Delco Strong

Small Business Support Grant Program

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Application Period:
July 7 — July 9
between 5:00am — 5:00pm

Drop-off location:
Delaware County Commerce Center

100 W. 6th Street, Suite 100
Media, PA 19063

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Need help translating your application?
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:

Regarding the application process:   [email protected]

Regarding the online portal:  [email protected]

Phone: (610) 566-2225

Delco Strong

ROUND 2 » Application Questionnaire

Business Information General:

Business Legal Name:

_________________________________________________________________

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

Year business was founded:

____________

State incorporated in:

_______________

Business Physical Address:

__________________________________________________________________

 

(number and street)

 

 

 

 

__________________________________________________________________

 

(suite number or location such as “rear”)

 

 

_________________________,

______

________________

 

(city)

 

(state)

(zip code)

Does the Business own or lease the property? ☐ Own ☐ Lease

If business leases the property, is property owned by business owner or relative of business owner?

☐ Yes

☐ No

If yes, please provide name of property owner and relationship to the business owner:

__________________________________________________________________________________________

 

What is the business website address?

______________________________________________________

Federal FEIN:

______‐____________

2‐Digit NAICS: _________

 

(2 digit ‐ 7 digits)

(2 digit)

 

(or last 4 digit of social)

 

Please provide a short description of what the business does:

__________________________________________________________________________________________________

__________________________________________________________________________________________________

Is the business 51% or more –

 

 

☐ Minority Owned

☐ Women Owned

☐ Veteran Owned

Business Ownership:

Please list the names and addresses of all individuals/companies with 20% or more ownership in applicant business. If 20% or more of the business is owned by a different entity (ie an LLC or partnership) and not an individual please include a breakdown of ownership (20% or more) of individuals who own that entity with your application.

Owner 1 Name:

____________________________________________________

Percent: _____________

Address:

______________________________________________________________________________

Owner 2 Name:

____________________________________________________

Percent: _____________

Address:

______________________________________________________________________________

Owner 3 Name:

____________________________________________________

Percent: _____________

Address:

______________________________________________________________________________

Owner 4 Name:

____________________________________________________

Percent: _____________

Address:

______________________________________________________________________________

Owner 5 Name:

____________________________________________________

Percent: _____________

Address:

______________________________________________________________________________

 

Business Employment:

Include the owners of the business if they are on the business payroll.

Number of employees on business payroll on March 1, 2020:

_____ full time

_____ part‐time

_____ Contract

Number of employees on business payroll today:

_____ full time

_____ part‐time

_____ Contract

Have you furloughed or laid off employees?

☐ Yes

☐ No

 

 

COVID‐19 Related Questions:

Is the business open today?

☐ Yes

☐ Partially

☐ No

 

 

 

Was or is this business closed or partially closed due to COVID‐19?

☐ Yes

☐ No

 

 

If the business is open today, are you in compliance with current public health guidelines?

☐ Yes

☐ No

Has the business complied with Pennsylvania’s phased reopening restrictions?

☐ Yes

☐ No

 

Please describe how long your business was closed, or if partially closed please describe the extent of your operation: Include dates that business was completely shut down, what normal business took place & when (dates)? what normal business did not take place (dates)? and how you modified your operation to continue operating if you did.

_________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

What is the estimated revenue loss, the business has or expects to experience for all of 2020 due to COVID‐19 shutdown? Estimated loss of income to the business because of COVID‐19.

☐ 100%

☐ 75%

☐ 50%

☐ 25%

☐ 0%

 

Has business applied for and has the business received any funding from other COVID‐19 relief programs?

SBA Economic Injury Disaster Relief (EIDL)

☐ Yes

☐ No

Amount Awarded:

$______________________

SBA Paycheck Protection Program (PPP)

☐ Yes

☐ No

Amount Awarded:

$______________________

PA COVID‐19 Working Capital Loan (CWCA)

☐ Yes

☐ No

Amount Awarded:

$______________________

Delco Strong Round One:

☐ Yes

☐ No

Amount Awarded:

$______________________

Other Program: _______________________

☐ Yes

☐ No

Amount Awarded:

$______________________

Post COVID‐19 Questions:

Is the Business interested in resources as we emerge from COVID‐19 shutdown?

Please check all that apply.

☐ Marketing

☐ Health/Cleaning/Safety

☐ Working Capital

☐ Accounting

☐ Legal

☐ Supply Chain

☐ Technology

☐ Finding Employees

Other: _________________________________________

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 dateof submission (initial block)

I attest that the business is current on all taxes. Further, 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. The County currently intends to fund this program with money received under the Federal CARES Act. ______(initial block)

I acknowledge that grants under this program are intended to provide economic support for businesses suffering from the coronavirus public health emergency, and that to receive a grant under this program, a certification will be required to the effect that the business has suffered a loss caused by the coronavirus public health emergency in an amount at least equal to the amount of the grant received under the program and which loss has not been compensated by any other grant (federal, state, county or otherwise). _____(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)

I certify that the business applicant is not an ineligible entity listed below ______(initial block)

Ineligible Entities: Businesses not headquartered in Delaware County, PA.

 

Businesses that did not experience revenue loss due to COVID‐19.

 

Businesses that were not operational by December 31, 2019.

 

Passive businesses such as commerical or residential landlords.

 

Government or government‐owned entities.

 

Non‐Profits including churches or other religious organizations.

 

For‐profit businesses with a direct tie to a non‐profit.

`

Private clubs/businesses that limit membership for reasons other than capacity.

 

Businesses primarily engaged in lobbying or policitial activities.

 

Businesses with annual revenue that exceeds $9M.

 

Business not compliant with all federal, state, & local laws including taxation.

 

Businesses awarded funding in the first round of Delco Strong are ineligible.

 

Businesses which are not in compliance with current public health guidelines.

 

Businesses which have not complied with phased reopening restrictions.

SIGNATURE:

_____________________________________________________________

PRINT FULL LEGAL NAME:

_____________________________________________________________

DATE:

_____________________________________________________________

Contact Information:

Phone: _______________________________________

 

Email:

_______________________________________

 

Title:

_______________________________________