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2. LEAP Program Application Overview

   The City is offering the Local Economic Assistance Program (LEAP) to small businesses in the community. The LEAP program is financed with Federal American Rescue Plan Act (ARPA) funds through the Department of the Treasury. Eligible businesses have the opportunity to receive up to $10,000 in grant funds. To qualify, the business must be able to show they have experienced a negative economic impact due to COVID-19 and must have 50 or fewer employees.  To find out more information and see if your business qualifies for this program, please visit www.jurupavalley.org/LEAP or click the link below.

4. Language Translation
   This form is available in English, Spanish, and over fifty (50) other languages. Use the Google Translate tool located on the bottom right of the screen to select your language preference.
6. Traducción de Idiomas
   Este formulario está disponible en inglés, español y en más de cincuenta (50) idiomas. Use la herramienta ‘Google Translate’ ubicada abajo a la derecha de la pantalla para seleccionar su idioma preferido.
8. Link to LEAP Web Page
   Jurupa Valley LEAP Web Page
12. Section 1: Applicant Business Owner Information
14. (1.1) Name of Business Owner*
    Provide the name of the business owner. For businesses with multiple stockholders, provide name of the chief executive/administrative officer.
16. (1.2) Home Address of Business Owner*
    Provide the full home address of the business owner (Number, Street, City, State, and Zip)
18. (1.3) Phone Number of Business Owner*
    Provide the phone number of business owner, including area code.
20. (1.4) Email Address of Business Owner*
    Provide email address of business owner.
24. Section 2: Business Information
26. (2.1) Name of Business*
    Provide the name that the business conducts business as (ie: name of restaurant).
28. (2.2) Legal Name of Business*
    Provide the full legal name of the business entity conducting business.
30. (2.3) Street Address of Business (Number & Street)*
    Provide the street address of the business.
32. (2.4) City, State, and Zip of Business*
    Provide the City, State, and Zip code for the business. Only Jurupa Valley businesses are eligible.
34. (2.5) Business Phone Number*
    Primary phone number for business.
36. (2.6) Business Email
    If applicable, email address that the business uses to conduct business.
37. (2.7) Business Website
    If applicable, provide the website for the business.
39. (2.8) Legal Nature of Business*
    -- Select One --C-CorporationS-CorporationLimited Liability Company (LLC)Sole ProprietorshipPartnership (LP or LLP)

    Select the legal nature of the business.

41. (2.9) Type of Business*
    -- Select One --RestaurantCatering Service or Food SupplierRetailPersonal Care (barber shop, beauty salon, nail salon, etc.)Fitness or Recreation CenterLogisticsManufacturingAuto Dealer or Repair ShopOther

    Which one of these categories best describes your business? If none, select other.

43. (2.9a) Other Type of Business*
    If you answered "other" in the previous question about the type of business you have, please describe what your business is.
45. (2.10) What year did you start your business in Jurupa Valley*
    -- Select One --2020201920182017201620152014201320122011Before 2011
47. (2.11) Current Number of Full-Time Employees (40 hrs/wk)*
    Currently, how many full-time employees (40 hours per week) work directly for your business? If none, put zero.
48. (2.12) Current Number of Part-Time Employees*
    How many part-time employees (less than 40 hours per week) currently work for your business? If none, put zero.
50. (2.13) Grant Amount Requested (Up to $10,000 available for small businesses with 50 employees or less) *
54. Section 3: Business Specifics & COVID-19 Impact
56. (3.1) Jurupa Valley Business Registration (Date business was registered with Jurupa Valley)

    Did you receive your Jurupa Valley Business Registration as required? If so, when? If no, you need to obtain a business registration before submitting this form. Please contact City Hall at (951) 332-6464 for more information.

58. (3.2) How was your business impacted by COVID-19? (Check all that apply)

    1. Business was deemed "non-essential" by the State, County, or City
    2. Business sales/revenue is down more than 25% since March 1, 2019 (or comparable period in 2019)
    3. Business had to lay off at least one of its employees due to COVID-19
    4. One or more of the employees have contracted COVID-19
    5. Other
60. (3.3) Other Impact of COVID-19
    If you selected "Other" from the question above, please describe how COVID-19 has impacted your business.
62. (3.4) Prior to March 1, 2020 - How many owners worked at the business?*

    Some businesses have multiple owners.

64. (3.5) Prior to March 1, 2020 - How many full-time employees worked at your business?*
    Full-time employees are employees that work 40 or more hours per week. If none, put zero.
66. (3.6) Prior to March 1, 2020 - How many part-time employees worked at your business?*
    If none, put zero.
68. (3.7) What was the total business revenue from 2019?*
    Enter total revenue or gross sales of the business for the period of January 1, 2019 to December 31, 2019.
70. (3.8) What was the total business revenue for 2020?*

    Enter total revenue or gross sales for the business for 2020.

72. (3.9) Has your business received any Federal COVID-19 financial assistance?*
    -- Select One --YesNo

    Has your business received any funds through the Economic Injury Disaster Loan Program, Paycheck Protection Program, or any other Federal assistance program?

74. (3.9a) COVID-19 Financial Assistance - If yes on question 3.9, what period did the already granted funds cover?
76. (3.10) Has your business applied to receive any Federal COVID-19 financial assistance?*
    -- Select One --YesNo

    To date, has your business applied to receive a Federal Economic Disaster Loan, Paycheck Protection Program assistance, or any other Federal economic assistance program?
78. (3.11) How will your business use funds received through this program? (Check all that apply)*

    1. Payroll Payments
    2. Rent Payments
    3. Mortgage Payments
    4. Utilities
    5. Other Operating Costs
80. (3.11a) If "Other Operating Costs" selected, please describe.
84. Section 4: Job Creation & Retention
86. (4.1) Eligible Full-time Job(s) Created or Retained if LEAP Funds Received*

    How many full-time LEAP-eligible jobs will be added or retained with the use of grant funds? If none, put zero.

88. (4.2) Eligible Part-time Job(s) Created or Retained if LEAP Funds Received*

    How many LEAP-eligible jobs will be added or retained with the use of grant funds? If none, put zero.

92. Section 5: Supplemental Questions
94. (5.1) Is your business a for-profit business?*
    -- Select One --YesNo, our business is a non-profit, religious, or charitable organization
96. (5.2) Is your business wholly owned and operated with the City of Jurupa Valley?*
    -- Select One --Yes, the only physical location that my business has is in Jurupa ValleyNo, my business has other physical locations outside the City of Jurupa Valley
98. (5.3) Do you have a lease on your current business operating location?
    -- Select One --YesNo
100. (5.4) Do you have a mortgage on your current business operating location?
     -- Select One --YesNo
102. (5.5) Is your business a home-based business?*
     -- Select One --YesNo

     At this time, home-based businesses do not qualify to receive LEAP funds.
104. (5.6) Does your business have any active code violations with the City of Jurupa Valley?*
     -- Select One --Yes, we have an active code enforcement case that we are working to resolveNo, we do not have any active code enforcement cases with the CityI am not sure
106. (5.7) Does your business currently operate in a way that is consistent with COVID-19 public health guidelines issued by the County of Riverside? *
     -- Select One --Yes, our business is in full compliance with guidelines provided by the County of RiversideNo, our business is not in full compliance with guidelines provided by the County of RiversideI am not sure
108. (5.8) Are you or your business currently or recently involved in any litigation?*
     -- Select One --YesNo
112. Section 6: Narrative (Optional)
114. (6.1) COVID-19 Impact Statement Short Narrative (Optional)
     Please provide a statement regarding how your business was specifically affected by COVID-19, including information that has not been requested in other parts of this form.
118. Section 7: Acknowledgement & Authorization
120. (7.1) Authorization to Submit Application*

     By submitting this form, I understand that this grant opportunity is being provided by the City of Jurupa Valley to provide relief for businesses impacted by COVID-19. I understand that this is Phase 1 of 3 of the application process. I understand that if I receive notice that my business qualifies to participate in the LEAP grant process, I will need to provide further documentation to be verified by the City of Jurupa Valley. Receiving preliminary approval by submitting this Phase 1 application does not guarantee grant funds for my business. I understand that to ultimately receive grant funds, my business must show negative economic impacts due to COVID-19 in accordance with the Local Economic Assistance Program guidelines. By submitting this application, I am certifying that no outstanding tax liens or legal judgments against my business currently exist. I agree that by submitting this Phase 1 application, I am authorizing the City of Jurupa Valley to verify sources of income, including, but not limited to, the submittal of a record request to the California Employment Development Department and other agencies administering unemployment benefits. By submitting this form, I certify that the above statements included in this application are true and correct to the best of my knowledge. I understand that a false statement may disqualify me from benefits.

     1. I authorize this application to be submitted
122. Full Name Authorization*
     Provide the full name of the person that is authorizing the submission of this form. This will serve as your electronic signature.
123. Date of Authorized Submittal*
     Date of Authorized Submittal

     Provide the date for the authorization/electronic signature.

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125. 1. Receive an email copy of this form.
126. Email address

     This field is not part of the form submission.

127. Submit

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