FPSO Questionare Test-B

Part I: Company Info

Step 1 - 4

1. Business Name (Legal Entity Name):

2. Trade Name (d/b/a):

3. Business Location (include County):

(Please provide statement with additional business locations and descriptions, if applicable)

4. Phone Number (Cell Preferred):

Email

6. Website:

7. Please describe your business:

8. Tax Classification:

Was your business considered “essential” during COVID and permitted to maintain operations during a "Executive (Stop) Order" in late March/early April 2020?

Part II: Full or Partial Suspension of Operations ("FPSO")

Your FPSO eligibilitycan be established if the operation of your business was fully or partially suspended due to orders from an appropriate governmental authority due to COVID19. When completing this section please use 2019 as a base year to compare your operations in both 2020 and 2021. The threshold for qualification is met if a government COVID order caused at least a 10% impact to at least 10% of your business vs. 2019 levels.

10. Date of Local COVID Stop Order:

11. Date Local Stop Order Lapsed:

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12. Social Distancing/Capacity Limit:

Start Date

Stop Date

Applicable Government Authority:

Please describe the steps you took to comply with specific capacity restriction(s) (e.g., 25%, 50% capacity, 6 feet, reduced working hours, smaller crews, etc.) and the impact it had on your business in 2020 and 2021.

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13. Reconfigured Working Space / Reduced Hours:

Start Date

Stop Date

Applicable Government Authority:

Did you reconfigure your workspace and/or reduce hours to comply with government orders, and how did this impact your business?

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14. Enhanced CDC/OSHA/Hygiene Guidelines:

Start Date

Stop Date

Applicable Government Authority:

Did you have to follow enhanced CDC or OSHA guidelines or implement new hygiene and sanitation procedures? What investment was required and what impact did it have on your operations?

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