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									                                       PUBLIC TRANSIT DIVISION
                             INTERCITY DISCRETIONARY GRANT APPLICATION
                                              2011-2013
                                                             v1.1
     Please read instructions before completing this form.

                                                    INSTRUCTIONS

A. Oregon Department of Transportation Public Transit Division (PTD) will evaluate intercity grant applications in the
   context of the intercity service to be supported by the grant. See the document "2011-2013 Intercity Grant
   Program Instructions.pdf" for additional background and instructions.

B. Use this application form to apply for grant funding in one or more grant categories (i.e., operations, marketing,
   capital vehicle, capital equipment, etc.). Use a separate application form for each service that your grant
   applications are intended to support.

     For example; use one form to apply for vehicles, marketing, and operations for a single service, or two forms to
     apply for vehicle funds for one service and operating funds for a second service.

C. Complete the “Service” section (Section 2) of the application even if not applying for operating funds.

D.    When entering data in yellow cells, if you inadvertently overwrite existing information, press the <Esc> key
     prior to exiting the cell to revert to prior cell contents.

E. Complete only the sub-sections of Sections 3, 4, and 5 from which you seek grant funds.

     E. Submit completed application to:              ODOT Public Transit Division
                                                      555 13th St. NE, Suite 3
                                                      Salem, OR 97301
F. All 2011-2013 Intercity Grant Applications must by received by ODOT Public Transit Division by
   5 p.m. March 1, 2011.

     Useful links:
     Program background and detailed instructions: 2011-2013 Intercity Grant Program,
     2011-2013-Intercity-Grant-Program.pdf
     Congressional district map,
     statecong.pdf
     Vehicle category descriptions,
     2009-Vehicle-Useful-Life-Descript.pdf




                           2009-11 Public Transit Division Intercity Discretionary Grant Application                 Page 1
                                           PUBLIC TRANSIT DIVISION
                                 INTERCITY DISCRETIONARY GRANT APPLICATION
                                                  2011-2013

Please read instructions before completing this form.

                                         CHECKLIST OF INCLUDED ITEMS
Please review and complete this checklist after completing the accompanying application and
budget forms.
Check application and budget forms you have completed and included in this application:
     Section 1: Applicant information (this section to be completed by all applicants)..    Page 3
                 New applicant information………………………..……………………………….                                       Page 3
        Section 2: Service information (this section to be completed by all applicants)….                Page 4
                 Service budget tables……………………………………………………………..                                          Page 6
        Section 3: Capital fund requests…………………………………………………….                                            Page 8
                 Subsection A–Vehicles……………………………………………………………                                            Page 8
                 Subsection B–Capitalized vehicle preventive maintenance……………...…….                      Page 9
                        Maintenance plan attached…………………………………………………
                 Subsection C–Equipment…………………………………………………………                                            Page 10
                 Subsection D–Passenger shelters, passenger amenities, signs……………..                      Page 11
                        Documented Categorical Exclusion Worksheet attached……………….
                 Subsection E–Facilities……………………………………………………………                                          Page 12
                        Documented Categorical Exclusion Worksheet attached……………….
        Section 4: Marketing……………………………………………………………………                                                   Page 13
        Section 5: Operations………………………………………………………………….                                                  Page 14
                 Operations budget sheet………………………………………………………….                                          Page 15

Please submit only the sections you have completed and that have been checked on this list. Additional
pages may be discarded.


By my signature below I certify that the attached application and budget forms checked above are
complete and accurate to the best of my knowledge, and that I have been authorized to submit this
NAME OF AGENCY OR ORGANIZATION



NAME AND TITLE                                         SIGNATURE                          DATE




                             2009-11 Public Transit Division Intercity Discretionary Grant Application      Page 2
                                            PUBLIC TRANSIT DIVISION
                                  INTERCITY DISCRETIONARY GRANT APPLICATION
                                                   2011-2013

Please read instructions before completing this application.
Section 1: Applicant information
AGENCY NAME (LEGAL)                                                 FEIN
                                                                                          PHONE                   FAX



AGENCY NAME (DBA)                                                   CONGR. DISTRICT/UZA   AGENCY WEB SITE URL



MAILING ADDRESS (STREET OR P.O. BOX)                                                      CONTACT PERSON NAME     CONTACT PERSON TITLE

                                                                                          f
CITY, STATE, ZIP                                                                          CONTACT PERSON E-MAIL ADDRESS




Check if applicable:              New applicant–has not received funding from PTD for the 2007-09 or 2009-11 bienniums.
                                  (If checked, complete New Applicant Additional Information section.)

New Applicant Additional Information
1. Description of the agency’s purpose:
DESCRIPTION




2. Description of legal entity type; registered with Oregon Secretary of State’s Office as corporation, non-profit, etc.,
or legal entity:
DESCRIPTION




                               2009-11 Public Transit Division Intercity Discretionary Grant Application                        Page 3
3. Description of the transportation service(s) provided and the populations served:
DESCRIPTION




                                                                                Yes        No
4. Copies of service maps, brochures, and fare schedule attached:
   If "No", URLs of service maps, brochures, and fare schedules on agency’s Web site:
URLS




Section 2: Service Information (this section to be completed by all applicants)

1. Describe the service that will be supported by the requested grant funds. What is the name of the service? What is
   the need for this service, and how was the need determined? How does this service benefit rural Oregonians?
   What makes this service intercity service?
DESCRIPTION




2. Describe how the service supported by this grant application interlined (ticketing and revenue sharing agreement)
   via the National Bus Traffic Association (NBTA) with other intercity carriers such as Greyhound or Amtrak. If not
   interlined, describe whether it will be and when.
DESCRIPTION




                         2009-11 Public Transit Division Intercity Discretionary Grant Application           Page 4
3. Is there a Web site with route, schedule, price, and ticketing information for the service supported by this grant
   application?
                                        Yes        No

    If "Yes", provide the URL. If "No", describe whether there will be and when:
DESCRIPTION




4. Is the service supported by this grant application represented on the TripCheck-TO web site?
               Yes        No
    If "No", describe whether it will be and when:
DESCRIPTION

sfsda



5. Is the service supported by this grant application represented on a public itinerary planner system such as Google
   Transit, Bing.com, Greyhound.com, or Amtrak.com?
         Yes         No

    If "Yes" which systems? If "No", describe whether it will be and when:
DESCRIPTION




6. Describe other ways In which service and ticketing information are available to the public.
DESCRIPTION




7. Will the service supported by this grant application result in fewer automobile trips (during 2011-13)?
Average number of one-way Average miles per one-way                                                Total vehicle miles
         trips per day                       trip                Days of service in Biennium         reduced (VMR)
                0                              0                               0                              0
Link to Oregon Office of Energy BETC page:         http://www.oregon.gov/ENERGY/TRANS/transhm.shtml

8. If the service supported by this grant application is a continuation or extension of an existing intercity service
   supported by PTD grant funds, list grant agreement numbers:
GRANT AGREEMENT NUMBERS




                          2009-11 Public Transit Division Intercity Discretionary Grant Application                 Page 5
Section 2: Service Information
Service Budget Tables
1. Select all that apply:
                   Grant application is to support an existing intercity service without expanding the service
                   Service to be provided by contractor

2. Fill out the following tables for the intercity service that you wish to support with this grant application. Fill out years
   during which there has been service and in which you expect to have service. In the “20xx Total” column show
   fully allocated costs. Do NOT include grants or BETC funds in the “Direct Service Revenue” category; do include
   direct service related revenue like fares, contract revenue, freight, etc. Calculate a year of capital cost by dividing
   cost of capital item by expected life of capital item. Profit is not a cost. In the “20xx 5311(f) funds” column, show
   your use of 5311(f) funds to cover part of the costs. Use “Notes” box for extra information, such as; “service will
   only be operational for 9 months in 2011”
   Year type for tables below:                 State fiscal yr (July 1-June 30)          Calendar yr (Jan 1-Dec 31)

    Table A: Actual 2010             2010 Total        2010 5311(f) funds         Notes:
Ridership                                                        0
Direct Service Revenue                                          $0
Service Miles                                                    0
Admin Costs
Operating Costs
Capital Costs
Total Costs                               $0                      $0
Cost per Mile
Cost per Ride
Revenue as a % of Cost
Admin as a % of Cost


  Table B: Estimated 2011            2011 Total        2011 5311(f) funds         Notes:
Ridership                                                        0
Direct Service Revenue                                          $0
Service Miles                                                    0
Admin Costs
Operating Costs
Capital Costs
Total Costs                               $0                      $0
Cost per Mile
Cost per Ride
Revenue as a % of Cost
Admin as a % of Cost




                                                                                  Notes: sdfjslfjsdfs sfda


                           2009-11 Public Transit Division Intercity Discretionary Grant Application                   Page 6
  Table C: Estimated 2012              2012 Total       2012 5311(f) funds             Notes: sdfjslfjsdfs sfda
Ridership                                                         0
Direct Service Revenue                                           $0
Service Miles                                                     0
Admin Costs
Operating Costs
Capital Costs
Total Costs                                  $0                    $0
Cost per Mile
Cost per Ride
Revenue as a % of Cost
Admin as a % of Cost


  Table D: Estimated 2013              2013 Total       2013 5311(f) funds             Notes:
Ridership                                                         0
Direct Service Revenue                                           $0
Service Miles                                                     0
Admin Costs
Operating Costs
Capital Costs
Total Costs                                  $0                    $0
Cost per Mile
Cost per Ride
Revenue as a % of Cost
Admin as a % of Cost


Table E: List communities (cities) in which the service stops, their population, connecting services and connection
            Community-City     Connecting Service
   Pop.        Name                  Name           Service Type        Connection description; wait times, shared stop, walk distance, etc.




    0     Population total



                             2009-11 Public Transit Division Intercity Discretionary Grant Application                                Page 7
Section 3: Capital Funds Requests
Subsection A: Vehicles
1. Is this request for one or more replacement vehicles?                                       See useful life document for info on
                                                                       Yes          No
   If yes, list the vehicles to be replaced:                                                   vehicle disposal and A-D or 1-7
  DISPOSAL        SEAT                            CATEGORY
     TYPE         COUNT      YEAR/MAKE/MODEL      A-D OR 1-7           VIN               LICENSE NUMBER                  MILEAGE




2. Vehicles requested:                  NO.                                                                             EST.
 CATEGORY                    COST      SEATS                          ADA                           EST. ORDER        DELIVERY
  A-D OR 1-7     QUANTITY    EACH       WITH     TOTAL CAPACITY     STATIONS       FUEL TYPE           DATE            DATE (a)
                     1
                     1
                     1
                     1
                     1
              Grand Total:     $0         0             0               0


3. a. Total vehicle cost (Line 2, Grand Total)………………………………………………………………..                                                         $0
   b. Local overmatch………………………………………………………………………………………….
      Overmatch source:
   c. Other non-5311(f) funding………………………………………………………………………………..
      Non-5311(f) source:
   d. Subtotal non-5311(f) funding (Line 3b + Line 3c)……………………………………………………..                                                     $0
   e. Remaining cost (Line 3a - Line 3d)…………………………………………………………………….                                                              $0
   f. Required local match (Line 3e x 0.2)………………………………………………………………….                                                             $0
      Local match source:
   g. Grant amount requested (Line 3e x 0.8)……………………………………………………………….                                                            $0

4. Describe any dependencies with other grants (Example: Capital grant only makes sense if operations grant.)
DEPENDENCIES




5. Describe how vehicles are to be used:
VEHICLE USE




6.

     If NOT planning to use the state price agreement contract for vehicles, then describe the reasons
DESCRIPTION




                             2009-11 Public Transit Division Intercity Discretionary Grant Application                    Page 8
Section 3: Capital Funds Requests

Subsection B: Capitalized Vehicle Preventive Maintenance

1. Number of vehicles…………………………………………………………………………………………
2. Maintenance plan attached?
   If no, describe maintenance plan:
MAINTENANCE PLAN




3. a. Total capitalized preventive maintenance cost………………………………………………………..
   b. Local overmatch………………………………………………………………………………………….
      Overmatch source:
   c. Other non-5311(f) funding………………………………………………………………………………..
      Non-5311(f) source:
   d. Subtotal non-5311(f) funding (Line 3b + Line 3c)……………………………………………………..                                    $0
   e. Remaining cost (Line 3a - Line 3d)…………………………………………………………………….                                             $0
   f. Required local match (Line 3e x 0.2)………………………………………………………………….                                            $0
      Local match source:
   g. Grant amount requested (Line 3e x 0.8)……………………………………………………………….                                           $0

4. Describe any dependencies with other grants (Example: Capital grant only makes sense if operations grant.)
DEPENDENCIES




5. Describe how vehicles are used:

VEHICLE USE




                        2009-11 Public Transit Division Intercity Discretionary Grant Application           Page 9
Section 3: Capital Projects Information

Subsection C: Equipment

Equipment cost should be $5,000 or greater, otherwise include in operation grant request.
1. Equipment requested:                                                                      EST. ORDER     EST.
     DESCRIPTION OF EQUIPMENT BY CATEGORY              QTY       COST EACH     TOTAL COST       DATE      DELIVERY
                                                        1                           $0
                                                        1                           $0
                                                        1                           $0
                                                        1                           $0
                                                        1                           $0
                                                        1                           $0
                                                        1                           $0
                                                        1                           $0
                                                        1          GRAND            $0
                                                                   TOTAL            $0


2. a. Total equipment cost……………………………………………………………………………………                                                       $0
   b. Local overmatch………………………………………………………………………………………….
      Overmatch source:
   c. Other non-5311(f) funding………………………………………………………………………………..
      Non-5311(f) source:
   d. Subtotal non-5311(f) funding (Line 3b + Line 3c)……………………………………………………..                                     $0
   e. Remaining cost (Line 3a - Line 3d)…………………………………………………………………….                                              $0
   f. Required local match (Line 3e x 0.2)………………………………………………………………….                                             $0
      Local match source:
   g. Grant amount requested (Line 3e x 0.8)……………………………………………………………….                                            $0

3. Describe any dependencies with other grants (Example: Capital grant only makes sense if operations grant.)
DEPENDENCIES




                        2009-11 Public Transit Division Intercity Discretionary Grant Application          Page 10
Section 3: Capital Projects Information
Subsection D: Passenger Shelters, Passenger Amenities, Signs
1. Items requested:                                                                                EST. ORDER     EST.
     DESCRIPTION OF EQUIPMENT BY CATEGORY                   QTY        COST EACH     TOTAL COST       DATE      DELIVERY
                                                             1                              $0
                                                             1                              $0
                                                             1                              $0
                                                             1                              $0
                                                             1                              $0
                                                             1                              $0
                                                             1                              $0
                                                             1                              $0
                                                             1           GRAND              $0
                                                                         TOTAL             $0.00


2. a. Total shelters, amenities, signs cost………………………………………………………………….                                                  $0
   b. Local overmatch………………………………………………………………………………………….
      Overmatch source:
   c. Other non-5311(f) funding………………………………………………………………………………..
      Non-5311(f) source:
   d. Subtotal non-5311(f) funding (Line 3b + Line 3c)……………………………………………………..                                           $0
   e. Remaining cost (Line 3a - Line 3d)…………………………………………………………………….                                                    $0
   f. Required local match (Line 3e x 0.2)………………………………………………………………….                                                   $0
      Local match source:
   g. Grant amount requested (Line 3e x 0.8)……………………………………………………………….                                                  $0

3. Documented Categorical Exclusion Worksheet attached?.................................
   Categorical exclusion must be provided prior to grant award.

4. Describe any dependencies with other grants (Example: Capital grant only makes sense if operations grant.)
DEPENDENCIES




                           2009-11 Public Transit Division Intercity Discretionary Grant Application             Page 11
Section 3: Capital Projects Information
Subsection E: Facilities
 1 Facilities requested:                                                                           EST. ORDER     EST.
DESCRIPTION OF FACILITY LIST ANY SUBCATEGORIES              QTY        COST EACH     TOTAL COST       DATE      DELIVERY
                                                                                            0
                                                                                            0
                                                                                            0
                                                                         GRAND              0
                                                                         TOTAL             $0.00


2. a. Total facility cost…………………………………………………………………………………………                                                            $0
   b. Local overmatch………………………………………………………………………………………….
      Overmatch source:
   c. Other non-5311(f) funding………………………………………………………………………………..
      Non-5311(f) source:
   d. Subtotal non-5311(f) funding (Line 3b + Line 3c)……………………………………………………..                                           $0
   e. Remaining cost (Line 3a - Line 3d)…………………………………………………………………….                                                    $0
   f. Required local match (Line 3e x 0.2)………………………………………………………………….                                                   $0
      Local match source:
   g. Grant amount requested (Line 3e x 0.8)……………………………………………………………….                                                  $0

3. Documented Categorical Exclusion Worksheet attached?.................................
   Categorical exclusion must be provided prior to grant award.

4. Describe any dependencies with other grants (Example: Capital grant only makes sense if operations grant.)
DEPENDENCIES




                           2009-11 Public Transit Division Intercity Discretionary Grant Application             Page 12
Section 4: Marketing
1. Describe marketing activities:
DESCRIPTION




2. a. Total marketing cost…………………………………………………………………………………….
   b. Local overmatch………………………………………………………………………………………….
      Overmatch source:
   c. Other non-5311(f) funding………………………………………………………………………………..
      Non-5311(f) source:
   d. Subtotal non-5311(f) funding (Line 3b + Line 3c)……………………………………………………..                                   $0
   e. Remaining cost (Line 3a - Line 3d)…………………………………………………………………….                                            $0
   f. Required local match (Line 3e x 0.2)………………………………………………………………….                                           $0
      Local match source:
   g. Grant amount requested (Line 3e x 0.8)……………………………………………………………….                                          $0

3. Describe any dependencies with other grants (Ex: Marketing grant needed only if ops grant approved.)
DEPENDENCIES




                         2009-11 Public Transit Division Intercity Discretionary Grant Application        Page 13
Section 5: Operations
1. Describe operations:
DESCRIPTION




3. Operations Budget
Admin expenses                                                                      Estimated      Estimated    Total
   Wages & benefits                                                                          $20

   Facilities (rent, janitorial, utilities, etc.)
   Insurance
   Professional services
   Services & supplies (IT, travel, office expenses, telecom), etc.
   Other (list) Item -   dsfsad
   Other (list) Item -
   Other (list) Item -
                                                                      Admin Total           $20            $0           $20




                             2009-11 Public Transit Division Intercity Discretionary Grant Application          Page 14
Operations expenses
  Cost of purchased service                                                                $20
  Cost of direct service
  Wages & benefits
  Insurance
  Fuel
  Vehicle maintenance
  Stop maintenance
  Facility (rent, janitorial, utilities, etc.)
  Services & supplies (IT, travel, office expenses, telecom, etc.)
  Training
  Other (list) Item -
  Other (list) Item -
  Other (list) Item -
                                                       Operations expense Total           $20          $0       $20
Durable equipment less than $5000
  Item -
  Item -
  Item -
  Item -
                                                        Durable equipment Total            $0          $0        $0
                                                                          Total           $40          $0
                                                                     Grand Total                                $40
4. a. Total operations cost (from Grand Total above).…………………………………………………….                                      $40
   b. Local overmatch………………………………………………………………………………………….                                                         $0
      Overmatch source:
   c. Fare revenue………………………………………………………………………………………………                                                           $2
   d. Other non-5311(f) funding………………………………………………………………………………..                                                  $3
      Non-5311(f) source:
   e. Subtotal non-5311(f) funding (Line 3b + Line 3c + Line 3d)……………….………………………..                               $5
   f. Remaining cost (Line 3a - Line 3e)…………………………………………………………………….                                             $35
   g. Required local match (Line 3f x 0.5 or 0.3)…………………………….…………………………….                                       $18
      Local match source:
   h. Grant amount requested (Line 3f x 0.5 or 0.7)……………………………………………………………….                                    $18




                           2009-11 Public Transit Division Intercity Discretionary Grant Application        Page 15
5. Describe any dependencies with other grants (Ex: OPS grant needed only if capital grant approved.)
DEPENDENCIES




6. Is this service expected to generate more revenue than the service costs?
   (for this question include all direct or indirect revenue generated by the service, include fares, grants, BETC,
   contract income, contributions from other agencies, etc.)
   If "Yes", approximately how much?

    And, describe how excess revenue is expect to be used to support intercity bus service.
DESCRIPTION




8. If BETC funds will not be earned in conjuction with this grant, why not?
DESCRIPTION




                         2009-11 Public Transit Division Intercity Discretionary Grant Application              Page 16
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Service Revenue
5311(f) Grant        $50,000
Fares                $10,000
BETC                 $12,500
Advertising           $8,000
Contract Income      $44,500
Total               $125,000
Service Cost        $110,000
Revenue less Cost    $15,000

								
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