ITRequest@cityofpleasantonca.gov
City of Pleasanton, PO Box 520, Pleasanton, CA, 94566, US
925-931-5083
BUSINESS ASSISTANCE PROGRAM
2. I acknowledge that I will submit the following with this application:
Download Fillable W-9
Download Outdoor Dining Installation Grant Program Itemization of Expenses Form
3. Business Owner/Applicant Name
7. Business Physical Address
8. Business Mailing Address
11. Primary Business Activity (select one)
13. Is the business currently open and operating?
14. How many employees does this business currently employ?
15. Indicate type of business entity (select one):
16. Is this business a franchise?
17. If the business is a franchise, is it independently owned or corporately owned?
18. Does the business have a physical location in the City of Pleasanton?
19. Do you own or lease the establishment at this location?
22. Does the business or owner have any outstanding liens or judgements?
23. Is the business or business owner currently the subject of any litigation, or filed for bankruptcy?
• I certify that my business is in good standing with the City of Pleasanton and does not have any open code enforcement, building code violations or fire cases related to the business. • I certify that no payment received from this grant program will be used to cover costs reimbursed by other sources of funding, including but not limited to federal, state, or local sources or insurance payments. • I understand the maximum reimbursement grant amount per business may not exceed $10,000. • I understand that I am responsible for 100% of the purchase and the City will reimburse up to 50% for eligible expenses as approved by the City. • I hereby certify that my business follows all applicable federal, state, and local laws as well as the State of California and Alameda County COVID-19 regulations and guidelines to receive grant funding. • I agree to inform the City Economic Development Department and Business License Division if the business has a change of ownership, moves location, or closes permanently. Notice may be in writing and received within 30 days of the change. • I understand that the City may be required to issue an IRS Form-1099-MISC for the grant funds. • I acknowledge and agree that any and all federal, state, and local taxes resulting from participation in this program is the responsibility of the business and shall not be paid by the City. • I agree that the City of Pleasanton may determine in its sole discretion whether information submitted through this application is subject to disclosure under the California Public Records Act or through another legal process. • I certify that any contractors performing construction work under this Program has paid prevailing wages pursuant to the requirements of the California Labor Code, Section 1771, et seq. • If business receives grant, business shall hold harmless, defend, and indemnify the City, its officers, agents, and employees from and against all claims for liabilities, losses, penalties, fines, injuries to or death of any person, or damage to any property whatsoever, including without limitation, reasonable attorneys’ fees and costs which the City may suffer or incur arising from or in any way connected to business’ use of grant funds to construct the outdoor installation and the use thereof. • I certify that all the information submitted in this application is true and correct and is subject to audit by the City of Pleasanton.
Agreement of Terms and Conditions
Signature
Date Picker
Please submit the following with this application:
IRS Form W-9
Itemization of Expenses (form)
Copies of all paid invoices, receipts, proof of payment documents (in one PDF)
