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Elbert County, Colorado 2020 COVID-19 NON-PROFIT ASSISTANCE PROGRAM GRANT APPLICATION – Round 2 Elbert County, Colorado 2020 COVID-19 Non-Profit Assistance Program Grant Application Round 2 (10/19/2020) 1 The purpose of this grant program is to support the ongoing work of Elbert County non-profits that provide services to mitigate or respond to the current coronavirus (COVID-19) pandemic. Non-profits may request funds to support food assistance programs or service expansions related to COVID-19. Applicants will be vetted through a grant application process, and all expenses must be appropriately justified. Grants will be disbursed on a reimbursement basis upon review and approval of documented expenditures. Grant funds under this program do not need to be repaid. Some examples of eligible requests include service organizations that provide food, essential supplies, personal protective equipment, and medical access to individuals impacted by COVID- 19. Elbert County will work with organizations to track expenditures and ensure that funds can be reasonably spent within the designated timeframe. All funding requests must align with the CARES Act guidelines. This means that all expenditures must be directly related to COVID-19, not previously budgeted, and incurred between March 1, 2020 and December 30, 2020. In some cases, a non-profit organization may also apply for a grant to reimburse eligible expenses under the County’s COVID-19 Business Relief Grant program. If your nonprofit does not offer programs or service directly related to COVID-19, please complete the application for Elbert County’s COVID-19 Business Relief Grant program. Which nonprofits qualify? 1. The organization can provide proof of non-profit 501(c) or other tax-exempt status and is in good standing with the Colorado Secretary of State as of the application date. 2. The organization has its principal place of business in Elbert County, Colorado. 3. The organization provides COVID 19-related relief services to the residents of Elbert County. 4. The organization can meet the technical requirements of the grant program, including the ability to provide financial records and program validation. 5. The nonprofit has been operating since March 16, 2020. 6. The nonprofit gross annual revenues in 2019 (if applicable) did not exceed $5 million. 7. The nonprofit must accurately disclose whether any staff, volunteers, or board members are (or are not) an employee of Elbert County Government, an Elected Official in Elbert County Government, or a member of an employee’s or Elected Official’s immediate family. How much is the grant? A total of up to $150,000 is available for the grant program as of October 19, 2020. Grants are expected to be awarded in amounts up to $10,000; exceptions to that amount may be authorized on a case-by-case basis. How do I apply? Complete the Grant Application, which can be found online at www.elbertcounty-co.gov. Return the completed application and all the required information via email to [EMAIL REDACTED]. You will receive an email advising you that your application has been received. An incomplete application will delay the review of your application. Listed documentation is a minimum requirement and staff may request additional documentation to determine eligibility. If you have any questions, please email the County’s Public Information Officer at [EMAIL REDACTED], or leave a message at (720) 639-5850. Funding is limited and will be disbursed on a first come, first served basis. Applications for Round 2 are due by November 9, 2020; this deadline may be extended depending on demand. ---PAGE BREAK--- Elbert County, Colorado 2020 COVID-19 NON-PROFIT ASSISTANCE PROGRAM GRANT APPLICATION – Round 2 Elbert County, Colorado 2020 COVID-19 Non-Profit Assistance Program Grant Application Round 2 (10/19/2020) 2 NONPROFIT INFORMATION Name of Nonprofit: Type of Nonprofit 501(c)(3), church): Nonprofit Tax ID number: Address of Nonprofit: Years in Existence: # of Employees (as of date of application): 2019 Revenue: LEADERSHIP INFORMATION BOARD OF DIRECTORS Names of Board members: Executive Director (or other staff member/lead volunteer: Applicant Contact Phone: Applicant Email: What is your organization’s Mission Statement? ---PAGE BREAK--- Elbert County, Colorado 2020 COVID-19 NON-PROFIT ASSISTANCE PROGRAM GRANT APPLICATION – Round 2 Elbert County, Colorado 2020 COVID-19 Non-Profit Assistance Program Grant Application Round 2 (10/19/2020) 3 Please provide a brief explanation of the effects COVID-19 has had on your nonprofits services: Grant Request (Up to $10,000): $ Please provide a full description of the services for which you are seeking funding and how you will implement the services. All services should have a clear correlation to addressing the impacts of the COVID-19 pandemic: Please describe how the need for your organization’s services has grown as a result of the COVID-19 pandemic. What specific outcomes will be achieved by the grant? REQUIRED DOCUMENTS-SEE DOCUMENT CHECKLIST FOR DOCUMENTS ACCEPTED FOR VERIFICATION 1. Proof of non-profit status (IRS Determination Letter) 2. Most recent IRS 990 and 941 forms 3. Completed W9 form 4. Completed application signed by appropriate board or staff leadership. 5. Signed attestation acknowledging grant program terms 6. Most recent financial statements to include current year's approved budget 7. Activity logs for any 60-day period after March 1, 2020 documenting the number of individuals served, activities completed, the number of supplies distributed, or other relevant activities. 8. Payroll reports documenting the number of employees, if any. ---PAGE BREAK--- Elbert County, Colorado 2020 COVID-19 NON-PROFIT ASSISTANCE PROGRAM GRANT APPLICATION – Round 2 Elbert County, Colorado 2020 COVID-19 Non-Profit Assistance Program Grant Application Round 2 (10/19/2020) 4 ACKNOWLEDGMENT AND CERTIFICATION Acknowledgement: I understand that this grant is being provided by Elbert County, Colorado based solely upon the information provided in this application. Certification: I certify that the information provided in this application is true and complete to the best of my knowledge as of the date set forth opposite my signature(s) in this application and acknowledge my understanding that any intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liability and/or criminal penalties. By signing below, I certify that the above statements are true and correct to the best of my knowledge. I understand that a false statement may disqualify the organization from benefits under this program. Signature: Date: