Downtown Revitalization Improvement Program Loan Application
Date of Application: ______/______/______ Applicant Information Applicant Name: _________________________________________________________ Business Name: __________________________________________________________ Street Address: __________________________________________________________ City: ________________________________ State: _______ Zip: _________________ Phone Number: ________________________ Fax: ____________________________ E-‐mail address: __________________________________________________________ Building Information Address of building where work is to be done: _________________________________ Years in Business: _________ Property is: ____ Occupied by Owner ____ Leased Name of Tenant if Leased: __________________________________________________ Financial Information Estimated Cost of Improvements: $_________ Total Amount Requested $_________ Requested Payment Structure: ______________________________________________ Existing Loans Payable (Property Owner) Creditor Name & Original Loan Date Term Interest Outstanding Collateral Account Number Amount Mo/Yr Rate Balance
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Improvement Information Types of Improvements Planned (check all that are applicable): _____ Stationary Fixtures _____ Plumbing _____ Structural Alterations _____ Electrical Work _____ Wall Improvements _____Flooring _____ Other (describe) _____________________________________________________ Brief Description of Improvements to be made: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Please attach the following: 1. Two separate cost estimates from licensed contractors (if work can be done locally, we encourage bids to be sought from Dodge City/ Ford County Vendors) 2. Drawings that show work to be done (if applicable) 3. Pictures of building in present condition 2
WAIVER OF LIABILITY I agree to the repairs proposed in the attached estimate and hereby release Main Street Dodge City and the City of Dodge City, from any and all claims of liability arising from the Downtown Revitalization Façade and Exterior Improvement Grant Program. _____________________________ ___________________________ Date Signature of Property Owner _____________________________ _____________________________ Date Signature of Business Owner Date received by __________________________ by _____________________________ ECONOMIC RESTRUCTURING COMMITTEE RECOMENDATION APPROVED OR REJECTED Signature_____________________ Date _________ Notes: DESIGN COMMITTEE RECOMENDATION APPROVED OR REJECTED Signature_____________________ Date _________ Notes: FINAL APPROVAL (MAIN STREET BOARD OF DIRECTORS) APPROVED OR REJECTED Signature_____________________ Date _________ AMOUNTED AWARDED: $___________________
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