SAMPLE- Visit FirehouseSubsFoundation.org to apply online. Firehouse Subs Public Safety Foundation Grant Application

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1 SAMPLE- Visit FirehuseSubsFundatin.rg t apply nline. Firehuse Subs Public Safety Fundatin Grant Applicatin 1

2 SAMPLE- Visit FirehuseSubsFundatin.rg t apply nline. Cngratulatins! Yur rganizatin has met Firehuse Subs Public Safety Fundatin s pre-qualificatin criteria t be cnsidered fr a grant. STOP HERE & PRINT THIS PAGE. Yu will nt be able t return t this page. Thank yu fr yur interest in Firehuse Subs Public Safety Fundatin, where we are cmmitted t giving back t cmmunities by supprting first respnders and public safety rganizatins with life-saving equipment and funding resurces. Grants are cnsidered n a quarterly basis by the Fundatin s Bard f Directrs, and ALL applicants will be ntified f a decisin regarding their applicatin within six weeks f the clse f the grant deadline. PLEASE APPLY EARLY Due t the large number f applicatins, technical assistance is available at fundatin@firehusesubs.cm until tw weeks befre the deadline. Any inquiries received after that time will nt be addressed until the next grant cycle. PLEASE: DO NOT send inquiries t the Firehuse Subs Care Center r thrugh the Firehuse Subs EMS survey. DO NOT phne the Firehuse Subs main ffice r Firehuse Subs restaurants with grant inquiries. The grant prcess is a partnership. We greatly appreciate yur cperatin and cmpliance. A PRINTABLE COPY OF THE APPLICATION FORM CAN BE DOWNLOADED HERE. THE PDF IS AVAILABLE AS A REFERENCE FOR YOUR CONVENIENCE, IT IS NOT MEANT TO BE SUBMITTED. 2

3 SAMPLE- Visit FirehuseSubsFundatin.rg t apply nline. APPLICATION GUIDELINES AND REQUIRED ATTACHMENTS STOP HERE & PRINT THIS PAGE. Yu will nt be able t return t this page. Please prepare the fllwing attachments befre yu cntinue. We cannt cnsider yur applicatin if any f the required infrmatin is missing. Backgrund/Histry Brief histry f yur department r rganizatin, and hw this grant will benefit yur cmmunity Vendr Equipment Qute Online qutes will nt be accepted. Yu must prvide an fficial vendr qute with the fllwing infrmatin t be grant eligible. Submitted qutes MUST meet the requirements belw, please read carefully Must be dated within six mnths f the applicatin deadline Vendr sales representative first and last name & cntact infrmatin ( and/r phne number) must be included Must cntain the name & physical address f yur rganizatin, and a cntact persn Must cntain nly the item(s) pertaining t yur grant request The ttal dllar amunt and equipment quantities in the vendr qute MUST MATCH the ttal that yur department is requesting Include sales tax if applicable Include an estimated freight charge if applicable The cst f maintenance plans and extended warranties are nt permissible Firehuse Subs Public Safety Fundatin will nt be respnsible fr restcking fees r csts related t errrs within yur qute Firehuse Subs Public Safety Fundatin will nt be respnsible fr additinal shipping csts r tax nt included in the submitted qute Nte: When requesting a qute frm yur vendr, we recmmend sharing ur qute requirements with the sales representative and making them aware the qute is fr a Firehuse Subs Public Safety Fundatin grant applicatin. Mst Recent Financial Infrmatin Yur financials must be n mre than tw years ld, and include bth revenue and expenses meet the requirements belw. One f the fllwing ptins must be submitted. A recent - within ne mnth - Balance Sheet which cnsists f Assets and Liabilities A recent - within ne mnth - Prfit & Lss Statement als called an Incme Statement A current year annual budget shwing prjected incme and expenses A previus year audit r 990 Equipment Inventry Please include a list f apparatus such as vehicles and ther majr equipment. The lists we receive vary in length depending n the size f the department. Fr mre details, please reference the FREQUENTLY ASKED QUESTIONS & TIPS n the next page. 3

4 SAMPLE- Visit FirehuseSubsFundatin.rg t apply nline. FREQUENTLY ASKED QUESTIONS & TIPS STOP HERE & PRINT THIS PAGE. Yu will nt be able t return t this page. Please Apply Early. Technical assistance is available thrugh fundatin@firehusesubs.cm until tw weeks prir t the grant deadline. Please d nt cntact area restaurants r Firehuse Subs Care center with grants questins. What des the Firehuse Subs Public Safety Fundatin supprt? Our Missin is t impact the life saving capabilities, and the lives f lcal heres and their cmmunities. This is accmplished by prviding life-saving equipment and preventin educatin tls first respnders and public safety rganizatins. Requests such as event spnsrships, exercise equipment, and family supprt services are nt supprted by ur Fundatin. Is this grant nly available fr Fire Departments? N. Law enfrcement, EMS, public safety rganizatins, nn-prfits and schls are encuraged t apply fr lifesaving equipment. What are the mst cmmn reasns a grant applicatin is marked incmplete? Online qutes are nt permissible Organizatin must be a registered nn-prfit Qute des nt match the dllar amunt r quantity requested in the grant applicatin Qute is missing pertinent vendr and/r applicant cntact infrmatin Qute includes item(s) that are nt being requested in the grant Attachments are upladed that dn t pertain t the grant Attachments are missing Attachments that are nt saved as.dc,.pdf,.jpeg r.xlsx Financials are utdated r d nt include bth revenues and expenses Alternate cntact infrmatin is missing Can an individual apply fr a fire schl r plice academy schlarship? N, hwever, the Fundatin may partner with accredited schls fr schlarship prgrams fr individuals pursuing r advancing their career in the public safety sectr. Is the Firehuse Subs Public Safety Fundatin grant a matching grant? There are n matching funds invlved in ur rganizatin s grants prgram. If my request is mre r less than $20,000 will it be denied? $15,000-$25,000 is a guideline. What financial infrmatin shuld we prvide? We lk fr a balance f funds and financial stability. Yur financials must include bth revenue and expenses and meet the requirements listed belw. One f the fllwing ptins must be submitted: A recent - within ne mnth - Balance Sheet which cnsists f Assets and Liabilities 4

5 SAMPLE- Visit FirehuseSubsFundatin.rg t apply nline. A recent - within ne mnth - Prfit & Lss Statement als called an Incme Statement A current year annual budget shwing prjected incme and expenses A previus year audit r 990 If yur rganizatin is funded by a lcal gvernment, yu may nly have a budget fr yur department. Please submit the lcal gvernment s audited financials, alng with yur specific department s budget if this is the case. These are ften available n yur city s website. What is needed fr the required vendr qute attachment? Online qutes will NOT be accepted. Yu must prvide an fficial vendr qute with the fllwing infrmatin t be grant eligible. Submitted qutes MUST meet the requirements belw, please read carefully: Must be dated within six mnths f the applicatin deadline Vendr sales representative first and last name & cntact infrmatin ( and/r phne number) must be included Must cntain the name & physical address f yur rganizatin, and a cntact persn Must cntain nly the item(s) pertaining t yur grant request The ttal dllar amunt and equipment quantities in the vendr qute MUST MATCH the ttal that yur department is requesting Include sales tax if applicable Include an estimated freight charge if applicable The cst f maintenance plans and extended warranties are nt permissible Firehuse Subs Public Safety Fundatin will nt be respnsible fr restcking fees r csts related t errrs within the submitted qute Firehuse Subs Public Safety Fundatin will nt be respnsible fr additinal shipping csts r tax nt included in the submitted qute Nte: When requesting a qute frm yur vendr, we recmmend sharing ur qute requirements with the sales representative and making them aware the qute is fr a Firehuse Subs Public Safety Fundatin grant applicatin. What inventry infrmatin shuld I prvide? Please include a list f apparatus such as vehicles, special equipment and ther majr equipment. The inventry list will vary accrding t the size and type f department. If my department is lcated mre than 60 miles frm a Firehuse Subs restaurant, shuld I still apply? Our Fundatin mainly fcuses its resurces in areas served by Firehuse Subs restaurants. We recgnize the need f rural and vlunteer departments thrughut the cuntry, and will cnsider applicatins utside f the 60 mile guideline. When can we expect t find ut if ur grant has been apprved r denied? ALL applicants will be ntified f a decisin regarding their applicatin within six weeks f the clse f the grant deadline. Please d nt cntact restaurants r the Firehuse Subs Care Center with questins regarding yur grant. Fr technical assistance r questins ther than grant status, fundatin@firehusesubs.cm. We ffer technical assistance until tw weeks befre the grant deadline. Des Firehuse Subs Public Safety Fundatin fund requests fr "use f frce"? As per ur guidelines, Firehuse Subs Public Safety Fundatin des nt accept grant requests fr "use f frce" items such as guns r tasers. 5

6 SAMPLE- Visit FirehuseSubsFundatin.rg t apply nline. Are there items that yur Fundatin des nt supprt? All requests must fall within ur Fundatin's funding guidelines which can be fund n ur website via firehusesubsfundatin.rg/abut-us/funding-areas. Examples f items that are nt supprted by ur bard f directrs at this time include pwer lad systems, exercise equipment, radar detectrs and use f frce equipment. Des the Fundatin accept requests fr partial funding? The Fundatin des cnsider request fr partial funding, hwever, the balance f funds must already be secured and utlined within yur grant request. We recmmend including a nte abut the prject and the secured funding as part f yur rganizatin's backgrund/histry attachment. 6

7 SAMPLE- Visit FirehuseSubsFundatin.rg t apply nline. ACCOUNT REGISTRATION Applicant First Name Last Name Title *Please nte, this infrmatin cannt be edited nce submitted. APPLICANT and DEPARTMENT INFORMATION Firehuse Subs Public Safety Fundatin Organizatin/Department: Grant Applicatin Department Tax ID # (xx-xxxxxxx): Mailing Address 1: Mailing Address 2: City, State & Zip Cde: Shipping Address: Organizatin Phne Number: Organizatin Phne Ext: Alternate Cntact Name: (must be different frm applicant name) Alternate Cntact Phne Number: (must be different frm applicant phne number) Alternate Cntact Ext: Alternate Cntact Address: (must be different frm applicant ) Cmmunities Served: Ppulatin: Number f Runs/Calls fr Service per Year (fr fire, EMS and plice nly): Lcal Apprval Pre-Qualificatins (Select the ptin that applies t yur department/rganizatin) As required by ur cmmunity, this request has been presented and apprved by ur lcal gvernment as part f ur prcess when applying fr external funding. Our jurisdictin requires apprval frm lcal fficials nce the award is granted. Our jurisdictin des nt require pre-apprval frm lcal fficials. 7

8 SAMPLE- Visit FirehuseSubsFundatin.rg t apply nline. APPLICATION REQUEST INFORMATION Please select the type f grant yu are requesting: Equipment Dnatin/Preventin Educatin Items Schlarships/Cntinuing Educatin Please nte, ur Fundatin nly reviews schlarship/cntinuing educatin grants cnnected with accredited schls Fr all-terrain wheelchair grant applicatins, fundatin@firehusesubs.cm t request a paper allterrain wheelchair grant applicatin, and please title the All-Terrain Wheelchair Grant Request Equipment Dnatin/Preventin Educatin Items The Fundatin will determine the prcurement methd if yur grant is apprved. The equipment purchase will be implemented in ne f tw ways: 1) The Fundatin Team will purchase the requested equipment n yur behalf, and the vendr will ship it directly t yur rganizatin. Upn delivery, yu must a signed & dated cpy f the packing slip t the Fundatin. OR 2) Yu will receive a Mem f Understanding frm the Fundatin. Once it is signed by bth parties, yu will receive a check t make yur purchase accrding t the vendr qute. After yu receive yur equipment, yu must signed and dated cpies f all invices t the Fundatin within ne week f delivery. What Equipment are yu requesting? Please include the quantity f each item. What is the TOTAL cst f the equipment? (including sales tax and shipping, where applicable) I understand that in rder t be cnsidered fr funding, the ttal dllar amunt and equipment quantities listed n the submitted qute must match the ttal abve. Has yur department applied fr this specific request in the past and been denied? Yes N If yes, hw many times, prir t this applicatin, has this request been submitted? Briefly explain hw the equipment will benefit yur cmmunity and yur department. This wuld have a direct impact n mre than children and senir citizens in ur cmmunity. (Fr preventin educatin items.) SCHOLARSHIPS/CONTINUED EDUCATION REQUESTS 8

9 SAMPLE- Visit FirehuseSubsFundatin.rg t apply nline. Please nte: Our Fundatin nly reviews schlarships/cntinuing educatin grants cnnected with accredited schls. Fr all-terrain wheelchair grant applicatins, please fundatin@firehusesubs.cm t request a paper All- Terrain Wheelchair Grant Request. If yu are requesting funds fr schlarships r cntinued educatin: Hw d yu plan t use the funds requested? What is the amunt f funding yu are requesting? Has yur department applied fr this specific request in the past and been denied? Yes N If yes, hw many times, prir t this applicatin, has this request been submitted? Please prvide a detailed descriptin f hw the funding will assist yur department: What psitive effects will the funds specifically have? Please use statistics when pssible. COMMUNITY IMPACT Have yu unsuccessfully reached ut t the city fr funds t purchase the equipment? Was there a particular instance where a life wuld have been psitively impacted if yu wuld have had the equipment available? What psitive effects will the funds specifically have? Please use statistics when pssible. 9

10 SAMPLE- Visit FirehuseSubsFundatin.rg t apply nline. FIREHOUSE SUBS RELATIONSHIP Address f Firehuse Subs lcatin nearest yu: Hw far is this lcatin frm yur department? Miles Hw did yu hear abut ur rganizatin? Has yur department received funding frm Firehuse Subs Public Safety Fundatin in the past tw years? This infrmatin will be verified, if submitted incrrectly it will result in an autmatic denial. Yes N It is strngly recmmended and greatly appreciated that yur rganizatin acknwledges the dnatin by displaying ur Fundatin lg n dnated items/equipment whenever pssible. Please nte that the artwrk will need t be apprved by ur Fundatin team befre being displayed. If apprved fr funding we may facilitate a media presentatin/press event at a lcal Firehuse Subs restaurant t demnstrate the equipment and acknwledge the dnatin. It may take up t a year depending n lcatin and dnatin delivery timeframe. In the meantime, we ask that any immediate media annuncements regarding the grant award be apprved by the Fundatin. By applying, yu grant Firehuse Subs Public Safety Fundatin (the Fundatin ) permissin t use yur rganizatin s name and identifying trademarks in cnnectin with this applicatin and in cnnectin with the Fundatin s slicitatins fr supprt. Initial Acceptance PIO (Public Infrmatin Officer) Name: (If yu d nt have a PIO, please list a cntact fr event planning and publicity. This individual will need t be readily available by and phne.) PIO PIO phne number: 10

11 SAMPLE- Visit FirehuseSubsFundatin.rg t apply nline. FIREHOUSE SUBS PUBLIC SAFETY FOUNDATION PRINT/VIDEO RELEASE Applicant First and Last Name: Applicant Organizatin: Date: The undersigned representing the rganizatin listed abve, and its members, hereby grants Firehuse Subs Public Safety Fundatin, Inc., Firehuse Restaurant Grup, Inc. (including its subsidiaries and affiliates) and its fficers, directrs, nminees, designees, successrs, and assigns (hereinafter called Prducer ), permissin t use, sell, assign, cnvey, reprduce, cpyright, and publish images r visual likenesses, names, and/r vices ( Persnal Infrmatin ) in any mtin picture, videtape, phtgraph, sund r ther recrding, and/r ther media fr cmmercial, infrmatinal, educatinal, advertising, r prmtinal purpses. I hereby waive any right that I may have t inspect r apprve the finished prduct r the advertising cpy which may be used in cnnectin therewith, r the use t which it may be applied. I hereby release, discharge, and agree t hld harmless Prducer frm any liability f any nature r descriptin by virtue f any use whatsever f my Persnal Infrmatin, whether intentinal r therwise, including but nt limited t any change that may ccur r be prduced in the taking f said pictures r images r in the recrding f any sund, r in any prcessing in cnnectin with the cmpletin f the finished prduct. I Accept the Terms f the Agreement 11

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