Royalties for the Regions - Round 4

Expression of interest

Please ensure all relevant sections of this form are completed. Please refer to the Royalties for the Regions Program Guidelines when completing this form.

All figures in this form must exclude GST.

Following the assessment process, applicants will be notified in writing of the outcome of all applications.

Should you have any questions or require any assistance, please contact the Royalties for the Regions program team on (07) 3452 7377 or 13 QGOV (13 74 68).

Part A: Applicant details

Council

Part B: Project details

Project title / 500 character constraint
Project description / 1000 character constraint

Indicate which best describes the project:

Water/sewerage/waste infrastructure (e.g. water supply, sewerage systems, landfills)
Social infrastructure (e.g. multipurpose health facilities, childcare centres)
Cultural, sports and recreational infrastructure (e.g. museums, parks, sporting complex)
Roads and transport infrastructure (e.g. local roads, causeways, road upgrades, sealings, airports)
Flood mitigation infrastructure (e.g. levees, floodgates, dams, drainage improvements)
Other infrastructure (e.g. agricultural, communications, energy, economic infrastructure)

Is this project:

New infrastructure
Upgrade of existing infrastructure
Replacement of existing infrastructure
Other (please specify):
Chainage
(Required for Roads projects only) / Please list all chainage details for all works relevant to this project. Please include all chainage locations, including start work and end work points, width, length, etc.
Road Classification
(Required for Roads projects only) / For example, local roads of regional significance, district roads, locally controlled roads and other eligible road classifications.
Estimated project timeframe
Commencement date / Completion date

Part C: Project contact

Please provide a contact person from the council for correspondence and enquiries regarding this project and application for funding.

Title / First name / Surname
Position
Phone / Mobile / Fax
Email
Postal address
Street address
Town/suburb / Postcode

Part D: Project site

Project site address
Street address
Town/suburb / Postcode

For GIS spatial mapping purposes, please attach either an ESRI Shape File or MapInfo Tab File for this project site (if available) OR complete the Real Property Description fields below.

ESRI Shape file / Attachfile:
MapInfo TAB file / Attach file:
Other GIS file / Attach file:

Real Property description of the project site:

Lot / Parish
Registered Plan / County
Title Reference

Please provide all the relevant longitude and latitude coordinates for all work sites relevant to this project, i.e. start and finish coordinates.

Longitude Start: / Longitude
Finish:
Longitude range is numeric between 0.0 and 180.0
Latitude Start: / Latitude
Finish:

Latitude range is numeric between -90.0 and 0.0

Are there any land issues which need to be addressed for this project to proceed (e.g. land ownership, native title, a road reserve, strategic cropping land issue etc)?

Yes / No
* If yes, please provide an explanation and supporting documentation.
Character limit 1000

Part E: Project costings

Provide a breakdown of the proposed financial contributions to the project.
Royalties for the Regions funding sought / (ex GST)
Council contribution
How much will council contribute towards this project (not including in-kind contributions or ongoing costs such as maintenance and repair costs)? / (ex GST)
Other financial contributions
Please detail all proposed or confirmed financial support that will be provided by any other organisations (in-kind contributions are not to be included)
Category / Funding contributor / Contribution description / Amount
(ex GST) / Funding
status / Funding status details
Queensland Government;
Australian Government; Industry; Other / Name of organisation / For example, Name of government grant or purpose of funding. / Confirmed or not confirmed / Please provide details if any special conditions apply or when funds are likely to be confirmed
Total contributions / $
Please note the total estimated project cost equals the total amount of funding being sought
plus total council contribution plus total other financial contributions.
TOTAL ESTIMATED PROJECT COST / (ex GST)

Part F: Response to assessment criteria

1.What need, issue or opportunity will this project address?
Please summarise the problem,need, or opportunity this project is designed to address.Where possible please quantify the scale of the problem/need.
Character limit 2000
Please describe the current road conditions (for roads projects only):
Crash History / 500 character constraint
AADT (per cent of Heavy Vehicles) (Date): / 500 character constraint
Deficiencies / 500 character constraint
Future safety assessment / Does the proposed scope of work make any aspect of the road less safe? For example, traffic moved closer to hazards, or approach speed to a tight curve increase) 500 character constraint
Other Information / 500 character constraint
2.How will this project address the problem, need or opportunity?
Where possible, benefits should be quantified. For example: new jobs created; estimated value of new investment; increased flood immunity; protection of built environment; higher level of community safety; reduced costs; improved community access; improved amenity; more reliable infrastructure.
Character limit 1000
3. How will this project improve the regional economy and/or liveability, e.g. job growth, new industry opportunities, increased flood immunity, protection of the built environment, community safety, amenity, accessibility to services etc?
Please describe how this project will impact the local economy and generate future economic growth and/or improve liveability.
Character limit 1000
4.Please outline any further evidence to support your case, including any community or regional support for the project. Evidence may include letters of support, traffic history data or reports, or flood history data etc.
If community consultation has previously occurred, existing supporting documentation may be attached or where available online, the relevant hyperlinks provided.
Character limit 1000
5.Does the project align with existing planning? Is the project currently prioritised in state, local or regional planning material?
Please describe how the project aligns with existing planning and identify any planning documents that prioritise the project or its aims.
Character limit 1000
6.Have other solutions been considered?
Yes / 500 Character constraint
(provide details)
No
(provide details)
7.Why is this project the preferred option?
Character limit 1000
8.Are approvals, permits and/or licences required for this project?
Yes / No / In progress
9.Does council have a plan in place to manage and fund the ongoing costs of this project (such as maintenance and repair costs)?
Yes / No
10.Does this project link to an infrastructure or social impact mitigation strategy from a project environmental impact statement?
Yes / No
11.How have you determined the cost of this project?
For example, costs identified by quantity surveyor.
Character limit 500