fpso-questionnaire-testadminequipay2023-03-16T09:36:04+00:00 FPSO Questionnaire Please enable JavaScript in your browser to complete this form. - Step 1 of 10 Part I: Company Info 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: Visual Text 8. Tax Classification:Tax ClassificationC-Corporation S-Corporation LLC - PartnershipLLC - Sole Proprietor (Sch C)Other 9. Was your business considered “essential” during COVID and permitted to maintain operations during a "Executive (Stop) Order" in late March/early April 2020?YesNoNot Sure Next 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:Date of Local COVID Stop OrderN/A12/03/202013/03/202014/03/202015/03/202016/03/202017/03/202018/03/202019/03/202020/03/202021/03/202022/03/202023/03/202024/03/202025/03/202026/03/202027/03/202028/03/202029/03/202030/03/202031/03/2020Other Date of local COVID Stop Order (If Selected Other) 11. Date Local Stop Order Lapsed: Layout12. 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. Please describe your business: Visual Text PreviousNext Layout 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? Please describe your business: Visual Text PreviousNext Layout14. 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? Please describe your business: Visual Text PreviousNext Layout (copy)15. Changes in Format of Service: Start Date Stop Date Applicable Government Authority: How did the way you delivered your product or service change in 2020 and 2021 (e.g. move to appointment only, place restrictions on performing elective procedures, delivery/take-out only, other), and what impact did this have on your business? Please describe your business: Visual Text PreviousNext Layout 16. Lead generation / Customer Acquisition Changes: Start Date Stop Date Applicable Government Authority: Did you have to change the way you generate new business during COVID (e.g. inability to market in person, go to conferences, host events, etc.) Please describe your business: Visual Text PreviousNext Layout (copy) (copy)17. Travel Restrictions: Start Date Stop Date Applicable Government Authority: Did travel restriction hurt your business in any way, possibly through events you or your customers could no longer attend or host? Please describe your business: Visual Text PreviousNext 18. Supply Chain: Please indicate specific examples, locations, and start and end dates if your business' suppliers were unable to make deliveries of critical goods or materials for your business in a timely manner due to a governmental order. What steps did you take to address these supply chain issues, and what impact did they have on your business? Please describe your business: Visual Text PreviousNext 19. Other: Please provide any additional information you feel may be helpful to better understand how your business operations in 2020 and 2021 were affected by the COVID-19 pandemic. Please describe your business: Visual Text PreviousNext 20. When considering the above modifications or restrictions that were required by governmental order(s), please indicate a reasonable estimate of the following: Please estimate, had governmental orders not been in place, what would provision/production of goods / services have been vs. actual results by quarter in 2020 and 2021: Do not take into account changes in customer behaviors, or inability to hire employees. If your business has multiple divisions/ locations, please provide for the most impacted division or location (if the impact was disproportionate) We understand that this request is highly subjective; please provide as reasonable of estimate as possible Core Product / Service Provided: 2020 Q1N/A; No modification or restrictions were in placeN/A; Modifications or restrictions did not affect Company's ability5%; Modifications or restrictions reduced ability to provide goods or perform services by at least 5%10%; Modifications or restrictions reduced ability to provide goods or perform services by at least 10%15%; Modifications or restrictions reduced ability to provide goods or perform services by at least 15%20%; Modifications or restrictions reduced ability to provide goods or perform services by at least 20%25%; Modifications or restrictions reduced ability to provide goods or perform services by at least 25%50%; Modifications or restrictions reduced ability to provide goods or perform services by at least 50%75%; Modifications or restrictions reduced ability to provide goods or perform services by at least 75%100%; Modifications or restrictions reduced ability to provide goods or perform services by 100% 2020 Q2 N/A; No modification or restrictions were in placeN/A; Modifications or restrictions did not affect Company's ability5%; Modifications or restrictions reduced ability to provide goods or perform services by at least 5%10%; Modifications or restrictions reduced ability to provide goods or perform services by at least 10%15%; Modifications or restrictions reduced ability to provide goods or perform services by at least 15%20%; Modifications or restrictions reduced ability to provide goods or perform services by at least 20%25%; Modifications or restrictions reduced ability to provide goods or perform services by at least 25%50%; Modifications or restrictions reduced ability to provide goods or perform services by at least 50%75%; Modifications or restrictions reduced ability to provide goods or perform services by at least 75%100%; Modifications or restrictions reduced ability to provide goods or perform services by 100% 2020 Q3 N/A; No modification or restrictions were in placeN/A; Modifications or restrictions did not affect Company's ability5%; Modifications or restrictions reduced ability to provide goods or perform services by at least 5%10%; Modifications or restrictions reduced ability to provide goods or perform services by at least 10%15%; Modifications or restrictions reduced ability to provide goods or perform services by at least 15%20%; Modifications or restrictions reduced ability to provide goods or perform services by at least 20%25%; Modifications or restrictions reduced ability to provide goods or perform services by at least 25%50%; Modifications or restrictions reduced ability to provide goods or perform services by at least 50%75%; Modifications or restrictions reduced ability to provide goods or perform services by at least 75%100%; Modifications or restrictions reduced ability to provide goods or perform services by 100% 2020 Q4N/A; No modification or restrictions were in placeN/A; Modifications or restrictions did not affect Company's ability5%; Modifications or restrictions reduced ability to provide goods or perform services by at least 5%10%; Modifications or restrictions reduced ability to provide goods or perform services by at least 10%15%; Modifications or restrictions reduced ability to provide goods or perform services by at least 15%20%; Modifications or restrictions reduced ability to provide goods or perform services by at least 20%25%; Modifications or restrictions reduced ability to provide goods or perform services by at least 25%50%; Modifications or restrictions reduced ability to provide goods or perform services by at least 50%75%; Modifications or restrictions reduced ability to provide goods or perform services by at least 75%100%; Modifications or restrictions reduced ability to provide goods or perform services by 100% 2021 Q1 N/A; No modification or restrictions were in placeN/A; Modifications or restrictions did not affect Company's ability5%; Modifications or restrictions reduced ability to provide goods or perform services by at least 5%10%; Modifications or restrictions reduced ability to provide goods or perform services by at least 10%15%; Modifications or restrictions reduced ability to provide goods or perform services by at least 15%20%; Modifications or restrictions reduced ability to provide goods or perform services by at least 20%25%; Modifications or restrictions reduced ability to provide goods or perform services by at least 25%50%; Modifications or restrictions reduced ability to provide goods or perform services by at least 50%75%; Modifications or restrictions reduced ability to provide goods or perform services by at least 75%100%; Modifications or restrictions reduced ability to provide goods or perform services by 100% 2021 Q2N/A; No modification or restrictions were in placeN/A; Modifications or restrictions did not affect Company's ability5%; Modifications or restrictions reduced ability to provide goods or perform services by at least 5%10%; Modifications or restrictions reduced ability to provide goods or perform services by at least 10%15%; Modifications or restrictions reduced ability to provide goods or perform services by at least 15%20%; Modifications or restrictions reduced ability to provide goods or perform services by at least 20%25%; Modifications or restrictions reduced ability to provide goods or perform services by at least 25%50%; Modifications or restrictions reduced ability to provide goods or perform services by at least 50%75%; Modifications or restrictions reduced ability to provide goods or perform services by at least 75%100%; Modifications or restrictions reduced ability to provide goods or perform services by 100% 2021 Q3N/A; No modification or restrictions were in placeN/A; Modifications or restrictions did not affect Company's ability5%; Modifications or restrictions reduced ability to provide goods or perform services by at least 5%10%; Modifications or restrictions reduced ability to provide goods or perform services by at least 10%15%; Modifications or restrictions reduced ability to provide goods or perform services by at least 15%20%; Modifications or restrictions reduced ability to provide goods or perform services by at least 20%25%; Modifications or restrictions reduced ability to provide goods or perform services by at least 25%50%; Modifications or restrictions reduced ability to provide goods or perform services by at least 50%75%; Modifications or restrictions reduced ability to provide goods or perform services by at least 75%100%; Modifications or restrictions reduced ability to provide goods or perform services by 100% Submit
