SLU Chamber Small Business & Nonprofit Relief Fund

Organization *

First Name *

Last Name *

Title *

Email *

My business/organization is a SLU Chamber member *

In order to be eligible for this fund you must be a current SLU Chamber member **If you are not a current member and meet the Fund eligibility requirements, you may JOIN HERE for 2020 at no cost. Use promo code FREE**

Address Line 1 *

In order to be eligible your business/organization must be located in SLU or have a majority client base in SLU.

Address Line 2

City *

State *

Enter required value

Postal Code *

Unified Business Identifier (UBI) for WA *

Type of Business/Orgnaization *

For Profit

Non Profit

For how many years have you operated in SLU? *

1. Please provide a brief description of your business or organization *

Full-Time Employees *

Prior to impact of COVID-19

Part-Time Employees *

Prior to impact of COVID-19

2a. How many employees (full & part time) have you had to lay off or reduce hours to zero? *

2b. How many employees (full & part time) have you had to reduce hours for? *

3a. 2019 April revenue *

3b. 2020 projected April revenue *

3c. Projected April operating expenses *

If you have received rent abatement or laid off employees, these and any associated costs should not be included in your operating expenses

3d. 2020 projected revenues lost (through end of April) *

3e. Minimum cost to maintain current critical staff (monthly) *

3f. If applicable describe any special circumstances (outside of COVID-19) that impact figures above

4. Business impacts *

Describe how your business or organization has been impacted.

5. Describe the intended use of the funds, if awarded? *

Example:

xx% staffing & xx% business supplies/goods, etc

$xx staffing, $xx business debt, $xx rent, etc.

6a. Total amount of grants & forgivable loans approved and/or received to date *

This includes funding such as PPP and SBA's EIDL

6b. List all grants & forgivable loans you have received or been approved for

7. Are you currently receiving full or partial rent abatement? *

8. Agreement & Disclaimers *

Accuracy of information provided

Applicant certifies that all answers and information provided are true and complete to the best of its knowledge. If this application leads to acceptance, Applicant understands that false or misleading information in its application may result in termination from the program or withholding of awarded funds.

Grant awards are final

Applicant understands and acknowledges that all determinations of grant award amounts are final and not subject to appeal or contest. Except where a decision is based on inaccurate information, Applicant agrees to accept the decision of the Fund and agrees that the Fund is not obligated to give any additional rationale or justification for the decision to grant or not grant funds, nor the decision on how much funds to grant. If the reason given for a decision not to award a grant is based on information that is not accurate, please email director@sluchamber.org with any information correcting the inaccuracy (e.g., an award is not granted due to location because a food truck business is incorporated in Vancouver, WA, but it receives 70% of its revenue from business in South Lake Union).

Anti-terrorism

Applicant will not use funds provided by the Fund, directly or indirectly, in support of activities (a) prohibited by U.S. laws related to combating terrorism; (b) with persons on the List of Specially Designated Nationals (www.treasury.gov/sdn) or entities owned or controlled by such persons; or (c) with countries against which the U.S. maintains comprehensive or targeted sanctions (currently, Cuba, Iran, Syria, North Korea, and the Crimea Region of Ukraine), unless such activities are fully authorized by the U.S. government under applicable law and specifically approved by the Fund in its sole discretion.

Anti-corruption and anti-bribery

Applicant will not offer or provide money, gifts, or any other things of value directly or indirectly to anyone in order to improperly influence any act or decision relating to the Fund, including by assisting any party to secure an improper advantage.

Applicant understands and agrees that Grant Funds will not be used for any of the following purposes:

A. To carry on propaganda or otherwise to attempt to influence legislation within the meaning of Internal Revenue Code Section 4945(d)(1);

B. To influence the outcome of any specific public election within the meaning of Internal Revenue Code Section 4945(d)(2);

C. To make any grant to an individual for travel, study or similar purposes by such individual within the meaning of Section 4945(d)(3);

D. To make any grant to any other organization except as permitted under Internal Revenue Code Section 4945(d)(4);

E. To undertake any activity for any purpose other than the charitable purposes specified in Internal Revenue Code Section 170(c)(2)(B)