SDP_Application_Template_07-11-2018.docx

State Damage Prevention (SDP) Grant Word Template

Use this template to fill out the required text elements of your application as outlined in the Funding Opportunity Announcement Section D.2.

1. Insert your organization name on page 2.

2. Project Abstract/Statement of Objectives is required. (You may copy/paste from another document or type directly into the space provided.)

3. You must address all nine elements. There are 5 sections for each element – sections 1 and 2 are required, sections 3,4 and 5 are required *only* if your proposal addresses that element. (You may copy/paste from another document or type directly into the space provided.)

4. Legislative/Regulatory Actions is required. (You may copy/paste from another document or type directly into the space provided.)

5. You must attach this document to your grants.gov forms package.

6. You must mail a hardcopy of your application to the address on page 2 which includes the signature page.

2018 State Damage Prevention Grant Application

The ____ {your organization name} __________hereby applies to the Department of Transportation for Federal funds appropriated for the support of Programs established under 49 U.S.C. Section 60134 et seq.

The State agency plans to carry out the Program, during fiscal year 2018, as described in the "Project Abstract/Statement of Objectives". To accomplish the program, the state agency proposes to expend funds as set forth in the "State Damage Prevention Estimated Budget."

Authorized Signature:____________________________

Title:_____________________________________

Date:_____________________________________

Please print, sign, scan, and email to:

Brandon Beyer Contract Specialist

(202) 366-5513 brandon.beyer@dot.gov

Project Abstract/Statement of Objectives

Please provide a clear and concise description of the work this grant will fund for fiscal year 2018

{type or insert your Project Abstract here}

ELEMENT 1 - EFFECTIVE COMMUNICATIONS

"Participation by operators, excavators, and other stakeholders in the development and implementation of methods for establishing and maintaining effective communications between stakeholders from receipt of an excavation notification until successful completion of the excavation, as appropriate."

1.1 Does the proposed project address this element? (Required – Yes or No)

1.2 Describe any existing state-wide initiatives that support this element: (Required) type or insert text here

1.3 Describe how the proposed project will enhance or continue implementation of this element. If you received funding in previous years for a project that is ongoing and are requesting grant funding for the continuation of that project, provide a summary of accomplishments and tasks completed during the previous grant period. The information provided should include measurable results and deliverables, and also include any information about tasks that were not completed or other challenges encountered during the grant period: (Required only if proposal addresses this element)

1.4 Estimated budget for this element: (Required only if proposal addresses this element)

j. Indirect Charges:

1.5 Budget Narrative for this element: (Required only if proposal addresses this element)

ELEMENT 2 – COMPREHENSIVE STAKEHOLDER SUPPORT

"A process for fostering and ensuring the support and partnership of stakeholders, including excavators, operators, locators, designers, and local government in all phases of the program."

2.1 Does the proposed project address this element? (Required – Yes or No)

2.2 Describe any existing state-wide initiatives that support this element: (Required)

2.3 Describe how the proposed project will enhance or continue implementation of this element. If you received funding in previous years for a project that is ongoing and are requesting grant funding for the continuation of that project, provide a summary of accomplishments and tasks completed during the previous grant period. The information provided should include measurable results and deliverables, and also include any information about tasks that were not completed or other challenges encountered during the grant period: (Required only if proposal addresses this element)

2.4 Estimated budget for this element: (Required only if proposal addresses this element)

j. Indirect Charges:

2.5 Budget Narrative for this element: (Required only if proposal addresses this element)

ELEMENT 3 – OPERATOR INTERNAL PERFORMANCE MEASUREMENT

"A process for reviewing the adequacy of a pipeline operator's internal performance measures regarding persons performing locating services and quality assurance programs."

3.1 Does the proposed project address this element? (Required – Yes or No)

3.2 Describe any existing state-wide initiatives that support this element: (Required)

3.3 Describe how the proposed project will enhance or continue implementation of this element. If you received funding in previous years for a project that is ongoing and are requesting grant funding for the continuation of that project, provide a summary of accomplishments and tasks completed during the previous grant period. The information provided should include measurable results and deliverables, and also include any information about tasks that were not completed or other challenges encountered during the grant period: (Required only if proposal addresses this element)

3.4 Estimated budget for this element: (Required only if proposal addresses this element)

j. Indirect Charges:

3.5 Budget Narrative for this element: (Required only if proposal addresses this element)

ELEMENT 4 – EFFECTIVE EMPLOYEE TRAINING

"Participation by operators, excavators, and other stakeholders in the development and implementation of effective employee training programs to ensure that operators, the one call center, the enforcing agency, and the excavators have partnered to design and implement training for the employees of operators, excavators, and locators."

4.1 Does the proposed project address this element? (Required – Yes or No)

4.2 Describe any existing state-wide initiatives that support this element: (Required)

4.3 Describe how the proposed project will enhance or continue implementation of this element. If you received funding in previous years for a project that is ongoing and are requesting grant funding for the continuation of that project, provide a summary of accomplishments and tasks completed during the previous grant period. The information provided should include measurable results and deliverables, and also include any information about tasks that were not completed or other challenges encountered during the grant period: (Required only if proposal addresses this element)

4.4 Estimated budget for this element: (Required only if proposal addresses this element)

j. Indirect Charges:

4.5 Budget Narrative for this element: (Required only if proposal addresses this element)

ELEMENT 5 – PUBLIC EDUCATION

"A process for fostering and ensuring active participation by all stakeholders in public education for damage prevention activities."

5.1 Does the proposed project address this element? (Required – Yes or No)

5.2 Describe any existing state-wide initiatives that support this element: (Required)

5.3 Describe how the proposed project will enhance or continue implementation of this element. If you received funding in previous years for a project that is ongoing and are requesting grant funding for the continuation of that project, provide a summary of accomplishments and tasks completed during the previous grant period. The information provided should include measurable results and deliverables, and also include any information about tasks that were not completed or other challenges encountered during the grant period: (Required only if proposal addresses this element)

5.4 Estimated budget for this element: (Required only if proposal addresses this element)

j. Indirect Charges:

5.5 Budget Narrative for this element: (Required only if proposal addresses this element)

ELEMENT 6 – DISPUTE RESOLUTION

"A process for resolving disputes that defines the State authority's role as a partner and facilitator to resolve issues."

6.1 Does the proposed project address this element? (Required – Yes or No)

6.2 Describe any existing state-wide initiatives that support this element: (Required)

6.3 Describe how the proposed project will enhance or continue implementation of this element. If you received funding in previous years for a project that is ongoing and are requesting grant funding for the continuation of that project, provide a summary of accomplishments and tasks completed during the previous grant period. The information provided should include measurable results and deliverables, and also include any information about tasks that were not completed or other challenges encountered during the grant period: (Required only if proposal addresses this element)

6.4 Estimated budget for this element: (Required only if proposal addresses this element)

j. Indirect Charges:

6.5 Budget Narrative for this element: (Required only if proposal addresses this element)

ELEMENT 7 - ENFORCEMENT

"Enforcement of State damage prevention laws and regulations for all aspects of the damage prevention process, including public education, and the use of civil penalties for violations assessable by the appropriate State authority."

7.1 Does the proposed project address this element? (Required – Yes or No)

7.2 Describe any existing state-wide initiatives that support this element: (Required)

7.3 Describe how the proposed project will enhance or continue implementation of this element. If you received funding in previous years for a project that is ongoing and are requesting grant funding for the continuation of that project, provide a summary of accomplishments and tasks completed during the previous grant period. The information provided should include measurable results and deliverables, and also include any information about tasks that were not completed or other challenges encountered during the grant period: (Required only if proposal addresses this element)

7.4 Estimated budget for this element: (Required only if proposal addresses this element)

j. Indirect Charges:

7.5 Budget Narrative for this element: (Required only if proposal addresses this element)

ELEMENT 8 - TECHNOLOGY

"A process for fostering and promoting the use, by all appropriate stakeholders, of improving technologies that may enhance communications, underground pipeline locating capability, and gathering and analyzing information about the accuracy and effectiveness of locating programs."

8.1 Does the proposed project address this element? (Required – Yes or No)

8.2 Describe any existing state-wide initiatives that support this element: (Required)

8.3 Describe how the proposed project will enhance or continue implementation of this element. If you received funding in previous years for a project that is ongoing and are requesting grant funding for the continuation of that project, provide a summary of accomplishments and tasks completed during the previous grant period. The information provided should include measurable results and deliverables, and also include any information about tasks that were not completed or other challenges encountered during the grant period: (Required only if proposal addresses this element)

8.4 Estimated budget for this element: (Required only if proposal addresses this element)

j. Indirect Charges:

8.5 Budget Narrative for this element: (Required only if proposal addresses this element)

ELEMENT 9 – DAMAGE PREVENTION PROGRAM REVIEW

"A process for review and analysis of the effectiveness of each program element, including a means for implementing improvements identified by such program reviews."

9.1 Does the proposed project address this element? (Required – Yes or No)

9.2 Describe any existing state-wide initiatives that support this element: (Required)

9.3 Describe how the proposed project will enhance or continue implementation of this element. If you received funding in previous years for a project that is ongoing and are requesting grant funding for the continuation of that project, provide a summary of accomplishments and tasks completed during the previous grant period. The information provided should include measurable results and deliverables, and also include any information about tasks that were not completed or other challenges encountered during the grant period: (Required only if proposal addresses this element)

9.4 Estimated budget for this element: (Required only if proposal addresses this element)

j. Indirect Charges:

9.5 Budget Narrative for this element: (Required only if proposal addresses this element)

Legislative/Regulatory Actions

Provide a description of any legislature or regulatory actions (including legislative/regulatory studies) taken by the State within the past five (5) years pertaining to damage prevention program improvement, even if those actions were not completely successful.

Add up each element budget and insert the total for each category below

DIRECT COSTS

Personnel ..............................................................................................................................$

Fringe Benefits .....................................................................................................................$

Travel ...................................................................................................................................$

Equipment ............................................................................................................................$

Supplies ................................................................................................................................$

Contractual ...........................................................................................................................$

Construction .........................................................................................................................$ 0.00

Other .....................................................................................................................................$

Total Direct ..........................................................................................................................$

INDIRECT COSTS

Indirect Charges ....................................................................................................................$

State Damage Prevention Estimated Budget - Fiscal Year 2018

TOTAL ESTIMATED COSTS……………………………………………………………………$

2016 State Damage Prevention Grant Page: 19