Small Business Relief Program Grant Application Form

To be considered, applicants must meet all eligibility requirements and submit a complete application before 5:00 pm MST on Sunday, February 7, 2021. The entire application process will take about 10 minutes to complete once all your supporting documentation is prepared.* If you have questions on eligibility, the application form, or required supporting documentation, please email us at info@townofdillon.com. *Please gather a W-9 and 2019 and 2020 Profit & Loss Statements. If your business was established after Jan 1, 2020, then only a 2020 Profit & Loss Statement is required.


Eligibility Questionnaire

Is your business located within the jurisdictional boundaries of the town of Dillon, from which business operations are conducted?*

If you are unsure of your location, please use the Summit County mapping tool: http://gis.summitcountyco.gov/Map/

Is your business currently open and operating in the town of Dillon?*
Was your business established prior to March 26, 2020?*
Does your business have at least one (1) employee currently employed, which may include the owner/manager if the owner/manager works in the business as an employee?*
Is your business current in its sales tax remittance to the Town of Dillon?*
Does your business have a Colorado Income Tax Account Number or Tax Exempt Certificate number?*
Is this business a publicly traded corporation, or owned by, controlled by, or a subsidiary of a publicly traded corporation?*
Are you applying for this business assistance grant as a short-term rental unit owner?*
Does this business have less than two and a half million dollars ($2,500,000) in annual gross revenues, or is this business owned by, controlled by, or a subsidiary of any such entity that has over two and a half million dollars ($2,500,000) in annual gross revenues?*
Has your business experienced a minimum of 20% revenue loss since March 26, 2020 due to the restrictions imposed on the business under the Governor’s Executive (Order D 2020 017, ordering Coloradoans to stay at home), and the CDPHE Amended Public Health Order 20-24 implementing stay at home requirements. OR, did your business open between January 1, 2020 and March 26, 2020?*
Have you applied for or received any other relief payment from the Arts Relief Program created in C.R.S. 24-48.5-316?*

Small Business Relief Program Application Form

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Do you intend to continue operating in Colorado for at least the next 6 months?*
Are you in compliance with all public health orders?*

Please upload a copy of your W-9 and Profit & Loss statements for 2019 and 2020 to provide verification of revenue loss.

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By checking the box below, I am certifying to the Town of Dillon Government and the State of Colorado that all of the following statements are true and accurate to the best of my knowledge: • The answers I have provided both in this Application and the Eligibility Quiz are true and accurate. • I am retaining documents that support the statements regarding my company’s financials that I have made in this Application and the Eligibility Quiz to justify a relief payment and will provide such documents to State or County officials upon request for the purposes of an audit. • I understand that if I cannot validate the accuracy of any answers provided or statements made in this Application and the Eligibility Quiz that I will be required to pay back any relief payment received and I may be subject to prosecution for civil and/or criminal penalties. • I certify that I am an officer of the above-named company with the authority to sign on its behalf.


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