ESTIMATED DISASTER ECONOMIC INJURY WORKSHEET FOR BUSINESSES

We know the local business community has been heavily impacted by the natural gas outage this past week. The Chamber is working closely with the Governor’s office and Commerce Corporation of Rhode Island to identify what the small business community needs to help them through this process and what kind of resources are needed to get back to full operational capacity. Would you be willing to share what you think your overall losses have been for this past week, including damages and the interruption of operations in comparison to performance this same time last year?

Your help would be greatly appreciated in estimating the true cost of this event, identifying capital needs, and also in assisting the State in their request for a SBA Economic Injury Declaration, which will free up access to SBA disaster loan funds for businesses.

Thank you for any help you can provide. We will continue to work on your behalf to ensure all avenues and resources are pursued.

Please be advised that this is preliminary information and your final loan request may have additional or different claims.

Question Title

* 1. Please share your information below

Name(s) of property owner(s)

Business/Property Address

Mailing Address

Telephone Numbers of Business/Home

Email address

Question Title

* 2. Estimated Adverse Economic Impact: Did the disaster economically impact your business? If so, when did the impact start and end?

Start Date

End Date

What were your business' revenues during that period?

What were your business' revenues during the same period of the prior year?

Question Title

* 3. Amount of business interruption insurance received or anticipated, if any?

Question Title

* 4. Provide a brief explanation of what adverse economic effects the disaster had on your business.

Question Title

* 5. How many people did you employ prior to and after the disaster?

Before

After

Question Title

* 6. If your business also suffered property damage, please answer the following questions.

Estimated dollar loss to real property (building) if owned.

Estimated dollar loss to contents (machinery, equipment, furniture, fixtures, inventory, leasehold improvements, etc.)

Question Title

* 7. Insurance recovery received or anticipated for property damages.

Question Title

* 8. In order to get this declaration and access to SBA disaster loan funds, the State must gather information from individual businesses to see if there is sufficient economic injury to request an SBA Economic Injury Declaration. If you authorize this information to be used by the State to request an SBA Economic Injury Declaration, please check this box.

Approve

ESTIMATED DISASTER ECONOMIC INJURY WORKSHEET FOR BUSINESSES

Question Title

* 1. Please share your information below

Question Title

* 2. Estimated Adverse Economic Impact: Did the disaster economically impact your business? If so, when did the impact start and end?

Question Title

* 3. Amount of business interruption insurance received or anticipated, if any?

Question Title

* 4. Provide a brief explanation of what adverse economic effects the disaster had on your business.

Question Title

* 5. How many people did you employ prior to and after the disaster?

Question Title

* 6. If your business also suffered property damage, please answer the following questions.

Question Title

* 7. Insurance recovery received or anticipated for property damages.

Question Title

Question Title

* 9. What is your revenue forecast for the year/fiscal year?

Question Title

* 10. What is the estimated date when your business will return to normal/did return to normal?

Question Title

* 11. Do you have any other questions or comments to share?