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Microloan Program Final Report Form - for Round Two Recipients

  1. This form is for Small Business Emergency Microloan recipients of a CARES Act-funded microloan (Round Two). To comply with federal CARES Act regulations, you are required to complete this Final Report by no later than 11:59 p.m. on Friday, January 29, 2021.
  2. If you are a recipient of a City-funded microloan, please use the Round One Final Report form available at
  3. If you have any questions about the form, or require assistance to complete the form, please contact Economic Development Staff prior to the deadline by calling 925-833-6650 during business hours.
  4. (include “doing business as” if any)
  5. (Physical Location)
  6. (include part-time and full-time)
  7. Expenditure of Loan Funds
    Note: City of Dublin Small Business Emergency Microloan Funds are to be used only for payment of rent, mortgage, payroll or operating expenses, subject to the restrictions as set forth below, and incurred between March 1, 2020 and December 30, 2020 for business located at the address listed above. Additionally, loan funds are subject to the restrictions set forth in the CARES Act and the United States Department of Treasury’s Coronavirus Relief Fund Guidance for State, Territorial, Local, and Tribal Governments, which can be found at
  8. Were all loan funds spent by December 30, 2020? *
  9. Amount of unspent funds
  10. Date
  11. Please specify how loan funds were spent
    Note: total should equal loan amount (less unexpended funds returned to the City). Enter "0" if no loan funds were used for that purpose.
  12. Amount Spent
  13. Amount Spent
  14. Amount Spent
  15. Amount Spent
  16. Terms and Conditions
    By checking each box below, Borrower affirms the following statements are true:
  17. Borrow affirms that:*
  18. Borrower affirms that loan funds were NOT used for: *
  19. Thank You
    Thank you for being part of the Dublin business community. If you have any questions about the Small Business Emergency Microloan Program, please reach out to the Office of Economic Development via email at or call 925-833-6650.
  20. Leave This Blank:

  21. This field is not part of the form submission.