GeneralDATE



This form was developed to provide preliminary guidance to assist SMART SCALE applicants with the development and refinement of potential projects to be considered through the SMART SCALE process. This form is not the official application. All applicants are required to enter project applications through the SMART Portal. When navigating between fields in this form, only use the Tab key. For specific help information on the data entry fields, refer to either the Status Bar on the bottom left of the window or the associated Pre-Application Cordination Form Help Information. Fields with additional help information are denoted with numbers.GeneralDATE (MM/DD/yyyy): FORMTEXT ?????Applicant Information (Select one of the following) FORMCHECKBOX MPO FORMCHECKBOX PDC FORMCHECKBOX NVTA FORMCHECKBOX Public Transit Agency FORMCHECKBOX Local Government (City, Town, County)Applicant Name: FORMTEXT ?????Project Point of Contact Information The primary person that the State can contact for information during the screening process.Point of Contact Name: FORMTEXT ?????Point of Contact Phone Number: FORMTEXT ?????Point of Contact Email Address: FORMTEXT ?????Project Information Project Title: 60 character max, Short Project Description: 250 character max, Detailed Project Description: 2,000 character max, VTRANS Need: 1,300 character maxProject Title: FORMTEXT ?????Principal Improvement: (Select one of the following) The main or primary intent of the proposed improvement. FORMCHECKBOX Highway FORMCHECKBOX Bike/Pedestrian FORMCHECKBOX Bus Transit FORMCHECKBOX Rail Transit FORMCHECKBOX Freight Rail FORMCHECKBOX TDMDoes This Project Include Improvements to Non-VDOT Maintained Roadways? FORMCHECKBOX Yes FORMCHECKBOX No If yes, please enter available traffic volume data on those roadways in Attachment A.Short Project Description: FORMTEXT ?????Detailed Project Description: FORMTEXT ?????SMART SCALE Need Categories: (Select all that apply) The sponsoring applicant must meet the eligibility requirements for submittal based on the selected project type as outlined in the SMART SCALE Policy Guide: . FORMCHECKBOX Corridor of Statewide Significance FORMCHECKBOX Regional Network FORMCHECKBOX Urban Development Area FORMCHECKBOX SafetyApplication Program: (Select all that apply) HB 1887 funding eligibility is based on the selected SMART SCALE need category as outlined in the SMART SCALE Policy Guide: . FORMCHECKBOX High Priority FORMCHECKBOX District GrantHow Does This Project Address a VTrans Need? FORMTEXT ?????LocationPlease include a project sketch, design plan and/or map that details the location, elements, and limits of the proposed improvements. For the SMART SCALE on-line application, applicants will be required to locate the proposed project on a map. The space provide below can be used to import a sketch of the project. VDOT District(s) (Select all that apply) FORMCHECKBOX Bristol FORMCHECKBOX Culpeper FORMCHECKBOX Fredericsburg FORMCHECKBOX Hampton Roads FORMCHECKBOX Lynchburg FORMCHECKBOX Northern Virginia FORMCHECKBOX Richmond FORMCHECKBOX Salem FORMCHECKBOX StauntonIn what jurisdiction(s) is this project located? FORMTEXT ?????Project SketchFeaturesProject FeaturesThere can be multiple project improvements associated with one project application. Please use the lists provided below, broken down by principal improvement, to identify all of the improvements that are associated with your project application. In the description (350 character max), please provide specific information regarding the improvements.Highway (Select all that apply)Description (Type, Quantity, and Location) FORMCHECKBOX ?Add New Through Lane(s) FORMTEXT ????? FORMCHECKBOX Widen Existing Lane(s) (No New Lanes)??? FORMTEXT ????? FORMCHECKBOX ?Managed Lane(s) (HOV/HOT/Shoulder)??? FORMTEXT ????? FORMCHECKBOX ?Shoulder Improvement(s)??? FORMTEXT ????? FORMCHECKBOX ?Turn Lane Improvement(s)??? FORMTEXT ????? FORMCHECKBOX ?Access Management??? FORMTEXT ????? FORMCHECKBOX ?Road Diet??? FORMTEXT ????? FORMCHECKBOX Roadway Reconstruction/Realignment FORMTEXT ????? FORMCHECKBOX ?Roadway on New Alignment??? FORMTEXT ????? FORMCHECKBOX Intersection Improvement(s)??? FORMTEXT ????? FORMCHECKBOX Innovative Intersection(s) / Roundabout(s)??? FORMTEXT ????? FORMCHECKBOX ?New Intersection??? FORMTEXT ????? FORMCHECKBOX ?New Traffic Signal??? FORMTEXT ????? FORMCHECKBOX ?Traffic Signal Modification??? FORMTEXT ????? FORMCHECKBOX ITS Improvement(s) / Adaptive Signal Control??? FORMTEXT ?????FeaturesProject Features (continued)Highway (continued)(Select all that apply)Description (Type, Quantity, and Location) FORMCHECKBOX Improve Rail Crossing FORMTEXT ????? FORMCHECKBOX Ramp Improvement(s) FORMTEXT ????? FORMCHECKBOX Improve Grade-Separated Interchange FORMTEXT ????? FORMCHECKBOX New Interchange, Non-Limited Access Facility FORMTEXT ????? FORMCHECKBOX New Interchange, Limited Access Facility FORMTEXT ????? FORMCHECKBOX Improve/Replace Existing Bridge(s) FORMTEXT ????? FORMCHECKBOX New Bridge FORMTEXT ????? FORMCHECKBOX Highway Other FORMTEXT ?????Bike / Pedestrian (Select all that apply)Description (Type, Quantity, and Location) FORMCHECKBOX Add / Construct Bike Lane FORMTEXT ????? FORMCHECKBOX Construct Shared-Use Path FORMTEXT ????? FORMCHECKBOX Construct Sidewalk FORMTEXT ????? FORMCHECKBOX Improve Bike / Pedestrian Crossing (At Grade) FORMTEXT ????? FORMCHECKBOX Improve Bike / Pedestrian Crossing (Grade Separated) FORMTEXT ????? FORMCHECKBOX Bike / Pedestrian Other FORMTEXT ?????FeaturesProject Features (continued)Bus Transit (Select all that apply)Description (Type, Quantity, and Location) FORMCHECKBOX New Route/Service FORMTEXT ????? FORMCHECKBOX Increase Existing Route Service - Additional Vehicle(s) or Increased Frequency FORMTEXT ????? FORMCHECKBOX Construct or Convert Existing General Purpose or Parking Lane to Bus-only Lane FORMTEXT ????? FORMCHECKBOX Construct or Improve Bus Stop / Shelter FORMTEXT ????? FORMCHECKBOX Construct/Expand Bus Facility FORMTEXT ????? FORMCHECKBOX Other Transit Technology Improvements FORMTEXT ?????Rail Transit (Select all that apply)Description (Type, Quantity, and Location) FORMCHECKBOX Rail Service Improvements FORMTEXT ????? FORMCHECKBOX New Station or Station Improvements FORMTEXT ????? FORMCHECKBOX Rail Transit Other FORMTEXT ?????Intercity Passenger Rail (Select all that apply)Description (Type, Quantity, and Location) FORMCHECKBOX Freight Rail Improvements FORMTEXT ????? FORMCHECKBOX New Intercity Passenger Rail Station or Station Improvements FORMTEXT ?????Freight Rail (Select all that apply)Description (Type, Quantity, and Location) FORMCHECKBOX Freight Rail Improvements FORMTEXT ?????FeaturesProject Features (continued)Travel Demand Management (TDM) (Select all that apply)Description (Type, Quantity, and Location) FORMCHECKBOX New Park and Ride Lot FORMTEXT ????? FORMCHECKBOX Improve Park and Ride Lot FORMTEXT ????? FORMCHECKBOX New / Expanded Vanpool or On-Demand Transit Service FORMTEXT ????? FORMCHECKBOX TDM Other FORMTEXT ?????Right of Way Description (Type, Quantity, and Location) FORMCHECKBOX Right of Way / Easements Acquisition Required FORMTEXT ????? FORMCHECKBOX Includes Utility Relocations FORMTEXT ????? FORMCHECKBOX Includes In-Plan UtilityBetterment FORMTEXT ?????FactorsRespond yes or no to each of the comments for each factor and provide information (250 character max) to support your response. Note: Additional supporting information may be required in the web-based application depending upon selected Project Features.Accessibility (Please reference Appendix C from the SMART SCALE Technical Guide)AccessibilityResponseSupporting InformationProject includes improvements to existing or new HOV/HOT lanes or ramps to HOV/HOT. FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ?????Project provides real-time traveler information or wayfinding specifically for intermodal connections (access to transit station or park and ride lot). FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ?????Provides traveler information or is directly linked to an existing TMC network/ITS architecture. FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ?????Environment (Please reference Appendix D from the SMART SCALE Technical Guide)EnvironmentResponseSupporting InformationProject include special accommodations for hybrid or electric vehicles, or space or infrastructure for electric vehicle parking/charging). FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ?????Project includes energy efficient infrastructure or fleets, including: hybrid or electric buses, electronic/open road tolling, alternative energy infrastructure (e.g., roadside solar panels). FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ?????FactorsEconomic Development (Please reference Appendix E from the SMART SCALE Technical Guide) Commercial, industrial or mixed-used developments only. Residential development(s) only eligible as part of mixed-used zoning.Transportation Project – Consistency with Local Comprehensive Plan or Local Economic Development Strategy: (Select one of the following) FORMCHECKBOX Consistent with FORMCHECKBOX Referenced in (requires documentation)Transportation Project – Consistency with Regional Economic Development Strategy: (Select one of the following) FORMCHECKBOX Consistent with FORMCHECKBOX Referenced in (requires documentation)Site Name: FORMTEXT ?????Development Project (Consistent With Locality Comprehensive Plan / Zoning) (Select one of the following) FORMCHECKBOX Consistent with Comprehensive Plan Future Land Use FORMCHECKBOX Specific Reference (requires documentation)Development Project (Site Planning Type) (Select one of the following) FORMCHECKBOX Zoned Only (requires documentation) FORMCHECKBOX Conceptual Site Plan (requires documentation) FORMCHECKBOX Detailed (Constuction Ready) Site Plan (requires documentation)Development Project (Site Plan Status) (Select one of the following) FORMCHECKBOX Future (Zoned Only) FORMCHECKBOX Existing (Zoned Only) FORMCHECKBOX Submitted (Conceptual/Detailed) FORMCHECKBOX Approved (Conceptual/Detailed)Development Project (Building Square Footage) FORMTEXT ????? square feetDoes Transportation Project Provide Direct or Indirect Access to the Development Site? FORMCHECKBOX Provides Primary Access to the Site or is Adjacent to the Site FORMCHECKBOX Enhances Access Near the Site But is Not Adjacent to the SiteDriving Distance from Project to Development Site FORMTEXT ????? milesAdditional Economic Development SitesSite Name: FORMTEXT ?????Development Project (Consistent With Locality Comprehensive Plan / Zoning) (Select one of the following) FORMCHECKBOX Consistent with Comprehensive Plan Future Land Use FORMCHECKBOX Specific Reference (requires documentation)Development Project (Site Planning Type) (Select one of the following) FORMCHECKBOX Zoned Only (requires documentation) FORMCHECKBOX Conceptual Site Plan (requires documentation) FORMCHECKBOX Detailed (Constuction Ready) Site Plan (requires documentation)Development Project (Site Plan Status) (Select one of the following) FORMCHECKBOX Future (Zoned Only) FORMCHECKBOX Existing (Zoned Only) FORMCHECKBOX Submitted (Conceptual/Detailed) FORMCHECKBOX Approved (Conceptual/Detailed)Development Project (Building Square Footage) FORMTEXT ????? square feetDoes Transportation Project Provide Direct or Indirect Access to the Development Site? FORMCHECKBOX Provides Primary Access to the Site or is Adjacent to the Site FORMCHECKBOX Enhances Access Near the Site But is Not Adjacent to the SiteDriving Distance from Project to Development Site FORMTEXT ????? milesSite Name: FORMTEXT ?????Development Project (Consistent With Locality Comprehensive Plan / Zoning) (Select one of the following) FORMCHECKBOX Consistent with Comprehensive Plan Future Land Use FORMCHECKBOX Specific Reference (requires documentation)Development Project (Site Planning Type) (Select one of the following) FORMCHECKBOX Zoned Only (requires documentation) FORMCHECKBOX Conceptual Site Plan (requires documentation) FORMCHECKBOX Detailed (Constuction Ready) Site Plan (requires documentation)Development Project (Site Plan Status) (Select one of the following) FORMCHECKBOX Future (Zoned Only) FORMCHECKBOX Existing (Zoned Only) FORMCHECKBOX Submitted (Conceptual/Detailed) FORMCHECKBOX Approved (Conceptual/Detailed)Development Project (Building Square Footage) FORMTEXT ????? square feetDoes Transportation Project Provide Direct or Indirect Access to the Development Site? FORMCHECKBOX Provides Primary Access to the Site or is Adjacent to the Site FORMCHECKBOX Enhances Access Near the Site But is Not Adjacent to the SiteDriving Distance from Project to Development Site FORMTEXT ????? milesTo identify information for additional development sites, make copies of this sheet. delivery / fundingProject Delivery InformationPlease provide information identifying prior work that has been completed for the project. Such information will be provided to the CTB to understand project readiness. Project Planning Status: (Select all that reference this project) FORMCHECKBOX Constrained Long Range Plan (MPO) FORMCHECKBOX Vision Long-Range Plan (MPO) FORMCHECKBOX Rural Long Range Plans FORMCHECKBOX Other Regional Plan FORMCHECKBOX Transportation Element of Local Comprehensive Plan FORMCHECKBOX Planning / Safety Study FORMCHECKBOX State Transportation Plan FORMCHECKBOX Transit Development Plan (TDP) FORMCHECKBOX NEPA Study FORMCHECKBOX Preferred Alternative (NEPA or Planning Level)Project Administered By: (Select one of the following) FORMCHECKBOX VDOT FORMCHECKBOX LocalityOther: FORMTEXT ?????Project Designed By Please Indicate Who is Responsible for the Design of this Project: (Select all that apply) If more than one of the entities below is responsible for the design, then please note the percentage for which each entity is responsible. FORMCHECKBOX VDOT FORMTEXT ???% FORMCHECKBOX Locality FORMTEXT ???% FORMCHECKBOX Consultant FORMTEXT ???%Project Delivery Method: (Select one of the following) FORMCHECKBOX Not Determined FORMCHECKBOX Design-Bid-Build FORMCHECKBOX Design-Build FORMCHECKBOX State Forces FORMCHECKBOX Locality Forces FORMCHECKBOX Other: FORMTEXT ?????Cost Estimate and Schedule Estimates and schedules should reflect the fact that all work that is federally eligible will be performed following the federal process. If needed, please describe what activities are covered in the other phase (100 character max).Phase MilestoneStatus(Select one of the following for each phase)% CompleteCostEstimateStartDate(dd/mm/yyyy)EndDate*(dd/mm/yyyy)PE(Survey, Environmental, Design) FORMCHECKBOX Not needed FORMCHECKBOX Not started FORMCHECKBOX Underway FORMCHECKBOX Complete FORMTEXT ???%$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????RW(Right of Way and Easement Acquisition, Utility Relocation) FORMCHECKBOX Not needed FORMCHECKBOX Not started FORMCHECKBOX Underway FORMCHECKBOX Complete FORMTEXT ???%$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????CN(Construction, Oversight, Inspection, Contingencies) FORMCHECKBOX Not needed FORMCHECKBOX Not started FORMCHECKBOX Underway FORMCHECKBOX Complete FORMTEXT ???%$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other FORMTEXT ????? FORMCHECKBOX Not needed FORMCHECKBOX Not started FORMCHECKBOX Underway FORMCHECKBOX Complete FORMTEXT ???%$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total Cost Estimate$ FORMTEXT ?????* End Date not required for PE and RW phases – allows for project development phase overlap.Project UPC(s)/DRPT Project Number(s) Identify projects that are currently included in the Six-Year Improvement Program that will be used as a funding source(s) for the proposed project. Describe the relationship of the referenced project number to the proposed project (i.e. funds are to be transferred from referenced project number to proposed project). The amount of funds being used to leverage and reduce the SMART SCALE request should be shown as SYIP Allocations in the Project Funding Sources below. Provide Existing VDOT UPC(s) or DRPT Project Number(s), if applicable: VDOT UPC(s) or DRPT Project Number(s) FORMTEXT ????? FORMCHECKBOX Donor FORMCHECKBOX Project FORMTEXT ????? FORMCHECKBOX Donor FORMCHECKBOX Project FORMTEXT ????? FORMCHECKBOX Donor FORMCHECKBOX Project FORMTEXT ????? FORMCHECKBOX Donor FORMCHECKBOX Project FORMTEXT ????? FORMCHECKBOX Donor FORMCHECKBOX Project FORMTEXT ????? FORMCHECKBOX Donor FORMCHECKBOX ProjectVDOT UPC(s) or DRPT Project Number (s) Description Describe relationship for each project (200 character max). FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????SYIP Amount$ FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ?????Total SYIP Allocations$ FORMTEXT ?????delivery / fundingProject Funding Sources Other Committed Funding Source(s): 200 character maxIf there are anticipated funds used to leverage and reduce the SMART SCALE request (that are not included in the SYIP), such anticipated funds should be identified below. Applicants must have an approved or pending application for other sources of committed funds, such as local/regional or other federal funds at the time of the SMART SCALE application submission. The cost of proffers, in-kind contributions, in-plan utility betterments, etc. should be identified here as other committed funds and included in the cost estimate. Includes an explantion of the source of committed funds. If submitting an application with other committed funds that have not yet been approved, then the applicant must provide documentation such as a resolution of support, letter of support, grant application, etc. Each source of other committed funds must be identified. The Total Project Funding must equal the Total Cost Estimate.Other Committed Funding Source(s) (Not Included in SYIP) FORMTEXT ?????$ FORMTEXT ?????SMART SCALE Request$ FORMTEXT ?????Total Project Funding (SYIP Allocations + Other Committed Funds + SMART SCALE Request)$ FORMTEXT ?????Supporting DocumentsThe following checklist will help you prepare and compile supporting documentation that can be uploaded into the on-line application.Required FORMCHECKBOX Project Improvement Sketch FORMCHECKBOX Resolution of Support from Submitting Entity FORMCHECKBOX Resolution of Support from Relevant Regional Entity, if applicable (MPO, PDC, NVTA) {See Table 2.2 of Technical Guide} FORMCHECKBOX Detailed Project Cost Estimate FORMCHECKBOX Documentation of Source of Other Committed Funds (Resolution, Letter, Application) FORMCHECKBOX Local Comprehensive Plan, if applicable FORMCHECKBOX Local/Regional Economic Development Strategy, if applicable FORMCHECKBOX Site Development References per Economic Development Responses, if applicableNote: Required MPO Resolutions of Support may be provided up to September 1.Optional – Strongly Recommended FORMCHECKBOX Previous Study(ies) FORMCHECKBOX Traffic Counts and/or Turning Movements FORMCHECKBOX Traffic ForecastsATTACHMENT A – Traffic volume InformationPlease provide the following traffic volume information if the proposed project is not on a VDOT-maintained facility.Non-VDOT Maintained Roadway Segment Traffic Volume InformationSegmentNumberRoute NumberRoute NameFromToAADT% TrucksYear1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ????2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ????3 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ????4 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ????5 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ????6 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ???? ................
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