You are on page 1of 6
‘ ton Civil Disorder Suevey Tracking Form survey File No._SOSF Rs Survey Staff Person with Primary Responsibility. [LF tosiness oR [TJ Property SR — Survey Steff Person with Secondary Responsibility. Gane 2 Geplstenes end hogwraay hegeee e By Date 5 ‘a "Fins Asetgmed’ 702” coe PR Contre. "/30 LY Questionmire Non-Response File: 2, ‘Tracking Form ONLY Received m 22 3. Further Identificetion end Cell-Packs: Ae S PR Be PR Ee 27 c. FR soe Bevene n PR #7-670¢ PR : 2 Roceob esi: PR Cy iabutnsa Qhectionnaste’ Bina: ” WORE for Febisa ts b USi- GvesT A, Questionnaire Received OR If Filled Out by PR, Reported to CONTROL PR 7 2 ~>- 5. Questionnaire Exmined: “Tdentiftortion Checked; If Ineorrect, Reported to CONTROL m 16% Ge w gg LB eset & Loss; File Returned to COMMA, & Ternimtod FR Senor a “ EX Damage or Less; Reported to CONTROL for Agency Inf. Form PR >. Ek Guostionrete Complete; No Call-Baeks Needed PR ea P ™ [J Yeestionneire Incomplete; Celi-Packs Needed PR 6. FR rR PR mR FR rR — % tions, of Other Affected Businesses or Properties Found: No O% Yes, Reported to CONTROL PR 7 FE. 8, Gomplloted Gractitnnaine Referred’ 10. "UC CPS "eh tom bake m [Uz _(% 9. Questionnaire Received for Cas sR Lio CHAC Completed; Qnestionmire Returned to PR a Bho 10, Questicnneire Received mR Additional Work, If Any, end Questionneire Completed PR “U ganty Informmidcn Fork Gompieteds’ "TT e Tocation Information Recorded Boe DUC ED Informtion Reesries PR 800. SEC. Infermtion Recorded fc 12, EDP Coding Sheet Completed PR 13, Entire File Referred T0:, SR for C&AC PR ‘14, Entire File Received for C&AC sR C&AC Completed; Entire File Returned to PR SR “45, Entire File Received PR Additional Work, If Any, and File Certified Completed and Forewarded to CONTROL PR 16, Entire File Received; Entry Made on Control Sheets Control ‘EDP Coding Sheet Forewarded for EDP Control All Other Meterials Filed Control —— File 88 _Che. PR: 1. [J Tracking Form; 2. [J Questionnaires 3. ‘Agency Information Form; and 4, [J BDP Coding Sheet. 2 TS | < — | agton Civil Disorder Suevey Tracking Form Survey File Wo,_SOSF ~ ‘R= Survey Staff Person with Primry Responsibility, LF masiness on [7 Property SR Survey Steff Person with Secondary Responsibility. C&AC ~ Complsteness and Accuracy Chee). Ey Date is peryoctts tetst Cmte ‘be ig Sect casas SeRSR Toe lone gag cia 2, ‘Tracking Form ONLY Received PR tb 22 3. Further Identification end Cell-Packs: Started > FR R FR FR PR PR PR OSI. QuesT 4, Questionnaire Received OR If Filled Out ty PR, Reported to CONTROL PR do > 5. Questionnsire Emmined: y Identification Checked; If Incorrect, Reperted to CONTROL La gv® Derage or Loss; File Returned to CONTROL & Terminated © om © or Loss; Reported to CONTROL for Agency Inf. Form Questionneire Complete; No Call-Backs Needed oR [J Wwestionnire Incomplete; Call-Baeks Needed ~ 6 eee A. Started Contact Hotes: BSSS 8 83 8s Hl (ear a. aodet “aa Hao uate 7! ew or 9 Get? x) iM | Sy [4 BedF Bylo District of Columbia Civil Disturbance Report Business Information Survey Flease complete one of these forms for each business establishnent you are associated with that sustained any physical damage or theft, however minor, during the recent civil disturbance in the District of Columbia. If an establishment are associated with sustained no cal damage or theft at all, please complete It 1, 2, and 3 only and return the form. A business establishment, is defined as any eommercial enterprise or unit at ono address. If you need nore forms, please call Miss Geraldine Johnson, D.C. Redevelopment. Land Agency, telephone: 382-4950. Business Establishment: 1. Nanes_ S/AL OES oo. 2. Addresss, C22 as Lad + Phones, hetite First Manage or Theft Occurred: ALLL (> ELS = y Specify Principal Product or Service: yn fees Licey er eit cletorsanoy@ta the tuoiness: 77 os af Begone fox shaent? If thorfremises were rented, he peas ‘Total Annual Rent: § 20, Totel Floor Area: jaye Feet 21. Annual Rent Per Square Foot? eit the premises were rented for this establishment, has there beer! any change up to now in ‘the rental status of the establishment as a result of the civil disturbance: Wo Change Business or Establishment Sold Lease Terminated Rent Increased and Establishment Still in Business Rent Decreased and Eetablishnent Still in Business Hetablighment is Out of Business, But Continuing to Pay Same Rent RetabjYehment is Out of Business, But Paying Lower Rent ke Approximate Gable Income from This Establishment During Last Tax Year+ td, thment Before Civil Disturbance (Check All Appropriate Boxes): 25. Trade Area of This E Primary Market Secondary _Market:(s) Wore Than 50 Percent Less Than 30 Percent ‘of Total Della: ‘of Total Dol. Value of Sales Value of Salé ae Vholesais Gonsumer B, Larger Sectifn of pistrict of Columbia G. ALL of Distfict off Columbia D, Parts or AZL of Washington Metropolitan Area a Ay Inmediate Nejghborijood (Within 10 Blocks) g A “ 2. Employment, of ment During Full Work Week Before Civil Disturbance: Wumber of Persons White Wearo Wale Female ie Female Female (6 : A. Paid and Unpaid Family Workers (Including Owner) B, Part-time Paid Buployees (Less Than 40 Hours) | [| [| Full~time Paid Eup! Hours or More): a Managerial. & Projessional b, Clerical ce Sales, d. Craftsmen & Other) Skilled e. Drivers & Other Semi~skilled f, Laborers & Other Unskilled yees (40 =z Jit TLL HUN | 2 Rc 4 Dp SEVIS el FA C ECW ( a LUCHA 296 30. 31. 32. 33= Blbe Establishment: During Most Recent Full Work Week: Hot Regent PIA Wor Hee pergone TU hunnen ‘A. Paid and Unpaid Family Workers (Including Owner) ei Ot! Total Female ale ee Wale Female | | Bs Part-time Paid Exployees (Less ‘Than 40 Hours) . Full-time Paid Employees (10 Hours or Hore): a. Managerial & Professional be Clerical as er Sales &. Craftemen & Other Skilled Sf Drivers & Other Soni-skilled £1 laborers & Other Unskilled | | | \| | How [reyes of this eatablishnent vere transferred to other Locations of your busi rere ea rosult of danage fron the civil disturbance? persons How fomployees of this establishment, if any, did your firm help find jobs with other How many ig because of danage fron the civil disturbance? persons ype of Danae or Loss (Check A11 Appropriate Boxes): =} 2) Timited Extensive Ae Breakage of Glass B. Theft of Merchandise Ge Smoke Damage D. Water Damage E, Fire Damage F. Other ~ Speeify:. pronent Conastion of Promises: [7] Denolisheds, 57 No Repairs Undertakens sot Feenincenmy; LD Repairs Completed present status of Business: [ff Closed; (7 in Partial Operations £7 10 Fell Operation; TS et easinghd or astablisiment Operations to Another Lecatione If the business or eotaer{stmeht operations were moved to another_location, please indicate where? se" uhe Same Neighborhoods /-/ Elsewhere in D.Cos LJ outside DC. mxtent of Financial Loss (Please listinate, If Necessary): a 2: Hock or Inventory Fixtures & Equipment Ae Value Prior to Civil Disturbance sSYor eer B. Value of Damage or Loss from aa Civil Disturbance Ce Amount of Insurance Coverage Dz Insurance Compensation Received Up to Now oe 36. las the insurance on _this establighment been changed since the civil disturbance? Caneelied; // Reduced; /-/ Other ~ Specity: 37.,/Puturg Plans (Even Though Plans May Be Tentative): f Sell Business or Establishment Remain Open for Business at, Same Location Reopen for Business at Same Location Relocate Business or Establishnent Elsewhere in Sane Neighborhood Relocate Business or Establishment Outside of Former Neighborhood, But Inside D.C. Relocate Business or Establishment Outside of D.C. Simply Go Out of Business Other ~ Specify: 38. What reasons are the most important in selecting one of the above alternatives over the others for you, your business or establistment? (Please explain and use the reverse side of this page, if needed.) “747 Ee a setdtusase! Loin) Bet 2 39 VE the appropriate box below if you wish information about any of the following: Small Pusiness Administration programs Assistance in finding a new location Retraining or employment assistance Other assistance, such as legal or accounting - Specify’, <€ 40. /fvas tom vas. completed by = sigiatire: 2 YL Lif. 96 une Vann Do Not Write Below This Line Bldg. Nos: buc IDe Par EM: sits |