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Employers

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#BounceBackContraCosta

Employers

We are in this together

COVID-19 Layoff Aversion Fund Application

  • Application Deadline: December 2, 2020

  • SECTION A: BUSINESS INFORMATION (MUST HAVE AT LEAST 1 EMPLOYEE NOT INCLUDING THE PROPRIETOR)

  • SECTION B: COVID-19 IMPACT

  • SECTION C: LAYOFF AVERSION PLAN

  • Please enter a number less than or equal to 5000.
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    Accepted file types: pdf, png, jpg.
    Accepted file types: PDF, PNG, or JPEG
  • SECTION D: BUDGET

  • 33. Budget Category34. Description35. Cost 
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  • SECTION E: CERTIFICATION BY AUTHORIZED BUSINESS REPRESENTATIVE

  • I hereby certify that I am an authorized representative of the business named above, with the authority to commit the business to legally binding contracts and agreements. I further certify that the information given as part of and attached to this application is true and accurate. I am aware that any false information or intended omissions may subject me to civil or criminal penalties for filing of false public records and/or forfeiture of any funds approved through this program.

    This application does not constitute a contractual agreement. If any portion of the application is approved, a formal agreement between parties will be executed to obligate funds for the approved expenditures. Purchases may not start prior to the effective date of the agreement. Proof of liability insurance and of legal signatory of the business company will need to be provided upon final agreement.

  • Date Format: MM slash DD slash YYYY
  • SECTION F: DOCUMENT UPLOAD

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    Accepted file types: jpg, png, pdf.
    Accepted file types: PDF, PNG, and JPEG

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