Delco Strong
Small Business Support Grant Program

Table of Contents



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Paper Submission Deadline: Today
between 8:30am — 1:00pm

Drop-off location: Delaware County Courthouse
201 W. Front Street
Media, PA 19063

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We have volunteers who are bi-lingual willing to assist Delaware County Small Business owners to complete an application for this program. If you are a small business owner in Delaware County and need assistance in making application because of a language barrier, please call or email with your name, email, phone number, and preferred language, so we can assist you.

For assistance:
Email: [email protected]
Phone: (610) 566-2225

Application Window for in-person is today, between 8:30 AM — 1:00pm

See "Application Submission" below.

Delco Strong Small Business Support Grant Program

General Business Information

Business Legal Name:

 

___________________________________________________________

d/b/a if operating under a different name:

___________________________________________________________

Year Business was founded:

 

 

_______________________

State business was organized or incorporated in:

_______________________

Business Physical Address

Street Address:

____________________________________________________

 

City, State Zip Code

____________________________________________________

 

 

Business Website Address:

____________________________________________________

Federal EIN:

______ ‐ _________________________

Type of Business:

______________________________________________________________________________

2‐digit NAICS Code:

______

( 2‐Digit NAICS List is at the end of form)

Business Ownership

Please list the names and addresses of all individuals/companies with 20% or more ownership in applicant Business:

Owner 1:

___________________________________________________

Percent Owner:

__________

Address:

_____________________________________________________________________________________

Owner 2:

___________________________________________________

Percent Owner:

___________

Address

_____________________________________________________________________________________

Owner 3:

____________________________________________________

Percent Owner:

___________

Address:

_____________________________________________________________________________________

Owner 4:

____________________________________________________

Percent Owner:

___________

Address:

_____________________________________________________________________________________

Owner 5:

____________________________________________________

Percent Owner:

___________

Address:

_____________________________________________________________________________________

Business Employment

Number of full‐time employees on business payroll on March 1, 2020: ______________________________________

Number of full‐time employees on business payroll today:

 

______________________________________

Have you furloughed or laid off employees? (circle one)

Yes

No

Is the business open? (circle one)

Yes

No

Partially

 

 

 

Is this business closed or partially closed due to COVID‐19 shut down? (circle one)

Yes

No

If yes, what is the estimated revenue loss the business experienced for March/April? (circle one)

 

0%

25%

 

50%

75%

100%

 

 

Has business or owner applied for relief programs? (circle one for each)

 

 

 

SBA Economic Injury Disaster Relief (EIDL)

 

Yes

 

No

SBA Paycheck Protection Program (PPP)

 

 

Yes

 

No

Pennsylvania COVID‐19 Working Capital (CWCA)

 

Yes

 

No

Pennsylvania Pandemic Unemployment Assistance (PUA)

Yes

 

No

If you answered yes has Business been awarded funding?

 

 

 

 

Please indicate from which program and amount of award:

 

 

 

 

Program:

______________________________

Amount:

$_______________________________

Program:

______________________________

Amount:

$_______________________________

Program:

______________________________

Amount:

$_______________________________

Program:

______________________________

Amount:

$_______________________________

Post COVID‐19 Questions

Does the business have a plan for emerging from the Commonwealth of Pennsylvania COVID‐19 shutdown? (please describe in 500 characters maximum)

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

Is the Business interested in resources for coming out of Commonwealth of Pennsylvania COVID‐19 shutdown? (circle all that apply)

Marketing/Promotion

Accounting

Legal

Safety

Cleaning of physical location

Health

Finding Employees

 

Working Capital Resources

Supply Chain

Technology

 

Other: ______________________________________________________________________________________

Contact Information

 

 

 

Name:

_____________________________________________

 

Title:

_____________________________________________

 

Phone Number:

_____________________________________________

 

Email:

_____________________________________________

 

Primary Language Spoken of Business contact person: ___________________________________

Acknowledgements

I acknowledge that I am an owner or authorized by the owners of the business to submit this application, and that all of the information submitted is true to the best of my ability on the date of submission. ____ (initial block)

I attest that the business is current on all taxes. Futher, I acknowledge that if awarded through this program I am responsible for any reporting requirement and tax payment obligation at the state and federal level. ____ (initial block)

I acknowledge that applicants and grantees for this program are responsible for following the rules, regulations, and contract stipulations of loan and grant programs regardless of the source of funds; furthermore, I acknowledge that it is the responsibility of a grantee to use and report on all funds appropriately whether sourced from County Level Authority, State, or Federal government programs. ___ (initial block)

I acknowledge that by submitting this application, I am not automatically awarded funding. ___ (initial block)

I acknowledge that if my business is awarded funding that all owners that hold 20% or more interest in the business will be required to execute a contract with the Delaware County Economic Development Oversight Board in order to receive grant funds. ____ (initial block)

PRINT FULL LEGAL NAME:

_______________________________________________________

SIGNATURE:

_______________________________________________________

DATE:

_______________________________________________________

Application Submission (How to Submit)

Paper submission of application for this program will only be accepted at the following location:

Delaware County Courthouse
201 W. Front Street
Media, PA 19063

On May 6, 2020 between the hours of 12 o'clock noon and 4:30 pm and
On May 7, 2020 between the hours of 8:30am and 1:00pm

Full Application

Only full and complete applications will be reviewed for this grant program.

Full and complete applications include:

  • Application Questionnaire completed with acknowledgements initialed and signed by submitter.
  • A copy of the most recent tax return submitted for business, signed.
  • 2019 Financial Statements
  • 1st Quarter 2020 financial statements (January through March)
  • W9 Executed by the Business
  • Copies of invoices for grant award consideration included with submission