Active Living Community Grant Application Packet

Transcription

1 Active Living Community Grant Application Packet

2 Healthy Places: Designing an Active Arvada Active Living Community Grants Calling all fitness instructors, neighborhood leaders and community organizations! We want to hear your ideas around creating fun, affordable ways to be active in southeast Arvada! The Healthy Places Initiative has been working with community members to identify improvements that will make southeast Arvada a healthier and more active community. A major area of focus has been creating, walkable, bikeable connections to key destinations, including parks, neighborhoods and the three future Gold Line Commuter Rail stations slated to open in To this end, the Healthy Places Initiative is sponsoring a community grant program for the development and implementation of healthy programming during 2015 and Programming is required to target residents of southeast Arvada (defined as south of west 64 th, east of Kipling, west of Sheridan, north of the I-70 corridor, see attached map). Active Living Community Grants available up to $5000 Total Funding Available $22,500 We want to encourage physical activity through a variety of affordable activities and events that cater to all ages, abilities, and interests. Types of Programs We Will Support Include: Fitness classes in the park Neighborhood walks and group bike rides Yoga, Tai Chi, Zumba and Dancing Be creative, we want to hear YOUR ideas! Timeline: a. Friday April 24 th, 2015 Application due by 2:00 pm b. May 2015 Awarded applicants notified c. Friday, October 23 rd, 2015 Year 1 report due d. Friday, May 27 th, 2016 Year 2 mid-term report due e. Friday, October 21 st, 2016 Final report due Grant Issued: Friday April 3 rd, 2015 *All funds must be spent and reported on by October One electronic application should be submitted to the Healthy Places Coordinator, Rose Chavez rchavez@arvada.org or dropped off in the City Manager s Office at Arvada City Hall, 8101 Ralston Road, Arvada CO by 2 pm April 24 th Contact the Healthy Places Coordinator and visit HealthyPlacesArvada.org for questions and more information.

3 Healthy Places: Designing an Active Arvada Active Living Community Grant Application Score Sheet **Applicants are not required to live and/or work in southeast Arvada Project Plan: Score Range 0-10 points Project goals, objectives, communication plan and timeline are all well aligned with priority areas of active living and built environment Project plan includes sustained outreach and engagement of neighborhood residents Work is specific and measurable with high likelihood of success There is clear evidence that the applicant and/or applicant team will possess all the skills needed to make the project plan highly successful Desired Results/Sustainability: Score Range 0-10 points Proposed strategies relative to target population capture needs in relation to problem Sustainability plan is viable to support long term continuation of program The applicant team has concise knowledge of how they envision success Project clearly aligns with priority areas of promoting active living and built environments Budget: Score Range of 0-10 points Budget is well crafted and in synergy with work plan Effectively leverages our funding with other sources Strong funding prospects or actual sustainability secured for the future to ensure programming will continue after funding has ended Subjective Assessment: Score Range 0-10 points Cleverly developed project with high potential for success A novel proposal that will have positive impact and touch a relatively large number of southeast Arvada residents Total Maximum score = 40 points *All funds must be spent and reported on by October One electronic application should be submitted to the Healthy Places Coordinator, Rose Chavez rchavez@arvada.org or dropped off in the City Manager s Office at Arvada City Hall, 8101 Ralston Road, Arvada CO by 2 pm April 24 th Contact the Healthy Places Coordinator and visit HealthyPlacesArvada.org for questions and more information.

4 Healthy Places: Designing an Active Arvada Active Living Community Grant Application Funding will not be awarded for personnel salary Review the Application Score Sheet to understand how your application will be evaluated, see attached All applications must have a budget with total cost and leveraged dollar amount outlined, see attached A special event permit must accompany this application if the program will be held on public space, see attached Name: Date: Name of Agency/Organization (If applicable) Title of Program Class(es) / Session(s): Provide a brief (500 words or less) description of your program class(es) /session(s): Explain if this program has been done elsewhere? List all relevant certifications and attach a copy of each to this application: Do you have liability insurance for the event? If so, attach a copy to this application. If you do not have liability insurance please explain:

5 What age groups and income levels does your program target? How many people do you anticipate participating? How you will ensure the programming is sustainable beyond the funding offered? What type of equipment will you be using during your programming? Desired Location in southeast Arvada: Preference will be given to applications that submit programming in the following two locations: Terrace Park Homestead Park I do not have any preference of location. Please assign me to any location. If your program is located in a park, please indicate the specific location within the park (i.e., next to the basketball courts, in the parking lot, etc.) AND attach a map to this application and indicate location: Is this a one-time program or ongoing, explain? Which months will your program be offered? (Please check all that apply) Feb. March April May June July Aug. Sept. Oct. Nov. Dec. List your proposed program session dates and times: Signature: Date:

6 City of Arvada TEMPORARY USE PERMIT SPECIAL EVENTS PERMIT APPLICATION $ (Non-profit agencies are exempt) NOTE: THE APPLICANT SHOULD BECOME FAMILIAR WITH CERTAIN IMPORTANT PROVISIONS OF THE CITY S LAND DEVELOPMENT CODE AND THE CITY CODE WHICH MAY BE RELEVANT TO THE PROPOSED SPECIAL EVENT, INCLUDING, BUT NOT LIMITED TO, SECTIONS D AND 3.17 OF THE LAND DEVELOPMENT CODE ( SPECIAL EVENTS ). 1. Applicant: Status: Corporation Other:_ Address: Street City State Zip Code Phone: address Applicant Contact Person (if different): Address: Street City State Zip Code Phone: address Contractor(s) hired to assist in planned event (if any): Name Address Phone 2. Dates of event: (from and including) (to and including) Hours of operation: 3. Estimated Daily Attendance Basis of Estimate: Previous Attendance (Year ) Reservations/Sales/Communications, etc. Other : 4. Specific location of planned event: 5. Status of Planned Event Site: A. Private property within one of the following zoning districts: B-1, B-2, B-3, B-4, B-5, PUD-BPR, PUD-BP, P-1, I-1, I-2, PUD-CC, PUD-NC, or PUD-I (indicate zoning district: ) B. Private Property within a residential zoning district, but not utilized as a private residence and containing at least 2 acres, or a private street (indicate zoning district: ) C. Public property, including public parks, public street rights-of-way, or other property owned by the City, a special district, or other political subdivision of the State. If more than one box is checked, explain: 6. Describe type/nature of planned event (including special structures, rides, noises, etc.): Will there be entertainment?: If so, explain: Will alcohol be served/sold?: If so, explain: Does applicant have liability insurance for the event? (If so, please attach copy of policy or certificate of insurance) If not, explain:_ 7. In addition to the above information, Section 3.17 requires, or may require, that an application for a special events permit include the following. A. A site plan displaying hard surface access, hard surface parking, location of existing structures, location of temporary structures, any signs to be erected in relation to the special event, and the signature of the property owner indicating acceptance and approval of the proposed site plan; (MUST BE ATTACHED TO APPLICATION) B. Written description or site plan displaying any signs to be erected In relation to the special event; (see Section 6.17) Submitted Submitted No sign

7 C. Will there be any tents or structures over 200 sq. ft.? Yes (must contact Building Division) No D. An acknowledgement that the other ordinances, policies, Acknowledged If not, explain: procedures, and rules and regulations of the city or other applicable public entity have been or will be complied with and that all other necessary permits have been obtained; E. Payment of any applicable fees authorized by the City; F. Such other information as the reviewing authority may require. G. Will any public right of way be obstructed? Yes No 8. If the planned event will be held, in whole or in part, in a public park, public street right-of-way, or on other property owned by the city, a special district, or other political subdivision of the state, then applicant must execute the following indemnification agreement as part of this application: Applicant agrees to indemnify and hold harmless Arvada (and any other applicable special district or political subdivision of the state) and any of its officers or employees from any and all claims, damages, liability, or court awards, including costs and attorneys fees, arising out of, in connection with, resulting from, or in any way related to, the issuance of the requested special events permit or any act of omission or commission by the applicant or any of its employees, agents, representatives, or contractors, in conducting the special event. Signature Position Date 9. This application, when completed, signed, and accompanied by all required documentation, should be submitted to the: City Planning Director - if no portion of the event is to be held within a public park or public street right-of-way. City Park Superintendent - if the event is to be held wholly within a public park (or primarily within a public park and partly within a public street right-of-way). City Traffic Engineer - if the event is to be held wholly within a public street right-of-way (or primarily within a public street right-ofway and partly within a public park). I, DECLARE UNDER PENALTY OF LAW, THAT THE ABOVE STATEMENTS ARE TRUE AND CORRECT AND THAT ALL APPLICABLE CITY ORDINANCES AND REGULATIONS HAVE BEEN OR WILL BE COMPLIED WITH. I/MY ORGANIZATION WILL TAKE REPONSIBILITY FOR ANY VIOLATION OF CITY LAWS THAT OCCUR IN RELATION TO THE ABOVE-NAMED SPECIAL EVENT. Signature Position Date * Administrative Use Only * Application approved Conditions: (Attach separate page, if necessary) Application denied Review process waived Basis of denial/waiver (MUST INCLUDE Section 3.17 grounds, factual basis, reasoning) (attach separate page, if necessary): Approval Signature Position Date Copies to: Planning City Clerk Sales Tax Parks Maintenance Traffic and Transportation City Manager Police Fire Marshal Risk Management Apex Park & Recreation District

8 SPECIAL EVENTS PERMIT INSURANCE REQUIREMENTS Prior to submitting the application, please contact the Risk Management Division at for determination of insurance requirements. Failure to provide proper insurance information could delay the application process.

9 Healthy Places: Designing an Active Arvada Active Living Community Grant Budget Sheet Template Personnel (Salaries) * Note: Personnel salaries won t be funded through the Active Living mini grant program Partnership Fund Request 2015 Partnership Fund Request 2016 Other Funding Sources $ NA $ NA $ $ Total Program Budget $ NA $ NA $ $ Total Personnel (a) $ NA $ NA $ $ Operating Costs (Please list each Operating Cost) $ $ $ $ $ $ $ $ Total Operating Costs (b) $ $ $ $ Other (Please list each Other Cost) $ $ $ $ $ $ $ $ Total Other Expenses (c) $ $ $ $ Total Expenses (a+b+c) $ $ $ $ * Special Event Permit fees are not applicable to non-profits with 501(c)(3) status. All other applicants should incorporate the Special Event Permit fee into their operating cost.

10 Healthy Places: Designing an Active Arvada Map of Southeast Arvada