Pajaro Small Business Assistance Program Pajaro Small Business Assistance Program Application (Home-Based Business) SECTION 1. BUSINESS INFORMATION1. Preferred language for communication:(Required) English Spanish Other 2. Business name (Legal Entity and DBA):(Required) 3. Date established (MM/DD/YYYY):(Required) MM slash DD slash YYYY 4. Business type:(Required) 5. Business phone number:(Required)6. Business/Home Address (on March 10, 2023):(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code 7. Business website address: 8. Business owner's first, middle, last name:(Required) First Middle Last 9. Business owner's phone number:(Required)10. Business owner's email address:(Required) 11. Primary contact's first and last name (if different from business owner): First Last 12. Primary contact phone number:13. Primary contact email address: SECTION 2. DISCLOSURES14. Was the business in operation prior to March 10, 2023?(Required) Yes No 15. What is the current status of your business?(Required) Fully open Open with restrictions Temporarily closed Permanently closed 16a. How many full-time employees did the business have on March 10, 2023 (30 or more hours per week)?(Required)16b. How many part-time employees did the business have on March 10, 2023 (Less than 30 hours per week)?(Required)17a. How many full-time employees does the business currently have (30 or more hours per week)?(Required)17b. How many part-time employees does the business currently have (Less than 30 hours per week)?(Required)18a. Has the business received any funds from the following?(Required) Federal Emergency Management Agency (FEMA): Rental Assistance Federal Emergency Management Agency (FEMA): Personal Property Compensation Federal Emergency Management Agency (FEMA): Vehicle Compensation Insurance: Flood Insurance Compensation Insurance: Homeowners Insurance Compensation Insurance: Personal Property Compensation Insurance: Vehicle Compensation State Compensation/Assistance: CalFresh Disaster Assistance State Compensation/Assistance: Storm Assistance for Immigrants State Compensation/Assistance: Disaster Unemployment Assistance Small Business Administration (SBA) Non-Profit Assistance, Gift Cards, Cash and/or Donated Goods/Services County Assistance Programs I have NOT received any of the above listed assistance I have received a different type of assistance than what is listed above Check all that apply.18b. If you have received a different type of assistance than what is listed in #18a, please specify: 19a. If you selected one of the options in question #18, how much financial assistance did the business receive in total?19b. How were the funds used?20. What was the gross revenue for the business in 2022 as declared on your business' tax return?(Required)21. What was the gross revenue for the business in 2023 as declared on your business' tax return?(Required)SECTION 3. GRANT REQUEST INFORMATION22a. What business expenses from March 10, 2023 to December 31, 2023 do you want reimbursed for if your business is awarded a grant?(Required) Inventory: Good available for sale that were damaged or lost and needed to be replenished. Receipts required. Computers, Laptops, and Tablets; Printer/Copier/Fax Machine: Damaged electronic devices that needed to be replaced to continue business operations. Receipts required. Check all that apply22b. Please elaborate on the selected business expenses.(Required)23. Describe the economic impact the flood had on your business. Include information about any periods of closure, employee layoffs, reduction of hours, expenses incurred due to damages, etc.(Required)24. Total amount requested (Must be equal to or less than $5,000 and match the invoice for reimbursement form):(Required)Please enter a number less than or equal to 5000.SECTION 4. DOCUMENTATIONThe following documentation is required and must accompany your application. Please ensure that no documents are missing. Required documentation subject to change to allow as much flexibility as possible. Government-Issued Photo Identification such as Driver’s License, Identification Card, Passport / Passport Card, US Military Identification Card, etc. Utility Bill, Lease Agreement, or Credit Card Statement Valid on March 10, 2023 to verify that the business owner’s residence is either in Monterey County or within a 20-mile radius of Pajaro. 2022 Federal Tax Return Schedule C / Form 1040 to verify the business’ authenticity. Request for Taxpayer Identification Number and Certification / Form W-9 attesting the business’ information to enable payment. Withholding Exemption Certificate / Form 590 attesting the business’ headquarters location required by Monterey County Auditor-Controller to process payment to businesses. Vendor Data Record Form required by Monterey County Auditor-Controller to issue payment to approved businesses. Invoice for Reimbursement Form accompanied by proof of payment(s) from March 10, 2023 to December 31, 2023 that match the items and totals listed. Proof of Payment dated from March 10, 2023 to December 31, 2023 for eligible expenses. Upload your documentation here:(Required) Drop files here or Select files Accepted file types: jpg, png, pdf, Max. file size: 128 MB. SECTION 5. CERTIFICATIONI hereby certify that I am authorized to commit the business to legally binding contracts and agreements. I further certify that the information given as part of and attached to this application are accurate and true. I am aware that any false information or intended omissions may subject me to civil or criminal penalties for filing of false public records and/or forfeiture of any funds approved through this program. I attest that my business meets all the requirements listed below: Business is owned, operated, and located in Pajaro on one of the streets in either the evacuation or flood zone. Business was established and in operation prior to March 10, 2023. Business experienced financial losses and/or building damage as a result of the flood. Business is not requesting duplication of benefits previously received from FEMA, insurance, state compensation, nonprofits, etc. I understand and agree that: The Monterey County Workforce Development Board (MCWDB) exercises the right to share my business’ information with other agencies as needed to properly determine funding eligibility. All funds issued that are later determined to be a duplication of benefits are required to be repaid to the MCWDB within 60 days. Funding is not guaranteed as it is subject to availability of funds, meeting the eligibility requirements, and providing all requested documentation and information. The MCWDB is not authorized to provide legal and/or tax advice to applicants. All businesses requesting Phase 2 Beautification funding must undergo onsite inspections before and after completion of approved work by a licensed contractor. I declare under penalty of perjury that if awarded a grant, I commit to only using the funds for one or more of the following eligible expenses: Inventory – Goods available for sale that were damaged or lost and needed to be replenished. Computers / Laptops / Tablets; Printer / Copier / Fax Machine – Damaged electronic devices that needed to be replaced to continue business operations.