/ CVP Application Score Sheet
  1. Application Information

Applicant Legal Name
  1. Application Reviewer

DPIT Staff / Initial Review / Date Started / Date Completed
  1. Replacement Vehicle Eligibility

Please select the appropriate eligible funding criteria (more than one may apply):
Section 5311 Public Transit Operator (If yes, review Parts II, III and Appendix A, B & C only)
New or Expanded Service of Territory
Vehicle Replacement Criteria (more than one may apply)
Auto, Mini- or Raised-Roof Van (Greater than 95,000 miles or 5 years AND in UNSAFE condition)
Light Duty Paratransit Vehicle (Greater than 100,000 miles or 7 years AND in UNSAFE condition)
Medium Duty Paratransit Vehicle (Greater than 120,000 miles or 8 years AND in UNSAFE condition)
Super Medium Duty Paratransit Vehicle (Greater than 180,000 miles or 9 years AND in UNSAFE condition)
Heavy Duty Paratransit Vehicle (Greater than 280,000 miles or 10 years AND in UNSAFE condition)
1993-1995 MST Heavy-Duty Vehicle Eligible at Any Mileage or Condition
Replacement vehicle does not meet mileage or age criteria, but is documented to be in UNSAFE and POOR OPERATING CONDITION for passenger transport.
Letter from Mechanic/Inspector / Pictures of unsafe condition
**if none of the above criteria have been met, do not proceed with scoring this application**
  1. Submittal Checklist
/ Date Received
(If submitted separately)
State of Illinois Tax Exempt Certificate
(Note: applications which do not include this certificate will be deemed ineligible)
Appendix A: IDOT/FTA Assurances w/proper signature page
Appendix B: Notice of Public Hearing, Report, and Comments
Appendix C: Opinion of Counsel
Appendix D: Executed Board Resolution with Designee
Part I: Application Checklist Completed
Part II: Vehicle Inventory Completed
Part III: Vehicle Request Form(s) w/Priorities and Budget Page
(Note: Vehicle Request Form(s) and Budget Page MUST MATCH)
Part IV: Project Justification
Part V: Description of Services and Experience w/Table II
Part VI: Fleet Control and Maintenance
Part VII: Transportation Training
Part VIII: Proposed New or Expanded Service (if applicable)
Part IX: Coordination Efforts with Local Govt., Transits, Others
Part X: Financial Administration w/Funding Sources
Part XI: HSTP Review (Northeast Illinois Applications Only)
TIP Inclusion Letter (Northeast Illinois Applications Only)
Letter of Support from Local Public Transit Agency
Letter(s) of Support from Local County Boards, Legislators, etc.
Comments:
  1. Applicant Service Scoring

Criteria 1: Level of Existing Services (Maximum 3.0)
  1. Inexperienced (new agency, new to transportation services or fleet administration)
/ 0.0 – 1.0 Points
  1. Experienced (transportation services offered, new to 5310 program)
/ 1.0 – 2.0 Points
  1. Established (current grantee, history of transportation services within the program)
/ 2.0 – 3.0 Points
  1. Only available provider for specialized/private services, very active coordination partner
/ 3.0 Points
Comments:
Criteria 2: Application (Maximum 3.0)
  1. Incomplete (missing information, difficult to understand, ineligible request)
/ 0.0 – 1.0 Points
  1. Effective (new or primary transport services for elderly or disabled riders)
/ 1.0 – 2.0 Points
  1. Established (current grantee, history of transportation services within the program)
/ 2.0 – 3.0 Points
Comments:
Criteria 3: Equipment Utilization (Maximum 3.0)
  1. Low (less than 5,000 miles per year)
/ INELIGIBLE
  1. Poor (5,000-8,000 per year)
/ 0.0 – 1.0 Points
  1. Fair (8,000-15,000 per year)
/ 1.0 – 2.0 Points
  1. Excellent (15,000 or more per year)
/ 2.0 – 3.0 Points
Comments:
Criteria 4: Administration/Fleet Control (Maximum 3.0)
  1. Poor (incomplete records, lack of detailed recordkeeping)
/ 0.0 – 1.0 Points
  1. Limited (planning documents complete, lacking long-term vision)
/ 1.0 – 2.0 Points
  1. Excellent (long-term strategic planning, expansion of services planned)
/ 2.0 – 3.0 Points
Comments:
Criteria 5: Vehicle Maintenance/Driver Training (Maximum 4.0)
(Note: Examples of maintenance and training policies should be included with submission)
  1. Poor (no maintenance plans, no training policy, no records)
/ 0.0 – 1.0 Points
  1. Fair (incomplete maintenance plan and training records)
/ 1.0 – 2.0 Points
  1. Satisfactory (following suggested maintenance plan, offers required training)
/ 2.0 – 3.0 Points
  1. Excellent (comprehensive maintenance plan and records, periodic refresher training required)
/ 3.0 – 4.0 Points
Comments:
Criteria 6: Coordination Efforts (Maximum 4.0)
  1. Inactive (not currently participating in meetings, planning, or service provision)
/ 0.0 – 1.0 Points
  1. Participant (an agency that regularly attends planning meetings only)
/ 1.0 – 2.0 Points
  1. Active Participant (an agency that routinely meets committee requests with data, information, and resources in the development of strategy planning)
/ 2.0 – 3.0 Points
  1. Leadership Participant (an agency that routinely volunteers leadership, data, and resources to coordination planning and service provision)
/ 3.0 – 4.0 Points
Comments:
TOTAL SCORE / 0.0
PRIOR YEAR SCORE (if applicable)
General Comments

Printed 10/21/2018Page 1 of 2DPIT TR140 (11/20/13)