Grant Application Form

Transcription

1 The Alberta (ACRP) will provide grants to applicants for the details design and construction of eligible projects that: a. Enhance or enable the protection of critical infrastructure, b. Mitigate public safety hazards, or c. Do both (a) and (b). For additional information about program eligibility, please refer to the Application Guideline Document. APPLICATION INFORMATION Application is hereby made to the Minister of Environment and Parks (hereinafter called the Minister ) for Grant Pursuant of the Environment and Parks Grant Regulation, A. R. 182/2000 [refer also to the Designation and Transfer of Responsibility Regulation, A. R. 80/2012, Section 8(8)]. APPLICANT INFORMATION Name of Applicant: Contact Name: Address: City: Province: Postal Code: Phone: Fax: Project Name: PROJECT INFORMATION Project GPS Marker: (in decimal degrees) Project Description: Latitude: Longitude: Page 1 of 5

2 PROJECT CATEGORIES Select the most appropriate category your project fits under (select multiple if applicable) Water/Wastewater infrastructure projects (includes relocation of facilities or providing flood protection in place) Community Protection and Public Safety Projects (includes property buyouts or providing flood protection in place) Stormwater Management Projects Erosion Control Projects (bank armouring including bio-engineering techniques wherever possible) Other (Please Describe): How has the project location been previously affected by flood or drought? Please Describe: Is the project located in or does it impact a flood plain area? Yes No Unknown Please check one: Floodway Flood Fringe Unmapped Estimated Start Date Detailed Engineering Regulatory Authorizations Project Duration Key Project Milestones Tender Construction Other (please describe) Estimated Completion Date Can this project be completed in phases? Yes No Please expand: Has an application been submitted for Water Act and/or Public Land Act authorization? Yes No Not Applicable Application being prepared If yes, please provide the application/authorization number(s): Page 2 of 5

3 FINANCIAL INFORMATION Cost Share Requirement: The Alberta has a cost share component in order to promote shared accountability between the province and its communities. Alberta Environment and Parks will provide 90% of eligible engineering and construction costs up to $3 million and 70% of eligible costs in excess of $3 million. Please be aware that ongoing operation and maintenance costs for the life of the project are the responsibility of the grant recipient. Project Costs: Please refer to the Application Guideline Document for additional information regarding eligible and ineligible projects and/or project costs. Total Estimated Costs* Municipal Contribution Provincial Contribution * Any Ineligible costs will be deducted from total estimated project costs. The municipal and provincial contribution will be adjusted accordingly. Is this project eligible for funding from another program? Yes No Unknown If Yes, has the community applied to: Watershed Resilience & Restoration Program (WRRP) Yes Not Applicable Federal Small Communities Fund (PTIC-SCF) Yes Not Applicable Disaster Recovery Program Yes Not Applicable Alberta Municipal Water/Wastewater Partnership (AMWWP) Yes Not Applicable Strategic Transportation Infrastructure Program (STIP) Yes Not Applicable Indigenous & Northern Affairs Canada Yes Not Applicable Please Describe: Page 3 of 5

4 Using the space below, please provide additional information about alternate funding sources that have been confirmed, any decisions pending, and any decisions outstanding through the Disaster Recovery program: (Examples may include: third party cost-sharing arrangements private business, industry partners etc.) What is the community s plan if funding is not immediately available for your project, what interim and/or contingency options are available? Please describe below: Page 4 of 5

5 APPLICATION REQUIREMENTS Your application must include the following supporting documentation: Community Resilience and Mitigation Assessment Preliminary Engineering Report; Other information that will benefit the decision-making process (optional) FLOOD DAMAGE ASSESSMENT TOOL The Provincial Flood Damage Assessment Tool is available to communities with completed flood hazard mapping upon request from the province. The assessment tool uses municipal tax information to calculate the economic impact from a variety of flood frequencies. For more information please AEP.ACRP@gov.ab.ca Name of Applicant: Contact Name: Address: APPLICATION AUTHORIZATION AND SUBMISSION Signature**: Date: **All applications must be signed by the applicant. Consultants may not apply on behalf of the applicant. Please submit your completed grant application no later than 11:59:59 EST on September 30 to AEP.ACRP@gov.ab.ca For additional information please contact your program coordinator: South Saskatchewan Region Micaela Gerling at Red Deer-North Saskatchewan, Peace, and Upper and Lower Athabasca Regions Alison Roberts at Page 5 of 5