California Microbusiness COVID-19 Relief Grant Application A collaboration with local partners and the California Office of the Small Business Advocate (CalOSBA) Application PreparationAll grant application guidance and forms may be found on the program website: www.montereycountywdb.org/monterey-county-works/small-business-grants/ Review the grant program eligibility requirements and instructions carefully on the website. Prepare these documents before beginning the application and attach them to your completed application: Government-issued Photo Identification 2019 Federal Tax Return Payroll Record W-9 Vendor Data Record NOTE: Failure to submit all required documentation may result in a delay in processing your application and/or disqualification of your application. If you have questions or need assistance with completing the application, contact the Monterey County Workforce Development Board via email at mcsbg@co.monterey.ca.us. You may also come to our main office at 344 Salinas Street, Salinas, CA 93901 (Monday-Friday between 8:30 am - 4:30 pm). Section 1. Business Information1. Business Name(Required) 2. Date Established(Required) MM slash DD slash YYYY 3. Business Phone Number(Required)Phone Extension 4. Street Address(Required) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code 5. Business Website Address 6. Business Owner's Name(Required) 7. Business Owner's Phone(Required)Phone Extension 8. Email(Required) The email listed here will be used for ALL correspondence regarding this grant. Make sure you check this email regularly and respond promptly to communications from the MCWDB email address (mcsbg@co.monterey.ca.us).9. Veteran-Owned Business(Required) Yes No 10. Woman-Owned Business(Required) Yes No 11. Minority-Owned Business(Required) Yes No 12. Race/Ethnicity(Required) American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White If "Other" is selected, please specify.13. Preferred Language for Communication(Required) English Spanish If "other" is selected, please specify.14. Total Number of Current Full-Time Employees(Required)Please enter a number from 1 to 5.15. Employer's Federal ID Number(Required) 16. Select Your Business' NAICS:(Required)11. Agriculture, Forestry, Fishing and Hunting21. Mining, Quarrying, and Oil and Gas Extraction22. Utilities23. Construction31-33. Manufacturing42. Wholesale Trade44-45. Retail Trade48-49. Transportation and Warehousing51. Information52. Finance and Insurance53. Real Estate and Rental and Leasing54. Professional, Scientific, and Technical Services55. Management of Companies and Enterprises56. Administrative and Support of Waste Management and Remediation Services61. Educational Services62. Health Care and Social Assistance71. Arts, Entertainment, and Recreation72. Accommodation and Food Service81. Other Services92. Public Administration17. Describe Your Business(Required)Make sure to include information such as a brief history, what type of business it is, and the goods/services sold.18. How did you learn about this grant?(Required) Section 2. COVID-19 Impact19. How has your business been affected by the COVID-19 pandemic?(Required)20. Did you previously receive funding from the California Small Business COVID-19 Relief Grant Program?(Required)Yes (Not Eligible to Apply)NoIf you have previously received funding from the California Small Business COVID-19 Relief Grant Program, you are NOT ELIGIBLE to apply for the California Microbusiness COVID-19 Relief Grant Program.21. Have you previously received any other COVID-19 related grants and/or loans?(Required) Yes No 21a. You selected "Yes". Please specify: 22. How do you plan to use the funds if you are awarded the grant?(Required)23. Are you interested in receiving additional funds, should they become available?(Required) Yes No 23a. You selected "Yes". Please describe in detail how the additional funds would be used to support your business:Section 3. DocumentationGovernment-Issued Photo Identification(Required)Can be state, domestic or foreign such as a driver's license, passport, and state ID cards. Drop files here or Select files Accepted file types: pdf, jpg, Max. file size: 128 MB. 2019 Federal Tax Return(Required)Form 1040, Schedule C that lists the business name, business address, Employer Identification Number (EIN), and revenue amount. Drop files here or Select files Accepted file types: pdf, jpg, Max. file size: 128 MB. Payroll Record(Required)Upload your company’s current payroll record showing proof of current number of employees. Contact us if you are unable to provide a payroll record. Drop files here or Select files Accepted file types: jpg, pdf, Max. file size: 128 MB. Form W-9(Required)This form must be completed specifically for this application process for the County. It must be signed and dated. Drop files here or Select files Accepted file types: pdf, jpg, Max. file size: 128 MB. Vendor Data Record(Required)This form must be completed with your business information in order to receive a check from the County, if awarded a grant. NOTE: The address listed on the VDR will be the address used to mail a check to you, if awarded a grant; if you want your check mailed to an address that is different from your business address, put it in the “Remit To” box on the form. Drop files here or Select files Accepted file types: pdf, jpg, Max. file size: 128 MB. Section 4. Certification By Authorized Business Representative I. I hereby certify that I am an authorized business representative of the business named above, with the authority 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 is true and accurate. 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.Business Owner's Signature(Required)Signature Date(Required) MM slash DD slash YYYY II. I attest that my business meets all the requirements listed below: Currently has 5 or less full-time equivalent employees and also had 5 or less full-time equivalent employees in the 2019 and 2020 taxable years Is owned, operated, and headquartered in Monterey County Was established and in operation prior to December 31, 2019 Made less than $50,000 in revenues in 2019 Has been negatively impacted by the COVID-19 crisis, as evidenced by at least a 10% reduction in revenue from the 2019 and 2020 taxable years Did not receive a grant under the California Small Business COVID-19 Relief Grant Program Is able to provide government-issued photo identification and secondary documentation such as a bank statement, tax return, or business license Is currently open or has a reopening plan Business Owner's Signature(Required)Signature Date(Required) MM slash DD slash YYYY III. 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: The purchase of new certified equipment including, but not limited to, a cart An investment in working capital Application for, or renewal of, a local permit including, but not limited to, a permit to operate as a sidewalk vendor Payment of business debt accrued due to the COVID-19 pandemic Costs resulting from the COVID-19 pandemic and related health and safety restrictions, or business interruptions or closures incurred as a result of the COVID-19 pandemic Business Owner's Signature(Required)Signature Date(Required) MM slash DD slash YYYY CAPTCHAUntitled Δ
