Facility Grant Application

Boating Facility Grant Application Form

To Acquire, Improve, and RenovatePublic Recreational Boating Access

Oregon State Marine Board

For OSMB use only / Boating Facility Grant number:
Biennium:2017-19 / Date received:

Instructions regarding this application and the Boating Facility Grant program can be found in the Boating Facilities Grant Procedure Guide

I. Applicant Information
Applicant or entity name: / Telephone number: / Cell phone:
Applicant mailing address: / City: / StateZip code:
Name and title of the project manager: / E-Mail: / Office phone number:
2. PROJECT Information
Project type: Acquisition Construction Consultant design/engineering
Master planningConsultant permitting/environmental/cultural
Project name:
Is the need for this project identified in the Marine Board’s Statewide Boating Access Improvement Plan “Six-Year Plan”? Yes No If yes, indicate the priority ranking: Low Medium High
Are you requesting assistance from OMB staff for: Waterway Permitting (USACE, DSL, DEQ) Yes No
Engineering (Survey & Design) Yes No
3. SITE LocationAND OWNERSHIP INFORMATION
Park or facility site name: / Waterbody: / River mile:
Site location:County: GPS coordinates (Decimal): Latitude: Longitude:
Tax map # Tax lot #
Driving directions– How would a boater find this facility from a major highway or interstate?
U.S. Congressional District Number: Oregon Legislative District Numbers: House: Senate:
Identify the current ownership of the site:
Site is owned in fee simple by the applicant. How long has the applicant owned the site? yrs.
Describe any restrictive easements or deed restrictions:
Site is leased by applicant. Number of years remaining in lease:
Name of property owner:
Describe other interest in site and tenure:
Identify the applicant’s current management of the site:
Site is managed solely by the applicant. Site is managed cooperatively with another entity
Identify the entity (volunteer host, concession, etc.):
4. General SITE information
Existing site features/amenitiesnot related to recreational boating
Day use area Marina/Moorage Trails
Campground Designated swim area Dog parks
Picnic Area Commercial Boating Onsite business’ or rentals
Other
Site maintenance:
Identify who maintains the site and facilities? Applicant Other (specify):
5. SITE USE
Identify all of the entrance, parking, day-use, and any boating-related use fees charged at this site:
Day-use $ Launch $ Parking $ Short-term dock: $ per (foot, day)
Other fees (describe and list the amounts):
Estimate the current mix of boats that use this facility (based on 100%):
<16 ft. motorized %17-26 ft. motorized % 27 ft. and over % All non-motorized %
Identify the types of boats currently using this site (by percent):
Fishing boats %General pleasure boat %
Sail boats %Ski boats %
Cruiser/yachts %Personal watercraft % Kayak/canoe % Other paddle craft % / Estimate the amount of use at this facility:
Number of launch/retrievals per year:
Number of boats mooring overnight per year:
Identify the months that boating activities take place using a scale of High (H), Medium (M) andLow (L) for the amount of use occurring in the month. If no activity leave blank.
Month / Boating Activities
Fishing / Watersports / Cruising / Sailing / Paddling / Other
January
February
March
April
May
June
July
August
September
October
November
December
Please identify Other Boating Activity
Identify any other public or private boating facilities(ramps, tie-up facilities or marinas) within a 5-mile radius on the same waterbody:
Name of facility: Direction (N,S, E,W) Distance (Miles)
1.
2.
3.
4.
5.
6.
6. Project nARRATIVEdescription
Answer all parts completely (the spaces expand, if you need more space use a separate piece of paper). This is your opportunity to “sell” your project. Do not assume Marine Board staff will know this information.
A.Describe the need for the project (i.e.; what is the problem or issue; how long have problems existed; what measures have been taken to address problems; how will the project resolve problems or issues; etc.).
B.Describe thespecificactions, materials or equipmentthe Applicant or Others will be matching to this project (i.e.; administration oversite, inspections, force account labor, equipment, volunteer labor, donated materials, or other items not completed by a contractor or consultant). This narrative supports information in Sections 8, 9, and 10.
C.Describe all uses and activities occurring at the site.
D.Briefly describe the history of the site (i.e.; how was it acquired; what was the historic or traditional use of the site).
E.Describe how the project relates to local or regional plans to meet current and future public recreation needs and the needs of the boating public. Identify if the project is included in a Master Plan, Resource Management Plan or other plan.
F.Describe any factors that make this project timely and necessary (i.e.; are facilities in jeopardy of being closed to the public due to unsafe conditions; would matching funds be lost or unavailable if not used; are there other critical conditions or known actions with which this project needs to be coordinated.)
G.Describe how this project may result in a change of current use at the site. (Increase/decrease use, change in types of boat use, increase/decrease in conflict etc.)
7. Existing and proposed project components
Check all existing amenities at this site. / Existing / Replace / Expand / Repair / New / Consultant
BOAT ACCESS / Boat ramp
Boarding docks
Short term tie-up dock
Gangway
Piles
RESTROOMS / Flush restroom
Vault toilet
Composting toilet
Utilities
PARKING AREA / Access road
Paved parking
Gravel parking
Curbs, signs, etc.
VESSEL WASTE
DISPOSAL (CVA) / Pumpout station
Dump station
Floating restroom
Utilities
MISCELLANEOUS / Dredging
Breakwater
Ski dock
Debris deflection boom
Other (specify)
PROPERTY
ACQUISITION / Attach completed
Appendix A

8. PROPOSED PROJECT FUNDING – administrative matchNot eligible for Grant Reimbursement

Applicant / Other / Marine Board / TOTAL
Administration / $ / $ / N/A / $
Federal indirect rate (complete table below) / $ / $ / N/A / $
Pre-agreement expenses (complete table below) / $ / $ / N/A / $
Permit fees / $ / $ / N/A / $
Legal fees / $ / $ / N/A / $
System development charge (SDC) / $ / $ / N/A / $
Other (specify) / $ / $ / N/A / $

Total AdministrativeMatch

/ $ / $ / N/A / $
Federal Indirect Rate
Federal Approved Indirect Rate / What is it applicable to? / Total Value / How much is match?
$ / $
$ / $
Pre-agreement Expenses and Match (include documentation)
Item Description / Value
$
$
$
$

9. PROPOSED PROJECT FUNDING – FORCE ACCOUNTMATCH

Complete tables below for each. / Applicant / Other* / Marine Board / TOTAL
Force account labor / $ / $ / N/A / $
Force account materials / $ / $ / N/A / $
Force account equipment / $ / $ / N/A / $

Total Force Account Match

/ $ / $ / N/A / $
Force Account Labor
Staff / Other / Labor Description / Value
$
$
$
$
Force Account Equipment
Owned / Donated / Equipment Description and Purpose / Value
$
$
$
$
Force Account Materials or Supplies
Owned / Donated / Material or Supply Description and Purpose / Value
$
$
$
$
10. PROPOSED PROJECT FUNDING – cash Match
Applicant / Other / Marine Board / TOTAL
Property acquisition cost / $ / $ / $ / $
Construction contract / $ / $ / $ / $
Materials Purchased / $ / $ / $ / $
Equipment Rental / $ / $ / $ / $
Eligible permit fees / $ / $ / $ / $
Federal indirect rate*-
(complete table below) / $ / $ / $ / $
Consultant contract
(attach copy of contract) / $ / $ / $ / $
Other: / $ / $ / $ / $

Total Cash Match

/ $ / $ / $ / $
Federal Indirect Rate
Federal Approved Indirect Rate / What is it applicable to? / Total Value / How much is match?
$ / $
$ / $

*Reimbursement is only eligible on projects that have federal funds from Clean Vessel Act (CVA), Boating Infrastructure Grant (BIG) or Sport Fish Restoration Funds (SFR).

11. Total proposed project funding
Applicant / Other / Marine Board / TOTAL
Total AdministrativeMatch(from 8) / $ / $ / N/A / $
Total Force Account Match(from 9) / $ / $ / N/A / $
Total Cash Match(from 10) / $ / $ / $ / $
Grand total / $ / $ / $ / $
12. “other” source, type and amount of (non-applicant) Contributions
Grant/Loan Agency / Name of Grant/Loan / Approved- Y/N / Amount of Grant
$
$
$
$
Cash Contributions by / Amount of Contribution
$
$
$
$
13. PERFORMANCE
Describe your performance on any grant(s) previously awarded by the Board. Are you in compliance with applicable rules, policies and guidelines? This includes, Boating Facility Grants, Small Grants and the Maintenance Assistance Program Grants.
14. PUBLIC INPUT, COMMENT, NOTICE AND PUBLIC SUPPORT / OPPOSITION
Describe the stepstaken to notify neighbors, adjacent land owners, site users, etc. of the proposed project. (Please attach supporting documents.)
Describe what opportunities have been provided to involve the public in decisions resulting in this proposed project. (Please attach supporting documents.)
Identify specific public support and opposition to the proposed project:
Note: this section is part of the grant ranking criteria-include emails and letters
Supporters Name / Opponents Name
Adjacent land owners:
Users groups:
Neighborhood association
Local government:
State/federal government:
Legislator/congressional:
General Public
Other (specify):
15. CUTURAL AND ENVIRONMENTAL Yes No Unknown
Cultural Resources: If question 1 is YES and question 2 is Nothen fill outAppendix BCultural Resources Form

Are there any historic, archaeological, or cultural sites or resources on the site?

Has a cultural resources survey or report been completed for the project site?

Fish and Wildlife Resources / Yes / No
Have you consulted the local Oregon Department of Fish & Wildlife (ODFW)?
Name of ODFW Local biologist: Phone Number:
Are there any protected upland species or habitat on this site? If Yes, answer the following questions. If No go to next section.

Identify any listed species and where the proposed work will be in relationship to the species and any impacts:

Describe how the project may impact the protected plan or animal species including changes to their habitat. Identify the mitigation measures that will be used to reduce adverse effects on the species and their habitat:

Wetland Water Resources / Yes / No / Unknown
1.Will any work be done in wetlands on this site? If No go to Water Resources
2.Has the wetland delineation or mitigation plan been completed? If No complete Appendix C Part 1
Water Resources

Structures in federally navigable waterways may require a Section 10 Permit from the Army Corps of Engineers (ACOE). See Corps Guidance

Public boat ramps and docks in state navigable waterways may require a Facility license from Oregon Department of State Lane (DSL) See DSL Guidance

Will the project require any work to be done below the high water mark? If No, go to next section.

Pending Applications:

If DSL and ACOE have not issued permits, have both applications been submitted and accepted? If Yes, provide application numbers and filing dates
ACOE Permit Number: ACOE Acceptance date:
DSL Permit Number: DSL Acceptance date:

Issued Permits:

Have DSL and ACOE permit application for the project been issued?
If Yes, provide permit numbers and dates.
ACOE Permit Number: ACOE Approval date:
DSL Permit Number: DSL Approval date:

No Permit Applications Filed:

If DSL and ACOE permit applications have not been filed, who will prepare them? Complete Appendix C Part 2
Applicant
Consultant
OSMB to assist Applicant
16. City/County Planning Department AffidavitNote: construction projects only
THIS SECTION TO BE COMPLETED BY LOCAL AUTHORITY HAVING JURISDICTION
This information is needed to determine if the proposed project complies with statewide planning goals and is compatible with local comprehensive plans (ORS 192.180). Not applicable to federal agency applicants.

YES

NO

N/A (FEDERAL)

Is the project subject to a local comprehensive plan and zoning ordinance?
Have land uses been approved?
(Please include documentation of final approval)
Is the project compatible with the local comprehensive plan & zoning ordinances?
(Please cite appropriate plan policies, ordinance section, and case numbers).
Policy/Ordinance/Case Number
Compatibility of this project with the local planning ordinance cannot be determined until the following local approvals are obtained:
Conditional use permit Development permit Plan amendment Zone change
Other
An application has has not been made for the local approvals checked above.
Planning comments:
*Signature of local planning official:
Title: Date:
*Must be authorized signature from your local City/County Planning Department.

This space intentionally left blank.

17. RAcial and ethnic impact statement

Thisformis used forinformationalpurposesonlyand mustbeincluded withthe grantapplication.

Chapter 600ofthe2013Oregon Lawsrequireapplicantstoincludewith each grantapplicationa racial and ethnicimpactstatement. Thestatementprovidesinformation astothedisproportionateor unique impacttheproposed policiesor programsmayhave on minoritypersons1in theStateofOregon if the grantisawarded toacorporation or otherlegal entityotherthan natural persons.

1. Theproposed grantproject policiesorprogramscouldhavea disproportionateorunique positiveimpactonthefollowing minority persons:

Indicateall thatapply:

Women

PersonswithDisabilities

African-Americans

Hispanics

Asians orPacificIslanders

American Indians

Alaskan Natives

2. Theproposed grantproject policiesorprogramscouldhavea disproportionateorunique negativeimpacton thefollowingminoritypersons:

Indicateall thatapply:

Women

PersonswithDisabilities

African-Americans

Hispanics

Asians orPacificIslanders

American Indians

Alaskan Natives

3. Theproposed grantproject policiesorprogramswill havenodisproportionateoruniqueimpact onminoritypersons. Yes No

If youchecked numbers1or2above,ona separatesheetof paper,providetherationaleforthe existenceof policiesorprogramshaving a disproportionateoruniqueimpactonminoritypersonsin this state.Furtherprovideevidenceof consultationwith representative(s)oftheaffectedminoritypersons.

I HEREBYCERTIFY onthisdayof , 20,theinformationcontained on this form and anyattachmentiscompleteand accuratetothebestofmyknowledge.

Signature

Printed Name:

Title:

1“Minoritypersons”aredefinedinSB463(2013RegularSession)aswomen,personswithdisabilities(asdefined inORS174.107),African-Americans,Hispanics,AsiansorPacificIslanders,AmericanIndiansandAlaskanNatives.

18. APPLICATION SIGNATURE AND CERTIFICATION

Applicant Signature and Certification

Application is hereby made for the activities described above, together with attachments. I certify that I am familiar with the information contained in the application and, to the best of my knowledge and belief, this information is true, complete, and accurate. I further certify that I possess the authority, including the necessary requisite property interests, to undertake the proposed activities.
I also certify that the Applicant’s governing body is aware of this request and has authorized the person identified as the official representative of the Applicant to act in connection with this application and subsequent project as well as to provide additional information as may be required.
By signing below, I affirm the Applicant’sintention to enter into a Cooperative Facility Grant Agreement and agree to comply with Oregon State Marine Board’s program rules, policies, and guidelines as well as all applicable federal, state, and local laws relating to this proposal, additional conditions applicable to an approved Boating Facilities Grant, and the resulting project.
Print/Type Name / Title
______
Applicant Signature / Date

18. ATTACHMENTS (Are the following items attached to this application?)

Required For:

Acquisition

Consulting

Construction

Cover letter

Existing condition and photographs of boaters using facilities

Location/vicinity map (Assessor’s map)

Design/engineering or conceptual plans & engineers estimate

Letter(s) of support or opposition, including e-mails (printed)

Documentation ofopportunitiesfor public input/comment

Copies of permit applications or approved permits, if available

SHPO clearance and/or cultural resources report, if available

Consultant contract, if applicable

Pre-Agreement Documentation, if applicable

Federal Indirect Rate Documentation, if applicable

Property acquisition form, Appendix A

Cultural resources form, Appendix B

Wetland Water Resources form, Appendix C

Note: Instruction regarding this application and the facility grant program can be found in the Boating Facilities Grant Procedure Guide, or you may contact the Boating Facilities Manager, Oregon State Marine Board, 435 Commercial St. N.E. #400, PO Box 14145, Salem, Oregon 97309, Phone: (503) 378-2628.

Appendix A

Property Acquisition Form

Please answer the following to the best of your ability.

Appraisal completed: Yes No Date of Appraisal: Type of appraisal:

Appraised value of property: $ Assessed value: $ Acreage:

Current ownership:Private Public Agency Other (Specify)

Willing seller: Yes No Name of Seller (unless confidential):

Acquisition Method: Purchase Eminent Domain Transfer Condemnation Donation

Current Zoning: Will property need to be rezoned? Yes No

Describe what is located on the site and how the site is currently being used:

Is the applicant prepared to initiate within two years from the purchase, design, permitting andconstruction of boating improvements Yes No If NO answer the following questions:

Reasons for immediate acquisition of property.

Facilities to be developed and timeline for development.

Non-boating uses to be continued on the property and the projected date when non-recreation use will be terminated. If non-boating use on the property is not terminated within three years from date of acquisition, then conversion requirements may apply. A determination that a conversion of use has taken place can only be made by the Board.

Type of public recreation access to be provided during the interim period.

Demonstration that income derived during the interim period will be used on the project site.

Attach supporting documentation.

Appendix B

Cultural Resources Form

Please answer the following to the best of your ability.

YES, there are known historic, archaeological or cultural sites or resources at this site.

Describe how the proposed work may affect these resources and identify proposed measures to mitigate any impacts (NOTE: Do not divulge the location of archaeological sites or objects here. Archaeological site information is exempt from the public records disclosures and must be kept confidential pursuant to both federal and state laws.)

Describe the natural condition prior to modifications or settlement:

Describe the land-use history, when it was first settled or modified, and the depth of ground disturbance or fill:

Describe the current land use and condition. Identify any natural agents (e.g., sedimentation, vegetation, inundation) or cultural agents (e.g., cultivation) that might affect the ability to discover cultural resources:

Explain whether you or anybody else knows of cultural resources in or near the project area:

Have the State Historic Preservation Office or tribal archaeologist been contacted?

Please identify who has been contacted and the status of any inquiry or review.

Person contacted:

Affiliation:

Status of review:

Provide a copy of the cultural resources survey or report that was completed for this project site.

Appendix C

Wetland Water Resources Form