After Image Syling Salon 12/28/2020

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