Tri-County Area APPLICATION FORM

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Ezra Golden
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1 Tri-County Area APPLICATION FORM Special Transportation Discretionary (STF) 2016 STF Fund Discretionary Program for Regional Projects and Projects with Statewide Significance

2 I. Organization s Information Name of Organization: Contact Person: Address: Telephone: FAX: 2016 STF Fund Discretionary Program for Regional Projects and Projects with Statewide Significance GRANT APPLICATION Type of Organization (mark one): Public Entity Private non-profit Provider s geographic area of service is (mark one): Inside the TriMet Service District Outside the TriMet Service District Both Inside and Outside of the TriMet Service District Geographic area to be served (please indicate the geographic features that define y our service area such as streets, rivers or jurisdictional boundaries): North Boundary East Boundary South Boundary West Boundary Other General Geographic Area (ex Canby School District) Optional please provide a map of your service area as a separate, single page, letter sized attachment. 1

3 Days and Hours of Operation: Days Monday Tuesday Wednesday Thursday Friday Saturday Sunday Please list any planned periods of service closure greater than 3 days. (ex. Closed the last week of December) Hours II. Funding Proposal Project Title: STF funds Requested: Start Date: Underline Proposed Funding Source: 1. Regional Project or 2. Project with Statewide Significance Underline Funding Request Type: 1. Continuation of existing service at same level of service 2. Expansion of existing service 3. New service 4. Capital request 5. Other Transportation Program Cost by Year: FY17 FY18 FY19 2

4 STF Grant fund needs by Year: (Circle below) FY17 FY18 FY19 Regional Project Project of Statewide Significance Scalable STF Grant Request by Year: You are strongly encouraged to request the full amount of funding that is needed for each program, including funding for new programs, but funding is limited. Describe the scalability of your STF funding request below. Enter your scaled down request. Then describe how you scaled down your request and what aspects of the program would not be funded under this funding scenario. FY17 FY18 FY19 Scaled request Description: Amount of other funds leveraged to support the total transportation program: (list county contributions, STF Discretionary funds, donations, other): Contribution/Source Number of Units/Hours Amount % of Program Funding STF Grant Request 3

5 STF Discretionary Project Type Category (mark one): Direct Service Mobility Management/Coordination Both Direct Service and Mobility Management/Coordination Program Description (limit 900 words) Describe services or capital investment to be provided by STF funding. Please include a description of the following: Who do you serve What geographic area do you serve? Level of service provided to customers Operational activities; how customers request and receive rides, including scheduling and dispatching Describe if volunteers are utilized to provide service and how this occur (is the volunteer program supported with STF or other funds? Do you provide mileage reimbursement to volunteers using their own vehicles?) How the service is marketed. Do your program activities preserve existing service and/or provide new service? (describe how the project preserves existing service or provides new or expanded service) (limit 200 words) Do you coordinate between providers to avoid duplication? (describe what level of coordination between partners is done and how duplication is avoided) (limit 200 words) Is your program cost- effective? (describe average cost per ride, cost per mile and cost per hour) (limit 200 words) Does your program address one or more of the strategy recommendations in the Tri-County Elderly and Disabled Transportation Plan (EDTP) or improves service coverage as recommended in the EDTP? (describe activities) (limit 200 words) 4

6 III. Budget and Ridership Information A. Budget Information -- Governmental Organizations, please complete the FY16 and FY17 projected budgets for your projects here: Name of Organization Ridership Operations Costs Fuel Maintenance Dispatch Operators Admin Insurance/Eligibility/Other Other (Contracted Service) Vehicle Hours Vehicle Miles FY17 Projected FY18 Projected FY19 Projected -- Ride Connection Organizations, complete Form A Measurables and Form B2 Condensed Budget Information below and the detailed electronic budget worksheet provided by Ride Connection. Form A. Measurables Ride Data FY17 (projected) FY18 (projected) FY19 (projected) One way rides miles Miles per trip paid driver hours STF Program STF Program STF Program 5

7 Ride Data FY17 (projected) FY18 (projected) FY19 (projected) volunteer driver hours Cost per trip Number of individuals served STF Program STF STF Program Staffing data: (please identify positions supported with STF Discretionary funds and the amount of FTE per position) Position FY17 FY 18 (projected) (projected) Example: Driver 1 1 FY 19 (projected) Mobility Management: For mobility management/coordination projects, please indicate activities support with STF Discretionary funds and the number of individuals that benefit from project activities. Activity FY17 (projected) FY 18 (projected) FY 19 (projected) 6

8 Form B2. Condensed Budget Information ESTIMATED STF DISCRETIONARY PROJECT COST 1. Project administration expense 2. Personal services (wages and benefits) 3. Facility (rent, janitorial, utilities, etc.) 4. Professional services* 5. Insurance, services and supplies (IT, travel, office expense, telecommunications, etc.) 6. Other (list): Item - 7. Item - 8. Item - 9. Operations expense 10. Item Item Preventative Maintenance expense 13. Item Item - Grand : Amount % of total STF *For amounts over $5000, please provide an explanation of services rendered. Limit 300 words. 7

EMERGENCY COMMUNICATIONS

EMERGENCY COMMUNICATIONS FY2004-2010 1. BACKGROUND ISSUES The Emergency Communications element of the capital plan is comprised of three projects concerning emergency radio communications, computer aided