STC
APPALACHIAN REGIONAL COMMISSION
AREA DEVELOPMENT PROGRAM
GRANT APPLICATION
PROJECT TITLE
SECTION 302
NON-CONSTRUCTION
FISCAL YEAR 2015
APPALACHIAN REGIONAL COMMISSION PROGRAM
APPLICATION--FY 2015
New York State Department of State, 41 State Street, Albany, NY 12231
Project Name ______
Sponsor Name ______
Address ______
Contact Person ______Phone ______
(Name and Title)
Fax______
E-Mail ______
Project Location/Service Area ______
Short Description of Project ______
______
______
Amount of ARC Funds Requested ______Total Project Cost______
Basic Federal or State Administering Agency (if any; contact LDD): ______
Type of Project:
ARC Goal: ______
NYS Strategy: ______
______
CERTIFICATION
The project sponsor certifies that the information contained in this initial application is correct. It is understood that any significant changes prior to funding approval may affect funding priority and that ARC funds are to be considered the last dollars spent on a given project and subject to adjustment in the event of underrun. If the project is approved, it is recognized that the sponsor has the obligation to keep the appropriate Local Development District (LDD) fully informed about all aspects of the project's progress and completion, including status of project performance measures (outputs and outcomes). The sponsor agrees to provide requested information regarding project outputs/outcomes during project implementation and for a period of three years after project completion.
______
(Date) (Signature)
______
(Name and Title)
PROJECT TITLE
Table of Contents
Section 302 Non-Construction Project
ARC PROGRAM APPLICATION CERTIFICATION/SIGNATURE SHEETPROJECT APPLICATION TABLE of CONTENTS
Page
SECTION 1 – FEDERAL FORMS
Standard Form 424
Standard Form 424 A Budget Information
Standard Form 424 B Assurances
Self-sufficiency Statement
Memorandum of Understanding for ARC Projects
SECTION 2 – PROJECT PROPOSAL SUMMARY
One Page Project Summary
SECTION 3 – PROJECT NARRATIVE
1. Goal, Objective and Strategy
2. Purpose, Description, Rationale and Time Line
3. Relation to Other Local, Regional, and State Activities
4. Geographic Area
5. Benefits and Performance Measures
6. Agency Capacity, Staff & Consultant Qualifications and Procurement Procedures
7. Funding Need and Sustainability
SECTION 4 – BUDGET INFORMATION and SUPPORTING MATERIALS
1. Budget Format B
2. Budget Narrative
3. Letters of Commitment
4. Additional Documentation
SECTION 1: FEDERAL FORMS
INSERT
Federal Standard Form 424
Application for Federal Assistance
Please insert/check the following information on the SF424:
9. Appalachian Regional Commission
10. 23-002
Area Development Program
16b. Program has not been selected by State for Review
Be sure to include ARC plus all matching funds on the SF 424 and SF 424 A.
INSERT
Standard Form 424 A
Budget Information
INSERT
Standard Form 424 B
Assurances
SELF-SUFFICIENCY STATEMENT
______
INSTRUCTIONS: The attached forms and the assurance statement below are to be completed and submitted with the formal grant application.
ASSURANCE STATEMENT
The sponsoring agency understands that grant assistance is limited to the amount approved and that there is no obligation on the part of ARC or the Department of State to fund budget overruns or additional project phases. The sponsoring agency further understands that ARC funds are to be considered the last dollars spent on a given project and subject to adjustment in the event of budget underrun.
SIGNED ______
Responsible Sponsor Representative
RRevised 1/93
A. Is this project part of a phased development effort?
______YES __X__NO
B. If the answer to A is YES, describe briefly the other phases. Indicate whether they are complete, underway, or planned. For phases which are complete or underway, indicate the specific sources of all funding. For future planned phases, indicate the planned sources of funding. Give approximate total costs for each phase and give the ARC funding anticipated for each phase.
C. If the answer to A is YES, what will be the impact on this project if other phases are not completed? To what extent is the implementation of future phases essential for the programmatic success and financial self-sufficiency of this phase of the project?
D. From what sources will operations, maintenance, and eventual replacement costs for buildings, equipment, etc. which have been acquired, built, or renovated under this grant be paid? Where user fees are involved, provide relevant projections of use.
Appalachian Regional Commission
Program Operations Division
1666 Connecticut Ave, NW Phone 202-884-7750
Washington, DC 20009-1068 Fax 202-884-7682
Memorandum of Understanding for ARC Projects
Project Name: ______
State: ______Federal Agency: NA ______
The Following Conditions Apply to all ARC Projects:
Deadline: The Commission may revoke or revise its approval of any project if work intended to be assisted is not underway within 18 months after the date of approval of such project.
Davis Bacon Wages: Davis Bacon wage rates (as determined by the Department of Labor for your respective area) must be paid for all construction projects in accordance with Section 402 of the Appalachian Regional Development Act of 1965, as amended.
ARC Underrun Policy: Each disbursement of funds for a project receiving assistance from more than one federal source will be deemed to be a proportional disbursement from each source. In the event of an underrun, the ARC will be entitled to recover its proportionate share of the underrun.
Additional Funds: It is understood that if the applicant receives additional funding from any new source towards
Added to the Project the eligible cost of this project after the ARC approval, these funding sources should not be used
After ARC Approval: to reduce the amount of local funds pledged. If new funds are made available to this project, the ARC and the Basic Federal Agency, if any, should be notified immediately. ARC reserves the right to reconsider the level of its funding approval in such as eventuality.
Changes in Scope: It is understood that a change-in-scope may not be implemented without prior written approval from the ARC and the Basic Federal Agency, if any. A change in scope is any major change to the project design, the type of project to be completed, capacity of the system, size of project, the number and/or type of customers served or the equipment items purchased.
Close Working It is understood that the applicant must work closely with the Basic Federal Agency identified in
Relationship With the ARC application, if any, and follow bidding and contract award procedures to insure that all
Basic Federal Agency: pertinent federal laws are complied with. Coordination with the Federal agency begins with filing an application with the basic Federal agency.
Restrictions on ARC funds shall not be used for: a) any form of assistance to relocating industries; b) recruitment
Assistance: activities that place a state in competition with other state or sates: and c. projects that promote unfair competition between businesses within the same immediate service area.
Cornerstone or Any facility constructed in whole or in part by funds provided under the ARDA shall include a
Plaque: Cornerstone or plaque appropriately acknowledging the assistance provided through the ARC program, provided that such an item not be required if it would be prohibited as an eligible project cost under the basic federal program through which the ARDA assistance is provided.
Applicant/Authorized Representative:
Signature: ______Date: ______
APPALACHIAN REGIONAL COMMISSION
PROJECT PROPOSAL SUMMARY
(One Page Only)
Project Title:
Project Grantee:
Transitional County (ies)
to be Served:
Basic Agency: Not applicable
Goal/Strategy: List the single ARC Goal and Objective and NYS Strategy addressed by project.
Purpose: One or two sentence descriptive statement of the overall purpose of the proposed project.
Funding: Source * Amount Status** Type***
ARC
Other Federal
State
Local
Other (specify) ______
TOTAL $
Description: Provide a brief description of the major activities that will be done under this grant proposal. This description should include the who, what, where, when and how for each major activity.
Rationale: Describe the local, regional, and/or state need for this project, including the problem(s) or issue(s) the project addresses.
Benefits & Describe the primary benefits to be derived from the project. State the outputs
Performance and outcomes of the project in accordance with ARC Guidelines for Bench-
Measures marks and Performance Measurements.
*Please list agency/program.
**Please list committed or pending.
***Please list cash, loan, or in-kind.
SECTION 3: PROJECT NARRATIVE
(Suggested length 5 to 8 pages; please number pages)
1. Goal, Objective, and Strategy
Please refer to Section V of the Application Guidance:
a. Identify and state in full the primary ARC goal and Objective that the project will address.
b. Identify and state in full the NYS State Strategy that the project will address.
2. Purpose, Description and Rationale
a. State in one sentence the main purpose of the project as it relates to the goal and strategy being addressed (e.g., to create jobs by providing training for small business owners).
b. Describe specific problems or issues the project will address and how these issues impact the community.
c. Provide a detailed description of all major project activities including evaluation and monitoring procedure. Include what will be done, who will complete each activity, and a timeline for starting and ending the project.
d. Explain why the proposed approach is the most beneficial.
e. Although multi-year funding is rare, sponsors who are requesting a second or third year of ARC funding must provide a status report on the successes and failures of the previous years of operations of the ARC project in order to be considered for second or third year of ARC funding.
f. Illustrate local demand for the project (e.g., letters from key stakeholders, customer data, labor statistics, etc.).
g. Reference appropriate documentation in Section 4.
3. Relation to Other Local and Regional Activities
a. Describe how the project meets the priorities of local, county, regional (Local Development District), or state community or economic development plans and describe efforts to coordinate the project with other area economic development activities.
b. Describe project fit with recent past and planned future activities of sponsoring agency, identifying any relevant agency planning documents.
c. Identify all agencies and organizations participating in the implementation of the proposed project or with which coordination is needed for effective implementation. In Section 4 include a letter of support/commitment for each such agency or organization affirming its involvement in the proposed project.
d. Describe and document private sector involvement (if any) in this project. Examples of private sector involvement: monetary contributions, space, expertise, equipment donations, monetary or job investment in related projects resulting from project activities, or corporate community leadership and involvement in planning or implementing project activities.
4. Geographic Area
a. Describe the project’s anticipated service area including counties and census tracts served.
b. If applicable, comment on the project’s impact on ARC’s designated distressed areas. Does the project meet the income requirements of any other funding sources such as HUD or Rural Development, whether or not those funding sources are used in this project?
c. Provide a map showing the project’s service area. If it is close to or in a distressed area, please indicate that on the map.
5. Benefits and Performance Measures
Please refer to Section V of the Application Guidance.
a. State outputs and outcomes in absolute numerical terms, not percentages.
b. Attach letters documenting jobs retained, jobs created and leveraged private investment (LPI) where applicable.
c. Describe other project benefits as appropriate such as the likely impact on future economic development activity in the area or anticipated spin-off results.
6. Agency Capacity, Staff & Consultant Qualifications, and Procurement Procedures
a. Briefly review the applicant’s capacity to undertake the proposed activity by
describing previous experience with relevant activities.
b. Describe the qualifications needed for key individuals who will manage and operate the project. Attach position descriptions or brief resumes.
c. Describe qualifications for all proposed consultants and subcontractors and describe the competitive procedures used to select them.
7. Funding Need and Sustainability
ARC dollars are considered to be the last dollars spent on a given project, and as such are subject to adjustment in the event of a budget underrun.
a. Complete the Funding Source and Status form (towards end of application packet). Identify each funding source for the project, specifying whether cash or in-kind, and the current status of each funding commitment including expected dates of application submission and approval for matching funds.
b. Detail why ARC funding is needed at this time. Explain clearly and document fully the attempts made to secure other funds for the project. Provide assurance that the proposed project would utilize all available federal and non-federal resources.
c. Describe the applicant’s strategy for ensuring the project’s long-term sustainability once ARC funds are no longer available. Include efforts to secure other sources of support for future operations.
d. If the project is part of a phased development effort, briefly describe the other phases and indicate planned sources of funding including federal, state, and local shares for the total development effort.
SECTION 4: BUDGET INFORMATION
AND SUPPORTING MATERIALS
1. Detailed Budget and Budget Narrative
a. Provide a detailed budget using Budget Format B for Non-Construction Projects (next page), clearly showing all estimated expenditures for ARC and non-ARC funds and sources of all non-ARC matching funds.
b. Provide a budget narrative keyed to Budget Format B that explains expenditures by line item. Provide descriptions of specific in-kind resources including the methods used to determine their value.
2. Letters of Commitment
a. Include letters citing specific amount of funds committed from all matching fund sources.
b. Provide descriptions of specific in-kind resources including the methods used to determine their value.
3. Additional Documentation
a. Enclose other pertinent supporting materials that will lead to a better understanding of the proposed project. Please do not include form letters or financial audits.
THIS BUDGET FORM IS AVAILABLE FROM STC AS AN EXCEL SPREADSHEET
BUDGET FORMAT B
Project Name: Section 4 Question 1a Budget Period:
CATEGORY / % OF TIME / ANNUAL SALARY / ARC FUNDS / OTHER FEDERAL / STATE / LOCAL CASH / LOCALIN-KIND / TOTAL
1. PERSONNEL
SUBTOTAL PERSONNEL
2. FRINGE BENEFITS
SUBTOTAL PERSONNEL AND FRINGE
3. TRAVEL
4. SUPPLIES
5. OTHER
OPERATIONS - TOTAL
6 CONSTRUCTION/ RENOVATION
Specify in budget narrative
7. EQUIPMENT
Specify in budget narrative
EQUIPMENT -
FUNDING SOURCE PERCENTAGE
TOTAL PROJECT -
FUNDING SOURCE PERCENTAGE
GRAND TOTAL
NON-CONSTRUCTION PROJECT