ARPA Project Request Form: Non-profits/ Outside Agencies

1.) Administrative Information:

A.) Name of Organization

B.) Date

C.) Primary Contact Person

First

Last

D.) Position/Title

E.) Organization Address

City

State/Province

Zip/Postal

F.) Primary Contact Email

G.) Primary Phone

H.) Person Signing Sub-recipient Contract

First

Last

I.) Position/Title

J.) Sub-recipient Signer's Email

K.) Tax ID

L.) DUNS #

2.) Name of Proposed 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.

Please list each project milestone and date (approximate).

Upload any relevant project files (optional).

Maximum upload size: 516MB

6.) Project Description:

Please enter a brief description of the project.

7.) Performance Measurement:

A.) Please elaborate goals for project performance measurement. List percentages of accomplishments within an activity.

B.) # Low and moderate-income persons expected to service:

C.) % Low and moderate-income persons expected to service:

8.) Identify the Category for Eligible Use :

Select the Category for Eligible Use

9.) 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. 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

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

Please provide a brief explanation.

11.) 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.

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

Please provide a brief explanation.

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

Explain how project performance will be measured.

14.) Project Cost:

A.) Estimated TOTAL Cost of Project:

B.) Amount of Lynn ARPA Funds Requested:

15.) 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).

16.) Are matching funds available from another source?

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

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

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

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

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

If yes, please identify:

18.) Budget summary of activity, including all proposed and confirmed funding sources:

Please provide a brief description.

Upload any relevant project files (optional).

Maximum upload size: 516MB

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

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

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

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

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

If yes, please explain:

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

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

If yes, please explain:

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

(i.e. project management)

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

If yes, please explain:

23.) 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:

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

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

If yes, please describe how:

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

Select one option below (Dropdown).

Please elaborate (optional):

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Non-Government/Non-Profit Project Application Form

1.) Administrative Information:

2.) Name of Proposed ARPA Project:

3.) Type of Project:

4.) Estimated Project Timeline:

5.) Please note project milestones:

6.) Project Description:

7.) Performance Measurement:

8.) Identify the Category for Eligible Use :

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

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

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

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

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

14.) Project Cost:

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

16.) Are matching funds available from another source?

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

18.) Budget summary of activity, including all proposed and confirmed funding sources:

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

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

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

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

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

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

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

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