 15, 2021.

Additional grant funds must be used for operational working capital used to sustain the business and maintain employment. The grant funds will be issued on a reimbursement basis whereby the applicant can clearly demonstrate that expenses have been paid.

Repeat applicants may apply below if they meet the following conditions:

Applied and received a Chesapeake Small Business COVID-19 Recovery Grant
Complete the application below
Submit the Required Affidavit Form (needs to be signed by a notary public)
Attach reimbursable receipts (up to $2,500) dated on or after March 15, 2021

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Application ID:
INFORMATION AND DOCUMENTATION (* indicates required field)
Business Legal Name:*
DBA or Tradename (if applicable):*
Business Information:*
Street Address: Address Line 2: City: State / Province: ZIP / Postal Code: Country:
Business Phone:*
Cell Phone:*
Email:*
Website:
When did the business start operating / open in Chesapeake?*
MM
DD
YYYY
Federal Tax ID# (EIN):*
Chesapeake Business License #:*
Legal structure (choose one):*
- Sole Proprietorship
- LLC
- Corporation
- Partnership
- Independent Contractor
Check all that apply:
- Small, Women, and Minority Owned (SWaM) Certified
- Small, Women, and Minority Owned (SWaM) Eligible
- Veteran-Owned (must provide copy of DD-214)
If Veteran-owned, please provide a copy of DD-214:
As of February 15, 2020, do you have employees?*
- Yes
- No
If yes, how many?
Description of business:*
OWNERSHIP INFORMATION
Complete this section for each person who has 20% or more ownership interest in the business.
Name:
First Last
Home Address:
Street Address: Address Line 2: City: State / Province: ZIP / Postal Code: Country:
Home Phone:
Work Phone:
Mobile Phone:
Email:
Position:
Percentage of ownership:
ADDITIONAL OWNERSHIP INFORMATION (If Applicable)
Complete this section for each person who has 20% or more ownership interest in the business.
Name:
First Last
Home Address:
Street Address: Address Line 2: City: State / Province: ZIP / Postal Code: Country:
Home Phone:
Work Phone:
Mobile Phone:
Email:
Position:
Percentage of ownership:
If you have additional ownership information, please upload additional documents here:
Drop files here or
APPLICANT QUALIFICATION QUESTIONNAIRE
Program eligibility is limited to those businesses which meet the following qualifications.
Is the business currently operational in the City of Chesapeake?
- Yes
- No
Is the business current on all City of Chesapeake tax obligations?
- Yes
- No
Litigation Disclosure:
A. Have you, or any principal, officer, or director of your company been involved in any claim or litigation with the City of Chesapeake during the last ten (10) years?
- Yes
- No
B. Has any parent company or wholly owned subsidiary of your company been involved in any claim or litigation with the City of Chesapeake during the last ten (10) years?
- Yes
- No
If you answered “yes” to A and/or B above, please state the name(s) of the person(s), the nature and the status, and/or outcome of the litigation:
How often do you process and run payroll?
- Weekly (52x per year)
- Bi-weekly (26x per year)
- Semi-monthly (24x per year)
- Monthly (12x per year)
Total number of employees as of February 15, 2020:
Full Time:
Part Time:
Total number of employees as of last payroll run:
Full Time:
Part Time:
Total number of employees either laid-off or furloughed as a result of COVID-19 (since February 15, 2020):
Full Time:
Part Time:
Describe how business operations have been adversely impacted by the COVID-19 pandemic. Describe your plans for current and near term operations (during reduced COVID19 business restrictions) in order to remain operational. Identify how you have maintained employment of all or certain employees and the type of positions being retained in comparison to preCOVID-19 disruption:
Please list all grant/loans and dollar amounts received from SBA programs via the 2020 CARES Act:
Notary is Required for the Affidavit!
Please Upload Your Notarized Affidavit Here:*
This affidavit certifies that all expenses for which grant proceeds are sought are related to COVID-19 related expenses, and that these expenditures have not been submitted as part of a successful grant application under the Payroll Protection Program (“PPP”) or the CARES Act.
Drop files here or
Proposed Use of Grant Funds (Reimbursable Expenditures)
Building Rent/Mortgage Payments Amount ($)
Description:
Working Capital Amount ($):
Description:
Inventory Amount ($):
Description:
Supplies Amount ($):
Description:
Marketing/Advertising ($):
Description:
Amount Total ($):
Upload Receipts for Reimbursable Expenditures:*
Receipts must be dated on or after March 15, 2021.
Drop files here or
Acknowledgement
I HEREBY CERTIFY AND ACKNOWLEDGE THAT I HAVE READ THIS ENTIRE APPLICATION AS COMPLETED, AND THAT EACH RESPONSE IS TRUE, COMPLETE, AND ACCURATE.
Signature*
Title:
Date:*
MM
DD
YYYY

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RECOVERY GRANT REIMBURSEMENT APPLICATION

INFORMATION AND DOCUMENTATION (* indicates required field)

OWNERSHIP INFORMATION

ADDITIONAL OWNERSHIP INFORMATION (If Applicable)

APPLICANT QUALIFICATION QUESTIONNAIRE

Acknowledgement

Data & Reports

Business Services

Living Here

Business Resources