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Nonprofit Assistance Application Form

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Nonprofit Assistance Application Form Nonprofit Assistance Application Form APPLICATION MATERIALS SHOULD BE SUBMITTED ON PAPER (ONE COPY) AND ELECTRONICALLY. (INDIVIDUAL EMAIL CANNOT EXCEED 25 MB.) Complete and submit with all required attachments to: [email protected] and NJDEP Green Acres Program For G.A. Use Only Mail Code 501-01 Date Rec’d: ________________ P.O. Box 420 Application No. _____________ Trenton, NJ 08625-0420 Contact: (609)984-0500 ______________________________________________________________________________________________ PROJECT INFORMATION Project Title ___________________________________________Trail & Parking Improvements at Locust Grove, South__________ Mountain _______Reservation_______________________ Location of site __________________________________________________________South Mountain Reservation _______________________ Municipality(ies) ___________________________Millburn __________ County(ies) _______________________________Essex Street(s) _____Glen_____________________________________ Avenue ____________________________________________ Block(s) and Lot(s)_______________________________________Block 5503, Lot 1 _______________________________________ Size of site to be acquired or developed: ___650 acres Type of Application (select one): Acquisition: Will land be acquired in fee simple ______ or easement ______? Development: Is land owned by ______ or leased to*_______x the Nonprofit? (*Minimum 25-year lease must be provided upon project approval. Letter from landowner agreeing to do so must be submitted with application. Lease is subject to Green Acres’ approval.) State Legislative District (of project site)_____________NJ-27 Congressional District (of project site)_______________NJ-07 Total Estimated Cost of Project: Land Acquisition: Park Development: Land $____________ Construction $______________262,000.00 Survey $____________ Professional services Appraisal $____________ (up to 13% of construction) $______________34,060.00 Preliminary assessment $____________ Preliminary assessment $______________ Title $____________ Other costs (itemized) $______________52,400.00 Demolition* $____________ (contingency) Other related costs (itemized) $____________ Total project cost $____________ Total project cost $_______________348,460.00 Total request this round $ ______________ Total request this round $ _____________174,230.00 * Demolition and incidental costs will be limited to established caps. Profile of municipality and county in which project is located, per most recent census: Municipality: Area _____9.3 (in sq. mi.) Population _____20,308_____ Population per square mile: ________2,183 6 County: Area _____126.2 (in sq. mi.) Population __________808,825 Population per square mile: ________6,405 Estimated yearly operating/maintenance expenses after acquisition or development $____________________See attached. Have there been previous loans/grants related to this property? _____x Yes _____ No If yes, explain:____Other_______ grants ___did _______not address_________________________________________ parking and trails. Is the property listed on the New Jersey Register of Historic Places? ____Yes ______Nox (If yes, additional coordination with the NJDEP’s Office of Historic Preservation will be required, depending on the potential impact to the listed property. Please see www.nj.gov/dep/hpo/2protection/njrrevew.htm for more details.) Is the project site a current or former landfill site, known or suspected hazardous waste site, or adjacent to (or affected by) such sites? _____ Yes _____x No. If yes, explain: ________________________________________________________ Are there any structures located on the project site? Yes___ No___.x If yes, please describe the intended use of the structure(s) or if they will be demolished____________________________________________________________ (Please be aware that all structures must be used in support of outdoor recreation.) USE AND PUBLIC ACCESS INFORMATION Please describe the project in detail, including physical characteristics of site, existing land use, and intended short and long-term use of the project site. (Attach additional sheets, if necessary.) ________________________________ __________________________________________________________________________________________________ _______South Mountain___________________________________________________________________________________________ Reservation is a 2,110 acre nature preserve located in Essex County. The proposed project is located __________________________________________________________________________________________________in Millburn at the southern entrance to the park. Proposed improvements include upgrade of existing parking and ___________________________________________________________________trailhead areas, as well as the development of additional parking using permeable _______________________________surfaces. Describe the proposed public access to the site. _______________________________________________________________________________The park can be accessed at multiple points, including the Locust Grove Parking Area to be improved._______ The________ proposed project will enhance access to the site by increasing parking, improving circulation, and enhancing trailhead access ______________________________________________________________________________________________ points. ______________________________________________________________________________________________ ______________________________________________________________________________________________ If applicable, describe any possibility of transferring ownership of the site to any government agency or another qualifying nonprofit organization. ________________________________________________________________ ___________________________The property will remain under______ the__________________________________________________________ ownership of Essex County. __ For acquisition projects, has the project site been identified by a municipality or otherwise designated for use in meeting municipal fair share low- and moderate-income housing obligations under the Fair Housing Act of 1985 (N.J.S.A. 52:27D-301)? _____ Yes _______No If yes, please describe alternative plan to meeting such obligations, if known: ____________________________________________________________________________ _______________________________________________________________________________________________ 7 APPLICANT INFORMATION Name of applicant organization _________________________________________________________________South Mountain Conservancy a.k.a. _______________________________________________________________________________________ Address ____________P.O. Box 273_________________________________________________________________________ City ____________________________________South Orange State ____________________NJ Zip ___________07079 Telephone number (____) 973-868-6994_____ Fax number (___) _____________________ Chief Executive Officer ________________________________________________________________________Dennis Percher, Chair Does the organization qualify as a Charitable Conservancy for the purposes of P.L. 1979, c. 378 (C. 13:8B-1 et seq.)? ______x Yes _______ No (Please attach a letter from the organization's attorney certifying compliance.) N.J. Charitable Registration #:___________________CH2454600 from the New Jersey Department of Consumer Affairs, Office of Consumer Protection/Charitable Registration. All organizations with current registration are listed at http://www.njconsumeraffairs.gov/ocp/charities.htm Nonprofit must be registered and in full compliance with the Charities Registration and Investigation Act of 1994. (N.J.S.A. 45:17-A-18 et. seq.) State major purposes, activities, and membership policies of the organization: ___________________________South Mountain Conservancy is _____________________________________________________________________________________________a volunteer-driven, nonprofit corporation founded in March 2000. Through volunteer activities, public programs, __________________and partnership with the___________________________________________________________________________ Essex County Parks Department, the Conservancy serves as a steward and advocate for the _____________________________________________________________________________________________Reservation, striving to preserve, protect, and enhance the ecology, infrastructure, and nature beauty of the site. Please attach the bylaws. Describe your organization’s size, including number of staff, board members, committees, and membership. _____________________________________________________________________________________________There are 7 members of the Board of Trustees, one Operations Director, seven Program Coordinators (Forest _____________________________________________________________________________________________Regeneration (2), Hikes, Mayapple Trail, Chain Saw Gang, Trash Tacklers, and Curation), and four Hike Leaders. _____________________There were a total of 124________________________________________________________________________ members of the Conservancy in 2018. Please describe the proposed source of the required matching funds and any conditions of those funds (e.g. ownership interest in an acquisition project.) If matching funds are not in hand, please describe the status (i.e., planned application vs. pending application vs. secured award), amount (indicate anticipated or actual), and timing of award. ___________________________________________________________________________________
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