HomeMy WebLinkAboutContractGRANT BENEFICIARY AGREEMENT
SMALL BUSINESS RESILIENCY REIMBURSEMENT GRANT FUND PROGRAM
THIS AGREEMENT, dated for reference purposes only as December 15, 2021, is by and between
the City of Renton (the “City”), a Washington municipal corporation, and Blossom Awesome Inc
dba Blossom Vegetarian Restaurant (“Beneficiary”), a Washington Corporation and sets forth
the terms and conditions under which the City will provide a grant to Beneficiary under the
Small Business Resiliency Grant Program (“Program”), authorized by the Renton City Council on
September 20, 2021. The Program is funded through the Coronavirus Local Fiscal Recovery Fund
(42 USC 803) (“CLFRF”) award to the City as authorized by the American Rescue Plan Act of 2021
(“ARPA”) (CLFRF and ARPA together “Fund”).
The City and the Beneficiary are referred to collectively in this Agreement as the “Parties.” Once
fully executed by the Parties, this Agreement is effective as of the last date signed by both
parties.
RECITALS:
WHEREAS, beginning in March 2020, local, state, and federal jurisdictions, including the City of
Renton, issued proclamations of emergency due to the public health impacts of the novel
coronavirus and COVID-19 infections; and
WHEREAS, the State of Washington issued a series of prohibitions and advisories to limit public
gatherings and intermittent closures of non-essential businesses in order to limit the spread of
COVID-19; and
WHEREAS, many businesses experienced negative impacts to their in-person revenues; and
WHEREAS, use of CLFRF monies are intended to be used to respond to a variety of needs arising
from the COVID-19 public health crisis, including assistance to address negative economic
impacts to small businesses; and
WHEREAS, the City of Renton entered into an Interagency Agreement with the US Department
of Treasury (“Interagency Agreement”) for $18,113,855.00 under the Fund for the period
March 3, 2021 through December 31, 2024, attached hereto as Exhibit 1 and incorporated
herein; and
WHEREAS, on September 20, 2021, the City Council directed City administration to establish
CAG-21-334
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the City of Renton Small Business Resiliency Grant Fund Program (”Program”) to utilize Fund
resources to support short-term economic stability via monetary grants to qualifying small
businesses located within City limits that qualify under applicable federal, state, and local criteria;
and
WHEREAS, the City established an application program laying out eligibility criteria for the
Program. The City’s eligibility criteria for small businesses with less than $3 million in gross annual
revenue are as follows: (1) the business is located in a building with a commercial storefront or
office within the defined downtown area shown in Exhibit 2, attached and incorporated herein;
(2) the business has a current City of Renton business license in good standing and obtained on
or before June 30, 2020; (3) the business has no more than fifty (50) full time-equivalent
employees, and fewer than three national or local locations; (4) the business is subject to the
Washington State retail sales tax; (5) the business has experienced a revenue loss attributable
to COVID-19; and (6) the business is not owned, or partially owned, by managers, officers,
directors or public officials associated with the City of Renton; and
WHEREAS, the City made the application available to small businesses to seek funding
under the Program, and Beneficiary applied. Program Call for Application and Beneficiary’s
Application are attached hereto as Exhibit 3 and Exhibit 4 respectively, are incorporated herein;
and
WHEREAS, the City has reviewed the Application and determined that the Beneficiary is
eligible for assistance under this Program (1) the business is located in a building with a
commercial storefront or office within the defined downtown area shown in Exhibit 2; (2) the
business has a current City of Renton business license in good standing and obtained on or before
June 30, 2020; (3) the business has no more than fifty (50) full time-equivalent employees, and
fewer than three national or local locations; (4) the business is subject to the Washington State
retail sales tax; (5) the business has experienced a revenue loss attributable to COVID-19; and
(6) the business is not owned, or partially owned, by managers, officers, directors or public
officials associated with the City of Renton.
NOW THEREFORE, in consideration of the mutual covenants and agreements herein, the
Parties agree as follows:
AGREEMENT
1. Grant Amount. The total amount to be awarded to Beneficiary under the program is up
to seven thousand five hundred dollars ($7,500.00) as a single, one-time reimbursement
for eligible expenses. Except as specifically provided herein, the Beneficiary shall be solely
responsible for payment of any taxes imposed as a result of this Agreement .
a. Award Disbursement.
i. Expenses. The award will be disbursed in a single payment based on
actual eligible reimbursable expenses described in paragraph 2 of this
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Agreement, and occurring between March 3, 2021 and December 31,
2021 which is further described inparagraph 8 of this Agreement.
ii. Reimbursement Request. Within 30 days of execution of this
agreement, but in no case after March 4, 2022, Beneficiary shall submit
a single reimbursement request in a format acceptable to the City
(Exhibit 5) with supporting documentation including, but not limited
to, invoices or reports demonstrating losses for which reimbursement
is sought. Payment shall be made by CITY within thirty (30) calendar
days after receipt and approval by the appropriate CITY representative
of the invoice.
iii. No waiver. Payment for any reimbursement shall not constitute a
waiver by the City of any remedies it may have for any breach of this
Agreement by the Beneficiary.
iv. Tax implications. Grant funds may be taxable. Please consult your
financial advisor/tax professional for guidance. If it is required by the
IRS, a 1099 form will be issued to the Beneficiary.
2. Scope of Eligible Expenditures: Grant funds disbursed under this Agreement shall only be
used to pay or reimburse eligible expenses as described in the Interagency Agreement
(Exhibit 1) and in the “Program Call for Applications” (Exhibit 3)
a. Eligible Expenses. Under the Fund, eligible expenses are those which support
reimbursement of costs attributable to business interruptions due to the
COVID-19 public health emergency including required closures, voluntary
closures to promote physical distancing, or decreased customer demand and
according to the SLFRF Guidance in effect at the time of the disbursement .
Specifically, eligible expenses include:
i. Payroll expenses;
ii. Rental expense;
iii. Utilities;
iv. Machinery and equipment (e.g., HVAC upgrade);
v. Equipment to advance technology used in response to COVID-19;
vi. Business revamp or conversion to virtual business in response to
COVID-19 closures or decreased customer demand;
vii. Personal Protective Equipment (PPE) and/or sanitation supplies,
equipment and services to respond to COVID-19;
viii. Temporary or permanent changes to business operations in response
to COVID-19 closures or decreased customer demand; and
ix. Marketing.
b. Reimbursement Defined. “Reimbursement” means grant disbursement to
Beneficiary upon receipt by the City of invoices and documentation
demonstrating eligible expenses.
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c. No Duplication of Payment. No grant funds may be used to pay or reimburse
costs for expenditures for which Beneficiary has received any other funding,
whether state, federal or private in nature, for that same expense.
d. Beneficiary Relationship. Beneficiary agrees it is a beneficiary of the award,
that is an entity for whom the grant project is undertaken in response to the
national COVID-19 public health emergency (a local business that suffered
business losses related to COVID-19 closures of decreased customer
demand). Beneficiary agrees it is neither a subrecipient carrying out a
purpose of the federal award, nor a contractor for which it is providing goods
and services to create a procurement relationship with the City under this
disbursement.
3. Beneficiary Responsibilities.
a. Federal Compliance. Beneficiary understands and agrees that funds provided
under this Agreement may only be used in compliance with section 603(c) of
the Social Security Act (“the Act”), as added by section 9901 of the American
Rescue Plan Act (“ARPA”), the U.S. Department of Treasury’s (“Treasury’s”)
regulations implementing that section, guidance issued by Treasury regarding
the foregoing, and any other applicable federal provisions, including those
described in the Interagency Agreement (Exhibit 1).
b. False Statement. The Beneficiary understands and acknowledges that
providing false information in the Application or on any documents submitted
to the City or its designees as part of the Beneficiary’s participation in the
Program may constitute fraud, justify termination of this Agreement, trigger
the Beneficiary’s obligation to return funds, and may be subject to civil and/or
criminal penalties and/or sanctions.
c. No Employee Relationship. The Beneficiary understands and acknowledges
that neither the Beneficiary nor any officer, employee or agent of the
Beneficiary shall be considered to be an employee of the City, nor entitled to
any benefits accorded City employees, by virtue of the services provided
under this Agreement. The City shall not be responsible for assuming the
duties of an employer with respect to the Beneficiary or any employee of the
Beneficiary.
d. Non-discrimination. During the performance of this Agreement, the Company
shall comply with all federal and state nondiscrimination laws, including but
not limited to, chapter 49.60 RCW, Washington’s Law Against Discrimination,
and 42 U.S.C. 12101 et seq., the Americans with Disabilities Act (ADA). In the
event of the Company’s noncompliance or refusal to comply with any
nondiscrimination law,regulation, or policy, this Agreement may be rescinded,
canceled, or terminated in whole or in part.
e. Debarment and Suspension Certification. Beneficiary, by signature to this
Agreement, certifies that Beneficiary is not currently debarred, suspended, or
proposed for debarment, by any Federal department or agency. Entities that
are debarred, suspended, or proposed for debarment, by the U.S.
PAGE 5 OF 15
Government are excluded from receiving federal funds and contracting with
the City. Grantee, by signature to this Agreement, certifies that Grantee is not
currently debarred, suspended, or proposed for debarment, by any Federal
department or agency. Grantee also agrees that it will not enter into a
subcontract with a person or entity that is debarred, suspended, or proposed
for debarment. Grantee will notify the City if it, or a subcontractor, is
debarred, suspended, or proposed for debarment, by any Federal department
or agency. Debarment status may be verified at https://www.sam.gov/.
i. Debarment: As used in this Agreement means that an entity has been
excluded from participating in transactions with the US government (2
CFR 180.925)
ii. Suspension: As used in this Agreement means that an entity ha s been
temporarily prohibited from participating in transactions with the US
government pending completion of an investigation. (2 CFR 180.1015)
f. If the Beneficiary is a sole proprietorship or if this Agreement is with an
individual, the Beneficiary agrees to notify the City and complete any required
form if the Beneficiary retired under a State of Washington retirement system
and agrees to indemnify any losses the City may sustain through the
Beneficiary’s failure to do so.
4. Records: Maintenance, Access, Disclosure.
a. Beneficiary shall maintain all records and accounts with respect to all matters
covered by this Agreement, including personnel, property, financial, and
programmatic records and documents sufficient to evidence compliance with
section 603(c) of the Act, Treasury’s regulations implementing that section,
and guidance issued by Treasury regarding the foregoing.
b. These records shall be maintained for as long as may be required by applicable
Washington State records retention laws, but in any case for a period of six (6)
years after all funds have been expended or returned to the City, whichever is
later, to ensure proper accounting for all funds and compliance with the
Agreement.
c. If any litigation, claim or audit is started before the expiration of the six (6)
year period provided in Section 4(b) above, the records shall be retained until
all litigation, claims, or audit findings involving the records have been resolved.
a. The City, the Treasury Office of Inspector General, and the Government
Accountability Office, or their authorized representatives, shall have the right
of access to records (electronic and otherwise) of Beneficiary in order to
conduct audits or other investigations.
b. Beneficiary acknowledges that records may be subject to disclosure under the
Public Records Act, Ch. 42.56 RCW.
i. To the full extent the City determines necessary to comply with the
Washington State Public Records Act, Beneficiary shall make a due
diligent search of all records in its possession or control relating to this
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Agreement and the Work, including, but not limited to, e-mail,
correspondence, notes, saved telephone messages, recordings,
photos, or drawings and provide them to the City for production.
ii. In the event Beneficiary believes said records need to be protected
from disclosure, it may, at Beneficiary’s own expense, seek judicial
protection. Beneficiary shall indemnify, defend, and hold harmless the
City for all costs, including attorneys’ fees, attendant to any claim or
litigation related to a Public Records Act request for which Beneficiary
has responsive records and for which Beneficiary has withheld records
or information contained therein, or not provided them to the City in
a timely manner.
iii. Beneficiary shall produce for distribution any and all records
responsive to the Public Records Act request in a timely manner, unless
those records are protected by court order. The provisions of this
section shall survive the expiration or termination of this Agreement.
5. Publications. Any publications produced with funds from this Agreement must display the
following language: “This project is being supported, in whole or in part, by state and local
fiscal recovery funds awarded to the City of Renton, Washington by the U.S. Department of
the Treasury.”
6. Disclaimer by the City and United States.
a. The City expressly disclaims any and all responsibility or liability to Beneficiary
or third persons for the actions of Beneficiary or third persons resulting in
death, bodily injury, property damages, or any other losses resulting in any
way from the performance of this Agreement or any other losses resulting in
any way from the performance of the Agreement, or any subcontract thereto.
This Agreement does not in any way establish an agency relationship between
or among the United States, the City, and/or Beneficiary.
b. The United States has expressly disclaimed any and all responsibility or liability
to the City or third persons for the actions of the City or third persons resulting
in death, bodily injury, property damages, or any other losses resulting in any
way from the performance of this award or any other losses resulting in any
way from the performance of the award of Federal funds to the City under
section 603(c) of the Act, or any contract or subcontract under such award.
7. False Statements. Beneficiary understands that making false statements or claims in
connection with this Agreement may be a violation of federal law and may result in
criminal, civil, or administrative sanctions, including fines, imprisonment, civil damages
and penalties, debarment from participating in federal or City awards or contracts, and/or
any other remedy available by law.
PAGE 7 OF 15
8. Time Period and Expenses incurred in Excess of Program Award Funds.
a. Beneficiary acknowledges that any expenses incurred in excess of Program
Award Funds are the Beneficiary’s sole responsibility and will not be paid by
the City.
b. All funds remain subject to statutory requirements that such funds must be
used for costs incurred by Beneficiary during the period that begins on March
3, 2021 and ends on December 31, 2021, and that award funds for the financial
obligations incurred by December 31, 2021 must be submitted to the City for
reimbursement no later than March 4, 2022.
9. Repayment of Funds. If any funds provided to Beneficiary were used in a manner that is not
consistent or allowable as outlined in this Agreement or in the Federal Terms, Beneficiary
shall return funds to City in the amount determined to be ineligible. Beneficiary further
agrees that it is financially responsible for and will repay the City any and all indicated
amounts following an audit exception which occurs due to Beneficiary’s failure, for any
reason, to comply with the terms of this Agreement. This duty to repay the City shall not
be diminished or extinguished by the termination of the Agreement.
10. Termination. The City reserves the right to terminate this Agreement at any time, with or
without cause by giving ten (10) calendar days’ notice to the Beneficiary in writing. In the
event of such termination or suspension, any unspent grant proceeds shall be
immediately returned to the City.
11. Conflict of Interest.
a. Beneficiary designees, agents, members, officers, employees, consultants,
and any other public official who exercises or who has exercised any functions
or responsibilities with respect to the Program during his or her tenure, or who
is in a position to participate in a decision-making process or gain inside
information with regard to the Program, are barred from any interest, direct
or indirect, in any grant or proceeds of the Program, or benefit there from,
which is part of this Agreement at any time during or after such person's
tenure.
b. The City’s Code of Ethics and Washington State law prohibit City employees
from soliciting, accepting, or receiving any gift, gratuity or favor from any
person, firm or corporation involved in a contract or transaction. To ensure
compliance with the City’s Code of Ethics and state law, the Beneficiary shall
not give a gift of any kind to City employees or officials. Beneficiary also
confirms that Beneficiary does not have a business interest or a close family
relationship with any City officer or employee who was, is, or will be involved
in selecting the Beneficiary, negotiating or administering this Agreement, or
evaluating the Beneficiary’s performance of the Work.
PAGE 8 OF 15
12. Interagency Agreement Amendments. The Parties acknowledge that Treasury or other
agencies may request changes to the Fund or the provisions of the Interagency
Agreement. Any changes or revisions to the Fund or the Interagency Agreement terms
and conditions that are applicable to this Agreement shall be incorporated by
amendment of this Agreement, following written notice by City to the Beneficiary.
13. Waiver/Conflict of Terms.
a. Any waiver by the Beneficiary or the City of the breach of any provision of this
Agreement by the other party will not operate, or be construed, as a waiver
of any subsequent breach by either party or prevent either party from
thereafter enforcing any such provisions.
b. In the event of any inconsistencies between Beneficiary proposals and this
Agreement, the terms of this Agreement shall prevail. Any
exhibits/attachments to this Agreement are incorporated by reference only to
the extent of the purpose for which they are referenced within this
Agreement. To the extent a Beneficiary prepared exhibit conflicts with the
terms in the body of this Agreement or contains terms that are extraneous to
the purpose for which it is referenced, the terms in the body of this Agreement
shall prevail and the extraneous terms shall not be incorporated herei n.
14. Modification. This Agreement may only be amended by written agreement signed by both
Parties.
15. Severability. In the event any term or condition of this Agreement or application thereof to
any person or circumstances is held invalid, such invalidity shall not affect other terms,
conditions, or applications of this Agreement that can be given effect without the invalid
term, condition, or application. To this end, the terms and conditions of the Agreement
are declared severable.
16. Governing Laws. Any lawsuit or legal action brought by any party to enforce or interpret this
Agreement or any of its terms or covenants shall be brought in the King City Superior
Court for the State of Washington at the Maleng Regional Justice Center in Kent, King
City, Washington, or its replacement or successor or the U.S. District Court for the
Western District of Washington. Beneficiary hereby expressly consents to the personal
and exclusive jurisdiction and venue of such court even if Beneficiary is a foreign
corporation not registered with the State of Washington.
17. Indemnification. To the maximum extent permitted by law, Beneficiary shall, at its cost and
expense, protect, defend, indemnify, and hold harmless the City, its directors, officers,
employees, and agents, from and against any and all demands, liabilities, causes of action,
costs and expenses (including attorneys’ fees), claims, judgments, or awards of damages,
arising out of or in any way resulting from the acts or omissions of Beneficiary, its
directors, officers, employees, or agents, relating in any way to Beneficiary’s performance
PAGE 9 OF 15
or non-performance under the Agreement. Beneficiary agrees that its obligations under
this paragraph extend to any demands, liabilities, causes of action, or claims brought by,
or on behalf of, any of its employees or agents. For this purpose, Beneficiary, by mutual
negotiation, hereby waives, as respects the City only, any immunity that would otherwise
be available against such claims under any industrial insurance act, including Title 51
RCW, other Worker’s Compensation act, disability benefit act, or other employee benefit
act of any jurisdiction which would otherwise be applicable in the case of such claim.
These indemnification obligations shall survive the termination of the Agreement.
18.Complete Agreement. This Agreement sets forth the complete expression of the agreement
between the Parties, and any oral representations or understandings not incorporated
herein are excluded. The Parties may execute this Agreement in any number of
counterparts, each of which shall constitute an original, and all of which will together
constitute this one Agreement.
Exhibits
1 – Interagency Agreement Between City of Renton and US Department of Treasury
2 - Small Business Resiliency Grant Fund Program – Downtown Project Area Map
3– Small Business Resiliency Grant Fund Program – Call for Applications
4 – Small Business Resiliency Grant Fund Program – Beneficiary Application
5 – Small Business Resiliency Grant Fund Program –One-Time Reimbursement Form
[SIGNATURES ON FOLLOWING PAGE]
Approved by Patrice Kent via 2/15/2021 emai
1/10/2022
PAGE 11 OF 15
EXHIBIT 1: Interagency Agreement Between
City of Renton and US Department of Treasury
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CAG-21-170
June 28, 2021
Attest:
Jason A. Seth, City Clerk
EXHIBIT 2: Small Business Resiliency Grant Fund Program
Downtown Project Area Map
EXHIBIT 3: Small Business Resiliency Grant Fund Program
Call for Applications
Renton Small Business Resiliency Grant Fund
Renton’s City Council has authorized $600,000 to support a Grant Program to provide relief to
Renton businesses experiencing direct economic hardship due to COVID -19 using Federal
American Rescue Plan funds. This program provides a limited number of $7,500 relief grants to
small, Renton businesses that meet specific criteria. Applications close October 31, 2021 at
11:59 PM. Details and assistance are available at rentondowntown.com/covidrelief
Questions regarding this grant program can be directed to City of Renton at
thrive@rentonwa.gov or calling 425.430.7271. Assistance completing the application in
multiple languages can be requested at re.startup425.org/technical-assistance-request/
Grant Funds May Be Used For:
Grant funds can be used to support the cost of business interruption due to COVID -19 as a
result of required closures, voluntary closures to promote physical distancing, or decreased
customer demand, including:
•Payroll expenses
•Rent expense
•Utilities
•Machinery and equipment (Example: HVAC upgrade)
•Equipment needed to advance technology used in response to COVID-19
•Company revamp or conversion into a virtual business
•Personal Protective Equipment (PPE) and/or sanitation supplies, equipment , and
services
•Modifications and changes temporarily or permanent to business operation s
•Marketing
Eligibility to Apply:
To be eligible, businesses:
•Must have an active Renton business license obtained on or before June 30, 2020 an d
be in good standing.
•Must have generated business revenue of less than $3 million in gross annual revenue.
•Must have a physical office or storefront within the area identified in the map below.
•Must have no more than 50 full-time equivalent employees.
•Must demonstrate negative economic impact due to COVID-19 by demonstrating loss of
revenue.
•Only one application per business will be considered. Chains (national or local with 3 or
more locations) will not be eligible for awards.
•Businesses must be subject to WA State retail sales tax.
•To receive grant payment, the business owner is required to enter into a Grant
Agreement with the City.
Application Process:
•Applications must be submitted no later than October 31 at 11:59 PM.
•Priority will be given to businesses on a first-come, first-serve basis.
•Complete the online application at rentondowntown.com/small-business-grant
•If you do not have the ability to fill out the application and submit online, please email
thrive@rentonwa.gov or call 425.430.7271 to pick up or be mailed a hard copy
application.
Grant Awardee Notification & Disbursement Process:
•Applicants will be notified of grant decisions via e-mail for all online applications and via
letter for hard copy submittals in November 2021.
•If awarded, grant recipients must submit a W-9.
•Funds are distributed only with supporting documentation .
•Grants will be distributed via check payment between November 1 and December 31,
2021.
•Grant funds may be taxable. Please consult your financial advisor/tax professional for
guidance. A 1099 will be issued, as required by the IRS no later than January 2022.
In their application, businesses must:
•Demonstrate a decline in gross receipts due to the COVID-19 pandemic by completing
the revenue loss calculator and providing applicable Dept of Revenue tax return(s).
This project is being supported, in whole or in part, by state and local fiscal recovery funds
awarded to City of Renton, Washington by the U.S. Department of the Treasury.
This project is being supported, in whole or in part, by state and local fiscal recovery funds
awarded to City of Renton, Washington by the U.S. Department of the Treasury.
EXHIBIT 4: Small Business Resiliency Grant Fund Program
Beneficiary Application
CAUTION: This email originated from outside the City of Renton. Do not click links, reply or open
attachments unless you know the content is safe.
From:Renton Downtown
To:Jessie Kotarski
Subject:Covid Grant Submission
Date:Monday, October 18, 2021 4:50:48 PM
Business/Organization Legal Name:blossomawesome inc
Date of Establishment:10/01/2017
"Doing Business As" name :blossom vegetarian restaurant
Business/Organization Physical Address:305 burnett ave s, suite A
renton wa 98057
Contact Name:van nguyen
Contact Email:blossomvegetarian@gmail.com
Contact Phone:(206) 483-8006
Business UBI#:604169517
City Business License #:001
Total Number of Employees:12
Gross Receipts 2019:957970
Assumed Growth Rate of 13.39%:0.1339
Gross Receipts 2020:552031
Gross Receipts Jan-Sept 2021:560633
File Upload:tax-return-2020.pdf
blossom-tax-return-2019.pdf
I attest that the business is open and intends to remain open
or will reopen when the restrictions are lifted. :Checked
EXHIBIT 5: Small Business Resiliency Grant Fund Program
One-Time Reimbursement Form
Small Business Resiliency Grant Fund Program
One-Time Reimbursement Form
GRANT RECIPIENT NAME _______________________________________________
ADDRESS _______________________________________________
GRANT AGREEMENT NO. _______________________________________________
EXPENSES TO BE REIMBURSED (UP TO $7,500):
EXPENSES AMOUNT DATE RANGE
PAYROLL
RENT
UTILITIES
MACHINERY AND EQUIPMENT
TECHNOLOGY EQUIIPMENT
VIRTUAL
REVAMP/CONVERSION
PPE/SANITATION COSTS
MODIFICATION TO BUS.
OPERATIONS
MARKETING
TOTAL EXPENDITURES
☐Attached supporting documentation for expenses to demonstrate, by date, expenses were incurred
between the eligible dates of March 3, 2021 and December 31, 2021. Sufficient documentation
includes:
1.Receipts
2.Payroll reports
3.Copies of cancelled checks
☐Attached IRS Form W9.
☐Submitted a completed invoice within 30 days of execution of the agreement, but in no case after
March 4, 2022.
*REMINDER: Grant funds may .be taxable. Please consult with your financial advisor/tax professional for
guidance. If it is required by the IRS, a 1099 form will be issued to the Beneficiary.
_________________________________________________________________________________
Business Owner/Authorized Agent Signature Date
FOR CITY USE ONLY:
☐Supporting documentation for expenses are determined to be eligible for reimbursement under the Renton
Small Business Resiliency Grant Fund program.
☐Expenditures were incurred between March 3, 2021 and December 31, 2021.
☐An IRS W-9 form has been reviewed.
☐Reimbursement submitted to the City no later than March 4, 2022.
___________________________________________________________________________________
COR Employee Signature Date