South Australian River Murray Sustainability Program

Regional Development and

Innovation Fund

APPLICATION FORM

This program is funded by the Australian Government and delivered by the Government of South Australia

APPLICATION CLOSING DATE

To be included in the Round One Application process, completed applications must be received by the South Australian River Murray Sustainability - Regional Development and Innovation Fund (RDIF) by 5.00pm (ACST), Friday 19 September 2014.

SUBMISSION PROCESS

Applicants are required to forward their completed applications by the above closing date including any supporting documentation:

· One electronic copy via email to pirsa.sarmsadmin@sa.gov.au (supporting documentation in Microsoft Word, Excel or Adobe PDF format) and

· One unbound signed original copy of application and supporting documentation (postmarked no later than 5.00pm (ACST) Friday 19 September 2014 to:

Regional Development and Innovation Fund

Assessment Panel

PIRSA

GPO Box 1671

ADELAIDE SA 5001

CONTACT US

For further information about RDIF, please contact:

Mr Kym Walton

Team Leader – Regional Support, River Murray Sustainability

Department of Primary Industries and Regions

Telephone: (08) 8539 2118

Email: kym.walton@sa.gov.au

Alternatively, please call 1300 364 322 or email pirsa.sarmsadmin@sa.gov.au

Part 1:Applicant Eligibility Checklist

Please complete all questions listed below by placing a tick in the box next to your response (Yes or No).

If the answer to any of the questions below is ‘No’, applicants are ineligible to participate in the Regional Development and Innovation Fund.

In addressing the Applicant Eligibility Criteria, please read carefully Section 4.1 of the RDIF Guidelines

1. Does the applicant hold an Australian Business Number (ABN) or Australian Company Number (ACN)?

Yes☐

No☐

2. Is the applicant a recognised legal entity capable of entering into a legally binding funding deed with the Minister for Agriculture, Food and Fisheries?

A recognised legal entity includes a natural person/s, a company formed under the Corporations Act 2001 (Commonwealth), a council constituted under the Local Government Act 1999 (South Australia), an association incorporated under the Associations Incorporation Act 1986 (South Australia) or a body corporate established under other legislation.

Yes☐

No☐

3. Can you confirm that the applicant has NOT previously failed to meet the conditions in any State or Australian Government Funding Agreements?

Yes☐

No☐

4. Can you confirm that the applicant is NOT from a State or Australian Government agency, or a commercial arm of these agencies?

Yes☐

No☐

5. Can you confirm that the applicant does NOT hold water access entitlements and is NOT directly involved with irrigation (i.e. irrigation is not the primary business activity) ?

Yes☐

No☐

Part 2:Project Eligibility checklist

Please complete all questions listed below by placing a tick in the box next to your response (Yes or No).

If the answer to any of the questions below is No, the project is ineligible for funding under the Regional Development and Innovation Fund.

In addressing the Project Eligibility Criteria, please read carefully Section 4.1 of the RDIF Guidelines

1. Is the project for infrastructure works, the provision of services, equipment, studies, training and research, or similar?Yes☐No☐

2. Does the project deliver against one or more of the program outcomes of the RDIF? (NB: refer to Sections 4.1 Eligibility Criteria and 4.2 Merit Criteria of the RDIF Funding Guidelines) Yes☐No☐

3. Is the total project cost greater than or equal to $1 million, inclusive of funding co-contributions?Yes☐

No☐

4. Is the project proposal located within the Region, as defined in the RDIF Guidelines?Yes☐No☐

5. Are at least 50 percent of the total proposed project costs covered by cash or in-kind co-contributions?Yes☐No☐

6. The RDIF will not fund projects that require recurrent State or Australian Government funding. Does your project satisfy this eligibility criterion?Yes☐No☐

7. Requests for retrospective funding (where projects have commenced prior to the application being received by PIRSA) are not eligible for funding. Does your project satisfy this eligibility criterion?Yes☐No☐

8. The RDIF will not fund the development of feasibility studies, business plans, cost benefit analyses and economic impact studies, unless they are part of a larger project that meets the criteria for RDIF. Does your project satisfy this eligibility criterion? Yes*☐No☐

9. Costs of operation and maintenance of existing businesses, back-office costs and costs of foregone business activity are not eligible for funding. Does your project satisfy this eligibility criterion? Yes☐No☐

10. Activities that other Australian Government programs have funded, have committed to funding, or have provided a loan for are not eligible for funding. Does your project satisfy this eligibility criterion? Yes☐No☐

11. Will your project commence within 6 months of signing the Funding Deed and conclude by January 2017?Yes☐No☐

* If you answered ‘yes’ in Question 8 and have requested these activities as part of a larger project, please use the text box below to provide justification for their inclusion.

Part 3:Applicant Details

Organisation Name:

ABN:

ACN: (If Company)

Type of legal entity:

Registered for GST Yes / No

Street address:

Postal Address:

Contact Person:

Position:

Telephone:

Mobile:

Fax:

Email:

3A – Applicant Overview:

Please provide an overview of your company/organisation and any partners/co-contributors in this project (1000 words)

Further detail can be attached and listed in Part 10

3B – Previous Project Delivery Experience:

Please describe any other projects of similar size or scale to this application that you have been involved in previously? (500 words)

Further detail can be attached and listed in Part 10

(Note: This should include a description of the successful execution and/or long-term outcomes of these projects)

3C – Financial Details:

· Attach 3 most recent years audited financial statements (profit and loss, balance sheet) of the applicant

· Attach next 3 years financial projections (profit and loss or cashflow basis) of the applicant

List these at Part 10

Part 4:Project Description

Project Title

Proposed project start date

Proposed project end date

4A - Project summary: (1000 words)Please include the following:

· Nature of the project (e.g. infrastructure works, provision of services, equipment, studies, training, research or similar)

· What the project aims to achieve

· Key project activities

· Project Outcomes (consistent with RDIF guidelines)

· Resources required to deliver project eg human, physical, financial

· Existing capabilities

Note: Further detail must be attached in a project/business plan at Part 10

4B – Project Outcomes:

Describe briefly how the project delivers opportunities for employment and/or economic diversification within the South Australian River Murray Region – further detail is sought in the merit criteria below.

4C – Project Location:

(Note: Projects must be within the South Australian River Murray Region which is defined as the area contained within the Local Government areas of Renmark Paringa Council, Berri Barmera Council, the District Council of Loxton Waikerie, District Council of Karoonda East Murray, Mid Murray Council, the Rural City of Murray Bridge, Alexandrina Council, the Coorong District Council and the Gerard Community Council)

4D – Staff Resources and Credentials:

Please list key staff within your organisation that will be involved in the project delivery, and their relevant experience/qualifications. (500 words)

Further detail such as CV’s can be attached and listed in Part 10.

4E – Previous Grant Funding:

List previous Australian or State Government assistance, current applications and/or contracts received by applicants relating to this and/or other projects.

Funding Source

Amount of funding received / requested

Description

4F - Is this project part of a larger initiative, program or project?

If this project is part of a larger activity (initiative, program, project or series of projects), please describe those activities here briefly and how this project contributes to the overall activities and whether the project in this application is dependent on the completion of any other works. (500 words)

4G - Is the project ‘investment ready’?

Please list any approvals or licenses that are required before or during the project.

Please describe any precedent activities, in addition to any listed in response to section 2.7 and 2.8 of this Application Form.

Have all co-contributors agreed to participate in writing?

Add any other comments about the investment readiness of the project.

Part 5: Budget Summary

Note: Supporting detailed budget documents must be attached to this application at Part 10.

All costs should be expressed as GST exclusive.

Table 1. Overall budget

(Reminder: Projects must have a minimum cost of $1 million and at least 50% of the total project cost must be covered by cash or in-kind co-contributions).

RDIF Funding sought ($)

Applicant co-contributions

All other co-contributions

Total RDIF Project cost ($)

Cash ($)

In-kind ($)

Cash ($)

In-kind ($)

Table 2. Co-contributor detail

Name of other co-contributors

Amount of co-contribution

Cash ($)

In-kind ($)

Table 3. Cashflow

Organisation

2014/15

2015/16

2016/17

Total ($)

RDIF Funding Sought

Co-contributions

Total RDIF Project Cost

Table 4. Personnel (FTE) contributed in-kind

Organisation

Role

Salary and direct on-costs

FTE

Total value ($)

2014/15

2015/16

2016/17

Table 5. Other in-kind *

Organisation

Item

In-Kind Value ($)

Justification for valuation

2014/15

2015/16

2016/17

Please Note : In-kind contributions include the commitment of non- monetary resources (eg labour, equipment use, time etc) to complete a project. An in-kind contribution related to the delivery of the RDIF Project can be made by the RDIF applicant or a third party. All in kind contributions must be relevant work included under the approved activities of the RDIF Funding Agreement. When stating the value of an in-kind contribution, successful RDIF applicants must ensure that it is done at a competitive commercial rate and provide evidence of this rate (eg cost and time allocation). The Program will need to be satisfied that in-kind commitments are completed to appropriate quality standards in order to receive milestone payments.

5A - Budget comments:

Please add an itemised budget plus supporting comments or assumptions, such as whether they have been independently assessed, contingency arrangements, risk management, asset ownership, clarify purpose etc.

Part 6:Merit Criteria

Please complete the table below by addressing Section 4.2 of the RDIF Guidelines - Merit Criteria.

(Note: To add more lines in the boxes, press enter)

6A - Economic Development (section 4.2.1 of the RDIF Guidelines):

Describe how the project has a strong and identifiable impact on the long-term and sustainable economic development of the Region.

6B - Social Impact (section 4.2.2 of the RDIF Guidelines):

Describe how the project strengthens, expands or enhances regional institutions to improve social conditions and liveability in the Region and how the project will build social capacity, including for disadvantaged groups.

6C - Innovation (section 4.2.3 of the RDIF Guidelines):

Describe here the new ideas, opportunities and business/operating models that will be delivered by the project and how this will result in significant improvements in the Region’s social fabric, infrastructure or economic activity.

6D - Leveraging:

Describe here how the project uses leveraging to maximise the project’s benefits to the Region.

Part 7: Value-for-money Criteria

Please complete the table below by addressing Section 4.3 of the RDIF Guidelines – Value-for-money Criteria.

(Note: To add more lines in the boxes, press enter)

7A - Value for Money Overview:

Describe here how the project will deliver value for money for the South Australian Government. Applications should identify that RDIF funding will be used in an efficient, effective, economical and ethical manner and deliver the outcomes of the program. This may involve illustrating that project costs will be reasonable compared to industry benchmarks; that an acceptable level of project planning has been undertaken to ensure that the project will be delivered on time and within budget, and that open and competitive procurement processes will be employed to deliver the project.

7B - Potential long-term economic activity in the region:

Describe the nature of long-term economic activity that will result from the project.

7C - Goods and services purchased from South Australian enterprises:

Please describe how you will notify SA River Murray and South Australian suppliers of these opportunities and the process/criteria for assessing tenders and /or awarding contracts.

7D - Need for government support:

Describe why this project needs government funding and why other avenues of funding (e.g. venture capital, loans, private investment) could not achieve the outcome being sought.

7E - Uniqueness of the project in the Region:

Explain the unique aspects of the project and why the project is not a duplication of existing or proposed activities within the Region.

Part 8: Milestones and Payments

In addressing milestones and payments please refer to Section 5 of the RDIF Guidelines.

RDIF funding will be linked to the achievement of the milestones, which must be completed within a specific timeframe. Milestones will be based on the achievement or delivery of an activity or set of activities – not solely based on dates. Milestones will be agreed between the applicant and PIRSA during contract negotiations.

In completing your application, you are required to identify your milestone and proposed payment schedule by completing the table provided in Attachment 1.

Part 9: Key Performance Indicators (KPIs)

Please indicate potential KPIs for your project. KPIs are a quantifiable performance measurement and will demonstrate performance against project deliverables. For example, in your application you may state that your project will increase regional employment by ‘x’ FTEs by ‘y’ date.

Project KPIs will be agreed to between the applicant and PIRSA during contract negotiations and will be included in the Funding Deed as binding obligations on the applicant’s part. Applicants will be provided with a draft Funding Deed for review.

KPI

Activity

Due Date

e.g. New training courses available

Four training courses completed with 75 people trained

30th June 2015

Part 10: Attachments Check List

Please list here the filenames and the title of all attached documents

(Note: To add more lines in the table, press enter)

Filenames

Document Title

Required Documents to Support Application

(Please tick to show attached)

Documentary evidence of support from all other co-contributors*

Last 3 years audited financial information of applicant

Next 3 years business financial projections of applicant

Project Plan / Business Plan including detailed project financial projections

Itemised Budget with supporting comments

Industry Participation Plan (when funds requested are $1.25 million GST inc or more) **

* The co-contributor support letter/documents should outline the value and nature of the commitment and any conditions relating to this commitment and be signed by the authorised representative of the co-contributor

**Industry Participation Policy : To ensure regional businesses leverage maximum opportunities from programs such as SARMS, all applicants requesting program funding of $1.25 million or more (GST inc) are required to submit an Industry Participation Plan. The plan will be reviewed by a team of experts from the Office of the Industry Advocate.

Applicants should be familiar with the requirements of the Industry Participation Policy at www.dpc.sa.gov.au/office-industry-advocate

Other Relevant Attachments

(Please tick to show attached)

Risk Plan (if applicable)

Marketing Plan (if applicable)

Existing Feasibility Studies (summary only)

Letters of support from within the Region

Details of relevant experience of applicant and other co-contributors

Other(s) please list

Part 11: Signature and Declaration

In signing this document I acknowledge that submission of this document and receipt by PIRSA of this proposal does not create an offer or a binding agreement. I also acknowledge that successful applicants will have to execute a Funding Deed that will include (but not be limited to):

· identification of any existing, apparent or potential conflicts of interest when applying for RDIF funding or delivering the project

· acknowledging the contribution of the South Australian and Australian Governments on any promotional material

· providing opportunities for the South Australian Minister for Agriculture, Food and Fisheries and the Federal Minister for Infrastructure and Regional Development, or their representatives, to take part in any launch of the project

· a requirement to complete the project and all reporting requirements, and acquit funds within the agreed timeframe

· an undertaking to only apply the funds to the intended purpose

· provision of annual financial statements relating to the project

· the return of any unspent funds to the RDIF on completion of the project

· a requirement that the applicant retain assets purchased with project funds for at least five years from project completion

· a requirement that the principal component of the project will commence within six months of the date that the Funding Deed is executed

· a requirement that the project must be completed with all funding acquitted and proponents must have submitted their Final Report to PIRSA by January 2017

· a requirement that projects will comply with all applicable laws, regulations and Australian standards

· a statement that the Funding Deed may be disclosed by PIRSA pursuant to Department of the Premier and Cabinet Circular 27-Disclosure of Government Contracts

· a statement that any cost overruns or losses will be the applicants responsibility.

I hereby declare that I have read the RDIF Guidelines and that the information provided in the Application Form is true, complete and correct in every particular and that I am duly authorised to sign this Application Form on behalf of the applicant.

Signature

Name

Date

Office Use Only

□ Full Application received (Parts 1-10)

□ All attachments as listed in Part 9 have been received

□ Application signed

□ Application received before 5.00pm (ACST) on Friday 19 September 2014.

Page 14 of 15

Attachment 1: Milestone and Proposed Payment Schedule

Please ensure you have considered Section 5 of the Guidelines and use the table below to identify your project’s key milestones and proposed payment schedule.

Milestone Description

Proposed Milestone Achievement Date

Funds for Milestone Achievement

Total Budget for Milestone (including applicant and co-contributor inputs)

Evidence/measurement standards (proof) that milestone has been achieved

Page 15 of 15