Recycling and Illegal Dumping Grant Application Form
Scrap Tires
New Mexico
Environment Department
Solid Waste Bureau
2013-2014

Contents

Application Instructions 3

Scrap Tire Grant Application Form 4

Contact Person 4

Person Preparing Application 4

Type of Organization 5

Type of Project 5

Project Information 6

Project Description (50 Points) 6

Need and Urgency (25 points) 9

Feasibility and Sustainability (25 points) 10

Value For Money (35 points) 12

Community Tire Management and Business Plan (10 points) 12

For Abatement Projects (30 points) 13

Budget Proposal (25 points) 14

Litigation, Liabilities, and Land Information 15

Certifications 16

Authorized Agent 16

Responsible Financial Officer 16


Application Instructions

·  All applicants must read and understand the Recycling and Illegal Dumping Grant Fund Application Instruction booklet.

·  To be considered for a grant, an applicant must complete the entire form, answer all narrative questions, and note any attachments. If a question is not applicable, note "N/A" in the appropriate location. Do not leave any question blank.

·  Clearly describe your grant project. Provide enough narrative details so committee members may fully understand what you plan to use the funds for, or what you plan to accomplish if you are awarded a grant. In past grant cycles, several applicants did not receive funding because the description of what the funding would be used for was confusing or unclear.

·  To be considered for additional funding you must provide an itemized budget for committee members to consider for partial or possible full funding. Additionally, if you itemize task costs, if a grant is withdrawn from another applicant, you may be allowed to amend your contract to receive additional funds for those tasks that were not funded. The committee is not able to make decisions based on lump sums provided in a budget. If possible, attach a budget estimate from a consultant or contractor to support your application.

Scrap Tire Grant Application Form

Organization Name
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Choose date.
Project Title
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$ Enter amount.

Contact Person

Name
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Address
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Email
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Person Preparing Application

·  If different from contact person.

Name
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Address
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Email
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Type of Organization

Municipality / Land Grant Community
County / Cooperative Association (See Definition in Grant Instructions)
Indian Nation, Pueblo, or Tribe / Solid Waste Authority

Type of Project

·  Check all that apply

Illegal tire dumpsite / stockpile abatement with recycling / Transportation of tires or tire derived products
Illegal tire dumpsite / stockpile abatement with disposal / Equipment purchase
Tire recycling facility equipment, construction, operations / Other (Please specify):
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Tire bale or loose tire civil engineering project construction
Purchase of tire-derived products (e.g., tire bales, ground rubber, rubberized asphalt, etc.)

Do 95% or more of the tires or tire-derived products in your project come from sources in New Mexico?

Yes / No

Project Information

Project Description (50 Points)

  1. Describe the proposed use of grant funds. Use the following questions to demonstrate your ability to meet these assessment criteria (bulleted responses are encouraged):

·  Briefly, but clearly, state how you plan to use tire grant funds. Be sure to include how all items listed in the Budget Proposal will be used for the project.

·  State the expected date of completion of the project.

·  Indicate the approximate number of tires abated, recycled or beneficially used in this project.

·  How will success of this project be measured?

·  Where do you intend to conduct the project? For clean ups of illegal tire dumps and stockpiles, briefly describe the locations of each site in this section.

·  Describe the project's consistency with surrounding land use

·  Provide a short narrative explaining how this application is consistent with NMED priorities defined in the grant announcement.

«  Applications for tire dump abatements should include requests for funding for a mechanism for non-recurrence, such as signage, fencing, law enforcement patrols, etc.

«  400 word maximum

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  1. Give project team specifics.

·  Describe the steps to be taken.

·  Describe how each step will be done.

·  State who will do each step.

«  150 word maximum

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  1. If the requested funds are for equipment purchases, the following materials must be provided for each piece of equipment requested.

·  Why was this equipment chosen? (e.g., recommendation from current user, research, advertisement, demonstration, etc.).

·  Explain how this equipment will do the job you want it to do.

·  Attach readable quotes and specifications for the equipment requested. (NMED recognizes that these quotes are subject to change based on date of contract reward)

«  Note: Grant funds cannot be used to purchase used equipment unless the applicant can obtain a warrantee or service agreement equivalent to the one provided for a new piece of the same equipment.

«  If funds are not being requested for equipment purchases, mark N/A here and go on to section D.

«  50 word maximum for each piece of equipment.

Item #1
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Item #2
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Item #3
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  1. If the requested funds are for the purchase of tire-derived products, please provide the following information:

Type of product to be purchased, e.g., tire bales, ground rubber, rubberized asphalt, etc. / Click here to enter text.
Estimated Passenger Tire Equivalent (PTE) of waste tires contained in the quantity of the product being purchased. One PTE is the weight of an average passenger tire or 22.5 pounds. A truck tire weighs approximately 5 PTEs. For ground or crumb rubber, assume that each passenger tire produces 0.67 PTE of product or 15 pounds.

«  Note: 95% or more of the recyclable materials used must be produced from New Mexico scrap tires.

Need and Urgency (25 points)

·  Why is this project necessary?

·  What factors make this project urgent at this time?

·  What is the population of the area affected?

·  Describe any special considerations about fire, vectors, or other environmental or health hazard.

«  100 word maximum

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·  Is tire management a problem in your area?

Yes (Please explain how this project will address the problem. 100 word maximum) / No
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Feasibility and Sustainability (25 points)

Use the following questions to demonstrate your ability to meet these assessment criteria:

·  Why will this project succeed and continue beyond the grant period?

·  Were there alternative solutions considered and if so, what were they, and why were they not chosen?

·  What local actions (such as an ordinance, resolution, increased tip fees, etc.) have been taken or will be taken to insure the continued support of this project?

·  If applicable, why will this project develop or expand markets for recycled scrap tires?

·  If this grant cannot be fully funded, what costs can be eliminated / reduced or what alternative financing is available to assure completion of the project? Be sure to consider partial funding by NMED for the project (25%, 50%, 75%, ... ).

·  How will this program be funded in the future?

·  Can this project be implemented without this application being funded?

·  List previous experiences that may demonstrate the applicant's success with other projects / programs.

·  Demonstrate your ability to successfully complete the project by June 15, 2014.

«  400 word maximum

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Have you received state or government grants in the past?

Yes (Please summarize your past record in completing the grant objectives. State why you believe the project was successful.) / No
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Value For Money (35 points)

·  Divide the NMED grant funds requested by the number of passenger tire equivalents (PTE) that are to be abated / transported / processed / used in the project.

·  For purchase of ground or crumb rubber, assume that each PTE produces 15 pounds of product.

·  For processing equipment purchases only, divide the NMED grant funds requested by the number of PTEs processed in 5 years. Applicants should attempt to achieve as low a cost per tire as possible.

«  The answer to this should be a number. Show your calculations.

Calculations:
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Cost per tire:

Community Tire Management and Business Plan (10 points)

·  Does your community have a Tire Management / Business Plan?

Yes (Please describe the plan including the tire tip fee and information about any local ordinances. 100 word maximum.) / No
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For Abatement Projects (30 points)

Answer each of the following questions for each illegal scrap tire dump site or stockpile that will be abated through this proposal. This section must be completed for all abatement projects including stockpiles at landfills and other registered or permitted facilities.

How many sites are you proposing to clean up? / Click here to enter the number.

You will need to fill out that number of “For Abatement Projects” forms.

«  Attach at least one photo of each dump site.

Name of site / Click here to enter text.
Location and/or physical address / Click here to enter text.
Name of property owner (if known) / Click here to enter text.
Number or weight of scrap tires at the site / Click here to enter text.
Length of time the illegal dump site or stockpile has been in existence / Click here to enter text.
Population within a five-mile radius of the illegal dumpsite / Click here to enter text.
Schools, hospitals, businesses, and industries within a five-mile radius of the illegal dumpsite / Click here to enter text.
Distance to the nearest river, stream, and/or arroyo / Click here to enter text.
What fire hazard or vector problems does the illegal dumpsite pose? / Click here to enter text.
Is the illegal dumpsite active, and if so, is it still growing? / Click here to enter text.
Is there pending litigation or other contingent liabilities that have a bearing on this project or application? / Click here to enter text.
Has the landowner granted access to the property for the abatement? / Click here to enter text.
What action will be taken (e.g., city ordinance, resolutions, signs, fencing, gate locks, etc.) to prevent the recurrence of illegal dumping at the site? / Click here to enter text.

Budget Proposal (25 points)

Expense item* / Basis of budget estimate / Grant application amount / Applicant contribution / Totals
In-kind / Cash
Administrative Cost / N/A / Not allowed / $ / $ / $
Professional Services (Professional engineers, architects, surveyors) / Click here to enter text. / $ / $ / $ / $
Construction Costs (Materials, equipment rental, etc.) / Click here to enter text. / $ / $ / $ / $
Contract Labor / Click here to enter text. / $ / $ / $ / $
Capital Equipment (list each separately) ** / Click here to enter text. / $ / $ / $ / $
Click here to enter text. / $ / $ / $ / $
Click here to enter text. / $ / $ / $ / $
Transportation / Click here to enter text. / $ / $ / $ / $
Purchase of tire-derived products / Click here to enter text. / $ / $ / $ / $
Contingency (up to 15% of total request) / Click here to enter text. / $ / $ / $ / $
Tipping fees / Click here to enter text. / $ / $ / $ / $
Other costs (specify)
Click here to enter text. / Click here to enter text. / $ / $ / $ / $
Totals / $ / $ / $ / $

* How did you come up with your budget figure? For example, quote, estimate, published price? Attach a copy of the information. If the quote is verbal, give the person’s name, company information and date of conversation.

**Provide the proposed make, model of the capital equipment item(s). Specifications and quotes must be attached. Attach additional sheets if necessary.

Litigation, Liabilities, and Land Information

Is there pending litigation or other contingent liabilities that have a bearing on this project or application (i.e. need Army Corps of Engineer’s approval, need other NMED or other agency permits to proceed)?

Yes (Please explain below) / No
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Is the project on State, BLM or other lands not owned by the applicant?

Yes (Please explain below) / No
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Have all parcels of land and rights-of-way necessary for completion of this project been purchased, leased, or otherwise acquired by the applicant?