piiop rd3 application form stage web viewyou can access either a microsoft word or an adobe acrobat...

PRIVATE IRRIGATION INFRASTRUCTURE OPERATORS PROGRAM (PIIOP) IN NSW

ROUND THREE (2015-2019)

STAGE ONE Application Form

Applications must be submitted by 2:00pm AEDT Thursday, 30 APRIL 2015

APPLICATIONS MUST BE SUBMITTED IN ELECTRONIC FORMAT (USB DRIVE) AND IN HARD COPY FORMAT

Post your hard copy and electronic application to: OR Courier your application to:

DirectorWater Recovery Infrastructure SectionWater DivisionDepartment of the EnvironmentGPO Box 787CANBERRA ACT 2601

DirectorWater Recovery Infrastructure SectionDepartment of the EnvironmentJohn Gorton BuildingKing Edward Terrace PARKES ACT 2600

You can access either a Microsoft Word or an Adobe Acrobat Reader version of the Guidelines for Round Three of the Programme and the Stage One application form on the Department of the Environment website at http://www.environment.gov.au/water/rural-water/srwui/state-priority-projects/piiop-nsw

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http://www.environment.gov.au/water/rural-water/srwui/state-priority-projects/piiop-nsw


Before completing an application, read all other relevant documents available at http://www.environment.gov.au/water/rural-water/srwui/state-priority-projects/piiop-nsw

In addition to this application form, the relevant Programme documentation includes:

Funding Guidelines for Round Three of the Programme Programme Sample Funding Agreement

Completing and submitting the application form

Be concise and factual in all responses when completing this application form as the assessment will be based principally on the information contained within it.

Failure to address all questions in this application could result in your application being deemed ineligible.

Applicants should only provide only the attachments referred to in the Application Map on page 3. Any additional attachments that Applicants provide WILL NOT be assessed as part of the Stage One application. Successful Stage One Applicants will be able to provide more detailed information in Stage Two.

Applicants must submit the documentation in the format described in Section D of this application form by the Closing Date.

Assessment of Stage One applications

This application form is designed to obtain the information the Department needs to assess an application against the Eligibility Criteria and the Merit Criteria.

Applications which satisfy the Eligibility Criteria are then assessed against the weighted Merit Criteria based on the information provided by the Applicant in their application form. Writing an effective response to each section of the application form will assist the Department in making an informed assessment of the application.

Refer to the Programme Funding Guidelines for further detail on the assessment process.

The Parliamentary Secretary or his delegate will provide in-principle approval to Shortlisted Applicants for some or all of the Applicants’ Sub-Project types as part of Stage One, taking into account the availability of Programme funds in deciding which applications are offered in-principle support. A written notification of the decision by the Parliamentary Secretary (or his delegate) will be provided to the Applicant.

Within 60 days of being given in-principle approval, Shortlisted Applicants will be required to submit Stage Two individual irrigator Sub-Project information. This information will be used to assess Sub-Projects against the same eligibility and merit criteria used in the Stage One assessment (but more comprehensively), as described in the Funding Guidelines.

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APPLICATION MAP

SECTION AELIGIBILITY CRITERIA

Mandatory eligibility requirements for Organisations and Projects

Mandatory Attachments

SECTION BAPPLICANT DETAILS & PROJECT OVERVIEW

ELIGIBILITY AND MERIT CRITERIA

High-level information on your organisation and an overview of the Project as a whole

Include Attachment 1(A3 size map of the Project area)

SECTION CMERIT CRITERIA

Organisation and Project specific information addressing the merit criteria:

Project Details

Stakeholder Support

Value for Money

Financial Information

Include Attachment 2(Project Timeline in MS Excel

format)Template not provided

Include Attachment 3(Sub-Project description)

Use MS Word template provided

Include Attachment 4(Evidence of stakeholder support)

Template not provided

Include Attachment 5(Project Budget)

Use MS Excel template provided

Include Attachment 6(Water Savings Calculations)

Use MS Excel template provided

SECTION DDECLARATION & CHECKLIST

Application declaration and checklist for Making an application

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THIS PROGRAMME SEEKS APPLICATIONS FROM PRIVATE IRRIGATION INFRASTRUCTURE OPERATORS IN THE NSW MURRAY OR MURRUMBIDGEE CATCHMENTS

APPLICATIONS ARE NOT OPEN TO INDIVIDUAL IRRIGATORS

Privacy Notice

This Privacy Notice describes how we collect and manage your personal information and is provided pursuant to Australian Privacy Principle 5.

The use and disclosure of personal information collected by the Department of the Environment (the Department), from Applicants will be managed in accordance with the Privacy Act 1988.

The Department will use the personal information collected in this application form for the purposes of discharging its functions under the Programme, and for related uses. These functions include determining eligibility for funding under the Programme, assessing merit, preparing funding agreements, calculating the amount of funding that will be paid to successful Applicants, and assisting with compliance activities. The Department may also use personal information received in applications in any other legitimate Departmental business.

As part of the assessment of this application, the Department may need to consult with and provide material from the application, including personal information, to other government agencies or bodies, other organisations and/or relevant individuals, in order to substantiate any claims or statements made in the application form, or to otherwise assist in the assessment of the application. If this occurs, the Department will endeavour to ensure that the parties who are consulted observe appropriate confidentiality.

Following Stage Two assessment, successful Projects will be announced by the Parliamentary Secretary to the Minister for the Environment or his delegate. The public announcement will include details of the names of successful Applicants and the amount of funding to be awarded. Publicity material may also be produced in relation to all or particular Projects supported by the Programme.

You can access the Department’s full privacy policy at http://www.environment.gov.au/privacy-policy. The privacy policy contains details about how you can access the personal information that the Department holds about you and seek to make corrections to it. The privacy policy also contains information about how you may make a complaint about a breach of an Australian Privacy Principle and how the Department will deal with that complaint.

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SECTION A – ELIGIBILITY CRITERIA

Is the Applicant a private entity that owns or operates infrastructure within the Murrumbidgee or Murray catchments in NSW for the purpose of delivering water to other persons for the primary purpose of use in irrigation?

Yes No

Has the Applicant undertaken or completed a modernisation plan in accordance with the Australian Government guidelines, or equivalent, to the satisfaction of the Department?

Yes No

Has the Applicant undertaken an assessment of the irrigation district water losses, consistent with the Australian Government ‘Hotspots’ assessment methodology, or equivalent, to the satisfaction of the Department?

Yes No

Is the Applicant proposing an ‘eligible Project’ in accordance with the Programme Guidelines? (see pages 6 and 7 of the Programme Guidelines) Yes No

Is the Applicant a legal entity capable of entering into a Funding Agreement with the Australian Government? (Note: unincorporated associations are not eligible) Yes No

Does the Applicant have a valid Australian Business Number?

Yes No

Is the Applicant registered with the Australian Taxation Office for Goods and Services Tax purposes? Yes No

Does the Applicant comply with the Water Market Rules 2009 under the Water Charge (Termination Fees) Rules 2009 under the Water Act 2007? Yes No

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SECTION B - APPLICANT DETAILS & PROJECT OVERVIEW

Name of Applicant

The Applicant is the organisation that is applying for a grant under Round Three of the Programme.

Please see the Programme Guidelines () for further explanation in the section: “Who is eligible for the Programme?”.

Legal name of organisation

Trading name (if different to legal name)

Address of Applicant

Business AddressStreet

Suburb/Town

State/Territory Postcode

Postal Address

Street

Suburb/Town

State/Territory Postcode

Website Address

Type of legal entityPlease tick most appropriate

This is usually the type listed on your Australian Business Register entry (if applicable).

Legally incorporated organisationCompanyOther Detail

s:

Applicant identification

Australian Business Number (ABN)

Applicant GST registration

Are you GST registered? Yes No

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Applicant incorporation (if applicable)

Is your organisation incorporated? Yes No no

Incorporation number

Date of incorporation

Authorised person (for Applicant)

The authorised contact is the person with the authority to sign a funding agreement with the Commonwealth Government on behalf of the Applicant.

Title Ph (work)

First Name Ph (a/h) optional

Surname Ph (mobile)

Position in organisation

Email address

Project officer (If different from the authorised person)

The Project officer will manage the Project and be our contact for information or day-to-day aspects of the Project.

Title Ph (work)

First Name Ph (a/h) optional

Surname Ph (mobile)

Position in organisation

Email address

Project area/locationPlease attach a one-page A3 size map to your application that indicates the proposed Project’s boundaries and mark as Attachment 1. Additional maps may be provided if appropriate.

Irrigation districtList irrigation district(s) in which the Project is located

Latitude (eg – 34.2401)

Longitude (eg 140.5507)

Nearest major town

Location description (if your site is not easily located by a street address and lat/long)

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SECTION C - MERIT CRITERIA

The information you provide in this section is required for assessment purposes.

Please address each item below, noting that only the attachments referred to in the Application Map will be assessed as part of the Stage One application. Any additional material provided WILL NOT be assessed as part of the Stage One application.

Shortlisted Stage One Applicants will be invited to provide additional detailed information in Stage Two..

Project titlePlease advise your proposed Project name. If the Applicant is successful, this title will be used by the Australian Government when publishing the results of the Programme round on the Department’s website and in published material.

eg: XYZ Channel Modernisation & Rationalisation Project

Project description/activities Summarise the overall Project proposed for funding under the Programme.

The summary should include a brief description of which eligible activities are proposed to be undertaken by the Project (the ‘what and ‘where’ of the Project), including objectives, expected outcomes and a Project timeline in Microsoft Excel format.

For details on “What is an eligible Project?” see pages 6 and 7 of the Programme Guidelines.

Please provide the summary below and attach a Project timeline in Microsoft Excel format marked as Attachment 2.

Please limit your summary to approximately 2 pages

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Sub-Project descriptionPlease complete Attachment 3 for each Sub-Project including activity description, estimated water savings and cost for each Sub-Project.

Number of Sub-Projects attached to this application

Rationalisation

If your proposed Project includes rationalisation:

Provide the number of proponents anticipated to be rationalised

Attach evidence (eg. results of meetings, emails, letters, etc) from potential rationalisation customers confirming their willingness to participate in the Project and mark as Attachment 4

Estimated total Project cost (GST excl) Please include details of Applicant cash co-contribution (if applicable). Details must be provided in the Budget at Attachment 5.

$

Funding sought (GST excl)Please provide total funding sought from the Commonwealth $

Total water savings (ML)Please provide the total volume of water savings anticipated to be achieved through the Project. Details must be provided in the Water savings calculations at Attachment 6.

.................... ML

Total water return (ML)Please provide the volume of water savings to be returned to the Commonwealth

.................... ML

Transferable water entitlementsIf the water entitlements to be transferred to the Commonwealth are encumbered, or cannot be transferred, detail the steps being taken to resolve the problem.

Delivery system efficiencyOutline the anticipated increase in the efficiency of the delivery system

Cost-benefit analysis Note: not required as part of this application. If your application is shortlisted in Stage One, Applicants will be required to provide a cost-benefit analysis with a ‘no change’ option in Stage Two.

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FURTHER DETAILS

Duplication/overlap of funded activitiesHas current or previous funding been received, or have you applied for any Commonwealth or State funding, from any source for the same activities as those you are proposing? If yes, please provide details including actual or expected completion date and/or the expected date for notification of application outcomes.

Previous or current grantsPlease provide details of any Commonwealth or State Government grants that have been awarded to the organisation in the past [5] years and advise if these have been successfully completed and acquitted.

Grant title Granting organisation

DateReceived

Amount received (GST excl) Status

Risk managementNote: not required as part of this application. If your application is shortlisted in Stage One, you will be required to complete a Risk Management Plan in the format determined by the Department, providing an analysis and management strategies for any risks associated with the Project.

Approvals and ExemptionsPlease indicate if the Project, including Sub-Projects, will require any of the following approvals/exemptions for your Project activities, and whether or not you have obtained them yet.

Note: If your application is successful in Stage Two, you will be required to provide written evidence that the appropriate approvals have been obtained during implementation of the project.

Conflict of Interest

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Approval/Exemption Required Obtained & attached

Application made

Yet to be sought

Local approval

State/Territory approval

National approval Development approval

Throughout the duration of the Project, if there are any matters related to the business interests of persons directly involved with Projects under this Programme that may conflict with their role in the project, these matters must be brought to the Department’s attention as soon as a potential or actual conflict of interest is known.

Please describe how you will manage potential or actual conflicts of interest.

Compliance with Funding AgreementFinal approval of funding will be dependent upon the willingness of the Applicant to accept the terms and conditions of the standard Funding Agreement.

Please indicate any clause / sub-clause / paragraph / subparagraph of the Funding Agreement (see http://www.environment.gov.au/water/rural-water/srwui/state-priority-projects/piiop-nsw) which you ‘do not comply’ or ‘partially comply’.

Clause / sub-clause / paragraph / subparagraph of the Funding Agreement

Do not comply

Partially comply

ConfidentialityThe Department is subject to certain legislative and administrative accountability and transparency requirements of the Australian Government, including disclosures to the Parliament and its Committees. While the Department will treat all information provided by Applicants sensitively, any information contained in or relating to an application, including information identified by an Applicant as confidential, may be disclosed by the Department.

Detailed confidential information contained in applications may also be disclosed for audit or evaluation purposes to contractors engaged by the Department and to other Commonwealth agencies for audit, evaluation, reporting and law enforcement purposes. Further, the Department may release confidential information if it obtains the applicant’s consent or is required or permitted by law to do so. This could happen, for example, if the Department is required to respond to a resolution of the Parliament, or the order of a court.

See page 16 of the Programme Guidelines for more information on Confidential Information.

As required under the Commonwealth Grants Rules and Guidelines, names of successful Applicants under this Programme, the amount granted and the purpose for which the funds were granted will

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also be published on the Department’s website (see http://www.environment.gov.au/water/rural-water/srwui/state-priority-projects/piiop-nsw).

If any information provided in this application is confidential, please clearly identify such information and the reason for its confidentiality.

Insurance

Do you hold appropriate insurance to cover the proposed activities? Yes No

Appropriate insurance includes:

Workers compensation insurance as required by law where the Organisation or Proponent (as the case may be) carries out activities under the Funding Agreement;

Public liability insurance to the value of at least $20 million per claim, or occurrence giving rise to a claim, in respect to activities undertaken under the Funding Agreement, where occurrence means either a single occurrence or a series of occurrences if these are linked or occur in connection with one another from one original cause, as the case may be; and

Professional indemnity insurance for an amount of not less than $10 million per claim.

If your application is successful, you will be required to provide evidence of appropriate insurance at the time of funding.Comments, if applicable:

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SECTION D – DECLARATION & CHECKLIST

I, the undersigned, certify that: the information in this application is true and correct to the best of my knowledge. the application is submitted with the full knowledge and agreement of the Board/Executive

of the Applicant (if applicable). the activities proposed are in addition to any statutory and non-statutory obligations. none of the particular activities in this proposal have previously been funded by other

government programmes. I acknowledge that the application may not be accepted if it is not fully completed and it

does not include all attachments referred to in the Application Map. I have read and understood the Programme Guidelines and understand the eligibility

requirements and terms and conditions of funding. I have completed all questions on the application form and completed (or attached) the

required attachments.

Signature of person authorised to sign on behalf of the Applicant (Authorised person for Applicant)

Print name

Signature

Position in organisation (if applicable)

Date

In the presence of:

Print name of witness

Signature of witness

Position in organisation (if applicable)

Date

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CHECKLIST OF IMPORTANT DETAILS

Please ensure that you have answered all of the questions in the Application Form. Incomplete applications may not be assessed.

Application forms must be written in English, with any financial information provided in Australian dollars inclusive of GST.

YES

Is your proposed Project eligible?

Are you/your organisation an eligible Applicant?

Are all your Project activities eligible activities?

Is your application form complete?

Has an official contact signed the application?

Have you included all mandatory attachments, including: Attachment 1: A3 size map of the Project area Attachment 2: Project Timeline in MS Excel format Attachment 3: Sub-Project description (using template provided) Attachment 4: Evidence of stakeholder support Attachment 5: Project Budget (using template provided) Attachment 6: Water Savings Calculations (using template provided)

Have you provided One (1) UNBOUND ORIGINAL SIGNED hard copy of theapplication together with one (1) copy of eachmandatory attachment referred to in the Application Map?

Have you provided ONE (1) ELECTRONIC COPY of the application in Microsoft Wordformat and the mandatory attachments referred to in the Application Map in Microsoft Word or Excel format (as applicable), on a USB drive?

Have you ensured that electronic files submitted in a USB drive are compatible with Microsoft Office 2007?

Have you certified that the USB drive and its contents are free of viruses, worms or other malicious codes that might compromise the integrity or the security of the Department’s

computer systems?

Have you kept a copy of your entire application for your records?

APPLICATIONS MUST BE SUBMITTED BY

2:00pm AEDT Thursday, 30 APRIL 2015

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piiop rd3 application form stage web viewyou can access either a microsoft word or an adobe acrobat...

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