2020 GeneralMMGrantApplication.pdf

State of Oregon Department of Environmental Quality

2020 Materials Management Grant Program Materials Management Grant Application

Application sections:

General Information Applying Entity’s Culture Applying Entity’s Project Details Budget Timeline Nonprofit and Small Business Supplemental Questions Tribe, Government and School Supplemental Questions Signatures Reminders

General information Name of applicant: Federal taxpayer ID #: Dun & Bradstreet D-U-N-S #:

Type of applicant:

☐ Local Government ☐ Nonprofit (must attach as reference piece proof of 501(c)(3) and (c)(4) status) ☐ Tribal Nation ☐ Organizations created through intergovernmental agreements ☐ Public School, Public university or Community College (for a food waste prevention project) ☐ Small business (50 employees or less)

Do you have a certification with the office for business inclusion and diversity (COBID)? Yes ☐ No ☐ If yes, which one:

Organization address:

County:

State Legislative Districts (one district only): Indicate district numbers where project is based, not of project reach.

House: Senate:

(For help with your Senate and House Districts, see: http://bluebook.state.or.us/state/legis/legis.htm)

Phone: Website:

Contact person: Title:

Mailing Address (if different from above):

Applications must be received by 11:59 p.m. PDT, Oct. 30, 2020

Updated Sept. 18 https://www.dnb.com/duns-number/get-a-duns.html http://www.oregon4biz.com/How-We-Can-Help/COBID/ http://bluebook.state.or.us/state/legis/legis.htm mdiodat Highlight

Phone: Email:

Name of project or plan:

Amount requested from DEQ (this must match the total indicated in budget section):

Total cost of project:

Matching funds (not required):

Yes ☐ No ☐

If applicable, amount of matching funds:

How did you learn about this opportunity? Click all that are appropriate.

☐ Colleagues, partners ☐ Word of mouth ☐ Chamber of Commerce ☐ Social media ☐ Email ☐ Seen or received flyer online ☐ DEQ staff directly ☐ GovDelivery/subscription to DEQ email list ☐ Other:

Did you receive a Materials Management grant in the past? Yes ☐ No ☐

• Is your project complete? Yes ☐ No ☐

• If so, provide the grant agreement number here (whether project is completed or not):

Is this a Focus Area proposal? Yes ☐ No ☐

• Focus Area Proposal are projects that increase or improve online or other access to activities that reduce the environmental and human health impacts of materials (materials management activities).

Access must comply with state COVID-19-related guidelines and restrictions. Additional points will be awarded for projects that increase or improve access for historically marginalized communities.

If a Focus Area proposal, describe how your project meets the requirements for the Focus Area. (2000 character limit with spaces) https://govstatus.egov.com/or-covid-19

Will you use a subcontractor? Yes ☐ No ☐ If yes, fill out subcontractor information below:

Subcontractor name, if known: Contact person:

Contact person title:

Mailing address: Email address:

Phone:

Web address:

Applying entity’s culture

Refer to the instructions for assistance and additional details. All questions have a set limit of characters;

respecting the character limits is strongly recommended. Please see instructions for additional aid.

Question A. Values What are your organization’s mission and core values? In what ways are your mission and/or core values linked to diversity, equity and inclusion? (2000 character limit with spaces)

Question B. Accountability How does your organization hold itself accountable for racial equity, diversity, and inclusion?

(2000 character limit with spaces)

Question C. Training What informal or formal training is provided to staff and leadership to learn about racial equity, diversity, and inclusion? Please be as descriptive as possible. (3000 character limit with spaces).

Question D. Sustainability What does sustainability mean to your organization? How do you put it into practice? (3000 character limit with spaces)

Applying entity’s project details

Question 1. Project description

a) Provide a project/plan description. What environmental need does this project address? Does it address economic and environmental needs as well? (3500 character limit with spaces)

b) Where will this project be implemented? (e.g., cities, counties, statewide) (1000 character limit with spaces)

c) What are the goals of the project and how will the project success be measured? Describe if your outcome measurement tools are culturally responsive to the population to be served, such as describing strengths and challenges of the outcome measurement tools for the population. (3500 character limit with spaces)

Question 2. Project resources and commitment

a) Identify the key people who will be involved in developing and implementing the project and describe their roles. The personnel and supplies mentioned in your budget, later in the application, must be mentioned here, so DEQ understands the link between what is being funded in your budget and your project. In addition, explain the stakeholders or community support. (3000 character limit with spaces)

b) If applicable, provide a list of in-kind contributions to the project. (2000 character limit with spaces)

Question 3. Potential for Project Continuity/Ongoing Benefits Describe how this project will achieve benefits beyond the grant period. (2000 character limit with spaces)

Budget

(A) Personnel Costs - List key people of your organization who will be working on the project. Include their names, titles, salaries and costs of benefits, such as quoted payments for insurance, retirement, social security, etc. Include the indirect cost rate, which is expected to be included in your budget. Please give subtotals of funds requested, matching funds, and total costs in the spaces provided.

DEQ will compare the budget wages to the current minimum wage or prevailing wage for your region and industry. If you are budgeting a “trainee/apprenticeship wage”, explain below the table what wage you plan to eventually assign to the trained staff.

List Project Personnel Name, Title

Hourly Rate Including Benefits

Est.

Hours on Project

DEQ Grant Funds Requested per person

Matching Funds

(if applicable) Total Costs

1.

2.

3.

4.

5.

6.

SUBTOTAL

Source of matching funds:

Have you provided documentation of matching funds? ☐ Yes ☐ Not applicable

If applicable, add details to accompany this budget table. (1000 character limit with spaces)

Complete all sections of the budget. “Matching Funds" are cash contributions ONLY, used to support the grant project. (“In-kind contributions” such as office space, goods or services, and labor should NOT be reported here, but listed in Question 2b) above.) Please note: any matching funds from local governments, partners, or other sources that may potentially be funds that came from the federal government MUST be disclosed.

(B) Professional Services - List consultants, subcontractors, etc. Please give subtotals of funds requested, matching funds, and total costs in the spaces provided. If matching funds are claimed, state the source and attach documentation.

List Consultants or Contractors Name, Title

Hourly Rate Est. Hours on Project

DEQ Grant Funds

Requested

Matching Funds

(if applicable) Total Costs

1.

2.

3.

4.

SUBTOTAL

Source of matching funds:

(C) Services and Supplies - Include items not listed in “Personnel Costs” and “Professional Services.”

Examples are computer services, materials/supplies, postage, publication charges, telephone, fuel, travel, etc. Please review the standard Materials Management Grant Agreement for more information regarding State of Oregon travel reimbursement policy. The services and supplies listed in this section should be discussed (at a minimum) in your answers to Question 2(a) above. If you need to clarify further, you may provide additional information below. Please give subtotals for funds requested, matching funds, and total costs. If matching funds are claimed, state the source and attach documentation.

List Services and Supplies DEQ Grant

Funds Requested

Matching Funds

(if applicable) Total Costs

1.

2.

3.

4.

5.

6.

7.

8.

SUBTOTAL

Source of matching resources:

Additional Information (1000 character limit with spaces):

https://www.oregon.gov/deq/FilterDocs/mm-grantagreementtemplate.pdf

(D) Equipment and Infrastructure – List all items to be purchased with a value greater than $5,000. Include equipment, land, structures, and items pertaining to them. Give subtotals of grant funds requested, matching funds, and total costs in the spaces provided. If matching funds are claimed, state the source and attach documentation. For equipment, provide at least a single bid or specification sheet that demonstrates the anticipated cost. For real estate, provide the address and a copy of the listing, showing the asking price. If matching funds are claimed, state the source and attach documentation.

List Equipment Items DEQ Grant

Funds Requested

Matching Funds

(if applicable) Total Costs

1.

2.

3.

4.

SUBTOTAL

(E) Project Budget Summary - Fill in all applicable spaces. Please total grant funds requested, matching funds, and total costs.

Project Budget and Summary DEQ Grant

Funds Requested

Matching Funds

(if applicable) Total Costs

A. Personnel Costs

B. Professional Services

C. Services and Supplies

D. Equipment and Infrastructure

E. Total DEQ Grant Funds Requested

F. Total Matching Funds Committed to the Project

G. Total Project Cost

Timeline

Project Work Plan and Schedule Please identify all major activities required for project completion to the best of your capacity considering these unprecedented times. Include dates for progress reports and the final report. You may add additional lines as necessary. Note that it can take one to six months from the time a grant is awarded to the time a grant agreement is signed and funds are available, please consider this timing when developing your project timeline and your project’s anticipated start date. Only expenses incurred after the grant agreement is signed and incurred during the term of the agreement are eligible for grant funds, unless expressly agreed in the grant agreement. Keep this task list concise.

☐ My organization has the financial resources to make purchases eligible for reimbursement. I understand reimbursements may approximately take 6 weeks or longer.

Anticipated project start date (recommended to not put anything before Feb. 1, 2021):

Anticipated project end date:

Task or Activity Beginning Date Ending Date Person/Group Responsible for

Completion

Non-profit organization and small business supplemental questions Complete this section only if the APPLICANT is a nonprofit organization or small business (does not apply to non-profit subcontractors to local governments).

1. Financial statements

a. Does your organization have an independent audit of its financial statements conducted annually?

Yes ☐ No ☐

If no, why doesn’t your organization have audited financial statements? (1000 character limit with spaces)

b. If yes, what opinion did the auditor report? (Unqualified or “Clean”) (A ‘clean’ audit report means the auditors have provided an Unqualified Opinion. That means the financial statements were presented in accordance with GAAP (Generally Accepted Accounting Principles), and there were no reported material weaknesses with the data presented or with the internal controls of the entity.)

Unqualified (or “Clean”) Finding other than Unqualified (or “Clean”)

For findings other than “Clean,” what were those findings and what steps are being taken to address audit issues? (1000 character limit with spaces)

c. If you have received previous grant or contract awards from DEQ, please provide the contract/ document numbers.

2. Financial management controls Describe briefly your financial management and accounting procedures:

Include: (1500 character limit with spaces)

• Your financial management structure (i.e., who has control of finances), including the roles and responsibilities of those (including Board members) involved, and your financial reporting systems and policies.

• Financial controls (e.g., expense tracking and approval procedures, and separation of duties)

• Systems for monitoring project finances (e.g., reports or software that provide an overview of current financials against project budgets).

3. Revenue Describe your organization’s primary sources of revenue for the last three years.

What percentage of your annual revenue for each of the last three years was supplied by your largest three revenue sources (e.g., largest donors, grantors, fees for service, etc.)? (1000 character limit with spaces)

4. Financial records Attach copies of the following for the most recent three years, or all available if the organization is less than three years old. Examples:

• Income statements

• IRS Form 990

• Profit & Loss statements

I have attached final records copies to this application: Yes No

5. Indirect costs (overhead) If your organization is charging an indirect cost rate, what is your rate? Charging an indirect cost rate is expected.

☐ Not Applicable Please note: If your organization is charging an indirect rate, that indirect rate CANNOT be greater than 10%, unless you have a negotiated indirect rate with the federal government. If you have a negotiated agreement with the Federal Government, please supply executed letter with Federal Agency.

Additionally, the indirect rate that is charged to DEQ cannot be higher than what is charged against any other provider of funding.

6. References

Provide three former/current grantor references or partner references. Include name, title, email address and telephone number, along with a one sentence summary of the work performed with the grant funding.

Reference 1 Reference 2 Reference 3 Grantor/Partner

Contact Name

Title

Email

Phone

Work Performed

7. Support of local jurisdictions

It is not mandatory, but DEQ encourages applying entities to learn about their local government’s current objectives and plans. Maybe your city or county is working within a similar industry as your project. If so, it is important to complement each other’s efforts. Did you explore your city’s or county’s solid waste management or materials management plan? Describe your efforts to seek support from jurisdictions within the service area of your project and the outcome of those contacts. Letters of support from local governments in the service area of your proposed project are highly recommended.

(1500 character limit with spaces)

Tribe/government/schools supplemental questions Only complete this section if the APPLICANT is a tribe, government or school.

1. When was your last independent audit? (1000 character limit with spaces)

2. What opinion did the auditor report?

(A ‘clean’ audit report means the auditors have provided an Unqualified Opinion. That means the financial statements were presented in accordance with GAAP (Generally Accepted Accounting Principles), and there were no reported material weaknesses with the data presented or with the internal controls of the entity.)

Unqualified (or “Clean”) Finding other than Unqualified (or “Clean”)

For findings other than “Clean,” what were those findings and what steps are being taken to address audit issues? (1000 character limit with spaces)

3. If you have received previous awards from DEQ, please provide the grant contract numbers.

Not applicable

4. If your organization is charging an approved indirect cost rate, what is your rate?

Not applicable

Signatures Authorized Representatives of the applicant must sign the application. An Authorized Representative is an official who has the authority to obligate the applicant’s resources. All necessary Authorized Representative signatures must be provided at the time of the grant application submittal for your project to be considered.

I certify that, to the best of my knowledge, the information provided in this application and attachments is correct. I understand and agree that if grant money is awarded as a result of this application, I will comply with all applicable statutory provisions and with applicable terms, conditions, and procedures of the DEQ grant agreement.

Signature of Authorized Representative Date

Title Telephone Number

Signature of Authorized Representative Date

Title Telephone Number

Signature of Authorized Representative Date

Title Telephone Number

Scan signed page and attach to completed application form prior to emailing.

Is your application complete?

Ensure that you have a complete application package, including:

Tribe/Government/School Checklist Nonprofit Checklist Small Business Checklist

Obtained Dun & Bradstreet D-U-N- S® Number

Obtained Dun & Bradstreet D-U-N- S® Number

Obtained Dun & Bradstreet D-U-N- S® Number

All applicable questions answered All applicable questions answered All applicable questions answered

Bids, specification sheets, or required real estate listing information for any capital expenditures of $5,000 or more

Documentation confirming your nonprofit official status

Bids, specification sheets, or required real estate listing information for any capital expenditures of $5,000 or more

Budget, including matching funds and source (matching fund are not required, but good to have)

Bids, specification sheets, or required real estate listing information for any capital expenditures of $5,000 or more

Budget, including matching funds and source (matching fund are not required, but good to have)

If applicable, documentation of matching funds (see acceptable documents to ensure compliance)

Budget, including matching funds and source (matching fund are not required, but good to have)

If applicable, documentation of matching funds (see acceptable documents to ensure compliance)

Project work plan and schedule If applicable, documentation of matching funds (see acceptable documents to ensure compliance)

Project work plan and schedule

Tribe, Government and School Supplemental Questions Answered

Project work plan and schedule

Nonprofit/Small Business Supplemental Questions answered

If applicable, letter of commitment from project partners, including any resource contributions

Nonprofit/Small Business Supplemental Questions answered

If applicable, letter of commitment from project participants, including any resource contributions

If applicable, letters of support from community and stakeholders

If applicable, letter of commitment from project participants, including any resource contributions

If applicable, letters of support from community and stakeholders

If applicable, documentation of your organization’s indirect cost rate

If applicable, letters of support from community and stakeholders

Letters of local government support, if applicable and available

Required signatures scanned and attached to electronic document

Letters of local government support, if applicable and available

List of reference contacts, if applicable

W-9 form, if you are a new applicant or the FEIN has changed

List of reference contacts, if applicable

Required financial statements from last 2 years (e.g. profit and lost statement)

Required annual income statements and IRS Form 990 (three most recent for both

If applicable, documentation of your organization’s indirect cost rate

If applicable, documentation of your organization’s indirect cost

Required signatures scanned and attached to electronic document

Required signatures scanned and attached to electronic document

W-9 form, if you are a new applicant FEIN has changed

W-9 form, if you are a new applicant FEIN has changed

Ready to submit?

Attach the completed Application form and all required documents to an email, and send to:

mmgrants2020@deq.state.or.us

If you are having problems submitting electronically, please contact your DEQ Headquarters staff listed on page 10 of the Project Grant instructions before 5 p.m. PDT on Oct. 30, 2020. Applications must be received by 11:59 p.m. (PDT), Oct. 30, 2020.

Applicants are encouraged to participate to the conference call DEQ is hosting to answer any questions about the application document on Tuesday, Aug. 4, 2020, from 1 – 2 p.m. for the general public and Tuesday, Aug. 11, 2020, from 10 – 11 a.m. for Oregon Tribes. The webinar link is on the DEQ website here. You will be able to find the recording of the webinar on the website as well.

Applicants are encouraged to submit their application before the due date and confirm receipt with DEQ staff listed in the grant application instructions. The email subject line format should be “[organization name] project grant application.”

Emails have a 10MB limit. If your application exceeds 10MB, submit it in parts. Add to the subject line “Part 1 of (total number of parts),” “Part 2 of (total number of parts)” etc. Please confirm list the items you are attaching to the email in the email body, list all attachments that are included in the email.

mailto:mmgrants2020@deq.state.or.us https://www.oregon.gov/deq/mm/Pages/Grants.aspx mdiodat Highlight

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