Safety Improvement Application Please enable JavaScript in your browser to complete this form.Business Name *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeContact Name *FirstLastEmail *Phone *Is your business located in the ACBID boundaries *YesNoIf you are unsure, please copy and paste the link to view the map of the ACBID boundaries. https://alamedaconnects.org/wp-content/uploads/2022/11/ACBIDMap.pdfIf you answered NO to the question above you are NOT eligible for this grant.5. Is your business in good standing with the City of Lakewood *YesNoIf you answered NO to the question above you are NOT eligible for this grant. (copy)Please provide your Lakewood Business License Number *Do you accept ACH Payments *YesNoIf you answered NO to the question above you are NOT eligible for this grant. (copy)Describe in detail your proposal. *Please provide a cost estimate for your project. *Please provide a timeline for your project. *Please upload ONLY the CPTED recommendations list. * Click or drag files to this area to upload. You can upload up to 5 files. Only attached the CPTED recommendations sheet in PDFAttach W9 * Click or drag files to this area to upload. You can upload up to 3 files. PDF onlySubmit
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