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PART 2. INSURANCE <br /> Insurance assistance received for COVID-19 Pandemic National Emergency related losses.insurance company information must be <br /> completed even if the business did not receive insurance monies as compensation for the COVID-19 Pandemic National Emergency, If <br /> there was insurance on the damaged property,the name of the insurance company,policy number,claim number,and settled <br /> amount, if any,must be completed. Copies of the insurance policies in place at the time of disaster,and any correspondence with the <br /> insurance companies on or after March 13,2020, must be attached to the form(Section 4 below). <br /> Under the Everett CARES Small Business Grant Program I make the following statements that are true: <br /> 1. I hereby state that I am the owner of[enter legal business name&DBA] Absolute Hair INC <br /> bi <br /> (the"Applicant")and am duly authorized by the Applicant to make the certifications contained in this Reporting Form on <br /> if behalf of the Applicant. <br /> 2. I hereby state and certifyto the Cityof Everett as follows(please check ONE and fill in blank): <br /> � <br /> QOn any date on or after March 13,2020,economic injury,business interruption or any other kind of impact related to <br /> COVID-19 WAS experienced by[enter legal business name&DBA] Absolute Hair Inc <br /> ❑ On any date on or after March 13,2020,economic injury, business interruption or any other kind of impact related to <br /> COVID-19 WAS NOT experienced by[enter legal business name&DBA] <br /> E v E R E T T Everett CARES Small Business Grant Program Round 3 ; page 8 <br /> II=EWASHINGTON p <br />