ATTACHMENT A 2018 TRAINING ATTENDANCE VERIFICATION I hereby certify that a representative from the applicant s organization attended the required application training provided by the NDOT. The certificate of attendance has been submitted as an attachment to this grant application. Applicant Authorized Official Signature Date Please submit the applicant s CERTIFICATE(S) OF ATTENDANCE with Attachment A.
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ATTACHMENT B SPECIAL SECTION 13(C) WARRANTY OPINION OF COUNSEL [Applicant] has agreed to be the legally and financially responsible party for the performance of terms and conditions of the following (and incorporated herein by reference) Special Section 13(c) Warranty, for this grant request. This will serve as the requisite Opinion of Counsel that the APPLICANT is legally capable of assuming the legal and financial responsibilities for the terms and conditions of the Warranty. I have reviewed the pertinent federal, state, and local laws and regulations, and I am of the opinion that there is no legal impediment to the APPLICANT assuming these responsibilities. Furthermore, as a result of my examinations, I can find no pending litigation or legislation that might in any way adversely affect the APPLICANT S ability to assume and discharge these Responsibilities. Printed name of Legal Counsel Printed name of APPLICANT S authorized representative Signature of Legal Counsel Signature of APPLICANT S authorized representative Date Date Please submit this form: SPECIAL SECTION 13(C) WARRANTY OPINION OF COUNSEL as Attachment B.
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ATTACHMENT C RISK MANAGEMENT PLAN Risk management and sustainability go hand in hand. Risks affect the sustainability of the project and its long-term viability. The NDOT requires applicants of federal funds to develop a risk management plan that demonstrates the applicant s technical and financial capacity to protect the federal assets and fulfill the contract requirements. The organizations risk management plan should include: Financial policies and procedures approved by the governing board Facility, equipment, and vehicle preventative maintenance plans Human resources policy and procedures Employee training System safety and security policies and procedures o o o o Facility safety Information safety Personnel safety Weather related policies and procedures Please submit the applicant s RISK MANAGEMENT PLAN or RISK MANAGEMENT DOCUMENTS as Attachment C.
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ATTACHMENT D LOCAL MATCH AND FUND LEVERAGING COMMITMENT Applicants must certify the availability of matching funds to support the grant application. Grant recipients who are able to leverage additional funds above the required matching funds will receive higher funding priority ratings based on the percentage of additional funds leveraged. Committed funds must be verifiable. Letters of commitment and funding approval must be submitted as an attachment to the application. LOCAL FUNDING COMMITTED List funding sources and committed amounts for each federal program. Add additional funding source and amount lines as necessary to identify all committed funding. Section Funding Source Amount Signature of Authorized Official Title of Authorized Official Date Please submit this form: LOCAL MATCH AND FUND LEVERAGING COMMITMENT as Attachment D and LETTERS OF COMMITMENT and FUNDING APPROVAL with Attachment D.
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ATTACHMENT E FOUR-YEAR CAPITAL AND OPERATING PLAN WORKBOOK The four-year capital and operating plan is an Excel document contained as an attachment to this application. Please submit the applicant s FOUR-YEAR CAPITAL AND OPERATING PLAN WORKBOOK as Attachment E.
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ATTACHMENT F COORDINATION EFFORTS The NDOT expects transit systems to participate in the local and regional planning processes for the initial as well as in the updates to the coordinated public transit human service transportation plans. Additionally, the NDOT expects transit systems will participate in coordination activities at the local and regional level. Provide evidence of participation in local coordination efforts. Evidence of participation in coordination efforts include, but are not limited to: Participation and cooperation with Mobility Managers Agreements among providers Participation in meetings with health and human service agencies Need assessment surveys Participation with Transportation Advisory Committees Please describe coordination efforts the applicant has participated in over the last year. Provide evidence of participation, such as a sign in sheet or meeting minutes. Please submit the applicant s COORDINATION EFFORT DOCUMENTATION as Attachment F.
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ATTACHMENT G PERFORMANCE MEASURES The NDOT requires all Section 5311 applicants to evaluate system performance on an annual basis, at minimum. All Section 5311 applicants must complete the appropriate form on the following two pages. Please submit these forms: PERFORMANCE MEASURES as Attachment G.
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PERFORMANCE MEASURES Performance standards will be used by the NDOT as a tool for measuring the effectiveness and efficiency of your system's rural public transportation DEMAND RESPONSE service. The program is set up such that services can be rated as "Successful", "Acceptable", or "Needs Review" based on how a system performs in each of the operating measures. The following standards apply to demand response and rural route services and all Section 5311 recipients: Measure Successful Acceptable Needs Review Operating Cost per Revenue Vehicle Mile Operating Cost per Passenger Trip <$6.00 $6.00 to $11.00 >$11.00 >$38.00 $38.00 to $62.00 >$62.00 Farebox Recovery Ratio >9% 4% to 9% <4% Trips per Revenue Mile >.34.12 to.34 <.12 Trips per Revenue Hour >3.5 1.75 to 3.5 < 1.75 1. Please complete the chart for the past three fiscal years. Refer to the year-end data and financial reports to obtain these measures. Then indicate in the appropriate column whether the measure is Successful (S), Acceptable (A), or Needs Review (N). Measure FY 2015 S/A/N FY 2016 S/A/N FY 2017 S/A/N Operating Cost per Revenue Vehicle Mile Operating Cost per Passenger Trip Farebox Recovery Ratio Trips per Revenue Mile Trips per Revenue Hour 2. What steps are you taking to bring your service from Needs Review to the Acceptable level? 3. What steps are you taking to bring your service from Acceptable to the Successful level?
PERFORMANCE MEASURES Performance standards will be used by the Nevada Department of Transportation as a tool for measuring the effectiveness and efficiency of your system's rural public transportation FIXED ROUTE, INTERCITY, AND ROUTE DEVIATION services. The program is set up such that services can be rated as "Successful", "Acceptable", or "Needs Review" based on how a system performs in each of the operating measures. The following standards apply to demand response and rural route services and all Section 5311 recipients: Measure Successful Acceptable Needs Review Operating Cost per Revenue Vehicle Mile Operating Cost per Passenger Trip <$5.00 $5.00 to $6.50 >$6.50 >$114.00 $114.00 to $120.00 >$120.00 Farebox Recovery Ratio >12% 9% to 12% <9% Trips per Revenue Mile >7 4 to 7 <4 Trips per Revenue Hour >5 3.25 to 4.75 < 3.25 4. Please complete the chart for the past three fiscal years. Refer to the year-end data and financial reports to obtain these measures. Then indicate in the appropriate column whether the measure is Successful (S), Acceptable (A), or Needs Review (N). Measure FY 2015 S/A/N FY 2016 S/A/N FY 2017 S/A/N Operating Cost per Revenue Vehicle Mile Operating Cost per Passenger Trip Farebox Recovery Ratio Trips per Revenue Mile Trips per Revenue Hour 5. What steps are you taking to bring your service from Needs Review to the Acceptable level? 6. What steps are you taking to bring your service from Acceptable to the Successful level?
ATTACHMENT H EQUAL EMPLOYMENT OPPORTUNITY (EEO) POLICY If your agency receives capital and/or operating assistance: less than $1,000,000; or planning assistance of less than $250,000; then you must submit an EEO Policy. Please submit the EEO policy as Attachment H of this application. -or- ATTACHMENT H EQUAL EMPLOYMENT OPPORTUNITY (EEO) PLAN If your agency receives capital and/or operating assistance: greater than $1,000,000; or planning assistance in excess of $250,000 and 100 or more transit-related employees; then you must submit an EEO Plan. If applicable, please submit the EEO plan as Attachment H of this application. Please submit the applicant s EEO POLICY or EEO PLAN as Attachment H.
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ATTACHMENT I TITLE VI The NDOT and Sections 5310, 5311, and 5339 subrecipients must comply with applicable provisions of 49 U.S.C. 5332. These provisions prohibit discrimination based on race, color, religion, national origin, sex, age, and disability, and prohibit discrimination in employment or business opportunity. Applicants must submit a Title VI plan with this application. Please include the plan as Attachment I. Please submit the applicant s TITLE VI PLAN as Attachment I.
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ATTACHMENT J DBE GOAL AND METHODOLOGY Please submit the applicant s DBE GOAL AND METHODOLOGY as Attachment J.
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ATTACHMENT K AMERICANS WITH DISABILITIES ACT (ADA) The ADA requires public transit systems to provide equivalent service to individuals with disabilities. Demand response public transit systems are required to provide program accessibility for persons with disabilities. Such features and services of the transit system must be provided in the most integrated manner possible. Demand response service providers must certify equivalent service on the form below. This form must be submitted as Attachment J with the application. Fixed route public transit systems are required to provide complementary paratransit service and therefore, must submit a complementary paratransit plan to the NDOT. Fixed route service providers must attach the applicant s paratransit plan as Attachment J of the application. Service providers that provide both demand response and fixed route public transit systems will provide both attachments as Attachment J. Please submit the applicant s PARATRANSIT PLAN with Attachment K. ADA COMPLIANCE for Demand Response Service [APPLICANT] hereby affirms that [TRANSIT SYSTEM] is in compliance with the Americans with Disabilities Act for providing equivalent service. Applicant Authorized Official Signature Date
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ATTACHMENT L DRUG AND ALCOHOL POLICY Please submit the applicant s DRUG AND ALCOHOL POLICY as Attachment L.
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ATTACHMENT M VEHICLE REQUISITIONS This form should be used by Applicant s who are applying for vehicle funding. 1. The vehicle types listed below are available for purchase as identified in the Quantity Purchase Agreement (QPA) with the State of Nevada. 2. Vehicles will be available and funded with 80%/20% matching requirements. 3. Additional option prices are not reflected in the Estimated Unit Price. Model Year Vehicle Type Quantity to be Purchased New Acquisition or Replacement Estimated Unit Price w/lift Estimated Federal Funding 80% Estimated Local Match 20% 2019 2019 Minivan (MV) w/ramp and low floor Minivan (MV) 3 passenger 2 wheelchair $50,000 $40,000 $10,000 $50,000 $40,000 $10,000 2019 Minivan (MV) 5 passenger $50,000 $40,000 $10,000 2019 2019 2019 Cutaway (CU) 10 passenger 3 wheelchair Cutaway (CU) 12 passenger 2 wheelchair Cutaway (CU) 16 passenger 1 wheelchair $77,000 $61,600 $15,400 $71,000 $56,800 $14,200 $75,000 $60,000 $15,000 2019 Cutaway (CU) 20 passenger $75,000 $60,000 $15,000 Please submit this form: VEHICLE REQUISITIONS as Attachment M.
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ATTACHMENT N CERTIFICATE OF INSURANCE All applicants must submit a Certificate of Insurance (COI) with the application. The state requires minimum liability coverage and the NDOT requires full coverage for the vehicle as long as NDOT holds a lien on the vehicle. Please submit the applicant s CERTIFICATE OF INSURANCE as Attachment N.
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ATTACHMENT O VEHICLE INVENTORY SHEET Applicants must provide a current inventory list of all vehicles in their fleet, whether obtained through the NDOT or another source. Applicants are required to submit an updated vehicle inventory report with this application report as Attachment M. Please submit the applicant s VEHICLE INVENTORY SHEET as Attachment O.
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ATTACHMENT P LETTERS OF SUPPORT Provide at least three (3) letters of support for the application. Letters of support should be from organizations such as local community organizations or funding agencies, and describes the benefits of your project and the needs your program addresses. Please submit the applicant s LETTERS OF SUPPORT as Attachment P.
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ATTACHMENT Q ORGANIZATION CHART Provide your agency s organization chart, as requested in Question 18. Please submit the applicant s ORGANIZATION CHART as Attachment Q.
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