Take it Outside: North Kingstown Chamber of Commerce

To be eligible to receive support from the North Kingstown Chamber of Commerce under the Take it Outside (TIO) program, a small business must meet certain eligibility criteria. This applications allows the Take it Outside team to vet applicants as well as track the supports given to businesses.

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* 1. What is your email address?

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* 2. Please provide the exact legal business name (e.g., Main Street Business, LLC), as listed on your Secretary of State filing, or tax filing

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* 3. If applicable, what is your business DBA ("Doing Business As"):

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* 4. What is the full name of the business owner or authorized representative?

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* 5. What is your physical business address?

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* 6. What is the business taxpayer identification number

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* 7. Is your business in or considering federal bankruptcy or state receivership? "Yes" means that your business is in or considering federal bankruptcy or state receivership. "No" means that your business is not in or considering federal bankruptcy or state receivership.

Yes

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* 8. Is the business permanently closed? If you are taking actions necessary for running your business and generating business income, your business would not be considered to be permanently closed. Seasonal businesses should answer "No" even if they are not open yet for the 2022 season.

Yes

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* 9. Is your business at least 51% owned by women and/or minorities? (A small business concern which is at least fifty-one percent (51%) owned and controlled by one or more social and economically disadvantaged individuals or in the case of a publicly owned business, at least fifty-one (51%) of the stock of which is owned by one or more socially and economically disadvantaged individuals; and whose management and daily business operations are controlled by one or more such individuals. "Socially and economically disadvantaged individuals" are individuals who are citizens or lawful permanent residents of the United States. Members of a definable minority group means a person who is a citizen or lawful permanent resident of the United States.

Yes

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* 10. If you answered yes, please check the following box(es) to indicate ownership descriptions:

Women (any female qualifies as a class of minority)

Black (all persons having origins in any of the black racial groups of africa)

Hispanic (all persons Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race)

Portuguese (all persons of Portuguese, Brazilian or other Portuguese culture or origin regardless of race)

Asian (all persons having origins in any of the original peoples of the Far East, Southeast, Southeast Asia, the Indian Subcontinent, or the Pacific Islands)

American Indian / Native American (all persons having origins in any of the original peoples of North America

Eskimo / Aleut

Economically and Socially Disdvantaged Members of other groups or other individuals, found to be economically and socially disadvantaged by the Small Business Administration under Section 8 (a) of the Small Business Act, as amended (15 U.S.C. Chapter 637 (a)).)

Not Disclosing

Did Not answer "Yes" to the above question

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* 11. Have you received funding from any other Take it Outside Intermediary?

Yes

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* 12. If yes, please specify which:

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* 13. Have you received funding from any other RI Rebounds Grant's (Small Business Grant, etc.) this year?

Yes

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* 14. If yes to the above question, please specify the name of the grant and the money received.

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* 15. Please explain how your business has been negatively impacted by COVID-19?

Being forced to close or curtail business operations due to the pandemic or a government order pertaining to the pandemic

Experiencing a supply chain delay or disruption that negatively impacted operations

Experiencing increased cost as a result of the pandemic

Being forced to lay off workers as a result of the pandemic

Other (please specify)

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* 16. Did your business earn less than $1 Million in gross revenue in either 2020 or 2021? Please choose the revenue range that most closely reflects your gross revenue.

$0 - $50,000

$50,001 - $100,000

$100,001 - $250,000

$250,001 - $500,000

$500,001 - $999,999

$1,000,000 or greater

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* 17. Please attach a copy of your IRS W-9 form

PDF, DOC, DOCX, PNG, JPG, JPEG file types only.

Choose File

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* 18. Do you attest to your establishment being not disbarred from SAM.gov?

Yes

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* 19. What is your federal UEI number (generated by SAM.gov)

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* 20. Will this grant funding assist your business with expanding your outdoor capacity?

Yes

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* 21. What category of items are you seeing procurement?

Tables

Chairs

Tents

Heaters

Signage

Bike Racks

Weatherization

Outdoor Security Improvements

Contactless technology

Cleaning supplies

Covers / Roofs for Outdoor Patios (not fully enclosing space)

Lumber for Building Outdoor Decks

Labor for Building Outdoor Decks (labor, time, materials for third party contractors to install outdoor decks, patios, and similar structures

Other (please specify)

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* 22. Please attached a quote / checkout screenshot for the requited items specified above

PDF, DOC, DOCX, PNG, JPG, JPEG file types only.

Choose File

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* 23. Please attach an additional quote / checkout screen (if necessary)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 24. Please attach an additional quote / checkout screen (if necessary)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 25. Please attach an additional quote / checkout screen (if necessary)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 26. Please attach an additional quote / checkout screen (if necessary)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 27. *Terms & Conditions: Take it Outside is a Commerce RI initiative to combat COVID-19 and increase outdoor small business operations. The North Kingstown Chamber of Commerce does not guarantee full or partial purchase upon completing this form. Recipients must meet and attest to the eligibility criteria. All recipients understand they can and may be audited by state or federal authorities.

I understand and agree to the terms & conditions above

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* 28. Electronic Signature (Please type legal name). By signing this, I verify that to the best of my knowledge, the above information is accurate and true.

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* 29. Date of Signature

Date / Time

Date