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Microloan Program Final Report Form - for Recipients of Both Round One and Two

  1. This form is for Small Business Emergency Microloan recipients that received both a Round One (City Funded) and Round Two (CARES Act Funded) microloan. 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 single microloan, please use either the Round One Final Report form or the Round Two 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, Round Two 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 Round One loan funds spent by December 30, 2020? *
  9. Amount of Round One unspent funds
  10. Were all Round Two loan funds spent by December 30, 2020? *
  11. Unspent Amount
  12. Date
  13. 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.
  14. Round One Use of Funds
  15. Round Two Use of Funds
  16. Amount Spent
  17. Amount Spent
  18. Amount Spent
  19. Amount Spent
  20. Amount Spent
  21. Amount Spent
  22. Amount Spent
  23. Amount Spent
  24. Amount remaining, if any
  25. Amount unspent by 12/30/2020, if any
  26. Terms and Conditions
    By checking each box below, Borrower affirms the following statements are true:
  27. Borrow affirms that:*
  28. Borrower affirms that no loan funds (Round One or Round Two) were used for:*
  29. Borrower affirms that no Round Two loan funds (CARES Act Funds) were used for: *
  30. 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.
  31. Leave This Blank:

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