15-060BAppendix B-1 –New Program Grant Application

RTC of Southern Nevada – Section 5310 Grant Funds

FOR RTC Date Received: / Time Received: / Received By:
USE ONLY / /

APPLICATION:NEW PROGRAM REQUESTS ONLY

APPLICANT INFORMATION

Applicant Information
Date
Legal Name of Applicant
Contact Person
Street Address
City/State/Zip Code
Email
Phone Number
Fax Number
Project Title (question #1)
Organizations Type
State or Local Government Authority
Private Non-Profit Organization (please attach documentation certifying non-profit status)
* For-Profit firms cannot be subrecipients of 5307 or 5310 grant funds.
Partnering Organizations and Contact Information
Partnering Organization
Contact Person
Title / Position
Street Address
City/State/Zip Code
Email
Phone Number
Fax Number
Project Request Information
Project Cost: * (Refer to Total Program Expense line from Appendix F-3)
Grant Portion Requested: ** (Refer to Total Federal Share from Appendix F-3)
Funding Source Requested(A separate application needs to be submitted for each category of funding being requested)
FTA 5307 Formula Grant Funds –Job Access Reverse Commute
FTA 5310 Formula Grant Funds- Enhanced Mobility of Seniors and Individuals with
Disabilities (New Freedom Type Projects)
Operating - 50 percent Federal Funds / 50 percent Local Match
(Use Appendix B-2, Budget Form A)
Planning - 80 percent Federal Funds / 20 percent Local Match
(Use Appendix B-2, Budget Form B)
Capital - 80 percent Federal Funds / 20 percent Local Match
(Use Appendix B-2, Budget Form C)
Letters of Support
Number of letters of support
Application Instructions
a.The font is Times New Roman 12 point. Please limit the number of typed pages submitted in the application to 20 single spaced pages maximum answered in the format provided.
b.The Word document form is provided for your input. Please adjust the spacing to fit the response, leaving two (2) spaces at the end of each question’s response.
c.Please use full justification and no indentation of new paragraphs.
d.Please check the document for spelling, typing, or grammar errors, and contact RTC with any questions regarding the format prior to submitting it for consideration.
f.Attachments required do not count as pages for the 20 page maximum.
g.Please be concise when formulating your responses. Specific information that describes your project, its relevance to the community, its goals and costs will be well received by the evaluators. Vague or broad generalized statements may detract from understanding the project.
Checklist of Application Attachments (in order of placement):
Appendix B- Application Form
Appendix B-2 Budget Form (Excel spreadsheet)
Non-Profit Status Documentation (501(3)(c), if applicable)
Appendix C - Form for Certification of Ability to Provide Local Match
Appendix D - Federal Requirements:
Certification Regarding Lobbying
Certificate Regarding Debarment, Suspension, Ineligibility & Voluntary Exclusions
Verification Regarding Disadvantaged Business Enterprises
Certificate of Insurance
Map of Service Area
Letters of Support
Project Information
  1. Project Title: (Please keep project names to no greater than five (5) words. Anagrams count as one word. Place the Project Title in Applicant Information on page 1). Provide a brief description of the project.

Answer here:
  1. Please indicate the type of clients that your program will serve, check all that apply. If multiple client types please indicate percentage of clients being served.

Senior 60+ 1-25% 26-50% 51-75% 76-100%
Individuals with Disabilities 1-25% 26-50% 51-75% 76-100%
Veterans 1-25% 26-50% 51-75% 76-100%
  1. Describe the target population of the project and define how the target population is 1) identified as meeting the program definition [such as age, gender, race, ethnicity, socio- economic level, disability, etc.] and 2) how are potential clients notified of the available service.

Answer here:
  1. Please include the number of clients that will be served using the grant funding, the estimated number of trips that will be provided and the number of clients served that are certified for RTC ADA Paratransit services.

Clients:
Trips:
RTC ADA Certified Clients:
RTC ADA Certified Trips:
  1. Describe the geographic boundaries of the project (use entity names, zip codes, or other descriptive items. Geographic area is limited to locations within Clark County, NV). Provide a map of the geographic area.

Answer here:
  1. Describe which specific priority or priorities as outlined in the Coordinated Transportation Plan dated March 2015 (Appendix A) this project will meet or address.

Answer here:
  1. Briefly explain how this project currently diverts trips from RTC ADA Paratransit Services and any new and innovative plans, ideas or structures that the project will implement to improve upon this process.

Answer here:
Responsiveness to Evaluation Criteria
  1. Explain how this project partners with existing public and private agencies, non-transit entities, and/or private non-profit or for-profit transportationproviders.

Answer here:
  1. Describe how the program will meet the unmet transportation needs in Clark County and what strategies will be used to continue to address those needs in the future.

Answer here:
  1. Provide an operational plan to support the implementation and operation of the project, including activities to be conducted to accomplish the program’s goals/objectives. Describe the project deliverables and expected outcomes along with the methods to be used in implementing the project.

Answer here:
  1. Describe how the data outlined in Appendix J Eligible Projects – Reporting will be collected to ensure compliance with FTA requirements for reporting enhancements to service, impact of vehicles added to the service and number of one-way trips provided.

Answer here:
  1. Provide an example of project goals and the steps to accomplishment of those goals.

Answer here:
  1. Describe the steps that will be taken if the anticipated goals of the project are not beingmet.

Answer here:
  1. Indicate the proposed operator of the service.

Answer here:
  1. Would your project be ready to commence on July 1, 2015? Please note that the grant period is a maximum of 12 months from the commencement.

Answer here:
  1. Project Timeline and Milestones: (Add or delete rows to the Table as required)

Step / Milestone / Start Date / Complete
Budget Experience and Implementation
  1. Describe your organization’s experience in administering federal grants?

Answer here:
  1. Provide a narrative budget justification that describes how the categorical costs outlined in Budget Form Exhibit 1 are derived. Include the necessity, reasonableness, and allocation of the proposed costs related to proposed capacity building activities.

Answer here:
  1. Indicate the source of Local Match funds. If the funds are coming from In-Kind or Soft Match contributions, explain the contribution including naming the contributor and listing the portion contributed (Information may be listed on –Appendix F-3, Tab(s) A – CBudget Form or further explained in Question 22.)

Answer here:
  1. Please list below potential funding sources for sustaining the project beyond the grant period. Environmental sustainability.

Answer here:
  1. Could the project be implemented on a more limited scope with less funding?

YES (Proceed to Question 22)
NO (Proceed to Question 23)
  1. If the project could be offered on a more limited scope, please describe.

Answer here:
  1. Describe any steps subrecipient has taken to identify other sources of funds to sustain programs if the grant funding is no longer available.

Answer here:
Miscellaneous
  1. Identify and list such current or former RTC employees involved in the preparation of this Application or the anticipated performance of work or services if selected. (Note requirements in Section 22 (c)(2) of Solicitation No. 15-060)

Answer here:
  1. If awarded continued grant funding, indicate below if your program is able to participate in the RTC Coordinated Network of Providers.
Note: All recipients of FTA 5307 and 5310 Formula Grant Funds, funding may be required to participate in the RTC Coordinated Transportation Network. As part of the coordinated network your organization may be required to assist in the transportation of clients beyond the initial scope described in the agreement, but remaining in conformity with the mission and guidelines of your organization.
YES NO
If answered NO, please explain.
If answered YES, please explain to what extent applicant can participate, and what restrictions may apply to participation.
Explain here:
  1. Does your organization employ 50 or more employees?

YES NO
If answered YES, does your organization have an EEOC policy?
YES NO

Name of official who can on behalf of Applicant affirm that Applicant is authorized to submit a Proposal and execute the Subrecipient Agreement if selected.

Name:

Title:

______

SignatureDate

Solicitation No. 15-060B

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