HomeMy WebLinkAboutexhibit3Florida Department of State, Division of Library and Information Services
R.A. Gray Building, 500 South Bronough Street, Tallahassee, FL 32399-0250
Public Library Construction Grant Program
Payment Request #1
At least 30% of the construction costs must be expended before this payment request can be
submitted. Complete this form and submit along with the following items, or indicate that the
items are already on file with the Division.
Organization Name:
Project Number
Project Name:
Required Document
On File
With
the
Division
Attached
Not
App1icii<ble
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1.
Specific location of site and a narrative evaluation of the site of
the building to be constructed, expanded, or remodeled that is
prepared and signed by a professional librarian functioning as a
library building consultant. The site evaluation should justifyii;f'R
the choice of site considering:
a. Community growth and traffic pattern projections for the
future;
b. Adequate parking, taking into consideration local zoning
and building codes;
c. Convenient access to major pedestrian and vehicular
traffic routes; and
d. Physical characteristics of the site.
2.
Certification that the construction project will be in compliance
with Federal Executive Order 11988 Floodplain Management,
as amended byExecutive Order 12148, includingcertification'''
that the use of flood plains in connection with the construction
will be avoided as far as practicable. If problems are identified
in the analysis, the Division must be informed of how the,
problems will be corrected.
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3.
Assurance that the site selected for the construction project
does not interfere with the protection of properties listed in the
National Register of Historic Places in accordance with Section
267.061, Florida Statutes. If problems are identified in the
analysis, the Division must be informed of how the problems
will be corrected.
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Public Library Construction Grant Program
Payment Request #1 (DLIS/PLCO2), Effective: 1/9/2003
Page 1 of 3
Required Document
On File
With
the
Division
Attached
Not
Applicable
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4. Assurances, such as a deed, showing that the applicant has legal
title to the property and building, a long-term lease of not less
than 20 years or a resolution adopted by the applicant's'
governing body, that the applicant has unconditional use of the
site and the building. If a resolution is used as proof, it shall
state whether the applicant owns or leases the site and building.
5. Subsurface soil analysis. If problems are identified in the
analysis, the Division must be informed of how the problems
will be corrected.
6. A comparison of the proposed project to .6 square feet perE�"
capita for total floor space and standards for library facilities
and services. Cite standards used and the source of standards.
This shall include at a minimum:
1. Total floor space;
2. The amount and kind of space required for all library
functions, including both public and staff areas, meeting
space, and space for specific services;
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3. The amount of parking required for library, patron, and'�['r;.
staff vehicles;
4. Shelving required;
5. Staffing required;
6. Lighting required; and
7. Telecommunications and electrical requirements.'
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7. A list of the kind and amount of initial furniture and
equipment needed for the project.
8. Final floor plan with furnishings and equipment.
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9. Final site plan.
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10. Final elevations.
11. Changes in the final floor plan, site plan and elevations after
the project has been let for bid.
Public Library Construction Grant Program
Payment Request #1 (DLIS/PLCO2), Effective: 1/9/2003
Page 2 of 3
Required Document
On File
With
the
Division
Attached
Not
Applicable
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12. Certification that the project was competitively bid and
awarded in accordance with Section 255.20, Florida Statutes,
and local bidding requirements. If competitive negotiations
are used, the certification shall include that the contract was
awarded in accordance with Section 287.055 Florida Statutes.
13. Executed contract for architectural services between the
owner and architect.
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14. Complete and executed contract(s) for construction that
shows the total cost to construct the facility or the guaranteed
maximum price.
15. Application and Certificate for Payment (AIA Document
G702) and Continuation Sheeta(AIA Document G703), or the
equivalent showing at least 30% of the construction
completed.
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I hereby certify that the information provided is accurate to the best of my knowledge; that all
provisions of the library construction guidelines and the grant agreement have been met; that
sufficient local matching funds have been disbursed, obligated, or are currently available, and at
least 30% of the construction costs have been expended.
Signature:
Signature:
Project Manager or Authorized Official Chief Financial Officer of Governing Body
Print/Type Name Print/Type Name
Title
Title
Name of Agency Name of Agency
Date Date
Public Library Construction Grant Program
Payment Request 41 (DLIS/PLCO2), Effective: 1/9/2003 Page 3 of 3