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Pure Potential Small and Micro Business Grant Application

  1. Section 1

    Eligibility Criteria

    Answers to the following questions are required in order to determine grant eligibility.

    Provide documentation for the response to each answer. 

  2. Has your business experienced hardship recruiting and retaining employees due to the COVID-19 pandemic (since March 2020)?*
  3. Do you need assistance with employee recruitment and retention? *
  4. Do at least 90% of employees (full-time and part-time) at your business receive a pay rate of less than or equal to $50,150 annually?  *
  5. Section 2: Business Information
  6. Select the business type that best describes your business:*
  7. *Important Note about Eligibility: gun shops, pawn shops, cannabis businesses, franchises of national or regional chains, social clubs, home-based business and adult entertainment businesses are not eligible for this grant.
  8. Are your property taxes and water bills current? *
  9. Does the business have any outstanding code enforcement violations?*
  10. Have applied for and/or received any other business aid support through any other local, state and/or federal government, foundation, or any other business aid program since March 16, 2020? *
  11. Businesses that are a part of the program will be expected to self-certify that they are not receiving a small business grant from another government entity, non-profit, faith-based group or other non-governmental entity. This form will be required to be filled out at the time of signing the grant agreement. If self-certification is discovered to be false, the grantee is responsible for 100% repayment of funds to the City of Livonia.
  12. Approved for such funds?*
  13. Appoved for such funds?
  14. Approved for Such Funds
  15. Section 3: Employment Information Information entered in this section should represent the circumstances of the business for which you intend to use any grant funds. When calculating total employees, include yourself and all full-time and part-time employees.
  16. Section 4: Financial Information Answer the following questions to the best of your ability. Applications will be evaluated based on the information provided.
  17. Have you increased your starting pay rate?
  18. Have you offered signing bonuses? *
  19. Monthly Working Capital Costs (amount expended during a typical month for the following expenses):
  20. Cost of goods sold: 
  21. Rent/mortgage: 
  22. Gas and electric: 
  23. Water and drainage: 
  24. Insurance - general liability, property, workers comp, & others - total: 
  25. Taxes - income, sales, payroll, property & any other outstanding tax liability: 
  26. Subscription services - internet, POS, & other: 
  27. Payroll: 
  28. Debt service: 
  29. Additional monthly expenses (include explanation and dollar amounts): 
  30. Section 5: Other Information – Your Business Story
  31. Are you aware of the City of Livonia's programs and are you interested in learning more about we can do? *
  32. Does your company have 5 or fewer employees? *
  33. Completed W9 form 

    Business bank statements (last 2 months) 

    Business incorporation documents 


    DBA License/Certificate from the State of Michigan 

    Most recent business tax return filed. 

    Proof of quarterly tax payments if made quarterly 

    Profit and Loss Statement for the prior two years and quarterly for the current year. 

    Bank statements for the prior two months. 

    Balance sheet prior three years 

    Current balance sheet no older than 90 days 

    Copy of lease or rental agreement, or mortgage, for your commercial premises in Livonia if you are seeking SBG assistance for commercial lease/rent/mortgage. 

    Copy of lease, rent, or mortgage statement showing you are CURRENT on lease, rental agreement, or mortgage 

    Copy of utility bills for utilities for which you seek SBG assistance. 

    Statement of cash flows 

    Signed AFFIDAVIT regarding receipt of other funds. 

    IF YOU ARE A LOW/MOD INCOME OWNER OF A MICRO ENTERPRISE, your most recent personal tax returns are required. 

    Payroll reports for prior year and quarterly reports for current year. 

  35. Leave This Blank:

  36. This field is not part of the form submission.