Pre-Application Form

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General Business Information ( denotes required fields)*

Business Name *

Address *

Address 2

City *

State *

Zip *

Contact Name *

Contact Phone *

Contact Email *

Website URL

Federal Employer Identification Number (EIN)

Federal Unique Entity Identifier (UEI)

Business Structure (sole proprietorship, LLC, corporation, partnership, etc.) *

Owner/Members and percentage ownership *

Years and months in business (from business start date)

Years

Months

Number of years the business has been in the current location
Years

Number of years the business has been at its proposed location
Years

Describe the business and its products and services. *

Is the business (select all that apply): * A business that is at least 51% owned and controlled by one or more minority persons (a "MBE") A business that is at least 51% owned and controlled by a woman (a "WBE") Registered with the State of Connecticut as a minority or women-owned business Declines to provide that information None of the above / I prefer not to answer

Is the business current on all tax obligations to the Internal Revenue Service, the State of Connecticut, and the City of Meriden? *
Yes No

If no, please explain.

Is the business compliant with the Connecticut Department of Labor Office of Unemployment Assistance and all applicable state and federal employment laws and regulations, including but not limited to minimum wages, unemployment insurance, workers' compensation, and child labor? *
Yes No

If no, please explain.

Project Information

Project Name *
Brief description of project *
Address of project *
Estimated project timeline and completion date *
Estimated total cost of project *
Estimated amount of grant request for project - (Code Correction Assistance or Vanilla Box Assistance - $300,000 Maximum; or Economic Development Funding - $50,000 Maximum) *
Does the business own or rent at its project location? *

Required Cash Matching Funds: (50% or 25% for Projects Located in Meriden Transit Oriented District)

Describe Source of Matching Funds: *
List Names of Parties Supplying Matching Funds: *
List Expenditures Prior to Pre-Application Date Listed Included in Matching Funds: *

Affirmations and Acknowledgements

The Applicant is not delinquent in paying taxes or other amounts to the federal government or to the State of Connecticut or City of Meriden.
Submission of this pre-application does not guarantee being selected to submit a detailed application for funding consideration. Approval of applications will not be completed until the detailed application is approved and a grant contract is executed by the successful Applicants and the City of Meriden. Grant funds may not be used to repay loans drawn before approval of the final detailed grant application.
The Applicant acknowledges that all Project expenses funded by grant funds must be purchased through the Purchasing Department of the City of Meriden under City purchasing guidelines and that qualifying expenses will be reimbursed to the Applicant after the work is completed and paid by the Applicant and required documentation is submitted to the City for approval. State and federal prevailing wage regulations may be required based upon the proposed Project and funding sources.
This pre-application and any non-exempt information submitted are public documents and subject to the Freedom of Information Act.
The City of Meriden is relying on the accuracy of this pre-application and all representations made by the applicant.
The City of Meriden may request additional information to consider this pre-application and may approve or disapprove any pre-application or detailed application or change program guidelines at any time at its sole discretion.
Successful pre-applicants will be directed to the City of Meriden’s Applicant Concierge and invited to submit a detailed application with their assistance. No funding will be approved without a completed and accepted full detailed application. Detailed additional information will be required in the detailed application, including, without limitation, for building projects requiring City permits, submission of plans that have been stamped as approved by a CT licensed architect, engineer, or other authorized design professional.

Applicant Certification

THE UNDERSIGNED CERTIFIES THAT:

The Applicant affirms and acknowledges to have read, understands, and accepts the above Affirmations and Acknowledgements.
The Applicant has reviewed the Meriden Growth and Investment Funds Program Description containing the most current guidelines and limitations on applicants, approval of applications and use of grant funds.
The information contained in this document is true, complete, and accurate; and
Has the capacity and legal authority of the Applicant to submit this application.

Applicant Name: *

Signature of Authorized Applicant Representative *

Date *

Printed Name and Title *