Regional Investment Plan



Community and Industry Engagement (CIE) program

Application Form 2019

Application Closing Date – 10am Monday 23 September 2019

Stream 1: Recycling Infrastructure

For detailed information, please refer to the CIE program guidelines at wasteauthority..au/programs/cie

If you have remaining questions, please contact the CIE Coordinator at cie@dwer..au

Please attach additional supporting information as relevant.

|ORGANISATION DETAILS |

|Name of Organisation | |

|Postal address |Street | |Suburb | |

| |Postcode | |State | |

|Website / Facebook page | |

|Organisation’s ABN | |

|Registered for GST |YES | |NO | |

|Brief description of the organisation | |

|CONTACT PERSON |

|Title | |

|Email | |Phone/Mobile | |

|ALTERNATIVE CONTACT PERSON |

|Title | |

|Email | |Phone/Mobile | |

|WASTE STRATEGY 2030 |

|The strategy includes three objectives to guide the Western Australian community and enable the development of a sustainable, low-waste, circular |

|economy. Select the objective(s) your project contributes to. |

|AVOID | |RECOVER | |PROTECT | |

|generating less waste |recovering more value and resources from waste|protecting the environment by managing waste |

| | |responsibly |

|FACILITATE WASTE AVOIDANCE AND RECOVERY (Action 8.2) |

|The Waste Strategy 2030 is underpinned by an Action Plan. Please select the element(s) below that best reflect the target of your project. If |

|multiple elements apply, please rank in order of your projects focus. |

|(1 = highest, 4= lowest). |

|Focus materials - (if selected, please also complete Targeted Focus Materials table below) | |

|Reuse and low-waste alternatives | |

|Community, government and industry initiative that leads to waste avoidance and resource recovery | |

|Increasing the uptake of better practice approaches | |

|TARGETED FOCUS MATERIALS |

|Select the material(s) that your project targets. |

|Construction and demolition waste | |Glass: packaging and containers | |

|Organics: food organics and garden organics | |Plastics: packaging and containers | |

|Metals: steel, non-ferrous metals, packaging and containers | |Textiles: clothing and other fabric-based materials | |

|Paper and cardboard: office paper, newspaper and magazines | |Hazardous waste | |

|PROJECT SUMMARY |

|This summary may be used to promote your project on the Waste Authority website and in media releases. |

|Project Title | |

|Brief description | |

|(50 words or less) | |

|Expected project timeframe |Start Date | |End Date | |

|CIE funding requested in this application |$ |

|A maximum $250,000 grant limit applies per project. | |

|PROJECT DESCRIPTION (limit project description to two pages maximum) |

|What waste problem or opportunity does the project address; and how will the project address it? |

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|PROJECT DETAILS |

|Objective(s) |

|What are the project’s specific goals? What does it aim to achieve? |

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|Outcome(s) |

|What are the project outcomes (results)? How will it help to achieve the Waste Strategy targets? |

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|Key deliverable(s) |

|What quantifiable goods or services will your project produce? What is the volume of waste being recovered / recycled? What will it deliver to the |

|market(s)? What education/knowledge sharing events will the project deliver? What is the target audience (number of people, demographics, background|

|etc)? |

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|Key performance indicators |

|How will the success of the project be measured against achievement of its objectives? |

|What type of data/information will be collected to evaluate the project? |

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|ASSESSMENT CRITERIA |

|(IMPORTANT: Refer to section 4.2 of the CIE guidelines for more information) |

|Extent of beneficial project impacts |

|Please include any identified economic, environmental and/or social benefit, such as an increase in value of recovered material, estimated jobs |

|created (full-time or part-time) and flow-on benefits to the WA economy. |

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|Viability of the project |

|Consideration to be given to the financial, commercial and/or technological viability of project, including markets. |

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|Capacity of applicant to deliver all aspects of the project to a high standard |

|Please include evidence of organisational skills, capacity and financial capability to support successful delivery of the project. Include |

|additional information if relevant (e.g. staff profile/experience, recent accounts/balance sheet etc.) |

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|Value for money |

|Describe the extent to which all activities relating to the project are carried out and deliver economic, social and environmental benefits in |

|Western Australia. |

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|Siting, licensing and compliance considerations |

|Describe location, ownership/leasing of land, and/or permissions required from site owner and any other relevant issues relevant to the project’s |

|location. |

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|PROJECT PARTNERS |

|List details of partnering organisations and their contribution/s if relevant. |

|Partner |Contribution/role in relation to the project |

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|PROJECT STAKEHOLDERS (if applicable) |

|List details of any stakeholders directly involved in the project and describe their role. |

|Stakeholder |Role |

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|PROJECT APPROVALS |

|Attach supporting information where necessary. Mark N/A if not required. |

|What planning, environmental or other approvals are required for the project? (provide details) |

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|If required approvals have not been yet granted, what strategies are in place to obtain approval and when is approval anticipated? |

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|SITE LOCATION AND DESCRIPTION |

|Name of site | |

|Site |Street | |Suburb | |

|Address | | | | |

| |Post Code | |State | |

|Does the recipient organisation own the |Yes |No |If no, describe leasing arrangements below and attach written confirmation |

|site? | | |from owner/operator: |

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|PROPOSED INFRASTRUCTURE PURCHASE |

|List the infrastructure and equipment to be purchased as | |

|part of the project. | |

|Detail the analysis that has been undertaken in selecting | |

|the specific infrastructure and equipment, including | |

|evidence of consideration of alternatives not nominated. | |

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|CAPACITY, THROUGHPUT AND MARKET ANALYSIS |

|What is the current capacity at the facility (materials and | |

|tonnes, where applicable)? | |

|What is the current throughput at the facility (materials | |

|and tonnes, where applicable)? | |

|What is the estimated additional processing capacity of your| |

|facility once the project is completed (materials and | |

|tonnes)? | |

|What is the estimated additional throughput six months after| |

|completion of the project (materials and tonnes)? | |

|Describe the competition that currently exists in the market| |

|for the source material(s) that you propose to accept as | |

|part of this project. | |

|Provide information on the expected end products of your | |

|processing operation and the demand or market for these end | |

|products. | |

|PROJECT BUDGET – INCOME AND EXPENDITURE |

|Use the table below to list the items to be funded through this CIE funding application. |

|Do NOT include GST in the costings |

|GRANT AMOUNT REQUESTED (excl GST): $ |

|A maximum $250,000 grant limit applies per project |

|Item (please provide description) |Estimated expenditure ($, excluding GST) |

| |CIE funding |Co- contribution |Other funds |

| | | |(if applicable) |

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|Sub–totals | | | |

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|Total project budget (excl GST) | |

Refer to the CIE guidelines for further information on eligible budget items.

|PROJECT MILESTONE SCHEDULE (if applicable) |

|*please note that projects finishing before 1 June 2020 may be prioritised |

|Milestone number and description |Proposed due date |

|Please add lines if your project requires more milestones. | |

|Start of project | |

|Mid project update | |

|Acquittal, including final project evaluation and financial report | |

|Milestone due dates and payment schedule may be modified in consultation with successful grant applicants prior to the execution of a funding |

|agreement. Refer sections 8 and 9 of the Guidelines for further information. |

|INSURANCES |

|It is a condition of your grant that you have adequate insurance to cover potential liability in conducting activities funded through CIE. |

|Provide details of insurance held (type of insurance/s, provider, value insured and expiry date) and attach relevant documents as relevant. |

|Relevant insurances may include: Workers’ Compensation; Director’s and Officer’ Liability, Public Liability; Personal Accident Insurance for |

|Volunteers; Contents / Mobile Plant & Equipment |

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|CONFLICT OF INTEREST (if not relevant for your project – please mark as N/A) |

|Declare any real, potential or perceived conflict of | |

|interest that you may be aware of. | |

|DECLARATION |

|I, (name) …………………………….…..………. (position) …………………..………..…………………. of (organisation) |

|…………………………................................................................................................. declare |

|that the information given in this Community and Industry Engagement program application and all attached documents is complete and correct to the |

|best of my knowledge, information and belief. |

|Authorised officer | |Signature |

| | |Name/Position |

| | |Date |

| | |Signature |

|Witnessed by | |Name/Position |

| | |Date |

| | | |

CIE Stream 1 – Infrastructure

APPLICATIONS CLOSE – 10am Monday 23 September 2019

Late applications will not be accepted

Applications must be electronic and lodged through the public submissions portal on the Waste Authority website.

wasteauthority..au/programs/public-submissions/

Applicants will be notified that their applications have been received by automated email.

If you experience problems with your application form or submitting through the portal, please contact the CIE Coordinator at cie@dwer..au.

|APPLICATION CHECKLIST |

|Before you lodge your application – please ensure you have completed all the information and attached relevant supporting documentation, including: |

|I have read and understand the Community and Industry Engagement program guidelines | |

|Application includes all details of project funding | |

|Completed all relevant fields of the form | |

|Confirmed budget details are correct and all amounts are GST exclusive | |

|Application has been signed by the authorised officer | |

|All supporting documents are ready to be attached to the submission as applicable (financial statement/balance sheet, quotes, | |

|certificates of insurance, project approvals support/partnership letters etc) | |

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