Attachment #1, Planning Application Template.pdf

FY 2022 Bridge Investment Program (BIP) Planning Projects

Application Template

This FY 2022 BIP Application Template is provided to assist project sponsors who intend to apply for a Planning FY 2022 BIP grant. Interested eligible applicants should read the FY 2022

BIP Notice of Funding Opportunity (NOFO) in its entirety and especially where noted in this application template to submit eligible and competitive applications.

Basic Project Information

Basic Project Information – Provide a narrative for the below items on basic details pertinent to the project, including project name, description, location, involved parties, etc. Items in this section will be used to determine grant program eligibility as detailed in Section C of the

NOFO.

Project Name

Project Description

Provide a concise description of the project, the transportation challenges that it is intended to address, and how it will address those challenges. This section should discuss the project’s history, including a description of any previously incurred costs. Applicants should describe the activities (planning, feasibility analysis, and revenue forecasting) the grant funding would be used to support the project’s development. The applicant may use this section to place the project into a broader context of other infrastructure investments being pursued by the project sponsor.

For each bridge that is part of the project, please indicate whether it is on the National Bridge Inventory under 23 U.S.C. 144(b).

State(s) in which project is located

Does the project serve an urban or rural community?

State whether the project serves an urban or rural community. In determining, the DOT will rely on the Census Bureau Census 2010 definition of Urbanized Area (UA) as an area that consists of densely settled territory that contains 50,000 or more people. Updated lists of

UAs are available on the Census Bureau website at http://www2.census.gov/geo/maps/dc10map/UAUC_RefMap/ua/. For the purposes of the BIP program, Urbanized Areas with populations of less than 50,000 will be considered rural.

Total Project Cost

(Estimated to include planning and construction costs)

Estimate in year-of-expenditure dollars: $____________ http://www2.census.gov/geo/maps/dc10map/UAUC_RefMap/ua/

Who is the Project

Sponsor?

(Name and identify which eligible applicant category applies. Select from the below statutory eligible applicants:

1. A State or a group of States;

2. A metropolitan planning organization that serves an urbanized area

(as designated by the Bureau of the Census) with a population over

200,000;

3. A unit of local government or a group of local governments;

4. A political subdivision of a State or local government;

5. A special purpose district or a public authority with a transportation function;

6. A Federal land management agency;

7. A Tribal government or a consortium of Tribal governments; and

8. A multistate or multijurisdictional group of entities as described above in 1 – 7.)

List all Project Co-

Applicants.

Identify the Lead

Applicant (who will be also the applicant responsible for administration of

BIP funds if application is selected and point of contact for the application.)

Was an application for USDOT discretionary grant funding for this project previously submitted?

(If Yes, please include project title, applicable grant programs and year.)

National Bridge Inventory Data

National Bridge Inventory Data - For each bridge included in the project description above, fill out the NBI data in the following form. For projects with multiple bridges, including those utilizing bridge bundling, this table should be duplicated and populated with data for each individual bridge. This data is used to support and verify statements made about the project in other sections in this application template as noted in Section D.2.d.II of the NOFO. Data, format and coding information can be downloaded from Download NBI ASCII files - National https://www.fhwa.dot.gov/bridge/nbi/ascii.cfm

Bridge Inventory - Bridge Inspection - Safety Inspection - Bridges & Structures - Federal

Highway Administration (dot.gov):

Identification

Item 1 – State Code & Name

Item 8 – Structure Number

Item 5A – Record Type

Item 3 – County Code & Name

Item 6 – Feature Intersected

Item 7 – Facility Carried

Item 16 - Latitude

Item 17 – Longitude

Item 98 – Border Bridge

Item 99 – Border Bridge

Structure Number

Classification

Item 112 – NBIS Bridge Length

Item 21 – Maintenance

Responsibility

Item 22 – Owner

Age and Service

Item 42 – Type of Service

Condition

Item 58 – Deck Condition

Item 59 – Superstructure

Condition

Item 60 – Substructure

Condition

Item 62 – Culverts

Geometric Data

Item 49 – Structure Length

Load Rating and Posting

Item 70 – Bridge Posting

Item 41 – Structure Open, Posted, or Closed to Traffic

Appraisal

Item 113 – Scour Critical

Bridges

Inspections

Item 90 – Inspection Date

Project Costs

Project Costs – Provide information detailing the costs associated with the planning project activities. These costs will be used to determine eligible award amount, how the project supports financial goals of the program, and other factors. Future cost data should be based on estimates for the planning project. Future costs for construction of a Large Bridge Project or

Bridge Project are not necessary for the DOT’s evaluation of BIP Planning grant. More information on this section can be found in Section D.2.d.III of the NOFO

BIP Request Amount Exact Amount in year-of-expenditure dollars: $____________

Estimated Total of Other

Federal funding

(excluding BIP Request)

Estimated Other Federal funding (excluding BIP) further detail

(List each Federal Program and identify Formula or

Discretionary and the amount for each Federal Program, e.g.

Program:_____________________________

Amount:_____________________________, and repeat for each source)

Estimated non- Federal funding

(Identify each source of non-Federal funding and estimated amount, e.g.

Source:_____________________________

Amount:_____________________________, and repeat for each source)

Total Planning Project

Cost

Project Outcome Criteria

Project Outcome Criteria – Provide narrative response how the project responds to the project outcome criteria in Section E.1.a of the NOFO. This section should elaborate on previously provided information to address the project selection criteria in more detail.

Criteria #1: BIP Program Goals

This planning project is envisioned to lead to a Bridge Project or a Large Bridge Project that would achieve one or more of the BIP program goals by…

Criteria #2: Project Description

This planning project will evaluate a bridge project that will…

Criteria #3: Project Schedule

Submit a detailed description of the current status of the planning process including all activities either completed or under way at the time of the submission of the BIP Planning grant application. Applications should include also a post-Planning grant schedule with the planned start and end dates of all major activities that will need to be completed from the end of the BIP

Planning grant through the completion of a BIP Bridge Project or Large Bridge Project, including but not limited to environmental review, design, and construction.

Criteria #4: Project Budget

Describe, in detail, the proposed planning project budget.

Planning Priority Considerations

Planning Priority Considerations: Does the application support any of the DOT Planning

Priority Considerations listed in Section E.2.a of the NOFO? If the application supports one or more of the considerations for the FY22 submissions, describe which consideration(s) it supports and how. In the discussion below, reference to previous sections in which additional information was detailed to support the consideration(s).

This application supports the following priority considerations by…