ohv-ccs commitment document.docx

BLM-ALASKA CHALLENGE COST SHARE PROGRAM

CCS COMMITMENT DOCUMENT FOR ASSISTANCE AGREEMENT APPLICATIONS

The form is intended to confirm and verify future cooperator participation in a Challenge Cost Share (CCS) project, and to outline the cost share matching responsibilities of both the BLM and the Partner.

1. PROJECT INFORMATION. (PRE-POPULATED BY BLM)

Project Title: Challenge Cost Share –Alaska Off Highway Vehicle Safety and Education Project BLM BPS Number:

Brief project description: BLM-RFA-L12AS00033 This project will develop educational materials that will promote safe trail use and stewardship of public lands in Alaska.

2. BLM CONTACT INFORMATION. (PRE-POPULATED BY BLM)

. PARTNER INFORMATION.

Organization Name:

Project Contact Name: Title:

Address:

Telephone: E-mail:

4. PARTNER MATCH INFORMATION. This project has a minimum match requirement of one non-federal Partner dollar for each federal BLM dollar contributed. The BLM cannot contribute more than 50% of total costs of a CCS project. This includes the sum of BLM's in-kind and monetary contributions, excluding labor costs of permanent employees. The partner's match must be wholly non-federal in origin. If the Partner contributes other federal grants toward this project, they cannot be counted toward the Partner's match requirement. Furthermore, the Partner's match cannot be pledged toward any other federal cost share project, regardless of agency or program. This section documents the source and amount of the Partner's non-federal match. Please list all applicable sources.

Source #1 of Partner's Non-Federal Match: Amount:

Source #2 of Partner's Non-Federal Match: Amount:

Total:

Are any of the above amounts being pledged to another federal cost share project or program? No Yes

If the Partner will be contributing federal dollars toward completion of this project, please list the source and amount below:

Source #1 of Partner's Federal Contribution: Amount:

Is any of this Partner federal contribution being applied toward CCS match requirements? No Yes

CCS Commitment Document for Assistance Agreements (Continued)

5. Describe how the Partner will participate in and benefit from the success of this project.

6. PROJECT BUDGET SUMMARY. In the table below, the BLM and Partner should enter the total project costs as summarized in the corresponding ‘Subtotal’ rows from Section 8 Project Budget Worksheet.

Category

A BLM In-Kind[footnoteRef:1] [1: To be pre-populated by BLM. In-kind contributions are provided to the project directly by BLM without transferring funds to the Partner. BLM in-kind contributions cannot include permanent labor force personnel costs, fringe benefits, or indirect charges. Temporary (seasonal) labor is allowed.]

B BLM Funds[footnoteRef:2] [2: BLM funds are any agency funds transferred to the Partner via the Cost-Share Agreement. This includes funds originating from the Challenge Cost Share Program and all other BLM programs. ]

C BLM Total[footnoteRef:3] [3: The total amount of this column (C) must not exceed 50% of column G.]

(A+B)

D Partner In-Kind

E Partner Funds

F Partner Total[footnoteRef:4] [4: The total amount of this column (F) must meet or exceed 50% of column G .]

(D+E)

G Total Contributions (C+F)

A. Personnel

B. Fringe Benefits

N/A

N/A

N/A

C. Consultant Fees

D. Travel and Per Diem

E. Supplies and Materials

F. Equipment

G. Construction

H. Other (describe)

I. Indirect Charges

N/A

N/A

N/A

TOTAL PROJECT COSTS.

7. AUTHORIZED SIGNATURES

Partner Authorized Official Name (printed):

Signature: ________________________________________________________ Date: _______________________

Title: Phone:

Signed Last:

BLM Manager Name (printed):

Signature: ______________________________________________________ Date:

Title: Phone:

8. PROJECT BUDGET WORKSHEET AND TOTAL PROJECT COSTS.

In the worksheet below, the Partner must detail the contributions to the total project costs by major expense categories. Each cost item must clearly show how the total cost for that item was determined. BLM will pre-populate the BLM In-kind fields. Expand the fields as necessary. Each subtotal entered on this worksheet must be carried forward to the appropriate line in Section 6.

Please note: All BLM contributions applied toward total project costs must be disclosed in this worksheet and receive a 1:1 Partner match with non-federal dollars. Partner may not use federal funds from any source for any portion of their match. All contributions by BLM and the Partner must occur during the project period, which begins when the agreement is signed by both parties.

A. Personnel. Provide the names and titles of key project personnel. Please note that the salaries of permanent federal employees cannot be paid with CCS funds, or be included as match/cost share.

Name/Title of Position

Wage or Salary $

Total $

Subtotal

B. Fringe Benefits. If more than one rate is used, list each rate and the wage or salary base.

Rate

Salary or Wage $

% of

N/A

N/A

N/A

N/A

N/A

C. Consultant Fees. This should include payments for professional and technical consultants participating in the project.

Name and Type of Consultant

# of Days

Daily Rate of Compensation $

PROJECT BUDGET NARRATIVE WORKSHEET (continued)

D. Travel and Per Diem. Indicate the number of persons traveling, the total days they will be in travel status, and the total subsistence and transportation costs.

From/To

# of People

# of Travel Days

Subsistence Costs (Lodging & Per Diem) $

Transportation Costs (Airfare & Mileage) $

Subtotal

E. Office Supplies and Materials. Include consumable supplies and materials to be used in the project and any items of expendable equipment, i.e., equipment costing less than $5,000 or with an estimated useful life of less than two years. Equipment costing more than that should be listed in the Equipment category (Category F, below).

Item

Cost $

Subtotal

F. Equipment. List all equipment items in excess of $5,000. Items worth less than $5,000 or that have a useful life of less than two years must be listed in the Supplies and Materials category (Category E, above).

PROJECT BUDGET NARRATIVE WORKSHEET (continued)

G. Construction/Conservation Materials.

Cost

H. Other (please describe). (Example: Transportation costs of equipment or materials to the project site.)

I. Indirect Rate (Partner Match Only)

1 To be pre-populated by BLM. In-kind contributions are provided to the project directly by BLM without transferring funds to the Partner. BLM in-kind contributions cannot include permanent labor force personnel costs, fringe benefits, or indirect charges. Temporary (seasonal) labor is allowed.