Hunter Local Land Services Flood Recovery Grant Application Form – 2015-16

This form is to be used to apply for funding under any Hunter Local Land Services (LLS) Grants Programs. Please refer to the Grants Program Guidelines for further information about the terms and conditions of applying for LLS funding.

Funding for LLS Grants programs is provided from a variety of sources including the Australian Government’s National Landcare Program, New South Wales Government’s Catchment Action NSW, and Hunter Catchment Contributions.

1. PROGRAM DETAILSWhat LLS Grant Program are you applying for funds through?Please refer to the Guidelines for each Program for grant eligibility and identified priority areas.

If you are eligible, only one program can be applied for per application form.

Hunter Flood Recovery Program

Flood Readiness Program

Torryburn Green Army Assistance Program

Note: Your application may also be considered for funding under other LLS Programs.

2. APPLICANT AND PROPERTY DETAILSApplicant (The name at the Applicant should match the name of ABN holder if provided)

Contact Person Mr/Mrs/Ms

Landowner(s) (if not applicant) Mr/Mrs/Ms

Is the applicant an Aboriginal or Torres Strait Islander individual or organisation?

Yes No

Property Address (Project Location) Applicant Postal Address

Suburb: Postcode Suburb: Postcode

Contact DetailsTelephone Home: Bus: Mob:

E-mail

Project Location:Lot/DP:

Property Identification Code (PIC):

LGA:

Area of proposed project (Ha)

Total Area of Property (Ha)

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Event Number(LLS office use only)

ABN and GST Status

Registered Business name:

Are you currently registered for GST?

Yes No ABN:

Group membership

Are you affiliated with an Industry, Landcare or community group

Yes No

Group name: _____________________________________________

Property Planning

Do you have a current Property Plan?

Yes No

If no, would you be interested in undertaking training? Yes No

3. PROJECT DESCRIPTIONPlease provide a description of your project and the objectives you are aiming to achieve. Include your production, environmental, cultural, and social objectives.

Project Description:

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4. TECHNICAL ADVICE AND CONSULTATIONPlease provide details of what advice you have sought or consultation you have undertaken in developing your application.

5. RELEVANT LAND MANAGEMENT EXPERIENCEPlease provide an outline of your experience in land management, including details of any relevant training or qualifications you have.

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6. PROJECT PLAN

What are you proposing to achieve through implementing the project (outcomes)?

Examples: re-establish native vegetation; improve groundcover and pasture species composition, raise

community awareness

What works or activities will you undertake?Examples: Plant & establish 500 trees; 2km fencing to exclude stock from stream; install 5 stock watering points, control 2ha of lantana & blackberry

Completion date?(month & year)

(Implementation of projects must be completed by 31 December 2016

according to project plan timeframes)

7. PROJECT BUDGETNote: For estimate purposes landholders/community groups should cost their in-kind labour component at $30/hour.

LLS funding is provided exclusive of GST. Please see the LLS’s GST Fact Sheet for more advice on funding and the GST implications.

Proposed activity/work/action Examples: Plant trees, erect electric fence

Unit of Measure Quantity Unit Cost

(excl GST)Total Item Cost (Excl

GST)

LLS Funds Sought

(Excl GST)

Own Cash Contribution (Excl GST)

Own Labour In-kind

@$30/hr

Total – funds sought + in kind+ cash contribution

(Excl. GST)GST

TOTALSNOTE: An excel version of the budget sheet is available from your Hunter LLS Contact Officer upon request.

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8. MONITORING, MAINTENANCE AND REPORTINGHow will you monitor whether your project is achieving

the Outcomes?(BOLD rows are mandatory)

Tick adopted monitoring techniques.

Frequency or due date

Photo-point monitoring Before and after photos of works Step Point transect for assessing groundcover Event evaluation sheets Attendance records Pasture composition quadrats Tree survival rates Final Report Grazing records/Plan

8. ABORIGINAL CULTURAL HERITAGE AND CONSULTATION

Checklist Questions Yes No

Do you know of any Aboriginal sites or objects on your property or in the immediate area?

Are you aware of any Aboriginal history, stories or significant events that took place on your property or in the immediate area? If YES, please provide a brief description below.

Is your project area located near a river, stream, lake, wetlands or watercourse?

Does your project area contain any of the following landforms: rocky or sandy hills, mountains, claypans, caves, sandstone overhangs?

Will there be any native vegetation removed permanently?

Are you interested in planting any native vegetation on your property?

Will there be any ground disturbance involved in the project? If YES, please provide brief description below.

Is the property on private (freehold) land?

Do you give permission for relevant project information to be provided to the Local Aboriginal Land Council for the purpose of cultural heritage assessment?

Other Notes:

10. PUBLIC LIABILITY INSURANCEYes No

I currently have Public Liability Insurance and a copy is attached

If you currently don’t have this insurance coverage, are you willing to acquire $10 million public liability coverage, if you are successful?

11. MAP OF PROPOSED PROJECT WORKSContact your Hunter LLS contact officer to discuss your project and to develop a map of your project area and works proposed for inclusion in your application.

You may also wish to provide photographs or a sketch of the proposed project site in the space provided below to support your application.

12. CONFLICT OF INTEREST

Outline any conflict of interest you may have with the business or any director or staff of Hunter LLS

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13. OTHER FUNDING

Please list any current or previous grants or financial assistance you have received that is relevant to the activities in this project.

Funding source Year Project title Amount Continuing commitments

Do you have any other related funding applications currently under consideration?YES / NO (If Yes list)

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14. DECLARATION AND SIGNATUREBefore signing please ensure your application is complete in all sections as incomplete applications will not be considered.

Successful applicants will need to adhere to the terms and conditions outlined in the Program guidelines.

If a company or organisation, the applicant must be an authorised representative of the entity.

I,Name of applicant (please print)

as the applicant confirm that all details outlined in this application are true and correct.

Signature of applicant Date

If you are applying to undertake a project on land of which you are not the owner, the landowner must also sign the application for private holdings or the responsible entity must sign for public land. If the landowner or responsible entity is a company or organisation, the signatory must be an authorised representative of the entity.

I,Name of land owner or responsible entity (please print)

as the landowner (or responsible entity) grant permission for the applicant to undertake the project on the land and confirm that I will be bound to all details outlined in this application.

Signature of landowner Date

Submission details for each Program are presented in the Program guidelines.

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Applicants Checklist for Grant Application

Do you have in your application for submission... Yes No

Have you attached your LLS generated map? Yes No

Have you attached a copy of your Public Liability Insurance? Yes No

Has the land owner or responsible entity signed the application? Yes No

Does the person/entity responsible for the agreement name match the name against the ABN number (if applicable)?

Yes No

Are you aware of LLS minimum activity standards and/or activity definitions for projects and that you will be required to deliver your project in accordance with these?

Yes No

Have you answered every question? Yes No

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