FY16 SRC 5310 ApplicationN-Ef'�V :.A1 X01 C'Q1JN-1"Y"J-3.0A-R.D OF (--0wMM-1'b'z'8J03KERS
P4-'EeQ1UJY-,S'1'1,"0R DOARDAM ON
Knalm M,
DEPARTMENT: VRESENTERM: Brenda "Ben"Brow, Senil-)r -T'(esNTrre Ceili:er Manager
CONTACTfS). Brenda "Beo" Brow, Senior Resource Center Manag
per
QW11lux "
Fdbikic Hearing and Consideradon otf ApprWiTOto Submit Appal "floe fw- --fty q
Seniors and Individuals with Disa*hflifles, ?r0G.lr%Y;1 Funds iu'aie Awrupt ox'S175,,300 �zrj f
The Public Transportation Divls!on of the N.C. DeparLment of Transportation is soliciting applications for
U.S. Department of Transportation Federal Trar-sit Admini 7,,xativc, 'funds available through e Section 53 10
Enhanced Mobility of Seniors and Individuals with Disabilities 7-1rogram.for FY 15-16. Tice Senior Resource
Center requests approval to submit an application -in the amount of $175,000. The fant would be used to
provide transportation for seniors (age 6-5 and Wider) a„d 6 isabio clients whose special needs make it
difficult/ impossible to use slandard public traa portatloxj, The boai-d must hold a public hearing to provide
the opportunity for public input regarding the prqject and subtlahal of the application for funding, If
awarded the grant requires a 10% County match i-11 Ole arnow-Tr of t,500, which will be submitted with the
F`115- 16 recommended budget.
STRATEGIC PLAN ALIGNMENT-
Superior Public Health, Safety and Ed- ation
Provide health and wellness ucation, prog-murns, ald services
Understand and act on. citizen needs
Conduct public bearing and approve request to submit application for 53 10 Ex-�, 3aitc-ed .1,vlol, ii- iy jcf as ors
mid Individuals with Disabilities Program Funds in the Amount of $1'15'000,
appropriate certifications and assurances for the application and acceptmee of tbrr—,ant
h,Ltps:llnewhanover.novusagenda .cc m[Preview.aspx?ltemlD=4941&MeetingID--O&Mecti... 10/31/20 ;'
MORI
i R ♦►.
(Federal Section 5310 )
North Carolina t of Transportation
Public Transportation Division
September 15, 2014
]l lM
This call for projects in the small urbanized areas and rural areas will result in grants with a
maximum period of performance of 12 months (no earlier than July 1, 2015 — June 30, 2016).
NCDOT is no longer funding two year projects. Funding for subsequent years is not guaranteed.
will be necessary to reapply and • through another competitive process for subsequent funding.
Funded projects are selected through a competitive process that will be coordinated by the
NCDOT — Public Transportation Division. Applicants should at least read the Application Cov
Letter and Overview before beginning their application. These documents contain information
about the federal and state regulations associated with the funding programs and guidance on
how
• prepare a grant application. I
REMINDER: If you need technical assistance with the programmatic information or
requirements, please contact the Mobility Development Specialist assigned to your area. A list is
provided in Appendix C of the 5310 Application Overview.
'' ` � � ! i
3
Applicant should select "Yes" if they are subject to the reporting
requirements of FFATA and "No" if they are not subject to ❑ YES No
Executive Compensation Reporting.
Executive Compensation Preporting: If "Yes" is selected above, enter the Names and Compensation
amounts for the top five officers of the Applicant.
10M
NNW Mitil
Funding Source
Federal Section 5310
E] Federal Section 15�310
Traditional 5310 Project
;In �.17
,.,t
Other 5310 Project
Riders or
Rural area
❑Rural area
Consumers will
Small Urban area
El Small Urban area
live in:
Total Project
Capital $ 175,000
Capital $
Cost by Budget
Operating $
Type:
Mobility Manager $
Mobility Manager $ i
Total Federal
Request
Total Federal Request
Total Federal Request
Matchles) not
$175,000
$
included
B. SCOPE OF PROPOSED SERVICES
Instructions: Complete this table for the targeted population group/groups you plan on serving in the project. Put NI/A if the population is not a
target in this project. Definitions of each of these populations is included in Appendix A of the 5310 Overview.
How many
• the targeted population live in
the area you propose to serve?
Of the number listed above, how many have
the unmet transit need your project addressesq.
9
IMPORTANT - The FTA requires that projects receiving, unds from the Section 5310 Program (Enhanced
Mobility of Seniors and Individuals with Disabilities) be included in the locally developed, Coordinated
Public Transit - Human Service Transportation Plan. Only 5311 grantees and/or small urban 5307 grantees
will be allowed to request 5310 funded replacement vehicles. No requests for expansion vehicles will be
approved.
•M
Answer: New Hanover County is second smallest in area, but is also 2nd in population
density. The 2010 census increased •4%• 2000 census with 14.2% over the age of 65 years.
15.9% live below poverty level. Northern areas remain rural with limited tranp.
4. Provide information about the locally developed, Coordinated Public Transit - Human
Services Transportation Plan (LCP) used to prepare this project application.
IName of Plan/Title Coordinated Public Transportation
Human Service Transportation Plan for
Applicable Need, Strategy
or Activity Included on M
L�= �
fflffulffli.
Explain how the capital project you are proposing, enhances the mobility of seniors and/or
individuals with disabilities in your service area.
Answer: Shared rides have exceeded 2-hours one-way, reducing transit time minimizes
joint pain & exhaustion while increasing compliance with appointments. Door-to-door durin,,V
inclement weather reduces exposure and illness. Compliance improves health.
6. According to the Federal Circular, it is not sufficient to assume seniors and/or individuals
with disabilities will be included in the traditional 5310 project. Describe the details of the
planning and design of your project that establishes that seniors and/or individuals with
disabilities will be included in the project.
Answer: The SRC will maintain service to 302 clients 65 and over in our database. With
the anticipated aging of baby-boomers this nunmber will increase. We added 2- more
shopping trips for access to supplies ( groceries, meds, & toiletries).
7. Estimate the annual number of unduplicated passengers who will be served or the number of
one-way trips that will be provided from the proposed project.
1-11 �
• The New Hanover County Senior Resource Center Transportation team is well complimented
with a Transportation Coordinator and Program Assistant who have worked together serving
our seniorsIdisabled for the past 2 years.
• Our local MPO (WAVE Transit) has not applied for 5310 funds. We are working with WAVE
to meet the recommendation of the Local Coordinated Plan to collaborate with area service
providers to address gaps in service without duplication of service.
• Clients complete a 3-page information package to determine eligibility and special needs.
• Coordination with other vendor1resources are reviewed and appropriate triage determined. If a
client is unable to get curbside, a private taxi company is utilized. Most dialysis clients are
transported via taxi to avoid prolonged transport and exposure with shared riders. Also, taxi's
can be called to pick-up client when treatment completed, instead of anticipating when treatment
will be completed and having to return for "not ready" clients at additional expense.
• Transportation is scheduled with appropriate vendor (DART, Public, DSS, Taxi, SRC Van).
• Eligible grant funding source is determined and entered into ServTracker database.
• Demand schedule information faxed to dispatch andlor appropriate vendor.
Milestones:
• Triage all clients on waiting list (30). Ages 65 and over will be assigned to 5310 grant list.
• Assign current clients 65 and over to 5310 grant list -302 clients. Develope routes for 1-
congregate nutrition clients, 2-medical appointments, and 3- shopping trips. Increase
shopping trips as needed for the upcoming holiday season.
10. Describe the method that will be used to monitor and evaluate the success of this project.
List the measurable indicators of success.
Answer: All transportation is maintained in ServTracker database and query reports
generated.
A
11. Describe how the project relates to any federal or other programs that the applicant
operates and, if applicable, how the applicant plans to use these resources to leverage this
project.
Answer: Funding from the Home and Community Care Block Grant (Older Americans
W sen-�tzv-. -r%;t-t6 lrelf. itra�vft-&,
their health and independence.
12. How will the applicant sustain the proposed service and maintain any vehicles after the
grant period?
Answer: County vehicle management currently maintains the single van the Senior
Resource Center uses for nutrition and shopping trips. Vehicle management for othe
service providers is the responsibility of the provider. We will continue to identify a
seek grant funding for this population as they continue to age. I
13. What is the applicant's organizational mission? Explain how this project fits in with the
other services the applicant already provides.
socialization for community involvement and mental health is vital to meet this
objective.
14. Describe the applicant's preparedness to manage the project and/or the applicant' s technical
capacity to provide the proposed transportation service.
15. Describe the qualifications of the key personnel assigned to the project and the percentage of
time each person will be involved in the project. Win the applicant need to hire additional
personnel to support the project?
Answer: The Transportation Coordinator (College level education) is full time (40
Hrs/week) and the Transportation AssistantUjg
, ,,4h School education with extensiv
experience as a transport driver) works 25 hrs/week, and is computer saavy with
scheduling and ServTracker data entry. No anticipated new hires.
0
111�M 11111111��
2. Describe the intended service area that will benefit from your proposed project. Ihnclu
pertinent demographic information about the service area in your answer. It should b
clear from your description whether your project's targeted population lives in a small
urban or rural area of North Carolina. I]
1E
3. Describe the mobility options the seniors and/or individuals with disabilities in this
service area have now and discuss how these are insufficient and/or inappropriate. If
public transportation is unavailable
• the targeted populations, how are they getting tv.
life-sustaining, social and recreational activities without it?
4. Provide information about the locally developed, Coordinated Public Transit - Human
Services Transportation Plan (LCP) used to prepare this project application.
�11 W
M
Applicable Need, Stratagy
2 or Activity Included on
Page Number(s)
0
5. To be funded as an Other 5310 Project, the project must meet at least one of three
qualifying criteria including:
a. Does your project exceed ADA minimum requirements? Answer:
b. Does your project improve access to fixed route service and decrease reliance by
individuals with disabilities on AA complementary paratransit service?
Answer:
c. Does your project provide alternatives to public transportation that assist seniors
and/or individuals with disabilities with transportation? Answer:
6. If you answered 'yes' to any of the questions in 5(a), 5(b) or 5(c) above, describe how
your project meets this qualifying criteria.
7. Other 5310 Projects must be planned, designed and carried out to meet the
transporation needs of seniors and/or individuals with disabilities, although the service
may also be used by the general public. Describe how seniors and/or individuals with
disabilities will be targeted and how the general public will be part of the project.
kill
lz=
Answer (additional trips):
9. Describe how the project will be coordinated with human service agencies, nearby
jurisdictions and/or public and private transportation providers. Identify any
partnerships that will be involved in the implementation of the project. (i.e. vehicle
sharing, scheduling & dispatching center, training, shared rides, shared costs)
11. Describe the method that will be used to monitor and evaluate the success of this
project. List the measurable indicators of success.
12. Describe how the project relates to any federal or other programs that the applicant
operates and, if applicable, how the applicant plans to use these resources to leverage
this project.
13. How will the applicant sustain the proposed service and maintain any vehicles after the
grant period?
W
14. What is the applicant's organizational mission? Explain how this project fits in with the
other services the applicant already provides.
15. Describe the applicant's preparedness to manage the project and/or the applicanfs
technical capacity
• provide the proposed transportation service.
16. Describe the qualifications of the key personnel assigned to the project and the percentage
• time each person will be involved in the project. Will the applicant need to hire
additional personnel to support the project?
17. Describe how the applicant will manage risk and provide for the safe delivery of
services.
Rim
North Carolina Department of Transportation (NCDOT)
Public Transportation Division (PTD)
FY1 6 Elderly Disabled Capital
W.,
:Legal Name: NEW HANOVER COUNTY
Total
Federal
Address: SENIOR RESOURCE CENTER
'N'CDO . T
Local
230 GOVERNMENT CENTER DR
80.00%
L
WILMINGTON, NC 28403-1672
10.00%
Total Funding $175,0k i I
:County: NEW HANOVER COUNTY
Congressional District: 7
$17,500
,Contact Person- Brenda Brow
,Telephone: +1 (910) 798-6410
Fax: +1 (910) 798-6411
:Email: bbrow@nhcgov.com
:Web Site: http://src.nhcgov.com
;,Federal ID Number: 56-6000324
DUNS Number: 04-002-9563
CFDA #:
.Period of Performance: Jul 1, 2015 to Jun 30, 2016
;Federal Billable/Non-Billable Billable
1. Total Project Expenditures
(NCDOT Maximum Participation Amounts)
Requested
NCDOT Use Only
Replacement Vehicles
$0,
$0!
Expansion Vehicles
$0
$0:
Other
L Capital Expenses
$175,000;
$175,0001
Advanced Technology Expenses
$Oi
ME=
Amount
Total Federal
100.00% 80.00%
$175,0001! $140,
MA
11M
Federal Non-Billing NCDOT Local
J 10.00% 10.00%
. . .. .. ...........
$Oi $17,5001 $17,500
REI
MBE I WBE
$01
J $0
MBE i WBE
EEO
Total
Federal
Federal Non-Billing
'N'CDO . T
Local
100.00%
80.00%
L
10.00%
10.00%
Total Funding $175,0k i I
$140,0001 i
i
$17,500
$17,5001
ME=
Amount
Total Federal
100.00% 80.00%
$175,0001! $140,
MA
11M
Federal Non-Billing NCDOT Local
J 10.00% 10.00%
. . .. .. ...........
$Oi $17,5001 $17,500
REI
MBE I WBE
$01
J $0
MBE i WBE
EEO
4orth Carolina Department of Transportation (NCDOT)
Public Transportation Division (PTD)
Project Number'
PROPOSED PROMC7711UG-t-T
CAPITAL EXPENSES
G546
04u2rff -Ud"r-d =1 I iepartment ot-l'fa--nsportation (R;CD*T)
Public Transportation Division (PTD)
FY1 6 Elderly Disabled Capital
UAl IBM \� / /d \� /` ~� d »\ \#\ 24
:and wider body; fully automatic side lift. 2
'wheelchair station floor plan. Min.
ambulatory capacity -8 pax; Max.
ambulatory capacity -10 pax. fmaybe
,driven w/o CDL)
on
$13,00011
IE
go
$0:
-,�Of T�ransportation (NCDOT)
)&ft:jL
Public Transportation Division (PTD)
Optional Engine - Diesel
G573
Option: Accessible Minivan compliant
with ADA; Lowered floor, wheelchair ramp
and 1 to 2 wheelchair stations.
ME
Optional Engine - CNG
Optional Engine - Hybrid Electric
Optional Engine - Diesel
Budgeted Cost
W
$36,0001
$9,6001-.--
1,9c
01
Is
IEW
EE
$0
WN
0
E
III
RE
EE
Morth Carolina Department of Transportation (NCDOT)
Public Transportation Division (PTD)
FY1 6 Elderly Disabled Capital
$U
| Optional Engine
Optional Engine - Flybrid Electric
$45,0001
,Optional Engine - Diesel
$12,0001
$&
Brake Retarder
$8,600!
W
so!
Description
Budgeted Cost Oty
Qty
�Other Transit Vehicle (Replacement)
Other transit--type vehicle not otherwise
identified in UPTAS. Specifly type and if lift 1
,equipped. (include estimated cost
Public Transportation Division (PTD)
FY16 Elderly Disabled Capital
CAPITAL EXPENSES
Applicant: NEW HANOVER COON
ZMEMM=
Total Cost NC DOT Maximum
Participation
G563
ffim
Optional Engine ® CNG
:,Optional Engine ® Natural Gas
41
$200,006;
'-figh - top Vehicle (Expansion) —
School bus door entry; lowered stepwell;
NO LIFT; maximum capacity-12
passengers.___",
Optional Engine - Diesel
$01 $0
$o! $0
$o! $0
A—UPM—U-5rolina partm—ent ot Frans portation tACLYO-T)
Public Transportation Division (PTD)
FY1 6 Elderly Disabled Capital
w ee c air
I(Expansion) —
'offering increased headroom and wider
$60,100,
$0:
$0
body; fully automatic side lift. 2 wheelchair
so;!
station floor plan. Min. ambulatory capacity
-8 pax; Max. ambulatory capacity -10 pax.
�(rnay be driven w/o CDC,)
'Optional Engine - Diesel
$13,000:
$0.
$0!
Bike Rack
$1,4101
$0i
$01
$0
$0i
G567 Descnpfion
Budgeted Cost Qty
Qty
25® Light Transit Vehicle w/ Lift
'(Expansion)
—Body-on-chassis
type vehicle(Cutaway van
chassis); retaining the van-type cab; offering!
increased headroom and wider body; full y
or
$71,500
$&
automatic side life. 2 & 4 Wheelchair
Station floor plans Min. ambulatory
capacity - 8 pax; Max. ambulatory
capacity - 18 pax.
i
Optional Engine - CNG
$30,000!
$0:
$a
Optional Engine - hybrid Electric
$45,000;
45,000� i
$01
'Optional Engine - Diesel i
$131!
P 000
$0
$0;
Brake Retarder
Bike Rack
G568 Description
G572
$8,5001
$1,410
$0
$6
$0:
$0!
$0?
so;!
zz_��
9E
$Oi
1E
E
EE
G,
it
G578
Optional Engine - Diesel
Optional Engine - Hybrid Electric
(1695
optional Engine - Diesel
Brake Retarder
optional Engine - CNG
*ther Transit Vehicle (Expansion) -
Other transit-type vehicle not otherwise
identified in UPTAS. Specify type and if lift
equipped. (include estimated cost
documentation)
Engine - Hybrid Electric
M
$12,000!i
11
$6,600
27,000
$0
$o!
$01 $0
$ol $0
$Oi $0
s0i $0
$01
$01
Budgeted Co . st Qty
Qty
$91,2001
$0 ,
$o t;
$55,00&
$0,
!
so
-------
$12,000
W
$oi
$9,600
$ - &
$0�,
$1,900
$0,
$0
$0?
01
$
Budgeted Cost Qty
Qty
*ther Transit Vehicle (Expansion) -
Other transit-type vehicle not otherwise
identified in UPTAS. Specify type and if lift
equipped. (include estimated cost
documentation)
Engine - Hybrid Electric
M
$12,000!i
11
$6,600
27,000
$0
$o!
$01 $0
$ol $0
$Oi $0
s0i $0
North Carolina Department of Transportation (NCDOT)
Public Transportation Division (PTD)
FY1 6 Elderly Disabled Capital
W, 1111,1111 ''11 1 .......... 1111, 11
171 wzzzn,—*
*NOTE-, If you prefer to use a local vendor for, lettering, &ase budget cost under line code G591 located under
"Other Capital". Logos are now eligible under that code also,
$0!
1
North Carolina Department of "rr n tiol
Public Transportation Di i io n T
Y15 Elderly Disabled Capital
51 'Audio-Visual Equipment - includes the costs of overhead projector,
'TV and VCR to be used for training purposes.
Usi one item per line, the no. of units per item, and the estimated cost.
(provide one cost estimate for each item r ted.)
Item Description
City Estimated cost Ea Total
North Carolina ar met of Transportation T)
Public "ran p ati n Division (PTD)
I -Y16 Elderly Disabled Capital
G551 !Vehicle Spam Parts - Cast of spare pare for revenue producing
vehicles, I I`e sj'mre p pra k aCa € nave a �"G t O" re-JO; thz n ;x ���;•
c% 4� g
ar °` �5:.sC ot p; -x C i`z1y r, r`B
Ifr &e'bs e`v ;x,..'.te'l:✓ i6{tE3a -v �,S"'`.
ory
U t one item per lire, the number of units, and the
;estimated cost per each.
(provide one cost estimate for each item requested.)
nested.)
Item Description Qty Estimated Cost Ea. Total Qty Dot Rite € csia
_... -.
_ --- ----------- - - - -- ._ - -- --
I I I
'.♦_, •
IMobile Radio Unit - 2-way radio installed in vehicle
Attach estimate of cost from vendor.
Watts:
item Description Qty Estimated Cost Ea. Total Qty Dot Rate Total
New!
Replacernent;
an -held ki—d-io'--U-- nit ---- portable -2-way radio (limit 2 per transit system{}
'Attach estimate of cost from vendor.
i
Vatts:
item Description Qty Estimated Cost Ea, Total Qty Dot Rate Total I
dew!
Replacement!
6556 Telephone equipment - Individual telephone instruments (does not include
see G524 in Facility Improvements);
new or replacement telephone systems
may include cellular (digital) phones.
List one item per line, the no. per item, and the estimated cost.
timated Cost Ea. Total City Dot Rate Total
Item Description City Es
G585 �Bus to Signs - Sign used to indicate location where passengers
can board or exit a public transit vehicle.
,*Do not request Bus Stop Shelters/ Benches here. Must request in Facility Improve,.
Bus Stop Sign(s)
Aorth Carolina Department of Transportation (NCDOT)
Public Transportation Division (PTD)
G591
:Vehicle Lettering & Logos - Cost of lettering and/or logos and the
I
Ilabor involved in having the transit system name, phone number,
Viand/or
logo applied to vehicles. Costs to be incurred by using a local vendor.
(Attach cost estimate for
reference only.)
Item Description City Estimated Cost Ea. Total
Qty Dot Rate
Total
Vehicle Lettering & Logos!
G11
irect Purchase of Service '(Private)
I
Purchase of transportation services from a privately owned
$150,0001
$150'000�
transportation provider.
G612
User Side Subsidy
Purchase of service contract in which the passenger (user) pays for a
portion of the full fare.
0621
Volunteer Reimbursement
Reimbursement to volunteers for mileage on personal vehicle for
public transportation.
0641
Direct Purchase of Service (Public)
Purchase of transportation services from a publicly owned
$25,000;
$25,000
transportation provider.
TOTAL OTHER CAPITAL EXPENSES.
$175 , 000
$175,000;
fi��
North Carolina , i
Public Transportation Division
FY16 Elderly Disabled Capital
P'ROP'OSED PROJECT BUDGET
CAPITAL EXPENSES
Applicant. NEW HANOVER COUNT I Y COT Maximum
Object Title Total Coast Participation
Code I
G524 c ed�alin � t re for 'T Advance c nol - Must coo ply ith-
Item Description City Estimated Cost Ea.
i
I
Total Qty Got Rate
� t
G526 Mobile Data Devices ( (DTs / C) -
Guist c0n1Pi7 it 1.
Item Description City
Estimated Cast Ea Total Qty Got Rate Total
l Replacements
Expansion`.
Fare Media: Smart Card 1 Magenetic Stripe Card
Qt
Item Description y
Estimated Cast Ea. Total Qty Got Rate Total ,
Initial Installation
-- —.
I ® ®_ ----. --
- -
Expansions
I
'Automatic Vehicle Location AVL
Must comply with.
0527
Qt
I Item Description y
Estimated Cost Ea Total Ctiy Gat Rate iota:
Replacement,
I
Expansion'
!
1, '1 Items - -.t
Must i
comply
ist other included o
ireplacement
item LieScripuon g -
E
North Carolina Department of Transportation (NCDOT)
Public Transportation Division (PTD)
FY16 Elderly Disabled Capital
North Carolina Department of Transportation (NCDOT)
Public Transportation Division (PTD)
FY16 Elderly Disabled Capital
zs.�
CAPITAL EXPENSES
Expansion.
G522 Printers - Laser jet network and non-network printers
Non-network Qty Estimated Cost Ea Total Qty Dot Rate Total
Replacement'i I
A,1477W-U–N—FUT na epartment ot-T-ransportation (0413DOT)
it ic 'Transportation Division (PTD)
FY16 Elderly Disabled Capital
r. Software -
— ---- --- -- -----
,Eligible software listed under FY08 Technical Specifications
!List software:
Item Description Qty Estimated Cost Ea. Total
---- ----- --- ----- - -- --------
Qty Dot Rate Tote?
..... .. . ... ...
'Operating System Software Upgrade:
�(Ensure that your current pc has enough RZAM)
,Windows XP PROFESSIONAL operating system
Item Description Qty Estimated Cost Ea Total
MY Dot Rate Total
Upgrade Version!
Full Versioni
.......... . . . ......... ...
�Microsoft Office — ----- ---
I
�(Ensure that your current pc has anough RAM)
AS Office XP PROFESSIONAL
Item Description Qty Estimated Cost Ea, Total
Qty Dot Rate , Total
Upgrade Version;
i
— - - ---------
Full Version
Scheduling Software reqLICStS should be i-nade on the Advanced Technology Budget
G525 Network Server -
For use with network applicationtprograms
'Use standard local IT specifications)
Item Description Qty Estimated Cost Ea. Total
Q(e Dot Rate Total
Replacement
Expanslon' I
6529 iOthen Technology Items - List other hardware not
(included above, such as replacement hard drives
!network cards, etc. (baseline technology)
Item Description Qty Estimated Cost Ea. Total
aty Dot Rate Total
9 � a A
w=-jtiA riansportationINCDOT)
Public Transportation Division (PTD)
FY16 Elderly Disabled Capital
MMMMMMM
FACILITY EXPENSES
G533 Description Qty Estimated Cost Ea.
IM
IM
Sitework/Grading - Pre- construction
work including site Prep
Describe work to be completed and
attach cost estimate.
Utility Workl Hook-Ups - Costs
associated with water, sewer,electrical
or telephone lines or wiring, pre or post
construction,
Describe work to be completed and
attach cost estimate,
Total City Dot Rate Total
North Carodna Department i`
Public Transportation ' ,
FY1 6 Elderly Disabled Capital
G ',1 I4,ncingiL;oghting - E tterior building and parking Iof Iighting. _
Fencing and gate to secure parking area for vehicles.
'List one item per line Attach cost estimate for reference only.
Item Description Qty Estimated Cost Ea, Total City Dot Rate Totaa
[
[
G539 iAccess y/ Sig na e/L ndscaping - Post.-construction site work
;Construction of ramps and and walkways that meet ADA. Permanent
signs, such as a facility signs. Soil erosion containment.
'List one item per Vne attach cost a firnate for reference only, .
Item Description Qty Estimated Cost Ea Total Qty Dot Rate Total'
G558 `telephone system - New or Replacement telephone system
Attach coast e ,Vm to for r-
eference c rty,
Item Description Oty Estimated Cost Ea Total Sy Dot Rate ion
i
f
-- ..... ..... ............ - - -- --- - --
G582 Description City
Facility acquisition - Purchase of
existing structure
;attach study and appraisal
G583 Bus Sr_ *, Shelter and Benches
�*Requires plan approval by city or county regarding
ADA requirements include minimum size and width of the shelter;
imin. turning radius in shelter; accessibility to shelter by sidewalk;
iand concrete pad adjacent to shelter for loading and unloading bus.
1Provide plan approval {-
iE
North Carolina Department of Transportation (NCDOT)
Public Transportation Division (PTD)
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WHERE-AS, Article 213 of Chapter 136 of the North Carolina General Status and the Governor of North Carolina have
designated the North Carolina Department of Transportation (NCDOT) as the agency responsible for administering federal
and state public transportation funds; and
WHEREAS, the North Carolina Department of Transportation will apply for a grant from the US Department of
Transportation, Federal Transit Administration and receives fonds from the North Carolina General Assembly to provide
assistance for public transportation projects; and
WHEREAS, the purpose of the Section 53 10 program is to enhance mobility for seniors and individuals with disabilities
throughout the country, by removing barriers to transportation services and expanding the transportation mobility options
available. Toward this goal, ETA provides financial assistance for trans ortation services Planned, desianed. and carried oin
-WTMT47-7V`S-, -11-CT)FUT-fi—as-Feen designated as the State agency with principle authority and responsibility for administering
the Section 5 3 10 Program for small urbanized and rural areas; and
WHEREAS, (Legal Name of Applicant) New Hanover County hereby assures and certifies that it will comply with the
federal and state statutes, regulations, executive orders, and all small administrative requirements related to the applications
made to and grants received fi-om the Federal Transit Administration, as well as the provisions of Section 1001 of 'Title 18,
U.S.C.
NOW, THEREFORE, be it resolved that the (Authorized Official's Title)* Chairman of (Name of Applicant's Governing
Body) New Hanover Coun1y Board of County Commissioners is hereby authorized to submit a grant for federal and state
funding, provide the required local match, make the necessary assurances and certifications and be empowered to enter into
an agreement with the NCDOT to provide public transportation services.
I ( Certifying Official's Name) -7inr e YJui cy-e- (Certifying Official's Title)* Interim Clerk to the TAnprd
do hereby certify that the above is true and correct copy of an excerpt from the minutes of a meeting of the (Name of
Applicant's Governing Board) New Hanover County Board of Commissioners duly held on the 17th dayofNovember,
2014.
41c)
Signature of Certifying Official Date
*Note that the authorized official, certifying official, and notary
should be three separate individuals.
Sea] Subscribed and sworn to me (date)
Iffilim
W11WOMM a IM �MWA
Printed NaMY and Address
My commission expires (date) W�
Kyrnberleigh G. Crowell
Notary Public
New Hanover
My Commission Expire
MEM
(Required of all Applicants)
CERTIFICATION AND RE, STRICTIONS ON LOBBYING
1, -Avril Pinder, Assistant CounqL��� on behalf of
Name of Authorized Official
New Hanover Cof
Legal Name of Applicant
Hereby certifies that:
The undersigned shall require that the language of this certification be included in the award documents for
sub-awards at all tiers (including sub-contracts, sub-grants and contracts under grants, loans, and cooperativ
agreements) and that all sub-recipients shall certify and disclose accordingly. I
This certification is a material representation of fact upon which reliance was placed when this transaction was
made or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction imposed by 31 U& C § 1352 (as amended by the Lobbying Disclosure Act of 1995). Any person
who fads to file the required certification shall be subject to a civil penalty of not less than $10, 000 and not
more than $100, 000 for each such failure.
The undersigned certifies or affirms the truthfulness and accurac y of the contents of the statements submitted on
or with this certification and understands that the provisions of 31 U.S. C. Section 3801, et seq., are applicable
thereto.
Signe-rdre—of Authorized Okcial
Subscribed and sworn to me (date)
® A . . AP I IM
................... ...................
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mss���
narrative:
Required by
PTD
Check all
that apply
Description
Write a letter to Certified DBEs in the service area to inform the of
purchase or contract opor hies;
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Document telephone calls, emails and correspondence with or on behalf of
DBEs;
Advertise purchase and contract opportunities on local TV Community
Cable Network;
Request purchase/contract price quotes/bids from DBEs;
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Monitor newspapers for new businesses that are DBE eligible
>
Encourage interested eligible firms to become NCDOT certified. Interested
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firms should refer to htw://wwA7. nc dot
n . gov usiness/ocs/dhe
J#FAQ10 or
contact the office of contractual services at (919) 733-5316 ext 330 for more
information
>
Encourage interested firms to contact Bridgett Wall -Lennon of the Office of
Z
Historically Underutilized Businesses at (919) 807-2330 for more
information.
>
Consult NCDOT Certified DBE Directory. A DBE company will be listed in
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the DBE Directory for each work type or area of specialization that it
performs. You may obtain a copy of this directory at
10-1
70
• IMM
Reminder: Documentation of all good faith efforts shall be retained for a period of five (5)
years following the end of the fiscal year.
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Local Share Certification for Fundi
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(This form is required for F"ACH separate funding request)
Local matching funds will be required for all application submittals. For projects requiring operating funds, the
required local match is 50 S2ercent of net o!2era ing-elLpenses. For projects requi��.api+,al
match is 10 percent of the net cost of the project, subject to the availa�ility of state funds. Applicants should be
prepared to incur a 20 percent local match in case state funds are not available.
'the local match must be provided from sources other than federal Department of Transportation funds. Guidance
is provided in the 5310 Overview about eligible sources of matching funds. Applicants are responsibl ' e for
verifying the eligibility of non-USDOT federal funds the applicant proposes to use as their local match.
3=1
(Vehicles & Other)
AM=
Requested Funding Amounts
Net
Local Share
Project
Cost
1 2. 11,500 ROAD Grant
certiFy—t—o—Me north
Carolina Department of Transportation, that the required local funds will be available as of Jkly �2015.
Signature of Authorized Official
Avril Finder, Assistant County Manager
Type Name and Title of Authorized Official
Date
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PUBLIC HEARING RECORD
Public Hearing Notice was published on this date: 11/9/14
DATE: 11/17/14
PLACE: Ass C
MUTH
1, the undersigned, representing (Legal Nanze of Applicant.) New HanoyeLCounty do hereby
certify to the North Carolina Department of 'rransportation that a Public Hearing was held as
indicated above and:
During the Public earing,
Section 531.0 Program
............ . . ....... .
O<T�6 public —comments)
[] (Public Comments were made and meeting minutes will
be submitted after board oval)
I I
The estimated date for board approval of meeting minutes is: l // i q
f)
Signature of Clerk/Secretary to the Board
Printed Name and Title
Date
I
'!STATE FUNDS
•
LOCALFUNDS
To provide transportation for disabled and seniors 65 and over who experience a gap in available services in collaboration with our MPO
and local taxi companies.
To work with local transportation service providers to collaborate in meetingt the needs of seniors and disabled who are affected by gaps
in service without duplication of effort. Grouping rides for close proximity in origination area and destination minimizes mileage and
reduces ride time for, ar 4,4rnu
disease (Flu etc) Reduction in the wait list for services improves opportunity to receive needed medical treatment to reduce
compiications of illness, also to be able to shop for needed medications, food, and comfort items improves physical and mental health
outcomes
!!1 1111 Pil III! I I '1 ;!11! FIR1111 WIN I III I III
11 No =11 ii iii I � i I III I iq�11111111111111 I
7A41;d I Al I Ly I RAU &M I %; Kowyg g] 1 miogljvi II al,,R2 Egg A4 II I rgmn ITA mol w--Tramg
NCDOT Public Transportation Division
Project Funding Request Form
DATE SUBMITTED:
November L1; 2014
APPLICANT'S LEGAL NAME:
New Hanover County
BUDGET TYPE:
I July to J u ne FY
MPO Affiliation:
Cape Fear public Transportation d/bla WAVE Transit==
RPO Affiliation:
NCDOT Division Number:
East 9
I
'!STATE FUNDS
•
LOCALFUNDS
To provide transportation for disabled and seniors 65 and over who experience a gap in available services in collaboration with our MPO
and local taxi companies.
To work with local transportation service providers to collaborate in meetingt the needs of seniors and disabled who are affected by gaps
in service without duplication of effort. Grouping rides for close proximity in origination area and destination minimizes mileage and
reduces ride time for, ar 4,4rnu
disease (Flu etc) Reduction in the wait list for services improves opportunity to receive needed medical treatment to reduce
compiications of illness, also to be able to shop for needed medications, food, and comfort items improves physical and mental health
outcomes
!!1 1111 Pil III! I I '1 ;!11! FIR1111 WIN I III I III
11 No =11 ii iii I � i I III I iq�11111111111111 I
7A41;d I Al I Ly I RAU &M I %; Kowyg g] 1 miogljvi II al,,R2 Egg A4 II I rgmn ITA mol w--Tramg
i230 Government Center Dr ► St 165
Wilmington, NC 28403
K=1 am. 111071m,05 milyl 1,
I
'!STATE FUNDS
•
LOCALFUNDS
To provide transportation for disabled and seniors 65 and over who experience a gap in available services in collaboration with our MPO
and local taxi companies.
To work with local transportation service providers to collaborate in meetingt the needs of seniors and disabled who are affected by gaps
in service without duplication of effort. Grouping rides for close proximity in origination area and destination minimizes mileage and
reduces ride time for, ar 4,4rnu
disease (Flu etc) Reduction in the wait list for services improves opportunity to receive needed medical treatment to reduce
compiications of illness, also to be able to shop for needed medications, food, and comfort items improves physical and mental health
outcomes
!!1 1111 Pil III! I I '1 ;!11! FIR1111 WIN I III I III
11 No =11 ii iii I � i I III I iq�11111111111111 I
7A41;d I Al I Ly I RAU &M I %; Kowyg g] 1 miogljvi II al,,R2 Egg A4 II I rgmn ITA mol w--Tramg
SUBSTrrUTE FORM W-9
M 1101 Baia IKE#]
Pursuant to Internal Revenue Set-vice (IRS) Regulations, vendors must furnish their Taxpayer Identification Number (TIN) to the State. If this number is
not provided, you may be subject to a 20% withholding on each payment. To avoid this 20% withholding and to insure that accurate tax information is
reported to the Internal Revenue Service and the State, please use this form to provide the requested information exactly as it appears on file with the IRS.
CORPORATION OR PARTNERSHIP : ENTER YOUR LEGAL BUSINESS NAME
NAME:
ff
MAILING ADDRESS: STREET/PO BOX- , ,, /, T , I e—, �
CITY, STATE, ZIP: G,
J
DBA / TRADE NAME (IF APPLICABLE):
BUSINESS DESIGNATION: ❑ INDIVIDUAL (use Social Security No.) ElsoLE PROPRIETOR (use SS No. or Fed ID No,)
❑ CORPORATION (use Federal ID No.) EIPARTNERSHIP (use Federal ID No,)
❑ ESTATE/TRUST (use Federal ID no.) S
I TATE OR LOCAL GOVT. (use Federal ID No.)
El OTHER / SPECIFY [A
SOCIAL SECURITY NO. (Social Security #)
OR
FEMEMPLOYER IDENTIFICATION NO (Employer Identification
COMPLETE THIS SECTION IF PAYMENTS ARE MADE TO AN ADDRESS OTHER THAN THE ONE LISTED ABOVE:
REMIT TO ADDRESS: STREET / PO BOX:
CITY, STATE, ZIP:
......... .
Participation in this section is voluntary. You are not required to complete this section to become a registered vendor. The information below will in no way affect the vendor registration process
and its sole purpose is to collect statistical data on those vendors doing business with NCDOT. Ifyou choose to participate, circle the answer that best fits your firm's group definition.
What is your firm's ethnicity? (❑Prefer Not To Answer, ❑African American, ❑Native American, ❑Caucasian American, ❑Asian American,
E]Hispanic American, ❑Asian-Indian American, ElOther: )
What is your fir led-Owned Business? (❑Preter Not to Answer, ❑Yes,E] No)
IRS Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification and
2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the IRS that I am subject to backup
withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and
3, 1 am a U.S. person (including a U.S. resident alien).
The IRS does not require your consent to any provision of this document other than the certifications required to avoid backup withholding. For
complete certification instructions please see IRS FORM W-9 at http://Nvww.irs.goy-/Rtib/irs-pdf/fw9.pdf .
AD(V_e
NAME (Print or Type) TITLE (Print or Type)
SIGNATURE DATE PHONE(NUMBER)
HONE NUMBER
To avoid payment delays, completed forms should be returned promptly to your local DOT office.