Attachment #2, Bridge Project Application Template.pdf

FY 2022 Bridge Investment Program (BIP) Bridge Projects

Application Template

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

2022 BIP Notice of Funding Opportunity 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

Eligibility Criteria

Project Description

(Replacement, Rehabilitation, Preservation, or Protection projects, including bridge bundling and NBIS culvert replacement and rehabilitation)

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. 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).

BIP Request Amount

(minimum grant award is $2.5 million)

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

Total Project Cost (total project cost cannot exceed

$100 million for Bridge

Projects)

Estimate in year-of-expenditure dollars: $____________

Applicant: (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.)

Maintenance Commitment

Applicant must certify the completed project will be maintained, if a co-applicant will maintain the completed structure, the co-applicant provides the certification.

Bike and Pedestrian

Accommodation required by

23 U.S.C. 217(e)

Federal law provides that all projects with Federal financial participation that replace or rehabilitate a highway bridge deck are required to provide safe accommodation of pedestrians or bicyclists when two conditions are met. If bicyclists and pedestrians are allowed to operate at each end of the bridge, and the anticipated project will be for replacement or rehabilitation, the applicant must detail how bicyclist and pedestrian access is included in the project or provide FHWA with the information needed to determine whether or not such access can be provided at a reasonable cost.

Additional Project Information

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 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.

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.)

http://www2.census.gov/geo/maps/dc10map/UAUC_RefMap/ua/

Is the project located (entirely or partially) in Federal or

USDOT designated areas?

Yes/No. If yes, please describe which of the four Federally designated community development zones in which your project is located.

Opportunity Zones: (https://opportunityzones.hud.gov/) Empowerment

Zones: (https://www.hud.gov/hudprograms/empowerment_zones)

Promise Zones:

(https://www.hud.gov/program_offices/field_policy_mgt/fieldpolicymgt

pz) Choice Neighborhoods:

(https://www.hud.gov/program_offices/public_indian_housing/program s/ph/cn)

National Bridge Inventory Data

National Bridge Inventory Data - For each bridge on the project, 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 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

Classification

Item 112 – NBIS Bridge Length

Item 104 – Highway System of

Inventory

Item 26 – Functional

Classification

Item 110 – Designated National

Network

Item 21 – Maintenance

Responsibility

Item 22 – Owner

Age and Service

Item 27 – Year Built

Item 106 – Year Reconstructed

Item 42 – Type of Service

Item 28A – Lanes on the

Structure

Item 29 – Average Daily Traffic https://www.fhwa.dot.gov/bridge/nbi/ascii.cfm

Item 109 – Average Daily Truck

Traffic

Item 19 – Bypass, Detour

Length

Structure Type and Material

Item 43 – Structure Type, Main

Condition

Item 58 – Deck Condition

Item 59 – Superstructure

Condition

Item 60 – Substructure

Condition

Item 61 – Channel and Channel

Protection

Item 62 – Culverts

Geometric Data

Item 49 – Structure Length

Item 50 – Curd of Sidewalk

Widths

Item 51 – Bridge Roadway

Width, curb-to-curb

Item 52 – Deck Width, out-to-out

Item 32 – Approach Roadway

Width

Item 47 – Inventory Route, Total

Horizontal Clearance

Item 53 – Minimum Vertical

Clearance over Bridge Roadway

Item 54 – Minimum Vertical

Underclearance

Item 55 – Minimum Lateral

Underclearance on Right

Item 56 – Minimum Lateral

Underclearance on Left

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 Selection Criteria

Project Selection Criteria – Provide narrative response how the project responds to the project selection criteria in Section E.1.b of the NOFO. In responding to project selection criteria, refer to statutory selection criteria included in Section E of the NOFO and address them in the appropriate project selection criteria.

Criteria #1: State of Good Repair

This project contributes to the State of Good Repair criteria by…

For each bridge on the project, indicate the condition based on the NBI data provided.

Are the bridge(s) on the project in Fair condition? Yes/No.

If yes, please describe why the bridge(s) are at risk of falling into poor condition within the next three (3) years.

Criteria #2: Safety

This project contributes to the Safety criteria by…

Criteria #3: Mobility and Economic Competitiveness

This project contributes to the Mobility and Economic Competitiveness criteria by…

Criteria #4: Climate Change, Resiliency, and the Environment

This project contributes to the Climate Change, Resilience, and the Environment criteria by…

Criteria #5: Equity, Partnership, and Quality of Life

This project contributes to the Equity, Partnership, and Quality of Life criteria by…

Criteria #6: Innovation

This project contributes to the Innovation criteria by…

Project Costs

Project Costs – Provide information detailing the costs associated with the project. These costs will be used to determine eligible award amount, how the project supports financial goals of the program, and other factors. 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)

Estimate in year-of-expenditure dollars: $____________

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)

Future Eligible Project

Cost (Sum of BIP request, Other Federal Funds, and non-Federal Funds, above.

Previously incurred project costs (if applicable)

Total Project Cost (Sum of

‘previous incurred’ and

‘future eligible’

If more than one bridge, will bridge bundling be used to deliver the

Project?

Yes or No. If yes, explain the intended benefits of bridge bundling for this set of bridges.

If proposed project utilizes bundling, Cost of

Unbundled Projects

Estimate in year of expenditure dollars: $

Amount of Future Eligible

Costs by Project Type

Indicate Improvement Type by Structure Number (Bridge

Replacement, Bridge Rehabilitation, Bridge Preservation, Bridge

Protection, or Culvert Replacement or Rehabilitation) and amount per bridge (if bundling, include the unbundled cost in brackets[$__]1) (Ex.

Bridge Replacement Str. 001: $20,000,000[$25,000,000]

Bridge Replacement Str, 002, $15,000,000[$18,000,000]

Bridge Rehabilitation Str. 003, $5,000,000)[$5,500,000]

1. Bridge __________ Str. ________: $___________ [$____]

1 Costs of unbundled project will be compared with bundled costs to determine potential amount of cost savings and as a factor in the ability to unbundle bridges for an award

2. Bridge __________ Str. ________: $___________ [$____]

3. Bridge __________ Str. ________: $___________ [$____]

4. Bridge __________ Str. ________: $___________ [$____]

5. Bridge __________ Str. ________: $___________ [$____]

6. Will request $_____________ of the amounts awarded to the entity to pay subsidy and administrative costs necessary to provide to the entity Federal credit assistance under 23 U.S.C.

chapter 6.2

Benefit-Cost Analysis

Benefit Cost Analysis– Submit the requested information in Section D.2.d.V for the DOT to conduct a review of the benefit-cost analysis for the project and provide a summary of the analysis.

The benefit cost analysis demonstrates . . .

Project Readiness and Environmental Risk

Project Readiness and Environmental Risk– Submit the requested information in Section

E.2.b.iii for the DOT to conduct a review of the project readiness and environmental risk criteria for the project and provide a summary. If project includes multiple bridges, indicate the information for each bridge included in the application and what impact would occur on the timeframes if the project were unbundled.

Other Federal Funding and

Non-Federal Funding

Secured

Yes/No

NEPA Status – Indicate if the determination will likely be the result of a

Categorical Exclusion

(CE), Environmental

Assessment (EA), or

Environmental Impact

Statement (EIS)

Planned or Actual Start of NEPA Date: ________________

Planned or Actual Completion of NEPA Date:___________

Final NEPA Determination or current status of NEPA process:

2 Receipt of a BIP award does not guarantee that an applicant will receive TIFIA credit assistance, nor does it guarantee that any award of TIFIA credit assistance will be equal to 49% of eligible project costs. Receipt of TIFIA credit assistance is contingent on the applicant’s ability to satisfy applicable creditworthiness standards and other

Federal requirements.

Is the project currently programmed in the:

• TIP

• STIP

• MPO Long

Range

Transportation

Plan

• State Long Range

Transportation

Plan

Yes/No

(please specify in which plans the project is currently programmed, the year in which the project is currently programmed and provide the identifying number if applicable)

Is right-of-way acquisition necessary?

Yes/No

If Yes, Planned or Actual Start of Right-of-Way Acquisition

Date:_______________

Planned or Actual Completion of Right-of-Way Acquisition

Date:

Right-of way acquisition considerations.

If right-of-way must be acquired for the project:

1. Would right-of-way acquisition require relocation of any people or businesses? Yes/No.

2. If yes, are people or businesses being relocated members of traditionally underserved and underrepresented populations

(Environmental Justice communities)? If yes, please describe.

Design Status Planned or Actual Start of Preliminary Design

Date:_______________

Planned or Actual Completion of Preliminary Design

Date:__________

Planned or Actual Start of Final Design Date:_______________

Planned or Actual Completion of Final Design Date:__________

Anticipated Construction

Start Date:

Date:___________________________

Anticipated Project

Completion Date:

Date:___________________________

The summary on project readiness and environmental risk demonstrates…

Project Priority Considerations

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

Considerations – Bridge Projects listed in Section E.2.b of the NOFO? If the applications supports one or more of the considerations for the FY22 submissions, describe which consideration(s) is 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…