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#5 CARES Business Grant Application 14669 Fitzgerald Avenue North, Hugo, MN 55038 • (651) 762-6300 • www.ci.hugo.mn.us Requested Grant Amount: Applicant: $ (max $10,000) Along with the application, please submit Address: the following materials: ❑ Completed W9 form City: State: Zip: ❑ 2019 Tax Statement Phone: ❑ Narrative on how applicant meets grant requirements Email: APPLICATION DEADLINE: OCTOBER 1, 2020 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, • Must be in good standing with the City and County. rent/lease payments, mortgage payments, private • Demonstrate that the business was adversely affected by Executive utilities, or other critical business expenses as a Orders related to COVID-19 business restrictions. result of the public health emergency. • Private businesses are required to be located within the City of • Expenses in response to CDC guidelines. Hugo. Non-profit businesses must provide service within the City of • Expenses from March 1, 2020 to September 30, Hugo. 2020. • 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. NON-ELIGIBILE USES • Funds cannot be used to replace lost revenues. • Only one application per business and may apply for up to $10,000. • Funds may not be used to cover taxes. • Applications are on a first come, first served basis. • Funds may not include expenses that have been • May include businesses that have applied for/received any other previously reimbursed by other sources of funding COVID related federal funding. However, only eligible expenses (County, State, and/or Federal). that have not been reimbursed by other programs are considered eligible for the Hugo CARES Business Grant Program.