OFFICE OF CHILDREN AND FAMILY SERVICES
DORMITORY AUTHORITY FUNDING
FOR VOLUNTARY AGENCY CAPITAL PROJECT
INITIAL APPLICATION PACKET
December 2005
GENERAL INSTRUCTIONS FOR COMPLETING THE
INITIAL APPLICATION PACKET
Please read the instructions provided for completion of each form in order to avoid an incomplete submission.
CP-1 - General Information: Self-explanatory
CP-2 - Staffing Summary
Not required for the Initial Application.
CP-3 - Description of Current Physical Plant
Not required for the Initial Application.
CP-4 – Initial Estimates of Project Cost
Please submit initial estimates of project costs in the format provided. Use the comment column for specifying "other" descriptions and/or to provide additional details pertaining to the cost estimate.
CP-5 - Projected Financial Impact on Facility Costs
Not required for the Initial Application.
CP-6 - Checklist and Signature Page
Please submit the required documents, as indicated.
Attachments
Preliminary Certification in Support of a Voluntary Agency’s Initial Application for Dormitory Authority Financing – Please complete.
Listing of Referral Sources in Support of Capital Project Financing – Please complete.
Revised Guidelines for Determining Depreciation of a Capital Project
These instructions are a replacement of existing guidelines in the Standards of Payment Manual regarding the cost reporting and reimbursement rules for a capital project.
Overview of Tax Exempt Financing Process for DASNY Financing
Vendor Responsibility Questionnaire – Please complete.
FORM CP-1 - General Information
1) Legal Name of Agency: ______
2) A/K/A, if applicable: ______
3) Executive Director’s Name: ______
4) Mailing Address: ______
(Administrative Offices)
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5) Telephone: ______
6) Fax: ______
7) Contact Person:
- Name, Title, and Phone Number: ______
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8) Agency Location (Administrative Offices)
- if different from mailing address: ______
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9) Street Address of Project: ______
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10) Legal Name of the Owner of the Property (where project is to be located):
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11) Project Description (describe purpose and scope of project): ______
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12) Please describe the Agency’s existing long term (with a term of more than 1 year) debt by providing the following information with respect to each loan:
Amount of outstanding debt / Lender / Security for the Loan / Term – when is it due
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13) Explain how the project will benefit the health and safety of the children served or to be served by the current program or new program. Describe population of current or new program, as appropriate.
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14) Complete the following in regard to the population to be served by the proposed project:
a) Licensed capacity* that will result from this project: ______
b) Current capacity in program affected by this project: ______
c) Anticipated care days in first year of operation following project: ______
* The total capacity of the institution program for which this project is being proposed may not
exceed the total licensed capacity currently approved.
15) Provide answers to the following in regard to the proposed project:
a) Type of project (e.g. replacement building, addition, alteration/renovation, site development)
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b) Type of facility (e.g., group residence or institution)
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c) Size of project (gross floor area, size of site, number of rooms, number of beds, etc.)
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d) If applicable, describe any changes in outdoor facilities on agency property as a result of the capital construction project.
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Agency Name: ______
Project Site: ______
FORM CP-4 – INITIAL EstimateS OF Project Cost
DESCRIPTION / NEW CONSTRUCTION / RENOVATION / COMMENTA1. General Construction / $ / $
A2. Heating, Plumbing, Electric
A3. Other (Specify):
A4. Total Building Costs (A1-A3): / $ / $
B1. Architect/Engineer Fees
B2. Construction Management
B3. General Administration/Legal and Insurance
B4. Site Purchase & Development / Land Purchase
Parking Areas
Walkways
Landscaping
Other (Specify)
B5. Utilities and Service
B6. Furniture & Equipment
(Please attach a detailed listing)
B7. Other / Demolition
Project Contingency
Other (Specify)
B8. Total Incidental Costs (B1-B7) / $ / $
C1. Total Building & Incidental Costs (A4+B8) / $ / $
C2. Total Project Costs (New Construction + Renovation) / $
Agency Name: ______Project Site: ______
FORM CP-6 (CHECKLIST AND SIGNATURE PAGE)
Checklist of Required Documents for Submission of Initial Application
DOCUMENTCP-1 General Information
CP-4 Initial Estimates of Project Cost
CP-6 (Initial Application) Checklist and Signature Page
CPA Reports for the past three years
Preliminary Certification(s) in Support of a Voluntary
Agency’s Initial Application for Dormitory Authority
Financing
Listing of Referral Sources in Support of DASNY Financing
Vendor Responsibility Questionnaire
I certify that I have examined the initial application packet and that it is a true and complete statement of the required information.
Signature ______Date: ______
Executive Director
A complete submission consisting of the above documents should be sent to the address specified on the following page:
Address Information
/ # CopiesNYS Office of Children and Family Services
Rate Setting Unit
52 Washington Street, 314 South
Rensselaer, New York 12144-2796 / 1
For programs licensed by OCFS, please send a copy of proposal to the applicable OCFS Regional Office, as follows:
OCFS Regional Offices
BRO Linda Brown, (716) 847-3145,RRO Linda Kurtz, (585) 238-8200,
SRO Jack Klump, (315) 423-1200,
ARO Glenn Humphreys, (518) 486-7078,
NYCRO Fred Levitan, (212) 383-1788,
YRO Pat Sheehy, (914) 377-2080, / 1
For programs licensed by the NYS Office of Mental Retardation and Developmental Disabilities, or other New York State agency, please send a copy of proposal to the applicable office representing that agency. / 1
Preliminary Certification in Support of an Agency’s
Initial Application for DASNY Financing
This preliminary certification is being submitted in support of the below named agency’s initial application for a capital improvement project using the DASNY financing mechanism authorized by Chapter 472 of the Laws of 2004. I understand that in submitting this certification, I am registering my district’s preliminary support for the ongoing public need of the program identified by the below named agency as well as for the capital project that the agency is proposing to the State for the purpose of improving the health and safety of children in its residential program.
I understand that the State will permit certain applicants to complete a comprehensive application, if so qualified. I understand further that as part of that process, the below named agency would develop detailed project plans and costs, and that those documents would be made available to me in the event that I am requested to complete a final certification in support of the agency’s application for DASNY financing. In signing this preliminary certification, I am recognizing the potential increase in the cost of said program should it be approved by the State for DASNY financing.
I further understand that if this capital project is approved, OCFS would establish an annual capital financing add-on rate that is over and above the established maximum State aid rate; that said add-on rate would cover the approved capital costs associated with any foster children and Committee on Special Education (CSE) children placed in the applicable program; that said add-on rate would be effective for the term of the bond that is issued to support the financing of the project; that for foster care placements, the State would reimburse each referring social services district at 50 percent of the DASNY add-on rate, net of any available federal funding for those costs that exceed the social services district’s foster care block grant allocation; and that for CSE placements, the existing formulas for reimbursing CSE maintenance would apply to the DASNY add-on rate.
I ______hereby certify that______
Commissioner or Other Official (print) Name of District (print)
supports the ______in its initial application for approval of a capital
Name of Voluntary Agency (print)
project for the program referenced by said agency in its attached letter of ______.
Date of Letter
I further certify that I am not aware of any ongoing investigations by governmental or non-governmental entities regarding concerns about the program or fiscal operations of the agency referenced above.
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Commissioner or Other Official’s Signature Date Signed
Listing of Referral Sources in Support of Initial Application
for Capital Project Financing
Name of Voluntary Agency ______
Please use the following format to specify the referral sources in support of the affected program at the time of the initial application for Capital Project financing, including the number of children represented by each referral source. This listing should be inclusive of all referral sources at the time of application. Use additional sheets as needed.
Name of Referral Source / Number of Children in Program from each Referral Source______
Agency Executive’s Signature Date Signed
Revised Guidelines for Determining and Reporting Depreciation of a Capital Project
Standards of Payment Program Manual (Revision to Chapter 4, Section C)
Account 38 - Use Charges: Reimbursement in the maximum State aid rate for the use of owned property (i.e., for buildings, for capital improvements, for equipment, and for other capitalized items), as well as for leasehold improvements, will be made through depreciation.
§ Assets having a cost of $1,000 or more and a useful life of 2 years or more must be depreciated. Conversely, items having a unit cost less than $1,000 or a useful life of less than 2 years may be expensed.
APPLICABLE REGULATION (the following references in this regulation to “department” should be interpreted to mean “OCFS”, which is the successor agency to the State Department of Social Services):
442.4 Buildings and equipment.
(a) Definitions. As used in this section, the following definitions shall apply:
(1) Building means a structure.
(2) Construction means the erection of a new structure.
(3) Addition means extension or increase in area, height or equipment of an existing structure.
(4) Substantial modification means any alteration, change, rearrangement or reconstruction to an existing structure or equipment except for ordinary repairs and maintenance.
(5) Equipment means fixtures or articles affixed to the structure.
(6) Occupancy means use of a building, structure or premises; abandonment or vacating a building or a major part of a building shall be considered a change in occupancy.
(b) Construction, addition, substantial modification and change in occupancy.
(1) Except for buildings or parts of building used in the operation of a child caring institution, in substantial compliance with applicable requirements on October 31, 1964, on and after November 1, 1964, no building and no part of a building shall be used for the care of children except with the approval in writing of the department. To qualify for approval by the department, the building or part thereof to be used must be in substantial compliance with the appropriate provisions of the State Building Construction Code relating to institutions, the regulations of the department, and all other applicable provisions of State and local laws, ordinances, rules and regulations.
(2) There shall be no construction, addition, substantial modification or change in occupancy of buildings or parts of buildings used or to be used in the operation of a child caring institution, except on plans and designs approved in writing by the department. Plans shall be submitted for approval in accordance with the procedure prescribed by the department thereof. To qualify for approval by the department, plans and specifications must be in substantial compliance with the appropriate provisions of the State Building Construction Code relating to institutions, the regulations of the department and all other applicable provisions of State and local laws, ordinances, rules and regulations.
(3) No changes or modifications shall be made to approved plans or specifications without the approval of the department.
(4) The approval of the department shall become void one year after given unless a contract for the approved construction or reconstruction shall have been entered into.
(c) Exceptions. The department may grant an exception to compliance with one or more of the provisions of this section upon finding that compliance will result in undue hardship to an institution, that, but for the exception, the facility is in substantial compliance with such provisions, and that granting the exception will not create any hazardous conditions which could impair the health or safety of the children; provided however, that the facility otherwise complies with any alternate requirements which the department may consider necessary for the protection of the health or safety of the children.
Proposals for construction, addition, or substantial modification, as those terms are defined above, and including the acquisition of buildings, must be submitted to the OCFS Regional Office and the OCFS Rate Setting Unit for review and approval.
Costs of facility acquisition or construction shall be depreciated over the expected useful life of the facility per the rules and guidelines specified below. The cost of facility acquisition or major renovation includes architect and inspection fees, which should be included in the cost of the building for depreciation purposes. Renovations or alterations that are considered to be directly related to the program and therefore reimbursable through depreciation charges over the estimated useful life of the renovation or alteration may include: the installation of safety devices, such as fire exits, alarms or smoke detectors in existing buildings; the replacement of roofs, boilers, plumbing systems, or other renovations needed to protect the agency’s physical plant, or to protect the health or safety of children, or to satisfy compliance with applicable New York State standards.
For cost reporting purposes, the submission of back-up details regarding depreciation expenses for assets such as buildings, equipment and vehicles are not required. However, the service provider is required to maintain depreciation schedules that include the following minimum information: