PRIVATE IRRIGATION INFRASTRUCTURE OPERATORS PROGRAM (PIIOP) IN NSW
ROUND THREE (2015-2019)
STAGE ONE Application Form

Applications must be submitted by
2:00pm AEDT Thursday, 30 APRIL 2015

APPLICATIONS MUST BE SUBMITTED IN ELECTRONIC FORMAT (USB DRIVE)

AND IN HARD COPY FORMAT

Post your hard copy and electronic application to: OR Courier your application to:

Director
Water Recovery Infrastructure Section
Water Division
Department of the Environment
GPO Box 787
CANBERRA ACT 2601 / Director
Water Recovery Infrastructure Section
Department of the Environment
John Gorton Building
King Edward Terrace
PARKES ACT 2600

You can access either a Microsoft Word or an Adobe Acrobat Reader version of the Guidelines for Round Three of the Programme and the Stage One application form on the Department of the Environment website at http://www.environment.gov.au/water/rural-water/srwui/state-priority-projects/piiop-nsw


Before completing an application, read all other relevant documents available at http://www.environment.gov.au/water/rural-water/srwui/state-priority-projects/piiop-nsw

In addition to this application form, the relevant Programme documentation includes:

·  Funding Guidelines for Round Three of the Programme

·  Programme Sample Funding Agreement

Completing and submitting the application form

Be concise and factual in all responses when completing this application form as the assessment will be based principally on the information contained within it.

Failure to address all questions in this application could result in your application being deemed ineligible.

Applicants should only provide only the attachments referred to in the Application Map on page 3. Any additional attachments that Applicants provide WILL NOT be assessed as part of the Stage One application. Successful Stage One Applicants will be able to provide more detailed information in Stage Two.

Applicants must submit the documentation in the format described in Section D of this application form by the Closing Date.

Assessment of Stage One applications

This application form is designed to obtain the information the Department needs to assess an application against the Eligibility Criteria and the Merit Criteria.

Applications which satisfy the Eligibility Criteria are then assessed against the weighted Merit Criteria based on the information provided by the Applicant in their application form. Writing an effective response to each section of the application form will assist the Department in making an informed assessment of the application.

Refer to the Programme Funding Guidelines for further detail on the assessment process.

The Parliamentary Secretary or his delegate will provide in-principle approval to Shortlisted Applicants for some or all of the Applicants’ Sub-Project types as part of Stage One, taking into account the availability of Programme funds in deciding which applications are offered in-principle support. A written notification of the decision by the Parliamentary Secretary (or his delegate) will be provided to the Applicant.

Within 60 days of being given in-principle approval, Shortlisted Applicants will be required to submit Stage Two individual irrigator Sub-Project information. This information will be used to assess Sub-Projects against the same eligibility and merit criteria used in the Stage One assessment (but more comprehensively), as described in the Funding Guidelines.


APPLICATION MAP

Section A
ELIGIBILITY CRITERIA
Mandatory eligibility requirements for
Organisations and Projects

Mandatory Attachments

Section B
applicant details & project overview
eligibility and merit criteria
High-level information on your organisation and an overview of the Project as a whole / / Include Attachment 1
(A3 size map of the Project area) /
Section C
MERIT CRITERIA
Organisation and Project specific information addressing the merit criteria:
·  Project Details
·  Stakeholder Support
·  Value for Money
·  Financial Information / / Include Attachment 2
(Project Timeline in MS Excel format)
Template not provided
Include Attachment 3
(Sub-Project description)
Use MS Word template provided
Include Attachment 4
(Evidence of stakeholder support)
Template not provided
Include Attachment 5
(Project Budget)
Use MSExcel template provided
Include Attachment 6
(Water Savings Calculations)
Use MSExcel template provided /




Section D
DECLARATION & CHECKLIST
Application declaration and checklist for
Making an application


This Programme seeks applications from private irrigation infrastructure operators in the NSW Murray OR Murrumbidgee catchments

Applications are not open to individual irrigators

Privacy Notice

This Privacy Notice describes how we collect and manage your personal information and is provided pursuant to Australian Privacy Principle 5.

The use and disclosure of personal information collected by the Department of the Environment (the Department), from Applicants will be managed in accordance with the Privacy Act 1988.

The Department will use the personal information collected in this application form for the purposes of discharging its functions under the Programme, and for related uses. These functions include determining eligibility for funding under the Programme, assessing merit, preparing funding agreements, calculating the amount of funding that will be paid to successful Applicants, and assisting with compliance activities. The Department may also use personal information received in applications in any other legitimate Departmental business.

As part of the assessment of this application, the Department may need to consult with and provide material from the application, including personal information, to other government agencies or bodies, other organisations and/or relevant individuals, in order to substantiate any claims or statements made in the application form, or to otherwise assist in the assessment of the application. If this occurs, the Department will endeavour to ensure that the parties who are consulted observe appropriate confidentiality.

Following Stage Two assessment, successful Projects will be announced by the Parliamentary Secretary to the Minister for the Environment or his delegate. The public announcement will include details of the names of successful Applicants and the amount of funding to be awarded. Publicity material may also be produced in relation to all or particular Projects supported by the Programme.

You can access the Department’s full privacy policy at http://www.environment.gov.au/privacy-policy. The privacy policy contains details about how you can access the personal information that the Department holds about you and seek to make corrections to it. The privacy policy also contains information about how you may make a complaint about a breach of an Australian Privacy Principle and how the Department will deal with that complaint.

SECTION A – ELIGIBILITY CRITERIA
Is the Applicant a private entity that owns or operates infrastructure within the Murrumbidgee or Murray catchments in NSW for the purpose of delivering water to other persons for the primary purpose of use in irrigation? / Yes No
Has the Applicant undertaken or completed a modernisation plan in accordance with the Australian Government guidelines, or equivalent, to the satisfaction of the Department? / Yes No
Has the Applicant undertaken an assessment of the irrigation district water losses, consistent with the Australian Government ‘Hotspots’ assessment methodology, or equivalent, to the satisfaction of the Department? / Yes No
Is the Applicant proposing an ‘eligible Project’ in accordance with the Programme Guidelines? (see pages 6 and 7 of the Programme Guidelines) / Yes No
Is the Applicant a legal entity capable of entering into a Funding Agreement with the Australian Government? (Note: unincorporated associations are not eligible) / Yes No
Does the Applicant have a valid Australian Business Number? / Yes No
Is the Applicant registered with the Australian Taxation Office for Goods and Services Tax purposes? / Yes No
Does the Applicant comply with the Water Market Rules 2009 under the Water Charge (Termination Fees) Rules 2009 under the Water Act 2007? / Yes No
SECTION B - APPLICANT DETAILS & PROJECT OVERVIEW
Name of Applicant

The Applicant is the organisation that is applying for a grant under Round Three of the Programme.

Please see the Programme Guidelines (Page 6) for further explanation in the section: “Who is eligible for the Programme?”.

Legal name of organisation
Trading name (if different to legal name)
Address of Applicant
Business Address
Street
Suburb/Town
State/Territory / Postcode
Postal Address
Street
Suburb/Town
State/Territory / Postcode
Website Address
Type of legal entity

Please tick most appropriate

This is usually the type listed on your Australian Business Register entry (if applicable).

Legally incorporated organisation
Company
Other / Details:
Applicant identification
Australian Business Number (ABN)
Applicant GST registration
Are you GST registered? / Yes / No
Applicant incorporation (if applicable)
Is your organisation incorporated? / Yes / No no
Incorporation number
Date of incorporation
Authorised person (for Applicant)

The authorised contact is the person with the authority to sign a funding agreement with the Commonwealth Government on behalf of the Applicant.

Title / Ph (work)
First Name / Ph (a/h) optional
Surname / Ph (mobile)
Position in organisation
Email address
Project officer (If different from the authorised person)

The Project officer will manage the Project and be our contact for information or day-to-day aspects of the Project.

Title / Ph (work)
First Name / Ph (a/h) optional
Surname / Ph (mobile)
Position in organisation
Email address

Project area/location

Please attach a one-page A3 size map to your application that indicates the proposed Project’s boundaries and mark as Attachment 1. Additional maps may be provided if appropriate.

Irrigation district
List irrigation district(s) in which the Project is located
Latitude (eg – 34.2401)
Longitude (eg 140.5507)
Nearest major town
Location description (if your site is not easily located by a street address and lat/long)
SECTION C - MERIT CRITERIA

The information you provide in this section is required for assessment purposes.

Please address each item below, noting that only the attachments referred to in the Application Map will be assessed as part of the Stage One application. Any additional material provided WILL NOT be assessed as part of the Stage One application.

Shortlisted Stage One Applicants will be invited to provide additional detailed information in Stage Two..

Project title

Please advise your proposed Project name. If the Applicant is successful, this title will be used by the Australian Government when publishing the results of the Programme round on the Department’s website and in published material.

eg: XYZ Channel Modernisation & Rationalisation Project

Project description/activities

Summarise the overall Project proposed for funding under the Programme.

The summary should include a brief description of which eligible activities are proposed to be undertaken by the Project (the ‘what and ‘where’ of the Project), including objectives, expected outcomes and a Project timeline in Microsoft Excel format.

For details on “What is an eligible Project?” see pages 6 and 7 of the Programme Guidelines.

Please provide the summary below and attach a Project timeline in Microsoft Excel format marked as Attachment 2.

Please limit your summary to approximately 2 pages


Sub-Project description

Please complete Attachment 3 for each Sub-Project including activity description, estimated water savings and cost for each Sub-Project.

Number of Sub-Projects attached to this application

Rationalisation

If your proposed Project includes rationalisation:
·  Provide the number of proponents anticipated to be rationalised
·  Attach evidence (eg. results of meetings, emails, letters, etc) from potential rationalisation customers confirming their willingness to participate in the Project and mark as Attachment 4
Estimated total Project cost (GST excl)
Please include details of Applicant cash co-contribution (if applicable). Details must be provided in the Budget at Attachment 5. / $
Funding sought (GST excl)
Please provide total funding sought from the Commonwealth / $
Total water savings (ML)
Please provide the total volume of water savings anticipated to be achieved through the Project. Details must be provided in the Water savings calculations at Attachment 6. / ...... ML
Total water return (ML)
Please provide the volume of water savings to be returned to the Commonwealth / ...... ML
Transferable water entitlements
If the water entitlements to be transferred to the Commonwealth are encumbered, or cannot be transferred, detail the steps being taken to resolve the problem.
Delivery system efficiency
Outline the anticipated increase in the efficiency of the delivery system
Cost-benefit analysis / Note: not required as part of this application. If your application is shortlisted in Stage One, Applicants will be required to provide a cost-benefit analysis with a ‘no change’ option in Stage Two.


FURTHER DETAILS

Duplication/overlap of funded activities

Has current or previous funding been received, or have you applied for any Commonwealth or State funding, from any source for the same activities as those you are proposing? If yes, please provide details including actual or expected completion date and/or the expected date for notification of application outcomes.

Previous or current grants

Please provide details of any Commonwealth or State Government grants that have been awarded to the organisation in the past [5] years and advise if these have been successfully completed and acquitted.

Grant title / Granting organisation / Date
Received / Amount received (GST excl) / Status

Risk management

Note: not required as part of this application. If your application is shortlisted in Stage One, you will be required to complete a Risk Management Plan in the format determined by the Department, providing an analysis and management strategies for any risks associated with the Project.

Approvals and Exemptions

Please indicate if the Project, including Sub-Projects, will require any of the following approvals/exemptions for your Project activities, and whether or not you have obtained them yet.

Approval/Exemption / Required / Obtained & attached / Application made / Yet to be sought
Local approval
State/Territory approval
National approval
Development approval

Note: If your application is successful in Stage Two, you will be required to provide written evidence that the appropriate approvals have been obtained during implementation of the project.

Conflict of Interest

Throughout the duration of the Project, if there are any matters related to the business interests of persons directly involved with Projects under this Programme that may conflict with their role in the project, these matters must be brought to the Department’s attention as soon as a potential or actual conflict of interest is known.