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THIS FORM IS FOR NON-PROFIT
CUTLURAL ORGANIZATIONS
REQUESTING MAYORAL CAPITAL
FUNDING.

PLEASE SUBMIT THIS FORM TO
CAPITALREQUEST@CULTURE.NYC.GOV

CAPITAL FUNDING REQUEST FORM

FOR NOT-FOR-PROFIT CULTURAL ORGANIZATIONS

FUNDING REQUESTED FOR
FISCAL YEAR (FY) 2009
(ENDING JUNE 30TH, 2009)

(NAME OF ORGANIZATION)

(ADDRESS OF ORGANIZATION)

(PHONE NUMBER OF ORGANIZATION)
CAPITAL FUNDING REQUEST FORM
FOR NOT-FOR-PROFIT ORGANIZATIONS
DEPARTMENT OF CULTURAL AFFAIRS OF THE CITY OF NEW YORK

Contents

Page
Introduction 3
Glossary of terms 4
Checklist of Requested Documents 7
I. Contact Information 8
II. Organizational Information 9
III. City Requirements for Projects on Non-City Owned Property 13
IV. Representation Form 16

Appendices: Specific Project Information
I. Construction or Renovation 17
II. Furniture & Equipment for Initial Outfitting 23
III. Other Equipment (Systems) 28

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CAPITAL FUNDING REQUEST FORM
FOR NOT-FOR-PROFIT ORGANIZATIONS
DEPARTMENT OF CULTURAL AFFAIRS OF THE CITY OF NEW YORK

INTRODUCTION
The New York City Department of Cultural Affairs (DCLA) is dedicated to supporting and
strengthening organizations that enhance New York City's vibrant cultural life.

The goals of DCA‟s Capital Program include assisting the nonprofit cultural community in
providing increased public service and greater access for the disabled, enhancing exhibition
and/or performing space, preserving historic buildings and increasing protection of botanical,
zoological and fine art collections. City capital funds may be used to construct or reconstruct
a capital asset, acquire equipment systems or outfit a new space.

Please note that City capital funding is awarded with limitations. The City‟s capital budget
is funded through the sale of municipal bonds and can only be spent in accordance with the
rules that govern the use of bond proceeds. Among other things, these rules require a City-
funded capital project to establish a public purpose (see page 13) and follow capital eligibility
guidelines stipulated by the bond rules. This form will help us determine how well your
project meets these requirements. We need as much information as possible about your
request to give it full consideration. The more thoughtfully you complete this form, the
better we can assess your project‟s compatibility with City capital funding.

You must complete pages 8-16, but you should only complete the appendix sections that are
relevant to your project type. If you are a member of the Cultural Institutions Group, you are
not required to complete pages 8-16 Please indicate your project type by marking „x‟ below:

a. Construction or Renovation (Appendix I)
b. Furniture and Equipment for Initial outfitting of newly (Appendix II)
constructed, reconstructed, or acquired or leased space
c. Other Equipment Systems (Appendix III)

We urge you to read the entire form before you complete it so that you understand the
information that is required of your organization and project.

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CAPITAL FUNDING REQUEST FORM
FOR NOT-FOR-PROFIT ORGANIZATIONS
DEPARTMENT OF CULTURAL AFFAIRS OF THE CITY OF NEW YORK

GLOSARY OF TERMS
Capital Asset - A capital asset is a tangible property or other kind of asset that meets the
minimum cost, minimum useful life, and other criteria for capital funding.

Capital Project - Capital Projects vary widely in nature and purpose. Examples include, but
are not limited to: major construction or improvement projects such as the
construction or rehabilitation of a school; standalone purchases of major equipment
such as a fire truck or mainframe computer; the purchase or development of
equipment systems (a grouping of related components that, in combination,
constitute a system or other logical assemblage) such as a neighborhood's street lights
or an agency computer system.

Committed Funds – Secured funds that have been granted according to specified terms

Construction or Renovation Project – Improvements, expansions, upgrades, rehabilitations,
and betterments to an existing Capital Asset; expanding or adding to the size of a
building, structure, or other Capital Asset; retrofitting a building, structure, facility or
other Capital Asset for a wholly new or significantly changed use; or the purchase,
construction, or improvement, betterment, or upgrade of buildings, structures, facilities,
or any element of infrastructure.

Declaration of Restrictive Covenant – Defined in Section III of this form

Equipment System - A group of related elements that are wholly or partly interdependent, are
logically or physically connected, and serve a defined geographic area, facility, or group.
Examples of equipment systems include, but are not limited to:
(1) Mechanical systems, such as plumbing, heating, ventilating and air conditioning;
(2) Streetscape systems such as parking meters and street lighting;
(3) Communications systems, such as telephones;
(4) Electrical systems, such as power supply, fire alarms and security;
(5) Computer systems; and
(6) Combination systems such as electro-mechanical and other systems that are
computer controlled.
Typical equipment system elements include:
(1) Machinery or equipment components, subcomponents and parts;
(2) Wire, cabling, interconnecting hardware, software, and transmission devices; and
(3) Any labor, service or incidental part necessary to assemble the elements and
prepare the system for its intended operational use.

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CAPITAL FUNDING REQUEST FORM
FOR NOT-FOR-PROFIT ORGANIZATIONS
DEPARTMENT OF CULTURAL AFFAIRS OF THE CITY OF NEW YORK

Furniture/Equipment for Initial Outfitting – Purchase of goods for outfitting a facility within
six months after the completion of its acquisition, initial lease signing, construction or
renovation. Initial outfitting requires a minimum funding request of $35,000. The
initial outfitting equipment can include:

(1) Non-moveable equipment that is attached to the building, structure, facility, or
other Capital Asset, regardless of cost.

(2) Individual pieces of moveable equipment or furniture, or equipment or furniture
units with a cost of more than $110. A unit consists of a functional group with
constituent elements that may cost less than $110. Examples include a desk and
chair or a conference table and chairs. The minimum will be reviewed at least
once every four years and will be updated as necessary.

Hard Costs - Costs and expenses in connection with the Construction Project that result in
tangible assets, including, without limitation, (a) payments to Contractors (excluding
the Construction Manager), subcontractors, suppliers and material men for labor
performed and materials supplied, and (b) costs and expenses for labor, services,
facilities or equipment customarily considered as "general conditions" items in an
amount not in excess set forth in the Project Budget.

Performance Term – Defined in Section III of this form

Pledged Funds - Signed and dated commitments to make a gift during a specified period
according to specified terms.

Requested Funds – Various funding prospects that an organization has sought, either through
application or appeal. These prospects include, but are not limited to, individuals,
government entities, foundations, for funding that is pending an award decision.

Security Agreement - A legal agreement between the City and the funding recipient that is
required when capital funds are used to invest in moveable equipment or systems
(i.e., computer system, furniture). The agreement gives the City a security interest in
the equipment or system and the right to repossess the asset if its terms are not
honored by the funding recipient.

Soft Costs - Costs and expenses in connection with the Construction Project that do not result
in tangible assets but are essential to the project, including, without limitation, (a)
permits, (b) legal fees, (c) strategic/business plans or feasibility studies, (d) cost
estimators, (e) office expenses, (f) project management services, (g) closing costs,
and (h) insurance, loan fees, soft cost contingency, etc.

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CAPITAL FUNDING REQUEST FORM
FOR NOT-FOR-PROFIT ORGANIZATIONS
DEPARTMENT OF CULTURAL AFFAIRS OF THE CITY OF NEW YORK

Subordination - An arrangement whereby a creditor, mortgage holder or lien holder agrees to
make secondary to the City‟s Declaration of Restrictive Covenant, any loan, mortgage
or lien. Subordination is accomplished by a legal agreement in which the creditor,
mortgage holder or lien holder agrees to be bound by the terms of the City‟s Covenant
and grants to the City a priority in the instance of foreclosure.

Title insurance - a policy issued by an insurance company guaranteeing that the title to a
parcel of real property is clear and properly in the name of the title owner, and that
the owner has the right to deed the property (convey or sell) to another. Should a
problem later arise with the title (such as an inaccurate description), the insurance
company will pay the damages to the new title holder or secured lender, or take steps
to correct the problem

ULURP – Uniform Land Use Review Procedure is a standardized procedure created by the New
York City Charter which provides for public review of the use, development, or
improvement of real property subject to City regulation.

Useful Life – Defined in section III of this form

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CAPITAL FUNDING REQUEST FORM
FOR NOT-FOR-PROFIT ORGANIZATIONS
DEPARTMENT OF CULTURAL AFFAIRS OF THE CITY OF NEW YORK

CHECKLIST OF REQUESTED DOCUMENTS
This form references and may request submission of some or all of the following documents.
Please indicate the documents you are attaching to this form by marking „x‟ next to the
appropriate document(s).

[Required for ALL Organizations]
II. Organizational Information
2.A. Organizational Chart
3.A. Organizational brochures or flyers
4.A. Organization‟s IRS Letter of Determination for 501(c)(3) status

[The appendices are separated by project type and you are only required to submit
attachments for the appendix/project type for which you are requesting funds.]
APPENDIX I (Construction or Renovation)
1.B. Strategic and/or business plan
1.C. Master and/or capital plan
3.B. Cost Estimate (if available, completed by an estimator, engineer or architect)
3.E. Fundraising Plan or related documents (if available)
6.A. Landmark Commission approval (if applicable)
6.C. Environmental Review documents (if applicable)

APPENDIX II (Furniture and Equipment for Initial Outfitting)
1.B. Strategic and/or business plan
2.A. F/E Items and Cost Estimates
2.C. Fundraising Plan or related documents (if available)
4.A. Cost Estimate for comprehensive upgrade/complete reconstruction (if applicable)
6.A. Consultant/Designer Scope of Work (if applicable)
6.B. Installation Rates and Scope of Work (if applicable)

APPENDIX III (Other Equipment Systems)
1.B. Strategic and/or business plan
1.C. Master and/or capital plan
3 F/E Items and Cost Estimates
4.B. Fundraising Plan or related documents (if available)
7.A. Consultant/Designer Scope of Work (if applicable)
7.B. Installation Rates and Scope of Work (if applicable)

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CAPITAL FUNDING REQUEST FORM
FOR NOT-FOR-PROFIT ORGANIZATIONS
DEPARTMENT OF CULTURAL AFFAIRS OF THE CITY OF NEW YORK

I. CONTACT INFORMATION

1. Organization‟s Legal Name:
2. “Doing Business As” Name:
3. Website:
4. Organization‟s Main Address:
Street: City:
State: Zip Code:
Borough:

5. Principal Contact:
Name: Phone:
Title: Fax:
E-Mail Address:

6. Chief Executive Officer
Name: Phone:
Title: Fax:
E-Mail Address:

7. Community Board #:
8. Council District #:
9. Council member representing your district:
10. Project Site(s) (If Address Is Different Than Main Address):
Street: City:
State: Zip Code:
Borough:

11. EIN #:
Taxpayer ID #: (If different from EIN # above)

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CAPITAL FUNDING REQUEST FORM
FOR NOT-FOR-PROFIT ORGANIZATIONS
DEPARTMENT OF CULTURAL AFFAIRS OF THE CITY OF NEW YORK
II. ORGANIZATIONAL INFORMATION

1. Organization’s Background: Briefly describe the mission, history and principal
activities of the organization:

2. Operations and Management:

A. Please attach an organizational chart and a list of the staff members and their
functions.

B. Please provide the following information about your Board of Directors:

1. How many members are on your full Board?
2. Do members have term limits? Yes No
3. How often does your Board meet? Monthly Quarterly Annually
Other Specify:
4. Does your Board have an active committee structure? Yes No
5. Does your Board have an Audit Committee? Yes No
6. Does your Board have a Finance Committee? Yes No
7. Does your Board have a Capital Committee? Yes No
8. How will your organization‟s Board of Directors be involved in the Project?

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CAPITAL FUNDING REQUEST FORM
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DEPARTMENT OF CULTURAL AFFAIRS OF THE CITY OF NEW YORK
3. Marketing and attendance figures

A. Please attach a copy of your Organization‟s brochures or flyers describing or
advertising the types of programs offered.

B. In the applicable categories below, please provide total actual Fiscal 2007 and
projected 2008 attendance figures for your organization, including all your activities,
not only those for which you requested DCA support:
FY2007 FY2008
Public attendance at events, performances,
exhibitions, etc.
Educational programs (lectures/demonstrations,
workshops,
classroom visits, performances for pre-K – grade
12)
Interactive web-based programming
Other (broadcasts, media distribution,
publications, etc.)
Total

4. Financial Information:

A. Please confirm your organization‟s tax-exempt status under section 501(c)(3) of the
IRS code by attaching one copy of the IRS letter of determination.

B. Please complete the Budget Chart on page 11 and indicate in the chart below your
percentage breakdown of actual and projected operating income. (Total must equal
100%)

FY07 Actual FY08 Projected FY09 Projected
Government % % %
support
Non-governmental % % %
supportIncome
Earned % % %
Other % % %
Total 100 % 100 % 100 %

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CAPITAL FUNDING REQUEST FORM
FOR NOT-FOR-PROFIT ORGANIZATIONS
DEPARTMENT OF CULTURAL AFFAIRS OF THE CITY OF NEW YORK

BUDGET CHART
The following information provides a budget history for the organization and TOTAL FY07
projections for FY2009. Provide accurate actual or projected amounts in all INCOME (ACTUAL)
categories.
If you have applied for a Cultural Development Fund Grant, please note that this TOTAL FY07
is a modified version of that application‟s budget form and should reflect your EXPENSES (ACTUAL)
organization‟s same budget information for the appropriate fiscal years.
ANNUAL OPERATING BUDGETS
2006-07/FY07 2007-08/FY08 2008-09/FY09
Actual Projected Projected
EARNED INCOME:
Admissions/Box Office
Contracted Services
Tuition, Class/Workshop Fees
Publications
Fundraising (Gross)
Other Earned Income

TOTAL EARNED INCOME
UNEARNED/NONGOVERNMENT INCOME:
Corporate Contributions
Foundation Grants
Individual Contributions
Other Unearned (see
SUBTOTAL

UNEARNED/GOVERNMENT INCOME:
NEA
NYSCA
Other Federal/State
DCA/Program Services
DCA/Other
Other City
Local Arts Councils
SUBTOTAL
TOTAL UNEARNED INCOME
EXPENSES:
Personnel Administrative
Artistic
Technical/Production
Outside Professional Services
Space rentals/Utilities
Equipment Rental/Supplies
Travel/Transportation
Advertising/Promotion Marketing
Other Expenses
TOTAL EXPENSES
SURPLUS/DEFICIT
INKIND SUPPORT
INKIND + EXPENSES

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CAPITAL FUNDING REQUEST FORM
FOR NOT-FOR-PROFIT ORGANIZATIONS
DEPARTMENT OF CULTURAL AFFAIRS OF THE CITY OF NEW YORK

C. Please indicate your organization‟s special funds:

Type of Restricted/Unrestricted Amount as of Projected Purpose (if
Fund 7/1/07 amount for restricted)
7/1/08
Endowment
Cash
Reserve
Other
Total

5. Property Information
A. Are your organization's primary physical facilities and real estate:
OWNED by: RENTED from:
Applicant organization Private landlord
City Agency: City Agency:
Other: Other:
DONATED by: Monthly rent: $
WORK OUT OF HOME Lease expiration: / /
Rented only on as needed/events basis
If your organization is in shared space, indicate with whom:
For all organizations:
Cost/Sq. Ft. (avg): $
% of annual budget spent on space (avg.): %

B. Where applicable, please indicate approximate square footage within your facility:

Office/Admin Exhibition/Gallery
Performance Studio/Rehearsal
Classroom/Education Collections/Storage

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CAPITAL FUNDING REQUEST FORM
FOR NOT-FOR-PROFIT ORGANIZATIONS
DEPARTMENT OF CULTURAL AFFAIRS OF THE CITY OF NEW YORK

III. CITY REQUIREMENTS FOR NON-CITY OWNED PROPERTY

If your property is City owned, please indicate by marking „x‟ here: and go to page 16.

If your property is non-City owned, please read below and answer questions at the end of this
section.

BACKGROUND: The City of New York funds its capital budget with the sale proceeds of
municipal bonds. Strict rules govern the spending of those sale proceeds and as a result the
City imposes strict requirements on the organizations that benefit from allocations in the
City‟s capital budget. In addition, such rules are required to protect the City‟s investment
with public funds. Generally, the City (a) may only fund the purchase or improvement of
capital assets and (b) must establish a legal interest in the premises being funded by
guaranteeing a City Purpose.

A. Capital Assets
Every capital asset has a useful life that is determined by the Mayor‟s Office of
Management and Budget (OMB) and is based on the asset‟s expected period of use and
New York State‟s Local Finance Law. The useful life is generally no less than five (5)
years and no longer than thirty (30) years depending on the kind of asset that the City
is funding.

B. The City‟s Legal Interest
Depending on the kind of capital asset that the City is funding on behalf of your
organization, the City will establish its legal interest with either a Declaration of
Restrictive Covenant or a Security Agreement.

1. Declaration of Restrictive Covenant (Covenant): When an organization is located
on non-City owned property and the City is funding construction or fixtures, the
owner of the property is required to sign and file a Declaration of Restrictive
Covenant. The Covenant establishes the City‟s legal interest in the property and
requires the property owner to comply with certain obligations. The Covenant is
filed against the real estate records of the property that the City is improving and
runs with the land for the length of the useful life of the asset (performance
term).

2. Security Agreements are used for purchases of moveable equipment with City
funds and also grant the City a legal interest in the equipment under the Uniform
Commercial Code.

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CAPITAL FUNDING REQUEST FORM
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DEPARTMENT OF CULTURAL AFFAIRS OF THE CITY OF NEW YORK

C. Legal Obligations
Both the Covenant and Security Agreement obligate the owner of the premises to do
the following:

1. use the equipment or the premises, which will be improved with City funding, for
its stated, not-for-profit purpose (City Purpose) and for the length of the
performance term

2. agree not to destroy, remove, alter or transfer the City-funded equipment or
improvements before the expiration of the bond term

3. agree not to use the equipment or premises to unlawfully discriminate against any
Person on the basis of race, religion, creed, color, national origin, sex, age,
disability, marital status, sexual orientation, or political affiliation

4. agree not to advance religion or support sectarian activity, including religious
worship, instruction or proselytizing with the City-funded equipment or on the
City-funded property

D. Other Requirements

1. Property Owners – If your organization is not the owner of the property that will be
improved with City funding, then both your organization and your landlord must
sign the Restrictive Covenant. The Covenant will also apply to any subsequent
occupant for the entire performance term. For instance, if your organization
outgrows its space and elects to move, your landlord will be obligated to find
another tenant to deliver the services outlined in the City Purpose section of the
Covenant for the remainder of the performance term.

2. Mortgages and Liens - There can be no mortgages, liens or other interests filed
against the property unless they are secondary to the City Purpose Covenant
through subordination. Subordination is accomplished with a legal agreement in
which the mortgage holder or creditor agrees to be bound by the terms of the
Covenant. Please be advised that creditors are often reluctant subordinate to the
City‟s Covenant. If you have mortgages and/or liens filed against your property
you should contact DCA‟s capital unit to discuss.

3. Sales and Transfers - There should be no current intention to transfer the property
or equipment to another party. Unanticipated transfers must be approved in
writing by the City and as stated above, will subject the purchaser to the
obligations of Covenant.

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CAPITAL FUNDING REQUEST FORM
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DEPARTMENT OF CULTURAL AFFAIRS OF THE CITY OF NEW YORK

E. Title Reports and Insurance

For capital construction projects, the City requires a title report for the property to be
improved by City funding in order to demonstrate the property‟s current state of title and
disclose any defects. In addition, organizations with capital allocations in excess of $1 million
are required to obtain title insurance to further insure the City that where a Covenant is
required, the Covenant has first priority and to provide the City with rights to make a claim
under the policy should any defects in the title exist. The property owner can purchase
either a fee owner‟s or mortgagee‟s title policy that includes within the policy (1) a form of
endorsement recognizing the existence of the Covenant; and (2) an assignment to the City of
rights under the policy to sue for any breach of the endorsement.

F. Questions
1. If you are leasing your space, have you explained the requirements of the
Covenant to your landlord?

Yes No

2. If yes, has your landlord agreed to abide by them?

Yes No

3. Do you have any mortgages or liens on your property?
Yes No

4. If yes, have you spoken with your mortgage holder or lender about the
requirements of the Covenant?
Yes No

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CAPITAL FUNDING REQUEST FORM
FOR NOT-FOR-PROFIT ORGANIZATIONS
DEPARTMENT OF CULTURAL AFFAIRS OF THE CITY OF NEW YORK

IV. REPRESENTATION FORM

I, , as (Title)of the organization listed above, have the authority to submit this
Capital Funding Request Form on behalf of (Organization‟s Legal Name).

I certify under penalties of perjury that all answers submitted are factual, accurate and that
this Form has been completed with the best efforts of the above named organization.

(Electronic Signature – Please Initial)

(Print Name)

(Date)

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APPENDIX I.
CONSTRUCTION OR RENOVATION
1. Project Description:
A. Briefly describe the goal(s) of the project, how the project will serve a public purpose
and any additional programming that the organization will offer once the project is
complete.

B. Does your organization have a strategic and/or business plan? YES NO
If so, please attach and describe how this relates to the overall project. (If you are
completing more than one appendix section, then please submit only one answer to
this question.)

C. Does your organization have a master and/or capital plan? YES NO
If so, please attach and describe how this relates to the overall project for which you
are requesting funding. (If you are completing more than one appendix section, then
please submit only one answer to this question.)

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D. If you have hired an architect or engineer, please identify below.

Firm Name: Website:
Contact person: E-mail:
Phone: Fax:

2. Scope of work
A. Please identify your project type by marking „x‟ in the right column:

Renovation
A. Exterior or envelope of the building
B. Infrastructure (plumbing, HVAC, electrical, etc.)
C. Interior space
New Construction
A. Demolition of current space in order to build brand new space. In this
case please explain what will be demolished and why, what will be built in
its place and how is it different than the old demolished space.
B. New addition either adjacent to its current building or adding floors to
the current building.
C. New construction on a newly acquired property.

B. Please provide a breakdown of the major aspects of the project. If the project is a
renovation, please describe the major project components, steps in the renovation,
etc. If project is new construction, please provide information on the size, make-up,
and cost of the new facility.

3. Proposed Project Schedule and Budget
A. What is your project timeline and what is your current project phase (scope
development, design or construction)?

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B. Please attach a cost estimate of the project that accounts for prevailing wages and
escalation for the projected life of the project. If possible, provide an official cost
estimate completed by an estimator, engineer or architect.

C. Please fill in budget information for the proposed project:

USE AMOUNT FUNDING SOURCE
(CITY/OTHER)
DESIGN COSTS
CONSTRUCTION
COSTS
CONTINGENCY
CONSTRUCTION
MANAGER
OTHER SOFT
COSTS
FURNITURE AND
EQUIPMENT
TOTAL

D. Estimated Project Funding Sources: Identify all sources and amounts of funds with a
breakdown of committed, pledged and/or requested funding for the project:

SOURCE OF TOTAL AMOUNT COMMITTED PLEDGED REQUESTED
FUNDS AMOUNT AMOUNT AMOUNT
FOUNDATIONS
CORPORATE
CONTRIBUTIONS
INDIVIDUAL
CONTRIBUTIONS
BOARD
CONTRIBUTIONS
OTHER PRIVATE
CONTRIBUTIONS
MAYORAL FUNDS
CITY COUNCIL
FUNDS
BOROUGH
PRESIDENT FUNDS
OTHER
GOVERNMENT (i.e.
State/Federal)
TOTAL

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E. Describe your fundraising schedule and goals. Please attach any other relevant
documents, if available.

4. Project Management: Please describe your project management chain of command.
Please list both internal and external staff involved in the project and describe their
responsibilities.

5. Project’s Impact on Operating Costs: Please explain how this proposed construction
project, once it is completed, will impact the organization‟s operating budget (i.e.,
energy costs; security costs; maintenance costs; etc.). Explain how the organization
will fund any increased operational costs and/or maintain the site after the project is
completed.

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6. Zoning, land, approval and environmental considerations

A. Please indicate below by marking „x‟ if the project‟s building/site has been designated
or is pending designation as part of one of the below. Please also indicate if the
relevant office has issued an approval for the project:

Designated or Approved
Pending Designation
NYC Landmark
NYC historic district
NYC special natural area
NYC Art Commission
National register of historic places
National historic landmark

B. Is the ULURP process required for your project? YES NO

C. Will your project have an environmental impact? YES NO
If yes, please describe the potential impact and state whether you know if an
environmental review is required for your project. (For more information on
environmental reviews, please visit New York City‟s Office of Environmental
Coordination‟s website for more information
http://www.nyc.gov/html/oec/html/ceqr/ceqr.shtml).

D. Will the project include the removal or containment or other remediation of any
hazardous materials or pollutants, such as lead paint, asbestos, mold, oil, other
petroleum products, or other contaminants? If yes, please describe.

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7. Green building standards law: The green building standards law (New York City
charter section 224.1 and chapter 10 of title 43 of the rules of the City of New York –
more information can be found on the web at www.nyc.gov/oec) applies to most
construction or reconstruction projects receiving City funds. If your project triggers
this law, please indicate by marking „x‟ below whether your project will comply with
the law.

YES NO

B. Are the project‟s facilities and real estate:
OWNED by: RENTED from:
Applicant organization Private landlord
City Agency: City Agency:
Other: Other:
DONATED by: Monthly rent: $
WORK OUT OF HOME Lease expiration: / /
Rented only on as needed/events basis
If your organization is in shared space, indicate with whom:
For all organizations:
Cost/Sq. Ft. (avg): $
% of annual budget spent on space (avg.): %
C. Where applicable, please indicate approximate square footage within your facility:

Office/Admin Exhibition/Gallery
Performance Studio/Rehearsal
Classroom/Education Collections/Storage

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APPENDIX II.
FURNITURE AND EQUIPMENT (F/E)
FOR INITIAL OUTFITTING
1. Project Description:
A. Briefly describe the goal(s) of the project, how the project will serve a public purpose
and any additional programming that the organization will offer once the project is
completed.

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2. Description of F/E
A. For all f/e purchases, please attach a detailed list of the items, using the format
below:

ITEM OF QUANTITY OF COST OF TOTAL FUNDING SOURCE
EQUIPMENT THE ITEM INDIVIDUAL PIECES COST OF (CITY/OTHER)
TO BE ITEM
PURCHASED

3. Estimated Project Funding Sources:
A. Identify all sources and amounts of funds with a breakdown of committed, pledged
and/or requested funding for the project:

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B. Describe your fundraising schedule and goals. Please attach any other relevant
documents, if available.

4. Initial Outfitting Requirements:
F/e purchases will be deemed “initial outfitting” if the location for the f/e includes
one of the following categories. Please indicate your project‟s category by completing
the relevant information below:

DATE OF FIRST
OCCUPANCY
BUILDING TYPE (F/E purchase must
DATES occur within 6 months
of the occupancy date)
Newly Acquired Purchase Date of Property:
Property
Newly Leased Lease Term:
Property
Lease Start Date:

Lease End Date:

Newly Constructed Construction Completion Date:
Property
Comprehensive Construction Completion Date:
Upgrade/Complete
Reconstruction

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5. Comprehensive Upgrade/Complete Reconstruction: If the proposed initial outfitting
project is in relation to a Comprehensive Upgrade/Complete Reconstruction, then
provide the following information:

A. Describe the scope of work, including the trades, such as demolition, painting,
carpeting, drywall, ceiling work, etc.). Please attach a detailed cost estimate for the
scope of work.

B. Describe the location in the facility and size of the area affected by the
reconstruction/upgrade.

6. Project Management: Please explain who will be managing the project. If you are
planning to hire outside consulting services, please explain the responsibilities of the
consultant.

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7. Installation and related soft costs:

A. Will there be any consultant or design fees, or other soft costs to install the
f/e? YES NO
If yes, then attach a detailed description of the scope of work for the consultant or
designer, the estimated hours to perform the consulting or design services, and the
hourly rates to be paid for such consulting and designing.

B. Will there be any installation or installation-related costs associated with the
f/e? YES NO
If yes, then attach a detailed description of the scope of work for the installation, the
estimated hours to perform the installation, and the hourly rates to be paid for the
installation.

8. Property Information: If your project is occurring at a property other than your
organization‟s primary facilities as described in Section II, Question 5, then please
complete the below information regarding the property where the project is
occurring.
A. Are the project‟s facilities and real estate:
OWNED by: RENTED from:
Applicant organization Private landlord
City Agency: City Agency:
Other: Other:
DONATED by: Monthly rent: $
WORK OUT OF HOME Lease expiration: / /
Rented only on as needed/events basis
If your organization is in shared space, indicate with whom:
For all organizations:
Cost/Sq. Ft. (avg): $
% of annual budget spent on space (avg.): %
B. Where applicable, please indicate approximate square footage within your facility:

Office/Admin Exhibition/Gallery
Performance Studio/Rehearsal
Classroom/Education Collections/Storage

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APPENDIX III.
OTHER EQUIPMENT SYSTEMS
1. Project Description:
A. Briefly describe the goal(s) of the project, how the project will serve a public purpose
and any additional programming that the organization will offer once the project is
completed.

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2. Type of Equipment to be purchased (Check all that applies):
Equipment System
Stand-alone Equipment

3. Detailed Cost Estimate: Please attach a detailed list of the items, using the format
below with the appropriate column headers. If the Equipment is Information
Technology or IT-related, then please attach to this Questionnaire a copy of the
Specifications for each IT-related item:

ITEM OF NUMBER COST TOTAL FUNDING LOCATION OF
EQUIPMENT OF OF COST OF SOURCE EACH UNIT
UNITS EACH ITEM (CITY/OTHER)
UNIT

4. Estimated Project Funding Sources:
A. Identify all sources and amounts of funds with a breakdown of committed, pledged
and/or requested funding for the project:

SOURCE OF TOTAL AMOUNT COMMITTED PLEDGED REQUESTED
FUNDS AMOUNT AMOUNT AMOUNT

FOUNDATIONS
CORPORATE
CONTRIBUTIONS
INDIVIDUAL
CONTRIBUTIONS
BOARD
CONTRIBUTIONS
OTHER PRIVATE
CONTRIBUTIONS
MAYORAL FUNDS
CITY COUNCIL
FUNDS
BOROUGH
PRESIDENT FUNDS
OTHER
GOVERNMENT (i.e.
State/Federal)
TOTAL

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B. Describe your fundraising plans, including the schedule and goals. If you have a
fundraising plan or other relevant documents, please attach them.

5. Equipment Systems: If the organization is purchasing an equipment system, then
provide the following additional information:
A. How will the Equipment System work when it is installed (what functions will it
perform)?

B. How does each individual component of the Equipment System relate to each other?

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6. Project Management: Please explain who will be managing the project. If you are
planning to hire outside consulting services, please explain the responsibilities of the
consultant.

7. Installation and related soft costs:

A. Will there be any consultant or design fees, or other soft costs to install the
equipment? YES NO
If yes, then attach a detailed description of the scope of work for the consultant or
designer, the estimated hours to perform the consulting or design services, and the
hourly rates to be paid for such consulting and designing.

B. Will there be any installation or installation-related costs associated with the
equipment? YES NO
If yes, then attach a detailed description of the scope of work for the installation, the
estimated hours to perform the installation, and the hourly rates to be paid for the
installation.

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WORK OUT OF HOME Lease expiration: / /
Rented only on as needed/events basis
If your organization is in shared space, indicate with whom:
For all organizations:
Cost/Sq. Ft. (avg): $
% of annual budget spent on space (avg.): %
B. Where applicable, please indicate approximate square footage within your facility:

Office/Admin Exhibition/Gallery
Performance Studio/Rehearsal

Classroom/Education Collections/Storage

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