Project Information Form - Project Solicitation for the Round 1 Implementation Application A. PROJECT INFORMATION 1. Project Title: 2. Project Sponsor(s): 3. Does the project provide direct water-related benefits to a project area entirely comprised of Disadvantaged Communities (DAC)s and/or Economically Distressed Areas (EDA)s? Yes No If Yes, see question D.7. Show on map if applicable. 4. Is the Project Sponsor a Tribe, or does the project provide benefits entirely to a Tribe as defined by Proposition 1? Yes No If Yes, see question D.8. Show on map if applicable. 5. Provide project map. Include location of project, project benefit and/or service area, and other applicable information. B. ELIGIBILITY REQUIREMENTS If "No" is checked on any question in this section, STOP. Project is ineligible for this solicitation. 1. Is the project consistent with the IRWM Plan? Yes No 2. Does the project address the most critical regional water resources needs of the IRWM Region? a. What IRWM Plan goal(s)/objective(s) does the project address? Identify and explain. No 3. If the project is a construction project as defined in 2018 PSP Concepts, Section 3. Proposal and Project Eligibility Requirements, does it provide a minimum 15-year life cycle benefit as required by Government Code 16727? NA, Not a defined project. Explain below. No 4. Does the project provide a benefit that meets at least one of the Statewide Priorities as defined in the 2016 IRWM Grant Program Guidelines? No If Yes, Please identify below. Page 1 of 8
5. Will CEQA be completed within 6 months of the Final Award release? See Section E for more details. NA, Project is exempt from CEQA NA, Not a Project under CEQA NA, Project benefits entirely to DAC/EDA/Tribe, or is a Tribe local sponsor No 6. Will all permits necessary to begin construction be acquired within 6 months of the Final Award release? See Section E for more details. NA, Project benefits entirely to DAC/EDA/Tribe, or is a Tribe local sponsor No C. WORK PLAN, BUDGET, and SCHEDULE 1. Work Plan: Provide a brief description of the Project. List of deliverables is not required. <250 words maximum> a. Land and Purchase/Easement. Provide a brief description of the scope of work to complete this task, if applicable. b. Land and Purchase/Easement. Provide a brief description of the scope of work to complete this task, if applicable. <150 words maximum> c. Planning/Design/Engineering/Environmental Documentation. Provide a brief description of the scope of work to complete this task, if applicable. <150 words maximum> d. Construction / Implementation. Provide a brief description of the scope of work to complete this task, if applicable. <250 words maximum> Page 2 of 8
2. Budget: Provide preliminary cost estimates for each Budget Category listed in the table below. Budget subject to change. Table 1 - Project Budget Category (a) (b) (c) (d) Requested Grant Amount Cost Share: Non State Fund Source Other Fund Source* Total Cost (a) Direct Project Administration (b) (c) (d) Land Purchase/Easement Planning/Design/Engineering/ Environmental Documentation Construction/Implementation (e) Grand Total (Sum rows (a) through (d) for each column) * Identify the source of Other Funds: a. Cost Share Waiver Requested (DAC or EDA)? No If Yes, continue below: Cost Share Waiver Justification: Describe what percentage of the proposed project area encompasses a DAC/EDA, how the community meets the definition of a DAC/EDA, and the water-related need of the DAC/EDA that the project addresses. In order to receive a cost share waiver, the applicant must demonstrate that the project will provide benefits (minimum 25% by population or geography) that address a water-related need of a DAC and/or EDA. <250 words maximum> 3. Schedule: Include reasonable estimates of the start and end dates, for each Budget Category listed in Table 2, to match the Budget included in this PIF. Schedule is tentative and subject to change. Category Table 2 Project Schedule (a) Start Date (b) End Date (a) (b) (c) (d) Direct Project Administration Land Purchase/Easement Planning/Design/Engineering/ Environmental Documentation Construction/Implementation Page 3 of 8
D. OTHER PROJECT INFORMATION 1. Operations and Maintenance: On defined construction projects, please identify a source of funding for operations and maintenance. 2. Project Physical Benefits Table: Anticipated Useful Life of Project (years): Type of Benefit Claimed: Type of Benefit Claimed: Table 3 Project Physical Benefits Benefit A (Required) Benefit B (Optional) Benefit Units: Benefit Units: Physical Benefits (At Project completion or Lifetime, as appropriate) (a) (b) (c) Benefit Added Physical Benefit Description Quantitative Benefit Benefit A <15 words maximum> Benefit B <15 words maximum> Comments: [Include narrative on additional physical benefits, as warranted.] 3. Does the proposed project provide physical benefits to multiple regions (or funding area(s)? No If Yes, provide a description of the impacts to the various regions. Page 4 of 8
4. Least-Cost Alternative a. Have alternative methods been considered to achieve the same types and amounts of physical benefits as the proposed project been identified? No If No, why? If Yes, list the methods (including the proposed project) and estimated costs. b. If the proposed project is not the least cost alternative, why is it the preferred alternative? Provide an explanation of any advantages of the proposed project that are different from the alternative project or methods. 5. Does the project provide safe, clean, affordable, and accessible water adequate for human consumption, cooking, and sanitary purposes consistent with AB 685? No If Yes, please describe. 6. Does the project employ new or innovative technologies or practices, including decision support tools that support the integration of multiple jurisdictions, inducing, but not limited to, water supply, flood control, land use, and sanitation? No If Yes, please describe. Page 5 of 8
7. If the project provides benefits entirely (100% by population or geography to a DAC, explain the water-related need of the DAC and how the project will address the described need. Explain how the area/community meets the definition of a DAC. 8. If the project provides benefits entirely (100% by population or geograpy) to a Tribe or a Tribe is the sponsor of the project, explain the water-related need of the Tribe and how the project will address the described need.. E. ENVIRONMENTAL 1. Please fill out the Table below, CEQA Timeline, if applicable: Table 4 - CEQA Timeline CEQA STEP COMPLETE? (y/n) ESTIMATED DATE TO COMPLETE Initial Study Notice of Preparation Draft EIR/MND/ND Public Review Final EIR/MND/ND Adoption of Final EIR/MND/ND Notice of Determination a. Please explain and justify how the timeline was developed. Page 6 of 8
2. Permit Acquisition Plan: List all permits needed to complete project. If the project does not provide benefits entirely to a DAC, all permits needed to begin construction must be acquired within 6 months of funding award or by Agreement execution, whichever occurs first. No. Type of Permit Permitting Agency Date Acquired or Anticipated 1. 2. 3. n. For each permit not yet acquired, describe the following: No. 1. a. Actions taken to date (include dates of any key meetings, submittals, etc.) b. Any issues or obstacles that may delay acquisition of permit 2. 3. n. 3. Permitting Checklist: This checklist is provided as a courtesy for documentation purposes. Not all permits are listed. a. Does the project involve any direct effects from construction activities, or indirect effects such as growth inducement that may affect federally listed threatened or endangered species or their critical habitat that are known, or have a potential, to occur on-site, in the surrounding area, or in the service area? No If Yes, please explain: b. Would the proposed project work in, over, or under navigable water of the US or discharge dredged or fill material in waters of the US? No If Yes, please explain: c. Will the proposed project have the potential to affect historical, archaeological, or cultural resources? No If Yes, please explain: Page 7 of 8
d. Will the proposed project discharge into a water of the US? No If Yes, please explain: e. Will the proposed project divert the natural flow of the river, stream, or lake? No If Yes, please explain: f. Will the proposed project change the bed, channel, or bank of a river, stream, or lake? No If Yes, please explain: g. Will the proposed project use any material from the bed, channel, or bank of a river, stream, or lake? No If Yes, please explain: h. Will the proposed project deposit or dispose of debris, waste, or other material containing crumbled, flaked, or ground pavement where it can pass into a river, stream, or lake? No If Yes, please explain: i. For water supply projects, do you need to obtain a water right? No If Yes, please explain: j. Is the proposed project within the defined coastal zone? No If Yes, please explain: Page 8 of 8