SPLOST PROJECT REQUEST FORM TEMPLATE (This template is for use in developing the answers for the form, not for submission.)

Transcription

1 SPLOST PROJECT REQUEST FORM TEMPLATE (This template is for use in developing the answers for the form, not for submission.) PLEASE READ This template maybe used to help prepare your submission. This template is only for use in developing the answers for the submission, not to be submitted. Only the on-line form version of the Project Request form will be accepted. This template is not an exact duplicate of the form but provides all of the relevant questions that are required by the form. Access Project Request Form Template in MS Word (*.docx) format by clicking on this link: Word Format Access Project Request Form Template in pdf format by clicking on this link: PDF Format NOTE: Before being allowed to proceed with filling out the form, the two following things must have be done: Acknowledgement of reading the SPLOST 2020 General Information Document Acknowledgement that the ACCGOV Department Director of the department that will be responsible for implementation and maintenance of the proposed project, if it is funded, has been contacted about the submission. The Department Directors will be provided a copy of the form once submitted. Things to know about completing the Project Request Form: Browser: Completion of the form works best using Google Chrome. Enter or Return Key: Using the Enter or Return Key when entering data will cause the form to skip forward to the next section. If that was not the desired intent use the previous button at the bottom of each page to go back. Entering Data: As the form is completed, fields will turn red if the information is not completed properly. For example, if a partial phone number is entered the field will turn red until completed correctly. Required Fields: Questions within the form that have asterisks (*) are required fields. The form cannot be submitted until all required fields are completed. Partial Completion: The Project Request Form does not have to be fully completed at one time. Use the Save and Resume Later option at the bottom each page. The hyperlink provided is good for 30 days and only applies to changes made the document before the hyperlink was provided. Completion by Multiple Parties: If more than one person is working on a Project Submission, use the Save and Resume Later option to obtain the hyper link that can be used to re-enter the form. Saving Work: Work done on the form is not saved until the Save and Resume Later feature is selected. Submission: Once submitted, the form cannot be changed by anyone other than the SPLOST office. If an error is found after submitting then please the SPLOST office at SPLOST.Forms@ACCGOV.com to provide the corrected information. Submission Confirmation: Once submitted, an confirmation with all of the data submitted, less the attachments, will be sent to the entered. Attachments: Supporting documents may be uploaded in the Project Request Form. There are several Upload Attachment options throughout the form. Only one document can be uploaded with each option. The total file size of all attachments may not exceed 25 Mb.

2 Before proceeding, please read the SPLOST 2020 Project Request General Information! Access the document here: SPLOST 2020 Project Request General Information *Have you read the SPLOST 2020 Project Request Form Instructions? Yes No In most cases, it is advised that individuals interested in submitting a project for consideration should work with an organization or agency. If funded, every project must be turned over to a department within ACCGOV to get the project implemented. Therefore, before submitting a project, all individuals, organizations, commissions or agencies are to contact the ACCGOV Department Director in the department that will be responsible for implementation and maintenance of the proposed project, if it is funded. Departments may be aware of similar project requests that are being formulated by staff or others and may be able to offer assistance in preparing the submission. Some potential project areas and their corresponding contacts are listed below. Please contact the department director, listed below, before submitting a project. Airport related projects - Athens-Ben Epps Airport ( ) Mike Mathews, Director Bus related projects - Athens Transit System ( ) Butch McDuffie, Director Environmental related projects - Environmental Coordinator ( ) Andrew Saunders Fire related projects - Fire Department ( ) Jeff Scarbrough, Chief Garbage, recycling, landfill related projects - Solid Waste Department ( ) Suki Janssen, Director Historic preservation related projects (ACCGOV owned) - Central Services Department ( ) David Fluck, Director Park related projects - Leisure Services Department ( ) Kent Kilpatrick, Director Police related projects (not including jail) - Police Department ( ) Mike Hunsinger, Interim Chief Roadway, stormwater, sidewalk, bicycle related projects - Transportation & Public Works Department ( ) Drew Raessler, Director Water, sewer related projects - Public Utilities Department ( ) Frank Stephens, Director If you are unsure about what area your project falls under or do not see a contact for your potential project above, please contact Jackie Harrington (jackie.harrington@accgov.com) in the SPLOST Office ( ) for additional assistance. * Have you contacted the ACCGOV Department that will be responsible for implementation of the proposed project and maintenance of the project once it is completed? Yes No *Who is submitting this Project? Athens-Clarke County Unified Government (ACCGOV) Department Authority, Association, Commission, Agency, or other organization Athens-Clarke County Resident

3 *Submitting Department, Agency, or Association: *Department, Agency, Division, Association, or Commission: Contact information not required for Projects submitted by ACCGOV Departmentss *Contact Person: Contact Information *Primary Phone: First Name Alternate Phone: Last Name * Address: Proposed Project Title: Indicate the name by which this Project will be identified (e.g., Sidewalk Improvements or Roundabout at Whitehall Road / Milledge Avenue Intersection, etc.). [60 Character Limit] Previous SPLOST or TSPLOST Submission *Would this project accomplish the next level(s) of a multi-phased project initiated in or continuation projects from one or more of the earlier SPLOST or TSPLOST programs? (Examples may include, but not limited to, bike & pedestrian improvements, greenway, greenspace acquisition, park facility improvements, etc.) Yes No If yes, select the most recent SPLOST or TSPLOST Program, and appropriate Project Name, for which this project would be a continuation: *Previous Program: *SPLOST IV Project: SPLOST 2000 *SPLOST 2000 Project:

4 *SPLOST 2005 Project: *If no, has this project or a substantially similar project been submitted for a previous SPLOST or TSPLOST Program but not selected? Projects that were submitted but never selected for a SPLOST or TSPLOST Program should select Yes to this question and then select most recent program for which this project was submitted and not selected. Projects that were selected for one SPLOST or TSPLOST Program but not by a more current SPLOST or TSPLOST Program should select Yes to this question and then select most recent program for which this project was submitted and not selected. Projects that were submitted but not selected for a SPLOST or TSPLOST Program but then later accepted by a subsequent SPLOST or TSPLOST Program should select No to this question. *Was this Project submitted for a previous SPLOST program and rejected? Yes No *Select the most recent SPLOST or TSPLOST Program in which this or similar Project was submitted but not selected: SPLOST 2000 Project Classification, Focus, & Type Review the descriptions of the three Project Classifications and select the one that best fits the overall Project. Project Classification:* Economic Prosperity Social Well-Being Environmental Protection Economic Prosperity Provide new or maintain existing infrastructure needed to grow equitable economic development as may be identified in previously adopted plans (e.g. Madison Athens-Clarke County Oconee Regional Transportation Study, the Public Utilities Service Deliver Plan, etc.). Provide facilities for youth development, job training, business incubators, or other similar functions, especially those serving historically marginalize populations. Provide funding for Capital Improvements Projects that are typically funded out of the General Fund. Reduce existing and/or future operating cost. Support other capital expenses needed to achieve action items identified in previously adopted plans for Land Use, Economic Development, Transportation, and/or Infrastructure elements (e.g. Comp. Plan, Envision Athens Action Agenda, etc.).

5 Social Well-Being Provide funding for infrastructure or incentives needed to increase access to workforce and lowincome housing. Maintain, expand, or improve equitable access to public facilities and infrastructure across the community. Support other capital expenses needed to achieve action items identified in adopted master planning documents (e.g. Leisure Services master plans, Greenway Network Plan, Comp. Plan, and or Housing, Health, Safety, and/or Social Services elements from the Envision Athens Action Agenda). Environmental Protection Provide and promote the use of alternative modes of transportation. Maintain or improve systems for conserving energy or reducing the use of fossil fuels. Maintain or improve resources associated with stormwater management and improved water quality. Improve waste diversion through recycling, composting, and/or materials reuse. Protect and enhance quality natural areas that provide for recreation, clean water, and habitat preservation. Install, maintain, improve and increase access to environmental infrastructure and greenspace, especially in historically marginalized communities. Support other capital expenses needed to achieve action items identified in the Environment, Transportation, and/or Agriculture elements from previously adopted plans (e.g. Stormwater Master Plan, Comp Plan, Envision Athens, etc.). *Review the below descriptions of the three Project Focuses and select the one that best fits the overall Project. Public Safety Basic Facilities & Infrastructure Quality of Life Public Safety - Includes fire stations, police sub-stations, fire trucks, police vehicles, sheriff vehicles, etc. Basic Facilities & Infrastructure - Includes water lines, roadway improvements, sidewalk improvements, bridge improvements, etc. Quality of Life - Includes parks, library resources, Rail to Trails, Greenway, Greenspace, etc. *Project Type: Select the one that best fits the Project as a whole.

6 *Project Construction Program/Description: Project Description Provide within this space a Construction Program/Description for the Project. Agencies and departments submitting requests should be prepared to submit detailed construction information, etc., as required during the technical review process. *Projected Useful Life of Project: (1,500 Character Limit) What Useful Life should this Project be expected to meet, based on its Mission Statement and its Goals and Objectives (i.e., fire stations are designed for a 50 year life, fire pumper trucks are designed for a 15 year life, etc.) (1,500 Character Limit) *The Leadership in Energy and Environmental Design (LEED) Green Building System compliance: (1,500 Character Limit) New ACCGOV facilities are required to meet LEED specifications. Please indicate if the facility will be designed to meet LEED Standards and if the costs for building and certification have been included into the request. (1,500 Character Limit)

7 *Project Mission Statement/Goals & Objectives: Project Justification Provide a one paragraph Mission Statement for the proposed Project. Include all of the Goals and Objectives that support this Mission Statement. *How will this project help meet the Public Safety, Basic Facilities/Infrastructure, and/or Quality of Life needs in Athens-Clarke County? Provide a description (no more than one page) of how this proposed project will meet one of the three classifications noted above. *To meet the Project Goals & Objectives, when should this project be completed? Describe the time frame this Project will need to be completed by in order to meet the identified Project Goal and Objectives. (2,500 Character Limit)

8 *Is this Project recommended/included in any approved ACCGOV Land Use Plan, Master Plan, Study, Service Delivery Plan, Envision Athens, etc.? Yes No Unsure If yes, please explain and provide necessary information. (1,500 Character Limit) (1,500 Character Limit) Triple Bottom Line Impacts *Positive Benefits for the Prosperity of Athens-Clarke County: Briefly describe how this Project positively benefits the economy and the tax base of Athens-Clarke County. *Detrimental Impacts to the Prosperity of Athens-Clarke County:

9 Briefly describe any challenges or negative impacts on the economy and tax base of Athens-Clarke County. *Positive Benefits for our Citizens and Visitors: Briefy describe how this Project positively benefits effective government, equity, and the overall livability. *Detrimental Impacts for our Citizens and Visitors: Briefly describe how this Project might negatively impact effective government, equity, and the overall livability on our community. *Environmental Benefits, including but not limited to Positive impacts on existing Infrastructure/Systems: Briefly describe how this Project would improve, protect, or enhance the environment.

10 *Detrimental Impacts for the Environment, including but not limited to Negative impacts on existing Infrastructure/Systems: Briefly describe how this Project might negatively impact the environment. *Positive/Negative Impacts on ACCGOV Departments, Agencies, or other Organizations, if not covered in one of the above questions: Briefly describe the impact this Project would have on ACCGOV Departments, Agencies, or other Organizations.

11 Project Costs Detailed project capital budget costs (to be funded from SPLOST 2020 only): Provide Budget Costs for each of the identified categories below. Cost estimates should be in current year dollars. An additional amount for escalation may be added during technical review. Also, if minimum amounts as stated in the costing section are not included those minimums will be added during the technical review. Gray boxes will be calculated on the actual for at the percentages indicated. Project Costs (round to thousand) 1. Land Acquisition / ROW / Easement: Estimated value of property. 2. Design Fees: Minimum of 12% of Construction costs for New Construction, 14% for renovations, and 16% for LEED designed projects. 3. Miscellaneous Fees: Minimum of 3% of Construction Costs used for permitting, etc. Utilize minimum of 10% if land acquisition if necessary. 4. Fixtures, Furniture, and Equipment (for a facility): A detailed estimate is preferred but dependent upon the specific project, utilize at a minimum $15 to $20 per square foot. 5. Construction: Provide a detailed cost estimate of this component. 6. Construction Contingency: Calculated at 10% of the Construction line item. If additional Construction Contingency is needed, use one of the Other fields below. 7. Acquisition of Capital Equipment: 8. Testing: Minimum of 3% of construction costs for projects whose construction component is over $1 million and 5% for those whose construction component between $1 million and $500,000 and 10% of construction costs for projects less than $500, Project Management: Calculated at 4% of the total budget line items above. 10. Project Contingency: Calculated at 10% of the total budget line items above. If additional Project Contingency is needed, use one of the "Other" fields below. 11. Public Art: Calculated at 1% of the Construction line item. 12. Other (describe): 13. Other (describe): 14. Program Management (3% of Project Subtotal): Project Subtotal: SPLOST 2020 Project Total: Amount

12 Operating Costs *Will the proposed Project require new ACCGOV Staff positions? Yes No Position 1 *Position Full Time Part Time Title: Enter Position Title Full Time: Anticipated Annual Salary, including benefits: $ Part Time: Anticipated Hourly Rate, including any benefits: $ Anticipated Average $ of hours per week per person: Number of Positions at this Rate and Hours: Total Annual Expense for this Position(s): $ Briefly describe the responsibilities of the additional staff position: *Do you have another position to enter? Yes No The online form gives you the capability of entering up to 10 positions.

13 Operating Cost Total Annual Operating Costs when Project is complete: Only identify additional or net operating costs to be paid by ACCGOV. Identify the additional or net costs needed above ACCGOV's current operating budget to operate the requested project and any additional project related revenues that would be generated. Provide budget costs for each identified category below. Please round all dollar amounts to the nearest $1,000. Operating Costs (round to thousand) Total Projected Revenues from Project Estimated Impact for Annual Operating Expenditures Expenditures 1. Personnel Costs: Calculated total of the Personnel Costs from each of the new ACCGOV positions required. 2. Annual Utilities: Gas: Electrical: Water: Sewer: Phone: Solid Waste Collection: Other: 3. Operating Supplies: 4. Equipment Maintenance: 5. Facility Maintenance: 6. Other (describe): 7. Other (describe): 8. Other (describe): TOTAL EXPENDITURES NET OPERATING COSTS OF PROJECT:

14 Project Financing *Is the proposed Project to receive funding from source(s) other than SPLOST 2020? Yes No If yes, please fill in information below. Total Capital Financing for Project: If the proposed Project is to receive funding other than SPLOST 2020, provide a listing of amounts from each of the categories listed below. Please round all dollar amounts to the nearest $1,000. Project Sources (round to thousand) 1. SPLOST 2020: 1 OTHER SOURCES 2. ACCGOV General Fund: 3. ACCGOV Enterprise Fund: 4. State Grant: 5. Federal Grant: 6. Previous SPLOST: 7. Other (describe): 8. Other (describe): TOTAL SOURCES: Amount Describe the current commitments for the other sources funding this project: If any additional sources of funding other than SPLOST 2020 are indicated above, please provide information related to the source here. Be specific and be prepared to provide all necessary written approvals. (For example: Roadway projects that have approval for Federal Aid and will utilize SPLOST 2020 funding for matching funds, you would need to provide specific written approval by GDOT) (2,500 Character Limit)

15 Project Site *Will the proposed Project be on a site currently owned by ACCGOV? Yes No Unsure *Approximately how many acres is available or will be needed for the new facility or Park? *Project Location/Address (Existing or Proposed): (500 Character Limit) Indicate the location, street name, intersection, and/or address here for the proposed Project. (500 Character Limit) *Will the Project require fee simple additional land acquisition? Yes No Unsure *Will the Project require Rights-of-Way or Easement acquisition? Yes No Unsure Current Property Owner (if applicable): (100 Character Limit) Site Criteria and Standards (Only applicable if site selection is needed) If the property is not owned by ACCGOV, indicate the current property owner here. (100 Character Limit) Acreage *Size: (100 Character Limit) Minimum acreage necessary for Project. (100 Character Limit) *Topography: (100 Character Limit)

16 *Estimated cost per acre: (500 Character Limit) Provide an estimated cost per acre and an explanation of how this estimate was derived. (500 Character Limit) Location/Accessibility: Relative to its service area: Define location relative to the Project's service area that best meets the Goals and Objectives. Vehicular: If necessary to meet the Goals and Objectives, describe what types of vehicular access will be required. Pedestrians: Same as vehicular, but for pedestrians. Bicycle Access: Same as vehicular, but for bicycles.

17 No further information on site criteria and standards is necessary for the project request form at this time. However, additional information may be requested during the administrative or technical review processes. If applicable, be prepared to furnish information regarding the following criteria: Development/Adjacent impacts (visibility, compatibility with land use plan, buffering, etc.) Economy/Financing (on- and off-site development costs, joint development opportunities, stimulation to private interests, etc.) Environmental (historic standards, traffic impacts, aesthetic standards, air quality, noise impacts, drainage types, wetlands compatibility, etc.) Community Values (displacements required, security needs, etc.)