Bayfield CARES Second Grant Survey

Bayfield CARES second round survey - very important -

The Town of Bayfield has grant money to assist businesses with expenses due to the COVID-19 pandemic. Questions? beth@bayfieldgov.org or 970.749.1877

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* 1. Please provide us with your contact information. Thank you!

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Type of Business

For Profit

Tax Exempt

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* 3. EIN Number

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* 4. Business Owners

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* 5. Business Website - if applicable

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* 6. Number of full-time or full-time equivalents. Please note: Grant funds are for businesses or non-profits with 50 or less as March 16, 2020.

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* 7. How many years has your business been operating in Bayfield?

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* 8. Please tell us how the pandemic has affected your business

Number of days your were closed?

Number of employees, including owner out-of-work for more than 30 days?

Income decreased by $$ from prior year time period: March - October

Expenses increased by $$ from prior year time period: March - October

Additional hardship information

More comments as needed

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* 9. How have you adapted? Brief description i.e., moved to online sales, pickup &delivery, remote office, expanded space, etc

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* 10. How much funding are you applying for? (Up to $3,000)

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* 11. To be reimbursed for expenses that have already occurred, please detail these costs. Proof of purchase will be requested as your grant advances through the process.

Personal Protective Equipment and counter shields

Building safety upgrades to protect customers and employees and/or encourage social distancing

Tent or other equipment to expand outside service

Propane or electric heaters

Remodeling of existing space or an addition

Office equipment for remote work

Creation or re-do to a business website to boost e-commerce

Marketing materials, print, on-line, brochures

Employee training

Technology upgrades, i.e. contactless POS, touch-less entry/exits

Other

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* 12. To request fund for new expenses, please detail these costs. Estimates or quotes for now. Receipts will be required by 12/21/2020

Personal Protective Equipment and counter shields

Building safety upgrades to protect customers and employees and/or encourage social distancing

Tent or other equipment to expand outside service

Propane or electric heaters

Remodeling of existing space or an addition

Office equipment for remote work

Creation or re-do to a business website to boost e-commerce

Marketing materials, print, on-line, brochures

Employee training

Technology upgrades, i.e. contactless POS, touch-less entry/exits

Other

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* 13. Certifications: As the funding for the Bayfield CARES grant originates from the Federal Government and the Colorado Dept. of Local Affairs, the following are required.

I acknowledge that my business self-certified with San Juan Basin Public Health or was deemed essential and didn't cease operating.

I acknowledge that my business is in compliance with Public Health Order 20-28 at present

I will email my Certificate of Good Standing from the Colorado Secretary of State's office when requested

I acknowledge that the Bayfield CARES grant will not be used for costs that have already been covered by other pandemic-related funding source

If awarded a grant from Bayfield CARES, I will use the funds as specificied by the grant award agreement by December 30, 2020

I agree to provide a post-grant report, if requested to do so.

All of the information submitted in this application is true and accurate to the best of my knowledge.