La Verne Grant Application

    The City of La Verne has partnered with the La Verne Chamber of Commerce (Chamber) to develop a Small Business Rescue Grant Program, funded through the American Rescue Program Act to provide vital economic support to small businesses needing assistance as a result of business interruption caused by COVID-19.
    Small businesses negatively affected by COVID-19 may be eligible to receive a working capital grant of up to $10,000. The grant may be used for business operating expenses incurred as a result of COVID-19, such as social distancing or for operating expenses such as rent/mortgage, payroll and benefit costs, utility expenses, etc.

    BUSINESS INFORMATION

    Fields marked with * are required

    Business Name:*

    Business Employer Identification Number (EIN) or Social Security (SSN):*

    City of La Verne Business License Account No.:*

    Business Owner Name:*

    Business Address:*

    Mailing Address:*

    Business Phone:*

    Contact Phone:*

    Email:*

    Website

    Business Structure:*

    Date Business Established:*

    Number of Employees:* Full Time Part Time

    Type of Business:*

    Briefly describe the service or product your business provides:*

    COVID-19 BUSINESS INTERUPTION

    The La Verne Small Business Rescue Grant is intended to cover fixed expenses specifically associated with losses and hardships endured during the COVID-19 Pandemic. Please check all of the below boxes that apply to your business:*






    DEMOGRAPHIC INFORMATION

    The City would appreciate you taking a moment to provide some basic demographic information to help us understand our business community and tailor future programs and services to local interests.

    Is your business more than 51% (check all that apply): Minority-ownedWoman-ownedVeteran-owned

    What is your gender identity:

    Which of the following best describes you:

    GRANT REQUEST – GRANT SPENDING PLAN

    In the section below, please explain how you will use the La Verne Grant Funds if approved.

    Amount of funds requested (max amount $10,000):*

    Recover Lost Revenue:

    Expenses:
    Please check one:

    Rent or Mortgage

    Payroll Costs

    Facade Improvements*

    Outdoor Operations*

    Hiring Bonus**

    Utility Bills

    Updates to Employee Handbook

    Personal Protective Equipment

    Other COVID19 Operational Expense

    Please describe other expense:

    *Façade Improvements must be in a public facing area (for visual improvements), outdoor operations must be for public- consumer gathering areas.
    **Hiring Bonus is made to employee for employers who have had a difficult time attracting new employees. The bonus should be given after 6 months of employment. Capped at $1,500 per employee.

    REQUIRED DOCUMENTS

    Current City of La Verne Business License:*

    Completed and signed W-9:*

    You must also submit one or both of the following

    Spending Plan or Invoices & Billing Statements demonstrating expenses:

    2019 Federal Tax Return:

    2020 or 2021 Federal Tax Return:

    The City reserves the right, in its sole and absolute discretion at any time: (1) to amend or terminate this program with no recourse for any proposing applicant; (2) to choose or reject any or all applications received in response to this program; (3) to request additional information of the applicants as deemed necessary and appropriate by the City; (4) to conduct further due diligence with applicants or any third party; (5) to modify the City's objectives or the scope of the program; (6) to modify program requirements, general terms and conditions, or eligible activities; and/or (7) to disqualify any proposing applicant on the basis of any real or perceived conflict of interest that is disclosed or revealed by materials submitted or by any data available to the City. By submission of this application with documentation, applicant agrees to these terms.

    ACKNOWLEDGEMENT, ATTESTATIONS AND CERTIFICATION

    Acknowledgement:*

    Attestations:*

    Certification:*

    By signing below, I/we certify that the above information and statements are true and correct to the best of my/our knowledge. I/we understand that a false statement may disqualify me/us.

    Owner Signature:*

    Co-Owner Signature