CHIRP Grant Application The COVID-19 Hospitality Industry Recovery Program (CHIRP) will allocate grant funding assistance to the hospitality industry businesses adversely affected by the COVID-19 pandemic for the purpose of alleviating revenue losses and paying eligible operating expenses. The Beaver County Board of Commissioners have selected the Beaver County Corporation for Economic Development (BCCED), an approved Certified Economic Development Organization (CEDO), to award grants in Beaver County. Eligible Beaver County businesses may apply for the CHIRP grant using this application. Step 1 of 5 20% Eligibility CriteriaEligibility Criteria*Before completing this application, please review the pre-application eligibility questionnaire below. Please place a check in all applicable boxes. My business is located in Beaver County, Pennsylvania. My business is organized as a for-profit entity. (Note: non-profits are NOT eligible for CHIRP.) My business is privately held and not publicly traded. My business’s North American Industrial Classification System (NAICS) code begins with 721 or 722 www.naics.com/search My business was in operation on February 15, 2020 and remains in operation and does not intend to permanently cease operations within one year of the date of application for this grant. My business has not received a grant and will not receive another grant under the CHIRP program between January 1, 2021 and June 30, 2021. (Note: PPP, EIDL, etc. are not considered here. Only CHIRP.) My business employs fewer than 300 employees (based on full time equivalents) in total, whether at one or more locations. My business’s tangible net worth is $15,000,000 or less. If you did not check ALL of the boxes above, your business is not eligible for the CHIRP grant. If you did check ALL of the boxes above, you may proceed to the application. Grant Award AmountsBeaver County has established a maximum grant of $25,000 to equitably distribute the limited funding to as many eligible businesses as possible in Beaver County. Grant awards will be in increments of $5,000 and determined as follows: Comparative Reduction in Annual Gross Revenue / Receipts - % - 2019 / 2020 Amount of CHIRP Grant per Eligible Business 25.00% - 34.99% $5,000 Grant 35.00% - 39.99% $10,000 Grant 40.00% - 44.99% $15,000 Grant 45.00% - 49.99% $20,000 Grant 50.00% or Greater $25,000 Grant Company InformationLegal Company NameDBA/Trade NameAddress Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code NAICS CodeNumber of FT or FT Equivalent employeesFEINContact InformationContact Name*Contact Title*Phone*Email* Eligible ExpensesGrant awards may not be used to pay the SAME eligible operating expenses for which an eligible business received payment, reimbursement or loan forgiveness from any of the following: The Coronavirus Aid, Relief, and Economic Security Act, commonly known as the CARES Act (Public Law 116-136, 134 Stat. 281) The Consolidated Appropriations Act, 2021 (Public Law 116-260, 134 Stat. 1182) The COVID-19 Emergency Supplement to the General Appropriation Act of 2019 (Act 2A of 2020) Receipt of a loan or grant issued under the authority of the Federal Government, Commonwealth or County does not disqualify an eligible business from eligibility for this CHIRP grant. However, monies received from those sources must be used for DIFFERENT eligible operating expenses than from CHIRP monies.I have received aid from the above.*YesNo Eligible Operating Expenses for Reimbursement from CHIRP Eligible operating expenses include payroll and non-payroll expenses that are both ordinary and necessary – ordinary meaning common and acceptable and necessary meaning helpful and appropriate – in the hospitality industry. SUBMITTED EXPENSES MUST HAVE BEEN INCURRED FROM MARCH 1, 2020 THROUGH THE DATE OF THIS GRANT APPLICATION. For mortgage, rent or utility expenses submitted, the mortgage, rent or utility must have been in force or service prior to February 15, 2020. PayrollContractorMortgageRentUtilitiesInventoryOther 1Total Expenses SubmittedUpload Proof of Expenses* Drop files here or Note that this application requires a self-certification that all information is true and accurate under penalty of perjury. No documentation is required to verify expenses UNLESS THE COUNTY OF BEAVER AND/OR BCCED REQUESTS IT AT A LATER DATE SUBSEQUENT TO SUBMITTING THIS APPLICATION.Revenue RecoveryIf applicable, what was your company’s total revenue in 2019, as reported on your 2019 business tax return?What was your company’s total revenue in 2020, as reported on your 2020 business tax returns and/or financial statements? Legal NoticesApplicant will not discriminate against any employee or against any person seeking employment by reason of race, gender, creed, color, sexual orientation, gender identity or expression, or in violation of the Pennsylvania Human Relations Act, which prohibits discrimination on the basis of race, color, religious creed, ancestry, age, sex, national origin, handicap or disability, or in violation of any applicable local, state, or federal laws. All contracts for work to be paid with program assistance must contain the Commonwealth’s official nondiscrimination clause. Applicant must maintain full and accurate records with respect to the activities and must ensure adequate control over related parties in the project. The PA Department of Community and Economic Development (DCED) requires access to such records, as well as the ability to inspect all work, invoices, materials, and other relevant records at reasonable times and places. Upon request of DCED, the applicant must furnish all data, reports, contracts, and other information relevant to the project. The Beaver County Corporation for Economic Development reserves the right to accept or reject any or all applications submitted contingent upon available funding sources and respective applicant eligibility.Supplemental Information Required to Complete Application 2019 Business Tax Return 2020 Business Tax Return or filed extension or Accountant-prepared financial statements (if Accountant Prepared Financial Statements are not available, company prepared financial statements will be sufficient) Copies of 2019 and 2020 quarterly Profit &Loss statements Copies of articles of incorporation/LLC operating agreement/partnership agreement (if applicable) Upload Supplemental Information* Drop files here or Self-CertificationThe undersigned is a duly authorized representative of this applicant and certifies that the information provided in this application and the information provided in all supporting documents and forms is true and accurate in all material aspects. An applicant/authorized representative that knowingly makes a false statement to obtain a grant under the program is punishable under penalty of perjury and fines pursuant to 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities.Applicant Signature*NameDate Date Format: MM slash DD slash YYYY TitlePhoneThis field is for validation purposes and should be left unchanged.