Northampton County 2015 CIPP Application
Project Overview
Municipal/Organization Name:
One-line Description of Project: (Activity/location. Ex: Oak Street Improvements)
Address of Project Site: (Street address or other description of location)
Federal ID #:
DUNS #: (Applicants without and existing DUNS # should visit www.dnb.com)
Chief Official’s Name and Title:
Address 1:
Address 2:
Phone:
Email:
Grant Administrator
Contact Person Name and Title:
Address (If different from above): Address 2:
Phone: Email:
Project Contact (If different from above. May be engineering firm or consultant)
Organization Name:
Contact Name:
Address: Address 2:
Phone: Email:
Federal ID #:
DUNS #:
Budget Overview
CIPP 2015 Request: $
Total Project Cost: $
Other federal funds committed to project (program and amt.) $
State funds committed to project (program and amt.) $
Local funds committed to project (program and amt.) $
Private/other funds committed to project (program and amt.) $
Has this project received past Northampton County funds? Yes No Amount: $
Expected Timeframe
Proposed Start Date of Activity:
Proposed Completion Date:
Project Type
All projects must fall into one of the CIPP Grant programs. Please identify what CIPP funding announcement and grant program you are applying for:
Community Planning Grants & Technical Assistance
Community Improvement Grants
Façade
Public and Non-Profit Capital Improvements
Implementation and Operations
Entrepreneurial and Workforce Development
Job creation and Economic Infrastructure Expansion
Please list the census tract and block group(s) in which the project will occur
1. Project Narrative
Must be completed by all applicants
Describe the project concisely and completely. Describe the community, why the funds are needed, how they will be spent, and the benefit that will result. Be specific so that the reviewer understands the project, understands what is to be accomplished, how it will be accomplished and how the community will benefit.
Please address:
The need for the project and how it fits into a larger plan for the community
Partnerships involved in implementing the project
A description of the project service area
The activities to be undertaken, including the scope of work and timeframe
The defined and measurable outcome(s) to be achieved including the measurable benefit to the public.
Use the space below. Attach additional sheets as necessary.
Northampton County 2015 CIPP Application
2. Project Budget
Must be submitted by all applicants
Please fill in the CIPP Sources and Uses Budget Spreadsheet (separate excel document) and provide the budget details (created by applicant).
For all construction projects, provide an itemized cost estimate from a qualified professional showing all costs, including engineering.
If CIPP funds will support a portion of the total cost, show which costs CIPP will support.
For all staffing costs, provide an itemization of costs by employee as an attachment.
3. Required Attachments
A cost estimate that cites credible sources
Provide an itemization of costs by employee as an attachment (Staffing Costs Only)
A Project time line that tracks key activities and the dates necessary to achieving the projects goals and outcomes
Design guidelines, policies and procedures (Façade Only)
A resolution of municipal support is required from all applicants. The resolution must authorize the filing of the application, state the amount requested, summarize the purpose of the request, guarantee the provision of the local share and guarantee to reimburse the County its share of any expenditure found by NCDCED to be ineligible.
Evidence of matching funds. If applicable, match funds are defined as those funds in addition to this application that are necessary to complete the project. Evidence can be demonstrated in the form of award letters from federal and state agencies, private funds commitments, financial institutions and local government commitments.
Submit map(s) of sufficient size and quality to describe the project location with regard to the nature of the application
Copies of the Applicant’s previous year’s audited financial statements.
4. Optional Attachments
Submit no more than eight (8) digital photo(s) of the project site
Submit any designs, renderings, engineering plans as applicable
A list of any permits that have been obtained or are anticipated to be needed
Design guidelines, policies and procedures (Façade Only)
Northampton County 2015 CIPP Application
Certifications and Official Authorization
I, ______, hereby certify that all parts of this application and all required attached documents are accurate to the best of my knowledge. I also certify that:
I have read this Application and Application Guide in its entirety.
I am authorized by the municipality or organization identified within to submit this application.
If selected to receive Community Investment Partnership Program Grant funds, the project will be operated in accordance with all applicable laws and regulations.
I understand all grant funding is provided through the Northampton County local share assessment of gross table games revenue under the Pennsylvania Race Horse Development and Gaming Act, 4 PaC.S. §§ 1101, et seq., therefore all projects must comply with applicable PA laws with regard to grant funding. This includes but is not necessarily limited to prevailing wage provisions for construction projects above $25,000 and competitive procurement practices.
The proposed project will not result in temporary or permanent displacement of any family, individual, business, non-profit organization or farm, or any of their personal property.
I understand that by submitting this application that our municipality or organization agrees to reimburse the County of Northampton for any expenditures paid that are found to be ineligible under CIPP program guidelines.
I understand that under Pennsylvania’s Right to Know Law (65 P.S. Section 67.101, et seq.), Northampton County must provide public access to public records. The law presumes that all records held by state and local agencies are public, including requests for funding, however Section 708 of the law does contain certain exemptions from production. One such category of documents exempt from production includes records that “constitute or reveal a trade secret or confidential proprietary information.”
If I believe that any information I submit to Northampton County is non-public “trade secret or confidential proprietary information,” as that term is defined in the Right to Know Law, I shall mark such materials as “CONFIDENTIAL” and provide therewith a written statement signed by Applicant’s authorized representative that the record contains a trade secret or confidential proprietary information (See Right to Know Law Section 707(b)). Thereafter, in the event Northampton County receives a Right to Know request for such materials, the County will provide you notice of the request and an opportunity to respond, consistent with Section 707(b) of the Right to Know Law.
Name of Chief Official Title
Signature of Chief Official Date
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