Form Center

2. 
3. Community Planning and Development Department
   Sustainability Division
   12400 NE 8 Avenue
   North Miami FL 33161
   305-895-9825
   
5. Personal Contact Information
7. Name (First, Middle, Last)*
8. Email Address*
10. Address*
12. City*
13. State*
14. Zip Code*
16. Cell Number*
17. Work Phone Number
19. Date of Birth
21. U.S Citizen:*

    1. Yes

    1. No
22. If not, are you a Lawful Permanent Resident Alien?*

    1. Yes

    1. No
24. Circle One:

    1. Own

    1. Rent
26. Mailing Address, if different from Home Address:
28. City
29. State
30. Zip Code
34. Proposed Uses of Funding*

    1. Lighting fixtures
    2. Insulation options
    3. Draft/light sealants for windows and doors to conserve energy
    4. Automatic timed devices
    5. Install energy efficient appliances per energy audit

    1. Provide options for solar energy such as fixtures (on a small scale)
    2. Generators
    3. Hurricane Impact windows
    4. EV Charging Stations
    5. Other (if Other, please explain below):
36. Other
40. Business/Property Information
42. Company Name*
43. Company Email Address*
45. Business Address*
47. City*
48. State*
49. Zip Code*
51. Company Phone Number*
53. Describe the nature of your business (What you sell/service you provide).*
55. Business Website*
57. How long in Business:
58. Years*
59. Months*
60. Years of operation at current location:*
62. Number of Current Employees:*
63. Full Time:*
64. Part Time:*
66. Annual Sales:*
68. Lease or Own Business Location*

    1. Lease

    1. Own
70. If Lease, provide the name of your landlord:
72. Landlord Phone:
73. Landlord Email
75. Do you have your landlord’s permission to make the requested grant improvements and/or are your improvements allowed in your current lease agreement?*

    1. Yes

    1. No

    1. N/A
77. Are there any City tax liens filed against the Business Applicant or any Guarantor or Co-applicant?*

    1. Yes

    1. No
79. If yes, please explain:
83. Project Information & Grant Request
85. Amount of Grant Requested:*
87. Estimated Total Project Cost:*
89. Detailed description of how funds will be used and what energy efficient improvement is being made (include a list of items to be purchased, if applicable):*
91. Required Documents for Funding
93. Energy Audit Completion - coordination with FPL (Free) 305-442-0388*
94. Proof of Sustainable Improvement or Bids *
96. Company’s Certificate of Incorporation*
97. Current Lease agreement or deed to the property (must be a commercial lease/space)*
99. Certificate of Use (CU)*
100. City of North Miami Business Tax Receipt*
102. Business Income Tax Return (Form 1120) for the past 2 years
     Year 1*
103. Business Income Tax Return (Form 1120) for the past 2 years
     Year 2
105. Verification of Employees (payroll)*
106. W9*
108. Business Insurance*
109. Copy of IRS determination letter as a non-profit organization (required for all non-profit organizations)
113. Applicants Certification and Electronic Signature Agreement

     By my signature, I (we) certify that I have read and understand the application, criteria and program requirements. I further certify that all of the information I (we) supplied is correct and accurate. All of the owners of the company/organization (regardless of ownership percentage) are aware of this grant and are in full agreement with the business securing financing for this project. My (our) signature(s) represent my (our) agreement to comply with the City of North Miami and the Department of Housing and Urban Development, as it relates to this grant request.
     
     Each Proprietor, General Partner, Limited Partner and Business Owner, owning 20% or more must sign below. For all Non-Profit Organizations, all guarantors must be approved by Community Planning & Development.
     
     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
115. Business Name:
117. By:
119. Electronic Signature
120. Title
121. Date
     Date
123. Guarantors:
125. Name - Guarantor 1
126. Email Address - Guarantor 1
128. Phone Number - Guarantor 1
130. Name - Guarantor 2
131. Email Address - Guarantor 2
133. Phone Number - Guarantor 2
Leave This Blank:


135. 1. Receive an email copy of this form.
136. Email address

     This field is not part of the form submission.

137. Submit Submit and Print

* indicates a required field