AIC 2021 Application Template.docx

United States Department of Agriculture Rural Development Rural Business-Cooperative Service Agriculture Innovation Center Program

CLICK TO ENTER THE TITLE OF THE PROPOSED PROJECT

Click to enter the name of the applicant Click to enter the street address Click to enter the city, Click to enter the state Click to enter the zip code Click to enter the name of the contact person Click to enter the contact’s email address

Click to enter the date submitted

Table of Contents

EXECUTIVE SUMMARY

Click to enter your Executive Summary here. Briefly describe your proposed Project, tasks to be completed, and other relevant information that provides a general overview of the Project.

GOALS OF THE PROJECT

Listing of Producer Services

Click to enter a listing of Producer Services that will be provided by the Center.

Goals

Identify one goal related to increasing and improving the ability of local agricultural producers to develop a market or process for Value-Added agricultural commodities or products.

Click to enter your goal here.

Identify any other goals of your project here.

Click to enter other project goals here.

SCORING CRITERIA

ABILITY TO DELIVER

Unique Abilities Click to enter a description of the Center’s unique abilities to deliver Producer Services.

Expected Sustainability of the Value-Added Ventures Supported by the Project Click to enter a description of the expected sustainability of the value-added ventures that will be supported by the Project.

Transferability of Abilities Click to enter a description of how the abilities described above are transferable.

Plans to Accomplish Work Click to enter a description of how the Center will accomplish its work. We recommend that you link the services you will provide to your project goals from above and explain how the results of the project will be measurable and attainable during the proposed project period.

SUCCESSFUL TRACK RECORD

WORK PLAN

Work Plan Narrative

Overview of Work Plan Click to enter an overview of your work plan. We recommend including a description of how your Center will begin operation (if applicable), how it will market its services (including customer identification), and how it will provide its services.

Task 1: Click to enter the name of Task 1

Task 1 Description Click to enter the description of Task 1.

Task 1 Objective Click to enter the objective of Task 1.

Task 1 Potential Outcomes Click to enter the potential outcomes of Task 1.

How Task 1 Connects to the Goals of the Project Click to describe how Task 1 connects to the goals of the project.

Task 2: Click to enter the name of Task 2.

Task 2 Description Click to enter the description of Task 2.

Task 2 Objective Click to enter the objective of Task 2.

Task 2 Potential Outcomes Click to enter the potential outcomes of Task 2.

How Task 2 Connects to the Goals of the Project Click to describe how Task 2 connects to the goals of the project.

Task 3: Click to enter the name of Task 3

Task 3 Description Click to enter the description of Task 3.

Task 3 Objective Click to enter the objective of Task 3.

Task 3 Potential Outcomes Click to enter the potential outcomes of Task 3.

How Task 3 Connects to the Goals of the Project Click to describe how Task 3 connects to the goals of the project.

Task 4: Click to enter the name of Task 4

Task 4 Description Click to enter the description of Task 4.

Task 4 Objective Click to enter the objective of Task 4.

Task 4 Potential Outcomes Click to enter the potential outcomes of Task 4.

How Task 4 Connects to the Goals of the Project Click to describe how Task 4 connects to the goals of the project.

Task 5: Click to enter the name of Task 5

Task 5 Description Click to enter the description of Task 5.

Task 5 Objective Click to enter the objective of Task 5.

Task 5 Potential Outcomes Click to enter the potential outcomes of Task 5.

How Task 5 Connects to the Goals of the Project Click to describe how Task 5 connects to the goals of the project.

Task 6: Click to enter the name of Task 6

Task 6 Description Click to enter the description of Task 6.

Task 6 Objective Click to enter the objective of Task 6.

Task 6 Potential Outcomes Click to enter the potential outcomes of Task 6.

How Task 6 Connects to the Goals of the Project Click to describe how Task 6 connects to the goals of the project.

Work Plan Chart

Task 1: Name

Task 2: Name

Task 3: Name

Task 4: Name

Task 5: Name

Task 6: Name

Budget Justification

Budget Chart

Salaries and Wages

Fringe Benefits

Travel

Supplies

Contractual

Other

Total Direct Charges

Indirect Charges

Total Charges

Program Income

Salaries and Wages Expenses Narrative Click to enter the name of each staff member, their position, and how much they will be paid.

Fringe Benefits Expenses Narrative Click to enter a description of how fringe benefits are calculated and what benefits are included.

Travel Expenses Narrative Click to enter the specific trips that will be taken, who will be traveling, and the reason for the travel.

Supplies Expenses Narrative Click to enter what items are included in supplies. These expenses must not be included in the indirect cost pool. They include items such as laptops, printers, and office supplies that do not meet the definition of Equipment.

Contractual Expenses Narrative Click to enter the contractors by name (if known) as well as the amounts expected for each contract and the purpose of each contract. If you are planning to make mini-grants of $5,000 or less to agricultural producers, include that amount here.

Other Expenses Narrative Click to enter expenses that do not fit into another category. An example is participant support costs.

Indirect Expenses Narrative Click to enter your indirect costs, if applicable.

Matching Funds Narrative Click to enter a description of your matching funds, including the source of funds and what types of expenses the matching funds will be used for.

Program Income Narrative Click to enter a description of how program income will be calculated and earned, if applicable. Note that if you are charging fees for services provided, you must address program income.

QUALIFICATIONS OF KEY PERSONNEL

Key Personnel 1: Click to insert name

Description of relevant skills and abilities Click to enter the description

Number of years of experience Click to enter the number of years of experience

Number of times assistance was provided Click to enter the number of times assistance was provided

Outcomes of assistance provided Click to enter the outcomes of the assistance provided

Total hours contributed to the project Click to enter the total hours contributed to the Project

Employer during the project (choose Center or Contractor) ☐ Center ☐ Contractor

Key Personnel 2: Click to insert name

☐ Contractor

Key Personnel 3: Click to insert name

☐ Contractor

Key Personnel 4: Click to insert name

☐ Contractor

Key Personnel 5: Click to insert name

☐ Contractor

Key Personnel 6: Click to enter name

☐ Contractor

LOCAL SUPPORT

List of supporting organizations (Letters of Support are attached as separate files to the grants.gov submission.)

Developmental Organization in the Service Area Click to add the name of the developmental organization

State Institution Click to add the name of the State institution

Tribal Institution Click to add the name of the Tribal institution

Local Institution Click to add the name of the local institution

Recognition of rural values Click to describe how the support listed above includes recognition of rural values that balances employment opportunities with environmental stewardship and other rural amenities.

FUTURE SUPPORT

Specific Plan for Obtaining Future Funding for the Center Click to describe the plan for obtaining future funding for the Center.

Diversification of Funding Sources

Name of Organization

Amount of Funds Committed Expected Time Period for Commitment

Purpose for which Funds Can Be Used

How In-House Capacity for Providing Technical Assistance Will Be Improved Click to describe how in-house capacity for providing technical assistance will be improved.

APPENDIX A: SF-424, “APPLICATION FOR FEDERAL ASSISTANCE”

(electronically submitted through Grants.gov)

APPENDIX B: FORM SF-424A, “BUDGET INFORMATION—NON-CONSTRUCTION PROGRAMS”

(electronically submitted through Grants.gov)

APPENDIX C: CERTIFICATION ON FEDERAL JUDGMENTS

[Click to insert the name of the applicant organization] certifies that the United States has not obtained an unsatisfied judgment against its property, is not delinquent on the payment of Federal income taxes, or any Federal debit, and will not use grant funds to pay any judgments obtained by the United States.

APPENDIX D: CERTIFICATION ON LOBBYING

Certification for Contracts, Grants, Loans, and Cooperative Agreements

The undersigned certifies, to the best of his or her knowledge and belief, that:

(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions.

(3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.

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 section 1352, title 31, U.S. Code. Any person who fails 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.

Name of Applicant: Click to enter the name of the applicant

Name of Authorized Representative: Click to enter the name of the authorized representative

APPENDIX E: FINANCIAL CAPABILITY

End-of-Year Current Ratio (from most recent audit)

Current Assets: Click to insert amount of current assets Current Liabilities: Click to insert amount of current liabilities Current Ratio: Click to insert current ratio

End-of-Year Cash on Hand (from most recent audit)

Amount of Cash on Hand: Click to insert amount of cash on hand at the end of the fiscal year

(Audit is attached as a separate file in Grants.gov submission)

APPENDIX F: APPLICANT ELIGIBILITY

Choose one:

☐ The applicant is a Local Government The legal citation that authorizes the organization is: [Click to insert legal citation]. A copy of the text is attached as a separate file to the Grants.gov submission.

☐ The applicant is a State Government The legal citation that authorizes the organization is: [Click to insert legal citation]. A copy of the text is attached as a separate file to the Grants.gov submission.

☐ The applicant is a Federally-Recognized Indian Tribe The legal citation that authorizes the organization is: [Click to insert legal citation]. A copy of the text is attached as a separate file to the Grants.gov submission.

☐ The applicant is a Nonprofit Organization The organization’s Certificate of Good Standing and Articles of Incorporation are attached as separate files to the Grants.gov submission.

☐ The applicant is a For-Profit Corporation The organization’s Certificate of Good Standing and Articles of Incorporation are attached as separate files to the Grants.gov submission.

☐ The applicant is an Institution of Higher Education The legal citation that authorizes the organization is: [Click to insert legal citation]. A copy of the text is attached as a separate file to the Grants.gov submission.

APPENDIX G: VERIFICATION OF MATCHING FUNDS

AGRICULTURE INNOVATION CENTER PROGRAM

VERIFICATION OF MATCHING FUNDS

For the purposes of carrying out the Work Plan identified in our application for the Agriculture Innovation Center Program, I verify the following information:

Legal Name of Applicant:

Proposed Start Date: Proposed End Date:

Total Project Cost: $ Matching Funds: $

As applicable, identify all sources, amounts, and uses of matching funds that your organization currently has available and committed to AIC project expenditures during the period of performance. If funds are being provided by a third party, a letter signed by the authorized representative of the organization that identifies the amount, use of funds, and time period of availability is attached as a separate file to the Grants.gov submission.

☐ Our Board of Directors has formally resolved/confirmed the matching funds amount to be contributed by this organization on [DATE].

☐ I/We do not need a resolution because it is not required by our governing body.

Click to enter the name of the authorized representative Name of Authorized Representative

APPENDIX H: GOVERNANCE STRUCTURE OF THE CENTER

Click to describe the governance structure of the Center. In particular, you must address how the Center carries out personnel decisions, including hiring and firing employees and contractors; sets its policies and procedures, including personnel and procurement; develops and approves its budget; and selects its own Board of Directors.

APPENDIX I: BOARD OF DIRECTORS

General Agricultural Organization (Most Members in the State)

Name of Organization: Click to enter the name of the organization Purpose of the Organization: Click to describe the purpose of the organization Number of Members in the State: Click to enter the number of members Name of Representative: Click to enter the name of the representative How did you determine this organization has the most members in your State?

Click to describe how you determined that the organization has the most members in your State

Note: The Letter of Commitment signed by the Representative is attached as a separate file to the Grants.gov submission.

General Agricultural Organization (Second Most Members in the State)

Name of Organization: Click to enter the name of the organization Purpose of the Organization: Click to describe the purpose of the organization Number of Members in the State: Click to enter the number of members Name of Representative: Click to enter the name of the representative How did you determine this organization has the second most members in your State?

Click to describe how you determined that the organization has the second most members in your State

Note: The Letter of Commitment signed by the Representative is attached as a separate file to the Grants.gov submission.

State Department of Agriculture OR State Legislator

Name of Representative: Click to enter the name of the representative Title and Job Responsibility OR District Represented: Click to enter title and job responsibility if the representative is from the State Department of Agriculture OR district represented if the representative is a State Legislator

Note: The Letter of Commitment signed by the Representative is attached as a separate file to the Grants.gov submission.

Agricultural Commodity Organization 1 Name of Organization: Click to enter the name of the organization Commodity Represented: Click to enter the commodity represented Name of Representative: Click to enter the name of the representative

Note the following:

1. The Letter of Commitment signed by the Representative is attached as a separate file to the Grants.gov submission.

2. Data from the State Department of Agriculture, or its equivalent, to demonstrate the commodity is produced in the State is attached as a separate file to the Grants.gov submission.

Agricultural Commodity Organization 2

Name of Organization: Click to enter the name of the organization Commodity Represented: Click to enter the commodity represented Name of Representative: Click to enter the name of the representative

Note the following:

1. The Letter of Commitment signed by the Representative is attached as a separate file to the Grants.gov submission.

2. Data from the State Department of Agriculture, or its equivalent, to demonstrate the commodity is produced in the State is attached as a separate file to the Grants.gov submission.

Agricultural Commodity Organization 3

Name of Organization: Click to enter the name of the organization Commodity Represented: Click to enter the commodity represented Name of Representative: Click to enter the name of the representative

Note the following:

1. The Letter of Commitment signed by the Representative is attached as a separate file to the Grants.gov submission.

2. Data from the State Department of Agriculture, or its equivalent, to demonstrate the commodity is produced in the State is attached as a separate file to the Grants.gov submission.

Agricultural Commodity Organization 4

Name of Organization: Click to enter the name of the organization Commodity Represented: Click to enter the name of the commodity represented Name of Representative: Click to enter the name of the representative

Note the following:

1. The Letter of Commitment signed by the Representative is attached as a separate file to the Grants.gov submission.

2. Data from the State Department of Agriculture, or its equivalent, to demonstrate the commodity is produced in the State is attached as a separate file to the Grants.gov submission.

APPENDIX J: EXISTING CAPABILITY TO PROVIDE SERVICES

NARRATIVE DESCRIPTION OF CAPABILITY

Click to describe the applicant organization’s capability of providing Producer Services OR if the applicant does not have at least three years of experience, you must describe the key personnel’s capability of providing Producer Services. This narrative must include a description of the services provided, the role of the applicant or the key personnel in providing the service, how many times it has been provided, and the outcomes of the services provided (preferably with quantitative measurements). You can choose to provide the information in the chart below rather than in a narrative description in this section.

CHART SUMMARY OF CAPABILITY

Type of Service Provided Time Period Provided Role of Center OR Key Personnel

Services Provided

APPENDIX K: SUPPORT OF THE AGRICULTURAL COMMUNITY

List of supporting organizations

Name of Agricultural Organization 1: Click to enter the name of the organization

Name of Agricultural Organization 2: Click to enter the name of the organization

Name of Agricultural Organization 3: Click to enter the name of the organization

Note: The Letters of Support are attached as separate files to the Grants.gov submission.

APPENDIX L: STRATEGIC COORDINATION AND ALLIANCES

Describe arrangements, including significant coordination, in place or planned with end users:

Click to enter the description

Describe arrangements, including strategic alliances, in place or planned with entities that have technical research capabilities:

Click to enter the description

Describe broad support from the agricultural community in your State or region:

Click to enter the description

Describe your delivery plan for reaching out to the producer community:

APPENDIX M: AUDIT

The applicant organization’s most recent audit is attached as a separate file to the Grants.gov submission.