Form Center

Microloan Program Final Report Form - for Round One Recipients

2. This form is for Small Business Emergency Microloan recipients of a City-funded microloan (Round One). Please complete this Final Report by no later than 11:59 p.m. on Friday, January 29, 2021.
4. If you are a recipient of a CARES Act-funded microloan, please use the Round Two Final Report form available at https://dublin.ca.gov/microloan.
6. If you have any questions about the form, or require assistance to complete the form, please contact Economic Development Staff by calling 925-833-6650 during business hours.
8. First Name*
9. Last Name*
11. Email:*
13. Business Name *
    (include “doing business as” if any)
15. Business Address*
    (Physical Location)
16. City, State, Zip
18. Website
20. Number of employees currently *
    (include part-time and full-time)
22. Expenditure of Loan Funds
    Note: City of Dublin Small Business Emergency Microloan Funds are to be used only for payment of rent, mortgage, payroll or operating expenses, subject to the restrictions as set forth below, and incurred between March 1, 2020 and December 30, 2020 for business located at the address listed above.
24. Round One (City Funds) Loan Amount*
26. Were all loan funds spent by December 30, 2020? *

    1. Yes
    2. No
27. If no, amount remaining
29. Please specify how loan funds were spent
    Note: total should equal loan amount. Enter "0" if no loan funds were used for that purpose.
31. Rent*
    Amount Spent
33. Mortgage*
    Amount Spent
35. Payroll*
    Amount Spent
37. Operating Expenses*
    Amount Spent
39. Unspent as of 12/30/2020*
    Amount remaining, if any
41. Total*
43. Terms and Conditions
    By checking each box below, Borrower affirms the following statements are true:
45. Borrow affirms that:*

    1. Business is still in operation (in some capacity) or has a clear plan to re-open once the State of California and Alameda County permits re-opening of businesses in your industry.
    2. Business has not undergone change in ownership or address since receiving loan.
    3. Business is in good standing with the City, including to have a current Business License.
    4. Upon request by City, Borrower can provide records to demonstrate that the loan funds have been used in accordance with the Promissory Note.
    5. Such records shall be kept for a period of five (5) years after the full amount of the loan has either been forgiven or repaid.
47. Borrower affirms that loan funds were NOT used for: *

    1. Any expense that has been or will be covered by insurance.
    2. Any expense that has been or will be reimbursed by a governmental assistance program, not limited to the Paycheck Protection Program, the Economic Injury Disaster Loan Program, or any other source.
49. If any "Terms and Conditions" box is not checked, please explain:
51. Thank You
    Thank you for being part of the Dublin business community. If you have any questions about the Small Business Emergency Microloan Program, please reach out to the Office of Economic Development via email at economic.development@dublin.ca.gov or call 925-833-6650.
Leave This Blank:


52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit Submit and Print

* indicates a required field