Office of Liquor and Gaming Regulation www.justice.qld.gov.au/grants 1994–2019 YEARS Department of Justice and Attorney-General EXPRESSION OF INTEREST ( closing 31 August 2018) Commemorative Grants Part A – Organisation details Section 1: Legal entity Legal entity name ....................................................................................................................................................... Registered legal organisation number L Section 2: Sponsored entity Sponsored organisation: Yes No If Yes, complete information below If No, proceed to Section 3 Sponsored organisation name .................................................................................................................................... Registered sponsored organisation number S Section 3: Application contact Contact person (the person who knows most about this application): First name ........................................................................ Last name ........................................................................ Phone number ................................................................. Email ................................................................................ ALL fields must be completed. Handwritten applications will not be accepted. How did you find out about the Commemorative Grants? .........................................................................................................................................................................
Transcript
Office of Liquor and Gaming Regulationwww.justice.qld.gov.au/grants
1994–2019YEARS1994–2019
YEARS
Department of Justice and Attorney-General
E X P R E S S I O N O F I N T E R E S T (closing 31 August 2018)
Commemorative Grants
Part A – Organisation details
Section 1: Legal entity
Legal entity name .......................................................................................................................................................
Registered legal organisation number L
Section 2: Sponsored entity
Sponsored organisation: Yes No
If Yes, complete information below
If No, proceed to Section 3
Sponsored organisation name ....................................................................................................................................
Registered sponsored organisation number S
Section 3: Application contact
Contact person (the person who knows most about this application):
First name ........................................................................ Last name ........................................................................
Phone number ................................................................. Email ................................................................................
ALL fields must be completed. Handwritten applications will not be accepted.
How did you find out about the Commemorative Grants?
Select the grant amount your organisation is applying for (one option only):
up to $100,000
up to $250,000
Select one of the categories below to identify why you are seeking funding:
Major capital works (if selected please proceed to section 5)
Wider community events or festivals (if selected please proceed to section 6)
Major equipment items (if selected please proceed to Part C)
Transportation (if selected please proceed to Part C)
Section 5: Major capital works
Is your land/building(s):
Owned by your organisation
Owned by government (local/state/federal)
Owned through a private owner (individual/company) If the property is government or privately owned, advise how long you have had this tenure agreement. Please note: If improvements are proposed for privately owned land or buildings the organisation must have a minimum of three years tenure from 31 August 2018.
Please attach a copy of the lease document and/or letter from the owner advising custom and practice.
Do you have written approval from the lessor to undertake major capital works? Yes No
If yes, please attach a copy of the lessor’s approval.
What type of major capital works are you undertaking?
New building works (if selected, proceed to Part C)
Repairs/refurbishment (if selected, complete the question below, then proceed to Part C)
Outline the cultural significance of the facility that you propose to repair/refurbish in the local community.
Section 6: Wider community events or festivals
Date of your proposed event: ............................................
Does this event occur annually? Yes No
Is the event reliant on this funding application? Yes No
How many people (approximately) will attend your event? ........................................................
Proceed to Part C.
Commemorative Grants EOI Form | p3
Part C – What is the organisation seeking funding for?
Section 7: Please summarise what item(s) you will be purchasing with your grant funds
Item Quantity Requested amount
Total
N.B. If you intend to provide financial support, you should only request the amount required to be funded excluding your contribution for each item. (Please note CBFU may request proof of any contributions.)
Service delivery address (the physical address where the items purchased will be located)
Please attach the preferred quotes for the item(s).
Section 8: Contributions
Are you providing a financial contribution to this application? Yes No If Yes, please outline your contribution in detail.
Are you providing in-kind contribution to this application? Yes No If Yes, please outline your contribution in detail.
Are you seeking funding for these items from another source? Yes No If Yes, please provide information on who the other source of funding will be and when you expect to receive an outcome.
Is this application reliant on the other source of funding? Yes No
If successful, how many months do you anticipate it will take to complete the grant? ..................................................
Proceed to Part D
Commemorative Grants EOI Form | p4
Part D – Why are you seeking funding?
Section 9: Grant purpose
Please outline in detail the reason for your grant application (please outline in a maximum 3000 characters)
Describe how this grant would provide significant and long-lasting benefit to the community. (please outline in a maximum 3000 characters)
Will this application provide opportunities for your organisation to generate income? Yes No If Yes, please outline.
Commemorative Grants EOI Form | p5
Section 10: Partnerships
If successful will the funding result in your organisation partnering with other organisations within the community to achieve a shared benefit? Yes No If Yes, please outline in detail your partnerships.
Section 11: Referees
Please provide two referees who support your application. Please note, if successful in your EOI and invited to submit a stage two application, the referees will be required to provide letters of support with that application.
First refereeFirst name......................................................................... Last name .........................................................................
Position ............................................................................ Phone number (business hours) ........................................
Second refereeFirst name......................................................................... Last name .........................................................................
Position ............................................................................ Phone number (business hours) ........................................
Warning: Grant writer fees and any other form of payment (as listed in the funding guidelines) are ineligible items. Grant funds must not be used for these fees. Any payments should be on a fee for service basis.
Are you completing this application as a grant writer or supplier/contractor on behalf of the applicant?
Yes No
If Yes, complete section below. If No, proceed to Part E.
Grant writer details
First name......................................................................... Last name .........................................................................
Email ................................................................................ Phone number ..................................................................
Company ....................................................................................................................................................................
Are you seeking payment for submitting this grant application? Yes No
Are you independent from the applicant organisation and suppliers/contractors? Yes No
Did you initiate contact with the applicant organisation to apply for grant funding? Yes No
If Yes, you must provide a copy of the completed EOI to the applicant organisation who may be contacted to verify information contained in this application.
Commemorative Grants EOI Form | p6
Part E – Declaration
Section 13: Declaration
By submitting an application for funding with any funding program administered by the Office of Liquor and Gaming Regulation (OLGR) your organisation, if successful, will enter into a contract with the Queensland Government. All grant funding and procurement provided by the Queensland Government in relation to social services is subject to a mandatory whole-of-government standard suite of contracts managed by the Department of Housing and Public Works.
To access the latest version of the terms and conditions applicable to all OLGR grant funding applications, visit www.hpw.qld.gov.au/SiteCollectionDocuments/UpdatedShortFormtermsandconditions.pdf
Note that the funding guidelines, completed expression of interest form and funding application form constitute the particulars referred to in the Short Form – Terms and Conditions and form part of the contract binding successful grant funding applicants.
Section 14: Privacy statement
The Department of Justice and Attorney-General collects information about Gambling Community Benefit Fund applicants to assist in the assessment and management of grant funding. This information is authorised under the Gaming Machine Act 1991. This information will only be accessed by authorised persons of the department. Information may be made available to other areas of the department for the purposes of correspondence, notification, marketing and promotional activities. Your information will not be disclosed to any other parties unless authorised or required by law. The Office of Liquor and Gaming Regulation may contact applicants and/or identified referees for more information. Details of successful applications may be provided to Members of Parliament and used in promotional material about the Gambling Community Benefit Fund including media releases, annual reports and brochures and on relevant Queensland Government websites.
I am authorised by the legal entity to make this declaration on its behalf.
Full name ...................................................................................................................................................................
Phone number .................................................................
I have read and accept the funding guidelines, terms and conditions, privacy statement and declaration.
Before submitting your EOI please ensure the following:
Your organisation/s (legal and/or sponsored) are registered with OLGR.
Preferred quote/s for requested item/s is attached.
Letter of approval to undertake works from lessor is attached (major capital works projects only).
Copy of lease/tenure is attached and/or letter from the owner advising custom and practice (major capital works projects only).
EOI and attachments to be emailed to [email protected] by midnight — 31 August 2018. Do not send a scanned copy of this EOI.
