CY 2012 NEW FREEDOM, JOB ACCESS/REVERSE COMMUTE

AND MOBILITY MANAGEMENT (OCP)

PROJECT PROPOSAL

Legal Name of Proposer:
Website: / Street Address:
City: Zip:
County:
Main Phone Number:
Name and Title of Designated Official with Signature Authority: / Phone:
Fax:
Email:
Name and Title of Project Contact Person: / Phone:
Fax:
Email:
Total Project Cost (Sum of All Project Types): / Total Federal Funding Requested (Sum of All Project Types):
Check all project types that apply:
New Freedom: Capital (80/20) Operating (50/50)
Total Project Cost – New Freedom: ______
Total Federal Funding Requested – New Freedom: ______
Job Access/ Capital (80/20) Operating (50/50) Planning (80/20) )
Reverse Commute
Total Project Cost - JARC: ______
Total Federal Funding Requested - JARC: ______
Mobility Management: Capital (80/20)
Total Project Cost – Mobility Management: ______
Total Federal Funding Requested – Mobility Management: ______
Proposed Project Period: Beginning date ______Ending date ______
Service Area: (list all municipalities, townships and counties to be served by this project)
Total Population Served (All Project Types): / - Enter the cumulative total in the space provided (left)
- Enter year of data and source of information
Disabled Population Served : / - Enter the cumulative total of individuals with disabilities in the space
provided (left)
- Enter percent of population who are individuals with disabilities
- Enter year of data and source of information
Low Income Population Served: / - Enter the cumulative total of the individuals at or below 150% of poverty level income in space provided (left)
- Enter percent of population at or below 150% of poverty level income.
- Enter year of data and source of information
Food Stamp Recipients: / - Enter the cumulative total of food stamp recipients in space provided (left)
- Enter percent of population receiving food stamps.
- Enter year of data and source of information
Ohio Works First Recipients: / - Enter cumulative total of Ohio Works First recipients in space provided (left)
- Enter percent of population that are Ohio Works First recipients.
- Enter year of data and source of information
Estimated Number of Transportation Clients Served in the Following Minority Groups
American Indian and Alaska Native, which refers to people having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
Asian, which refers to people having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent.
Black or African American Populations, which refers to peoples having origins in any of the Black racial groups of Africa.
Hispanic or Latino Populations, which includes persons of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
Native Hawaiian and Other Pacific Islander, which refers to people having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

I.  Project Summary

Please provide a detailed project description no more than two pages in length. This summary is NOT to be a description of your agency, but is intended to provide a description of the purpose and specifications of the project to be funded. While capital purchases are eligible under the program, they are not the primary thrust of your project and should be identified in your project summary as capital required to support the goal or purpose of the project. Attached documents (i.e. brochures, pamphlets, etc.) will not be accepted. A separate project summary should be included for each project type as listed on page 1 of this proposal.

II.  Project Outcomes

Please provide both quantitative and qualitative information on each of the following measures based on your proposed project (each project may not have measures for all listed categories):

  1. services provided that impact availability of transportation services for individuals with disabilities;
  2. additions or changes to environmental infrastructure, technology, and vehicles that impact availability of transportation services;
  3. the estimated number of rides (measured by one-way trips) provided for individuals with disabilities;
  4. estimated number of jobs that can be accessed;
  5. estimated number of rides (as measured by one-way trips) for work or work-related purposes provided;
  6. list all other measurable project outcomes that will be used to demonstrate the success of this proposal (while not required, points will be added in the scoring for additional measures of success); and
  7. anticipated number of unduplicated individuals who will be served during the calendar year.

III.  Coordination

1.  How does this project expand mobility, and/or the availability of transportation services or continue to expand transportation services?

2.  Is the intent of this project to reduce duplication of effort and/or increase efficiency? If so, please explain.

3.  Specifically, what services, if any, will be coordinated by this project? (check all that apply.)

Client trips ____ Purchasing of fuel ____

Schedules ____ Purchasing of supplies ____

Training ____ Vehicle sharing ____

Marketing ____ Grant writing ____

Maintenance ____ Vehicle storage ____

Dispatching ____

Other______

______

______

4.  Provide a complete list of all agencies participating and describe their role(s) in the project.

IV.  Administrative and Fiscal Capacity

Describe your agency’s ability to provide for the financial and program management needs of this project. Include: what accounting structure will be in place; who will be responsible for monitoring the budget, operations, procurement, maintenance, data collection and providing financial and outcome (data) reports. List all other key staff involved in the project and their specific tasks.

V.  Marketing and Outreach

Describe how the project will be marketed to serve the target population. Include all marketing materials your project has developed or proposes to use in this effort. Attach a copy of your current marketing plan for your project.

VI.  Capital

Is capital equipment needed for this project? If yes, please list each capital item and an estimated cost for each item listed. Any request for capital must be justified and be in support of the grantee’s existing or planned operating project. Capital purchases must be procured by and become the property of the grantee.


Attachment A

SELF CERTIFICATION FOR THE

LOCALLY DEVELOPED COORDINATED PUBLIC TRANSIT- HUMAN SERVICES TRANSPORTATION PLAN “Coordinated Plan”

  1. This project is derived from the Locally Developed Coordinated Public Transit – Human Services Transportation Plan adopted by on .
  1. The Locally Developed Coordinated Public Transit – Human Services Transportation Plan was completed on (date) by (lead agency). This project is identified and ranked as a priority on page of the plan. (A copy of the page showing the project must accompany the application).

______

Applicant Name

______

Signature of Authorized Authority

Date


ATTACHMENT B

PUBLIC PARTICIPATION (for capital only)

For capital projects only, upon notification of project selection, the applicant must publish a public notice regarding its intent to submit an application for a capital grant for the proposed project. This notice must be published within 10 days of receiving ODOT’s announcement that the project has been selected for implementation. Within 30 days, a copy of the published notice, an affidavit of publication and a copy of the minutes or hearing summary must be submitted to ODOT.

If the process is completed prior to submission of the proposal, the documentation should be included as Attachment B. If submitted subsequently, the documents will be added as Attachment B.


ATTACHMENT C

Sample Authorizing Resolution

Resolution No. ______

A resolution authorizing the filing of a project proposal with the Ohio Department of Transportation for grants through the US DOT Federal Transit Administration (FTA), as authorized under Federal Transit Laws, as codified, 49 USC Chapter 53, and executing a contract with the Ohio Department of Transportation upon project approval.

WHEREAS, the Director of the Ohio Department of Transportation is authorized to make grants for public bodies, private nonprofit organizations and other eligible entities;

WHEREAS, the contract for financial assistance will impose certain obligations upon the applicant, including the provision by it of the local share of the project costs in the program;

WHEREAS, it is required by the U.S. Department of Transportation in accordance with the provisions of Title VI of the Civil Rights Act of 1964, that in connection with the filing of an application for assistance under 49 USC Section 53 the applicant gives an assurance that it will comply with Title VI of the Civil Rights Act of 1964 and the U.S. Department of Transportation requirements thereunder; and

WHEREAS, it is the goal of the applicant that disadvantaged business enterprise be used to the fullest extent possible in connection with this/these project(s), and that definite procedures shall be established and administered to ensure that disadvantaged businesses shall have the maximum construction contracts, supplies, equipment contracts, or consultant and other services.

NOW, THEREFORE, BE IT RESOLVED BY ______

(Governing Body of Applicant)

1. That (Title of Designated Official) is authorized to execute and file (an) application(s) on behalf of (Legal Name of Proposer) with the Ohio Department of Transportation to aid in the financing of capital, and operating assistance projects.

2. The (Title of Designated Official) is authorized to execute and file with such applications and assurance or any other document required by the U.S. Department of Transportation effectuating the purposes of Title VI of the Civil Rights Act of 1964.

3. That (Title of Authorized Representative) is authorized to furnish such additional information as the Ohio Department of Transportation may require in connection with the proposal for the program of projects submitted to FTA.

4. That (Title of Designated Official) is authorized to set forth and execute affirmative disadvantaged business policies in connection to any procurements made as part of the project.

5. That (Title of Designated Official) is authorized to execute grant agreements on behalf of (Legal Name of Proposer) with the Ohio Department of Transportation for aid in the financing of operating, planning and capital assistance projects.

The undersigned duly qualified and acting (Title of Designated Official) of the (Legal name of Proposer) certifies that the foregoing is a true and correct copy of a resolution, adopted at a legally convened meeting of the (Governing Body of Proposer) held on ______, ______.

If proposer has an official seal, impress here.

______

Signature of Recording Officer

______

Title

______

Date


ATTACHMENT D

LOCAL MATCH SUMMARY FOR EACH PROJECT TYPE

SOURCE/AGENCY / DOLLAR AMOUNT / DATE AVAILABLE
NEW FREEDOM:
JARC:
MOBILITY MANAGEMENT:

This should include all match sources: including non-DOT Federal funds, contract revenue, fares, private donations, local funds, in-kind, etc.

Authorizing Signature:______

Title:______Date:______

This form should be copied as needed.

ATTACHMENT E
PROPOSED BUDGET FOR MOBILITY MANAGER
Expense Category / Direct Expenses
Mobility Manager's Salary/Wages / $0
Fringe Benefits for Mobility Manager / $0
Services:
Advertising Agency / $0
Custodial Services / $0
Other Services / $0
Office Supplies (related to the Mobility Manager) / $0
Utilities / $0
Casualty & Liability Costs - Expenses for Bonding for Bonding for Mobility Manager & Board Members / $0
Miscellaneous Expenses:
Dues & Subscriptions / $0
Travel & Meetings / $0
Advertising/Promotion Media / $0
Other Miscellaneous Expenses / $0
General Administration Facilities / $0
Total Direct Expenses / $0

For every line item with an amount on this exhibit, please provide a detailed calculation on a separate sheet of paper and include with your proposal. An example follows:

Labor –

Mobility Managers wages @ $15.00/hr. X 2,080 hrs. = $31,200


ATTACHMENT F

New Freedom JARC

PROPOSED OPERATING BUDGET
TOTAL EXPENSES
Labor-Management and Supervision / $0
Labor- Operations / $0
Total Labor / $0
Fringe Benefits / $0
Purchased Services / $0
Vehicle and Office Supplies
Fuel / $0
Other Supplies / $0
Utilities / $0
Insurance - Vehicle Liability / $0
Other / $0
Other / $0
Taxes / $0
Purchased Transportation Services / $0
Miscellaneous Expenses:
Dues and Subscriptions / $0
Travel and Meetings / $0
Marketing / $0
Other Misc Expenses / $0
Interest Expense / $0
Leases and Rentals:
Passenger Revenue Vehicles / $0
Maintenance Garages / $0
Admin. Facilities / $0
Other Costs
$0
$0
Subtotals / $0
Total Eligible Project Income / -$0
Total Operating Costs / $0

For every line item with an amount on this exhibit, please provide a detailed calculation on a separate sheet of paper and include with your proposal. An example follows:

Labor – Managers wages @ $25.00/hr. X 2,080 hrs. = $52,000


ATTACHMENT G

New Freedom JARC Mobility Management

PROPOSED CAPITAL PROJECT BUDGET
# / ITEM DESCRIPTION / QUANTITY / TOTAL COST / MILESTONE DATE*
1
2
3
4
5
Total Project Cost
Federal Share (80%)
Local Share (20%)

We intend to use ODOT’s Term Contract for vehicle Purchases: yes no

Comments: ______

______

______

*TOTAL COST: vehicle prices should be based on ODOT Term Contract Pricing, if available, and are available on the Office of Transit web page.

**MILESTONE DATES: use the purchase order dates for purchasing vehicles and/or equipment.


ATTACHMENT H

PLANNING PROJECT BUDGET

(JARC ONLY)

# / PLANNING PROJECT DESCRIPTION / TOTAL COST / MILESTONE DATE*
1
2
3
4
5
Total Project Cost
Federal Share (80%)
Local Share (20%)

Comments:

Note: only planning expenses associated with project implementation are eligible. Please note whether the planning is to be performed in-house or by a consultant or other external party.

*Milestone Dates: If performed in-house, date that planning work is to begin and end. If outsourced, use the purchase order date for the start date and indicate the anticipated completion date.