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4. 
8. Business Name/DBA*
9. Email Address*
11. Business Owner First Name*
12. Business Owner Last Name*
14. Business Address*
16. City*
17. State*
18. Zip Code*
20. Phone Number*
22. Mailing Address*
24. City*
25. State*
26. Zip Code*
28. Type of Business*

    This grant is only available to these business types. To read a copy of the signed legislation, go to: https://leg.colorado.gov/sites/default/files/2020b_001_signed.pdf

    1. restaurant
    2. bar
    3. caterer
    4. movie theater
    5. fitness and recreational sports center
29. North American Industry Classification System (NAICS) Code (https://www.naics.com/search/)*
31. Business Receipts (Please select one)*

    Businesses with receipts greater than $2.5 are not eligible for this funding

    1. My business had less than $500,000 in receipts in the 2019 calendar year
    2. My business had $500,000 but not more than $1 million in 2019
    3. My business had $1 million or more but not more than $2,500,000 in receipts in the 2019 calendar year
    4. My business began operating on or after Jan. 1, 2020 and before March 26, 2020, and had annual receipts of less than $2,500,000 in the 2020 calendar year
32. W-9 (Please upload a current copy of your business W-9)*
    (https://www.irs.gov/pub/irs-pdf/fw9.pdf)
34. Secretary of State Good Standing*
    Please upload a Certificate of Good Standing from the Colorado Secretary of State (https://www.sos.state.co.us/biz/BusinessEntityCriteria.do)
35. Glenwood Springs Business License*
    Please upload a copy of your current City of Glenwood Springs Business License. https://cogs.us/Admin/FormCenter/Item/Edit/57?categoryID=8
37. Business Revenue Loss*
    Please upload Profit & Loss statements in one PDF document which detail 2020 Receipts (Apr.-Dec.), 2019 Receipts (Apr.-Dec.), and 2019 Receipts (Full Year). For those that began operating on or after Jan. 1, 2020 but before March 26, 2020, please provide a statement for the entire year.
38. Verification of Operation in Colorado*
    Please upload either your Colorado Income Tax Account Verification, or receipt of your most recent Unemployment Insurance Payroll Tax payment.
40. Other information
    Please use this field to upload additional documentation, such as a 2019 federal business tax return in lieu of a 2019 profit and loss statement.
42. Certifications*

    1. My business is in compliance with all state public health orders, including capacity restrictions
    2. My business is headquartered in Colorado
    3. I intend to continue operating in the state for at least 6 months
    4. My business has at least one full-time employee or is a sole proprietorship
    5. My business has not applied for nor received any relief payments from “Arts Relief Program” or the “Minority Owned Business Relief Program” (also established in SB20B-001)
    6. My business realized a 20% revenue loss for the period March 26, 2020-December 31, 2020 over the same period in 2019.
    7. I have verified my business' State Income Tax Account Number
44. Disclaimer
    Submission of this application does not guarantee that you will receive funding. Should applicant’s business be granted an award, there may be tax implications to accepting this grant. The applicant shall ensure that any State funds received under this program do not pay for any resources paid for by CARES Act funding. If applicant’s business is no longer complying with local or State public health orders, the business may be required to return any funds received under this program. Due to the need for government transparency, the applicant’s name, business name, and amount of award may become public record. By entering the date and time and submitting this application, you certify that this application truthfully and accurately represents your request and is hereby submitted for review. You also certify that you have read and understood the above statements.
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46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field