Florida SERT

Business Damage Assessment Survey
Isaac - August 2012

The information provided in this survey will be shared among various state and local agencies to expedite implementation of appropriate disaster relief programs for businesses. This survey assists the State with determining if relief services for businesses, including the Small Business Emergency Bridge Loan, should be activated in CountyName County. If activated, Small Business Emergency Bridge Loans are for physical damage to a business only.

Company Name:

Federal Tax ID (FEIN):

State Tax ID:

Address 1:

Address 2:

City:

State:

Zip Code:

Contact Name:

Email Address:

Phone Number:

1) What type of business are you in?

Manufacuring Wholesale Service
Retail Transportation Tourism*
Other:

* If you are a tourism-related business (e.g., attraction or accommodation), please be sure to answer the additional questions at the end of this survey.)

2) Are you currently open for business?

Yes No Open in Alternate Location

If no, when do you anticipate reopening?

Within 30 Days 30-60 Days 60+ Days Will not reopen

3) Did you business suffer damage?

Yes No    

If yes, was the damage:

Physical Economic Both Physical and Economic

4) Did you or will you lose business due to this emergency/disaster?

Yes No    

5) Do you have an estimate of the cost to your business due to this emergency/disaster?

Yes No    

If yes, how much?

$0 $1-$100K $100K-$250K $250K-$500K $500K+

6) How many employees (Full Time and Part Time) do you currently have?

7) Did you lay-off employees, or will you lay off employees?

Yes No    

If yes, number of temporary lay-offs?

Expected lay-off period?

8) Have you registered with FEMA?

Yes No    

If no, please visit www.disasterassistance.gov to register

9) Other key factors hindering business operations:

Access to business Debris removal Product Supply
Financial/business loans Short-term capital Long-term capital
Training/personnel Water damage Insurance settlement
Employees' transportation Customer base Construction/contractor needs

10) If your business space is not usable, what type of space is needed?

Office Industrial Flex Retail None

Square feet needed:

Length of time needed:

Need permanently:

Yes No    

11) Would you like to schedule an appointment for access to business relief services and programs?

Yes No    

Check types of assistance your business is interested in receiving:

Emergency Bridge Loan A short-term loan up to $25,000 available to small business owners who have between 2 to 100 employees, have been in operation for at least one full year and have verifiable, physical damage to their business. Bridge loans are not available for economic injury due to decreased sales or temporary business closure.

SBA Physical Disaster Business Loans Loans are available to qualified applicant businesses of any size for uninsured losses up to $2M to repair or replace business property to pre-disaster conditions. Loans may be used to replace or repair real estate, equipment, fixtures and inventory and leasehold improvements.

SBA Economic Injury Disaster Loans (EIDLs) Loans up to $2M are available for small businesses that sustain economic injury as a direct result of a disaster. These working capital loans are made to businesses without credit available elsewhere to help pay ordinary and necessary operating expenses that would have been payable barring the disaster.

Small Business Development Center Business Counseling Certified business analysts will provide general business counseling to help access traditional SBA loans.

Please answer the following questions only if you are a tourism (attraction or accommodation) business.

A) Are you currently accepting visitors?

Yes No

If no, when do you expect to start accepting visitors?

Status of Attraction: Other/Comments:

Status of Transportation: Other/Comments:

Status of Lodging: Other/Comments:

Percentage of rooms available to public: %

Status of Beaches: Other/Comments:

Status of Restaurant: Other/Comments: