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2. Business Information
4. Name of business
6. Name of individual making application
8. Address
9. City
10. State
12. Mailing Address
14. Phone Number
15. Email Address
17. Financial Information
19. Grant funds requested (maximum of $4,000 per application period):
21. Please specify how the grant funds will be used
23. Please upload copies of your receipts and/or invoices
24. Please upload copies of your receipts and/or invoices
26. Please upload copies of your receipts and/or invoices
27. Please upload copies of your receipts and/or invoices
29. By the acceptance of any funds pursuant to this application, and on behalf of myself and my business, I agree:
    1. That I am the owner of the business named in this application.
    2. That my business is an independently owned and operated business with less than 100 employees and with annual revenues of less than six million dollars ($6,000,000).
    3. To release, indemnify, and hold the Town of Davidson harmless with respect to the use of any grant funds.
    4. That the Town of Davidson is providing grant funds only and is not a partner, owner or co-owner, agent, employee, independent contractor, or in any way associated with the ownership or management of my business.
    5. To ensure compliance with all applicable laws, rules, regulations, requirements, and policies affecting the distribution of grant funds, including, but not limited to activities associated with the use of such grant funds, whether or not the work is performed by the grantee or some other third party and whether or not grant funds have been awarded or distributed to any third parties or sub- recipients.
    6. To the extent the applicable laws, rules, policies or requirements are not followed (including, but not limited to representations made by a grantee in its application), the town can take a variety of corrective actions. Among other things, this includes the right of the town to (1) withhold or deny reimbursement of the full amount of the grant to the grantee where there is noncompliance with any applicable law, rule, policy, or requirement (even when such noncompliance is the result of a third party’s action); (2) require the grantee to repay all or part of a grant where improper use of the funds or non-compliance with any law, rule, regulation or requirement has occurred; or, (3) pursue any legal remedies available to the town to seek reimbursement of such funds, including any expenses the town incurs in seeking such reimbursement.
    7. To use the grant funds for the uses described herein and to comply with all terms and conditions associated with the receipt of such funds.
31. Signature
32. Date
34. Date submitted
36. Grant funds awarded
38. Grant funds distributed
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40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

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