2018 MDEQ Recycling Infrastructure Grant Application

Michigan Department of Environmental Quality

Waste Management and Radiological Protection Division

INSTRUCTIONS: Use the form below to provide all information related to your proposed grant project. Please refer

to the Recycling Infrastructure Grant Program Request for Proposals (RFP)for additional details as you complete

this application. The completed application must be saved, printed, signed, scanned and submitted to
by 11:59 pm on March 9, 2018. Required supporting documentation is listed

below under “Attachments,” and must be submitted in the email with your signed application.

Applicant Information

800-662-92781

EQP 1604

2018 MDEQ Recycling Infrastructure Grant Application

Applicant Name:

Applicant type:

Street Address:

City ST ZIP Code:

Mailing Address:

(if different)

County:

Contact Person Name:

Contact Person Title:

Contact Person Telephone:

Contact Person Email:

Applicant DUNS Number:

Federal ID Number:

State Senator:

State Representative:

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2018 MDEQ Recycling Infrastructure Grant Application

Grant Costs

Grant Amount Requested:$

Local Match Amount:$ (must be equal to or greater than the amount of grant funds requested)

Project Description

1.Project Goals and Objectives

Please clearly summarize your project goals and objectives, describing how these goals are realistic.

2.Current Program Description

Do you have a current recycling program? Is your program curbside, drop-off or both? (Check all that apply)

YesCurbsideDrop-off

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EQP 1604

2018 MDEQ Recycling Infrastructure Grant Application

Service Provider:

Number of Households Served by Program:

Year Program Started:

Collection Method(Check all that apply)

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EQP 1604

2018 MDEQ Recycling Infrastructure Grant Application

Single stream

Dual stream

Curbside

Curbside sort

Drop-off

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EQP 1604

2018 MDEQ Recycling Infrastructure Grant Application

Program Type(Check one):

Opt-in (resident may choose to be in community wide program)

Automatic (All residents automatically enrolled)

Subscription (resident contacts service provider directly)

Other. Please Specify:

Size and Type of Containers (specify gallons or cubic yards):

Collection Frequency:

List of Recyclable Materials Collected:

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EQP 1604

2018 MDEQ Recycling Infrastructure Grant Application

#1-2 Plastic

#3-7 Plastic

Metal

Newspaper

Magazines

Mixed Paper

OCC

Paperboard

Glass

Cartons

Other Please Specify:

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EQP 1604

2018 MDEQ Recycling Infrastructure Grant Application

Name and Location of Recycling Processor

Total Curbside Recycling Tonnage Collected for Previous Year (Identify and use the same continuous 12-month period for all quantities provided in this section):

Are Commercial or Drop-off Programs Included in the Recycling Tonnage Above?

Total Solid Waste Tonnage Collected for Previous Year:

BASELINE RECOVERY RATE:

Calculate Total Annual Recycling Pounds/Household for Previous Year
(Total annual pounds/number of households) Calculations and substantiating information must be attached.

Please summarize your current education and outreach program.

Please describe any existing community support and/or partners for the current program.

Please describe all existing operational funding sources (user fees, millage, special assessments, general funds, etc.)

3.Planned Program

Service Provider (if known):

Number of Households to Be Served by Program:

Size Type of Containers (specify gallons or cubic yards):

Collection Frequency:

Collection Method(Check all that apply):

800-662-92781

EQP 1604

2018 MDEQ Recycling Infrastructure Grant Application

Single stream

Dual stream

Curbside

Curbside sort

Drop-off

800-662-92781

EQP 1604

2018 MDEQ Recycling Infrastructure Grant Application

Program Type(Check one):Opt-in AutomaticOther, Please Specify:

List of Recyclable Materials Collected(Check all that apply)

800-662-92781

EQP 1604

2018 MDEQ Recycling Infrastructure Grant Application

#1-2 Plastic

#3-7 Plastic

Metal

Newspaper

Magazines

Mixed Paper

OCC

Paperboard

Glass

Cartons

Other Please Specify:

800-662-92781

EQP 1604

2018 MDEQ Recycling Infrastructure Grant Application

800-662-92781

EQP 1604

2018 MDEQ Recycling Infrastructure Grant Application

Name and Location of Recycling Processor (Include statements of hauler and materials recovery facility capacity as attachments):

Total Projected Curbside Recycling Tonnage:

Are Commercial or Drop-off Programs Included in the Recycling Tonnage Above?

PROJECTED RECOVERY RATE - Calculate Total Annual Recycling Pounds/Household/Year after implementation
(Total annual pounds/number of households) Calculations and substantiating information must be attached.

Please describe who will own the carts and who is responsible for maintaining the carts.

Please provide a detailed description of your planned education and outreach program. Include a description of the cart roll out (distribution) campaign and any proposed methods to address contamination.

Please describe any planned community support and/or partners for this project. Attach any specific letters committing time, money, activities or other resources in the attachments section of this application below.

Please describe how the project will be funded, and how the project will be sustained beyond the grant timeline. Include a description of all existing or proposed operational funding sources.

4.Project Evaluation

Please summarize the method you will use to evaluate the success of your project, including how success will be defined and measured. Include the proposed qualitative and quantitative methods to measure and track increase, and the frequency of monitoring and measurement. Participation rate is the percentage of homes that put the cart out for collection at least once during a one-month period. A final report will be due one year after cart deployment, but no later than February 28, 2021 and must include previous and new diversion rates, participation rate, lessons learned and recommendations for future action.

Please describe how evaluation results will be used and distributed, including any products that will result from the planned program.

5.Workplan and Timeline: Identify Tasks, Responsible Party and Timeline

Please provide tasks and subtasks as necessary. Include responsible party for each task and identify all products and deliverables. Please refer to the required key dates identified in the Timeline Considerations section of the RFP as you develop your timeline and workplan. At a minimum, your workplan must describe:

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2018 MDEQ Recycling Infrastructure Grant Application

Cart procurement process
Cart deployment process
Education and outreach campaign
Progress demonstration and reporting
Metrics of evaluation and methods of measurement
Final Report

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2018 MDEQ Recycling Infrastructure Grant Application

Task / Responsible Party / Start Date / Completion Date

Please include any further narrative needed to adequately describe your project:

6.Proposed Grant Budget: Please refer to the Budget section of the RFP for explanation of reimbursable and non-reimbursable items

Cart Budget (including matching amount) (REIMBURSABLE)

# of Carts / Cost/Cart / Grant Amount / Local Match Amount / Total Amount
$ / $ / $ / $

Education and Outreach Budget (NON-REIMBURSABLE)

Line Item Description / Quantity / Unit Price / Budget Amount
$ / $
$ / $
$ / $
$ / $
$ / $
$ / $
$ / $
Total / $

Equipment, Contractual Services and/or Staffing Budget (NON-REIMBURSABLE)

Line Item Description / Quantity / Unit Price / Budget Amount
$ / $
$ / $
$ / $
$ / $
$ / $
$ / $
Total / $

Sources of local matching funds (NON-REIMBURSABLE)

Source Name / Amount
$
$
$
$
$
(Total match must equal amount in local match amount listed above)Total / $

7.Attachments:

INSTRUCTIONS: The following supporting documentation must be submitted at the time you submit your application. Please reference your applicant name in the title ofall documents and submit these items as attachments, along with your completed and signed application,by email to . Full applications must be submitted by 11:59 p.m. on March 9, 2018.

Documentation of Financial Audit

Letters of Partnership or Community Support

Verification of Hauler Capability and MRF Capacity

Baseline Recovery Rate Substantiating Information

Projected Increase Substantiating Information

Price Quote

Photos

8.Applicant Signature (application must be signed by the person accepting responsibility for the terms and conditions of the grant agreement if awarded)

Name (printed)
Signature
Date

For information or assistance, please contact the Waste Management and Radiological Protection Division, through the DEQ Environmental Assistance Center at 800-662-9278. This document is available in alternative formats upon request.

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