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Home
Single-use plastics Extension of Time Application
Single-use plastics Extension of Time Application
Single-use plastic Extension of Time Form
Step
1
of
2
50%
Do you meet all three requirements for an extension of time 1) received free technical assistance offered by the City 2) Employ 10 full time equivalents or less 3) Have gross receipts less than $500,000 annually?
(Required)
Yes
No
Business Information
Legal Business Name
(Required)
DBA (if different)
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Ã…land Islands
Country
Phone
(Required)
Email
(Required)
Type of Business
Casual Dining
Retail Store
Cafe
Bakery
Consultation Services
Educational Services
Health Care and Assistance
Beauty Services
Catering
Food Truck
Finance and insurance
Other
If other, please enter type of business
Extension of Time Details
Type of Extension of Time Requested (check all that apply)
Foodware
Bags
Compliance Plan
1. Steps already taken
(Required)
2. Planned future actions in the 6 month time extension
(Required)
3. Timeline for implementation in the next 6 months
(Required)
4. Barriers to compliance
(Required)
Document Checklist
Upload the following documentation ( â–¡ Evidence of good-faith efforts to comply â–¡ Other supporting documentation)
File
Drop files here or
Select files
Max. file size: 100 MB.
Certification/Affidavit
Name of Owner/Authorized Representative
(Required)
First
Last
Title
(Required)
Signature
(Required)
I certify under penalty of perjury that the information provided in this application is true and correct to the best of my knowledge. I employ 10 full time equivalents or less; and Have gross receipts less than $500,000 annually I understand that: The foodware item(s) and/or bag(s) extension of time, if granted, is valid for up to six months. I must continue making efforts to achieve compliance during the extension period; one final 6 month extension may be granted. It should be the responsibility of the business to apply for any subsequent extensions in a timely manner. The waiver will automatically expire if the business undergoes renovation exceeding $60,000 or ceases operations;
Date
(Required)
MM slash DD slash YYYY
Notification
Go paperless. Would you like to opt-out of receiving a decision by mail and receive an email only?
Yes
No
The following prerequisites must be met before applying for an extension of time
1) Receiving City-offered technical assistance is required before your application will be considered.
SIGN UP HERE!
2) Employ 10 full time equivalents or less 3) Have gross receipts less than $500,000 annually
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