Catalyst Infrastructure Program

Application Form

Prior to submitting this proposal, please ensure the proposed project meets the eligibility criteria outlined in the Catalyst Infrastructure Program: Program Guidelines.

Project Information
Project Title: / Name of the project.
Type of Infrastructure: / Type of infrastructure: transport, water, wastewater, stormwater and public realm, etc.
Infrastructure Works: / Detailed information regarding the type of infrastructure and works to be constructed.
Location
Local Government Area (LGA): / Region where the infrastructure will be constructed.
Extent of Infrastructure: / Detailed information regarding the extent, location and sizing of the infrastructure.
Location Map: / Refer to an attachment with a location map of project: Google Earth or Google Map image, highlighting area expected to receive economic benefit.
Infrastructure Plan: / Refer to an attachment with a master plan or preliminary plan of the project.
Financials
Total Project Cost: / Cost estimate for the design and construction of the infrastructure.
CIP Funding: / Amount of CIP funding being sought, and what percentage of the total project cost this represents.
Other Funding: / List co-investment partners (other than the State), the amount of funding contributed by each, and what percentage of the total project cost this represents. Confirm that this funding will be available and expended towards the project prior to the CIP funding being drawn down.
Repayment of CIP: / Demonstrate financial capacity to repay the CIP co-investment funding. Refer to attachments, including: 2 years of audited financial statements and an annual cash flow forecast for the project over the proposed repayment period.
Programme
Current Status: / Current status of the project: “shovel ready”, designed, approved, etc.
Approvals: / Confirmation of all required approvals, including a summary of approvals that have been granted and approvals that are yet to be gained in order to commence the project.
Programme: / Programme detailing timeframes for design, approvals and construction. Refer to an attachment if need be.
Project Duration: / Indicative project duration, from the date funding is confirmed to practical completion.
Construction Start Date: / Indicative start date of construction. Extract from programme.
Practical Completion Date: / Indicative completion date of construction. Extract from programme.
Relevant Parties
Proponent: / Legal name of the entity who will be party to the co-investment funding agreement.
Land Holding: / Lot on Plan description of the land on which the infrastructure will be constructed.
Land Owner: / Legal name of the entity who owns the land on which the infrastructure will be constructed.
Delivery Method: / Details of the proposed delivery method, and the entity responsible for the delivery.
Capability: / Demonstrate capability to deliver the proposed infrastructure project.
Asset Owner: / Legal name of the entity who will ultimately own, operate, maintain the infrastructure (after construction is complete), and take responsibility for ongoing operation, maintenance and replacement costs associated with the infrastructure. If this entity is not the Proponent, provide evidence that the ultimate Asset Owner will accept the infrastructure.
Economic Benefit
Project Outcomes: / Demonstrate that the project will generate, facilitate or accelerate economic benefit and job creation.
Funding Catalyst: / Demonstrate that the CIP co-investment will catalyse the project and the associated outcomes (economic benefit and job creation).
Unlocked Development
Type / Retail Value ($m) / Number/ GFA / Timing of Delivery
Lots/Dwellings
Retail/Commercial
Industrial
Other
Job Creation (Indicative)
Timing / Number (FTE)
Short term – Design and Construction
Long term – Operation and/or Catalysed Development
Additional Information
Additional Information: / Provide any other information in support of the proposal.
Timeframe Commitments
The Proponent commits to execute a CIP funding agreement within three months of the date the project is approved for CIP co-investment funding / Yes / No
The Proponent commits to commence construction within nine months of the date the project was approved for CIP co-investment funding / Yes / No
The Proponent commits to repay the CIP co-investment funding, in annual instalments, over a period of no more than 15 years from the date the CIP funding agreement was executed. / Yes / No

Please return this to the Department of Infrastructure, Local Government and Planning:

Mail:Catalyst Infrastructure Program

Department of Infrastructure, Local Government and Planning

GPO Box 2202
Brisbane QLD 4001

Email:

Fax:(07) 3452 7404

September 2017