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Conservation Partnership 20 App Fillable (Commonwealth of Massachusetts)

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BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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Attachment A
A
PPLICATION FORM
FY
20 CONSERVATION PARTNERSHIP GRANT PROGRAM
Executive Office of Energy and Environmental Affairs
SUBMIT: One original application form with supporting documentation and two
paper copies of the completed application and supporting
documentation.* Please help reduce waste—print double sided and use
the minimum packaging necessary for good organization.
(*NOTE: Only ONE copy of the appraisal, market analysis, or opinion of
value is needed)
DEADLINE: Monday, July 15, 2019, 3:00 pm
TO: Melissa Cryan
RE: BID ENV 20 DCS 03
Executive Office of Energy and Environmental Affairs
100 Cambridge Street, 9
th
Floor
Boston, MA 02114
A. APPLICANT INFORMATION
Applicant Name:
Mailing Address:
City/Town: State: Zip:
Project Title:
Project Location (street address, including
municipality):__________________________________________
Type of project: Acquisition Due diligence for gift
Requested grant amount: $__________________________
[ Attachment 8: Articles of Incorporation and IRS 501(c)(3) letter, as well as a copy of your 2018
Massachusetts Annual Report as filed to the Secretary of State’s office. Corporation must be formed for
one of the purposes described in Section 4 of Chapter 180 of the General Laws.]
B. CONTACT PERSON
Name: Title:
Mailing Address:
City/Town: State: Zip:
Email address:
Telephone:
C. ORGANIZATIONAL CHARACTERISTICS
1a.) How many acres of land does your Organization have under fee ownership?
1b.) How many acres of land does your Organization have under CRs?
For how many acres of CR land have Baseline Documentation Reports been prepared?
2a.) Does your organization have a Strategic Land Acquisition Plan? Yes No
2b.) Does your organization have Land Acquisition Guidelines? Yes No
3.) How do you finance stewardship, monitoring, and enforcement?
Annual Operating Budget Yes No
Segregated Stewardship & CR Monitoring Fund Yes No
Segregated CR Enforcement Fund Yes No
Other (explain):
What is your annual stewardship/monitoring budget? $________________ Endowed? Yes
No
4.) Does your organization have full-time stewardship or land management staff? Yes No
5.) If no staff, how do you maintain your properties? Volunteers Contract work
6.) How do you intend to maintain the property proposed for protection in this application?
7.) What is the total number of full-time equivalent staff employed by your organization?
0-2
3-5
6-7
8-10
More than 10
8.) Does your proposed project have board approval? Yes No
If no, when do you expect to receive it? _______________________________
9.) Do your Articles of Incorporation specifically list permanent land conservation or habitat protection
or recreation as one of your organization’s goals? If yes, highlight the relevant passage in the Articles
(Attachment 8).
Yes No
10.) Do your Articles of Incorporation specify a land trust that will receive your land should your
organization go out of business? If yes, highlight the relevant passage in the Articles (Attachment 8).
Yes No
D. PARCEL INFORMATION
Please complete a copy of this section (i.e. PARCEL INFORMATION) for each parcel that is
part of this grant application.
1.) Total Project Acreage: _______
Total number of parcels (print off and fill out a copy of this page for each parcel): _____
2.) This Parcel Information form is being completed for:
A parcel or interest in a parcel to be purchased
Fee
CR
A parcel or interest in a parcel that will be donated
Fee
CR
3.) Parcel Information:
Owner(s):
Location: Acres:
(municipality)
Street:
Assessors Sheet #:_____________ Lot #
Building(s) on the parcel?
Yes
No
If yes, please explain how they will be utilized (Buildings that remain must contribute to the conservation/recreation
function of the property. Buildings that do not so contribute to the property should be removed.):
[ Attachment 3: Copy of a USGS topological map that clearly shows parcel location. Include name
and date of the USGS topo quad. If project involves multiple parcels, include one map that clearly
shows the location of each parcel.]
4.) Encumbrances? Yes No If yes, what type? Mortgage Easement
Lien(s)
Describe
5.) Appraisal – If the proposed project involves the purchase of land or a conservation restriction,
please refer to the Appraisal Requirements (Section 3B) in the Request for Response to determine the
type of appraisal that must be submitted with this application.
Please check one:
Full narrative appraisal Market analysis Opinion of
value
Appraiser:
Valuation: $
Date of appraisal, market analysis, or opinion of value:
(NOTE: Appraisal, market analysis, or opinion of value can be dated no earlier than one year prior to the
Application submission deadline)
[ Attachment 7: One copy of the appraisal, market analysis, or opinion of value.]
All projects that receive funding through the Conservation Partnership grant program must convey a
perpetual conservation restriction, or one-half interest, within the meaning of sections 31 and 32 of
MGL Chapter 184, to the municipality in which the project is located, a federal or state agency, or a not-
for-profit corporation, or combination of these entities. Please note that in the case of a grant
application for the acquisition of a CR or due diligence costs associated with a CR acquisition, the CR
must be co-held by the Applicant and an entity eligible to hold a CR.
6.) To what public agency/agencies or organization do you intend to convey a conservation restriction
or partial interest therein (for projects in which only the CR will be acquired)?
Organization Name:
Contact Person:
Address:
Telephone:
Email Address:
[ Attachment 4: Letter of commitment from the town or state agency (or both) or not-for-profit
stating the intent to hold the conservation restriction]
E. PROJECT DESCRIPTION
[ Attachment 1: Project Narrative: 2-3 pages]
1.) Using the Conservation Partnership Response Review Rating System (Appendix B) as a guide, please
describe in a 2-3 page attachment the nature of your project. At a minimum, describe:
a. The property(s) and property interest(s) to be acquired or donated
b. The natural characteristics and ecological value of the property
c. The proposed project’s ability to protect or promote sustainable working lands
d. The type of public recreational opportunities that will be available, especially those that go
above and beyond to provide access to people with disabilities, and how public access will
be assured
e. The project’s ability to advance objectives in the community’s current Open Space and
Recreation Plan (note: it is not sufficient to attach Goals and Objectives from the OSRP)
f. The project’s ability to advance objectives in the Statewide Comprehensive Outdoor
Recreation Plan (https://www.mass.gov/files/massachusetts-scorp-2017-for-submission.pdf)
(note: it is not sufficient to attach Goals and Objectives from the SCORP)
g. The impact of development on the project parcel’s resource and recreational value
h. The expansion of recreational amenities provided by the parcel to the Commonwealth’s
residents
i. The project’s ability to protect a State Priority Preservation Area as shown on the South
Coast Rail Corridor Plan, Merrimack Valley Land Use Priority Plan, 495/MetroWest
Development Compact Plan or other regional plan as they become available (if applicable).
See Executive Order No. 525.
j. The organization’s commitment to working with Native American tribes
k. The project’s location in an area with Environmental Justice populations
[ Attachment 2: Proposed Budget: 1-2 pages]
a.) An itemized list of estimated project costs
b.) Estimated total project cost
c.) Grant request amount
d.) Description of the methods/sources of financing for the proposed project
e.) Detailed timeline with the anticipated start and end date of each step needed to successfully
complete your proposed project on or before June 30, 2020.
F. WATER RESOURCES
1.) Approximate percentage of property located 0-300 feet from the edge of an ocean, lake, pond, river,
stream, or wetland:
> 75.0%
51.0% - 74.9%
26.0% - 50.9%
1.0% - 25.9%
0%
2.) What is the approximate percentage of the project that lies within an existing drinking water supply
area (i.e. Zone I/II or Zone A/B)?
> 75.0%
51.0% - 74.9%
26.0% - 50.9%
1.0% - 25.9%
0%
3.) Is the majority of project located over a medium or high yield aquifer?
The majority of project located over a high-yield aquifer
The majority of project located over a medium-yield aquifer
Neither
[ Attachment 3: Map(s) showing the location of the project parcel(s) in relation to relevant water
resources, existing drinking water supply areas, medium and high yield aquifers, and/or wetlands.]
G. LAND PROTECTION
1.) How many acres would this project protect?
> 15.0 acres
11.0-14.9 acres
6.0-10.9 acres
2.0-5.9 acres
< 2.0 acres
2.) Does the proposed project abut other protected open space?*
Abuts >25.0 acres of protected open space
Abuts 11.0-24.9 acres of protected open space
Abuts 1.0-10.9 acres of protected open space
*Chapter 61, 61A, and 61B lands are not considered protected open space
[ Attachment 3: Map(s) showing the location of the project parcel(s) in relation to other protected
open space.]
H. BIODIVERSITY AND NATURAL RESOURCE PROTECTION
1.) What percentage of the proposed project lies within or abuts Natural Heritage and Endangered
Species Program (NHESP) BioMap2 core habitat or critical natural landscape?
> 75.0% within core habitat
51.0%-74.9% within core habitat
26.0%-50.9% within core habitat
1.0%-25.9% within core habitat
> 75.0% within critical natural landscape
51.0%-74.9% within critical natural landscape
26.0%-50.9% within critical natural landscape
1.0%-25.9% within critical natural landscape
Abuts BioMap2 core habitat or critical natural landscape
Neither lies within or abuts
2.) How resilient is the proposed project considered to be resilient for climate change? See the
Resilient Mapping Tool on the Conservation Partnership web page. List the numeric score below.
________ SD
3.) How many acres of wetland are on the property? _____ acres
How many acres of upland are on the property? _____ acres
How many potential house lots are on the property? _____
[ Attachment 3: Map(s) showing the location of the project parcel(s) in relation to BioMap2
habitats.]
I. WORKING FARMS AND FORESTS
1.) Is the majority of the project parcel(s) enrolled in any of the following programs and will continue to
be once purchased? If yes, please indicate which program(s):
Chapter 61 or active forest management
Chapter 61A or active agriculture
Forest Stewardship program
Farm Viability program
Forest Viability program
2). Will the property continue, or begin, to have active forestry or agriculture?
Yes
No
If yes, explain:
[ Attachment 6: Documentation to support your answer (e.g. a letter confirming enrollment in one
of the above programs from the program administrator or documentation from town/city assessor’s
office).]
J. RECREATIONAL OPPORTUNITIES
1.) What public recreational opportunities will the project provide? (check which box best describes
your project; use the space below to describe or clarify.) Please note that preference will be given to
projects that permit hunting and provide opportunities for people with disabilities. Recreational
opportunities will be verified by the DCS representative during the site visit.
Trail-based activities (eg, walking, Nordic skiing, biking, horseback riding)
Water-based activities (eg, canoeing, fishing, swimming, skating)
Wilderness activities (eg, camping, hunting)
Describe/clarify:
2.) What is the protected open space per capita in the project’s region? ________
3.) What other similar recreational opportunities are available in the area and at what distance?
4.) Will the proposed project advance priorities, goals, or objectives in the current local Open Space
and Recreation Plan?
Yes
No
5.) Will the proposed project advance priorities, goals, or objectives in the Statewide Comprehensive
Outdoor Recreation Plan?
Yes
No
6.) Will the proposed project advance a local or regional greenway plan or the South Coast Rail
Corridor Plan, Merrimack Valley Land Use Priority Plan, 495/MetroWest Development Compact Plan,
Metro North Plan, or CMRPC Plan?
Yes
No
[ Attachment 5: Copy of the community’s current Open Space and Recreation Plan (relevant pages
only with relevant sections highlighted – your narrative should include a written description); copy of
the SCORP (relevant pages only with relevant sections highlighted – your narrative should include a
written description); and/or a local or regional greenway plan or the South Coast Rail Corridor Plan,
Merrimack Valley Land Use Priority Plan, or the 495/MetroWest Development Compact Plan, Metro
North Plan, or CMRPC Plan to support your answers.]
K. CERTIFICATION STATEMENT
This application was prepared by:
Name:
Title:
Mailing Address:
City/Town: State: Zip:
Email address:
Telephone: Fax:
To the best of my knowledge, the information and data which has been submitted to qualify for the
FY13 Conservation Partnership Grant are true and correct.
Signed: Date:
M. ATTACHMENT CHECKLIST
Please include the following supporting documentation and forms with your application:
Attachment 1: Project narrative
Attachment 2: Budget proposal, grant request, funding sources/methods, and project timeline
Attachment 3: Maps, including:
- USGS topographic map with parcel(s) outlined
- Surrounding other protected open space (identify adjacent parcels)
- Water resources (drinking water supply zones I/II or A/B; aquifers;
proximity to wetlands, etc.)
- BioMap2
- Local or regional greenway plan
- Nearby State Priority Development or Preservation Areas as shown on the
South Coast Rail Corridor Plan, Merrimack Valley Land Use Priority Plan, or
the 495/Metrowest Development Compact Plan (if applicable)
Attachment 4: Letter of commitment from the municipality or state agency (or both) stating the
intent to hold the conservation restriction
Attachment 5: Copy of the relevant text from the community’s current Open Space and
Recreation Plan and Statewide Comprehensive Outdoor Recreation Plan and/or a local or regional
greenway plan to support the answers provided in Section E: “Project Description.”
Attachment 6: Documentation to support parcel enrollment in the Chapter 61 or 61A, Forest
Stewardship program, Farm Viability program, or Forest Viability program.
Attachment 7: Appraisal, market analysis, or opinion of value
Attachment 8: Articles of Incorporation and IRS 501(c)(3) letter. Corporation must be formed
for one of the purposes described in Section 4 of Chapter 180 of the General Laws. A copy of your
2018 Massachusetts Annual Report as filed to the Secretary of State’s office.
Additional Forms required if selected for funding:
The following forms are available at the Commonwealth’s Operational Services Division website
http://www.mass.gov/osd
.
Commonwealth Terms and Conditions
Commonwealth W-9 Request for Taxpayer Identification Number and Certification
Contractor Authorized Signature Verification Form
Authorization for Electronic Funds Payment
Note: this form must be completed online.
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Completed 27 July 2020

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