Community Partnership Program – Capital Grants Application

Capital Project Program Capital Grant Application Form

This application is for projects that have been discussed with a Community Partnerships Liaison and you have been advised to complete. *DO NOT COMPLETE if you have yet to speak with a Community Partnerships Liaison. Contact partnerships@haldimandcounty.on.ca or 905-318-5932 and ask to speak with a Community Partnership Liaison regarding your Project!

Step 1 of 2

50%

Have you connected with the Community Partnership Liaison prior to starting this application?(Required)

If no, please use the above noted contact information to contact the Community Partnerships Liaison before continuing.

Yes

Are your supporting documents completed and ready to be uploaded?(Required)

Yes

Supporting Documents Include:

Organization Information:

List of Board of Directors/Executive with Contact Information;
Membership Profile of the Organization (e.g. number of members, age range, etc.);
Approval Motion for Project from Organization’s Board of Directors;
Previous Year’s Financial Statements/Accounting;
Current Operating Budget;
Evidence of Liability Insurance (minimum $2 million with Haldimand County named as added insured; WSIB compliance);
Business/Strategic Plan/Bylaws; and,
Two References (They should be knowledgeable about your organization, the work it does in the community and its capacity to implement the proposal).

Project Information:

Description/Details of Project;
Applicable Drawings (site plan, dimensions, elevations, engineer’s approval, etc.) to Represent the Project;
Budget/Project Cost Details;
Contractor Quotes and Cost Estimates (a minimum of two for each component of the Project);
In-Kind/Donated Materials, Supplies, Labour should be included with a financial value;
Funding/Business Plan; and,
(Optional) Supporting Documentation (feasibility study, needs assessment, community survey, etc.).

Application

Only complete this application if you have connected with a Community Partnerships Liaison.

Please indicate the intent of your application when applying for Project Concept Approval

100% funding provided by group

with partial County funding

with partial County funding and support in securing other funding

Proposed Project/Activity

Section 1

Organizational Information

Legal Name of Organization Applying:(Required)

Permanent Mailing Address:(Required)

Street Address City Postal Code

Organization Phone:(Required)

Organization Email:(Required)

Year the Organization was Formed/Incorporated

Charitable Status? If yes, please provide Organization registered charity number

Project Primary Contact(Required)

First Last

Role in Organization

Primary Contact Email:(Required)

Primary Contact Phone:(Required)

Secondary Contact:(Required)

First Last

Secondary Contact Email:(Required)

Secondary Contact Phone:(Required)

Number of Volunteers

Please enter a number greater than or equal to 0.

Total Annual Volunteer Hours

Number of Full-time Staff

Number of Part-time Staff

Total Annual Staffing Hours

Section 2: Project Overview

Name/Location of Facility/Asset where the project will take place(Required)

Address(Required)

Street Address City Postal Code

Please indicate the nature of the project(Required)

Enhancement of an Existing Asset

Replacement of an Existing Asset

New Initiative

Please indicate which of Haldimand County's Corporate Priorities the project primarily addresses(Required)

Growing our Local Economy by Creating Economic Opportunity

Community Vibrancy & Healthy Community

Corporate Image & Efficient Government

Please indicate which of the following objectives the project meets (must meet at least two of the objectives)

Creates or maintains public infrastructure;

Improves customer service;

Reduces the cost of government services by optimizing public sector resources;

Provides greater access to new sources of capital funding;

Capitalizes on collective energies and expertise of participating groups;

Addresses major social or economic initiatives; and,

Removes barriers to services and facilities by providing accessibility.

Overview of the Proposed Project(Required)

What do you want to do?

Community Need/Benefit(Required)

Why do you want to do the Project?

Project Budget

Please download and complete the Project Budget Form.

Attach additional documentation, including at least two (2) quotations, preferably three (3), for any planned work, unless it is in-kind. In-kind labour should be calculated at $16.50 per hour.

Note: The grant from Haldimand County for Community Beautification proposals cannot exceed $4,000, or 50% of the total project cost per project/per lead organization, whichever is lower. (For example, if the total project cost is $6,000, the maximum amount which can be requested from Haldimand County is $3,000.)

If the cost of the proposed project is larger in scope and the project will be completed in phases over more than one year, the request for funding may be specific to assisting with the cost of one or more phases of the total project.

Projects must include financial statements or written confirmation as to how the balance of the funding will be secured (for example, a fund-raising plan outlining revenue sources, confirmed or anticipated donations, etc.).

Proposed Project Budget upload(Required)

Drop files here or

Max. file size: 512 MB.

Anticipated Total Budget/Cost for the Project(Required)

Anticipated Start Date(Required)

mm/dd/yyyy

Month

Day

Year

Anticipated Completion Date(Required)

mm/dd/yyyy

Month

Day

Year

Section 3 - Detailed Project/Business Plan

Project Work-Plan/Description:

Project Partners:

Please provide the Name, Contact Information, and Description of Contribution of any Project Partners.

Anticipated Annual INCREASE in Operating Expenditures:

Anticipated Annual SAVINGS in Operating/Capital Expenditures:

Other Relevant Project Information

Many submissions to the Community Beautification Fund may be for permanent structures such as signs, benches, flower boxes, etc. and will require additional information for review and approval. Please keep in mind that Haldimand County may have specific standards regarding the purchase and installation of certain assets (e.g. benches, waste receptacles). Please contact County Staff to discuss any permanent amenities you would like to install on County property.

Applicants must include the following additional documentation with their Application Form:

REQUIRED Supporting Documentation:

Specifications (e.g. dimensions, building materials), drawings or photos of proposed structures;
Written Quotations for any purchased project supplies, materials and services (minimum two (2) quotes). Please provide specifications to contractors to ensure consistency between quotes;
Site Map of proposed location for structures, flower beds, etc.;
Work Plan outlining the proposed timeline and activities to complete the project;
Hold Harmless Agreement (signed);
Valid Certificate of Insurance (minimum $2 million liability insurance with Haldimand County named as additional insured);
Confirmation of WSIB participation by any contractors hired to complete work on the project;
Financial Statements and/or Fund-Raising Plan to prove readiness of project funding;
‘Before’ Photos of the project location.

Other Relevant Project Information upload

Any other information related to the project.

Drop files here or

Max. file size: 512 MB.

Additional Requirements:

Upon approval of your Project through the Community Projects Capital Fund, Haldimand County requires that the following conditions be met:

Final plans and specifications for all projects must be submitted to Haldimand County for review and approval before any work is started on the Project.
The Project must proceed in accordance with the final plans and specifications as approved by the County. Any revisions must receive prior approval from Haldimand County. Changes which significantly alter the nature or intent of the Project will be referred back to the Community Partnership Liaison staff for consideration.
Upon completion of the Project, a final inspection of the work will be carried out by Haldimand County. As well, depending upon the size and scope of the Project, interim inspections by staff may be required.
Evidence of liability insurance and WSIB compliance—satisfactory to the Haldimand County Corporate Services Department—must be provided for all projects.
Periodic audited financial statements or other evidence satisfactory to the Corporate Services Department may be required for all Projects to verify that the Project was undertaken as planned and that the funds were expended solely for the intended purpose.
A formal agreement, satisfactory to the County’s Corporate Services Department, is required prior to the start of construction and prior to funds being disbursed/reimbursed.
The applicant will be required to obtain all necessary permits, etc. and to comply with any and all applicable codes, regulations, etc.
The applicant will be required to adhere to all Haldimand County policies and procedures currently in place, or which may come into being, regarding the operation of the type of facility for which this grant is provided.
Projects must be initiated within one year of the approval date and completed within three years of the approval date.

Section 4 - Authorization

This section must be completed, signed and dated by two (2) authorized representatives of the Organization. The information provided in this application and progress and final reports is subject to the provisions of the Municipal Freedom of Information and Protection of Privacy Act. All granting decisions are public information.

Authorization(Required)

• I/WE AM/ARE A DULY AUTHORIZED REPRSENTATIVE HAVING LEGAL AND/OR FINANCIAL SIGNING AUTHORITY FOR THE ABOVE-NOTED ORGANIZATION.
• The information contained in this application and supporting documents is true and accurate and endorsed by the applicant.
• The general public shall have access to this facility for the provision of community and/or leisure services.
• An accounting of expenditures—showing compliance with conditions of the grant—shall be provided through progress reports during the Project and/or upon completion of the Project and no later than one year from the date of the granting of funds.
• Any grant awarded shall be used solely for the purposes stated within this application and according to the program parameters.
• As a condition of accepting financial assistance, access to all financial statements and records having any connection with monies received is hereby granted to the Treasurer of Haldimand County or his/her designate.

We, as authorized representatives of the below noted organization hereby understand and accept the conditions and requirements of Haldimand County's Community Partnership Capital Grants Program and acknowledge the information in this Application is true and accurate.

Name of Organization

Primary Contact Signature(Required)

Date

Month

Day

Year

Secondary Contact Signature(Required)

Date

Month

Day

Year

This field is for validation purposes and should be left unchanged.

Community Partnership Program – Capital Grants Application

Capital Project Program Capital Grant Application Form

Application

Section 1

Section 2: Project Overview

Project Budget

Section 3 - Detailed Project/Business Plan

Other Relevant Project Information

Section 4 - Authorization

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