Queen Anne's County Covid Sanitation Fund Form

The Queen Anne’s County Small Business Assistance and Recovery Fund have created a small Covid Sanitation Fund to reimburse Queen Anne’s County businesses required to “Deep Clean” or professionally sanitize their business due to employees testing positive with Covid-19.

The cleaning must have been required by our local health department and receipts and verification of payment must be provided to be eligible for up to $5,000.

Business Name

Name of Applicant

Please enter your Business Address

Address or Location

Phone Number

Date of Incident:

Briefly describe actions taken to comply with CDC recommendations on cleaning protocols when employees test positive:

Did the Health Department require you to professionally sanitize your location?

Total Cost of Cleaning: ( QAC may reimburse up to $5,000 of cost)

Please upload a copy of the invoice

Click Here to Upload

Please upload copy of proof of payment: This can include confirmation of payment from vendor, cancelled check or copy of bank transaction. Please black out all account information.

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Signature

First Name

Last Name

Choose how to sign

Draw Type

All information in this application and in the attached exhibits, attachments, and addendums are true and complete to the best of my/our knowledge, information, and belief.

Once the application is received by Economic and Tourism Development, the health department will verify the required cleaning, and application for reimbursement will then go before the grant review committee for approval. For additional questions please email Heather Tinelli at htinelli@qac.org or 410-640-2100