Heritage Capital Projects Fund 2015-2017 Grant Web view2015-2017 Heritage Capital Projects Fund...

APPLICATION SUBMISSION DEADLINEThursday, May 15, 2014 at 4 p.m.

Must be postmarked by May 15, 2014 orreceived by 4PM May 15, 2014 at:

HCPF Grant Applications ProcessingState Capital Museum and Outreach Center

211 21st Avenue SWOlympia, WA 98501

Washington State 2015-2017 Heritage Capital Projects Fund

Grant Application

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2015-2017 Heritage Capital Projects Fund Grant Application

GRANT APPLICATIONSEE THE HCPF GRANT GUIDELINES, Section 2.4 – APPLICATION INSTRUCTIONS

SECTION 1 - APPLICANT ORGANIZATION INFORMATION

A.Applicant Legal Name: Mailing Address: City: State: Zip Code: Telephone Number: Web address (if available):

B. Applicant Eligibility - please check the category that applies: Local Government Agency; Public Development Authority; Nonprofit Corporation; Tribal Government; Other

If “Other”, please describe: C. State Legislative District: D. WA State Unified Business Identifier # (UBI): E. Federal Tax ID # (TIN):F. Statewide Vendor Number:

SECTION 2 - KEY PERSONNEL

A. Applicant Contact person

Last Name: First Name: Title: Mailing Address: City: State: Zip Code: Telephone Number: E-mail address:

B. Application Preparer


C. Contract Administrator


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D. Project Manager


SECTION 3 - PROPOSED PROJECT

A. Project Title: B. Project Summary (50 word maximum - use the box below):

C.Project Start Date: D.Project Completion Date:E.Has project or organization received previous HCPF grants? Yes or No If yes, Contract #: F.Is the project or organization currently under an HCPF contract? Yes or No If yes, Contract #: G.Prevailing Wage Law Requirements per RCW 39.12

Has the Department of Labor and Industries (LNI) been consulted for a determination of whether the project is required to pay State Prevailing Wage? Yes or No

If yes, describe LNI Prevailing Wages determination: If prevailing wages must be paid, is Project Budget based upon this? Yes or No

H.High-performance Building Standards per RCW 39.35D: What is the building’s gross square footage of occupied or conditioned space? Is the project a building renovation project with a cost greater than fifty percent of the

assessed value? Yes or No Does the law apply to your project? Yes or No If yes, has a High-performance Green Buildings Exemption Declaration Form been

submitted to DES and a copy included as an attachment? Yes or NoI.Greenhouse Gas Law per RCW 70.235.005:

Has organization adopted policies to reduce greenhouse gas emissions? Yes or NoJ.Are you applying for a state Building for the Arts grant for this project? Yes or No

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SECTION 4 - FUNDING REQUEST

A.HCPF Grant Request / Percentage of Total Eligible Project Cost: $ / % B.Grantee Cost Share / Percentage of Total Eligible Project Cost: $ / % C.Total Eligible Project Cost: $ / 100 % D.Cost per square foot: $E.Has the applicant either: Secured all funding needed to complete the project, or Made substantial progress in an active fundraising campaign dedicated to the project?F.Percentage of Cost Share expended in-hand and/or pledged (min. 50% in cash): %

SECTION 5 - GEOGRAPHIC INFORMATION

G.Property / Project Address: H.City: State: Zip Code: I.County in which property / project is located:J.State Legislative District: K.GPS Coordinates:L.Parcel Number(s) and Legal Description(s) if applicable. (Submit together in one attachment.)

SECTION 6 - ARCHAEOLOGICAL AND HISTORIC PRESERVATION INFORMATION

A.Does your project involve the restoration, rehabilitation or relocation of an historic property or asset? Yes or No If yes, check category: Building; Structure; Ship; Locomotive; Airplane; Site; or Other Transportation Conveyances – please describe:

B.Will your new project disturb any ground? Yes or NoC.Are any structures on the site more than 50 years old? Yes or No

If, yes, please describe:D.Historic Designation (check all that apply and attach verification): Local Historic Designation;

State Heritage Register; National Register of Historic Places; NA E.Property Historic Name as listed on historic designation(s):F.Is your project undergoing a Section 106 review under NHPA? Yes or NoG.Is your project undergoing a local historic review? Yes or No

SECTION 7 - PROPERTY OWNERSHIP OR LEASE INTEREST - Check category that applies:

A. Applicant owns the real property, structure or object that is project focus. Date of acquisition: Real Property Value (If applied as cost share): $

B. Property is the subject of a purchase and sale agreement: Status of that transaction:

C. A lease has been entered into. Parties to the agreement:Dates of execution and expiration:

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SECTION 8 - PROPERTY OWNER INFORMATION AND PERMISSION / ACKNOWLEDGEMENT

Owner Last Name: First Name: Title: Mailing Address: City: State: Zip Code: Telephone Number: E-mail address:

The property owner, by the signature below, certifies that he and /or she gives permission for the work proposed in this grant application to be carried out, and acknowledges that the grantee must hold the property for 13 years past the project completion date.

________________________________________ _______________________Signature of Legal Property Owner DatePlease sign in blue ink

SECTION 9 - CERTIFICATION OF INFORMATION

The applicant representatives, by the signatures below, certify that they have read and understand the 2015-2017 HCPF Grant Application and Grant Guidelines and the Contract Documents that will apply if funding is appropriated; that all of the information contained in this application and the attached supporting materials is accurate and complete as of the above-listed date; and, that the applicant organization’s governing board has been legally constituted and supports the project as described in this application.

________________________________________ ______________________ Signature of Legally Authorized Representative Date Please sign in blue ink Title: Telephone Number: E-mail address:

________________________________________ ______________________ Signature of Legally Authorized Representative Date Please sign in blue ink Title: Telephone Number:

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SECTION 10 - ORGANIZATIONAL CAPACITY – Page 1

Responses must total no more than two pages. Indicate NA if not applicable. Note all attachments. Operating plans and fundraising plans can be provided as optional attachments.

A. Applicant organization’s mission and strategy and how the project aligns with them.

B. Applicant organization’s history and experience with managing grant-funded projects.

C. Identify contract administrator and project manager and describe their experience.

D. How will the facility be managed and operated, and by whom?

E. Will the proposed facility be used solely by your organization? Yes or No

If not, describe the extent of use of any space you intend to lease or rent out:

F. Describe your plans for fundraising for future.

G. Describe any project partnerships and stakeholder participation.

H. Budget and service data: 2011 2012 2013 2014 (est.) 2015 (est.)

Total operating budget $ $ $ $ $

Operating surplus / deficit $ $ $ $ $

Paid staff, full-time equivalent

Total participants

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SECTION 10 - ORGANIZATIONAL CAPACITY – Page 2

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SECTION 11 - COMMUNITY NEED – Page 1

Summarize the community need for the project and the ability of the project to meet the need. Responses must total no more than two pages. Indicate NA if not applicable. Note all attachments.

A. Describe the relative historic and cultural significance of facility.

B. Describe the preservation and / or interpretation needs.

C. Describe how the project will meet the needs described

D. Describe the urgency of the threat or need for repair.

E. Describe why now is the best time for HCPF support.

F. Describe any historic preservation, archaeology and tribal consultations undertaken, and the responses to date.

G. Describe any meeting minutes or signed resolutions showing official approval of the proposed project and authorization for this application (this document is a required attachment).

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SECTION 11 - COMMUNITY NEED – Page 2

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SECTION 12 – READINESS TO PROCEED

Demonstrate your readiness to initiate and complete a well-planned and cost-effective project by June 30, 2017. Within the narratives and forms which follow, describe the work that will be completed using both HCPF grant funds and your cost share. Note all attachments.

A. Project Scope of Work and Schedule Narrative - Page 1 Describe the size and scope of what will be designed, constructed, rehabilitated, and/or

purchased. Provide narrative timeline with project milestones for the proposed grant project. Anticipate - and describe if applicable - any additional work that may also be completed in the

event the described work is completed and grant funding remains. Indicate if this is one phase of a larger project or if it is the total project. If this is part of a multi-phased project, describe all phases, schedule and cost for the entire

project. Summarize stage of design and status of any project work: list bids, cost estimates, condition

assessments, including historic structures reports. (required attachments) Describe any legal, planning, permitting, review processes, public debates or any other factors

that could significantly change the timeline for the grant project.

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Project Scope of Work and Schedule Narrative - Page 2

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B. Project Scope of Work by Architectural Division Form Complete all divisions that are applicable, deleting those that are not. Separate out work being done within a building’s existing footprint from work such as additions or new structures.

Division 2 EXISTING CONDITIONS_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Division 3 CONCRETE_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Division 4 MASONRY_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Division 5 METALS_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Division 6 WOOD, PLASTICS AND COMPOSITES_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Division 7 THERMAL AND MOISTURE PROTECTION_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Division 8 OPENINGS_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Division 9 FINISHES_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Division 10 SPECIALTIES_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Division 14 CONVEYING EQUIPMENT_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Division 21 FIRE SUPPRESSION_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Division 22 PLUMBING_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Division 23 HEATING VENTILATING AND AIR CONDITIONING (HVAC)_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Division 26 ELECTRICAL_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Division 31 EARTHWORK_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Division 32 EXTERIOR IMPROVEMENTS_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

OTHER PROPOSED WORK IMPROVEMENTS_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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C. Project Budget and Source of Available Funds Narrative – Page 1 Describe how budget and cost share amounts were determined. Indicate whether the available funds are cash match or in-kind. Indicate whether the available funds are in hand or pledged. Document each individual contribution or pledge over $10,000 with a separate attachment.

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Project Budget and Source of Available Funds Narrative – Page 2

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D. Project Budget Form

Project Budget FormCOST CATEGORIES 1-8 AND SUBCATEGORIES

GRANTEE COST SHARE HCPF TOTALSCash Match In-kind Grant Funds

(1) Construction/Rehabilitation

Donated materials / labor Ineligible Building permits / fees Site work Landscaping

Staff work directly on project Ineligible Construction management Construction legal services Travel directly for project(2) Purchase, restoration, preservation of fixed assets (3) Acquisition of unimproved property Market value of a lease Ineligible Ineligible(4) Site acquisition, protection, stabilization, development (5) Physical improvement of interior facility spaces Permanent exhibits Art integral to the project(6) Design, architectural, and engineering Pre-design Ineligible Ineligible Archaeology / historic preservation services LEED Silver certification Professional consultants (7) Purchase of equipment Collections storage equipment(8) Bridge loans HCPF Administration – 3% Ineligible IneligibleCOST SHARE SUBTOTALSGRANTEE/HCPF TOTALS % OF TOTAL % % 100%

E. Source of Available Funds Form

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Source of Available Funds FormTYPE OF FUNDS AMOUNT

Grant Funds – HCPF Other Funds – Indicate Cash Match or In-kind:

TOTAL PROJECT FUNDS

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SECTION 13 - PROJECT PURPOSE AND RESULTS – Page 1

Responses must total no more than two pages. Indicate NA if not applicable. Note all attachments. Summarize the project purpose and expected results by including:

A. Intended public use upon project completion.B. The expected audience.C. How the facility will provide significant public accessD. How completed project will preserve a significant structure – if applicableE. How completed project will interpret history and heritage F. How the completed project is expected to expand or improve the services offered by your

organizationG. How the property will be maintained and preserved over time

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SECTION 13 - PROJECT PURPOSE AND RESULTS – Page 2

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SECTION 14 - ATTACHMENTS CHECKLIST

Label each attachment with the respective letter A through S, a description and applicant’s name, and check the box for all that are submitted.

Required of All Applicants for Heritage Capital Projects Fund – Attach to the master application and all copies:A. Digital photographs showing the property from the public right of way, the site and the

conditions of the property. If your project is an expansion or improvement of an existing facility or asset, please submit digital photographs that illustrate the state of the facility or asset prior to beginning the grant project work. Label and date each photo or provide a separate digital image index. (up to 10 images)

B. Architectural and site plans, which may be on 8½ x 11 or 11x17 sheets (up to 10 pages)

Required of All Applicants – Attach one copy of each to the master application only:

C. Dated and labeled meeting minutes or signed resolution showing official approval of the proposed project and authorization for this application

D. Proof of site control (such as property title, purchase and sale agreement or lease agreement)

E. Brief documentation of all individual sources of funding over $10,000 being applied as cost share

F. Evidence of partner commitments including contracts for facility operations if applicableG. Bids, cost estimates, condition assessments, historic structures reports, etc. that have

been developed for the projectH. Verification of historic designations - if applicableI. Parcel number(s) and legal description(s) J. Copy of High-performance Green Buildings Exemption Declaration Form - if applicable

Required of Non-profit Applicants – Attach one copy each to the master application only:

K. Copy of Internal Revenue Service 501 c) 3 determination letter L. Copy of State Certificate of IncorporationM. Current board of directors list N. Copy of current mission and goals statement O. Copy of financial statements for the two most recent yearsP. Copy of current operation budget

Optional of All Applicants - Attach one copy of each to the master application only:

Q. Operations planR. Capital campaign packet or fundraising plan; andS. Project feasibility studies

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