Please Complete the Required Information (Questions 1-11) and Submitelectronically To

PLEASE COMPLETE THE REQUIRED INFORMATION (QUESTIONS 1-11) AND SUBMITELECTRONICALLY TO THE REGIONAL TRANSPORTATION AREA (RTA).

ONCE RECEIVED BY THE RTA, THE RTA WILL THEN FORWARD THE COMPLETED APPLICATION ELECTRONICALLY TO:

Program Requirements s. 339.2819:

Projects to be funded with Transportation Regional Incentive Programfunds shall, at a minimum:

Be included in the Transportation Plan of a Regional Transportation Area, including the plan’sregionally significant facilities and priority list.
Support those transportation facilities that serve national, statewide,or regional functions and function as an integrated regional transportationsystem.
Be identified in the capital improvements element of a comprehensiveplan that has been determinedto be in compliance with part II of chapter163, after July 1, 2005, or to implement a long-term concurrency managementsystem adopted by a local government in accordance with s.163.3177(9). Further, the project shall be in compliance with local governmentcomprehensive plan policies relative to corridor management.
Be consistent with the Strategic Intermodal System Plan developedunder s. 339.64.
Have a commitment for local, regional, or private financial matchingfunds as a percentage of the overallproject cost.

1.Name of the Regional Transportation Area (RTA) sponsoring this project:

Note: If this is a new Regional Transportation Area, please attach a copy of the RTA inter-local Agreement

2.Implementation/Lead Agency:

Organization:

Address:

Contact Person/Title:

Phone: Fax:E-mail:

3.Description of Project(MUSTINCLUDE A LOCATION MAP WITH THIS APPLICATION):

Project description:

For highway projects, include facility nameFrom: To: Project Length (mi):

What County is the project located in?What City/Town is the project located in?

Does the project cross jurisdictional boundaries? Yes No

Is the project a SIS: Corridor SIS Connector Hub None

If a SIS/FIHS facility, is this project in the SIS/FIHS Ten Year Plan?

If a SIS/FIHS facility, is this project in the SIS/FIHS Cost Feasible Plan?

Check if a Capacity-type project (e.g.add lanes, new facility. For transit projects, check if includes new service or increased headway)

Improvement Type: New Facility 2 to 4 4 to 6 2 to 6

Transit or multi-modal. Note: Bus replacements are not eligible:(explain)

Other: (explain)

4. Traffic Data:

Existing traffic count: Year: , LOS: , source:

Future projected traffic: Year: ,LOS: , source:

FDOT LOS Standard: Local Government LOS Standard: Exception of Concurrency Requirements:

Are there any safety concerns? Also, list any Crash Data that is available:

Does the proposed project serve as an evacuation route or provide access to a shelter? Yes No?
If Yes, is it a: Primary evacuation route Secondary evacuation route

5.Public Transportation Capital for Transit Projects:

If Capital costs are requested to increase the size of a fleet, who is committed to paying for operating costs associated with the service expansion? Contact for that agency:

Is a letter of intent or Board resolution from that agency included in this request?
If other Capital costs are requested to expand or construct a new intermodal facility, please describe the scope of the project requested andthe proposed schedule.

6.Is the project already listed as a regionally significant facilitybased upon the Regional Transportation Area? Yes No

Is the project on themost recently approved:
Regional Transportation Area priority list?Yes No
Central Florida MPO Alliance list? Yes No

8. Programming Status:

Is the project currently in the adopted Transportation Improvement Element and/or Capital Improvement Element of the local government’s Comprehensive Plan (LGCP)? If No, when will the Comprehensive Plan be amended to include the project?If Yes, pleaseattach a copy of the relevant page of your Comprehensive Plan. Ensure your copy reflects the date of the Comprehensive Plan.

Yes No If No, date to be amended: (pursuant to s. 339.2819(4)(a)(2))

If this is a Transit project, is the project in the Transit Development Plan (TDP)?Yes No

If Yes, what year? and what page?

Is this project in an MPO Cost Feasible component of the Long Range Transportation Plan?

If applicable, what is the time period in which this project is shown in the Cost Feasible Plan?

Is this project in the MPO’s current TIP? If Yes, page number?

Is this project in the MPO’s (or non-MPOCounty’s) current Priority List? Priority Number?

Is this project already in the FDOT Work Program? If Yes, FM#: Phase(s) and Year(s):

Is this project,or the next phase or segment, related to (or would affect and/or be affected by) another past or present FDOT

Work Program project?

9.Potential Funding Sources and Agreements:

Are there any executed proportionate share agreements (through either the FDOT or the local jurisdiction) for the project? If

yes, what are the DRI or sub-DRI names?

Are thereany Developments of Regional Impacts (DRIs) or sub-DRIs pending approval that could contribute

additional local funding for this project?

If planned developments (DRI or sub-DRI) could potentially contribute to local funding, provide the contact information for

the local governments and the development applicant.

10.Funding Information

Note: If the project is selected for TRIP funding, the sponsor will be required to submit a funding commitment letter.

(Refer to sample layouts provided on page 7 for completing this table [for Highway/Multi-modal & Transit projects]).

PHASE / PHASE COSTS / SOURCE OF FUNDS / PHASE START DATE / PHASE COMPLETION DATE
PD&E or Equivalent / $
$
$
Design / $
$
$
ROW / $
$
$
CST / $
$
$
CEI / $
$
$
OTHER / $
$
$
$
TOTAL / $

TRIP Funding Request:

Requested TRIP Amount:

Project Phase requested for TRIP funding:

Total cost of requested phase:

Month and Year that funds are needed:

Note: As provided by law (s. 339.2819 (4)(B)), the Department will give priority to projects that do the following:

Provide connectivity to the Strategic Intermodal System developed under s. 339.64.
Support economic development and the movement of goods in rural areas of critical economic concern designated under s. 288.0656(7).
Are subject to a local ordinance that establishes corridor management techniques, including access management strategies, right-of-way acquisition and protection measures, appropriate land use strategies, zoning, and setback requirements for adjacent land uses.
Improve connectivity between military installations and the Strategic Highway Network or the Strategic Rail Corridor Network.

11. Pleaseprovide any additional relevant information for project eligibility:

SAMPLE (Highway & Multi-modal projects)

PHASE / PHASE COSTS / SOURCE OF FUNDS / PHASE START DATE / PHASE COMPLETION DATE
PD&E / $125,000 / Local - County / 4/15/2004 / 4/15/2006
$125,000 / Local - Developer
Design / $300,000 / Local - County / 7/12/2006 / 7/30/2007
$200,000 / Local - Developer
ROW / $2,000,000 / Local - Donation / 10/11/2007 / 3/15/2008
$1,000,000 / Local - County
CST / $5,000,000 / Federal - XU / 7/1/2009 / 8/15/2010
$7,500,000 / Local - County
$7,500,000 / TRIP Request
CEI

SAMPLE (Transit projects)

PHASE / PHASE COSTS / SOURCE OF FUNDS / PHASE START DATE / PHASE COMPLETION DATE
Purchase 10 buses / $1,750,000 / SIB Loan / NA
$1,750,000 / Trip Request
Operating Cost / $500,000 / Local - County / NA
$500,000 / Service Development Application / Will apply by July 2010

12.Design:

Please submit the following design documents:

Project Plans
Engineer’s estimate in electronic format
A summary of the Design progress to date
Project schedule (e.g. Primavera)

13.Drainage:

Please provide a general description of the proposed drainage provisions for the project:

Are there shared water retention areas on the project?

14.Permits:

Pleas provide a list of permits required for this project and their status.

15. Clearances:

Will this project affect any historic property that is included or eligible for inclusion in the National Register of Historic Places?
Yes No. If so, has the Division of Historical Resources been given a chance to comment on the project?Yes No (Please provide a copy of the letter or other supporting documentation).

Will this project involve the demolition or substantial alteration of a historic property in a way which adversely affects the character, form, integrity, or other qualities which contribute to the historical, architectural, or archaeological value of the property? Yes No. If so, timely steps must be taken to determine that no feasible and prudent alternative to demolition or substantial alteration exists, and, where no such alternative exists, timely steps must be taken to mitigate the adverse effects or to undertake an appropriate archaeological salvage excavation or other recovery action to document the property as it existed prior to demolition or alteration.

Please note. If federal funding or a federal permit will be involved, then the requirements of the National Historic Preservation Act of 1966 (as amended) and 36 Code of Federal Regulations Part 800 apply also.

The Department's process for complying with federal and state historic preservation requirements is found in the Project Development and Environment Manual; Part 2, Chapter 12 (Archeological and Historical Resources). If the local agency does not have its own process, we recommend they use the Department's.

16.Utilities:

Will the FDOT Utility Coordination Processed be followed?

Do the Utilities have property rights and eligible for reimbursement?
Note:If the Utility is in an easement within a private parcel, they have property rights and are entitled to reimbursement for any relocation created by the project. If the Utility is within public R/W by permit, any relocation required by the project will be done at the Utilities expense.

17.Right-Of-Way:

Has any of the Right-of-Way been acquired previously, by any means, by some entity other than FDOT?

If any Right-of-Way has been previously acquired, briefly describe acquisition history:

18.Maintenance:
Who is to be responsible for maintenance of the facility and/or structures after construction?

19.Agreement:
Please describe any agreements made for this project:

Are 3rd parties (other government entities, private sector, etc.) involved? If Yes, who and what is the involvement?

What is the agreement with respect to cost increases or overruns for the project?

Created on: 4/30/20071 of 9Printed on: 10/11/2018