Text Box: Attachment B





Please provide the following information in an organized format in the order below.


A.  Organizational Information:


  1. Agency Name:  List the full legal name of the organization requesting County funding.


  1. Mailing Address:


  1. Director:  List the name of the individual who serves as the organizationís Director/President, his/her telephone number and their primary email address.


  1. Board Members:  List all members of the organizationís board.


  1. Organization Contact:  If different than Director include same information as above.  This is the individual who is most knowledgeable about this request and with whom the County should contact with any follow up questions.


  1. Organization Web Address:


  1. Audit:  Please indicate whether your organization has an independent audit performed at the end of each fiscal year.  If so, submit a copy of the management letter or auditorís opinion for the most recent two year-end reports.


  1. Briefly describe your organization, its mission, and some specific overall organization goals.  If you are partnering with other organizations in this request please include same information for partnering organizations.  Include an organizational chart.


  1. Indicate the IRS classification of the requesting organization and partners:


B.  Funding Request:  Please describe exactly what is being requested from the County.  Be very specific and include the following in your response:


  1. Specific amount.


  1. Time frame:  When is funding needed?


  1. Is any additional funding expected from the County in the future?  (Capital, operating, fee for County usage, etc.)  If yes, please explain thoroughly including estimate of how much, when, etc.


  1. Proportionate amount of County funding to total funding:  Describe all funding sources including County and total amounts from each funding source.


C.  Purpose:  What will County funding be used for?  Please describe:


  1. Description of facility to be built including site amenities (i.e., bleachers, scoreboard, clock, etc.)


  1. Highlight any energy saving or environmentally friendly features of the proposed facility.  Specifically comment on the energy efficiency or inefficiency of the proposed facility as compared to other types of structures used for the same purpose.


  1. Anticipated life span of facility including any available warranty information.


D.  Services Provided to the County:  How will this facility/program benefit County programs/County residents?


  1. Scope and number of direct school program beneficiaries.


  1. Scope and number of direct County beneficiaries.


  1. Potential future program options to be offered which are not currently available to residents in the region.


  1. Fee schedule for use of facility.


  1. Scholarship availability and amount of annual funding for scholarships for low income residents.


  1. Detail anticipated user groups and anticipated numbers for each group.


E.  Experience:  Please describe your experience in operating a similar facility.


F.  Business Plan:  (Operations Ė Expenses/Revenues)


  1. Provide 5 years of actual financial results for current organizational operations.


  1. Provide pro forma for new operation including any new or modified facility.  This should be in the format of a 5 year forecast of income and expenses.


G.  Current Capital Fund Raising Status:


  1. Current secured funding.


  1. Plan and timetable for securing remaining funding.


H.  Anticipated Construction Schedule:  (Groundbreaking through Grand Opening)


I:  Alternatives:


  1. Please describe what would happen with your project and how you would proceed if the County funded 50% of your request.


  1. Please describe what would happen with your project and how you would proceed with no County funding.


J.  Other Community Benefits:  Are there other anticipated benefits of this project other than the direct benefits to facility users?  If yes, please provide specific examples and attempt to quantify those anticipated benefits.


K.  Security of County Investment:  How will the Countyís investment be protected if the organization receiving funding ceases to exist or cannot sustain operations of the facility?


L.  Additional Information:  Please feel free to provide any additional information regarding your request that has not been covered in your responses.


M.  Communications:  All questions regarding these funding request instructions should be directed to Pat Mullaney, Albemarle County Department of Parks and Recreation, 401 McIntire Road, Room 118, Charlottesville, Virginia 22902-4596; phone (434) 296-5844, email:  pmullan@albemarle.org.


N.  Review Process and Recommendation:  Funding requests will be reviewed by the County and representatives may choose to interview any or all requesting organizations before making a recommendation to the Board of Supervisors.


O.  Deadline for Funding Requests:  Please submit 6 hard copies to the Project Contact (Section M above) by October 31, 2008.


P.  Right to Fund/Reject:  The County of Albemarle reserves the right to fund a request that is in its best interest.  The County reserves the right to reject any or all requests.  The County also reserves the right to negotiate any or all requests.


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