Arts & Culture Capital Scheme2016
Application Form
STREAM 1
- This form should be completed for Stream 1 applicants only having regard to the eligibility criteria of the scheme and the guidelines attached.
- On completion please forward the form and accompanying documentation to: Arts Capital Unit, Department of Arts, Heritage, Regional, Rural andGaeltacht Affairs, New Road, Killarney, Co. Kerry, V93 A49X OR e-mail to:
- Applications will be accepted until 12 noon on 16 September 2016.Applications received outside of this timeframe will not be considered.
- Applicants can only apply for one Stream of funding and can only seek grant aid to the maximum level of that specified Stream.
Stream 1 – Refurbishment and Enhancement of existing dedicated arts and culture facilities. (Grant Application Value €20,000 - €300,000)
- ORGANISATION DETAILS AND STRUCTURE
1A. Name(s)
Name
Address
Postcode
Contact Name for correspondence
Position in Organisation
Telephone No.
1B. Structure of organisation
Voluntary Organisation
Company Limited by Guarantee
Trust
Other, please specify
No of employees
Please attach a copy of the Memorandum & Articles of Association or Constitution of the Organisation.
1C. The Code of Governance for Community and Voluntary Organisations.
Are you compliant with the Governance Code? YES______NO______
OR
Are you on the adoption journey towards compliance? YES______NO______
- APPLICANT TAX & RELATED DETAILS
Tax Reference Number:
Charity Number (CHY):
VAT Registration Number: (if applicable)
3.PROJECT OUTLINE
Please provide short summary of the proposed project under thefollowing headings(no more than 700 words)
List the main objectives of the project?
What are the planned outcomes of the project?
How will the project be delivered?
If the project involves a partnership, please list how the partner's involvement might assist in the delivery of the project?
Proposed commencement date
Proposed completion date
Please provide details of how your project meets the selection criteria set out in Section 7 of the Guidelines.
Please attach the following :
- If applicable, standard sketch drawings of proposed buildings/works and when available a full set of plans and elevations as per planning application or as subsequently amended.
4.DIRECTOR(S)/PROMOTERS OF ORGANISATION/PROJECT
Name(s),
Legal Status
Names of Promoters/ and /or Director
Address(es) of Promoter(s) and/or Director(s)
Overall aim of organisation
Solicitor:
Name of Company
Name(s)
Telephone No
Address
Financial Adviser/ Accountant :
Name of Company
Name(s)
Telephone No
Address
Details of qualifications and projects previously managed.
4A.PROFESSIONAL SERVICES:
Projects funded under this scheme will be varied and may often require the services of a building professional. If applicable, please provide details of professionals to be engaged. In cases where grant applications are in excess of €50,000 professional advice should be sought.
Architect and/or Engineer
Name of Company
Name(s)
Telephone No
Address
Details of qualifications and projects previously managed
Quantity Surveyor
Name of Company
Name(s)
Telephone No
Address
Details of qualifications and projects previously managed
Project Manager:
Name of Company
Name(s)
Telephone No
Address
Others Parties: (Specify nature):
Name of Company
Name(s)
Telephone No
Address
5. SITE OWNERSHIP /TITLE
Do the Promoters currently have:
Ownership / Satisfactory lease on premises / Yes / NO
If lease, please state term of lease
Planning Permission / YES / NO / N/A
Other Statutory Consents / YES / NO / N/A
If the answer is no, please provide details
What is the expected commercial life of the project
- Please provide with your application a written statement outlining the legal status of the property to be developed.
- Please include copy of planning permission/statutory consents, where applicable
6. CAPITAL COSTS
The purpose of this section is to establish the total capital cost involved in the project. Costs must be shown net of VAT.
Total project costs €______(Excluding VAT)
Where applicable / COST EXCLUSIVE OF VAT / VAT
Preliminary Surveys
Fees
Construction
Fittings - Fixed
Fittings - Loose
Equipment
Other (specify)
TOTAL
At least one professionally prepared quotation or pre-tender estimate must be provided for all aspects of the works being applied for. This can be one or more documents but must cover everything being applied for.
The following types of documents are acceptable as quotes:
1. An estimate prepared by a technical supervisor (typically an engineer, quantity surveyor or architect). The estimate must include details of who provided it and their relevant qualifications
2. A quote from a contractor/supplier including details of who is providing the quote
7. FUNDING SUMMARY
Source / €
Grants(where applicable ) / Please provide details in 7A
Equity(where applicable ) / Please provide details in 7B
Borrowing(where applicable ) / Please provide details in 7C
Other, specify
Total
- Confirmation of the availability of own funds from an independent auditor/solicitor should be provided. Alternatively,a letter of reference from a bank confirming availability of funds might be provided.
- Confirmation of the availability of borrowing in the form of a bank facility letter should be provided; a sample letter is attached at Appendix A of this document.
- In case of a Partnership, an indemnity is required from the authority i.e. Local Authority or ETB/third level to cover borrowings or operational losses of the proposed project.
Amount of grant sought under this application €______
OFFICIAL USE ONLY
Eligible costs grant % as per criteria = grant sought
€______x ______% = €______
7A. Where applicable, details of other grants received or proposed in respect of this proposal.
Grant Scheme / Amount €
7B.Equity Details – Where applicable, written evidence of equity is required to accompany this form.
Source/Type / Total €
Ordinary Shares
Fundraising
Other (specify)
TOTAL
7C. Borrowing: Where applicable written evidence of the availability of all borrowings should accompany this form. Please indicate as follows
Loan / Lender / Amount € / Rate % / Term Years / Moratorium Years
1.
2
.
3
.
4
.
Total borrowings
8. FINANCIAL PROJECTIONS
(FOR GRANT APPLICATION BELOW €50,000 COMPLETE YEARS 1 & 2)
(FOR GRANT APPLICATION IN EXCESS OF €50,000, COMPLETE YEARS 1-5)
The purpose of this section is to give an analysis of all additional income which will be earned by undertaking this project. It is very important that only incremental income is shown i.e. income generated directly as a result of the proposed development(e.g. admission charges; box-office receipts; operating subvention)
8A. Analysis of additional income after completion of project
Year 1
€ / Year 2
€ / Year
€ / Year 4
€ / Year 5
€
Operating Income
*Other Income (8D)
Less VAT @ ____ %
Total Net Revenue
Cost of Sales
Gross Profit
8B. Projected Profit and Loss Account/Cashflow
The purpose of this section is to match the incremental revenues as detailed with the incremental costs.
Profit and Loss Account
Year 1
€ / Year 2
€ / Year 3
€ / Year 4
€ / Year 5
€
Gross Profits:
Total Gross Profit (Before Subvention)
Salaries
Other Staff Costs
Rates
Rent
Repairs and Renewals
Light and Heat
Insurance
Telephone
Postage and Stationery
Marketing Budget
Bank Charges
Professional Fees
Motor and Travelling
Training
Other
Depreciation: Buildings 2%
Fix. & Fit. 12.5%
Equipment 20%
Net Profit/Loss (Before Operating Subvention)
Operating Subvention
Net Profit/Loss
8C. Assumptions Please provide supportive data on how annual revenue might be derived, (e.g. No. of attendance, price per admission, rental of spaces).
*8D. Other Sources of Income should be documented here
VERY IMPORTANT – PLEASE NOTE
- Audited Accounts for the last three years must be provided.(In the case of grant applications less than €50,000, one year's audited accounts mustbe submitted)
- A Business Plan must be provided in the case of all applicants.
9. DECLARATION
This proposal has been completed by me/completed on my behalf and I declare that the information provided is true and correct. I am aware that incomplete applications and/or applications that are not accompanied by the required documentation will not be considered.
In the event that this project is to be part funded by a Local Authority or other authority and this application is not made in the name of that Authority, this application should be countersigned by a duly authorised officer of the Authority in question.
Signed: Date: ______Name: ______
Capacity: ______Telephone: ______email: ______
Signed: ______
Name: ______
Capacity: ______Telephone: ______email: ______
Contact point and deadline
Applications will be accepted up until 12.00 noon on 16 September 2016.
N.B. Applications received by the Department of Arts, Heritage, Regional, Rural andGaeltachtAffairs outside of this timeframe will not be considered.
Please post your applications to
Arts Capital Unit
Department of Arts, Heritage, Regional, Rural andGaeltacht Affairs
New Road
Killarney
Co Kerry
V93 A49X
Or e-mail to:
10. CHECKLISTThe following is a list of items which should also accompany your application. If you require any clarification of these items please consult the guidelines or contact the Arts Capital Unit of the Department of Arts, Heritage, Regional, Rural andGaeltachtAffairs at (064) 6627333, 6627355, 6627213 or email
DOCUMENT TYPE / Y/NSECTION 1 ORGANISATION DETAILS AND STRUCTURE
A copy of the Memorandum & Articles of Association or Constitution of the Organisation should be attached
SECTION 3. PROJECT OUTLINE
- If applicable, standard sketch drawings of proposed buildings/ works and when available a full set of plans and elevations as per planning application or as subsequently amended
SECTION 4. DIRECTORS / PROMOTERS OF ORGANISATION/PROJECT
All applicants must complete this section
SECTION 4A. PROFESSIONAL SERVICES
For grant applications in excess of €50,000, please complete this section if applicable.
SECTION 5. SITE OWNERSHIP /TITLE
- Letter confirming legal status of the property being developed
- Copy of planning permission/statutory consents, where applicable.
SECTION 6.CAPITAL COSTS
At least one professionally prepared quotation or pre-tender estimate must be provided for all aspects of the works being applied for
SECTION 7. FUNDING SUMMARY
- Confirmation of the availability of own funds from an auditor/solicitor should be provided. Alternatively arecently dated letter of reference from the financial institution should be provided .
- Confirmation of the availability of borrowing in the form of a bank facility letter should be provided where applicable.
- In case of a Partnership, an indemnity is required from the authority i.e. Local Authority or ETB/third level to cover borrowings or operational losses of the proposed project.
SECTION 8. FINANCIAL PROJECTIONS
- Audited Accounts
For grant applications in excess of €50,000, audited accounts for the last three years must be provided
- A Business Plan must be provided in the case of all applicants.
Appendix A – Sample Loan offer letter
If the level of own funding includes a loan, you must confirm this with a letter from the financial institution involved indicating the amount of the loan and that it is not conditional on a grant allocation being approved. An example of a suitable loan offer letter is detailed below. You must either have this letter completed, signed and stamped by your financial institution or provide a letter from your financial institution containing the information sought in the sample letter.
Name of organisationWhat is the amount of the loan?
What is the purpose of this loan?
Is the granting of the loan dependent on the applicant receiving a grant from the Department of Arts, Heritage, Regional, Rural and Gaeltacht Affairs?
Has the applicant any other loans outstanding from this financial institution?
What term is the proposed loan?
What are the monthly repayments?
Is loan fully approved or approved in principle?
When will loan be available for draw down?
______
Please print name
______
Signature
______Financial Institution Stamp
Job Title
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