Okaloosa County BOCC — November 15, 2016 — 5339 Application FFY2017 — reading text

2017 49 U.S.C. SECTION 5339 BUS AND BUS FACILITIES FORMULA PROGRAM FOR RURAL AREAS CFDA 20.526 CAPITAL ASSISTANCE APPLICATION FLORIDA DEPARTMENT OF TRANSPORTATION - PUBLIC TRANSIT OFFICE TABLE OF CONTENTS 1. CAPITAL ASSISTANCE APPLICATION ..................................................................................... 2 Capital Assistance Application Checklist .................................................................................... 2 Cover Letter – Sample.................................................................................................................. 3 Resolution Form – Sample ........................................................................................................... 4 Form 424: Application for Federal Assistance ............................................................................ 5 Exhibit A: Current System Description ....................................................................................... 5 Exhibit A-1: Fact sheet ................................................................................................................. 6 Exhibit B: Proposed Project Description ..................................................................................... 7 Exhibit C: Public Hearing ............................................................................................................ 8 Public Notice – Sample ......................................................................................................... 8 Form C-1: Operating and Administrative Expenses .................................................................... 9 Form C-2: Operating and Administrative Revenues .................................................................. 10 Form C-4: Current Vehicle and Transportation Equipment Inventory (a)................................. 11 Form C-5: Capital Request......................................................................................................... 12 Exhibit D: Leasing ..................................................................................................................... 13 Exhibit E: Federal Certifications and Assurances ...................................................................... 14 Exhibit F: Certification of Equivalent Service .......................................................................... 14 Exhibit G: Applicant Certification and Assurances to FDOT.................................................... 15 Exhibit J: Standard Lobbying Certification Form ...................................................................... 17 Exhibit K: FTA Section 5333 (b) Assurance ............................................................................. 18 Title VI Program ........................................................................................................................ 19 Local Clearinghouse Agency Letter ........................................................................................... 19 Exhibit H: Protection of the Environment ................................................................................. 19 1. CAPITAL ASSISTANCE APPLICATION CAPITAL ASSISTANCE APPLICATION CHECKLIST Name of Applicant: ___________________________________________________________ Check one: New Applicant _________ Recurring Applicant _________ The following must be included in the Application for Section 5339 Capital Assistance in the order listed. ____1.1 Capital Assistance Application Checklist (this form) ____1.2 Applicant’s cover letter ____1.3 Governing board’s Resolution ____1.4 Form 424: Application for Federal Assistance ____1.5 Exhibit A: Current System Description ____1.6 Exhibit A-1: Fact Sheet (if grant is for vehicles/equipment) ____1.7 Exhibit B: Proposed Project Description ____1.8 Exhibit C: Public Hearing and Publisher’s Affidavit (public agencies only) ____1.9 Form C-1: Operating & Administrative Expenses ____1.10 Form C-2: Operating & Administrative Revenues ____1.11 Form C-4: Current Vehicle and Equipment Inventory (if grant is for vehicles/equipment) ____1.12 Form C-5: Capital Request ____1.13 Exhibit D: Leasing ____1.14 Exhibit E: Federal Certifications and Assurances ____1.15 Exhibit F: Certification of Equivalent Service (if grant is for non-accessible vehicles) ____1.16 Exhibit G: Applicant Certification and Assurance to FDOT ____1.17 Exhibit J: Standard Lobbying Certification Form ____1.18 Exhibit K: FTA Section 5333(b) Assurance ____1.19 Copy of the Title VI Plan (if agency has not previously submitted a Title VI plan) If grant is for facilities: ____1.20 Copy of cover letter sent with application submitted to Local Clearinghouse Agency/RPC Date: ____ ____1.21 Exhibit H: Protection of the Environment FOR DEPARTMENT USE ONLY Date: __________________Letter received from the Local RPC/Clearinghouse Florida Department of Transportation – 5339 Application Manual – FFY17 2  COVER LETTER – SAMPLE (On Agency Letterhead) STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION GRANT APPLICATION ____________________ (agency name) submits this Application for the Section 5339 Program Grant and agrees to comply with all assurances and exhibits attached hereto and by this reference made a part thereof, as itemized in the Checklist for Application Completeness. ____________________ (agency name) further agrees, to the extent provided by law (in case of a government agency in accordance with Sections 129.07 and 768.28, Florida Statutes) to indemnify, defend and hold harmless the Department and all of its officers, agents and employees from any claim, loss, damage, cost, charge, or expense out of the non-compliance by the Agency, its officers, agents or employees, with any of the assurances stated in this Application. This Application is submitted on this _______ day of _______________, 201___ with two (2) original resolutions or certified copies of the original resolution authorizing ____________________________ (Name & Title) to sign this Application. Agency Name By _________________ Date _______ Title____________________________ Florida Department of Transportation – 5339 Application– FFY17 3  RESOLUTION FORM – SAMPLE (On Agency Letterhead) A RESOLUTION of the ______________(Governing Board)________________________ authorizing the signing and submission of a grant application and supporting documents and assurances to the Florida Department of Transportation, the acceptance of a grant award from the Florida Department of Transportation, and the purchase of vehicles and/or equipment and/or expenditure of grant funds pursuant to a grant award. WHEREAS, _____________ (Applicant) ______________________________ has the authority to apply for and accept grants and make purchases and/or expend funds pursuant to grant awards made by the Florida Department of Transportation as authorized by Chapter 341, Florida Statutes and/or by the Federal Transit Administration Act of 1964, as amended; NOW, THEREFORE, BE IT RESOLVED BY THE ______ (Governing Board) _____ ________________________________________, FLORIDA: 1. This resolution applies to Federal Program(s) under U.S.C. Section(s) _________________. 2. The submission of a grant application(s), supporting documents, and assurances to the Florida Department of Transportation is approved. 3. __________________ (Authorized Individual by Name and Title) _____________is authorized to sign the application, accept a grant award, purchase vehicles/equipment and/or expend grant funds pursuant to a grant award, unless specifically rescinded. DULY PASSED AND ADOPTED THIS _____________________________, 20__ By: ____________________________ (Signature, Chairman of the Board __________________________ (Typed Name and Title) ATTEST: __________________________ (seal) Florida Department of Transportation – 5339 Application– FFY17 4  FORM 424: APPLICATION FOR FEDERAL ASSISTANCE Attach the completed Form 424 here. EXHIBIT A: CURRENT SYSTEM DESCRIPTION 1. What is a general overview of the organization including its mission, program goals and objectives? 2. What is the organizational structure, type of operation, number of employees, and other pertinent organizational information? Is the organization a government authority or a private non-profit agency? Include an organizational chart that shows the positions that are involved in the transit department i.e. fleet manager, vehicle maintenance. The organizational chart may be placed after this exhibit. 3. Who is responsible for insurance, training, management, and administration of the agency’s transportation program? 4. Who provides maintenance for the vehicles? Is it outsourced? What type of Preventative Maintenance work does the agency do on-site? 5. What is the agency’s current number of transportation related employees? 6. What is a detailed description of service routes and ridership numbers? If the applicant is a Community Transportation Coordinator (CTC), relevant pages of a Transportation Disadvantaged Service Plan (TDSP) and Annual Operating Report (AOR) containing the above information may be provided here. Please do not attach entire documents. Florida Department of Transportation – 5339 Application– FFY17 5  EXHIBIT A-1: FACT SHEET Name of Applicant: _____________________________________________ IF GRANT IS CURRENTLY AWARDED 1. Number of one-way passenger trips.* PER YEAR 2. Number of individuals served unduplicated (first ride per rider per fiscal year). PER YEAR** 3. Number of vehicles used for this service. ACTUAL 4. Number of ambulatory seats. AVERAGE PER VEHICLE (Total ambulatory seats divided by total number of fleet vehicles) 5. Number of wheelchair positions. AVERAGE PER VEHICLE (Total wheelchair positions divided by total number of fleet vehicles) 6. Vehicle Miles traveled. PER YEAR 7. Average vehicle miles PER DAY 8. Normal vehicle hours in operation. PER DAY 9. Normal number of days in operation. PER WEEK 10. Trip length (roundtrip). AVERAGE Estimates are acceptable. The information listed should be specific to the Section 5339 funds and not agency wide. * One way passenger trip is the unit of service provided each time a passenger enters the vehicle, is transported, then exits the vehicle. Each different destination would constitute a passenger trip ** The unduplicated riders are for current year and the subsequent year once the grant is awarded Florida Department of Transportation – 5339 Application– FFY17 6  EXHIBIT B: PROPOSED PROJECT