City of Lynn American Rescue Plan Act

ARPA Project Request Form: City Departments/ Agencies/ Commissions

City Departments/Commissions Project Application Form

City Departments/Commissions Project Application Form

1.) Administrative Information:

A.) Project Requestor

A.) Project Requestor

First

First

Last

Last

B.) Date

C.) Contact Email

D.) Primary Phone

2.) Name of ARPA Project:

Project Title

3.) Type of Project:

A.) Is this a new project or an expansion of an existing project?

B.) If applicable, please identify expansion to existing project:

4.) Estimated Project Timeline:

*Note – Projects must be under contract by 12/31/24 and completed by 12/31/26.

A.) Estimated Start Date of Project:

B.) Estimated Date of Completion*:

5.) Please note project milestones:

(e.g. launch, end of phase I, etc.). If available, attach a scope of work and project schedule in the attachments section.

Pease list each project milestone and date (approx.)

Upload any relevant project files (optional).

Maximum upload size: 516MB

6.) Project Description:

Please enter a brief description of the project

7.) Identify the Category for Eligible Use:

Select the Category for Eligible Use

8.) Allowable Expenditures for American Rescue Plan Act (ARPA) Funds:

Select an expenditure category for the proposed project (choose only one).

1. Expenditure Category: Public Health

2. Expenditure Category: Negative Economic Impacts (Household/Business/Non-Profit Assistance)

3. Public Health-Negative Economic Impact: Public Sector Capacity

4. Expenditure Category: Premium Pay (For Essential Workers)

5. Expenditure Category: Infrastructure (Water/Sewer/Broadband)

6. Expenditure Category: Revenue Replacement (General Government Services)

7. Administrative

9.) Please explain how the project qualifies under the expenditure category noted above:

Please provide a brief explanation.

10.) How does the proposed project relate to the COVID-19 pandemic and how will ARPA funding help address this need?

Please provide a brief explanation.

11.) How will this project benefit residents and/or businesses in the City of Lynn?

Please provide a brief explanation.

12.) What specific outcomes or accomplishments will this project receive?

Explain how project performance will be measured.

13.) Project Cost:

A.) Estimated TOTAL Cost of Project:

B.) Amount of Lynn ARPA Funds Requested:

14.) Are the project costs ready to be appropriated, or will they be phased?

(e.g., costs for planning then costs for execution).

Select one option (Dropdown).

15.) Are matching funds available from another source?

Select 'yes' or 'no' (Dropdown).

If yes, please identify source(s) and amount(s):

16.) Are there other funding opportunities available that may reduce the amount of ARPA funding needed?

(i.e. other state or federal grants or programs)

If yes, please identify:

Select 'yes' or 'no' (Dropdown).

17.) Will the proposed project incur any ongoing/recurring costs?

Select 'yes' or 'no' (Dropdown).

If yes, please identify how those costs would be funded:

18.) Will this project result in savings for a City Department or Community beyond 2026?

Select 'yes' or 'no' (Dropdown).

If yes, please explain:

19.) Will this project increase future revenues for the City of Lynn?

Select 'yes' or 'no' (Dropdown).

If yes, please explain:

20.) Is additional staff required for the duration of the project?

(i.e. project management)

Select 'yes' or 'no' (Dropdown).

If yes, please explain:

21.) Does the proposed project benefit residents disproportionately impacted by the COVID-19 pandemic?

(e.g., communities of color, people with disabilities, low-to-moderate income residents or elders)

Select 'yes' or 'no' (Dropdown).

If yes, please describe how:

22.) Does the proposed project reduce adverse climate impacts and/or promote environmental sustainability?

Select 'yes' or 'no' (Dropdown).

If yes, please describe how:

23.) Does the project benefit a neighborhood, region of the City, or the City as a whole?

Select one option below (Dropdown).

Please elaborate (optional):

Signature of Project Requestor

Δ

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