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CARES Business Grant Application 14669 Fitzgerald Avenue North, Hugo, MN 55038 ● (651) 762-6300 ● www.ci.hugo.mn.us Applicant: _____________________________________________________ Requested Grant Amount: $________________________ (max $10,000) Along with the application, please submit the following materials: □ Completed W9 form □ 2019 Tax Statement □ Narrative on how applicant meets grant requirements APPLICATION DEADLINE: OCTOBER 1, 2020 Address:_______________________________________________________ City: ____________________ State: _____________ Zip: _______________ Phone: _______________________________________________________ Email: ________________________________________________________ 1. Have you been previously reimbursed by other sources of funds (County, State, and/or Federal) in response to the COVID-19 pandemic? Yes: □ No: □ If yes, submit invoices of anything previously reimbursed by other sources of funds. 2. Are you requesting reimbursement of expenses in response to CDC guidelines? Yes: □ No: □ If yes, submit invoices, itemized copies of what was purchased, and proof of payment of expense. 3. Are you requesting reimbursement of operating expenses as a result of adversity due to the public health emergency? Yes: □ No: □ If yes, provide proof of loss of revenue due to COVID-19 outbreak. Requested grant amount cannot exceed loss of revenue. My signature indicates that the information provided is true, I have read and understood the grant program guidelines, and that I comply with the City of Hugo grant program requirements. Should the City of Hugo require any additional documentation to verify that business guidelines are met, I will provide the necessary materials. I acknowledge that the materials I am submitting are accurate and true. Signature: ______________________________________________________________ Date: ___________________ ELIGIBILE USES BUSINESS GUIDELINES • Cover operating expenses including payroll, rent/lease payments, mortgage payments, private utilities, or other critical business expenses as a result of the public health emergency. • Expenses in response to CDC guidelines. • Expenses from March 1, 2020 to September 30, 2020. • Must be in good standing with the City and County. • Demonstrate that the business was adversely affected by Executive Orders related to COVID-19 business restrictions. • Private businesses are required to be located within the City of Hugo. Non-profit businesses must provide service within the City of Hugo. • Expenses must have been incurred and paid for. • May not exceed an annual revenue of $3.5 million. • Demonstrate financial hardship as a result of the COVID-19 outbreak. • Only one application per business and may apply for up to $10,000. • Applications are on a first come, first served basis. • May include businesses that have applied for/received any other COVID related federal funding. However, only eligible expenses that have not been reimbursed by other programs are considered eligible for the Hugo CARES Business Grant Program. NON-ELIGIBILE USES • Funds cannot be used to replace lost revenues. • Funds may not be used to cover taxes. • Funds may not include expenses that have been previously reimbursed by other sources of funding (County, State, and/or Federal).