Business will sign the following certifications in the application:

• I certify that I have the authority to apply for this grant on behalf of the business described herein.

• I certify that my business is for-profit and has 5 or fewer employees including all owners (full-time equivalent). I do not operate as an independent contractor. My business is not a non-profit.

• I certify that my business has a valid and active Santa Ana Business license, Certificate of Occupancy or Home Occupation Permit issued by the City of Santa Ana, and my business complies with and is not in violation of any City codes and regulations.

• I certify that my business does not sell or promote a majority of items such as alcohol, tobacco, cannabis, firearms, and/or adult entertainment.

• I certify that my business is currently operational and will be at the time of reimbursement. The grant is for businesses that intend to remain open and operational after receipt of grant.

• I agree that if approved, reimbursements will be issued for paid receipts for business expenses according to approved costs as identified by the City.

• I understand that applying for the grant is not a guarantee of funding and the City has the right to reject any and all applications.

• Funding is not transferable and other restrictions may apply.

• I understand that eligibility for this program is based on Business Owner Income Qualification (LMI) – business owner(s) must be at, or below, the low-moderate income limits set by the U.S. Department of Housing and Urban Development (HUD) listed in the table provided in these grant guidelines (Section II Eligibility Requirements). Applicants must use total family household size as their measure of eligibility. If the business has more than one owner, at minimum, 51% of the ownership stake must be held by LMI qualified business owner(s).

• I agree to provide the City of Santa Ana and its employees additional documentation for audit and reporting purposes and to assess the benefits derived from participating in the program. Such information may include, but is not limited to, profit loss statements, payroll records, and income certifications of new or retained employees.

• This grant program is supported with Federal funding from the U.S. Department of Housing and Urban Development, Community Development Block Grant Program. According to Title 18, Section 1001 of the U.S. Code, it is a felony for any person to knowingly and willingly make false or fraudulent statement to any department of the United States Government. I understand that any willful misrepresentation on this application could result in a fine and/or imprisonment under provision of the United States Criminal Code U.S.C. Title 18, Section 1001.

• By providing my electronic signature below, I certify under penalty of perjury that all the information on this application is correct to the best of my knowledge and belief, and I acknowledge that such information is subject to verification. I also acknowledge that my failure to provide necessary documents within a reasonable period of time or falsification of information shall be grounds for repayment of funds, and that I may be subject to prosecution under the law. Any violation of the program guidelines will result in the business promptly repaying the City any amount issued pursuant to this program. I authorize the release of said information to local, State and/or Federal agencies and to City of Santa Ana staff within five years of this date.

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