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SECURITY IMPROVEMENT GRANT PROGRAM

PROGRAM APPLICATION


Business Name:

Owner's Name(s): _______________________________________________________________

Address: ______________________________________________________________________

Phone:__________________________________ FAX: _________________________________

Amount of funding requested: $ _______________________

Provide a complete description of the planned improvements and how you believe they will enhance the level of security and safety of your business: ____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Attach the recommendations provided by the Hampton Police following their Security Survey / CEPTED Assessment.

Will the project require any special permits? YES _______ NO _______
Please describe:_________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

For permit information, please contact Hampton's Central Permit Office at 728-2444.

Provide a breakdown of project budget:

Total project cost: $_______________________ (please complete the project cost breakdown below.)

Expenses......................................Amount
Design........................................$ _____________
Installation..................................$ _____________
Materials/Equipment...................$ _____________
Other ....$

Funding Sources Amount
Business Owner.........................$ _____________
Coliseum Central.......................$ _____________
Other .......................................$ _____________


Project schedule:

· Estimated Start Date _______________________
· Estimated Completion Date __________________
· Project Phasing (if applicable) _________________

If you are not the building or property owner, do you have permission from the building or property owner to make the above described improvements? (circle one) YES NO

Name of Building or Property Owner:____________________________ Tel:________________________
If NO, please explain: ___________________________________________________________________

You may use additional sheets of paper if necessary to complete the application. You may also attach any additional information about your company or project you think is relevant to this application.

I certify that the above information is correct to the best of my knowledge and that the requested funds will be used only for purposes described in this application.


Name, Title_____________________________________________________ Date____________________


All applications must be completed and submitted to Coliseum Central Business Improvement District. Mail or fax applications to 2021 Cunningham Drive, Suite 101; Hampton, VA 23666, FAX, (757) 826-2784. Please contact Jackie Gibson at (757) 826-6351 if you have questions.