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2. 
4. Overview

   West Norriton Township is offering a total of $300,000 in grants via American Rescue Plan funds to assist the local small business community recover from adverse impacts of the Coronavirus.

   DEADLINE TO SUBMIT APPLICATION IS ROLLING UNTIL FUNDS ARE EXPENDED.

   Complete each section and attach all required documents to be considered for the West Norriton Small Business Recovery Grant. The platform facilitates secure submission of supporting documentation. 

   Upon successful submission, a confirmation message will be received at top of the page. Users are encouraged to print/save a copy of the application for their records. 

   Due to anticipated response, staff will not provide feedback regarding the status of submissions. Applications will be reviewed in the order received. Contact will be limited to businesses selected to move forward in the process. 

6. Program Overview

   Eligibility

   • For-profit business located within West Norriton Township in operation as of March 1, 2020.
   • Have incurred a loss of income as a result of Coronavirus/COVID-19.

   Funding

   • Grant funding must be used for business payroll, rent, mortgage, utility, or COVID mitigation.
   •  Program period/expenditure time-frame is March 1, 2020-September 1, 2021.
   • During the program period, proof of payment must be submitted to document eligible use of grant funds.
   • The business recipient will be required to certify that the Township's assistance is not duplicative of any other funding.

   Awards 

   Award amounts will be based on number of eligible applications submitted at conclusion of the application deadline. 

   Other Assistance Resources 

   Due to limitations of federal funding, applicants are encouraged to identify and pursue all available resources. 

   • U.S. Small Business Administration www.sba.gov 

   Recipient Responsibilities

   • Enter into a formal, written, funding agreement with West Norriton Township.
   • Provide documentation to support expenditure of funds.
   • Make every effort to continue business operations through October 1, 2022.
   • Retain all related records for 3 years after receipt of grant close out letter.
   • If small business closed because of COVID, advise the Township of business closure by letter from Owner with last day of operation and detailed reason for closure.

   Fraud & Repayment 

   Applicants are advised that making false statements, concealing information, submitting altered documents, utilizing funds for ineligible purposes, or similar actions are considered fraudulent and may result in repayment of the grant award or other legal action. 

   Submission 

   • Applications should only be submitted by the owner, partner, or authorized corporation member. 
   • Applications may only be submitted using the online platform.
   • Applications will be reviewed in the order received.
   • Incomplete applications will not be considered for funding.

   
   

10. OWNER/PARTNER/AUTHORIZED MEMBER SUBMITTING APPLICATION
12. First Name*
13. Last Name*
15. Address1*
17. Address2
19. City*
20. State*
21. Zip*
23. BUSINESS INFORMATION
25. Business/Company Name*
27. Address1*
29. Address2
31. City*
32. State*
33. Zip*
35. Opening Date at this Location*
36. Business Phone*
38. Website
39. Facebook
40. Twitter
41. Instagram
43. Ownership Structure*
44. Business Type*

    1. Retail
    2. Health & Beauty

    1. Entertainment
    2. Restaurant

    1. Other
46. Total Current Full Time Paid Staff Positions*
47. Total Current Part Time Paid Staff Positions*
49. ADDITIONAL BUSINESS INFORMATION
51. Is business currently closed?*

    1. Yes

    1. No
52. If closed, when is reopening expected?
54. Since March 3, 2020 has application been made to other financial resources? If so, detail resources and status. If funding has been received, detail how funds were used and whether all funds have been exhausted?
56. Describe why the business needs assistance. Be specific as possible. Detail any closures, reduced capacity requirements or reduced income resulting from effects of the COVID-19 pandemic.
58. What adjustments have been made to sustain business operations during the Coronavirus?
60. REQUIRED UPLOADS
62. 2019 Business Tax Return*
63. 2020 Business Tax Return*
65. OPTIONAL UPLOADS

    Attach payroll, rent, mortgage, utility or COVID mitigation expenses incurred March 3, 2020 through application that West Norriton Township funding will be used for. Be sure that items HAVE NOT and WILL NOT be funded or reimbursed by any other source. 

67. Payroll, Rent, Mortgage, Utility, COVID Expenses
68. Payroll, Rent, Mortgage, Utility, COVID Expenses
69. Payroll, Rent, Mortgage, Utility, COVID Expenses
71. CERTIFICATIONS & ACKNOWLEDGEMENTS
73. Certify*

    I certify that this American Rescue Plan assistance is not duplicative of other public or private funding received.

    1. Yes
    2. No
75. Certify*

    I certify that this American Rescue Plan assistance will be used for payroll, rent, mortgage, utility or COVID mitigation efforts associated with the aforementioned business/company. 

    1. Yes
    2. No
77. Certify*

    I certify that the business/company will make consistent and assertive efforts to continue operations through October 1, 2022.

    1. Yes
    2. No
79. Certify*

    I certify that I am not aware of any conflicts of interest that exist between the business/company, myself, or any person who is an employee, agent, consultant, officer, elected official, or appointed official of West Norriton Township and is in the position to participate in a decision making process or are responsible for the administration or oversight of the Small Business Recovery Program.

    1. Yes
    2. No
81. Acknowledgement *

    I acknowledge that, if selected, a formal agreement will be signed with West Norriton Township.

    1. Yes
    2. No
83. Acknowledgement *

    I acknowledge that, if selected, the program requires an IRS Form W9 be completed in order to receive payment.

    1. Yes
    2. No
85. Acknowledgement *

    I understand that making false statements, concealing information, submitting altered documents, utilizing funds for ineligible purposes, or similar actions are considered fraudulent and may result in repayment of the grant award or other legal action. I also understand that failure to submit timely and adequate documentation may result in repayment of funds received.

    1. Yes
    2. No
87. AUTHORIZED SIGNATURE

    By signing and submitting this document, I certify that I am the sole proprietor, general partner, or member of the aforementioned LLC/corporation. Further, I have made the necessary notifications and received the appropriate authorization to submit an application on behalf of the business/company. I attest that I have thoroughly reviewed the application. The information presented is true and accurate.

89. First Name*
90. Last Name*
92. Today's Date*
    Today's Date

    Today's Date
Leave This Blank:


94. 1. Receive an email copy of this form.
95. Email address

    This field is not part of the form submission.

96. Submit Submit and Print

* indicates a required field