Laserfiche WebLink
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 1 make the following statements that are true: <br /> 1. I hereby state that I am the owner of[enter legal business name & DBAI t_ )I (A,L. L cI I r(C_ FT("J A k y(f C 1 lei 11 <br /> (the "Applicant") and am duly authorized by the Applicant to make the certifications contained in this Reporting Form on <br /> behalf of the Applicant, <br /> 2. I hereby state and certify to the City of Everett as follows(please check ONE and fill in blank): <br /> On any date on or after March 13, 2020,economic injury, business interruption or any other kind of impact related to .11 <br /> COVID-19 WAS experienced by[enter legal business name& DBA] iU Cti. i k t L 1 <br /> C On any date on or after March 1.3, 2020, economic injury, business interruption or any other kind of impact related to <br /> COVID-19 WAS NOT experienced p by [enter legal business name& DBA] <br /> tip <br /> EVERETT <br /> WASHINGTO N Everett CARES Small Business Grant Program Round 3 page 8 <br />