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GENERAL INFORMATION
NOHFC Project Number Project Name Legal Name of Applicant Corporation or Business Registration Number Date of incorporation or registration of business name Registered business name Type of Legal Entity of Applicant Lead Contact Mailing Address Project Location (Community) Alternate Contact Mailing Address NOHFC Program
Postal Code
Province Telephone Number ( Fax Number ( E-mail Address Last date of fiscal year ) ) -
Postal Code
Nature of organization or business Amount requested from NOHFC Proposed project start date Liability Insurance Amount
2. PROJECT DESCRIPTION
Project Summary: Briefly describe the project (3 or 4 sentences), including a high-level description of what will be done.
Project Background: Outline the context for the project. Provide necessary background to understand why the project is being undertaken.
Project Purpose: Explain the purpose of the project by describing what this project is aiming to achieve. What is its vision? What need or opportunity will it address?
3. PROJECT BENEFITS
In the table below, identify the following: number of permanent jobs that are expected to be created as a result of the project. Also include a brief description of each position, annual rate of pay and the expected start dates identify the number of jobs that are expected to be retained as a result of the project
Jobs Created/Retained No. of Jobs Created Dollars Leveraged How have number of jobs created or retained been determined and substantiated? Please provide rationale and evidence of how job creation numbers have been determined (e.g. increase in projected operating costs) No. of Jobs Retained
Other Benefits In the space below, identify specific results-based benefits that can be expected as a result of completing the project. Include the following: anticipated economic benefits/spin-offs (e.g., investment levered) both during and following the term of the project describe how the project promotes economic growth, innovation, and/or job creation in Northern Ontario (e.g., project leads to new business venture, results in marketable products or services, sector benefits, Northern Ontario benefits, sector development, improves quality of life, etc.) describe how the project enhances the community's ability to attract/retain businesses and professionals describe how the project will improve the capacity and investment readiness of the community describe how the project will enable the community to realize economic development opportunities
4. PROJECT BUDGET
Project Costs Chart Identify applicable cost categories such as: wages, consulting costs, materials, project management, equipment costs, etc. Indicate whether cost items are eligible or ineligible as per program criteria. Project cost category Eligible Project Costs Ineligible Project Costs Total Cost
TOTAL Project Funding In the table below specify type of financing to be provided by other organizations. Note: In-kind contributions are not generally considered as an applicants contribution to the project. However, in some cases in-kind contributions including materials, equipment and volunteer labour may be counted in evaluating the share of partner contributions. In cases where in-kind contributions are considered eligible, they must be measurable and recorded. The following formulas may be used:
In Kind Use of Equipment Used: (Rate per hour) X (# of Hours used) = In-Kind Value In-Kind Use of Labour: (# of employees) X (rate per hour) = In-Kind Value
Rates used should be in line with the skills trade rate established by Human Resources and Social Development Canada. A 100% in-kind to 0% cash ratio is not acceptable. The level of in-kind contribution accepted by NOHFC will be based on: o client ability to contribute some cash towards the project the breakdown of the in-kind costs the client is planning on providing towards the project.
Funding source
Financing Type
Provide the name and location of the Applicants current banking institution (for non-municipal applicants). (Note: Lending institutions may be required to confirm the Applicants financial situation)
How have project costs been reviewed/verified for accuracy, completeness and reasonableness? Explain.
Have all identified funding partners committed to the project? If so, provide details (e.g., letter received); if not, provide an explanation.
Provide details on how the Applicant will obtain the identified contribution, and identify contingency plans for how any cost over-runs will be addressed. Explain.
In addition to the funding sources identified above, has the Applicant approached/applied to any other funding programs? If yes, indicate organization and the status of those applications. If no, please explain.
Has private sector funding been considered? If not, explain whether there exist opportunities for private sector funding, corporate presence, etc.
5. PROJECT PLAN
List project milestones or major activities (e.g. project design & engineering, site preparation, construction) on the next page. For each milestone, shade the boxes to reflect when that activity will be undertaken. If more space is required, please use additional sheets. Project Plan Year 1 (20XX 20XX) Year 2 (20XX 20XX) Year 3 (20XX 20XX)
Project Milestones
Apr 1- Jun 30 Jul 1Sep 30 Oct 1Dec 31 Jan 1Mar 31 Apr 1- Jun 30 Jul 1- Sep 30 Oct 1- Dec 31 Jan 1Mar 31 Apr 1Jun 30 Jul 1- Sep 30 Oct 1Dec 31 Jan 1- Mar 31
Eligible Expenditures NOHFC Claim Note: The NOHFCs standard process is to distribute payments upon receipt of a payment request and supporting documentation indicating that the items claimed have been paid. While it is possible to request an advance of funds if one is required, significant justification will need to be provided. Justification must include the specific timing and size of the advance payments based on realistic cash flow forecasts (with a breakdown by quarters.
Identify any other completed projects for which the Applicant has received funding from NOHFC during the past five years
Has the Applicant received funding for similar types of projects from other government funding programs (provincial or federal)? Indicate program and project names.
8. PROJECT MANAGEMENT
Project Management Team: Identify the individuals who will be responsible for managing the project and provide their contact information and relevant experience with respect to this type of project.
Reporting Structure: Identify the reporting structure or management structure for the project.
Project Management Experience: Identify any previous experience the Applicant has in managing projects of a similar nature. Indicate the projects and identify the outcome.
9. PROJECT SUSTAINABILITY
Marketing Answer the following questions as appropriate to this project Identify the proposed marketing strategy for this project (e.g. Who is the customer, what is the product/service, competition, target market, pricing, promotion, etc.) Provide a general description of how the community/region, clients or other potential users/participants will be engaged to ensure the success of the project, and its future sustainability.
Is the project (e.g. facility) the only one of its nature in the community?
Will the project directly compete with existing businesses or with similar projects in neighbouring communities? Explain.
Is the project (e.g. facility) used primarily by community residents or is it frequently used by residents of the region and beyond?
Describe how this project (e.g. facility) will benefit the community as a whole? Identify how many people/what percentage of the community will benefit from the project (e.g., utilize the facility)?
How diverse is the use of the facility? Is it used for a variety of events representing a cross section of the community? Identify how many functions are convened at the facility?
Operating Costs Once complete, is the project expected to generate new on-going revenues and/or incur future on-going operating costs? Yes No Explain.
Complete the following chart if the project will generate on-going revenues and/or incur on-going costs:
Revenues
Historic (Actual)
Projected Year 1
Projected Year 2
Projected Year 3
Total: Expenses Historic (Actual) Projected Year 1 Projected Year 2 Projected Year 3
Total: Net Income Historic (Actual) Projected Year 1 Projected Year 2 Projected Year 3
Annual Cash Surplus: Provide a detailed rationale for all projected revenues and what they are based on.
Provide assumptions and details for projected operating costs. If the project includes job creation, make sure to account for the new jobs in the projected operating costs.
If there are any annual operating deficits shown, please explain where the funding will come from to cover these shortages.
Should revenues be lower or expenditures higher than projected, resulting in an operating shortfall, provide an explanation as to how this would be covered, and what the impact would be on the organization.
10. OTHER
Are there any potential risks that might threaten the successful completion of the project? Indicate how these risks will be mitigated.
Is there any other information relating to the project that the NOHFC should be aware of.
Please list all federal and provincial laws or regulations, all municipal by-laws, and any other orders, rules or bylaws that might affect the project (e.g. environmental approvals, zoning by-laws, etc.) What permits and/or approvals are necessary to initiate and complete the project? Indicate the status of each. (*Please see Appendix A for additional information)
As a condition of approval recipients will have to have in place adequate insurance coverage. Indicate the type and amount of insurance coverage currently in place by Applicant: commercial general liability insurance on an occurrence basis for third party bodily injury, personal injury and property damage, including: amount $____________________ a cross-liability clause; contractual liability coverage; tenants legal liability coverage (if applicable and with applicable sub-limits); non-owned automobile coverage with blanket contractual coverage for hired automobiles; employers liability coverage (or compliance with WSIA coverage) a 30-day written notice of cancellation, termination or material change, and other insurance coverage appropriate for the project Where the project requires the purchase of supplies, equipment or services, indicate how best value for money will be ensured. Indicate where the Applicant has a procurement policy in place.
Is any key information missing from this proposal that will be submitted at a later date? Explain.
Will energy savings directly lower the operating cost of the Applicants business? Explain
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Are the buildings/facilities and land related to the project owned or leased? Explain
Will completion of this project significantly enhance the quality of life, economic prosperity, and/or safety for residents of the community? region and beyond? Explain
Will this project strengthen existing connectivity networks in the community or region? Explain
Sault Ste. Marie Area 70 Foster Drive, Suite 200 Sault Ste. Marie ON P6A 6V8 Tel: 1-866-711-8304 (705) 945-5914
Sudbury Area Cedar Street, Suite 601 Sudbury ON P3E 6A5 Tel: 1-866-711-8304 (705) 564-7517
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APPENDIX A
TYPE OF ASSISTANCE REQUESTED
Identify type of assistance requested Conditional Contribution: NOHFC funding that is non-repayable if the objectives of the project are met and the Proponent has completed all obligations including reporting requirements. The conditions of the NOHFCs funding are outlined in the NOHFCs legal agreement with the client. Forgivable Performance Loan: NOHFC funding that may be forgiven and does not have to be repaid, if certain performance targets are met. For example, if a client receives NOHFC funding on the basis of ten jobs being created, and ten jobs are subsequently created, the NOHFC funding does not have to be repaid. If the performance target is not met, the NOHFC is in a position to demand repayment. Repayable Loan: NOHFC funding that is repayable. The loan may be interest bearing or noninterest bearing. In some cases the loan may be given as an incentive term loan. The incentive refers to the option of deferring interest and/or principle payments for some period of time possibly including, an elimination of interest for some period. An example of an incentive term loan is NOHFC funding that is interest free with the principle to be paid back over ten years.
Permits At its own expense, Recipient shall obtain all permits, licences, approvals and authorizations required to perform the project and the agreement and shall comply with all federal, provincial and municipal laws, ordinances, statutes, regulations, rules and orders in respect of same.
Insurance Recipient shall comply with all provisions and requirements of any of Recipients insurance policies applicable to the project and with all rules and regulations concerning safety and the proper conduct of work.
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APPENDIX B INSURANCE REQUIREMENTS If your project is approved, you will be required to provide a certificate of insurance that indicates the organization has a commercial general liability insurance policy on an occurrence basis for third party bodily injury and property damage, to an inclusive limit of not less than $5 million per occurrence. If the organization does not have a $5 million limit, include a quote from your insurance company for increasing your limit, to the $5 million required.
Insurance Recipients shall arrange for and keep current while carrying out the project or during the term of the agreement, whichever is longer, the following insurance policy with an insurer acceptable to NOHFC: A commercial general liability insurance policy on an occurrence basis for third party bodily injury, personal injury and property damage, to an inclusive limit of not less than $5,000,000 per occurrence, $5,000,000 products and completed operations aggregate. The policy is to include the following: NOHFC and its officers, directors, employees, subcontractors and agents as additional insureds with respect to liability arising in the course of performance of Recipients obligations under, or otherwise in connection with, the agreement; cross-liability clause; thirty (30) day written notice of cancellation, termination or material change; contractual liability coverage; tenants legal liability coverage (if applicable and with applicable sub-limits); non-owned automobile coverage with blanket contractual coverage for hired automobiles; and employers liability coverage, if Recipient is not insured by the Workplace Safety and Insurance Board of Ontario (WSIB).
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Recipient shall provide to NOHFC a valid certificate of the insurance prior to the start of the project and thereafter as may be subsequently requested during the course of the project or the term of the agreement, whichever is longer. If Recipient is subject to the Workplace Safety and Insurance Act, 1997 (WSIA), it shall submit a valid WSIB clearance certificate to NOHFC prior to the start of the project. Recipient shall, if NOHFC so requests, provide additional WSIB clearance certificates from time to time. Recipient shall pay when due, and ensure that each of its contractors pays when due, all amounts required to be paid by it/its contractors under the WSIA.
Third-Party Insurance Recipient shall ensure that any third-party contributors and contractors retained to perform any part of the project shall have adequate insurance in place that is appropriate to the project risks and to the third party.
Evidence of Insurance Recipient shall provide to NOHFC without delay, on receipt of a written request by NOHFC, a certified copy of the policy of insurance.
Notes for Insurers, Brokers and Recipients of Funding from the Northern Ontario Heritage Fund Corporation (NOHFC): How to complete a Certificate of Insurance to comply with NOHFCs requirements i. ii. Review the sample certificate that appears below, and the explanations that follow afterwards. Complete your Certificate of Insurance accordingly.
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How to fill out a Certificate of Insurance to comply with NOHFCs requirements (Keep the insurance clauses in NOHFCs contract handy while you do this. See section 9.2 of Schedule A in the NOHFC contract.)
Number* 1. 2. 3.
What is required Insert the legal name and address of the Recipient of NOHFC funds (must match the name on the NOHFC contract) Insert the expiry date of the insurance policy Insert Northern Ontario Heritage Fund Corporation and its officers, directors, employees and agents (not a Ministry) as the name of the additional insureds. Insert the types and amounts of insurance provided by the policy. For example: Commercial general liability insurance on an occurrence basis for $XXX. Unless NOHFC has agreed to a lower amount, your insurance amount must be at least $5 million on an occurrence basis. List all the endorsements required by the NOHFC contract (examples appear in the sample certificate above; see your contract for the particular endorsements required for your project). Include a statement that the insurer will endeavour to notify the certificate holder (NOHFC) of any cancellation or material change within 30 days. The certificate must be signed by an authorized insurance representative.
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