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The following form may request personally identifiable or protected health information. Please see our
for details. This form is encrypted. SSL is on to ensure a higher level of security. A recaptcha must be completed before submission, you cannot save progress, and you cannot receive an email copy of the form.
CARES Act Comprehensive Business Stability Award Application
This form has been modified since it was saved. Please review all fields before submitting.
Businesses can apply for assistance to stabilize operation and pay for COVID-related expenses incurred from March 1, 2020 through December 30, 2020.
Award funds may not be used to pay Jefferson County Real Property taxes.
The CARES Act prohibits the use of grant funds to replace County revenues.
Requests for funding to offset property taxes will be denied.
Awards will depend upon the number of applicants, availability of funds and demonstrated need. Considerations will be based on loss of revenue due to COVID-19 impact compared with 2019 financial statements and costs.
Once funding decisions are made, successful applicants will receive an award notification which will outline the terms and conditions to receive funding.
I have read and agree to the above terms and conditions, as well as those on the initial web page.
Please note, every question on the application must be completed. Please carefully review your application before submitting.
Have you filled out the CARES Act Business Stability Assessment Worksheet?
You must fill this out before completing this application.
Please upload your completed CARES Act Business Stability Assessment Worksheet
Please save and upload within the Excel spreadsheet. If you use other spreadsheet software, please save and upload as a PDF file.
Go back to the CARES Act Business Stability Assessment Worksheet
CARES Act Grant Funding Program web page
If you have not filled out your CARES Act Business Stability Assessment Worksheet, please go back to the CARES Act Grants Funding page (link above) to do so. Once you have completed that CARES Act Business Stability Assessment Worksheet (step one), please return to this online application (step two) to complete your request the award.
Name of Business
Doing business as (DBA)
EIN/FEIN (Employer Identification Number aka Tax ID)
Note: If you are a sole proprietor you may need to use your Social Security Number.
DUNS number (Data Universal Numbering System)
Jefferson County will also need the Dun & Bradstreet D U N S Number, the unique nine-digit identifier for your entity
Don't know your DUNS number?
Find information on a DUNS number
You can obtain one from the Dun & Bradstreet website.
System for Award Management (SAM) number
For CARES Act federal funding, every recipient needs to register with The System for Award Management (SAM), which is an official website of the U.S. government. You are not required to have this number to apply for this award, but you must be registered in order to receive the award. There is no cost to use SAM.
Don't have or know your SAM number?
Go to the SAM website to register for free with the U.S. government
Address Line 2, if needed
Note: Name of person should Jefferson County have questions regarding your application.
Contact's Email address
Address Line 2, if needed
Contact Phone Number
Best number to reach you.
What type of business?
-- Select One --
Natural Resources and Mining
Trade, Transportation and Utilities
Professional and Business Services
Education and Health Services
Marijuana Industry (note: marijuana businesses are not eligible for this grant)
If you selected "Other Services," please explain further
Fill in the type of business or services you provide.
Are you registered and in good standing with the Colorado Secretary of State?
Note: you must be in good standing with the Colorado Secretary of State to be eligible.
Note: Businesses not in good standing with the Colorado Secretary of State are not eligible for this grant.
Are you current with State of Colorado sales and withholding taxes?
Note: you must be current with State of Colorado sales and withholding taxes to be eligible.
Note: Businesses that are not current with State of Colorado sales and withholding taxes are not eligible for this grant.
Is the entity that would receive the grant funds currently in bankruptcy proceedings or does the entity plan to file bankruptcy within the next six months?
Is your business located in Jefferson County?
Note: The business MUST be located within Jefferson County to be eligible for this grant.
Have you been in business in Jefferson County at least since October 1, 2019?
Note: This business MUST have been in business since Oct. 1, 2019, in Jefferson County to be eligible for this grant.
How many employees do you anticipate to return to work within 60 days if awarded this grant?
What are the impacts you've seen to your business resulting from COVID-19?
Please check all that apply.
Business closure due to stay-at-home order
Reduced hours of operation
Decline in revenue
Increased operating costs (e.g. employee paid leave from Family First)
Inability to serve customers
If you selected 'Other,' please explain further.
How will the funds be used to help your business stabilize to full operation?
Please attach a copy of your most recent IRS Tax filing form for your business.
Please attach a copy of your COMPLETED and SIGNED W9
Blank W-9, if needed
For your convenience, you can download the blank W9 from the IRS website.
Signature Authority. If your application were approved, who would sign the agreement and what is that person’s title?
Is there any other information you would like to provide us regarding your application?
Electronic Signature Agreement
By clicking "I agree" you represent that that information provided in this application is true, correct, and complete to the best of your knowledge. You further understand that any false or misleading statements may result in denial or revocation of the award. By clicking 'I agree' you also covenant and agree that you will comply with all the requirements for the award and sign an award agreement if your application is approved.
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