Application Form - Small and Medium Rural Food ProcessorsTable of Contents
1. Application FormsSection 1. Tell us about yourselvesApplicants are required to complete the following information. Eligible applicants must share in the risks of the project, invest in the project and sign an Agreement with the Province of Ontario if approved. Businesses and organizations wishing to contract with the applicants for goods and services and/or provide donations to support the project are not considered to be applicants. Attach on a separate sheet additional applicants if needed. Language preferred for correspondence (please select one): Position: ______________________________________________________ Organization or Business (full legal name): __________________________ Mailing Address (street): _________________________________________ P.O. Box: _________________________ City/Town: ___________________________________ Region/County: _____________________ Province: ____________________________________ Postal Code: _______________________ Tel: _________________ Fax: ___________________ E-mail: _________________________________________ Describe your organization and its role in the project - Please also include a brief description of the nature of the partnership: ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ Name of Co-applicant(s): _________________________________ Position: ___________________________________________________ Organization or Business (full legal name): _______________________ Mailing Address (street): ______________________________________ P.O. Box: _________________________ City/Town: ___________________________________ Region/County: _____________________ Province: ____________________________________ Postal Code: _______________________ Tel: _________________ Fax: ___________________ E-mail: _________________________________________ Describe your organization and its role in the project: ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________
Name of ministry contacts who you have consulted regarding the project:
Section 2. Tell us about your projectType of Project: Small and Medium Rural Food Processing Description of Project (please include the purpose of the project, the need for the project, how the project will be carried out and the expected major outcomes of the project): ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________
List of Major Objectives of the Project:
_____________________________________________________________ ______________________________________________________________
______________________________________________________________ ______________________________________________________________
_______________________________________________________________ Deliverable of the Project (specific and measurable i.e. # of jobs created/retained, # of new technologies): ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ Proposed Project Start Date Proposed Project End Date Section 3. Tell us about the costs of your projectEligible expenditures must be directly related to the project and would not have otherwise been incurred by the applicants. Expenditures must be actual cash outlays to third parties that are documented through paid invoices and receipts. Proof of the applicant's ability to cash flow this project may be required. Claims for payment must be accompanied with copies of
paid invoices and proofs of payment. Payments will be subject to a 10%
holdback payable upon successful completion of the project and the approval
of a final report. Where the value of sub-contracts for work or services
exceeds $25,000, applicants must demonstrate that a competitive process
has been used. At least three written quotations should be obtained.
If sole or single sourced, the applicants must make a request in writing
to the RED Program with a rationale prior to making the expenditure.
Quarterly Projected Expenditures by Fiscal YearComplete the following table. Estimated costs must be in the quarter in which they were incurred but not necessarily paid. Note that the total in this table must be equal to the total estimated eligible costs.
Section 4. Tell us how you plan to carry out your projectProjects are cost-shared with the provincial government investing up to 50 per cent of the project's eligible cost in most cases. Please note that the RED program reserves the right to request financial information or a copy of the applicants Canada Customs and Revenue Agency tax return for the purposes of identifying the capacity of applicants to complete the project and understand the financial solvency of the entities applying for funds. Funding from other provincial or federal government programs will be considered in calculating the level of investment from the Rural Economic Development Program. Failure to disclose all funding or possible funding sources are grounds for termination of the application or contract. In determining contributions for cost-sharing, in-kind contributions will be defined as demonstrable staff costs directly related to the project (e.g. wages).
Section 5. General Company Information, Confidentiality, Consent and Certification Form
Each applicant must complete this form with
the application
General Applicant Information
_______________________________________________________
____________________________________________________________
____________________________________________________________
Partnership Requirements Each partner signing the Agreement with the Province of Ontario
is required to have comprehensive general liability insurance
with coverage for at least $2 million per occurrence. This insurance
must show the Province (Her Majesty the Queen in right of Ontario)
as an additional insured on the policy and contain the endorsements
specified by the Agreement and is required throughout the term
of the Agreement. Confidentiality Consent Certification Name (print):_______________________________ Title: _____________________________________ Organization: ____________________________ Signature: _________________________________ Date: __________________________________ Section 6. Appendices and additional information required checklistPlease include the following information prior to submitting your application:
Applications must be submitted to: Working Together For Success Rural Economic Development Program For more information:
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
English