City of Hailey 115 MAIN STREET SOUTH, SUITE H (208) 788-4221

HAILEY, IDAHO 83333 Fax: (208) 788-2924

City of Hailey Municipal Small Business Grant Application Period Now Open

Hailey’s Mayor and City Council allocated up to $200,000 of the City of Hailey’s Coronavirus Relief Funds for Hailey businesses and non-profits. These funds may be distributed to qualifying businesses and non-profits in the form of municipal small business grants. Eligible applicants may apply for up to $10,000 through this grant program to help pay for qualifying expenses incurred due to Covid-19.

Please review the Hailey Small Business Grant Program Details to fully understand the program. Applications will be processed and funded on a first-come, first served basis, so time is of the essence in this matter. Grant applications must be submitted no later than December 18, 2020.

Applicants should complete and submit the City of Hailey Small Business Grant Application available on our website. Form IDA-20, required by the State, is included within the application and is required by the City and State determine the applicant’s eligibility. Documentation (such as lease agreements, copies of invoices and receipts) for all qualifying expenses must be submitted with the forms before these applications are deemed complete. The last page of the application form may be reproduced multiple times to complete information for all expenses made between June 20, 2020 and December 30, 2020.

HOW TO APPLY: Download a copy of the City of Hailey Small Business Grant Application to your computer, then open the file in one of the PDF reading programs such as Microsoft Edge, Mac Preview, or Adobe Acrobat Reader DC. Fill out the form in one of those applications and then print or save it. You may email the completed application as an attached saved and signed pdf, with all documentation attached. We will also accept a mailed or hand-delivered printed application at Hailey City Hall, provided we receive it before close of business on December 18, 2020.

This grant is made possible through the work of Governor Brad Little, State Controller Brandon Woolf, The Association of Idaho Cities, and the US CARES Act. The Governor’s Coronavirus Financial Advisory Committee (CFAC) created this grant to help local businesses affected by COVID-19 pandemic, enabling cities and counties to provide aid within their community. The Mayor and City Council of the City of Hailey approved the funding parameters, allocating up to $200,000 of Cares Act Funding earmarked for the City of Hailey to be applied to qualifying costs incurred by small businesses and non-profits registered within the city limits of Hailey.

Questions may be addressed to Hailey City Administrator Heather Dawson phone 208-788-9814 x 1518 or by email heather.dawson@haileycityhall.org

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CITY OF HAILEY    115 MAIN ST. S., SUITE H   HAILEY, IDAHO 83333    208‐788‐4221 

City of Hailey Municipal Small Business Grant Program Application

Applicant Information 

First Name:_______________________  Last Name:______________________ 

Your Title or Affiliation with the Business / Organization:_________________________________ 

Mailing Address ‐ P.O Box or Street Address:__________________________ 

Street Address if P.O. Box Used Above:_______________________________ 

City:_________State/Province/Region:__________Postal/Zip/Code:_________Country:________ 

Phone Number:___________________    Alternate Phone Number:______________________ 

Applicant Email:__________________________________________ 

Official Business / Organization Name:_________________________________ 

Doing Business As (if applicable):____________________________________ 

Employer Identification Number (EIN):________________________________ 

Type of Business Organization:_______________________________________ 

Type of Entity (as reported to the Internal Revenue Service), select one:  

Corporation ___  S Corporation  _____  Partnership _____  Non‐Profit  Entity  ____

Sole Proprietorship ____  Other _____ 

Business / Organization Phone:______________ 

Street Address of Affected Business / Organization:_______________________________ 

Hailey, Idaho 83333 (must be located in City limits) 

How have your Business / Organization revenues been impacted by COVID‐19? 

____ No Change ____ Decreased: 1‐30%  ____ Decreased: 31‐50%  ____ Decreased: 51‐75% ____ Decreased: 76‐100% 

These changes are anticipated to be: 

____ Temporary  ______Permanent  ____ Unknown at this time 

Number of Full Time Equivalent Employees that are based in Hailey, Idaho: 

On March 27, 2020:________   And Today (current):____________ 

Impacts from COVID‐19 are the result of: 

______ Distancing Requirements _________Required Reduction/Closure ________Reduced Revenues _________ Other _________Employees' Personal/Family lllness and/or Responsibility 

*Indicates required field

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CITY OF HAILEY    115 MAIN ST. S., SUITE H   HAILEY, IDAHO 83333    208‐788‐4221 

Have  you  been  approved  for,  or  received,  funds  for  any  other  COVID‐19  related  grant  or program?:______Yes  ______No 

Required Information:  For expenses directly related to COVID‐19 impacts, including local closure orders, incurred

between June 20, 2020 and November 30, 2020.

Per State of Idaho guidelines, payroll expenses, including benefits, hazard pay, and overtimenot eligible.

Approved applicants will be expected to execute a Grantee Agreement indicating compliancewith all program criteria.

Please split out each expense by category and submit expenses individually and separately. 

Complete a separate page for each reimbursement category, and include invoices, date and amount 

paid for each transaction within each category. (Print page 2 for multiple categories) 

Reimbursement Expense Categories 

Type of Reimbursement Expense: 1. Personal Protective Equipment 6. Cleaning Supplies2. Furniture/Fixtures 7. Equipment3. Rent 8. Other4. Sanitation Supplies (hand sanitizer, sanitizing spray, etc.)5. Utilities (Per Federal rules, City of Hailey utility costs are not eligible for reimbursement)

The following documents are required before we can process your application: 

_____Completed IDA‐20 Form 

_____IRS W‐9 Form - You may submit now, or upon approval 

Signature  ________________________________________________ 

Printed Signature ________________________________ Date Submitted _______________ 

4Example: 06/05/20 Atkinson's 2453111 Debit Card $18.654 - 8 oz. bottles hand sanitizer

(See next page)

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Idaho Rebounds - Municipal Small Business GrantWelcome to the Idaho Rebounds - Municipal Small Business Grant application.

This grant is made possible through the work of Governor Brad Little, State Controller Brandon Woolf, The Association of Idaho Cities, and the US CARES Act. The Governor’s Coronavirus Financial Advisory Committee (CFAC) created this grant to help local businesses affected by COVID-19 pandemic, enabling cities and counties to provide aid within their community.

The parameters of the Municipal Small Business Grant:

1. For businesses that are closed or interrupted pursuant to a local health district or local government decisionmade on or after June 20, 2020.

2. For businesses that were otherwise not eligible for a state small business grant (e.g., volunteer organizations,businesses created on or after January 1, 2020, etc.).

3. For businesses that have specific PPE needs in order to operate safely.

The qualifications for your application include:

• Business must be a small business, defined as businesses with 500 employees or less.• Business must have an official EIN #.• Business must be an Idaho domiciled business.• Business must be in good standing and not federally debarred from receiving funds.• Business must have a qualified business interruption or expense caused by COVID-19 related incidents or

decisions, including but not limited to local closure orders, need for personal protective equipment, socialdistancing requirements, increased costs, disrupted supply network, etc.

• The business has not received funds for the current purpose by other COVID-19 grant programs.• Adverse effects and expenses planned for the use of the grant must occur between June 20, 2020 and December

30, 2020.• The business does not exist for the purpose of advancing partisan political activities or the business does not

directly lobby federal or state officials, defined as having had a registered lobbyist at any point during 2020.

Background information:Per Idaho's Coronavirus Financial Advisory Committee guidance memo on May 1, 2020, each local government is allocated a share of the Idaho Coronavirus Relief Fund (CRF). On June 26, 2020, Governor Little provided flexibility for local governments to utilize their allocation of the CRF to create a small business support grant to aid businesses affected by COVID-19 in their communities.

For information on allocations click here: Governor Brad Little Funding Allocation Memo

For information on CFAC approval click here: CFAC Approval for Local Small Business Grant Use

Application #: IDA-20-

FOR OFFICE USE ONLY

Approved: Yes No

Name:

FORM: IDA-20 - Municipal Small Business Grant V-07-21-2020

Page 1 of 3

Employee Identification Number (EIN):

Identity InformationPlease enter your official business Employee Identification Number (EIN) and the official business name you have registered with the Idaho Secretary of State. The business must have a valid and legal Employee Identification Number (EIN) to be eligible for the grant.

Official Business Name:

Business Owner's Name:

Affected Business Address:

City of Operations:

Grant Request DetailsSelect the best match for your business industry

Small Business Requested Amount:

Briefly Describe how COVID-19 has affected your business and your planned use of the funds.

Have you received funds from any other COVID-19 related grant?

If yes, please select all programs you have received support from:

How many employees does your business have?

Personnel Protection Program (PPP)

FEMA - COVID-19 Support Grants

USDA - Coronavirus Food Assistance Program

Other:

SBA - Economic Injury Assistance Program Idaho

Rebounds Cash Grants for Small Businesses

County of Operations: Zip-Code of Operations:

I have the authority on behalf of the applicant business to request the small business grant.

Print Name:

FORM: IDA-20 - Municipal Small Business Grant V-07-21-2020

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Is your business domiciled in Idaho?

Grant Purpose

Yes No

Yes No

Equipment Inventory PPEPPE Rent Utilities Other

Accommodations and Food Services

Agricultural, Forestry, and Fishing/ Hunting

Arts, Entertainment, and Recreation ConstructionEducational Services

Finance and Insurance Healthcare and Social Services

By digitally signing below, I attest the following:

1. I understand the State of Idaho will rely on this application and certifications as a material representationin making a disbursement of funds to the applying entity.

2. I certify the following:

3. Funds provided from the State of Idaho pursuant to this certification must adhere to official federalguidance issued or to be issued on what constitutes a necessary expenditure. Any funds used in any mannerthat does not adhere to official federal guidance shall be returned to the State of Idaho.

4. Any business receiving funds pursuant to this certification shall retain documentation of all uses of thefunds, including but not limited to invoices and/or sales receipts. Such documentation shall be produced to theState of Idaho if requested. Additionally, uniform reports may be requested and if requested shall be providedto the State of Idaho to ensure the receipt, disbursement, and use of federal funds is in alignment with federallaw.

5. All grants submitted through this portal and approved by the committee will be reported publicly onTransparent.Idaho.gov. It is the responsibility of the applicant to ensure the protection of sensitive data priorto the data being submitted for review by CFAC.

The grant's use is for necessary expenditures incurred due to the public health emergency with respect to the Coronavirus Disease 2019 (COVID-19), including local closure orders;

Expenses have been incurred during the period that begins on June 20, 2020, and ends on December 30, 2020, or for businesses who did not qualify for previous CARES Act funding;

The grant funds use has not been covered or reimbursed by any other federal or state grant. Funds received pursuant to this certification cannot be used for expenditures for which an entity has received funding from any other emergency COVID-19 or other federal and state funds;

That no owner of 20% or more of the business is incarcerated, on parole, or within the last 5 years for any felony has been convicted, pleaded guilty, pleaded nolo contendere, or been placed on any form of probation;

I understand and it is my intent to conduct and process this application by electronic means, and providing my signature by electronic means below satisfies all legal effect and enforceability as required by applicable law.

I therefore, certify that all information submitted in this request is true and accurate.

Signature:

Date:

FORM: IDA-20 - Municipal Small Business Grant V-07-21-2020

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The business does not exist for the purpose of advancing partisan political activities or the business does not directly lobby federal or state officials, defined as having had a registered lobbyist at any point during 2020;