A FY 2018 SWMB Grant Application MUST include:

Application Cover Sheet

A Complete Program Narrative (may include additional pages if necessary)

Must address the questions included on pg. 17

Budget Form

Include one quote for each budget item that is equal to, or exceeds $2,500

Budget Itemization Supplemental Form (if necessary)

Required for “grouped” items and where the request is more than $1,000

Timeline Graph

Grant Stipulation Form

Includes original signature of Chairperson (blue ink)

SWA Resolution Authorizing the Application

Includes original signature of Chairperson and certification from Secretary (blue ink)

Drug Free Workplace Form

Includes original signature of Chairperson (blue ink)

Board Appointment Form

Includes original signature of Chairperson (blue ink)

Recycling Information Survey

Required if applicable

Recycling Equipment Survey

Required if applicable

Cover letter requesting application review from your Regional Planning & Development Council District

Mailing addresses for your district has been included on pg. 14

A sample letter has been included on pg. 34

In accordance with 54CSR5.3.4, “incomplete” applications will not be considered. Applications must contain the required forms and information in order to be considered “complete”.

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WEST VIRGINIA SOLID WASTE MANAGEMENT BOARD SOLID WASTE AUTHORITY GRANT APPLICATIONFY 2018 APPLICATION CHECKLIST

Solid Waste Authority:

Amount Requested: $ Application Date:

Address:

FEIN: Year of Last Financial Examination: Audit or Review

(Check Applicable Type)

Grant Administrator:

Contact Telephone Numbers: Daytime Evening

In accordance with 54CSR5-4.10, when practicable, grant funds will be disbursed in two allotments. 50% of the grant award will be released at the beginning of the grant cycle and after the recipient has expended the first allotment and filed an approved semi-annual report. If this preferred disbursement schedule cannot be followed, please complete the requested dates and amount and explain in writing why it is necessary to deviate from the standard schedule.

First Disbursement Date: Amount:Second Disbursement Date: Amount:

Explanation:

Program Information:Is this a new program? Yes No

How many tons of waste will be diverted?

How many estimated jobs will this program create? Full-Time Part-Time

Date program is estimated to start? Estimated ending date?

If funds requested are for site improvements, who owns the property?

COMPLIANCE: If the grant project is associated with a solid waste facility, is the facility in compliance with all applicable Federal and West Virginia laws and rules including any compliance orders issued by state agencies and/or departments? If the answer is no, please explain. (54CSR6-4.5)

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WEST VIRGINIA SOLID WASTE MANAGEMENT BOARDSOLID WASTE AUTHORITY GRANT APPLICATIONFY 2018 COVER SHEET

FOR SWMB USE ONLY

GRANT PROGRAM NARRATIVEDescribe, as completely and concisely as possible, the activities to be funded.

Please address the following points:

A.) Describe the problem the program will address and state the purpose and objectives of the grant project. Also include what services will be provided and the need for funds to assist with this program/project. How will these requested funds be used? Any proposal that includes working with local school systems must have written approval by the local Board of Education responsible for the facilities involved.

B.) Describe in detail what services will be provided. Discuss the need for the funds requested and where and how they will be directed. Justify the need and use for each item being requested in the budget form.

C.) Who will administer this grant? Discuss their qualifications and experience. Will this person also manage the project? If not, who will and what is his or her qualifications/experience? Will the grant administrator or project managers’ salaries be paid by grant funds? If so, is either person currently employed by the SWA and if so, is his or her current salary being funded by the SWA or another governmental source? (54CSR5-5)

D.) Describe the geographic area within the county or region to be served by the program and estimate how many people will benefit from the program.

E.) Describe how this program is in agreement with your Comprehensive Litter and Solid Waste Control Plan and Commercial Solid Waste Facility Siting Plan. (54CSR5-4.2)

F.) The grant application will be evaluated in accordance with the factors identified in 54CSR5.7 of the Board’s rules. Please state how your grant addresses each of these factors. In your narrative be specific. Ambiguity will not result in a favorable evaluation of your proposal.

G.) Describe the in-kind services your organization will provide – if you receive the grant funds, what services will your organization provide, over and above the grant funding to make the project a success?

H.) Describe other programs that the organization is involved in, e.g., recycling, public education and awareness, litter control, open dump cleanup, mandatory disposal, etc.

I.) Has the SWA received a SWMB grant within the last three years? If so, discuss the past and current status of the project funded through the grant. If a SWMB grant is to be used to purchase vehicles, recycling equipment, buildings or to finance improvements on buildings, provide proof of insurance on these items.

J.) Who prepared the grant application?

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Solid Waste Authority:

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WEST VIRGINIA SOLID WASTE MANAGEMENT BOARDFY 2018 GRANT PROGRAM NARRATIVESee Page 17

19

20

Solid Waste Authority:

Amount Requested: $

NOTE: Each item listed below needs to be justified in the narrative. A supplemental budget form has been included to itemize requests for line items that are equal or

greater than $1,000. Quotes must be attached for items requested which exceeds $2,500.

Type of Expense Description Amount

Equipment/Vehicles

Recycling Equipment

Equipment Maintenance/Repairs

Vehicles

Vehicle Maintenance/Repairs

Other Equipment Expenses

Personnel (Refer to page 1 for stipulations on personnel requests)

Administrative Salaries

Hourly Wages

Other Personnel Expenses

Operating Expenses

Utilities

Transportation/Fuel Costs

Insurance

Office Supplies

Operating Supplies

Other Operating Expenses

(Form is continued to next page)

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WEST VIRGINIA SOLID WASTE MANAGEMENT BOARDFY 2018 GRANT BUDGET FORM

Type of Expense Description Amount

Property

Property Improvements

Property Purchases

Rent or Lease Payments

Other Property Requests

Public Education/Awareness

Promotional Materials

Events

Advertising

Travel Costs

Educational Conference Expenses

Other Educational Expenses

Contractual Services/Fees

Contracted Services

Hauling Service Fees

Consulting Fees

Financial Examination Expenses

Other Contractual Expenses

Additional Requests

TOTAL GRANT REQUESTS

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This page is used to itemize individual line items from the Grant Budget Form that are to be used to purchase more than one item (goods, services, labor, etc.) and where the line item is equal or greater than $1,000. State Expense requested, a breakdown of that line item and individual amounts that equal the total requested. Items requested exceeding $2,500 must have a quote attached.

EXAMPLE:Expense Breakdown of Line Item AmountVehicle Maintenance/Repairs Tires for collection truck $800

Breaks for truck $250Replacement of hazard lights on truck $350

$1,400

Expense Breakdown of Line Item Amount Quote

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WEST VIRGINIA SOLID WASTE MANAGEMENT BOARDFY 2018 BUDGET ITEMIZATION SUPPLEMENTAL FORM

Timeline is subject to change based on award date.

Task Aug17

Sept

17

Oct17

Nov17

Dec17

Jan18

Feb18

Mar18

Apr18

May18

June18

July18

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WEST VIRGINIA SOLID WASTE MANAGEMENT BOARDFY 2018 GRANT TIMELINE GRAPH AUTHORITY:

The applicant understands and agrees to the stipulations listed on this page and will implement them to fulfill all obligations under this grant agreement:

a.) The applicant(s) has, or will secure personnel with the necessary qualifications and experience required to perform the services under this Grant Award. (54CSR5-5.1)

b.) The applicant(s) will indicate whether grant funds will be used to hire employees. Additionally, the SWMB will review each grant budget to determine if employees will be hired with grant funds, and require copies of solicitations or advertisements for employees to be submitted with the grant application, if applicable indicate if the employees will be permanent, temporary, full-time, part-time or contract. Provide a job description of each employee whose wages will be partially or fully covered by grant funds. Provide names, the weekly hours worked, the rate of pay and discuss this person’s duties and responsibilities. If someone else is providing part of the employee’s wages, specify who and how much in dollar amounts. If all or parts of the employee’s wages are currently being paid from a DEP-REAP grant, or other grant, give the date when those funds will expire.

c.) The applicant(s) will not discriminate against any employee or applicant for employment because of race, color, age, religion, sex, national origin, or physical handicap. (54CSR5-6.1)

d.) If contractors will be employed, the applicant(s) will obtain a statement from the contractor that the contractor will treat employees without regard to race, color, age, religion, sex, national origin, or physical handicap. Such a statement will be forwarded to the SWMB. In addition, the applicant(s) will obtain a statement from the contractor that the contractor has complied with the regulations issued by the Contractors’ Licensing Board pursuant to W.Va. Code § 21-11-1 et seq. in regards to operating a contracting business in the State of West Virginia.

e.) The applicant must supply the SWMB with a project summary at the end of the grant period detailing the extent to which the project achieved the goals and objectives set out at the beginning of the grant period. (54CSR5-9)

f.) The applicant(s) must agree to retain all financial records, statistical records and all other documents relating to the grant for a period of three years from the end of the grant period. (54CSR5-8.5)

g.) The applicant(s) shall not use grant monies to fund lobbying activities. (54CSR5-8.4)

h.) If the SWMB does not have a copy of your last financial examination or audit on file, include one with the application. To maintain eligibility for SWMB grants, each authority must have had a financial examination or audit completed within three years preceding the filing of the application. An Authority that has not had a financial examination or audit within this three year period is eligible for grant funding for financial examinations and audits only.

i.) Solid Waste Authorities that do not have a current, approved Comprehensive Litter and Solid Waste Control and Commercial Solid Waste Facility Siting Plans on file with the Solid Waste Management Board may apply for funds to update their plans but are not otherwise eligible for grant funds. (54CSR5-4.4)

j.) Provide proof of insurance on all vehicles and equipment funded in part, or in full, by the Solid Waste Management Board grant funds.

k.) For the purposes of this application, all requests for equipment, property improvements, building improvements, advertising and contracted work that is equal to or exceeds $2,500 must be accompanied by at least one quote. Once grants are awarded, grantees must adhere to state purchasing guidelines.

The applicant understands and agrees that the money issued and received upon approval of this application will be used to carry out the purposes of this grant and the duties under W.Va. Code § 22C-4, and in accordance with the rules and regulations of the Solid Waste Management Board, and that the applicant can be held liable for the total sum due the SWMB for grant sums not properly used or accounted for. The undersigned hereby acknowledges that, to the best of his/her knowledge, the information documented in the above paragraphs is a true and accurate statement of the facts.

Signature of SWA Chairperson Date

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WEST VIRGINIA SOLID WASTE MANAGEMENT BOARDFY 2018 GRANT STIPULATIONS Authority:

Whereas the Solid Waste Authority recognizes the need for improved solid

waste collection, recycling, hauling and disposal within the boundaries of this authority, and

Whereas the West Virginia Code Chapter 22C, Article 4, Section 30 provides for grants to solid waste

authorities through the Solid Waste Management Board for the purposes of Chapter 22C, Article 4, and

Whereas having reviewed and considered the rules concerning such grants established by the Solid

Waste Management Board,

Be it resolved that the Solid Waste Authority endorses and supports such a

program as is described in the attached application and the State and Authority’s Solid Waste Plans.

Adopted on this day of , 2017.

Signature of SWA Chairperson Date

CERTIFICATION

I, the undersigned Secretary of the Solid Waste Authority, hereby certify

that the forgoing is a true, correct and complete copy of the test of a resolution adopted by the

Solid Waste Authority, at a meeting held on this day of ,

2017, after the giving of the required public notice and at which a quorum was present and acting

throughout, and which resolution has not been amended, modified, rescinded, repealed, superseded,

annulled, revoked or otherwise altered as of the date hereof.

Dated this day of , 2017.

Signature of the SWA Secretary Date

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WEST VIRGINIA SOLID WASTE MANAGEMENT BOARDRESOLUTION AUTHORIZING AN APPLICATION FOR A SOLID WASTE AUTHORITY GRANT

This certification is required by the Drug Free Workplace Act of 1988 (Pub. L. 100-690, Title V, Subtitle D) and is implemented through additions to Debarment and Suspension regulations, published in the Federal Register on January 31, 1989.

An organizational applicant certifies that it will provide a drug free workplace by:(a.) Publishing a statement notifying employees of the actions that will be taken against employees for violation of such prohibition;

(b.) Establishing a drug free awareness program to inform employees about:(1.) the dangers of drug abuse in the workplace;(2.) the grantee’s policy of maintaining a drug free workplace;(3.) any available drug counseling, rehabilitation, and employee assistance programs; and(4.) the penalties that may be imposed upon employees for drug abuse violations occurring in the workplace;

(c.) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph (a);

(d.) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will:

(1.) abide by the terms on the statement; and(2.) notify the employer of any criminal drug statute conviction for a violation occurring in the workplace not later than five (5) days after such conviction;

(e.) Notifying the agency within ten (10) days after receiving notice under subparagraph (d.)(2), from an employee or otherwise receiving actual notice of such conviction;

(f.) Taking one of the following actions, within 30 days of receiving notice under subparagraph (d.)(2), with respect to any employee who is so convicted:

(1.) taking appropriate personnel action against such an employee, up to and including termination; or (2.) requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency;

(g.) Making a good faith effort to continue to maintain a drug free workplace through implementation of paragraphs (a.), (b.), (c.), (d.), (e.) and (f.).

Place of Performance: The applicant shall insert in the space provided below the site(s) for the performance of work done in connection with the specific grant:

street address, city, county, state, zip code

An applicant who is an individual certifies that, as a condition of the grant, he or she will not engage in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance in conduction any activity with the grant.

This assurance is given in connection with any and all financial assistance from the West Virginia Solid Waste Management Board after the date this form is signed. This includes payments after such date for financial assistance approved before such date. The applicant recognizes and agrees that any such assistance will be extended in reliance on the representatives and agreements made in this assurance, and the United States shall have the right to seek judicial enforcement of this assurance. This assurance is binding on the applicant, its successors, transferees, and assignees, and on the authorized official (or individual applicant, as appropriate) whose signature appears below.

Organization Name

Authorized Representative Title

Signature Date

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WEST VIRGINIA SOLID WASTE MANAGEMENT BOARDCERTIFICATION REGARDING DRUG FREE WORKPLACE REQUIREMENTS

Solid Waste Authority Date

County Commission Appointee Expiring: 6/30/18Name Work PhoneBoard Title Home PhoneAddress Cell PhoneCity, State, Zip E-mail

County Commission Appointee Expiring: 6/30/20Name Work PhoneBoard Title Home PhoneAddress Cell PhoneCity, State, Zip E-mail

Department of Environmental Protection Appointee Expiring: 6/30/17Name Work PhoneBoard Title Home PhoneAddress Cell PhoneCity, State, Zip E-mail

Public Service Commission Appointee Expiring: 6/30/19Name Work PhoneBoard Title Home PhoneAddress Cell PhoneCity, State, Zip E-mail

Conservation District Appointee Expiring: 6/30/20Name Work PhoneBoard Title Home PhoneAddress Cell PhoneCity, State, Zip E-mail

Contact Person (will receive SWA correspondence) Financial Recipient (checks, financial information)Name NameTitle TitleAddress AddressCity, State, Zip City, State, ZipDaytime Phone Daytime PhoneFax Number Fax NumberE-mail E-mail

I hereby certify that the above information is true and correct.

SWA Chairperson Signature Date

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WEST VIRGINIA SOLID WASTE MANAGEMENT BOARDSOLID WASTE AUTHORITY BOARD APPOINTMENT FORM 2017

WEST VIRGINIA SOLID WASTE MANAGEMENT BOARDFY 2018 RECYCLING INFORMATION SURVEY

Solid Waste Authority:

1.) If this grant is to be used for a SWA recycling program, list information on the SWA members and staff who will be responsible for program administration and operation.

NAME JOB TITLE RESPONSIBILITIES

2.) List all recycling drop-off locations in your geographic area of responsibility.LOCATION MATERIALS COLLECTED FACILITY OWNER

3.) List all curbside recycling locations in your geographic area of responsibility.LOCATION MATERIALS COLLECTED FACILITY OWNER

4.) Estimate, to the best of your ability, the percentage of recycling services the authority provides within your county or geographic area of responsibility.

5.) Answer the following questions concerning yard waste and composting:

a.) Is yard waste collected for composting in your area? Yes No

b.) Check the items collected for composting in your area: Leaves and Grass Brush

c.) Estimate the annual tonnage of yard waste and brush collected -

d.) Estimate the annual tonnage of yard waste and brush composted -

e.) List all facilities in your geographic area of responsibility that collect yard waste or operate a composting facility.

Collectors Composters

6.) If your SWA owns, operates or sponsors a recycling program, list the materials collected, tons per year for each item and annual revenue from material sales for each type of material.

Material Collected Tons Per Year Revenue From Sales

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7.) What happens to the materials once they are collected? Who processes (bales, crushes, shreds, etc.) the material and where does it go from there?

Material Collected Material Processor Material Market

8.) If the SWA receives revenue from the sales of materials, how is it used? Does it go back into the program? Is revenue from sales sufficient to cover operational costs? If not, describe your other sources of funding used to keep the program operational.

9.) What were your total tons of material recycled in the past three years?

Year Total Annual TonnageCY 2014CY 2015CY 2016

10.) Does the SWA partner with any other organization in its recycling program? If so, please describe the relationship/program.

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11.) Describe your organizations public education and awareness efforts.

12.) What are the plans for the program over the next five years? Will the program expand? What problems does the program have? What will it take to fix them?

Solid Waste Authority:

1.) Describe the recycling equipment you use. (Include collection & materials processing equipment)

Equipment Type Serial # Purchase Date Describe Funding Source

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WEST VIRGINIA SOLID WASTE MANAGEMENT BOARDFY 2018 RECYCLING EQUIPMENT SURVEY

(Bailer, crusher, etc.) (SWMB, DNR/DEP, Other)

2.) How much are you spending on maintenance? Estimate costs for each piece of equipment for the last three years.

Equipment Type(Bailer, crusher, etc.) Description of Maintenance Activity Cost

FY 2014Cost

FY 2015Cost

FY 2016

3.) Do you have equipment loaned or leased to another party? If so, describe the arrangement. Enclose copies of all relevant documentation including lease agreements, contracts, joint venture agreements, etc.

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SAMPLE

4.) What do you anticipate your equipment needs to be over the next five years? Is the equipment you have adequate for the type of duties your operation requires? What about your processing capacity? Would you say you have an over-capacity or under-capacity to process the amount of material that goes through your facility?

5.) Use this section for a general discussion of equipment problems. Tell us what works, what doesn’t work and give us your ideas concerning how state programs can be improved to better assist you with your equipment needs.

6.) Do you have equipment that you don’t need and would be willing to donate/lend/lease/sell to another Solid Waste Authority? If so, please describe the equipment.

March 1, 2017

West Virginia Regional Planning & Development Council

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General County Solid Waste AuthorityPO Box 123, Hometown, WV 12345

SAMPLEJohn Smith, Executive DirectorRegion 234567 Main StreetAnytown, WV 98765

Director Smith:

Enclosed is a copy of the General County Solid Waste Authority’s grant application that is being submitted to the West Virginia Solid Waste Management Board (WVSWMB). The Authority is requesting $20,000 to assist with the county’s current recycling program.

An Intergovernmental Review of the project is requested, as required by the WVSWMB’s grant procedures.

Upon completing your review, we request that any comments be sent to the WV Solid Waste Management Board at 601 57th St. SE, Charleston, WV 25304, as well as the General County Solid Waste Authority at our address listed above.

Please feel free to contact me at (123)456-7890 if you have any questions.

Sincerely,

Jane DoeDirector

Enclosure

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