ENVIRONMENTAL MANAGEMENT SYSTEM QUICK START GRANT APPLICATION

The purpose of the Environmental Management System (EMS) Quick Start Grant Program is to assist EMS participants toward continuous environmental improvements in the six areas pursuant to Iowa Code Section 455J.7. The six “component” areas include:

·  Yard Waste Management

·  Household Hazardous Waste Collection

·  Water Quality Improvement

·  Green House Gas Reduction

·  Recycling

·  Environmental Education

Grant Information:

Once a solid waste agency/permitted facility service area is designated as a Solid Waste Environmental Management System pursuant to Iowa Code 455J.7, the new EMS will be eligible one time only for up to $20,000 in Quick Start Grant funds. The Quick Start Grant application due date will be established by council at the beginning of each fiscal year. Although no cash cost share is required, a cost share component in a project’s budget will be considered in the review process. Council may recommend funding at the full requested amount, funding at a lesser amount than is being requested or may recommend not to award funds.

Successful grant applicants will be subject to DNR contract terms. Please fill out the short application below.

SECTION 1 – Identification Information*

EMS Participant Area Name:
Contact Person:
Mailing Address:
Telephone:
Fax:
Email:

*One (1) original IRS Form W-9 (revised January 2011) and one (1) original Minority Impact Statement form must be submitted to DNR before the grant agreement is signed by DNR officials.

SECTION 2 – EMS Quick Start Grant Funding Proposal

EMS Quick Start Grant Funds may be used for but are not limited to the following types of expenses in support of one or more of the objectives and targets:

·  Equipment and supplies

·  Expertise – consultants, temporary employees, or media professionals - i.e. web/graphics/ad specialists – or for attending training or workshops to gain expertise, EMS training materials

·  Mini grants or subsidies, cost shares, or seed moneyfor residents, area governments, businesses, or partners outlined within approved fenceline

·  Media and advertising costs - i.e. print, web, television, radio, other promotions, displays

·  Gathering initial/baseline data in any of the six Component Areas

·  A new initiative or enhancing or improving an existing program or activity

Project Description:

Please write a brief description of how grant funds will be utilized to include: (separate sheet, one page or less).

Timeline and assignments:

·  Identify major tasks needed to implement the project(s) for which funds will be used and the timeline for those tasks

·  Identify the person(s) assigned to those tasks.

Budget: (separate sheet or spreadsheet)

·  If you propose to use funds for more than one project, please supply a separate timeline and budget for each project.

·  List items for which funding is requested – include copies of estimates, quotes (actual documents) when possible.

·  Identify why a specific item/piece of equipment/contractor (for example) was selected – give selection criteria such as price, vendor knowledge and convenience.

The EMS Council reserves the right to ask for additional information before approving or denying grant applications.

Total EMS Quick Start Grant Fund Request:

Amount of Funding Requested:
Amount of Matching Funds
Total Estimated Project(s) Cost:

SECTION 3 – Signature

I affirm the information provided on this Application is true, and that I will provide all other information requested for further substantiation. I agree that if awarded a Grant, I will execute the contract the DNR provides for conveying those funds, which contract will include but not be limited to conditions for expending those funds, and for making reasonable accounting of those expenditures and matching funds or in-kind expenses if there are any.

Signature, Title / Date

The application and other forms may be found: http://www.iowadnr.gov/InsideDNR/RegulatoryLand/SolidWaste/ComprehensivePlanning/SolidWasteEMS.aspx

Applications received at the Department of Natural Resources after 4:00 PM on the date set by the EMS council will not be considered.

Email or FAX your completed, signed and dated application and any additional information to:

DNR FAX: 515-725-8202

02/2014 bj 1 DNR Form 542-0086