HomeMy WebLinkAbout20111403.tiff RESOLUTION
RE: APPROVE APPLICATION FOR FEDERAL TRANSIT ADMINISTRATION (FTA) GRANT
ASSISTANCE FOR SECTIONS 5310 AND 5311 AND AUTHORIZE CHAIR TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with an Application for Federal Transit
Administration (FTA) Grant Assistance for Sections 5310 and 5311 from the County of Weld, State
of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the
Department of Buildings and Grounds, Transportation Unit, to the Colorado Department of
Transportation, with terms and conditions being as stated in said application, and
WHEREAS,after review,the Board deems it advisable to approve said application, a copy of
which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Application for Federal Transit Administration(FTA)Grant Assistance for
Sections 5310 and 5311 from the County of Weld, State of Colorado, by and through the Board of
County Commissioners of Weld County, on behalf of the Department of Buildings and Grounds,
Transportation Unit, to the Colorado Department of Transportation be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said application.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 1st day of June, A.D., 2011.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST:�� EXCUSED
Barbara Kirkmeyer, Chair
Weld County Clerk to the Board
ay, Pro-Tem
BY: . ,avwry � I /.
Deputy erk to the Boa ' :: .
Iasite";1/4° 9 C(�
..;...;,�1 F. Ga 'a
APPR DAB FORM: �, ""' ♦�,
e.vid E. Long
unty Attorney EXCUSED
Douglas Rademacher
Date of signature: I-a S- I a
I orof1-o barb U . fe , BAG
(F - 1 - II I- O5- 1D, 2011-1403
BG0013
APRIL 2011 2012-2013 CDOT Grant Application for FTA Funding
2012-2013
CDOT APPLICATION for FTA GRANT ASSISTANCE
Application Deadline: Monday, June 6, 2011, by 5 :00 P.M. No Exceptions !
A Complete Application Includes :
Online Database Application Requirements. Complete the Agency Profile, Capital Inventory, and
Capital Request sections of the database at http://apps.coloradodot.info/transit/.
Fillable-Form Application, the sections that deal with your 2012-2013 grant request must be emailed to
Sylvia.labrucherie@dot.state.co.us. These are Microsoft Word Documents.
Supporting Materials, signature pages, certificates, and assurances, which complete the application,
must be postmarked or delivered. CDOT will not accept faxed or emailed copies of signature pages.
All the certificates and assurances are the last section of the Application Instruction and Guidebook at
http://www.coloradodot.info/programs/transitandrail/transit/transit-grant-programs/grant-information.
For Postal Sylvia Labrucherie, Transit Unit, Division of Transit and Rail, Colorado Dept. of
Delivery: Transportation, Shumate Building, 4201 E ARKANSAS AVE, DENVER CO 80222
For Hand The Shumate Building is on the northeast side of the CDOT headquarters building and north
Delivery: of the big radio tower.
Important Notes
Flf You MUST complete or update your Agency Profile and Capital Inventory before submitting the ap-
plication. Applications will not be reviewed until the Agency Profile and Capital Inventory (when ap-
plicable) has been updated! Access the Agency Profile and Capital Inventory online at the Transit Unit
website, http://apps.coloradodot.info/transit/.
IIf you are making a capital request, it can only be done through the online database under "Capital
Equipment Requests." This is true for all four grant programs. All requests must be completed and
saved by the June 6th deadline, http://apps.coloradodot.info/transit/.
7IIf you are a new applicant or are unsure if your proposed project is part of a regional transportation
plan, contact John Valerio at 303-757-9769.
FrIf you are a human-service transportation provider and are unsure if your proposed Section 5310, 5316
(JARC), or 5317 (New Freedom) project is part of a local, coordinated human services-transportation
plan, contact John Valerio at 303-757-9769.
171 If you are applying for funds for a construction project, you must have National Environmental Policy
Act (NEPA) documentation completed. Contact Eric Ellis, Transit Grants Manager at 303-757-9766.
FrIf you are an INTERCITY BUS APPLICANT, complete Section A of the application. You must
ALSO complete the document entitled "5311 (0 Intercity Bus Application for New Projects," located
on the Transit Unit's home page, http://apps.coloradodot.info/transit/.
Division of Transit and Rail, Colorado Department of Transportation Section A-All- Page 1
2011 -1403
2012-2013 CDOT Grant Application for FTA Funding APRIL 2011
Pre-Submittal Requirements
BEFORE YOUR APPLICATION IS REVIEWED, you must complete the Agency Profile and
Capital Inventory on the Transit Unit website at http://apps.coloradodot.info/transit/ .
You will need a password to access the Agency Profile, Capital Inventory, and Capital Request
pages. Contact Matt Paswaters at 303-757-9771 if you need a password.
Submittal Information
Read the Application Instructions and Guidebook! Keep it handy as you fill out the application. The
Application Instructions and Guidebook is available online at
http://www.coloradodot.info/programs/transitandrail/transit/transit-grant-programs. It contains
important information, including additional required documents, explanations and definitions,
examples of eligible projects, worksheets, step-by-step instructions, and definitions.
Send in all the required attachments! We've included a checklist to help you make sure you've
included everything that needs to be sent in.
The application contains several sections that are listed below. You need to complete two or more
sections, depending on the grant or grants you apply for.
All applicants must complete Section A. Applicants for the individual grant programs must also fill
out the following sections:
SECTION of FTA GRANT FTA GRANT TITLE NAME OF SECTION FORMAT AND LOCATION
APPLICATION WITHIN THE APPLICATION
Agency — — Agency Profile, Capital Online form through
Profile Inventory, Capital Request Transit Unit website
— — All Applicants Fillable forms, MS Word
A
2012AppSectA-All.doc documents.
Transportation for Evaluation Narrative for Obtain online through
Sections
Transit Unit website.
5310, 5311 Elderly Persons and 5310 and 5311 Applicants Return via email to:
B Persons with 2012AppSectB-5310-11 .doc Sylvia.labrucherie
Disabilities; Rural and @dot.state.co.us
Small Urban Areas
Section Rural and Small Urban Proposed Scope of Work
C 5311 Areas for 5311 Applicants
2012AppSectC-5311 .doc
Section Intercity Bus Existing 5311 (f)
D 5311 (f) Applicants
2012AppSectD-IC B.doc
E Section Job Access/Reverse 5316 Applicants
5316 Commute (JARC) 2012AppSectE-JARC.doc
F Section New Freedom 5317 Applicants
5317 2012AppSectF-NewFree.doc
G Sections 5310, 5316, and 5317 Mobility Management
2012AppSectG-MoMgt.doc
H Certificates and Assurances, 2012AppSectH-CertsAssures.doc
Section A—All— Page 2 Division of Transit and Rail, Colorado Department of Transportation
APRIL 2011 2012-2013 CDOT Grant Application for FTA Funding
SECTION A
APPLICATION SECTION FOR ALL APPLICANTS
Add a short title for your project. For example: "5310 Capital fund for Security Cameras," 5311 Operating
Funds for Fixed Route in the Town of Uphill Battle," "5316 JARC Operating Funds for Employment Route in
Cannotretire County," "5317 Capital Funds for New Transit Bus for Help-Each-Other Transit, Inc.," and so
forth. (100 word maximum).
Add a brief, two or three sentence description of your project (250 word maximum).
Name of Applying Agency Weld County Transportation DUNS Number 75757955
Al . Project Request Summary
1st Grant Request Section 5311 , Rural Public Transportation
Project Name with Grant Number
1st Grant Request Agency provides deviated fixed routes, modified fixed routes and door to door
demand responsive transportation services to seniors, persons with disabilities,
Brief Description of Proposed Project low income individuals for medical services and human services.
2nd Grant Request This project is for the purchase of three (Type II) buses.
Project Name with Grant Number
2nd Grant Request 2012 Capital Request
Brief Description of Proposed Project
3rd Grant Request This project is for the purchase of three (Type II) buses.
Project Name with Grant Number.
3rd Grant Request 2013 Capital Request
Brief Description of Proposed Project
4th Grant Request
Project Name with Grant Number
4th Grant Request
Brief Description of Proposed Project
5th Grant Request
Project Name with Grant Number
5th Grant Request
Brief Description of Proposed Project
6th Grant Request
Project Name with Grant Number
6th Grant Request
Brief Description of Proposed Project
If you need to add more information to any of the questions in this applica-
tion, or if any of the questions fail to "fill" properly, submit the informa-
tion in a separate document when you email this application on or before
the deadline of Monday, June 6, 2011 , by 5 P. M .
2012-2013 CDOT Grant Application for FTA Funding APRIL 2011
A2 . FUNDING REQUEST SUMMARY
These two tables summarize your funding request(s). Only Enter The FTA Amount You Are Requesting,
table should fill in automatically. If it doesn't, submit information separately. Use whole dollars only.
2012 PROJECT FUNDING REQUESTS "--
FTA 2012 OPERATING 2012 CAPITAL 2012 ADMIN OR PLANNING"` 2012 TOTALS
Grant
FTA MATCH TOTAL FTA MATCH TOTAL FTA MATCH TOTAL FTA MATCH TOTAL
I 132,000 33,000 I65,000 132,000 33,000 165,000
53101
117,700 117,700 235,400 0 0 55.000 13,750 68,750 172,700 131,450 304,150
5311
0 0 0 0 0 0 0 0 0
5311(f)
0 0 0 0 0 0 0 0 0
5316
0 0 0 0 0 0 0
5317
Administrative expenses, but not planning expenses, are permitted under 5311 .
Planning expenses, but not administrative expenses, are permitted under 5316.
2013 PROJECT FUNDING REQUESTS
alla
FTA 2013 OPERATING 2013 CAPITAL 2013 ADMIN OR PLANNING'^` 2013 TOTALS
Grant
FTA MATCH TOTAL FTA MATCH TOTAL FTA MATCH TOTAL FTA MATCH TOTAL
5310 I 132,000 33,000 165,000 132,000 33,000 165,000
5311 129,470 129,470 258,940 0 0 55,000 13,750 68,750 184,470 143,220 327,690
5311 (f) 0 0 0 0 0 0 0 0 0
5316 0 0 0 0 0 0 0 0 0
I
5317 0 0 0 0 0 0 0
Administrative expenses, but not planning expenses, are permitted under 5311 .
Planning expenses, but not administrative expenses, are permitted under 5316.
A3. Proposed Subcontractors or Sub-Recipients
Provide the name(s) of any subcontractors you will use for this project.
1 . 6.
2. 7.
3. 8.
4. 9.
5. 10.
Section A—All— Page 4 Division of Transit and Rail, Colorado Department of Transportation
APRIL 2011 2012-2013 CDOT Grant Application for FTA Funding
A4 . TRANSPORTATION COORDINATION
A4. 1 . Resource Coordination - .
Answers to questions have a 1 ,000 character limit.
❑ YES Do you broker service or provide service to
z NO another agency? If yes, describe it briefly.
Z YES Do you share resources in any significant way Mechanics, facilities, insurance, fuel purchases, etc.
❑ NO with other agencies (e.g., maintenance/ mechan-
ics, vehicles, staff/drivers, facilities, marketing,
insurance, fuel purchases, training, bilingual pro-
grams, etc.)? If yes, describe it or them briefly.
❑ YES Have you realized any measurable or quantifiable
z NO savings in operating costs directly through, or as a
result of your coordination efforts? If yes, describe
it or them briefly.
A4.2. Community Coordination
Identify all the other transit providers in your service area. Include intercity bus, taxis, human service-
transportation providers, etc., if any. Identify the trade union to which these providers belong, if any (e.g.,
Independent Driver Association of Teamsters, ACME, etc.).
Answers to questions 1-10 have a 50 character limit; answers to questions 13-16 have a 1 ,000 character limit.
Transit Provider Trade Union
1 . Greeley-Evans Transit Unknown
2 Shamrock Taxi Unknown
3. NFRMPO - Van Go Unknown
4. Rocky Mountain Shuttle Unknown
5. Black Hills Stage Unknown
6. Greyhound Unknown
7. Greeley Airport Shuttle Unknown
8. Super Shuttle Unknown
9. Colorado Cab Company Unknown
10. El Paso-Los Angeles Limo Service Unknown
13. Describe your efforts to coordinate transportation services We communicate through the NFRMPO and WCMC
with these providers. meetings
14. Describe any barriers to coordination that you may have N/A
encountered with the providers listed in this section.
15. Describe your efforts to work with other organizations, We work with other organizations, as required, to
agencies, businesses, and other appropriate community provide services. In addition, we provide brochures
interests in order to provide service (e.g. , employers, and information on the web-page.
medical centers, social service agencies, visitor services,
activity centers, etc.).
16. Describe any other special efforts you have taken to N/A
coordinate in a manner not yet described.
Division of Transit and Rail, Colorado Department of Transportation Section A-All- Page 5
2012-2013 CDOT Grant Application for FTA Funding APRIL 2011
A4.3. Human Services-Transportation Coordination
Important Note! You MUST answer the following questions about human service-transportation
coordination if you are applying for funds under Sections 5310, 5316 (JARC), and/or 5317 (New Freedom).
Answers to questions have a 1 ,500-character limit.
® YES Have you attended a human service- The NFRMPO TAC/TAG, WCMC meeting/notes; and
❑ NO transportation coordination meeting within the periodic meetings with staff at Human Services.
last year? If you have, describe it briefly.
® YES Are you a member of a Local Coordinating Active member in the MFRMPO TAG and we review
❑ NO Council? If you are, discuss your activities. all WCMC meeting notes that are provided.
2. Describe your agency's efforts at local human service- Communication on-going.
transportation coordination planning.
3. If you have met with other agencies, providers, etc. , to Communication on-going.
work on coordination activities, describe how success-
ful your efforts have been so far.
4. Regarding your coordinated planning efforts, what are This list changes. Current list is available from
the contact names, agencies, and phone numbers of NFRMPO email: MWarring@nfrmpo.org for up-to-date
the other primary agencies, groups, or individuals you information.
are specifically working with?
5. Does your agency work with housing providers or de-
velopers to design or schedule routes?
6. Does your agency work with local employers, economic
development organizations, or workforce centers?
7. This project must be in CDOT's 2035 Statewide and Current description is available from NFRMPO email:
Regional Long Range Plans, even if it's described very MWarring@nfrmpo.org for up-to-date information.
broadly. Tell us how and where this project is described
in the plans.
Section A—All— Page 6 Division of Transit and Rail, Colorado Department of Transportation
APRIL 2011 2012-2013 CDOT Grant Application for FTA Funding
A4.4. Sustainability and Livability ,, m
The principles of sustainability have been gaining ground in the public transportation industry, according to
the American Public Transportation Association. At its core, sustainability is an effort to make our
communities more livable. Sustainability is about practices that make good business sense and good
environmental sense by balancing the economic, social, and environmental needs of a community. For the
public transportation industry, this could mean:
• Employing practices in design and capital construction, such as using sustainable building materials, re-
cycled materials, and solar and other renewable energy sources to make facilities as 'green' as possible.
• Employing practices in operations and maintenance such as reducing hazardous waste, increasing fuel
efficiency, reducing vehicle miles traveled, and using energy-efficient propulsion systems.
• Employing community-based strategies to encourage land use and transit-oriented development designed
to increase public transit ridership.
We're asking the next few questions to determine if sustainability, "livability," or "aging-in-place" factor into
your agencies policies or planning. Refer to the CDOT Application Instructions and Guidelines for a broader
discussion. Answers to questions have a 1500 -character limit.
® YES Has your agency reviewed any sustainability, Weld County Transportation has and is continuing to
❑ NO livability, or aging-in-place principles or guide- review sustainability, livability, and aging-in-place
lines? If yes, please discuss. principles and guidelines within Weld County. This is
done through many forums from building
design/improvements, vehicle purchases, evaluation of
existing Human Services programs and community/peer
discussions.
® YES Has your agency adopted any sustainability, Weld County Transportation is reviewing practical
❑ NO livability, or aging-in-place principles or guide- sustainability, livability, and aging-in-place principles.
lines? If yes, please discuss. For example our replacement public transit vehicles are
intended to use CNG as the propulsion mechanisms. In
addition, we have recently purchased computer software
to optimize routes in order to reduce miles traveled. For
buildings we have just finished a large capital outlay to
incorporate energy efficiency improvements through
upgrades to lighting, boilers, and HVAC equipment.
An empty bus can't be a sustainable bus! Describe your Since our program is a demand response type, we don't
agency's efforts to make transit riding more enjoyable. operate our busses empty. In addition, we strive to
Examples might be clean, attractive vehicles, stations, and maintain clean, attractive vehicles which contribute to
transit nodes; friendly and courteous services; or comfort, safe and comfortable operation.
safety, and security considerations.
Does your agency coordinate with other environmentally When evaluating future transit options for the
friendly forms of mobility such as walking and bicycling? community, these topics are discussed at monthly
Do any of your routine destinations access these modes? NFRMPO TAC/TAG meetings, Howerver, our system
does not directly access these modes as we are a
demand response service not a fixed route.
Describe your agency's efforts to reduce fuel consumption. We have purchased and incoporated new transit
scheduling software which optimizes routes and reduces
fuel consumption. In addition, we are working on
standardizing vehicles through capital grant
replacements so the many trips back-and-forth to base
to swap out to different type/size of vehicles would be
eliminated.
Does your agency work with other agencies to create or We would work with land use councils to assist in
support land use policies that support transit use? If so, transit improvements, coordination, and policies.
please describe. However, we are not aware of any current discussions
Division of Transit and Rail, Colorado Department of Transportation Section A-All- Page 7
2012-2013 CDOT Grant Application for FTA Funding APRIL 2011
involving this type of improvement.
Does your agency have policies or practices that Weld County Transportation views energy efficiency as
encourage energy and resource efficiency, whether in the a practical approach to sustainability. This is why we
fleet, in building facilities, or elsewhere on site? If so, have incoporated new software for route optimization to
please describe. reduce fuel costs. Plus our new vehcile purchases are
intended to use CNG In addition, the County has just
finished a large capital outlay to incorporate energy
efficiency improvements through upgrades to lighting,
boilers, and HVAC equipment.
Does your agency have policies or practices that encour- Weld County Transportation views energy efficiency as
age emission reduction and pollution control, whether in a practical approach to. This is why we have
the fleet, in building facilities, or elsewhere on site? If so, incoporated new software for route optimization to
please describe. reduce fuel costs. Plus our new vehcile purchases are
intended to use CNG In addition, the County has just
finished a large capital outlay to incorporate energy
efficiency improvements through upgrades to lighting,
boilers, and HVAC equipment.
Does your agency consider environmentally preferable Weld County Transportation considers environmentally
materials, local, low maintenance products when procuring preferable materials during the procurement process of
items, whether in the fleet, in building facilities, or else- disposable items. We garner our disposable supplies
where on site? If so, please describe. from Buildings and Grounds Department so the
products remain consistent throughout the County.
Describe any other activities your agency is engaged in One of the principles of livability is to develop safe,
that support sustainability or livability principles, if any. reliable, and economical transportation choices to
decrease household transportation costs, reduce our
nation's dependence on foreign oil, improve air quality,
reduce greenhouse gas emissions, and promote public
health. One of the programs we support with our transit
service is the HCBS program through Human Services.
This allows individuals who would normally be
institutionalized to remain at home because our system
fulfils this step by providing a great community service
and complying with this livability principle.
Section A—All— Page 8 Division of Transit and Rail, Colorado Department of Transportation
APRIL 2011 2012-2013 CDOT Grant Application for FTA Funding
Name of Applying Agency
SECTION B—EVALUATION NARRATIVE
for FTA SECTIONS 5310 AND 5311
Answers to questions have a 1 ,500 character limit.
B. 1 . Justification of the Need for Service
What is the criteria for determining Rural Clients
who's eligible to ride your service?
What is the purpose of the three Medical, therapy, shopping
most requested trips your clients
request or require?
What is the need for transit service Continued Service
in your area?
Why does this need exist? Economy, higher fuel prices, and more elderly reaching out for services
How did you determine this?
Are you the lead transit provider in Yes for rural Weld County
your area? If not, what is the rela-
tionship of your project(s) to other
transportation providers?
How many unduplicated clients do N/A
you serve annually (if applicable)?
Concerning the need for service, Other transit services in some rural areas is sparce and we are the only
what other factors might be relevant provider.
in support of this application?
B .2 . Justification of the Financial Need for Service
Describe the economic conditions Older populations on limited income (Census)
of the service area. What is the Higher fuel prices (news/papers/ media)
source of your information?
In the Agency Profile (online), you Funding is matched locally LAW this grant to secure this service to the
were asked to list sources of fund- community. Without the grant the service could be terminated.
ing. Explain why these funding
sources are not sufficient to provide
the project's services.
Describe any of your funding N/A
sources that have decreased by
more than ten percent over the last
five years.
Describe your fare structure and/or N/A
suggested donation. Include the
percentage of revenue from dona-
tions or fares, if applicable.
Division of Transit and Rail, Colorado Department of Transportation Section B-5310 & 5311— Page 1
2012-2013 CDOT Grant Application for FTA Funding APRIL 2011
List the names of other organiza- Medicaid--reimbursement varies in accordance with their rate structure)
tions you provide transportation for, HCBS (Medicaid)--reimbursement rate is set by Agency (HCPF)
if any. Tell us if they reimburse you
for that transportation, the basis for
that reimbursement, and how much
the reimbursement is.
Describe any other reasons you Without funding program would not be able to sustain operation.
have for needing funding.
B.3. Program Promotion (this section is required for 5311 applicants)
Describe how you promote your Brochures, clients, web page, clinics, Dr. offices, Social Services.
transit program and to whom you
promote it.
Describe how agency vehicles are We have the Weld County Emblem, phone number and designation numbers
marked.
® YES Do the markings include the agency's name?
❑ NO
® YES Do the markings include the agency's logo?
❑ NO
® YES Do the markings include the agency's phone number?
❑ NO
Section B-5310 & 5311— Page 2 Division of Transit and Rail, Colorado Department of Transportation
APRIL 2011 2012-2013 CDOT Grant Application for FTA Funding
B .4a Section 5310 PROJECT INFORMATION for CY 2012
These questions pertain to your proposed PROJECT, not your whole program.
, : 4a . 1 . Section 5310 Project Information for Calendar Year (CY) 2011 .
DEVIATED
ITEM DEMAND RESPONSE FIXED ROUTE FIXED ROUTE
What days of the week will this project
operate? (e.g. , M—F; M, TU , TH)
What hours of the day will this project
operate? (e.g. , 8 AM-4:30 PM)
What will the average fare or donation be? $ $ S
Do you have a reservation schedule? ❑ Yes ❑ No .7 ,
Do you broker trips? ❑ Yes ❑ No El Yes ❑ No ❑ Yes ❑ No
If you broker more than 50 percent of your trips, do not include these trips in your agency 's service information.
Do you have seasonal fluctuations? ❑ Yes ❑ No El Yes El No El Yes ❑ No
If you do have seasonal fluctuations, please describe them:
Many of the cells in the three tables below should fill in automatically. if not, submit information separately.
B4a . 2 . Section 5310 Administrative & Operating Expenses for CY 2012
DEMAND DEVIATED
ITEM RESPONSE FIXED ROUTE FIXED ROUTE TOTAL
Total Operating Expenses $ S $ $ 0
Total Administrative Expenses $ S S $ 0
Total of Administrative and Operating S o S 0 $ 0 $ 0
Expenses (excluding capital)
B4a . 3 . Section 5310 Service Information for CY 2012
DEMAND DEVIATED
ITEM RESPONSE FIXED ROUTE FIXED ROUTE TOTAL
Total Number of Passenger Trips 0
Total Number of Vehicles in Service 0
(excluding spares and backups)
Total Number of Vehicle Service Miles o
Total Number of Vehicle Service Hours 0
B4a .4 Section 5310 Performance Information for CY 2012 - --
ITEM TOTAL
Cost per Mile - - $
Cost per Vehicle Service Hour
Cost per Passenger Trip
Passenger Trip per Service Hour* - _ _ _ _ _
Division of Transit and Rail, Colorado Department of Transportation Section B-5310 & 5311— Page 3
2012-2013 CDOT Grant Application for FTA Funding APRIL 2011
B .4b SUBCONTRACTOR' s 5310 Project Information for CY 2012
Copy this page if using more than one subcontractor. CONTRACTOR NAME
B4b . 1 . Section 5310 Subcontractor' s Project Information for CY 2012
DEVIATED
ITEM DEMAND RESPONSE FIXED ROUTE FIXED ROUTE
What days of the week will this project
operate? (e.g. , M—F; M, TU , TH)
What hours of the day will this project
operate? (e.g. , 8 AM-4:30 PM)
What will the average fare or donation be? $ $ $
Do you have a reservation schedule? ❑ Yes ❑ No ve
A
Do you broker trips? ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
If you broker more than 50 percent olvour trips, do not include these trips in your agency 's service information.
Do you have seasonal fluctuations? ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
If you do have seasonal fluctuations, please describe them:
Many of the cells in the three tables below should fill in automatically. If not, submit information separately.
B4b . 2 . Subcontractor' s Administrative & Operating Expenses for CY 2012
DEMAND DEVIATED
ITEM RESPONSE FIXED ROUTE FIXED ROUTE TOTAL
Total Operating Expenses $ $ $ $ 0
Total Administrative Expenses $ $ $ $ 0
Total of Administrative and Operating $ 0 S U $ 0 $ 0
Expenses (excluding capital)
B4b . 3 . Subcontractor' s Service Information for CY 2012
DEMAND DEVIATED
ITEM RESPONSE FIXED ROUTE FIXED ROUTE TOTAL
Total Number of Passenger Trips 0
Total Number of Vehicles in Service 0
(excluding spares and backups)
Total Number of Vehicle Service Miles 0
Total Number of Vehicle Service Hours 0
B4b .4 Subcontractor' s Performance Information for CY 2012
ITEM TOTAL
Cost per Mile $
Cost per Vehicle Service Hour $
Cost per Passenger Trip
Passenger Trip per Service Hour* $
Section B-5310 & 5311— Page 4 Division of Transit and Rail, Colorado Department of Transportation
APRIL 2011 2012-2013 CDOT Grant Application for FTA Funding
B .4c 5310 PROJECT INFORMATION for CY 2013
These questions pertain to your proposed PROJECT, not your whole program.
B4c. 1 . Section 5310 Project Information for Calendar Year 2013 -
DEVIATED
ITEM DEMAND RESPONSE FIXED ROUTE FIXED ROUTE
What days of the week will this project
operate? (e.g. , M-F; M , TU, TH)
What hours of the day will this project
operate? (e.g. , 8 AM-4:30 PM)
What will the average fare or donation be? $ $
y
Do you have a reservation schedule? ❑ Yes ❑ No
Do you broker trips? ❑ Yes LI No ❑ Yes ❑ No ❑ Yes ❑ No
If you broker more than 50 percent of your trips, do not include these trips in your agency 's service information.
Do you have seasonal fluctuations? ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
If you do have seasonal fluctuations, please describe them:
Many of the cells in the three tables below should till in automatically. If not, submit information separately.
B4c.2 . Section 5310 Administrative and Operating Expenses for CY 2013
DEMAND DEVIATED
ITEM RESPONSE FIXED ROUTE FIXED ROUTE TOTAL
Total Operating Expenses $ $ $ 0
Total Administrative Expenses $ $ $ $ 0
Total of Administrative and Operating S $ 0 $ 0 $ 0
Expenses (excluding capital)
B4c. 3 . Section 5310 Service Information for CY 2013
DEMAND DEVIATED
ITEM RESPONSE FIXED ROUTE FIXED ROUTE TOTAL
Total Number of Passenger Trips 0
Total Number of Vehicles in Service 0
(excluding spares and backups)
Total Number of Vehicle Service Miles 0
Total Number of Vehicle Service Hours 0
B4c.4 Section 5310 Performance Information for CY 2013
ITEM TOTAL
Cost per Mile - $
Cost per Vehicle Service Hour _ _ ._ $
Cost per Passenger Trip
Passenger Trips per Service Hour*_ _ _
Division of Transit and Rail, Colorado Department of Transportation Section B-5310 & 5311- Page 5
2012-2013 CDOT Grant Application for FTA Funding APRIL 2011
B .4d SUBCONTRACTOR' s 5310 Project Information for CY 2013
Copy this page if using more than one subcontractor. CONTRACTOR NAME
B4d . 1 . Section 5310 Subcontractor' s Project Information for CY 2013
DEVIATED
ITEM DEMAND RESPONSE FIXED ROUTE FIXED ROUTE
What days of the week will this project
operate? (e.g. , M—F; M, TU , TH)
What hours of the day will this project
operate? (e.g. , 8 AM-4:30 PM)
What will the average fare or donation be? S ;
Do you have a reservation schedule? ❑ Yes ❑ No
Do you broker trips? ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
ifyou broker inure than 50 percent of your trips, do not include these trips in your agency 's service information.
Do you have seasonal fluctuations? ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
If you do have seasonal fluctuations, please describe them:
Many of the cells in the three tables below should fill in automatically. If not, submit information separately.
B4d .2 . Subcontractor' s Administrative & Operating Expenses for CY 2011
DEMAND DEVIATED
ITEM RESPONSE FIXED ROUTE FIXED ROUTE TOTAL
Total Operating Expenses S S S 0
Total Administrative Expenses S S S S 0
Total of Administrative and Operating $ 0 $ 0 $ 0 $ 0
Expenses (excluding capital)
B4d . 3 . Subcontractor' s Service Information for CY 2011 - - -
DEMAND DEVIATED
ITEM RESPONSE FIXED ROUTE FIXED ROUTE TOTAL
Total Number of Passenger Trips 0
Total Number of Vehicles in Service 0
(excluding spares and backups)
Total Number of Vehicle Service Miles 0
Total Number of Vehicle Service Hours 0
B4d .4 Subcontractor' s Performance Information for CY 2011
ITEM TOTAL
Cost per Mile
Cost per Vehicle Service Hour ;
Cost per Passenger Trip
Passenger Trips per Service Hour* S
Section B-5310 & 5311- Page 6 Division of Transit and Rail, Colorado Department of Transportation
APRIL 2011 2012-2013 CDOT Grant Application for FTA Funding
B . 5a 5311 PROJECT INFORMATION for CY 2012
These questions pertain to your proposed PROJECT, not your whole program.
B5a . 1 . Section 5311 Project Information for Calendar Year 2012
DEMAND DEVIATED
ITEM RESPONSE FIXED ROUTE FIXED ROUTE
What days of the week will this project N/A N/A M-F
operate? (e.g. , M—F; M, TU , TH)
What hours of the day will this project operate? N/A N/A 6AM-6PM
(e.g. , 8 AM-4: 30 PM)
What will be the average fare or donation? $ 0.00 $ N/A $ 0.00
Do you have a reservation schedule? ❑ Yes ® No � ` % /%l
Do you broker trips? ❑ Yes ® No ❑ Yes Z No ❑ Yes ❑ No
*1J;vou broker more than 50 percent ofyour trips, do not include these trips in your agency 's service information.
Do you have seasonal fluctuations? ❑ Yes ® No ❑ Yes Z No ❑ Yes Z No
If you do have seasonal fluctuations, please describe them:
Many of the cells in the three tables below should fill in automatically. If not, submit information separately.
B5a . 2 . Section 5311 Administrative & Operating Expenses for CY 2012
DEMAND DEVIATED
ITEM RESPONSE FIXED ROUTE FIXED ROUTE TOTAL
Total Operating Expenses $ $ $ 235,400 $ 235,400
Total Administrative Expenses $ $ $ 68750 $ 68.750
Total of Administrative and Operating $ 0 $ 0 $ 304, 150 $ 304, 150
Expenses (excluding capital)
B5a . 3 . Section 5311 Service Information for CY 2012
DEMAND DEVIATED
ITEM RESPONSE FIXED ROUTE FIXED ROUTE TOTAL
Total Number of Passenger Trips 15,000 15.000
Total Number of Vehicles in Service (excluding 9 9
spares and backups)
Total Number of Vehicle Service Miles 90,000 90,000
Total Number of Vehicle Service Hours 14,000 14,000
B5a .4 Section 5311 Performance Information for CY 2012
ITEM TOTAL
Cost per Mile _ $ 3.38
Cost per Vehicle Service Hour $ 21 .73
Cost per Passenger Trip .. _ e .> > 5 20.28
Passenger Trips per Service Hour* 1 .07
Division of Transit and Rail, Colorado Department of Transportation Section 8-5310 & 5311— Page 7
2012-2013 CDOT Grant Application for FTA Funding APRIL 2011
B . 5b SUBCONTRACTOR' s 5311 Project Information for CY 2012
Copy this page for more than one subcontractor. CONTRACTOR NAME N/A
B5b . 1 . Section 5311 Subcontractor' s Project Information for CY 2012
DEMAND DEVIATED
ITEM RESPONSE FIXED ROUTE FIXED ROUTE
What days of the week will this project
operate? (e.g. , M—F; M, TU, TH)
What hours of the day will this project operate?
(e.g. , 8 AM-4:30 PM)
What will the average fare or donation be? $
Do you have a reservation schedule? ❑ Yes ❑ No
Do you broker trips? ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
*If you broker more than 50 percent of your trips, do not include these trips in your agency's service information.
Do you have seasonal fluctuations? ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
If you do have seasonal fluctuations, please describe them:
Many of the cells in the three tables below should fill in automatically. If not, submit information separately.
B5b. 2 . Subcontractor' s Administrative & Operating Expenses for CY 2012
DEMAND DEVIATED
ITEM RESPONSE FIXED ROUTE FIXED ROUTE TOTAL
Total Operating Expenses $ rl $ $ $ 0
Total Administrative Expenses $ $ $ $ 0
Total of Administrative and Operating $ cl $ 0 $ 0 $ 0
Expenses (excluding capital)
B5b . 3 . Subcontractor' s Service Information for CY 2012
DEMAND DEVIATED
ITEM RESPONSE FIXED ROUTE FIXED ROUTE TOTAL
Total Number of Passenger Trips 0
Total Number of Vehicles in Service (excluding 0
spares and backups)
Total Number of Vehicle Service Miles 0
Total Number of Vehicle Service Hours 0
B5b .4 Subcontractor' s Performance Information for CY 2012
ITEM TOTAL
Cost per Mile _, $
Cost per Vehicle Service Hour - - $
Cost per Passenger Trip $
Passenger Trips per Service Hour
Section B-5310 & 5311— Page 8 Division of Transit and Rail, Colorado Department of Transportation
APRIL 2011 2012-2013 CDOT Grant Application for FTA Funding
B . 5c Section 5311 PROJECT INFORMATION for CY 2013
These questions pertain to your proposed project, not your whole program.
B5c. 1 . Section 5311 Project Information for Calendar Year 2013
DEMAND DEVIATED
ITEM RESPONSE FIXED ROUTE FIXED ROUTE
What days of the week will this project N/A N/A M-F
operate? (e.g. , M-F; M, TU , TH)
What hours of the day will this project operate? N/A N/A 6AM-6PM
(e.g. , 8 AM-4: 30 PM)
What will the average fare or donation be? $ 0.00 $ 0.00 $ 0.00
Do you have a reservation schedule? ❑ Yes ® No � a
Do you broker trips? ❑ Yes ® No ❑ Yes Z No ❑ Yes Z No
*11 you broker more than 50 percent ofvour trips, do not include these trips in your agency 's service information.
Do you have seasonal fluctuations? ❑ Yes ® No ❑ Yes ® No ❑ Yes Z No
If you do have seasonal fluctuations, please describe them:
Many of the cells in the three tables below should fill in automatically. If not, submit information separately.
B5c. 2 . Section 5311 Administrative & Operating Expenses for CY 2013
DEMAND DEVIATED
ITEM RESPONSE FIXED ROUTE FIXED ROUTE TOTAL
Total Operating Expenses $ $ 5 258,940 $ 258,940
Total Administrative Expenses $ $ $ 68,750 $ 68,750
Total of Administrative and Operating $ 0 $ 0 $ 327,690 $ 327,690
Expenses (excluding capital)
B5c. 3. Section 5311 Service Information for CY 2013
DEMAND DEVIATED
ITEM RESPONSE FIXED ROUTE FIXED ROUTE TOTAL
Total Number of Passenger Trips 0 15.000 15,000
Total Number of Vehicles in Service (excluding 9 9
spares and backups)
Total Number of Vehicle Service Miles 90,000 90,000
Total Number of Vehicle Service Hours 14,000 14,000
B5c.4 Section 5311 Performance Information for CY 2013
ITEM TOTAL
Cost per Mile _ $ 3.64
Cost per Vehicle Service Hour $ 23.41
Cost per Passenger Trip _ _ _ $ 21 .85
Passenger Trips per Service Hour* 1 .07
Division of Transit and Rail, Colorado Department of Transportation Section B-5310 & 5311- Page 9
2012-2013 CDOT Grant Application for FTA Funding APRIL 2011 B . 5d SUBCONTRACTOR' S 5311 Project Information for CY 2013
Copy this page for more than one subcontractor. CONTRACTOR NAME N/A
B5d . 1 . Section 5311 Subcontractor' s Project Information for CY 2013
DEMAND DEVIATED
ITEM RESPONSE FIXED ROUTE FIXED ROUTE
What days of the week will this project
operate? (e.g. , M-F; M, TU , TH)
What hours of the day will this project operate?
(e.g. , 8 AM-4: 30 PM)
What will the average fare or donation be?
Do you have a reservation schedule? ❑ Yes ❑ NoZA
Do you broker trips? ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
*11 you broker more than ")percent of your trips, do not include these trips in tour agency 's service information.
Do you have seasonal fluctuations? ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
If you do have seasonal fluctuations, please describe them:
Many of the cells in the three tables below should till in automatically. If not, submit information separately.
B5d . 2 . Subcontractor' s Administrative & Operating Expenses for CY 2013
DEMAND DEVIATED
ITEM RESPONSE FIXED ROUTE FIXED ROUTE TOTAL
Total Operating Expenses (2013) $ $ $ $ 0
Total Administrative Expenses (2013) $ $ $ $ 0
Total of Administrative and Operating $ a S 0 $ 0 $ 0
Expenses (excluding capital) (2013)
B5d . 3 . Subcontractor' s Service Information for CY 2013
DEMAND DEVIATED
ITEM RESPONSE FIXED ROUTE FIXED ROUTE TOTAL
Total Number of Passenger Trips (2013) 0
Total Number of Vehicles in Service (excluding 0
spares and backups) (2013)
Total Number of Vehicle Service Miles (2013) 0
Total Number of Vehicle Service Hours (2013) 0
B5d .4 Subcontractor' s Performance Information for CY 2013
ITEM TOTAL
Cost per Mile - $
Cost per Vehicle Service Hour $
Cost per Passenger Trip _
Passenger Trips per Service Hour
Section B-5310 & 5311— Page 10 Division of Transit and Rail, Colorado Department of Transportation
APRIL 2011 2012-2013 CDOT Grant Application for FTA Funding
Name of Applying Agency
SECTION C
SECTION 5311 PROPOSED SCOPE OF WORK FOR 2012
C . 1 . Section 5311 Project Funding Requests for Calendar Year 2012
In the table below, identify the federal funds requested, the required local match, and the total project costs.
Enter only the FTA amount you are requesting, the remainder of the table should fill in automatically. If it fails
to calculate properly, include the same information in a separate document.
2012 OPERATING 2012 CAPITAL I 2012 ADMINSTRATI0N 2012 TOTALS
FTA MATCH TOTAL FTA MATCH TOTAL FTA MATCH TOTAL FTA MATCH TOTAL
117,700 117,700 235,400 132,000 33,000 165,000 55,000 13,750 68,750 304,700 164,450 469,150
C .2. Section 5311 Sources of Match for CY 2012 Funding Requests
The State of Colorado awards Section 5311 funding based on match ratios. For each funding category, tell us
where this local match will come from and how much the match will be. If you have more than five sources of
local match, add another page to your application that identifies the type of assistance (operating, administra-
tive, or capital), the source of match, and the amount of that match.
C.2.1 . OperatingAssistance: CY 2012 Source of Cash Match (minimum 50&!o local match)
1 . Weld County General Fund $ 117,700
2. $
3. $
4. $
5. $
C. apitaf wmP
'ss stance: CY 2anSource.of Cas latch (minimum 20% loca match)
1 . Weld County General Fund $ 33 _000
2. $
3. $
4. $
5. $
0.2.3. Administrative 'Assistance: CY- 0 2 Source- of Cash atch •
-
. _� rninim,um,.20% local match)
1 . Weld County General Fund $ 13,750
2. $
3. $
4. $
5. $
Division of Transit and Rail, Colorado Department of Transportation Section C-5311-Page 1
2012-2013 CDOT Grant Application for FTA Funding APRIL 2011
C.2.4. Operating Assistance: CY 2012 Source of In-Kind Match (minimum 50% local match)
PRODUCT OR FAIR MARKET
DONOR NAME ITEM DONATED SERVICE VALUE
1 . ❑ P ❑ S 5
How was fair market value determined?
2. ❑ P ❑ S $
How was fair market value determined?
3. ❑ P ❑ S $
How was fair market value determined?
4. ❑ P ❑ S $
How was fair market value determined?
5. ❑ P ❑ S $
How was fair market value determined?
C.2.5. Administrative Assistance: CY 2012 Source of In-Kind Match
(minimum 20% local match)
PRODUCT OR FAIR MARKET
DONOR NAME ITEM DONATED SERVICE VALUE
1 . ❑ P ❑ S s
How was fair market value determined?
2. OP OS
How was fair market value determined?
3. OPUS $
How was fair market value determined?
4. OPUS $
How was fair market value determined?
5. ❑ P ❑ S $
How was fair market value determined?
Section C-5311— Page 2 Division of Transit and Rail, Colorado Department of Transportation
APRIL 2011 2012-2013 CDOT Grant Application for FTA Funding
C . 3 . Section 5311 Project Funding Requests for Calendar Year 2013
In the table below, identify the federal funds requested, the required local match, and the total project costs.
Enter only the FTA amount you are requesting, the remainder of the table should fill in automatically. If it fails
to calculate properly, include the same information in a separate document.
2013 • DMINSTRATION 013 TOTALS _
FTA MATCH TOTAL FTA MATCH TOTAL FTA MATCH TOTAL FTA MATCH TOTAL
129,470 129,470 258,940 132,000 33,000 165,000 55,000 13,750 68,750 316,470 176,220 492,690
C4 . Section 5311 Sources of Match for CY 2013 Funding Requests
The State of Colorado awards Section 5311 funding based on match ratios. For each funding category, tell us
where this local match will come from and how much the match will be. If you have more than five sources of
local match, add another page to your application that identifies the type of assistance (operating, administra-
tive, or capital), the source of match, and the amount of that match.
C.4. 1 . Operating Assistance: CY 2013 Source of Cash Match T'mmTF uW50% loca match)
1 . Weld County General Fund $ 129,470
2. $
3. $
4. $
5. $
SCEEL___,Atalitnigglicq; _9Y 2013 Source of Cash Match (minimum 20%local match)
1 . Weld County General Fund $ 33,000
2. $
3. $
4. $
5. $
C.4.3. Administrative Assistance: CY 2013 Source of Cash Match _
(minimum 20% local match)
1 . Weld County General Fund $ 13,750
2. $
3. $
4. $
5. $
Division of Transit and Rail, Colorado Department of Transportation Section C-5311-Page 3
2012-2013 CDOT Grant Application for FTA Funding APRIL 2011
C.4.4. Operating Assistance : CY 2013 Sow a of In-Kind Match minimum 0 oca match)
PRODUCT OR FAIR MARKET
DONOR NAME ITEM DONATED SERVICE VALUE
1 . OP OS s
How was fair market value determined?
2. ❑ P ❑ S $
How was fair market value determined?
3. ❑ P ❑ S $
How was fair market value determined?
4. OPUS $
How was fair market value determined?
5. OP OS $
How was fair market value determined?
C.4.5. Administrative Assistance: CY 2013 Source of In-Kind Match
(minimum 20% local match)
PRODUCT OR FAIR MARKET
DONOR NAME ITEM DONATED SERVICE VALUE
1 . ❑ P ❑ S
How was fair market value determined?
2. ❑ P ❑ S $
How was fair market value determined?
3. ❑ P ❑ S $
How was fair market value determined?
4. OPUS $
How was fair market value determined?
5. ❑ P ❑ S $
How was fair market value determined?
Section C-5311— Page 4 Division of Transit and Rail, Colorado Department of Transportation
APRIL 2011 2012-2013 CDOT Grant Application for FTA Funding
C . 5 . Description of Service
Answers to questions have a 1 ,500-character limit.
C.5A . Description of Fixed Route Service
Describe the Fixed Route Services this project N/A
will fund. Be specific!
Skip this question if you're not requesting
funding for a fixed route service.
What is the specific Service Area, including N/A
towns, communities, etc., your proposed project
will serve?
How will you meet the ADA-specified comple- N/A
mentary paratransit requirements?
C.5.2. Description of Demand Responsive Service
Describe the Demand Responsive Services Our program is for a deviated fixed route rural system so not sure if
this project will fund, excluding ADA this applies to this block? We provide a fixed schedule and deviate
complementary paratransit service. Be specific! for the as needed for the routes 1) SOUTH COUNTY ROUTE (Mon,
Skip this question if you're not requesting Wed, Fri) which serves the communities of Ft Lupton, Dacono ,
funding for a demand responsive service. Frederick, Firestone, Platteville, and Gilcrest; 2) NORTH
HIGHWAY 85 CORRIDOR (Daily) which serves the communities
of Galeton, and Eaton. 3) JOHNSTOWN - MILLIKEN CORRIDOR
(Daily) which serves the communities of Johnstown, and Milliken. 4)
WINDSOR - SEVERANCE CORRIDOR (Daily) which serves the
communities of Windsor and Severance. 5) KERSEY ROUTE
(Tues. & Thurs.) which serves the communities of Kersey and Gill.
6) GALETON ROUTE (Tues. & Thurs.) which serves the
community of Galeton.
Demand responsive services usually target the Our program is available to the general public and is posted as such
elderly and disabled. How will you ensure your in our materials and web-site
proposed services will be available for the
general public?
What percentage of riders will be general —23% are general public
public?
What type of trips, client priorities, or conditions None
do you propose?
Division of Transit and Rail, Colorado Department of Transportation Section C-5311-Page 5
2012-2013 CDOT Grant Application for FTA Funding APRIL 2011
C .6 . Service Area Population
Refer to the Application Instructions and Guidebook for specific instructions.
For population figures, visit the Colorado Department of Local Affairs, Demography Section:
http://dola.colorado.gov/dlg/demog/pop muni_estimates.html
COMMUNITY NAME IN SERVICE AREA POPULATION
(from 2009 data)
1 . Rural Weld County (excludes urban Greeley/Evans) 143,358
2.
3.
4.
5.
6.
7.
8.
9.
10.
Section C-5311— Page 6 Division of Transit and Rail, Colorado Department of Transportation
April 2011 2012-2013 FTA Grant Application Instructions
CERTIFICATES AND ASSURANCES FOR FTA/CDOT FY
2012-2013 GRANT APPLICATIONS
The certificates and assurances on the following V Mandatory Assurances include those provided
pages in this section are required by the Depart- in the checklist below.Applicants will complete
ment as part of a complete submission of your these certifications and have the legally autho-
application for funding. rized representative of their agency verify this
certification.
As an applicant,you are ultimately responsible
for your own compliance with federal laws,regu- ✓ Program Specific Assurances are managed by
lations,and directives if you are awarded federal a checklist.Applicable assurances (Federal
funds;and if awarded FTA funds,you are also Fiscal Year 2011) for this application process
responsible for compliance with any third-party are designated by the Department.Applicants
subcontractors participating in your project. are to certify they will comply with the appli-
cable assurances if awarded funding and have
✓ For reference only,the most current FTA Cer- a legally authorized representative of their
tifications and Assurances (FY2011) are avail- agency verify this certification.
able for download on the internet at
httn://www.fta.dot.gov/funding/apply/grants Please note: If you are awarded funding,the
financing 12194.html or on paper upon re- contract your agency will sign will include claus-
quest to the Department. es that will further legally bind your agency to
the following certifications and assurances.
V The Department has divided the assurance
section into two parts: Mandatory Assurances NOTE:A link to IRS form W-9 is on the Transit
and Program Specific Assurances. Unit website.
Mandatory Assurances Checklist
The following certifications and assurances must be signed by the legally authorized representative
of the applicant.
DONE? MANDATORY ASSURANCES
Assurance of Authority of the Applicant and Its Representative
Standard Assurances
Nondiscrimination Assurance in accordance with the Civil Rights Act
Civil Rights Lawsuits and Complaints
Debarment, Suspension,and Other Exclusions
General Applicant Assurances
Listing of Eligible Surface Transportation Providers (Section 5311(f)Applicants Only)
Certification of Equivalent Service (Applications for non-accessible vehicles only)
Colorado Department of Transportation Page 127/
2012-2013 FTA Grant Application Instructions April 2011
ASSURANCE OF AUTHORITY
OF THE APPLICANT AND APPLICANT REPRESENTATIVE
NAME OF APPLICANT
Weld County Transportation
The authorized representative of the Applicant and the attorney who sign these certifica-
tions, assurances, and agreements affirm that both the Applicant and its authorized repre-
sentative have adequate authority under applicable State, local, or Indian tribal law and
regulations, and the Applicant's by-laws or internal rules to:
(1) Execute and file the application for Federal assistance on behalf of the Applicant;
(2) Execute and file the required certifications, assurances, and agreements on behalf of
the Applicant binding the Applicant; and
(3) Execute grant agreements and cooperative agreements with FTA on behalf of the
Applicant.
AGENGY NAME
Weld County Transportation
PRINTED NAME(Chief Elected Official/Board President/Legal Representative)
Sean P.Conway
TITLE
Chairman Pro-Tern of the Board of County Commissioners
SIGNATURE DATE JUN 0 12011
Page 128 Colorado Department of Transportation
April 2011 2012-2013 FTA Grant Application Instructions
STANDARD ASSURANCES
NAME OF APPLICANT
Weld County Transportation
hereby assures that it will comply with all applicable Federal statutes and regulations car-
rying out any project supported by an FTA grant or cooperative agreement.
The Applicant agrees that it is under a continuing obligation to comply with the terms and
conditions of the FTA grant agreement or cooperative agreement, including the FTA Master
Agreement that is incorporated by reference and made part of the latest amendment to its
grant agreement or cooperative agreement with FTA issued for its project.
The Applicant recognizes that Federal laws and regulations may be modified from time to
time and those modifications may affect project implementation.
The Applicant understands that Presidential executive orders and Federal directives, in-
cluding Federal policies and program guidance may be issued concerning matters affecting
the Applicant or its project.
The Applicant agrees that the most recent Federal laws, regulations, and directives will
apply to the project, unless FTA issues a written determination otherwise.
AGENCY NAME
Weld County Transportation
PRINTED NAME(Chief Elected Official/Board President/Legal Representative)
Sean P. Conway
TITLE
Chairman Pro-Tem of the Board of County Commissioners
SIGNATURE \. DATEUA 0 12011
C / JUN
Colorado Department of Transportation Page 129
2012-2013 FTA Grant Application Instructions April 2011
INTERGOVERNMENTAL REVIEW ASSURANCE
Except if the Applicant is an Indian tribal government seeking assistance authorized by 49
U.S.C. 5311(c)(1),
NAME OF APPLICANT
Weld County Transportation
assures that each application for Federal assistance it submits to FTA has been submitted
or will be submitted for intergovernmental review to the appropriate State and local agen-
cies as determined by the State.
Specifically,the Applicant assures that it has fulfilled or will fulfill the obligations imposed
on FTA by U.S. Department of Transportation (U.S. DOT) regulations, "Intergovernmental
Review of Department of Transportation Programs and Activities," 49 CFR part 17.
This assurance does not apply to Applicants for Federal assistance under FTA's Tribal
Transit Program, 49 U.S.C. 5311(c)(1).
AGENGY NAME
Weld County Transportation
PRINTED NAME(Chief Elected Official/Board President/Legal Representative)
Sean P. Conway
TITLE
Chairman Pro-Tem of the Board of County Commissioners 1 SIGNATURE �-' DATEJUN 0 1 2011
Page 130 Colorado Department of Transportation
April 2011 2012-2013 FTA Grant Application Instructions
NONDISCRIMINATION ASSURANCE
As required by 49 U.S.C. 5332 (which prohibits discrimination on the basis of race, color,
creed, national origin, sex, or age, and prohibits discrimination in employment or business
opportunity), by Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C. 2000d, and
by U.S. DOT regulations, "Nondiscrimination in Federally-Assisted Programs of the De-
partment of Transportation-Effectuation of Title VI of the Civil Rights Act," 49 CFR part 21
at 21.7,
NAME OF APPLICANT
Weld County Transportation
assures that it will comply with all requirements imposed by or issued pursuant to 49 U.S.C.
5332, 42 U.S.C. 2000d, and 49 CFR part 21, so that no person in the United States, on the
basis of race, color, national origin, creed, sex, or age will be excluded from participation in,
be denied the benefits of, or otherwise be subjected to discrimination in any program or
activity (particularly in the level and quality of transportation services and transportation-
related benefits) for which the Applicant receives Federal assistance awarded by the U.S.
DOT or FTA.
Specifically, during the period in which Federal assistance is extended to the project, or
project property is used for a purpose for which the Federal assistance is extended or for
another purpose involving the provision of similar services or benefits, or as long as the
Applicant retains ownership or possession of the project property, whichever is longer, the
Applicant assures that:
(1) Each project will be conducted, property acquisitions will be undertaken, and project
facilities will be operated in accordance with all applicable requirements of 49 U.S.C.
5332, 42 U.S.C. 2000d, and 49 CFR part 21, and understands that this assurance extends
to its entire facility and to facilities operated in connection with the project;
(2) It will promptly take the necessary actions to effectuate this assurance, including notify-
ing the public that complaints of discrimination in the provision of transportation-
related services or benefits may be filed with U.S. DOT or FTA. Upon request by U.S.
DOT or FTA, the Applicant assures that it will submit the required information pertain-
ing to its compliance with these provisions;
(3) It will include in each subagreement, property transfer agreement,third party contract,
third party subcontract, or participation agreement adequate provisions to extend the
requirements imposed by or issued pursuant to 49 U.S.C. 5332, 42 U.S.C. 2000d and 49
CFR part 21 to other parties involved therein including any subrecipient,transferee,
third party contractor, third party subcontractor at any level, successor in interest, or
any other participant in the project;
(4) Should it transfer real property, structures, or improvements financed with Federal
assistance provided by FTA to another party, any deeds and instruments recording the
transfer of that property shall contain a covenant running with the land assuring nondi-
scrimination for the period during which the property is used for a purpose for which
the Federal assistance is extended or for another purpose involving the provision of
similar services or benefits;
Colorado Department of Transportation Page 131
2012-2013 FTA Grant Application Instructions April 2011
(5) The United States has a right to seek judicial enforcement with regard to any matter
arising under Title VI of the Civil Rights Act, U.S. DOT implementing regulations, and
this assurance; and
(6) It will make any changes in its Title VI implementing procedures as U.S. DOT or FTA
may request to achieve compliance with the requirements imposed by or issued pur-
suant to 49 U.S.C. 5332, 42 U.S.C. 2000d, and 49 CFR part 21.
AGENGY NAME
Weld County Transportation
PRINTED NAME(Chief Elected Official/Board President/Legal Representative)
Sean P.Conway
TITLE
Chairman Pro-Tern of the Board of County Commissioners
SIGNATURE DATE
JUN0 12011
Page 132 Colorado Department of Transportation
April 2011 2012-2013 FTA Grant Application Instructions
ASSURANCE OF NONDISCRIMINATION
ON THE BASIS OF DISABILITY
As required by U.S. DOT regulations, "Nondiscrimination on the Basis of Handicap in
Programs and Activities Receiving or Benefiting from Federal Financial Assistance," at
49 CFR 27.9,
NAME OF APPLICANT
Weld County Transportation
assures that, as a condition to the approval or extension of any Federal assistance awarded
by FTA to construct any facility, obtain any rolling stock or other equipment, undertake
studies, conduct research, or to participate in or obtain any benefit from any program ad-
ministered by FTA, no otherwise qualified person with a disability shall be, solely by reason
of that disability, excluded from participation in, denied the benefits of, or otherwise sub-
jected to discrimination in any program or activity receiving or benefiting from Federal
assistance administered by the FTA or any entity within U.S. DOT.
The Applicant assures that project implementation and operations so assisted will comply
with all applicable requirements of U.S. DOT regulations implementing the Rehabilitation
Act of 1973, as amended, 29 U.S.C. 794, et seq., and the Americans with Disabilities Act of
1990, as amended,42 U.S.C. 12101 et seq., and implementing U.S. DOT regulations at 49
CFR parts 27, 37, and 38, and any other applicable Federal laws that may be enacted or
Federal regulations that may be promulgated.
AGENCY NAME
Weld County Transportation
PRINTED NAME(Chief Elected Official/Board President/Legal Representative)
Sean P. Conway
TITLE
Chairman Pro-Tem of the Board of County Commissioners
SIGNATURE _ DATE
JUN 0 12011
Colorado Department of Transportation Page 133
2012-2013 FTA Grant Application Instructions April 2011
CERTIFICATION REGARDING DEBARMENT, SUSPENSION,
AND OTHER RESPONSIBILITY MATTERS
-PRIMARY COVERED TRANSACTIONS
Complete if receiving singularly or combined more than$25,000 in FTA Section 5310,5311,
5311(f), 5316,and 5317 funds.
In accordance with the terms of U.S. DOT regulations, "Nonprocurement Suspension and Debar-
ment," 2 CFR Part 1200,which adopts and supplements the provisions of U.S. Office of Management
and Budget (U.S. OMB) "Guidelines to Agencies on Governmentwide Debarment and Suspension
(Nonprocurement)," 2 CFR Part 180:
NAME OF AGENCY
Weld County Transportation
certifies to the best of its knowledge and belief,that it and its principals,:
(a) Are not presently debarred, suspended,proposed for debarment, declared ineligible, or volun-
tarily excluded or disqualified from covered transactions by any Federal department or agen-
cy;
(b) Have not within a three-year period preceding its latest application or proposal been convicted
of or had a civil judgment rendered against any of them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public (Federal,
State, or local) transaction, or contract under a public transaction;violation of any Federal or
State antitrust statute; or commission of embezzlement,theft, forgery,bribery,falsification or
destruction of records,making any false statement, or receiving stolen property;
(c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental
entity (Federal,State,or local) with commission of any of the offenses listed in subparagraph
(1)(b) of this certification;
(d) Have not within a three-year period preceding this certification had one or more public trans-
actions (Federal, State, or local) terminated for cause or default.
(If the applicant is unable to certify to any of the statements in this certification,such applicant shall
attach an explanation to this certification).
The potential grantee under this FTA project:
NAME OF AGENCY
Weld County Transportation
Certifies or affirms the truthfulness and accuracy of the contents of the statements submitted on or
with the certification and understand that the provisions of Title 49 CFR Part 29 and FTA C .2015.1
apply to this certification.
EXECUTED THIS DAY MONTH YEAR
1st . June 2011
TITLE OF AUTHORIZED REPRESENTATIVE
Chairman Pro-Tern of the Board of County Commissioners
SIGNATURE OF AUTHORIZED REPRESENTATIVE^
e
Page 134 Colorado Department of Transportation
April 2011 2012-2013 FTA Grant Application Instructions
CERTIFICATION REGARDING DEBARMENT, SUSPENSION,
INELIGIBILITY, AND VOLUNTARY EXCLUSION
-LOWER TIER COVERED TRANSACTIONS
Complete if receiving singularly or combined more than$25,000 in FTA Section 5310, 5311,
5311(l), 5316,and 5317 funds.
The potential grantee under this FTA project:
NAME OF AGENCY
Weld County Transportation
certifies to the best of its knowledge and belief, that it and its prospective lower tier participants
certify:
(2) that it and its principals, including its first tier subrecipients,will treat each lower tier contract
or lower tier subcontract under the Project that (a) equals or exceeds$25,000, (b) is for audit
services, or(3) requires the consent of a Federal official, as a covered contract for purposes of 2
CFR Part 1200 and 2 CFR Part 180, and will otherwise comply with the Federal requirements of
2 CFR Part 1200 and 2 CFR Part 180, and will assure that the each lower tier participant in-
volved in the Project is not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded or disqualified from participation in this transaction by any
Federal department or agency;
(3) that if, later,it or its principals, including any of its first tier subrecipients,become aware of any
information contradicting the statements of subparagraphs (1)(a) through (d) above, it will
promptly provide any necessary information to ETA;
(4) that if the Applicant (Primary Participant) or any of its principals,including any of its first tier
subrecipients or lower tier participants, is unable to certify to the statements within paragraphs
(1), (2), and (3) above,the Applicant shall indicate so on its Signature Page or a Page attached in
ETA's TEAM system providing a written explanation to FTA.
The potential grantee under this FTA project:
NAME OF AGENCY
Weld County Transportation
Certifies or affirms the truthfulness and accuracy of the contents of the statements submitted on or
with the certification and understand that the provisions of Title 49 CFR Part 29 and FTA C .2015.1
apply to this certification.
EXECUTED THIS DAY MONTH YEAR
1st June 2011
TITLE OF AUTHORIZED REPRESENTATIVE
Chairman Pro-Tem of the Board of County Commissioners
SIGNATURE OF AUTHORIZED REPRESENTATIVE
Colorado Department of Transportation Page 135
2012-2013 FTA Grant Application Instructions April 2011
U. S. OMB ASSURANCES
Consistent with U. S. OMB assurances set forth in SF-424B and SF 424D,
NAME OF AGENCY
Weld County Transportation
hereby assures that, with respect to itself or its project, the Applicant:
(1) Has the legal authority to apply for Federal assistance and the institutional, manageri-
al, and financial capability (including funds sufficient to pay the non-Federal share of
project cost) to assure proper planning, management, and completion of the project
described in its application;
(2) Will give FTA, the Comptroller General of the United States, and, if appropriate, the
State, through any authorized representative, access to and the right to examine all
records, books, papers, or documents related to the award; and will establish a proper
accounting system in accordance with generally accepted accounting standards or
agency directives;
(3) Will establish safeguards to prohibit employees from using their positions for a pur-
pose that constitutes or presents the appearance of personal or organizational conflict
of interest or personal gain;
(4) Will initiate and complete the work within the applicable project time periods follow-
ing receipt of FTA approval;
(5) Will comply with all applicable Federal statutes relating to nondiscrimination includ-
ing, but not limited to:
(a) Title VI of the Civil Rights Act, 42 U.S.C. 2000d,which prohibits discrimination on
the basis of race, color, or national origin;
(b) Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1681
through 1683, and 1685 through 1687, and U.S. DOT regulations, "Nondiscrimina-
tion on the Basis of Sex in Education Programs or Activities Receiving Federal Fi-
nancial Assistance," 49 CFR part 25, which prohibit discrimination on the basis of
sex;
(c) Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794,which
prohibits discrimination on the basis of disability;
(d) The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 through 6107,
which prohibits discrimination on the basis of age;
(e) The Drug Abuse Office and Treatment Act of 1972, as amended, 21 U.S.C. 1101 et
seq., relating to nondiscrimination on the basis of drug abuse;
Page 136 Colorado Department of Transportation
April 2011 2012-2013 FTA Grant Application Instructions
(f) The Comprehensive Alcohol Abuse and Alcoholism Prevention Act of 1970, as
amended, 42 U.S.C. 4541 et seq. relating to nondiscrimination on the basis of alco-
hol abuse or alcoholism;
(g) The Public Health Service Act of 1912, as amended, 42 U.S.C. 290dd through
290dd-2., relating to confidentiality of alcohol and drug abuse patient records;
(h) Title VIII of the Civil Rights Act, 42 U.S.C. 3601 et seq., relating to nondiscrimina-
tion in the sale, rental, or financing of housing; and
(i) Any other nondiscrimination statute(s) that may apply to the project;
(6) To the extent applicable, will comply with, or has complied with, the requirements of
Titles II and III of the Uniform Relocation Assistance and Real Property Acquisition
Policies Act of 1970, as amended, (Uniform Relocation Act) 42 U.S.C. 4601 et seq.,
which, among other things, provide for fair and equitable treatment of persons dis-
placed or persons whose property is acquired as a result of federally assisted pro-
grams. These requirements apply to all interests in real property acquired for project
purposes and displacement caused by the project regardless of Federal participation in
any purchase. As required by sections 210 and 305 of the Uniform Relocation Act, 42
U.S.C. 4630 and 4655, and by U.S. DOT regulations, "Uniform Relocation Assistance and
Real Property Acquisition for Federal and Federally Assisted Programs," 49 CFR 24.4,
the Applicant assures that it has the requisite authority under applicable State and lo-
cal law to comply with the requirements of the Uniform Relocation Act, 42 U.S.C. 4601
et seq., and U.S. DOT regulations, "Uniform Relocation Assistance and Real Property
Acquisition for Federal and Federally Assisted Programs," 49 CFR part 24, and will
comply with that Act or has complied with that Act and those implementing regula-
tions, including but not limited to the following:
(a) The Applicant will adequately inform each affected person of the benefits, policies,
and procedures provided for in 49 CFR part 24;
(b) The Applicant will provide fair and reasonable relocation payments and assistance
as required by 42 U.S.C. 4622, 4623, and 4624; 49 CFR part 24; and any applicable
FTA procedures, to or for families, individuals, partnerships, corporations, or as-
sociations displaced as a result of any project financed with FTA assistance;
(c) The Applicant will provide relocation assistance programs offering the services
described in 42 U.S.C. 4625 to such displaced families, individuals, partnerships,
corporations, or associations in the manner provided in 49 CFR part 24;
(d) Within a reasonable time before displacement, the Applicant will make available
comparable replacement dwellings to displaced families and individuals as re-
quired by 42 U.S.C. 4625(c)(3);
(e) The Applicant will carry out the relocation process in such manner as to provide
displaced persons with uniform and consistent services, and will make available
replacement housing in the same range of choices with respect to such housing to
all displaced persons regardless of race, color, religion, or national origin;
Colorado Department of Transportation Page 137
2012-2013 FTA Grant Application Instructions April 2011
(f) In acquiring real property, the Applicant will be guided to the greatest extent prac-
ticable under State law, by the real property acquisition policies of 42 U.S.C. 4651
and 4652;
(g) The Applicant will pay or reimburse property owners for their necessary expenses
as specified in 42 U.S.C. 4653 and 4654, with the understanding that FTA will pro-
vide Federal financial assistance for the Applicant's eligible costs of providing
payments for those expenses, as required by 42 U.S.C. 4631;
(h) The Applicant will execute such amendments to third party contracts and suba-
greements financed with FTA assistance and execute, furnish, and be bound by
such additional documents as FTA may determine necessary to effectuate or im-
plement the assurances provided herein; and
(i) The Applicant agrees to make these assurances part of or incorporate them by ref-
erence into any third party contract or subagreement, or any amendments thereto,
relating to any project financed by FTA involving relocation or land acquisition
and provide in any affected document that these relocation and land acquisition
provisions shall supersede any conflicting provisions;
(7) To the extent applicable, will comply with the Davis-Bacon Act, as amended, 40 U.S.C.
3141 et seq., the Copeland "Anti-Kickback" Act, as amended, at 18 U.S.C. 874, and at 40
U.S.C. 3145, and the Contract Work Hours and Safety Standards Act, as amended, 40
U.S.C. 3701 et seq., regarding labor standards for federally assisted projects;
(8) To the extent applicable, will comply with the flood insurance purchase require-
ments of section 102(a) of the Flood Disaster Protection Act of 1973, as amended, 42
U.S.C. 4012a(a), requiring the Applicant and its subrecipients in a special flood hazard
area to participate in the program and purchase flood insurance if the total cost of in-
surable construction and acquisition is $10,000 or more;
(9) To the extent applicable, will comply with the Lead-Based Paint Poisoning Prevention
Act, 42 U.S.C. 4831(b),which prohibits the use of lead-based paint in the construction
or rehabilitation of residence structures;
(10) To the extent applicable,will not dispose of, modify the use of, or change the terms of
the real property title or other interest in the site and facilities on which a construction
project supported with FTA assistance takes place without permission and instruc-
tions from FTA;
(11)To the extent required by FTA, will record the Federal interest in the title of real prop-
erty, and will include a covenant in the title of real property acquired in whole or in
part with Federal assistance funds to assure nondiscrimination during the useful life of
the project;
(12)To the extent applicable, will comply with FTA provisions concerning the drafting,
review, and approval of construction plans and specifications of any construction
project supported with FTA assistance. As required by U.S. DOT regulations, "Seismic
Page 138 Colorado Department of Transportation
April 2011 2012-2013 FTA Grant Application Instructions
Safety," 49 CFR 41.117(d), before accepting delivery of any building financed with FTA
assistance, it will obtain a certificate of compliance with the seismic design and con-
struction requirements of 49 CFR part 41;
(13)To the extent applicable,will provide and maintain competent and adequate engineer-
ing supervision at the construction site of any project supported with FTA assistance
to assure that the complete work conforms with the approved plans and specifications,
and will furnish progress reports and such other information as may be required by
FTA or the State;
(14) To the extent applicable,will comply with any applicable environmental standards
that may be prescribed to implement the following Federal laws and executive orders:
(a) Institution of environmental quality control measures under the National
Environmental Policy Act of 1969, as amended, 42 U.S.C. 4321 through 4335
and Executive Order No. 11514, as amended, 42 U.S.C. 4321 note;
(b) Notification of violating facilities pursuant to Executive Order No. 11738, 42
U.S.C. 7606 note;
(c) Protection of wetlands pursuant to Executive Order No. 11990, 42 U.S.C.
4321 note;
(d) Evaluation of flood hazards in floodplains in accordance with Executive Or-
der No. 11988, 42 U.S.C. 4321 note;
(e) Assurance of project consistency with the approved State management pro-
gram developed pursuant to the requirements of the Coastal Zone Manage-
ment Act of 1972, as amended, 16 U.S.C. 1451 through 1465;
(0 Conformity of Federal actions to State (Clean Air) Implementation Plans un-
der section 176(c) of the Clean Air Act of 1955, as amended, 42 U.S.C. 7401
through 7671q;
(g) Protection of underground sources of drinking water under the Safe Drink-
ing Water Act of 1974, as amended, 42 U.S.C. 300f through 300j-6;
(h) Protection of endangered species under the Endangered Species Act of
1973, as amended, 16 U.S.C. 1531 through 1544; and
(i) Environmental protections for Federal transportation programs, including,
but not limited to, protections for parks, recreation areas, or wildlife or wa-
terfowl refuges of national, State, or local significance or any land from a his-
toric site of national, State, or local significance to be used in a transporta-
tion project as required by 49 U.S.C. 303(b) and 303(c);
(j) Protection of the components of the national wild and scenic rivers systems,
as required under the Wild and Scenic Rivers Act of 1968, as amended, 16
U.S.C. 1271 through 1287; and
Colorado Department of Transportation Page 139
2012-2013 FTA Grant Application Instructions April 2011
(k) Provision of assistance to FTA in complying with section 106 of the National
Historic Preservation Act of 1966, as amended, 16 U.S.C. 470f; with the Arc-
haeological and Historic Preservation Act of 1974, as amended, 16 U.S.C. 469
through 469c; and with Executive Order No. 11593 (identification and pro-
tection of historic properties), 16 U.S.C. 470 note;
(15) To the extent applicable, will comply with the requirements of the Hatch Act, 5 U.S.C.
1501 through 1508 and 7324 through 7326,which limit the political activities of
State and local agencies and their officers and employees whose primary employ-
ment activities are financed in whole or part with Federal funds including a Federal
loan, grant agreement, or cooperative agreement except, in accordance with 49 U.S.C.
5307(k)(2) and 23 U.S.C. 142(g), the Hatch Act does not apply to a nonsupervisory
employee of a public transportation system (or of any other agency or entity per-
forming related functions) receiving FTA assistance to whom that Act does not oth-
erwise apply;
(16) To the extent applicable, will comply with the National Research Act, Pub. L. 93-348,
July 12, 1974, as amended, 42 U.S.C. 289 et seq., and U.S. DOT regulations, "Protection
of Human Subjects," 49 CFR part 11, regarding the protection of human subjects in-
volved in research, development, and related activities supported by Federal assis-
tance;
(17) To the extent applicable,will comply with the Animal Welfare Act, as amended, 7
U.S.C. 2131 et seq., and U.S. Department of Agriculture regulations, "Animal Welfare,"
9 CFR subchapter A, parts 1, 2, 3, and 4, regarding the care, handling, and treatment
of warm blooded animals held or used for research, teaching, or other activities sup-
ported by Federal assistance;
(18) Will have performed the financial and compliance audits as required by the Single
Audit Act Amendments of 1996, 31 U.S.C. 7501 et seq., U.S. OMB Circular A-133, "Au-
dits of States, Local Governments, and Non-Profit Organizations," Revised, and the
most recent applicable U.S. OMB A-133 Compliance Supplement provisions for the
U.S. DOT; and
(19) To the extent applicable, will comply with all applicable provisions of all other Fed-
eral laws or regulations, and follow Federal directives governing the project, except
to the extent that FTA has expressly approved otherwise in writing.
EXECUTED THIS DAY MONTH YEAR
1st June 2011
TITLE OF AUTHORIZED REPRESENTATIVE
Chairman Pro-Tern of the Board of County Commissioners
SIGNATURE OF AUTHORIZED REPRESENTATIVE
Page 140 Colorado Department of Transportation
April 2011 2012-2013 FTA Grant Application Instructions
FTA SECTIONS 5310, 5311, 5316, 5317
APPLICATION FOR CDOT/FTA GRANT ASSISTANCE
I hereby certify that as a person authorized to sign for:
AGENCY NAME
Weld County Transportation
1. The agency is a private non-profit organization incorporated in the State of Colorado,or a public
operator of public transportation body which has undertaken the requisite certification process to be
designated as an eligible recipient of FTA funding.
2. The Applicant has the requisite fiscal, managerial,and legal capacity to carry out the project(s) de-
scribed herein and to receive and disburse federal funds.
3. Some combination of federal,state,local and private funding sources has or will be committed by the
applicant in a timely fashion to provide the required local share for the project(s) described herein.
4. The Applicant has,or will have by the time of delivery,sufficient funds to operate the vehicles and/or
equipment purchased under this project,if applicable.
5. The transportation needs of elderly persons and persons with disabilities have or will be addressed
by the Applicant.
6. The Applicant will implement policies and procedures to ensure compliance with the provisions of
the Americans with Disabilities Act of 1990.
7. The Applicant will provide a fair and timely opportunity to private sector operators to participate in
the project.
S. I have reviewed the FTA Sections 5310, 5311, 5316,5317 Application for CDOT/FTA Grant Assistance
and that all the information contained herein is true and correct to the best of my knowledge.
PRINTED OR TYPED NAME OF AUTHORIZED REPRESENTATIVE
Sean P. Conway
TITLE OF AUTHORIZED REPRESENTATIVE
Chairman Pro-Tern of the Board of County Commissioners
SIGNATURE OF AUTHORIZED REPRESENTATI C DATE JUN 0 1 201,
c
1
For additional specific information regarding the 2010/2011 FTA Sections 5310, 5311, 5316,
5317 Application for CDOT/FTA Grant Assistance please contact:
NAME
Weld County Transportation
TITLE PHONE
Chairman Pro-Tern of the Board of County Commissioners 970-356-4000
EMAIL ADDRESS
sconwav@co.weld.co.us
Colorado Department of Transportation Page 141
2012-2013 FTA Grant Application Instructions April 2011
49 USC & 5333(b) ASSURANCE
SECTION 5311 (to include Intercity Bus) APPLICANTS ONLY
LISTING OF ELIGIBLE SURFACE TRANSPORTATION
PROVIDERS AND LABOR REPRESENTATION
1.APPLICANT NAME AND BRIEF DESCRIPTION OF PROJECT AND SERVICE AREA.
Weld County Government-Agency provides deviated fixed routes.modified fixed routes.and door-to-
door demand responsive transportation services to seniors,persons w/disabilites.low income individuals
for medical services and human services. Non-medical transporting for Medicaid transportation has been in
place for a number of years. We assist Human Services by performing some of the functions of the State
Designated Entity(SDE1 for Medicaid-Medical trips.we also provide transportation to general public in Weld
County and surrounding areas.
2.OTHER SECTION 5311 RECIPIENTS WITHIN THE SERVICE AREA(WILL USUALLY BE BLANK).
3.OTHER SURFACE PUBLIC TRANSPORTATION PROVIDERS WITHIN SERVICE AREA.
Greeley-Evans Transit
Shamrock Taxi Cab Company
NFRMPO - Van Go
Rocky Mountain Shuttle
Black Hills Stage
Greyhound
Greeley Airport Shuttle
Super Shuttle
Colorado Cab Company
El Paso-Los Angeles Lim, Com i an
4. UNION REPRESENTATION OF EMPLOYEES IDENTIFIED IN 2 AND 3 IF ANY(LIST UNION AND PROVIDER).
N/A
WE,THE UNDERSIGNED REPRESENTING
Weld County Transportation
AND SUB-RECIPIENT(IF APPLICABLE)
N/A
hereinafter referred to as the Applicant and Sub-recipient, respectively, have reviewed the
"Special Section 13(c) Warranty for Application to the Small Urban and Rural Program" and
certify to the Colorado Department of Transportation that we will comply with its provi-
sions and that all its provisions will be incorporated into any contract between the Appli-
cant and Sub-recipient which will expend funds received as a result of an application to the
Colorado Department of Transportation under the Section 5311Grant Program.
Page 142 Colorado Department of Transportation
April 2011 2012-2013 FTA Grant Application Instructions
SIGNATURE OF APPLICANT _ DATE JUN 0 12011
TITLE OF APPLICANT
Chairman Pro-Tern of the Board of County Commissioners
SIGNATURE OF SUBRECIPIENT DATE
05/31/2011
TITLE OF SUBRECIPIENT
J
CERTIFICATION OF EQUIVALENT SERVICE
Only required for all agencies applying for non-accessible vehicles
4 APPLIES ONLY TO DEMAND-RESPONSIVE SYSTEMS
If the applicant is applying for one or more vehicles that are not accessible to persons with dis-
abilities, the agency must submit a Certification of Equivalent Service.
Below are guidelines to assist an applicant in determining if its system is eligible to provide
equivalent service.
Response Time:
An agency shall establish a policy which provides the same response time to all requests for
service. Response time is defined as the amount of time between the request for service and the
delivery of service.
An agency shall have sufficient equipment to ensure compliance with this policy. Subcontracted
accessible service is not acceptable unless equivalent response time can be demonstrated.
Fares:
There shall be no premium fare charged for persons with disabilities including those persons
requiring a lift for vehicle access.
Geographic Area:
All persons shall be eligible for transportation within the established geographic service area of
the agency.
Hours and Days of Service:
All passengers shall be afforded service during the established hours and days of service.
Restriction on Trip Purpose:
No person shall be denied service for trip purposes which are provided to other passengers.
Constraints on Capacity or Service Availability:
Vehicle wheelchair carrying capacity shall not be constrained by a failure to provide an adequate
Colorado Department of Transportation Page 143
2012-2013 FTA Grant Application Instructions April2011
number of wheelchair positions where demand is evident. Lifts, ramps, and other transfer and
securement devices must accommodate all types of mobility devices in common use (specifically
including electric wheelchairs and three-wheel scooters).
Availability of Information and Reservation Capability:
The applicant shall have available a telecommunications device for the deaf(TDD) or compara-
ble two-way communications system. Any proposed comparable system must be described with
the filing of the certification.
Page 144 Colorado Department of Transportation
April 2011 2012-2013 FTA Grant Application Instructions
PROGRAM SPECIFIC ASSURANCES
The applicant's legally authorized representative must sign the signature block below identifying com-
pliance with the applicable certifications and assurances.The assurances are delineated by program or
type of assistance sought.This signed certification (along with the mandatory assurances) must be either
sent or hand delivered to the Transit Unit in order to complete the 2012-2013 application for funding.
FTA ASSURANCE APPLICABLE TO PROGRAM OR ASSISTANCE?
Title of FTA Required Assurance 5310 5311 5316 5317 CAPITAL
REQUESTS
If> If> If> If> If>
Lobbying Certification
$100,000 $100,000 $100,000 $100,000 $100,000
Procurement Compliance ✓ ✓ ✓ ✓ ✓
(Capital Requests only)
Private Transportation Providers Protections V V ✓ V ✓
Public Hearing(Capital Requests only) V ✓ V V V
Acquisition of Rolling Stock(Pre-Award and ✓ ✓ ✓ ✓ ✓
Post Delivery Reviews,Capital Requests only)
Bus Testing(Capital Requests only) V V V V V
Charter Service Agreement V
School Transportation Agreement V
Demand Responsive Service ✓ ✓ ✓ ✓
(Demand Response Services Only)
Alcohol Misuse and Prohibited Drug Use V
Intelligent Transportation Systems V V V V V
Elderly Individuals&Individuals with Disabil-
ities Formula Program ✓
Nonurbanized Area Formula Program V
Job Access and Reverse Commute Formula ✓
Grant Program
New Freedom Program V
We Certify and Assure that
AGENCY NAME
Weld County Transportation
will comply with the applicable portions listed above.
AGENCY NAME
Weld County Transnortation
PRINTED NAME(Chief Elected Official/Board President/Legal Representative)
Sean P. Conway
TITLE
Chairman Pro-Tem of the Board of County Commissioners
SIGNATURE r• m DATE JUN 2 12 11
Colorado Department of Transportation Page 145
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