<p> Municipal Infrastructure Grant MIG 1 Project Registration Form</p><p>Municipality Project Ref No: 1148 11/03/2004 Last Modified Project Name Amahlathi: Gasela - Bulk Water Supply Provincial Ref No: ALL FIELDS TO BE COMPLETED IN FULL </p><p>Project Infrastructure Type dd/mm/yyyy</p><p>Registration 01/04/2003 Date Received 01/04/2003 (FOR OFFICE USE ONLY) CONTENTS 1. Executive Summary 2. Applicant Details 3. Project Details 4. Project Feasibility 5. Socio Economic Impact 6. Outputs and Other Targets 7. Target Dates 8. Budget Control 9. Declaration 10. Certification by Municipal Manager 1. EXECUTIVE SUMMARY 1.1 Detailed Project Description:</p><p>Describe in detail the scope of the project including source, delivery area, communities and people to be served.</p><p>1.2 Special Municipal Infrastructure Fund (SMIF) Motivation: (Regional projects and Innovations only)</p><p>Provide sufficient motivation for SMIF funding as set out in the SMIF funding criteria/guidelines. 2. APPLICANT DETAILS 2.1 Name of Contact Person Responsible for the Project Applicant Amahlati Municipality Contact person Title: Mr Surname: Ahschlager Initials: A Position Works Manager</p><p>2.2 Address Postal Address Physical Address (if different from Physical) Maclean street Private Bag X2 Stutterheim Stutterheim</p><p>Postal Code 4930 Postal Code 4930 Email Address Fax 043-683 1127</p><p>Cellular Tel (Office) 043-683 1100</p><p>3. PROJECT DETAILS 3.1 Estimated Duration : </p><p> dd / mm / yyyy dd / mm / yyyy *Start Date: 01/02/2003 End Date: 29/09/2004 Duration (weeks) 86 weeks. Note: This period will be used to generate the cash flow period, and includes the retention period where the guarantee method is not used. *Start Date = Date on which design commenced.</p><p>3.2 Project Category</p><p>Labour Funding New Nodal Municipality EPWP Project? Rehabilitation SMIF U=Urban/ intensive Infrastructure Infrastructure project? (Yes/No) ISRDP/URP R=Rural (Yes/N (Yes/No) (Yes/No) Yes/No Yes\No EPWP Type Category Project o) Basic Residential Infrastructure (B) 0 3,733 Public Municipal Service Infrastructure (P) 0 0 Social Institutions and Micro Enterprises (E) 0 0 Note: (a) Select one of the following categories: a) Low-volume roads; b)Sidewalks; c) Storm-water drainage; d) Trenching and e) Other</p><p>3.3 Project Funding Applied For Project Infrastructure Training Total VAT Direct Costs Indirect Costs Type (Incl. VAT) Accredited Non- Accredited</p><p>Total Applied Training Source of Funds Total VAT Direct Costs Indirect Costs (Incl. VAT) Accredited Non- Accredited MIG Public sector**</p><p> a) Own Funds*</p><p> b) Loans*</p><p> c) Bonds*</p><p> d) Other*</p><p>Private Sector</p><p>2 Total Applied</p><p>Cost per Household (Total): Cost per Household (MIG): 75 Note: The 3.3.1 Cost per Household section is calculated from information received at 3.3 Project Funding and 3.6 Total Population of Suburb / Village directly benefiting from the Project Section of the Project Registration Form.</p><p>3.3.2 Percentage Labour Component to total project Cost</p><p>% Of Labour component to total project cost: Note: The 3.3.2 Percentage Labour section is calculated from information received at 3.3 Project Funding and 5.1 Employment Generation (Total value to local Community)</p><p>3.4 Project Funding Registered (National Office Use) Project Infrastructure Training Total VAT Direct Costs Indirect Costs Type (Incl. VAT) Accredited Non- Accredited</p><p>Total Applied Training Source of Funds Total VAT Direct Costs Indirect Costs (Incl. VAT) Accredited Non- Accredited MIG Public sector**</p><p> a) Own Funds*</p><p> b) Loans*</p><p> c) Bonds*</p><p> d) Other*</p><p>Private Sector Total Applied</p><p>Cost per Household (Total): Cost per Household (MIG): 75 Note: The 3.4.1 Cost per Household section is calculated from information received at 3.4 Project Funding Registered and 3.6 Total Population of Suburb / Village directly benefiting from the Project Section of the Project Registration Form.</p><p>3.4.2 Percentage Labour Component to total project Cost</p><p>% Of Labour component to total project cost: Note: The 3.3.2 Percentage Labour section is calculated from information received at 3.4 Project Funding Registered and 5.1 Employment Generation (Total value to local Community)</p><p>3 3.5 Project Location</p><p>Project Location Co-ordinates of the Project Province Eastern Cape</p><p>District Municipality Stutterheim Degrees ° Minutes ' Seconds '' Amahlati Longitude (E) 32 38 3 Local Municipality EC124 Latitude……….(S) 27 28 50 Nearest Business * Municipalities that fall within a rural context and setting, i.e. :> 50 km from an Centre Stutterheim urban Centre are also considered to be rural. Distance to Business Amatole Centre(km) DC12 3.6 Total Population of Suburb / Village directly benefiting from the project. </p><p>Total Total No. of Suburb/Village benefiting Population Households benefiting 75</p><p>4. PROJECT FEASIBILITY 4.1Beneficiaries (Poor Households – Those with household expenditure of below R1, 100.00 per month) Number of Beneficiaries (Persons) Formal Areas yyyyyyyyy Informal Areas 0 Total Residents 450 </p><p>75 low-income household will be served in this Number of Poor Households new development. dd/mm/yyyy Formal: No of New Stands 75 Date of Last Count 30/04/2001 Formal: No of Existing Stands (Rehabilitation) 0 No of Households 75 Informal: No of Backyard Dwellings 0 Informal: No of Households 0 Total 75 </p><p>Household Size 6 people per household on average. Average household size vvvvvvv6 </p><p>4.2 Household Contributions Income Analysis Ability to Contribute Yes No Average Monthly Expenditure 0 Number of households with the ability to contribute for service 450 </p><p>What is the Municipality’s strategy on Household contributions for higher level of service? Comment</p><p>4</p><p>4.3 Free Basic Services</p><p>The Municipality undertakes to implement a policy for free basic services System identified? Yes No </p><p>Describe</p><p>4.4 Backlog of service applied for</p><p>Backlog Total number of Total number of Total number of (remaining after Main Village/ Settlement/ Households to Households in Municipal households with below completion of Town Village/ Suburb benefit from Area (1) basic level of service (2) the project) project (3) = 2-3</p><p>Total</p><p>4.5 Operation and Maintenance Cash Flow Projection.</p><p>Expected Operating Expected Maintenance Total O & M Cost Period/Term Cost (1) Cost (2) (3=1+2) Year1 Year2 Year3 Year4 Year5 Total</p><p>GENERIC INDICATORS: 5. SOCIO ECONOMIC IMPACT 5.1 Employment Generation 5 Total Adult Youth Disabled Number of Persons Number of planned to be persons employed Women Men Female Male Female Male Number of persons planned to be employed 0 (A) Average length of employment (days) (B) Number of planned person days C = A x B 0 Please note: - The definition of youth is any person under the age of 35 years. (18-35 Years) - Each person may only be counted once. If a person falls into more than one category, disabled persons take preference, then youth, then adults. - Must include all occupational categories (Clerical, Labourer, Managerial, Semi skilled, Skilled and Supervisor). Permanent Employment after Construction</p><p>Total number of permanent employees to be appointed after the completion of the project Local Labourers</p><p>Average wage rate (per day) a</p><p>Number of labourers planned to be employed (Person Days) (Total of C) b </p><p>Total Value to local Community c Note: Calculation / Formula c= a x b </p><p>5.2 Employment Policy </p><p>Use of labour-based construction methods Use Yes/No Yes No </p><p>Details of policy and plans</p><p>Employment policy Describe</p><p>Maximum use of local labour Maximum use of local labour? Yes No </p><p>Reasons if not possible:</p><p>Use of ABE i.t.o the affirmable procurement policy Use of HDI's i.t.o. policy? Yes No Number of contractors planned Reasons if not possible:</p><p>Use of SMME i.t.o the affirmable procurement policy Use of HDI's i.t.o. policy? Yes No Number of contractors planned Reasons if not possible:</p><p>6</p><p>Community involvement at project level Community project involvement? Yes No </p><p>Describe nature of Involvement</p><p>5.3Training needs Analysis and Framework</p><p>Has a training needs analysis been done? Yes/No Yes No </p><p>Describe, If no motivate</p><p>Has a training framework been submitted? Yes/No Yes No </p><p>Description of training framework</p><p>5.4 Planned Training Activities 5.4.1 Accredited Training </p><p>Planned number Planned number Adult Youth Disabled of persons to be Training Type of training days trained Women Men Female Male Female Male Administration 0 0</p><p>Technical</p><p>Lifeskills/ ISD</p><p>Literacy & Numeracy</p><p>Vocational Skills</p><p>Business Skills</p><p>Total Training</p><p>5.4.2 Non-Accredited Training</p><p>7 Planned number Planned number Adult Youth Disabled of persons to be Training Type of training days trained Women Men Female Male Female Male Administration 0 0</p><p>Technical</p><p>Lifeskills/ ISD</p><p>Literacy & Numeracy</p><p>Vocational Skills</p><p>Business Skills</p><p>Total Training</p><p>5.5 Sanitation, Health and Hygiene </p><p>Has the community participated in a health and hygiene programme in the past Yes/No Yes No Describe</p><p>Effectiveness of the health and hygiene programme in the past Not effective [1-5] effective Describe</p><p>5.6 Environmental Protection </p><p>Has an environmental scoping report been registered? Yes/No Yes No Reg No Comments</p><p>Impact of this project on the environment and measures to limit negative No threat[1-5]Major</p><p> impact impact Describe</p><p>Water conservation and use Describe</p><p>SPECIFIC INDICATORS: 6. OUTPUTS AND OTHER TARGETS YOU WANT TO MONITOR 6.1 Basic Residential Infrastructure (B) Water (NB: Technical Report to be submitted to DWAF) 8 Water: Bulk Services: Geohydrological </p><p>Investigation Total Component Cost uuuu Construction Duration (months) uuuuuuuuuu Level of Service to be provided (1-Basic, 2- Number of boreholes planned Intermediate, 3-Full) Capacity of all boreholes required (l/s) Comments</p><p>Water: Bulk Services: Boreholes Total Component Cost uuuuuu Construction Duration (months) uuuuuuu Level of Service to be provided (1-Basic, 2- Number of boreholes planned Intermediate, 3-Full) Capacity of borehole planned (l/s) Comments</p><p>Water: Bulk Services: Reservoirs</p><p>Total Component Cost 154,500 Number of ground level reservoirs planned 0 Number of new reservoirs planned 3 Number of Towers planned 3 Number of reservoirs to be rehabilitated 0 Construction Duration (months) 1 Existing capacity for community Level of Service to be provided (1-Basic, 2- Capacity of all reservoirs planned (m3) Basic Intermediate, 3-Full) Comments Reservoir will consist of 3 x 10 m3 tanks erected on 6m steel stands.</p><p>Water: Bulk Services: Water treatment plants Total Component Cost Construction Duration (months) Existing capacity of WTW (m3 per Day) Level of Service to be provided (1-Basic, Number of new water treatment plants planned 2-Intermediate, 3-Full) Number of water treatment plants to be</p><p> rehabilitated Capacity of water treatment plants planned</p><p>(m3 per day) Comments</p><p>Water: Bulk Services: Pump stations</p><p>Total Component Cost 124,767 Construction Duration (months) 1 Level of Service to be provided (1-Basic, 2-Intermediate, 3- Number of new pump stations planned 1 Basic Full) Number of pump stations to be rehabilitated 0 Capacity of pump stations planned/ Existing 0 (l/s) Comments Supply and installation of electric submersible pump with a duty point of 5.4 m3/hr @ 74.9m and a power rating of 2kW.</p><p>Water: Bulk Services: Raw water storage dam</p><p>Total Component Cost Number of new Raw water storage Construction Duration (months) vvvvvvvvvvvvv dams planned Capacity of Raw Water Storage Level of Service to be provided (1-Basic, 2-</p><p> planned (m3) Intermediate, 3-Full) Number of Raw water storage dams</p><p> to be rehabilitated Exisiting capacity of Raw water</p><p> storage</p><p>9 Comments</p><p>Water: Connector Services: Supply lines</p><p>Total Component Cost ddfdd23,420 Construction Duration (months) fffffffgg1 Length of new main supply line Level of Service to be provided (1-Basic, 2- planned Intermediate, 3-Full) Length of main supply line to be G ggggggggddddf272 Labour Intensive Construction: Yes/No rehabilitated ggggggasic Capacity of all supply lines ddfddfdffdfdfddfdffrererrdffdf0 planned/existing (l/s) Diameter of supply line</p><p> planned/existing (mm) Comments mPVC Class 6 pipe.</p><p>Water: Connector Services: Pump stations Total Component Cost Construction Duration (months) Level of Service to be provided (1-Basic, 2- Number of new pump stations planned Intermediate, 3-Full) Number of pump stations to be</p><p> rehabilitated Capacity of pump station planned (l/s) Comments</p><p>Water: Connector Services: Reservoirs Total Component Cost Construction Duration (months) Existing capacity of Reservoirs Level of Service to be provided (1-Basic, 2- Number of reservoirs planned Intermediate, 3-Full) Number of reservoirs to be</p><p> rehabilitated Capacity of all reservoirs planned (m3) Comments</p><p>Water: Reticulation: Stand pipes Total Component Cost Construction Duration (months) Number of stand pipes to be Level of Service to be provided (1-Basic, 2-</p><p> reticulated Intermediate, 3-Full) Comments</p><p>Water: Reticulation: Metered stand pipes Total Component Cost Construction Duration (months) Number of metered stand pipes to be Level of Service to be provided (1-Basic, 2-</p><p> reticulated Intermediate, 3-Full) Comments</p><p>Water: Reticulation: Water meters Total Component Cost Construction Duration (months) Number of water meters to be Level of Service to be provided (1-Basic, 2- 16,520 1 reticulated Intermediate, 3-Full) Comments Water meter installed at bulk storage point.</p><p>10 Water: Reticulation: Pipe lines Total Component Cost Construction Duration (months) Level of Service to be provided (1-Basic, 2- Length of pipe line to be reticulated Intermediate, 3-Full) Capacity of all pipe lines to be Labour Intensive Construction: Yes/No reticulated (l/s) Diameter of pipe line to be reticulated </p><p>(mm) Comments</p><p>Water: Summary of Technical Details Current water demand Demand (l/capita/day) State</p><p>Future water demand Projected(l/capita/day) State</p><p>Supply Present water source (i.t.o type, quantity and reliability) (l/capita/day) State</p><p>Projected supply Future water source (i.t.o type, quantity and reliability) (Ml/day) State</p><p>Present water infrastructure Describe</p><p>Future water infrastructure Describe</p><p>Present water quality Meets potable standard? Yes No Describe</p><p>11 Future water quality No threat [1-5] Major impact Describe Threats</p><p>Are the legal aspects of water sources and abstraction in order? Yes/No Yes No Comment</p><p>Population growth trends Estimated growth % Description of trend and data accuracy</p><p>Sanitation (NB: Technical Report to be submitted to DWAF) Sanitation: Bulk Services: Treatment works Total Component Cost Construction Duration (months) Existing Capacity Number of treatment works to be Level of Service to be provided (1-Basic, 2-</p><p> rehabilitated Intermediate, 3-Full) Capacity of treatment works planned</p><p>(m3/day) Comments</p><p>Sanitation: Bulk Services: Oxidation ponds Total Component Cost Construction Duration (months) Existing Capacity Number of oxidation ponds to be Level of Service to be provided (1-Basic, 2-</p><p> rehabilitated Intermediate, 3-Full) Capacity of oxidation pond planned</p><p>(m3) Comments</p><p>Sanitation: Bulk Services: Pump stations Total Component Cost Construction Duration (months) Level of Service to be provided (1-Basic, 2- Number of new pump stations Intermediate, 3-Full) Capacity of pump station planned (l/s) Comments</p><p>Sanitation: Connector Services: Main outflow lines Total Component Cost Construction Duration (months) Level of Service to be provided (1-Basic, 2- Length of new main outflow lines Intermediate, 3-Full) Capacity of Main outflow lines Labour Intensive Construction: Yes/No planned (l/s) Diameter of Main outflow lines</p><p> planned (mm) Comments</p><p>12</p><p>Sanitation: Connector Services: Pump stations Total Component Cost Construction Duration (months) Level of Service to be provided (1-Basic, 2- Number of new pump stations Intermediate, 3-Full) Capacity of pump station planned (l/s) Comments</p><p>Sanitation: Reticulation: Toilets Total Component Cost Number of bucket to be eradicated Number of new toilets planned to be Construction Duration (months) built Level of Service to be provided (1-Basic, 2- Number of toilets to be rehabilitated Intermediate, 3-Full) Comments</p><p>Sanitation: Summary of Technical Details Which toilet technologies will be proposed in the programme/project? Toilet Technologies</p><p>Single pit VIP toilets Yes/No Yes No </p><p>Double pit VIP toilets Yes/No Yes No </p><p>Urine diversion toilets Yes/No Yes No </p><p>Other technologies Yes/No Yes No </p><p>Specify</p><p>What types of top-structures will be proposed in the Programme/project? At least three different types of top-structures must be promoted in each project to offer participants a choice in line with their preferences and affordability levels. Top Structures</p><p>Masonary Yes/No Yes No </p><p>Traditional materials Yes/No Yes No </p><p>13 Archloo Yes/No Yes No </p><p>Prefabricated structure Yes/No Yes No</p><p>Upgrade using existing structures Yes/No Yes No </p><p>Other Yes/No Yes No </p><p>Specify</p><p>Roads and Related Stormwater Roads and Stormwater: Local </p><p>Distributors: Gravel Total Component Cost Construction Duration (months) Kilometers of new gravel roads Level of Service to be provided (1-</p><p> planned Basic, 2-Intermediate, 3-Full) Kilometers of gravel roads to be Labour Intensive Project (Yes/No) rehabilitated Comments</p><p>Roads and Stormwater: Local Distributors: Paved Total Component Cost Construction Duration (months) Kilometers of new paved roads Level of Service to be provided (1-Basic, 2-</p><p> planned Intermediate, 3-Full) Kilometers of paved roads to be Labour Intensive Project (Yes/No) rehabilitated Comments</p><p>Roads and Stormwater: Local Distributors: </p><p>Tarred Total Component Cost Construction Duration (months) Kilometers of new tarred roads Level of Service to be provided (1-Basic, 2-</p><p> planned Intermediate, 3-Full) Kilometers of tarred roads to be Labour Intensive Project (Yes/No) rehabilitated Comments</p><p>14 Roads and Stormwater: Access Collectors: </p><p>Gravel Total Component Cost Construction Duration (months) Kilometers of new gravel Access Level of Service to be provided (1-Basic, 2-</p><p>Collectors planned Intermediate, 3-Full) Kilometers of gravel Access Collectors Labour Intensive Project (Yes/No) to be rehabilitated Comments</p><p>Roads and Stormwater: Access Collectors: </p><p>Paved Total Component Cost Construction Duration (months) Kilometers of new paved Access Level of Service to be provided (1-Basic, 2-</p><p>Collectors planned Intermediate, 3-Full) Kilometers of paved Access Collectors Labour Intensive Project :(Yes/No) to be rehabilitated Comments</p><p>Roads and Stormwater: Access Collectors: </p><p>Tarred Total Component Cost Construction Duration (months) Kilometers of new tarred Access Level of Service to be provided (1-Basic, 2-</p><p>Collectors planned Intermediate, 3-Full) Kilometers of tarred Access Labour Intensive Project:(Yes/No) Collectors to be rehabilitated Comments</p><p>Roads and Stormwater: Low-Water Bridges: Total Component Cost Construction Duration (months) Level of Service to be provided (1-Basic, 2- Low-Water Bridges planned Intermediate, 3-Full) Low-Water Bridges to be rehabilitated Labour Intensive Project:(Yes/No) Comments</p><p>Solid Waste Solid Waste: Bulk Services: Skips \Bins Total Component Cost Duration (months) Level of Service to be provided (1-Basic, 2- Number of Skips\Bins planned Intermediate, 3-Full) Comments</p><p>Community Lighting Community Lighting: Lighting: High mast Total Component Cost Construction Duration (months) Level of Service to be provided (1-Basic, 2- Number of new high masts planned Intermediate, 3-Full) Number of high masts to be</p><p> rehabilitated Comments</p><p>Community Lighting: Lighting: Street lights Total Component Cost Construction Duration (months)</p><p>15 Level of Service to be provided (1-Basic, 2- Number of new street lights planned Intermediate, 3-Full) Number of street lights to be</p><p> rehabilitated Comments</p><p>Stormwater Stormwater: Channels Total Component Cost Construction Duration (months) Cross sectional area Level of Service to be provided (1-Basic, 2- Kilometers of new channels planned Intermediate, 3-Full) Kilometers of channels to be Labour Intensive Construction: Yes/No rehabilitated Comments</p><p>Stormwater: Pipelines Total Component Cost Construction Duration (months) Pipe Diameter Level of Service to be provided (1-Basic, 2- Kilometers of new pipelines planned Intermediate, 3-Full) Kilometers of pipelines to be Labour Intensive Construction: Yes/No rehabilitated Comments</p><p>Stormwater: Retention Ponds Total Component Cost Construction Duration (months) Existing Capacity Level of Service to be provided (1-Basic, 2- Number of ponds planned Intermediate, 3-Full) Labour Intensive Construction: Yes/No Number of ponds to be rehabilitated </p><p>Total volume of ponds involved Comments</p><p>6.2 Public Municipal Service Infrastructure (P) Bus Shelters (Public) Bus Stop Shelters Total Component Cost Number of lights to be installed Area to be paved (m2) Number of toilet facilities Size of administration offices to be built Drainage (m2) Facilities for informal traders (m2) Construction Duration (months) Level of Service to be provided (1-Basic, 2- Area under cover (m2) Intermediate, 3-Full) Number of shelters to be accommodated Comments</p><p>Taxi Ranks (Public) Taxi Ranks Total Component Cost Number of lights to be installed Area to be paved (m2) Number of toilet facilities Size of administration offices to be built Drainage (m2) </p><p>16 Facilities for informal traders (m2) Construction Duration (months) Level of Service to be provided (1-Basic, 2- Area under cover (m2) Intermediate, 3-Full) Number of taxis to be accommodated Comments</p><p>Sidewalks (Public) Sidewalks: Gravel Total Component Cost Construction Duration (months) Kilometers of new gravel Sidewalks Labour Intensive Project (Yes/No) planned Kilometers of gravel Sidewalks to be</p><p> rehabilitated Comments</p><p>Sidewalks: Paved Total Component Cost Construction Duration (months) Kilometers of new paved Sidewalks Labour Intensive Project (Yes/No) planned Kilometers of paved Sidewalks to be</p><p> rehabilitated Comments</p><p>Sidewalks: Tarred Total Component Cost Construction Duration (months) Kilometers of new tarred Sidewalks Labour Intensive Project (Yes/No) planned Kilometers of tarred Sidewalks to be</p><p> rehabilitated Comments</p><p>Sidewalks: Pedestrian Bridges Total Component Cost Construction Duration (months) Number of new Pedestrian Bridges Labour Intensive Project (Yes/No) planned Number of Pedestrian Bridges to be</p><p> rehabilitated Comments</p><p>Fire Fighting Facilities (Emergency Services)</p><p>Total Component Cost Construction Duration (months) Level of Service to be provided (1-Basic, 2- Number of Facilities to be built Intermediate, 3-Full) Floor area of facilities to be built Comments</p><p>Disaster Management Facilities (Emergency Services)</p><p>Total Component Cost Construction Duration (months) Level of Service to be provided (1-Basic, 2- Number of Facilities to be built Intermediate, 3-Full) Floor area of facilities to be built </p><p>17 Comments</p><p>Health Services – Clinics (Community Services) Health Services - Clinics Total Component Cost Construction Duration (months) Level of Service to be provided (1-Basic, 2- Number of clinics to be built Intermediate, 3-Full) Number of beds catered for Floor area of clinics Comments</p><p>Multi Purpose Centre/ Facility - Community Facilities (Community Services) Community Facilities: Community Halls Total Component Cost Construction Duration (months) Level of Service to be provided (1-Basic, 2- Number of community halls to be built Intermediate, 3-Full) Floor area of community halls to be</p><p> built Comments</p><p>Community Facilities: Recreational Facilities\ </p><p>Sport Facilities Total Component Cost Construction Duration (months) Number of multi-purpose fields to be Level of Service to be provided (1-Basic, 2-</p><p> built Intermediate, 3-Full) Number of sports types to be</p><p> accommodated Comments</p><p>Community Facilities: Admin. Facilities Total Component Cost Number of admin. offices to be built Surface area of building Number of officials Size of admin. offices to be built Number of councillors Value of admin. offices to be built Construction Duration (months) Level of Service to be provided (1-Basic, 2- Size of council chamber Intermediate, 3-Full) Comments</p><p>Community Facilities: Multi Purpose Centre Total Component Cost Construction Duration (months) Number of Offices\ Rooms to be Level of Service to be provided (1-Basic, 2-</p><p> accommodated Intermediate, 3-Full) Floor area of MPC to be built Comments</p><p>Parks and Open Spaces (Community Services) Parks and Open Spaces Total Component Cost Construction Duration (months) </p><p>18 Level of Service to be provided (1-Basic, 2- Number of Parks to be built Intermediate, 3-Full) Number of Park types to be</p><p> accommodated Comments</p><p>Child Care Facilities /Nurseries Facilities/ Nurseries Total Component Cost Construction Duration (months) Surface area of building Number of staff Level of Service to be provided (1-Basic, 2- Size of facility to be built Intermediate, 3-Full) Value of facility to be built Comments</p><p>Beaches and Amusement Facilities Beaches and Amusement Facilities Total Component Cost Construction Duration (months) Level of Service to be provided (1-Basic, 2- Number of Facilities to be built Intermediate, 3-Full) Size of facility to be built Value of facility to be built Comments</p><p>Note: Describe the planned structure Cemeteries Community Facilities: Cemeteries Total Component Cost Number of offices Access Roads (km) Number of store rooms Internal Roads (km) Construction Duration (months) Level of Service to be provided (1-Basic, 2- Fencing (km) Intermediate, 3-Full) Number of graves </p><p>Number of ablutions Comments</p><p>Crematoriums Crematoriums Total Component Cost Number of offices Access Roads (km) Number of store rooms Internal Roads (km) Construction Duration (months) Level of Service to be provided (1-Basic, 2- Fencing (km) Intermediate, 3-Full) Number of crematoriums</p><p>Number of ablutions Comments</p><p>Fencing Fencing Total Component Cost Construction Duration (months) Level of Service to be provided (1-Basic, 2- Access Roads (km) Intermediate, 3-Full)</p><p>19 Internal Roads (km) Fencing (km) </p><p>Local Amenities Local Amenities Total Component Cost Number of staff Surface area of building Construction Duration (months) Level of Service to be provided (1-Basic, 2- Size of local Amenity to be built Intermediate, 3-Full) Value of local Amenity to be built Comments</p><p>Municipal Abattoirs Municipal Abattoirs Total Component Cost Number of offices Access Roads (km) Number of store rooms Internal Roads (km) Construction Duration (months) Level of Service to be provided (1-Basic, 2- Fencing (km) Intermediate, 3-Full) Number of Municipal Abattoirs</p><p>Number of ablutions Comments</p><p>Libraries Community Facilities: Libraries Total Component Cost Construction Duration (months) VVVVVVV Area (m2) VVVVVV Level of Service to be provided (1-Basic, 2-Intermediate, 3-Full) VVVVVVV Number of Libraries facilities Planned Furniture Comments</p><p>Solid Waste Disposal Site Solid Waste: Bulk Services: Solid waste removal site Total Component Cost Construction Duration (months) Number of new solid waste removal Level of Service to be provided (1-Basic, 2-</p><p> sites planned Intermediate, 3-Full) Number of solid waste removal sites Volume to Cater \excepted life time to be rehabilitated Comments</p><p>Solid Waste: Bulk Services: Refuse transfer stations Total Component Cost Construction Duration (months) Number of new refuse transfer Level of Service to be provided (1-Basic, 2-</p><p> stations planned Intermediate, 3-Full) Number of refuse transfer stations to</p><p> be rehabilitated Comments</p><p>20 Facilities for Animals Facilities for Animals Total Component Cost Construction Duration (months) Level of Service to be provided (1-Basic, 2- Number of Animal facilities to be built Intermediate, 3-Full) Floor area of Animal facility to be built Comments</p><p>6.3 Social Institutions and Micro-Enterprises Infrastructure (E) Street Trading Street Trading Total Component Cost Construction Duration (months) Level of Service to be provided (1-Basic, 2- Number of Trading Units to be built Intermediate, 3-Full) Floor area of street trading to be built Comments</p><p>Markets Markets Total Component Cost Construction Duration (months) Level of Service to be provided (1-Basic, 2- Number of markets to be built Intermediate, 3-Full) Floor area of market to be built Comments</p><p>Local Tourism Local Tourism Total Component Cost Construction Duration (months) Level of Service to be provided (1-Basic, 2-</p><p>Intermediate, 3-Full) Comments</p><p>7. TARGET DATES ITEMS </p><p>Target Date</p><p>Item to track dd/mm/yyyy 1 Design Report Approved 2 Tenders Awarded 3 Contract Signed 4 Contractor on Site 5 Contractual Conditions met</p><p>21 6 Construction Completion Date 7 Final Payment (Retention Payment is Final)</p><p>9. DECLARATION (To be completed by the Municipal Manager) I declare that we will implement the Project based on: Declaration</p><p>1. Maximum use of local labour Maximum use of local labour? Yes No Reasons if not possible: Will not meet 30% expenditure on local labour due to skilled eletrical and pump work. However local labour will be used for all trenching, pipe and cable laying and backfilling and also erected of steel stands.</p><p>2. Use of BEE i.t.o. the affirmable procurement Use of BEE's i.t.o. policy? Yes No policy BEE stands for Black Economic Empowerment</p><p>3. Community involvement at project level Community project involvement? Yes No Describe nature of Involvement if no, give reasons. The Local Municipality identified this development and will liaise with the DM and relevant Government Departments and Service Providers and community.</p><p>4. The Municipality undertakes to Submit Monthly, Quarterly and Close Out Reports on Report in prescribed format? Yes No prescribed dates If No, Reasons:</p><p>5. Approval of Project and Operation and Resolution forwarded? Yes No Maintenance Budget Resolution Number 81/48/22/1/2 Date of Resolution 30/07/2002 Comments</p><p>6. Will the municipality maintain the asset? Maintain the asset? Yes No Measures to be taken if No:</p><p>22 7. Does municipality set, bill & collect tariffs? Operate the system? Yes No Measures to be taken if No:</p><p>8. Project form part of an approved three-year Yes No Capital Plan? IDP No: 31/03/2002 Comments</p><p>9. Will the project form part of a Municipal Agreement Signed? Yes No Service Partnership? Duration of Contract Date Signed Value of Contract Comments N/A</p><p>10. Approval by Dept. of Water Affairs and Approved? Yes No Forestry of the technical report. DWAF reference number: Date approved Comments TR will be submitted to DWAF for approval</p><p>11. Does the project require an Environmental Yes/No? Yes No Impact Assessment? Duration (months) </p><p>13. Submit audits on prescribed dates Report in prescribed format? Yes No </p><p>15. Has Council approved the Registration Form for submission? Approved? Yes No </p><p>If not, why?</p><p>23 16. Labour Intensive (EPWP) Project only.</p><p> a) Will the DPW/EPWP guidelines be utilized on the project? Yes No </p><p>If No, Reason:</p><p> b) Will the Consultant and Contractor appointed on the project employ personnel that comply with specific requirements of the CETA NQF qualifications Framework? Yes No </p><p>If No, Reason:</p><p>17. Undertake to implement the project in accordance with their Occupation Approved? Yes No health and Safety specification. If not, why?</p><p>10. CERTIFICATION BY MUNICIPAL MANAGER Who warrants that he is authorized to do so and confirms that: 1. All details contained in this application are correct 2.The Municipality will immediately advise the Provincial MIG Manager if the project above receives funding from another source, and, that should funds be granted on this programme then, they will withdraw their funding application to other government grant funding programme. It is not illegal to "apply" for funds from two sources, however, it is illegal to accept money from two Government funding mechanisms for the same project. This is known as double funding. 3. The project is reflected in the Municipality's three-year Capital Development Plan. 4. The project has been approved by Council Council Approval</p><p>The project has been approved by council Council Resolution No.: 81/48/22/1/2 On: 30/07/2002</p><p> dd/mm/yyyy</p><p>Signed by Municipal Amahlati Municipality Date signed 22/05/2003 Manager on behalf of: Contact person 24 Title: Mr Surname: Magwangqana Initials: N.C. </p><p>Signature </p><p>Email Address Fax 043-683 1127</p><p>Cellular Tel (Office) 043-683 1100</p><p>11. CERTIFICATION BY PMM (Provincial MIG Manager)</p><p> dd/mm/yyyy</p><p>Signed by Provincial MIG Amahlati Municipality Date signed 22/05/2003 Manager on behalf of: Contact person Title: Mr Surname: Magwangqana Initials: N.C. </p><p>Signature </p><p>Email Address Fax 043-683 1127</p><p>Cellular Tel (Office) 043-683 1100</p><p>12. CERTIFICATION BY SMM (Senior Manager MIG)</p><p> dd/mm/yyyy</p><p>Signed by Senior Manager Amahlati Municipality Date signed 22/05/2003 MIG on behalf of: Contact person Title: Mr Surname: Magwangqana Initials: N.C. </p><p>Signature </p><p>Email Address Fax 043-683 1127</p><p>Cellular Tel (Office) 043-683 1100</p><p>13. CERTIFICATION BY SMF (Senior Manager Finances)</p><p> dd/mm/yyyy</p><p>Signed by Senior Manager Amahlati Municipality Date signed 22/05/2003 Finances on behalf of:</p><p>25 Contact person Title: Mr Surname: Magwangqana Initials: N.C. </p><p>Signature </p><p>Email Address Fax 043-683 1127</p><p>Cellular Tel (Office) 043-683 1100</p><p>26</p>
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