ARPA Impacted Ind Application Online

Grant Pursuit

Please select one of the following that best describes the overall request.

Aid to Non-profit Organizations

Aid to qualified small business

Non Profit - Select all that apply

Decreased revenue or gross receipts

Financial insecurity

Increased costs

Capacity to weather financial hardship

Challenges covering payroll, rent or mortgage, and other operating costs

Operating in Qualified Census Tracts

Qualified small business - select all that apply

Decreased revenue or gross receipts

Financial insecurity

Increased costs

Capacity to weather financial hardship

Challenges covering payroll, rent or mortgage, and other operating costs

Operating in Qualified Census Tracts

Small businesses

Small businesses eligible for assistance are those that experienced negative economic impacts or disproportionate impacts of the pandemic and meet the definition of “small business,” specifically:

1. Have no more than 500 employees, or if applicable, the size standard in number of employees established by the Administrator of the Small Business Administration for the industry in which the business concern or organization operates, and

2. Are a small business concern as defined in section 3 of the Small Business Act8 (which includes, among other requirements, that the business is independently owned and operated and is not dominant in its field of operation).

Will County has prioritized eligible small businesses in critical supply chain (select one below):

Information/communications technology

Energy

Transportation

Agricultural Commodities

Food Production

Medical Supply/Equipment

Benefit/Impact:

Please provide a brief description outlining the request and how it aligns with the selection criteria above:

Non-Profit/Small Business Information:

Legal Name of Organization

Doing Business As (DBA)

Federal Tax ID Number

SAM.gov ID

Organization Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is the organizations mailing address the same as their physical address?

yes

no

Organization Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Organization Phone Number

Organization Email

Organization Website

Date Founded

Tax Exemption Status

Geographic Areas Served

Contact Person Name

Contact Person Title

Contact Person Phone Number

Contact Person Email

I am the owner/operator of the small business:

Yes

No

Owner/Operator Name:

Owner/Operator Phone

Owner/Operator Email

Organization Information

1. Organization Mission or Vision Statement - Primary Purpose:

2. Is this organization currently in good standing with the State of Illinois and current on local taxes and utility bills?

Yes

No

3. Is this organization currently in good standing and in compliance with all applicable Federal, State and Local Laws?

Yes

No

4. If no to either #2 or #3, please provide information about status and standing:

5. Are any of the organization’s staff or Board Members immediate family members of County Staff or an Elected Official?

Yes

No

6. If you answered “yes”, please list out family members and their relation:

7. In the space below, please provide the number of full-time equivalents, part-time employees, or volunteers:

8. Non-Profit: Describe the services the organization provides to Will County residents.

9. Small Business: Describe how the business addresses critical supply chain.

COVID-19 Impact

10. Describe the impact the COVID-19 public health emergency has had on the organization’s finances (e.g., increased, or new expenses, reduced/canceled fundraising, loss of earnings, decline in revenue, etc.).

11. Describe the impact the COVID-19 public health emergency has had on the organization’s operations (e.g., increase/decrease in demand for services, operation modifications due to social distancing, staffing changes, impacts to volunteer numbers, periods of closure or shutdown, implementation of mitigation efforts to contain the spread of COVID, etc.)

12. What steps has the organization taken to address the financial impacts of COVID-19 to date?

Alternate Funding

13. Has the organization received other COVID-19 funding assistance such as, but not limited to, Federal CARES Act funding; Paycheck Protection Program (PPP) Loans; Economic Injury Disaster Loans (EIDL); or Community Development Block Grant Coronavirus (CDBG-CV) funds?

Yes

No

14. If you answered “Yes” to the question above, please complete the supplemental attachment.

15. Are there other grants the organization has currently applied for or intends to apply for?

Yes

No

16. If you answered yes to the question above, please list each application filed or intent to file below

17. If you answered yes to question #16, please confirm this applicant agrees to advise when they get a final response from each of those applications listed above(Required)

I agree

18. Does the organization currently employ, or have access to, a grant writer?

Yes

No

Financial/Insurance Information

19. Dates covered by organization’s fiscal year:

20. Revenue for the past fiscal year?

21. Projected revenue for the current fiscal year?

22. Projected expenditures for the current fiscal year?

23. Non-Profit: Describe how the organization typically raises funds, pre-COVID-19?

24. Please complete the types of insurance the organization carries and note the maximum amount per occurrence.

General Liability

Automobile Liability

Workers Compensation

Max General Liability Amount

Max Automobile Liability Amount

Max Workers Compensation Amount

Budget Exhibits Form Upload

Max. file size: 800 MB.

Signature

I hereby certify that the statements and documents submitted herein are true and the funds requested adhere to the Will County American Rescue Plan Comeback Program guidelines.

Grant Preparer Name

Grant Preparer Title

Grant Preparer Signature

Date

Organization CEO, Executive Director, or Authorized Representative Name

Organization CEO, Executive Director, or Authorized Representative Title

Organization CEO, Executive Director, or Authorized Representative Signature

Date

APPLICATION

U.S. Small Business Administration

Economic Development Grant Program

Aid to Impacted Industries Application

BEFORE YOU START!

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