Building our Regions — Round one
Application
Should you have any questions or require any assistance, please contact the Building our Regions program
team on (07) 3452 7377 or 13 QGOV (13 74 68).
PROJECT DETAILS
Project title
Project description
Indicate which best describes the project:
Water/sewerage/waste infrastructure (e.g. water supply, sewerage systems, landfills, recycling)
Social infrastructure (e.g. health, education)
Economic development infrastructure (e.g. headworks on council owned industrial land, commercial or
tourism precincts)
Roads and transport infrastructure (e.g. airports, marine infrastructure, flood mitigation road works, road
upgrades)
Flood mitigation infrastructure (e.g. levees, floodgates, causeways, drainage improvements)
Cultural, sports and recreational infrastructure (e.g. museums, parks, sporting facilities)
Other infrastructure (e.g. agricultural, communications, energy)
Is this project:
New infrastructure
Upgrade of existing infrastructure
Replacement of existing infrastructure
Other (please specify):
1
The following information is required for road projects only:
Why was TIDS funding not allocated to this project? Why is the project still considered a priority for the
region?
Road Classification
Road Chainage
Please describe the current road conditions:
Crash History
AADT (per cent of
Heavy Vehicles)
(Date):
Deficiencies
Future safety
assessment
Other Information
2
PROJECT CONTACT
Please provide a contact person from the council for correspondence and enquiries regarding this project and
application for funding.
Title
First name
Surname
Position
Phone
Mobile
Fax
Email
Postal address
Street address
Town/suburb
Postcode
3
ESTIMATED PROJECT TIMEFRAME
Project start date:
Project completion
date:
Construction
commencement date
To be eligible for Building our Regions funding, projects must be ready to commence construction by
30 September 2016.
PLEASE NOTE THAT PROJECTS THAT DO NOT COMMENCE CONSTRUCTION WITHIN THIS
TIMEFRAME MAY HAVE APPROVED FUNDS WITHDRAWN
Please indicate which of the following documents have been attached as evidence that construction can be
expected to commence during the required period.
A Gantt Chart or Detailed Project Delivery Schedule must be provided as a minimum, along with any other
documentation that demonstrates the project’s readiness. You may attach more than one document.
Gantt Chart showing the project’s delivery
Detailed project delivery/works schedule
Please indicate if any additional documentation is attached to demonstrate the project’s readiness.
professional designs (‘for tender’ or ‘for construction’)
tender documents
other (please specify):
What stage has the project reached at the time of application?
Detailed designs have been prepared
Tender documentation has been prepared
A contractor has been appointed
Ready to commence construction
Other (please answer question below)
If the project is not ready to proceed to construction, please describe what action is being taken to
ensure the project will be able to commence construction within the required timeframe.
4
PROJECT COSTINGS
Financial Contributions
Identify the proposed financial contributions to fund the project
Total Estimated Project Cost (ex GST)
Building our Regions funding sought (ex GST)
Please note that only eligible expenses will be reimbursed up to a maximum of the
approved funding — refer to the Program Guidelines for eligible and ineligible
expenditure.
Council’s financial contribution (ex GST)
Not including in-kind contributions or ongoing costs such as maintenance and
repair costs
Please detail all other proposed and confirmed financial contributions that will be provided to the
project by other organisations.
Category
Industry
Qld Govt
Aust. Govt
Other
Funding
contributor
Contribution
description
Amount
(ex GST)
Funding
status
Funding status
details
Name of
Organisation
Name of government
grant or purpose of
funding.
Financial
contributions
only – no
in-kind to be
included
Confirmed or
Not confirmed
Please provide
details of any
special conditions
that apply or when
funds are likely to
be confirmed
Total other financial contributions (ex GST) e.g., industry and/or other
government
Not including in-kind contributions
If financial contributions are not being made by other organisations, please describe any actions taken
to attract financial contributions and any reasons why they are not available.
Please detail any funding the Queensland Government has provided for any component of this project,
including earlier stages? Do not include financial contributions identified under ‘Other financial contributions’
in this section.
5
In-kind contributions
Please detail all proposed or confirmed in-kind support that will be provided by council and other
organisations and include an estimated value if known.
Funding
Contributor
Name of
organisation or
proponent
In-Kind contribution
description
Please detail the nature of the
contribution.
Value
(ex GST)
Funding
Status
Confirmed
Not confirmed
Status Details
Please provide details of any
special conditions that apply or
when the in-kind contribution is
likely to be confirmed.
$
$
$
Total in-kind contributions
$
Cost breakdown
Please provide a breakdown of the project costs.
Provide a breakdown of all project costs, including a contingency of up to 15%, and indicate how these costs
will be distributed between the financial contributors.
How have the project costs been calculated or determined?
Cash flow forecast
Please provide a Project Cash Flow.
A Project Cash Flow template is available as part of the application package.
The cash flow must identify total revenue and list all expenditure items to show net cash flow related to the
project. All project costs lists should be exclusive of GST.
Please note that Building Our Regions funding will generally be paid in arrears at Milestones determined by the
Department in negotiation with Councils.
A Project Cash Flow has been attached
6
PROJECT SITE
Project site address
Street address
Town/suburb
Postcode
Real Property description of the project site
If there are multiple sites, please provide details for all sites. Provide details of the primary site below and
include details of additional project sites in the Project Plan.
Lot
Parish
Registered Plan
County
Title Reference
Longitude and Latitude
Please provide relevant longitude and latitude coordinates for all work sites relevant to this project, i.e. start and
finish coordinates. Provide details of the primary site below and include details of additional project sites in the
Project Plan.
Longitude Start:
151.278061
Longitude Finish:
146.716967
Latitude Start:
-19.289074
Latitude Finish:
-19.292566
Mapping
For GIS spatial mapping purposes, please attach either an ESRI Shape File or MapInfo Tab File for this project
site if available. Please attach ALL file layers.
ESRI Shape file attached
File description:
MapInfo TAB file attached
File description:
Other GIS file attached
File description:
Federal and State Electorates
Please select the Federal and State electorates the project is located within. If a project site crosses electoral
boundaries (e.g. water pipeline, road upgrade) please select all that apply.
Federal Electorates
State Electorates
7
LAND OWNERSHIP
Who currently owns the land where the project will be located?
Council
Queensland Government
Please specify the agency responsible for the land
Other (please identify the owner of the land):
If council does not own the land:
a) Does Council have control over the land? (e.g. crown reserve)
Yes — Please provide details and attach supporting documentation
No
b) Does Council intend to acquire ownership or control over the land? (e.g. purchase, lease, be granted
an easement)
Yes — Please provide details
No — Please provide details
c) Has the owner approved the development on the proposed site?
Yes — Please provide details and supporting documentation (e.g. if Queensland Government
agency, a letter from DG/CEO)
No — Please provide details
Is there any third party interest in the land? (e.g. easement, lein, lease)
Yes — Please provide details and supporting documentation
No
Are there any land issues that need to be addressed before construction can commence? Issues to be
addressed could include road reserve, native title, cultural heritage, strategic cropping land, etc.
Yes — Please provide details, explain how these issues are being addressed or resolved, and attach
supporting documentation
No
8
REGULATORY REQUIREMENTS
Local governments are responsible for complying with relevant legislative requirements, and securing the
necessary licences and development approvals with the appropriate regulatory agencies.
Please provide details of all licences and/or development approvals required to deliver this project and
indicate current status.
Licence/development
approval
Regulatory agency
Approval status
Details
Licence Required /
Development Approval
Required
Name of Regulatory Agency
Approved / Not Approved
Please provide detail on
likely timeframe of approval.
9
RESPONSE TO CRITERIA
Project Demand and Solution
What is the critical need or opportunity to be addressed?
How will the proposed project address or respond to the identified need or opportunity?
Why is this project the most appropriate way to address or respond to the need or opportunity?
Have other solutions been considered? Please provide details of other options considered or explain why
other options were not considered.
Yes
No
RESPONSE TO CRITERIA continued
Value for money assessment
Each application must attach either a Cost Benefit Analysis (CBA) or a Benefits Assessment to enable
consideration of the project’s value for money and benefit to the community.
Completion of a CBA will be required where the total project cost is $500,000 or over. A Cost Benefit Analysis
template, with instructions, is available as part of the application package.
A Cost Benefit Analysis has been attached
Completion of a Benefits Assessment will be required where the total project cost is less than $500,000. A
Benefits Assessment template, with instructions, is available as part of the application package.
A Benefits Assessment has been attached
How many direct jobs will be supported by the project’s construction phase?
Provide an estimate of the number of Full Time Equivalent (FTE) positions directly supported by the
construction phase.
10
What assumptions have been used to identify the number of direct jobs supported by the construction
phase?
Provide details of assumptions and source of information used to estimate direct jobs supported by construction
phase. Identify the duration of employment in days or months.
How many direct jobs (if any) will be supported by project facilities on an on-going basis? Provide an
estimate of the number of Full Time Equivalent (FTE) positions that will be directly supported as a result of the
project on an ongoing basis.
What assumptions have been used to identify the number of direct jobs that will be supported by the
project on an ongoing basis?
Provide details of assumptions and source of information used to estimate direct jobs supported by project
facilities as a result of the project.
RESPONSE TO CRITERIA continued
Project Delivery and Management
How is council planning to deliver the project? (e.g council staff, building contractor, etc)
Please provide relevant details on key personnel below and attach copies of CVs.
The project key personnel must have the capabilities, skills and expertise to successfully deliver the project.
Please note date of birth is required for due diligence purposes.
Full Name
Date of birth
Role
Key skills
Fred Jones
5/05/1966
Project Manager (Council
Manager Infrastructure
Services)
Mary Smith
14/09/1971
Site Supervisor
Engineer with extensive
experience in project
managing major
infrastructure project
Engineer with 15 years
construction industry
experience, project
management
11
Please explain how council will fund the ongoing (whole-of-life) operation, maintenance and
replacement costs of the infrastructure? Please attach copies of the relevant documentation and identify the
relevant sections/page numbers.
Please provide any further information to support the application.
12
PROJECT PLAN
Applicants must provide a detailed project plan as part of their application.
A detailed project plan template is available. If applicants choose not to use the template they will still be
responsible for ensuring that all the required information is provided.
As a minimum, Project Plans must address the following:
•
Executive Summary
•
List of technical terms and acronyms
•
Project scope
−
provide a detailed scope of all works associated with the project
−
identify components of the works that are in scope and out of scope.
•
Project management, including:
−
Project delivery
−
Specialist expertise
−
Project constraints
−
Cost management
•
Risk Management Plan
•
Reference Materials (where relevant, such as site designs, maps and photos)
13
APPLICANT CHECKLIST
All sections have been completed
Mandatory attachments
I have attached:
A signed certification form
Evidence of local government support and approval for the application (e.g. council resolution or minute)
Evidence of local government commitment to management and costs associated with the ongoing
operation and maintenance of the infrastructure (e.g. council resolution or minute)
Project Gantt Chart or Detailed Delivery/Works Schedule showing timeframes for all project stages up to
and including project completion
Project Cost Breakdown
Project Cash Flow
Cost Benefit Analysis or Benefits Assessment
Detailed Project Plan
Copies of all supporting documents referred to and relied on as evidence in the application form (unless
web addresses have been provided in the relevant response field).
CVs for key project personnel
For Road Projects
Letter of support from the Chair of Regional Road and Transport Group (RRTG) or a copy of RRTG
minute stating that the project was considered, not funded, but is a priority and worthy of funding
Where the local government does not own or control the land
Letter from land owner confirming the local government has approval to build on and use the land for a
period of at least 10 years
Additional / optional attachments
I have attached:
Additional documentation supporting project readiness such as professional designs (‘for tender’ or ‘for
construction’), tender documents, etc
Letters from other contributors confirming financial or in-kind contributions
Mapping files (ESRI Shape File or MapInfo Tab File) attaching ALL file layers
Copies of all supporting documents referred to and relied on as evidence in the application form (unless
web addresses / hyperlinks have been provided in the relevant response field)
14