Reboot Whitehall Application

The City of Whitehall has authorized the Reboot Whitehall: Whitehall C.A.R.E.S. Act Small Business Relief Grants to assist businesses within Whitehall in recovering from revenue losses resulting from the COVID-19 pandemic.

Amount

Eligible businesses may apply for a one-time grant of up to $5,000 to be used for reimbursement of Eligible Expenses, as defined below. Award determination based on receipts, payroll records or other documentation indicating business loss/expenses. Documentation of eligible expenses must be submitted with grant application. Please be aware that this grant may be considered income for tax reporting purposes.

Deadline

The application period begins Monday, October 26 and will continue until all grant funding has been distributed. Grants will be awarded on a rolling basis.

Eligible Recipients:
- For profit companies located in the City of Whitehall (Applicant must be the business owner/operator)
- Must have 50 or fewer employees or 1099 contractors
- Must be actively in business and have positive revenue pre-pandemic
- Must have a Federal Taxpayer Identification Number
Eligible Expenses:
- Rent/Mortgage Payments (excludes businesses located in or operated from personal residence)
- Machinery/Equipment Payments
- Utility Expenses
- Salaries, wages, and/or compensation (if not receiving assistance from State/County/
- Federal Program)
- Personal Protective Equipment (PPE) or expenses related to compliance with Responsible Restart Ohio to meet social distancing requirements
Ineligible Expenses:
- Any expenses reimbursed through business interruption insurance or other federal aid received in connection with the COVID-19 pandemic.
- New Purchases
- New Debt
Application Process and Review:

The City of Whitehall Economic Development Department will accept and review applications for the Business Grant Program. Applications will be evaluated on a first come-first serve basis. In the event requests exceed available funds, priority will be given to applicants based upon the following criteria:
- Need for assistance
- Likelihood that grant funds will allow business to retain jobs in the City of Whitehall
- Overall impact of the grant on qualifying business
Applicants seeking COVID-19 Business Grant Program assistance through the City of Whitehall Economic Development Department must submit the following form and supplemental attachments for

consideration. All applicable information as requested in this form must be provided, and the applicant is responsible for the accuracy of the information submitted.

Questions?

Call Jenna Goehring at 614-545-9702 or email economicdevelopment@whitehall-oh.us.

Applicant and Business Information

Please provide the legal name, address and other contact information of the applicant for this request.
Total Business Grant Program Request
Amount cannot exceed $5,000
Applicant Business Name
Contact Name

First Name Last Name
Relationship to Business
(Owner, Manager, CEO, CFO, etc.)
Email
example@example.com
Phone Number

Area Code Phone Number
Main Business Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Federal Tax ID Number
(Business/User)
Company Website
Whitehall Business Address (if different from above)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
How long has the company that will benefit from the Business Grant Program been in existence at the Whitehall location?
(Years, Months)
Company Officers/Principals: Please provide the names of all owners, principals, and/or primary officers of the company

First Name Last Name Title
First Name Last Name Title
First Name Last Name Title
Current Employment and Payroll

For each of the following categories listed below, please specify the number of employees currently employed by the applicant and the total annual payroll.
Full-Time Permanent:
Number of employees
Full-Time Payroll:
Payroll category
Part-Time Permanent:
Number of employees
Part-Time Payroll:
Payroll category
Temporary/Contract:
Number of employees
Temporary Payroll:
Payroll category
Seasonal Workers:
Number of employees
Seasonal Payroll:
Payroll category
Total Payroll
Delinquencies and Judgements
Does the applicant, or affiliated company to benefit from the incentive program, owe any delinquent taxes to the State of Ohio or a political subdivision?

Yes No
Does the applicant, or affiliated company to benefit from the incentive program, owe any money to the State or a State agency for the administration or enforcement of any environmental laws?

Yes No
Does the applicant, or affiliated company to benefit from the incentive program, owe any other moneys to the State, a state agency or a political subdivision of the State that are past due, whether the amounts owed are being contested in a court of law or not?

Yes No
Are there any current or pending lawsuits involving either the principals or the company?

Yes No

Need for Assistance

Applicants must demonstrate the business experienced a decrease in gross revenue due to COVID-19 when comparing March 1 – August 31, 2019 to March 1 - August 31, 2020. Please provide a summary of the impacts of the pandemic on your business and provide supporting financial records or bank statements.
Please use this space to provide a summary of the impacts of the pandemic on your business...
Financial Impact Document(s) Upload *

Browse Files
Example documents: Financial records, bank statements, receipts Cancel of
Other Assistance: Please indicate any other assistance you have received toprovide relief to your business (i.e. rent reductions, utility waivers, SBA or PPP funding, etc.). Please note expenses reimbursed through business interruption insurance or other federal aid are not eligible for the Business Grant Program.

None Payment Protection Program Economic Impact Disaster Program Other SBA Loan SharedWork Ohio Assistance Personal or Business Loan
Eligible Expense

For each of the categories listed below, please estimate the amount to be expendedby the applicant related to the COVID-19 pandemic.
Rent/Mortgage Payments
Machinery/Equipment Payments
Utility Payments
e.g. Electricity, Gas
Salaries/Wages
Not covered by PPP
PPE/Restart Ohio Upgrades
Total Eligible Expenses
Sum of above fields
Use of Funds

Please indicate the eligible costs for which Business Grant Program funds will be used. Grant funds are provided on a reimbursement basis. Businesses must submit appropriate documentation related to expenses with the application.
Use this space to indicate how you intend for the funds to be used...
Should your business be awarded funding, please indicate who to make the grant payment payable to, and what address the check should be mailed to:
Required Uploads
Current Bank Statement *

Browse Files

Cancel of
2019 Federal Tax Returns *

Browse Files
First page only please Cancel of
Completed W-9 *

Browse Files
Document must be signed Cancel of
Financial Records/Bank Statements Demonstrating Decreased Revenue *

Browse Files
Documents must demonstrate decreased revenue from March 1-August 31, 2019 compared to March 1-August 31, 2020 Cancel of

Requirements and Certifications

The undersigned, duly authorized Officers of the Applicant, hereby certify that the
The undersigned, duly authorized Officers of the Applicant, hereby certify that the statements made in the foregoing application and in all attachments submitted in connection with this application are true and correct to the best information and belief of the undersigned and are submitted as a basis for determining approval of Business Grant Program assistance.

I/we certify that the requirements listed below will be met:
1. I/we agree to notify the City of Whitehall immediately of any project modification.
2. The Applicant agrees to supply additional information upon request.
3. This grant is to be used for COVID-19 business related expenses only.
4. I/we have not nor do we intend to be involved in illegal activity under federal, state, or local laws. Nor do I/we have any criminal proceedings pending against me/us.
5. I/we do not anticipate receiving business interruption insurance or other federal aid for reimbursement of Business Grant Program eligible expenses.
6. The Applicant agrees to allow the Whitehall Auditor, and Tax Administrator to share relevant income tax withholding information with the Economic Development Department as part of the Business Grant Program application review process.
7. The Applicant agrees that the City of Whitehall may share information publicly regarding grant recipients.
8. Unspent and/or improperly grant proceeds are to be repaid by the grant recipient to the City of Whitehall.
Signature of Applicant 1

Clear
Date Signed

Month Day Year
Date
Retype Full Legal Name

First Name Last Name
Signature of Applicant 2

Clear
Date Signed

Month Day Year
Date
Retype Full Legal Name

First Name Last Name
Signature of Applicant 3

Clear
Date Signed

Month Day Year
Date
Retype Full Legal Name

First Name Last Name
Please verify that you are human *
Should be Empty:

Applicant and Business Information

Current Employment and Payroll

Delinquencies and Judgements

Need for Assistance

Eligible Expense

Use of Funds

Required Uploads

Requirements and Certifications