COVID-19 Response Fund for New Organization HiddenAward RecievedNeeds Approval/ReviewApril 6, 2020April 20, 2020May 4, 2020May 18, 2020June 1, 20202June 15, 2020Not Approved, see notes.Organization's InformationOrganization Name* Organization Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code EIN Number* Website Is your organization a Non-Profit, 501(c)3* Yes No Upload Non-Profit DocumentationMax. file size: 32 MB.Description of Organization's Main Mission*Is your organization the local chapter for a National Organization?* Yes No National Organization Name National Organzation EIN Number Preparers InformationName* First Last Email* Phone*Emergency Funding Request InformationDescribe the Project or Program that needs relief funding.*Total Amount Requested*Upload Itemized List and Documentation for Funding Requested*Itemized list needs to total amount requested above. Upload up to 2 supporting documentation, total of 3 items may be uploaded. Drop files here or Select files Accepted file types: pdf, xls, xlsx, doc, docx, Max. file size: 4 MB, Max. files: 3. Describe how your Organization has been negatively impacted by COVID-19.*Will the Project/Program directly benefit the citizens of the Virginia Peninsula of Hampton Roads?* Yes No How will the relief funds be used to help support the Virginia Peninsula community during this time?*If you are awarded funds requested, in part or whole, describe how you will be tracking maintaining the documentation for the emergency relief funds.*Please add any additional information you would like to share.By submitting this request I hereby agree to and understand the following:If you are awarded COVID-19 emergency funds, your Organization will need submit a Closeout Statement to Community Knights verifying and detailing how funds were disbursed.* Yes, I agree to submit a Closeout Statement. To the fullest extent permitted by law, the Applicant shall indemnify, defend, and hold harmless Community Knights, Inc., Owner and their respective officers, directors, employees and agents (“Indemnified Parties”) from and against all claims, damages, demands, losses, expenses, fines, causes of action, suits or other liabilities, (including all costs reasonable attorneys' fees, consequential damages, and punitive damages), arising out of or resulting from, or alleged to arise out of or arise from, the performance of Applicant's Work under the Applicant, and any Work Order whether such claim, damage, demand, loss or expense is attributable to bodily injury, personal injury, sickness, disease or death, or to injury to or destruction of tangible property, including the loss of use resulting therefrom; but only to the extent attributable to the negligence of the Applicant or any entity for which it is legally responsible or vicariously liable and; regardless whether the claim is presented by an employee of Applicant. Such indemnity obligation shall not be in derogation or limitation of any other obligation or liability of the Applicant or the rights of Community Knights, Inc. contained in this Application or otherwise. This indemnification shall not be limited in any way by any limitation on the amount or type of damages, compensation or benefits payable by or for the Applicant under any workers' compensation acts, disability benefits acts or other employee benefits acts. This indemnification shall be in addition to any indemnity liability imposed by Community Knights, Inc. Documents, and shall survive the completion of the Work or the termination of the Application. The statements in this Application are true and correct to the best of my knowledge and understanding. I am attaching documentation of my organization's non-profit status with the IRS.I agree.* Yes CAPTCHAHiddenAdditional Notes from AdministratorHiddenAdditional Documentation collected by Administrator Drop files here or Select files Accepted file types: pdf, jpg, gif, png, doc, docx, xls, xlsx, Max. file size: 4 MB, Max. files: 10.