New Mexico Aging & Long-Term Services Department – Capital Projects Bureau
PROJECT EVALUATION—STATEMENT FROM SUBJECT MATTER EXPERT
2017 Capital Outlay Request Application (Required Attachment)
The Aging and Long Term Services Department will consider only critical activities which address an urgent need or emergency situation that immediately endangers occupants of the premises or creates a serious threat to the health and/ or safety of citizens. These include:
- Situations in which immediate action is necessary;
- The situation would disrupt a senior center from operating or failure is imminent if not corrected in a timely manner;
- The threat can be supported by a subject matter expert;
- The situation was not a direct cause of poor maintenance or neglect and steps were taken to prevent, alleviate and or correct the situation; and
- The resources required to correct the situation were unavailable.
NAME OF PROJECT: / APPLYING ENTITY:
entity contact name, phone number & email address: / DATE:
PROJECT EVALUALTION BY SUBJECT MATTER EXPERT
Please check the box and provide a project evaluation by the subject matter expertfor each project application being submitted. The subject matter expert must have thoroughly evaluated the project and provide an unbiased statement specifically addressing the issue. The subject matter expert must sign off on the project evaluation form (or may provide an independent estimate/quote on the contractor's own form). Subject matter experts may include State Fire Marshall’s Office, Environment Department, Department of Health, Office of Environmental Health, facility managers/engineers, nutrition experts, vendors, or other independent contractors.)
A-1: Code Compliance/Other Renovation Project: Requests for code compliance improvements and/or renovations must be detailed and fully identify the specific issue(s) being addressed. Describe how the issue was identified and how the improvement/renovation will address the issue.
A 2: Meals Equipment/Other Equipment Project: Includes machinery, apparatus, components and any other commercial equipment for use in preparing, cooking and serving food; and/or any other articles to make an action, operation, or activity easier or to serve a particular purpose. Equipment must have a useful life of at least 7-10 years and be valued at $5,000 or more. Provide a justification and describe the critical need for proposed new equipment for the senior center (provide specifications such as need for increase size, number of additional meals required per service period, cost, etc.).
A-3 Vehicle Request Project: to purchase and equip vehicle(s) for transporting seniors or goods (such as home-delivered meals). Vehicles must have over 100,000 miles and be more than 7-10 years old or provide documented proof that the vehicle requires extensive repairs and/or no longer meets the needs of the center.
A-4 Plan and Design Project: Requests for plan and design projects must provide a compelling justification for the proposed new construction or major addition.Describe the work plan to accomplish the project, (i.e. blueprints or 100% complete drawings, designed to scale to show the look and function of a facility any other steps incident to creating a plan for a final product before moving to the construction phase.
SUBJECT MATTER EXPERT STATEMENT
Signed by Subject Matter Expert / Print Name
Company Name & Address / Phone Number:
Cell Number:
Email Address / Website Address