LAC 34:III.201
B. For projects other than those funded from self-generated cash, federal funds or dedicated revenues, the only anticipated source of funding available is the sale of general obligation bonds. It is, therefore, necessary to limit capital outlay projects which do not have a cash source of funding to those which have an anticipated useful life of 20 years or more and a value or cost of at least $50,000. Examples of projects that qualify for inclusion in the capital outlay bill are:
C. Capital outlay requests should not include any of the following:
E. Submit six hard copies of the budget request document and the completed diskette(s) (soft copy) along with a transmittal to: Division of Administration, Facility Planning and Control, State Capitol Annex, Room B-31, Post Office Box 94095, Baton Rouge, Louisiana 70804-9095. In addition, one duplicate hard copy set must be submitted at the same time to both the: Joint Legislative Capital Outlay Committee, 21st Floor, State Capitol, Post Office Box 94062, Baton Rouge, Louisiana 70804-9062; and Legislative Fiscal Office, 18th Floor, State Capitol, Post Office Box 94097, Baton Rouge, Louisiana 70804-9097.
F. Terms Used in Capital Outlay Requests
21. Total Gross Area. This is the product of the total net area times the burden factor percentage.
NEW PROJECT REQUEST
CAPITAL OUTLAY REQUEST FOR FY 1996-97
PAGE – 1
PROJECT
TitleDescriptionPrograms ServedSite LocationTitleDescriptionPrograms ServedSite Location
DEMONSTRATION OF NEED
Purpose or Objectives of Proposed Project (Check as many as apply) [ ] Expand Existing Program [ ] Changes in Population Served [ ] Relocate Existing Program [ ] To Address Code Violations, Court Orders, [ ] Add New Program Accreditation [ ] Changes in Existing Program [ ] To Address Actual or Threatened Prop. Damage [ ] Changes in Mission, Goals, Objectives [ ] Changes in Accepted Standards/Guidelines [ ] Other Describe Program Service Description Number of Employees Present ____ Citizens Served ____ Future ____ Daily Users ____ Describe strategic long range plan for program (5 Yr?) APPLICABLE GUIDELINES/STANDARDS List publications, regulatory agencies guidelines for the program. Minimum or mandatory requirements of above listed for program. What alternatives were considered? [ ] Maintaining Status Quo [ ] Lease Space [ ] Use Existing Space [ ] Renovation of Existing Space [ ] New Space [ ] Expansions of Similar Program Elsewhere How use best option determined (Studies, Etc.)? Were any feasibility studies or needs assessment reports prepared? [ ] If so, please name contact person. Phone List socioeconomic and environmental affects of project. Identify and describe other similar facilities in your area and evaluate their capabilities to meet needs. Purpose or Objectives of Proposed Project (Check as many as apply) [ ] Expand Existing Program [ ] Changes in Population Served [ ] Relocate Existing Program [ ] To Address Code Violations, Court Orders, [ ] Add New Program Accreditation [ ] Changes in Existing Program [ ] To Address Actual or Threatened Prop. Damage [ ] Changes in Mission, Goals, Objectives [ ] Changes in Accepted Standards/Guidelines [ ] Other Describe Program Service Description Number of Employees Present ____ Citizens Served ____ Future ____ Daily Users ____ Describe strategic long range plan for program (5 Yr?) APPLICABLE GUIDELINES/STANDARDS List publications, regulatory agencies guidelines for the program. Minimum or mandatory requirements of above listed for program. What alternatives were considered? [ ] Maintaining Status Quo [ ] Lease Space [ ] Use Existing Space [ ] Renovation of Existing Space [ ] New Space [ ] Expansions of Similar Program Elsewhere How use best option determined (Studies, Etc.)? Were any feasibility studies or needs assessment reports prepared? [ ] If so, please name contact person. Phone List socioeconomic and environmental affects of project. Identify and describe other similar facilities in your area and evaluate their capabilities to meet needs.
PROJECT RECAP SHEET
CAPITAL OUTLAY REQUEST FOR FY 1996-97
PAGE - R-1
PROJECT REQUEST NUMBER
Title
Department Priority Number ___ of ___ Location
A. Emergency Project { } Parish
B. Current Project Requirements { } Senate District
C. Anticipated Program Needs { } House District
APPLICANT
Schedule No. Site Code
Department / Umbrella User State ID
Agency / Management Board Dept. Contact
Phone
Local User Facility Local Contact
Phone
FINANCIAL
Local User Agency Department F. P. & C
Total Project Cost Estimate Estimate: Estimate Estimate Estimate
| Land / Building Acquisition Planning Costs (10%) Construction Costs Hazardous Materials Abatement | ________________________________________________________ | ____________________________________________________________________________________ | ____________________________________________________________________________________ | ____________________________________________________________________________________ |
| Subtotal Misc./Contingency Costs (10%) Equipment Costs | __________________________________________ | _______________________________________________________________ | _______________________________________________________________ | _______________________________________________________________ |
| Total | 0 | 0 | 0 | 0 |
| Time Needed: Planning Construction |
If planning has begun, when will it be complete?
PRIOR FUNDING:
| Authorized Source | Amount | Year | Act Number | Priority Level | Were Bonds Sold or Lines of Credit Granted? |
| _______ | ___________ | Bonds ( ) Credit ( ) | |||
| Total (A) | 0 |
Proposed New Funding: First Year Years 2-5 Source of Funding
| State Funds Gen.Obl. Bonds Reimb. Bonds Self-Gen. Funds Federal Funds Other | ____________________________________________________________________________________________________________ ______________________________________________________ | ____________________________________________________________________________________________________________ ______________________________________________________ | Cash ( ) Rev.Bonds ( ) |
| Total | (B) 0 | (C) 0 |
Total Project Funding (A=B=C) ___________________________ (Should Equal Total Project Cost Estimate)
Annual Operation & Maintenance Cost Increase (Decrease) _________________________0
AGENCY IMPACT STATEMENT
| I hereby certify that this project/program has been reviewed, approved and integrated into our department's long range strategic plan and five year budget. The impact of this project/program's operating budget on our budget has been approved by Name: __________________________________________________________ Title: _______________________________ Date: _____/_____/_____ |
DOA REVIEW
| Review Architect/Engineer : Review Date: _____/_____/_____ FPC Director : Review Date: _____/_____/_____ Review Budget Analyst : Review Date: _____/_____/_____ OPB Director : Review Date: _____/_____/_____ |
DOA COMMENTS
NEW PROJECT REQUEST
CAPITAL OUTLAY REQUEST FOR FY 1996-97
PAGE - 2
ARCHITECTURAL PROGRAM
| Preparer Date Prepared ____/____/____ Type of Space # Occupants Net Area / Person Net Area Required | ||||
| Net Area Required | 0 |
Net Area _________________ X Burden Factor _________ = Total Gross Area Required ________________________________________
Totals
____________Employees _______________ Temporary Employees
____________ Visitors / Clients _______________ Student / Assistant
____________ Contract Employees _______________ Other
Additional program requirements (Parking, Utilities Tie-In, Location, Shipping & Receiving, Public Access, Site Amenities, etc.) Describe below.
What is the length of time needed for planning ?
Construction ?
NEW CONSTRUCTION
What will happen to existing facility? (Demolition, Renovation, Expansion of other programs)
How funded?
Has site been surveyed for underground storage tanks? ( )
When ?
RENOVATION /ADDITION
Describe history and condition of building, extent and date of previous major renovations.
Describe the extent of the proposed renovation /addition.
Where will the occupants be housed during construction ?
How funded ?
What portion of the const. Budget addresses modifications required to meet The Americans with Disabilities Act Guidelines (ADAG) ?
What hazardous materials are addressed in the construction budget?
( ) Underground Storage Tanks ( ) PCB's ( ) Asbestos
( ) Lead Paint ( ) Other
Has the facility's asbestos management plan been consulted for abatement requirements? ( )
Contact person
What is the current age, condition and type of the existing roof and estimated date of replacement?
Describe roof penetrations, equipment, etc.
For roofing projects, what is current condition of rooftop equipment & estimated date of replacement?
NEW PROJECT REQUEST
CAPITAL OUTLAY REQUEST FOR FY 1996-97
PAGE - 3
CONSTRUCTION COSTS
Source of Data Date Prepared _____/_____/_____
List special cost affecting factors considered (Unfinished Warehouse Space, Extraordinary HVAC, etc.)
COST OF CONSTRUCTION CALCULATION; (Provided Roof S.F. if Roofing Project)
Type of Space Total Gross Area Cost /S.F. Total Cost
| Subtotal/Average | 0 | 0.00 | 0 |
ADDITIONAL LINE ITEM EXPENSES (Parking, Utility Tie-In, Security System, etc.)
Item Unit Cost Total Cost
| Subtotal | 0 | |
| Total Construction Cost | 0 |
EQUIPMENT COSTS
Source of Data Date Prepared _____/_____/_____SUMMARY OF EQUIPMENT AND ESTIMATED COSTS: 0 0 0 0 0 Total 0If this project is a current year request, attach an itemized breakdown with unit costs, estimated useful life of the equipment.If this project is for renovation or relocation for an existing program, will existing equipment continue to be used ? ( ) If not, why? Source of Data Date Prepared _____/_____/_____SUMMARY OF EQUIPMENT AND ESTIMATED COSTS: 0 0 0 0 0 Total 0If this project is a current year request, attach an itemized breakdown with unit costs, estimated useful life of the equipment.If this project is for renovation or relocation for an existing program, will existing equipment continue to be used ? ( ) If not, why?
PROPOSED PROJECT FUNDING
96-97 97-98 98-99 99-00 00-01 Total
| G. O. Bonds State Funds Reimb. Bonds Self-Gen Revenue Federal Funds Local & Other Funds | ______________________________________________________ | ______________________________________________________ | ____________________________________________________________ | ____________________________________________________________ | __________________________________________________________________________________________ | ______________________________________________________________________________ |
| Total | 0 | 0 | 0 | 0 | 0 | 0 |
NEW PROJECT REQUEST
CAPITAL OUTLAY REQUEST FOR FY 1996-97
Page - 4
PROGRAM OPERATING 7 MAINTENANCE COSTS
BUDGET REQUEST SUMMARY
(Should match submittals BR-1 and BR-2 to Annual Projected
Office of Planning & Budget) Current Year Increase (Decrease)
Budgeted After Project Completion
| Expenditures: Salaries Other Compensation Related Benefits Travel Operating Services Supplies Professional Services Other Charges Debt Services Interagency Funds Acquisitions Major Repairs Unallotted | ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ | __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ |
| Total Expenditures | 0 | 0 |
| Means of Financing: State General Fund (Direct) State Gen. Fund By:: Interagency Transfers Fees & Self-Gen. Revenues Statutory Dedications Interim Emergency Board Federal Funds | _______________________________ ___________________________________________________________________________________________________________________________________________________________ | __________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________________________________ |
| Total Means of Financing | 0 | 0 |
| Excess or (Deficiency) of Expenditures over Financing | ______________________________0 (Should Equal 0) | _________________________________________0 (Should Equal 0) |
96-97 97-98 98-99 99-00 00-01
| Total Expenditures | 0 | 0 | 0 | 0 | 0 |
| Means of Financing: State Gen. Fund (Direct) State Gen. Fund By: Interagency Transfers Fees & Self-Gen. Revenues Statutory Dedications Interim Emergency Board Federal Funds | _________ _____________________________________________ | __________ __________________________________________________ | _______________ ___________________________________________________________________________ | ________________ ________________________________________________________________________________ | ______________ ______________________________________________________________________ |
| Total Means of Financing | 0 | 0 | 0 | 0 | 0 |
| MAILING ADDRESSES | |||||
| Applicant (Local User) Mailing Address Facility Physical Address |
AUTHORITY NOTE: Promulgated in accordance with R.S. 39:102.C.
HISTORICAL NOTE: Promulgated by the Office of the Governor, Division of Administration, Facility Planning and Control Section, LR 7:6 (January 1981), amended LR 20:185 (February 1994).