2020 TAC LG Grant Program - Infrastructure Project Application Form

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Introduction

* indicates a required ﬁeld

Thank you for submitting an application for a 2020 TAC Local Government Grant

Program - Infrastructure Project.

Local Governments must only submit one Infrastructure Project application. Available Funding: Up to $100,000 ex GST with conditional 1:1 contributions from the Local Government. All funding amounts referenced in this application form are to be

exclusive of GST.

Infrastructure project grants are available for the implementation of low cost road safety infrastructure solutions and/or the trialing of innovative new road safety infrastructure solutions that aim to reduce the likelihood and severity of fatal and serious injury crashes for pedestrians and cyclists.

Road safety infrastructure projects must;

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Be supported by a community engagement activity plan and/or evidence of existing community support for the project.

•

Be aligned to sound research and/or established road safety design principles and safety treatments (i.e. Safe System Principles which, for this context, are summarised below).

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Identify how the project will eliminate, or will come close to eliminating, the risk of severe crashes for pedestrians and cyclists in the local area.

All questions in this application are aligned to the Assessment Criteria outlined in the 2020 TAC Local Government Grant Program Guidelines.

Eligibility Criteria

To be eligible to apply for this grant program you must meet the following Eligibility

Criteria:

1. The organisation responsible for this application is a Victorian Local Government.

2. The project is primarily focused road safety issues relating to pedestrians and/or cyclists. 3. The project is covered by the insurance outlined in the 2020 TAC Local Government Grant Program Guidelines.

4. The Local Government will co-contribute funding on the condition of 1:1.

Can you conﬁrm that you meet all 4 of the Eligibility Criteria outlined above? *

○ Yes - eligible to apply ○ No - ineligible to apply

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the TAC Local Government Grant Program, TAC Towards Zero Community Grant Program or the Safe System Road Infrastructure Program (SSRIP). *

○ Yes ○ No

Provide details of when the funding was received, how much and what components of the project were completed. *

Word count:

You are ineligible to apply for this grant program.

Please review your answers above or contact the TAC Road Safety Programs Team [email protected] to discuss your application.

Organisation Details

Name of Local Government *

Organisation Name

Local Government ABN *

The ABN provided will be used to look up the following information. Click Lookup above to check that you have entered the ABN correctly.

Information from the Australian Business Register ABN

Entity name ABN status Entity type

Goods & Services Tax (GST) DGR Endorsed

ATO Charity Type More information

ACNC Registration Tax Concessions Main business location

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Local Government Address *

Address

Suburb State Postcode

NOTE: Please use drop down function to select address, do not manually enter. Address must be a street address, not PO Box. Map pin can be used to assist ﬁnding location

Local Government Website

Must be a URL.

Project Contact

The Project Contact is the person who TAC will contact and who will be accountable for the project reporting and delivery. This may be the Project Manager, Project Coordinator or Project Oﬃcer.

Project Contact Name *

Title First Name Last Name

Position *

Phone Number *

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Must be an email address.

Project Support Contact

The Support Contact is a secondary contact for this project. This may be the Grant Oﬃcer, Project Coordinator or Project Oﬃcer.

Support Contact Name *

Position *

Phone Number *

Must be an Australian phone number. Work Email Address *

Must be an email address.

Assessment Criteria 1 - Improving local community road safety for

pedestrians and/or cyclists

Questions in this section will be assessed against the following

assessment criteria:

Assessment Criteria 1 - Improving local community road safety for pedestrians and/or cyclists.

The application clearly outlines:

•

The local road safety issue, the target road user/s and the need for this project and the supporting evidence (examples of evidence include crash data or other indicators of systemic risk, safe system assessment, traﬃc counts, anecdotal evidence, survey outcomes, community/customer enquiries, observational data, research, demographic data and police records).

•

The project plan, objectives, activities, deliverables and the anticipated road safety and other related outcomes.

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Project Title *

Describe your project in a few sentences. Provide a high level summary of the project *

Word count:

Must be no more than 100 words.

Which option best describes the projects primary target road user group. *

What range does your TAC funding request sit within? *

○ $0 - $10,000 ○ $10,000 - $30,000 ○ $30,000 - $50,000 ○ $50,000 - $100,000

This is the amount you are requesting from the TAC to support this project.

Local Road Safety Issue

What is the local road safety issue? Outline the target road users. *

Word count:

Supporting Evidence

You need to outline the supporting evidence for this project. Examples of supporting evidence include:

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crash data or other indicators of systemic risk

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road user volumes (i.e. traﬃc counts)

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travel speed data

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anecdotal evidence

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survey outcomes

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community/customer inquiries

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observational data

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research

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demographic data; and

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police records.

Provide details of evidence that supports this project. *

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Use the table below to assist with outlining road user volumes (i.e. Traﬃc Counts)

Data Source Road User Volume

I.e. Pedestrian observation count over 5 hours

Attach any supporting evidence documentation. E.g. Copies of survey results, traﬃc counts, community enquiries etc.

Attach a ﬁle:

Maximum 25mb, recommended size no bigger than 5mb.

Project Objectives, Deliverables and Anticipated Outcomes

You will need to clearly outline the following:

Project Objective/Purpose: A high level statement that explains what the project is going

to achieve.

Project Deliverables: The project outputs. I.e. speciﬁc infrastructure treatments. Anticipated Outcomes: Outcomes are the road safety and other beneﬁts that will

result from this project. You will need to tell us how you will measure these in the 'Project Monitoring and Evaluation' section.

What is the objective/purpose of this project? *

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What are the deliverables of this project? *

Word count:

What are the expected outcomes of this project? *

Word count:

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Note that all project activities, deliverables and outcomes need to be achieved/completed between 01 January 2021 and 30 June 2022.

Project Start Date *

Must be a date and between 1/1/2021 and 30/6/2022.

Project End Date *

Must be a date and between 1/1/2021 and 30/6/2022.

Describe the activity/tasks to be undertaken as part of this project, who is responsible to deliver the activity/task and when will it be completed.

Note - completion dates need to be between the project start and end dates speciﬁed

above.

All project activities must be completed between 01 January 2021 and 30 June 2022.

Project Activity

Responsibility

Completion Date

*

The activities or tasks are being undertaken *

*

Who is completing the activity?

*

Date the activity will be completed. This is to be a date between your project start and end date.

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Attach a supporting project plan if available

Attach a ﬁle:

Maximum 25mb, recommended size no bigger than 5mb

Have you got a Risk Management Plan for this project? If you answer yes, you will be asked to attach a copy in the next question. *

○ Yes ○ No

Risk Management

List all of the identiﬁed risks that may be associated with the delivery of this project.

Risk Level of impact How will this be managed?

Attach a copy of the Risk Management Plan for this project. *

Attach a ﬁle:

Assessment Criteria 2 - Alignment to Towards Zero Strategy and

Action Plan 2016-2020 and good practice road safety principles.

Assessment Criteria 2 - Alignment to Towards Zero Strategy and Action Plan 2016-2020 and good practice road safety principles.

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practice road safety principles (i.e. Safe System principles) by;

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Investigating and/or implementing primary treatments to separate vulnerable road users from vehicles or, where this not possible, redesign streets to limit potential crash speeds to not more than 30 km/h.

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Outlining how the project will reduce the likelihood of crashes involving pedestrians and cyclists.

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The integration of the project with other pedestrian or cyclist programs. This may include links to Council plans and strategies and other investment programs.

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For all road safety infrastructure projects, and where appropriate for analysis projects, evidence of design drawings (i.e.concept designs).Concept designs that contain a level of detail suitable for a preliminary design stage road safety audit are suﬃcient.

•

Drawings must be in PDF format and no larger than 25mb per attachment.

Alignment with the Towards Zero Strategy and Action Plan 2016-2020

and Good Practice Road Safety Principles.

The Towards Zero Road Safety Strategy and Action Plan 2016-2020 is available at

www.towardszero.vic.gov.au.

For information about Safe System principles refer to the:

•

VicRoads Safe System Assessment Guidelines

•

Austroads (2016) Safe System Assessment Framework.

How will your project investigate and/or implement primary treatments that separate vulnerable road users from vehicles or, where this not possible, redesign streets to limit potential crash speeds to not more than 30 km/h. *

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How will this project contribute to reducing the likelihood of crashes involving pedestrians and cyclists? *

Word count:

Integration with Council Programs and Strategies

How does this project integrate with other cyclist or pedestrian programs/ projects and/or council strategies? *

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Word count:

Design Concepts and Project location

All design concepts that are provided will be reviewed as part of the TAC Local Government Grant Program technical assessment process.

•

Please provide designs that contain a level of detail suitable for a

preliminary design stage road safety audit.

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Designs should show the speciﬁc alignment of any infrastructure and how it

interacts with the rest of road network.

Attach the design drawings that support this project. *

Attach a ﬁle:

Maximum 25mb, recommended size no bigger than 5mb.

Comments to support the design drawing attachments.

URL link to project location in Google Maps

Search for the location in Google Maps, select 'share' function and copy link.

Assessment Criteria 3 - Partnerships, Community Engagement

and Capacity

Assessment Criteria 3 - Partnerships, Community Engagement and Capacity

The application demonstrates:

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One or more partnerships and outlines partner roles and responsibilities in supporting the delivery of the project. (I.e. Community groups, schools, traders etc to support project).

•

Evidence of community support and/or a clear plan to engage community in the project if the application is successful.

•

Capacity to implement and/or source expertise to manage the delivery of the project including fulﬁlling contractual reporting requirements and measuring the impact of the project.

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Partnerships

Examples include speciﬁc community groups, state government bodies, contractors etc.

Outline one or more partners and their role and responsibility in supporting the delivery of this project. *

Word count:

Community Support

You will need to demonstrate community support for this program.

Include information about the speciﬁc community groups that have been engaged (e.g. High St Trader groups etc.)

If you have an existing Community Engagement Activity Plan and supporting documentation you can upload this below.

Detail evidence of current community support for this project. *

Word count:

Attach a copy of any community support documentation

Attach a ﬁle:

I.e. Community Engagement Activity Plan. Maximum 25mb, recommended size no bigger than 5mb

Capacity

You must demonstrate capacity and expertise to deliver and manage this project.

Provide details of your organisation's capacity to implement and/or source expertise to manage the delivery of the project. This includes fulﬁlling

contractual reporting requirements and measuring the impact of the project. *

Word count:

Assessment Criteria 4 - Project Monitoring and evaluation

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Assessment Criteria 4 - Project Monitoring and evaluation

The application outlines:

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How the project will be monitored to measure its impact on the targeted local road safety issue. This includes outlining the evaluation design, methods and type of data (pre and post) that will be collected and analysed.

Monitoring and Evaluation Plan

If you have a monitoring and evaluation plan for this project you can upload it below.

Detail how the project will be monitored and evaluated to ensure it meets its objectives and achieves its expected outcomes. This includes outlining the

evaluation design, methods and type of data (pre and post) that will be collected and analysed. *

Word count:

If available, attach a supporting monitoring and evaluation plan.

Attach a ﬁle:

Assessment Criteria 5 - Value for Money

The application outlines:

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Innovative ways to reduce treatment costs through choice of materials, implementation processes or integration with other planned works.

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A realistic project budget that reﬂects project activities and deliverables.

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How the project will be maintained and sustained in the future without ongoing TAC funding support. Co-contributions and in-kind support will be taken into consideration.

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Innovation

You need to outline what innovative activities have been applied to this project such as :

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Innovative community engagement activities;

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Innovative design concepts that reduce costs and/or increase the safety aspects of the design;

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Any other innovative activities.

What is innovative about this project? *

Word count:

Project Budget

Provide a detailed list of all project costs and the contribution requested from TAC

exclusive of GST.

Total amount requested from TAC cannot exceed $100,000.00 ex GST.

Be as speciﬁc as possible (i.e one expense item per line). If your application is successful, you will be required to provide evidence of these expenses in the progress and ﬁnal reports. Please upload any supporting quotes in your upload section below.

Expenditure Cost Amount Requested from

TAC $ $

List the expense item. Exclusive of GST. Exclusive of GST

Must be a dollar amount. Total Project Cost *

$

This number/amount is calculated.

Exclusive of GST. This is calculated from the 'Cost' column in the table above.

TAC Funding Request

Total Amount Requested from TAC * $

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Income

List all funding contributions to this project, including the total amount of grant funding requested from TAC (if your application is successful) and other grant funding,

co-contribution (i.e. Council ﬁnancial co-contribution, schemes etc.) and in-kind support (i.e.

volunteer time and its value).

This must reﬂect the TAC funding condition of the co-contribution of 1:1 from Local

Government.

List all income exclusive of GST.

Income Source Grant Funding, Co-contribution, In-kind Support Contribution/Income amount $

List who is contributing to this in-kid support or funding (i.e. Council)

Exclusive of GST

Total Income Amount

$

This number/amount is calculated. Exclusive of GST

Attach any evidence to support your project budget request and outlined income.

Attach a ﬁle:

E.g. quotes, letters of support for co-contributions etc.

Project Sustainability

This project must clearly demonstrate how it can be maintained and sustained in the future without TAC funding.

Outline how you will maintain and sustain your project in the future without ongoing TAC support. *

Word count:

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Insurance

You indicated in the eligibility section that your organisation has the adequate insurances to support this project.

TAC will request copies of these prior to funding this project.

If available, upload adequate certiﬁcates of currency to support your application. These include:

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Professional indemnity insurance - $1,000,000.00

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Public liability insurance - $5,000,000.00

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Workers compensation insurance under the applicable legislation; and

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Personal accident insurance to cover any risks in relation to the project.

Attach Certiﬁcates of Currency

Attach a ﬁle:

Terms and Conditions

Privacy Policy

Any personal information collected as a part of this application will be used by the TAC to decide whether to provide you with a TAC Local Government Grant, and to communicate with you about your application and the grant assessment process. As a part of the grant process, your information may be assessed by a panel of subject matter experts from the TAC and from its key Road Safety Partners.

If you do not provide all or part of the information requested, the TAC may not be able to progress your application. You can gain access to the information you have provided on this form by contacting the TAC Road Safety Programs Team [email protected]

Declaration

I state that the information in this application and attachments is to the best of my knowledge true and correct. I will notify TAC of any changes to this information and any circumstances that may aﬀect this application. I acknowledge that the TAC may refer this application to external experts or other Government Departments for assessment, reporting, advice, comment or for discussions regarding alternative or collaborative grant funding opportunities.

I understand that this is an application only and may not necessarily result in funding approval. I have read and agree to the Terms and Conditions.

I have read and agree: *

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Position *

Date of acceptance *

Must be a date.

2020 TAC Local Government Grant Program Feedback

Before you REVIEW and SUBMIT, please take a few moments to provide us with some feedback.

How easy was it to ﬁll out this form? *

○ Very easy ○ Easy ○ Neutral ○ Diﬃcult ○ Very diﬃcult

Which of the following support resources did you use to assist with your application? *

☐ TAC Local Government Grant Program Guidelines ☐ Engaged with the TAC Road Safety Programs Team ☐ TAC Local Government Grant Program Webpage

☐ TAC Local Government Grant Program Application Tip sheet ☐ I didn't use any of the above support resources

☐ Other:

How helpful were the TAC Local Government Grant Program Guidelines? *

○ Very helpful ○ Helpful ○ Neutral ○ Unhelpful ○ Very unhelpful

How satisﬁed were you with the support provided by the TAC Road Safety Programs Team? *

○ Very satisfied ○ Satisfied ○ Neutral ○ Dissatisfied ○ Very dissatisfied

How helpful was the information provided on the TAC Local Government Grant Program web page? *

○ Very helpful ○ Helpful ○ Neutral ○ Unhelpful ○ Very unhelpful

How helpful was the information provided in the TAC Local Government Grant Program Application Tip Sheet? *

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*

Word count:

Must be at least 10 words.

More information