PLEASE NOTE: Your application MUST be completed and submitted prior to the deadline as this form will deactivate at 5:01 PM on April 30, 2021.
(Review the Essential/ Non-Essential Business List here: ( https://covid19.ca.gov/stay-home-except-for-essential-needs/ )
• Copy of Current FBN
• Proof of Liability Insurance
• Proof of Workers Compensation Insurance
• 2019 P&L, Balance Sheet, CPA Documents, or Other Financial Records showing proof of business revenue
• 2020 P&L, Balance Sheet, CPA Documents, or Other Financial Records showing proof of business revenue
• 2019 Payroll documentation (IRS Form 941)
• 2020 Payroll documentation (IRS Form 941)
• Copies of current utility bills
• Copies of current lease/ mortgage
Additional documentation which may be required to verify your request:
• Any additional documentation needed to support the application
• Tax returns – IRS Form 4506T (signed)
• Schedule of Payables
• Cash Flow Statements
• Debt Schedules
Acceptable file types: pdf, doc, docx, txt, rtf, jpg, jpeg, gif, tif, tiff, png, csv.
Note: All of the following statements must be checked in order to be considered for the SAFE Grant
By checking the "I agree" box below, you agree and acknowledge that: 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in the alternate manner below, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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