Office of Congressman Tim Bishop Surface Transportation Reauthorization Project Request Form INSTRUCTIONS: 1. ALL APPLICATIONS ARE DUE BY 5:00pm ON FRIDAY, April 24th, 2009. * No exceptions will be made. Applications received after this date may not be eligible for submission. 2. ***DO NOT ALTER THIS FORM*** altered forms may not be considered. 3. ALL SUBMISSIONS MUST BE MADE VIA E-MAIL. * Please return the questionnaire as an attachment via e-mail. If your organization does not have access to e-mail, arrangements must be made with my Office BEFORE the February 20th deadline. * Please do not attempt to submit your application(s) by mail. 4. NOTICE OF DISCLOSURE: * In order to ensure an open and transparent process, please be advised that by submitting this form to Rep. Bishop, the requestor agrees to public disclosure of the request and related information provided in support of a request pursuant to the rules and guidelines for the U.S. House of Representatives and the House Committee on Transportation & Infrastructure. Any and all information may be posted on the websites of the House Committee on Transportation & Infrastructure and the Office of Congressman Tim Bishop. 5. COMPLETED APPLICATIONS: * Completed applications must be submitted via E-MAIL to: mark.copeland@mail.house.gov * In the subject line of your e-mail, please include your organization�s name followed by Surface Transportation Reauthorization Project Request. Example: Organization X � Surface Transportation Reauthorization Project Request. Thank you for your cooperation and patience through this process. Please know that while the appropriations process begins early in the year, the vast majority of bills will not be considered by congress until the end of the calendar year. If you have any questions or Concerns, please contact my Legislative Director, Mark Copeland at: Mark Copeland Legislative Director Office of Congressman Tim Bishop 306 Cannon House Office Building Washington, D.C. 20515 (202) 225-3826 mark.copeland@mail.house.gov 1. Name of Project: Long Island State Veterans Home Transportation and Roadway Improvements 2. Project Priority: IMPORTANT NOTE: Organizations are allowed to submit a maximum of three (3) projects. 3. Name of Submitting Institution (legal grantee name) Projects will only be accepted by state and municipal agencies. Non-profit organizations and for-profit organizations must partner with a municipality to be eligible for consideration: Stony Brook University 4. Address of Submitting Institution: Please include both Street Address and P.O. Box, if applicable Street: P.O. Box (if applicable): City: State: Zip Code: Website: 5. Contact Information for Highest Level Person Who may Congressman Bishop contact? Name: Title: Work Phone: Cell Phone: Email Address: 6. Contact Information for Project Level Person Who may Bishop Staff contact with project questions? Name: Title: Work Phone: Cell Phone: Email Address: 7. If you have submitted this request to any other Members of Congress or Senators please list them here: PROJECT SPECIFICS: 8. What type of project would you describe your request? Pick one of the following: Highway/road, bridge, tunnel, bicycle/pedestrian, Intelligent Transportation System (Technology), Intermodal Freight Facility, Public Transit, Rail, Research, or Other. Highway/road, bicycle/pedestrian, public transit, and other (ADA and safety) 9. Is this project eligible under Title 23 (Highways) or Chapter 53 of Title 49 (Public Transit) of the U.S. Code is the project request? Requests for non-surface transportation projects, such as transportation museums, horse trails, or historic battlefields, will not be accepted. 10. Did the Federal Highway Administration (FHWA), Federal Transit Administration (FTA), or New York State Department of Transportation (NYSDOT), or public transit agency confirm that the project is eligible under Title 23 (Highways) or Chapter 53 of Title 49 (Public Transit) of the United States Code? Please identify the entity that confirmed the project eligibility and list their contact information. 11. Is the project located on a Federal-aid highway? NO 12. Is the project located on the National Highway System? NO 13. Is the project located on the Interstate System? NO Public transit refers to transportation services provided to the general public via a variety of vehicle modes, including buses, subways, light rail, commuter rail, monorail, passenger ferry boats, transit van pools, streetcars, inclined railways, and paratransit vehicles. Public transit does not include school bus or charter bus services, nor intercity passenger rail (such as Amtrak), high-speed rail, or private rail operations. For these types of rail projects, please proceed to the Rail portion. 14. Which description best describes your transit proposal? * Passenger Vehicles (Transit bus or van; transit rail car or locomotive, including streetcars; transit ferry) * Transit Facilities (Vehicle maintenance or administration facility, passenger facility, including intermodal facilities, stations, and terminals) * Transit Rights-of-Way (Property acquisition, corridor development, rail track construction or maintenance, bus-only lane construction or maintenance * Transit Equipment (vehicle-related equipment, system-related equipment) * New Start Project (A New Start project is a major new fixed guideway capital project seeking more than $75 million in Federal funds.) * Small Start Project (A Small Start project is a new fixed guideway capital project seeking less than $75 million in Federal funds and with a total estimated net capital cost of less than $250 million.) * OTHER � Roadway safety, site lighting, ADA compliance, drainage, executive order 111 , and executive order 142 for alternative fuel buses 15. Which description best describes your rail proposal? * Intercity Passenger Rail (Intercity rail passenger transportation means rail passenger transportation, except commuter rail passenger transportation. Commuter rail passenger transportation means short-haul rail passenger transportation in metropolitan and suburban areas usually having reduced fare, multiple-ride, and commuter tickets and morning and evening peak period operations. Intercity rail passenger transportation projects are not commuter rail projects. Funds for commuter rail projects should be requested under public transit, not under intercity passenger rail.) * Freight Rail (Class I freight rail, Class II or Class III freight rail) 16. Which description best describes your research proposal? * University Transportation Center * Other 17. Please identify the state, regional, or local governmental entity that is an eligible recipient of the funds. This can be NYSDOT, local government, the Metropolitan Planning Organization, transit agency. Entity Name: Street: P.O. Box (if applicable): City: State: Zip Code: Entity Contact: Title: Work Phone: Cell Phone: Email Address: 18. Project Description - Please identify the specific segment or activity for which project funding is requested (i.e. project location and scope). Be specific. Examples: Improvements to NY112 from Old Town Road to NY347; or Road and pedestrian safety improvements on Montauk Highway, between NYS Route 112 and Suffolk County Road 101 in Suffolk County: The Long Island State Veterans Home, in applying for this intermodal and site improvement grants wishes to provide a contextual solution to several issues along Patriots Road and on the grounds of the LISVH. Traffic and site monitoring revealed several problems that can be resolved through this grant. Integration of pedestrian, bicycle, and vehicular circulation routes will be addressed through hardscape and landscape planning and construction. The design will address: 1. ADA compliance issues 2. New York State University Construction Fund Directive of minimum site lighting requirements for roadways, pedestrian walkways, and parking areas. 3. Integration of the LISVH with Stony Brook University in interregional passenger facilities, with a new bus shelter and bus stop improvements at the building entrance 4. Improvement of on-site truck delivery and loading areas 5. Site engineering and improvement of water run off, site grading, and respective hardscapes and landscapes. 6. Meet New York State (NYS) Executive Order 111 through the installation of bike racks, solar lighting where eligible, and other sustainable means of site improvement issues and executive order 142 � encouraging use of alternate fuels, both consistent with the Department of Energy Federal Energy management Program (FEMP) guidelines. 7. Purchase of two new fully ADA compliant buses for the use of the residents at the LISVH � with the use of biodiesel as an acceptable alternative fuel. IMPORTANT NOTE: Eligible projects must be financed to at least 80 percent of the total estimated cost of the specific segment or activity by the amount requested by Congressman Bishop and other specifically designated Federal, state, local, or private funding sources. 19. If you are requesting funding for a specific segment or activity, what is the total estimated cost for that project segment or activity? $4,085,188.00 20. If you are requesting funding for a specific segment or activity, what is the estimated cost for the overall project? 21. What is the amount of funding being requested for consideration by Congressman Bishop? $3,268,150.00 22. All anticipated sources of funding for the project segment and the amount expected from non-congressional sources (e.g. State, Local, Private): $817,037.00 23. If you are requesting funding for a specific segment or activity, please describe the overall project of which this segment/activity is a part: (Please limit your response to 3-4 sentences) Roadway safety, site lighting, ADA compliance, drainage, executive order 111 , and executive order 142 for alternative fuel buses 24. Overall project description: (Please limit your response to 3-4 sentences) 25. Is the project included in the State�s Long-Range Transportation Plan? If so, please provide the date of approval of the most recent version of the plan and the title of the plan. 26. Is the project included in the Metropolitan Transportation Improvement Program (TIP) and/or State Transportation Improvement Program (STIP)? If so, please provide the date of approval of the most recent version of the program(s), and the title of the program(s). 27. If the project is an intercity passenger rail project, is it included in the State Rail Plan? Please provide the date on which the Governor approved the most recent version of the plan, and the title of the plan. 28. Please describe the current status of the project and the expected schedule for its completion. * Federal-aid Highway projects - In Planning, In Environmental Review, In Final Design, In Right-of-Way Acquisition, Under Construction * Public Transit projects - In Planning, In Alternatives Analysis, In Preliminary Engineering, In Final Design, Under Construction or Procurement * Rail projects - In Planning, In Environmental Review, In Preliminary Engineering, In Design, Under Construction * Research - Under Research, Under Development, Under Demonstration, Under Deployment In planning 29. What is the expected date of completion of the project for which you are requesting funding? TBD 30. Does the project have regional or national significance? (A project of regional and national significance is typically a high-cost transportation infrastructure facility that often includes multiple levels of government, agencies, modes of transportation, and transportation goals and planning processes that are not easily addressed or funded within existing surface transportation program categories. These projects have national and/or regional benefits, including improving economic productivity by facilitating international trade, relieving congestion, and improving transportation safety by facilitating passenger and freight movement.) YES 31. Please describe the regional or national significance of the project: (Please limit your response to 3-4 sentences) The Long Island State Veterans Home (LISVH) is distinctive in servicing the nursing home and adult day care needs of honorably discharged members of our armed forces, their spouses, and Gold Star Parents. The LISVH serves all of Long Island and is the regional State Veterans Home, one of five(5) in New York State. Coupled with the fact that we are the only State Veterans Home residing on a university campus in the United States, we hold a unique spot in the region and nationally. As part of a State University campus, we overlap with a larger community, essentially a high-density facility in a typical suburban setting. The populations that come to our facility include not only our adult day care registrants and staff, but also family members, visitors, community program members, and university program participants through our medical education and volunteer curricula. We have been proactive in engaging county buses to include us as a stop. These funds would further solidify our regional uniqueness by making our facility available via many modes of transportation, including additional bus service, biking (including linking our new bike path to the existing campus bike path), and safe ADA compliant sidewalks and paths 32. Describe the safety, economic development, mobility, and environmental benefits associated with completion of the project. If there are the safety benefits, please describe (Limit your response to 2-3 sentences) Safety benefits � The LISVH will achieve safety benefits through addition of blue light emergency phones (connected to the University Police) and remediation of physical limitations by combining pedestrian plans and ADA transition plans and upgrading existing outside lighting to meet the State University Construction Fund Directive of minimum site lighting requirements for roadways, pedestrian walkways, and parking areas If there are the economic development, please describe (Limit your response to 2-3 sentences) Economically � By providing safer and ADA compliant walkways and bike paths, as well as providing a bus shelter and alternative fuel buses, we will provide easy and inexpensive access to the Long Island State Veterans Home. If there are the mobility benefits, please describe (Limit your response to 2-3 sentences) Congestion Mitigation � The LISVH will mitigate congestion by providing barrier free sidewalks and plazas along the roadways, and full site integration with the existing grounds, improvement of on-site truck delivery and loading areas, and an additional bus shelter for bus service, as well as procurement of alternative fuel buses. If there are the environmental benefits, please describe (Limit your response to 2-3 sentences) Environmentally � The LISVH will meet New York State (NYS) Executive Order 111 through the installation of bike racks, solar lighting where eligible, and other sustainable means of site improvement issues and executive order 142 � encouraging use of alternate fuels, both consistent with the Department of Energy Federal Energy management Program (FEMP) guidelines. Finally, the creation of an additional compactor bay � housing a new recycling compactor on site will be consistent with State University campus directives for campus recycling. 33. Has the project previously received any Federal funding? If yes, please list the year in which the project received funding and amount of funding received. NO 34. Has the project received any prior funding from a State, local, or private source? If yes, please state the amount and the source. NO PROJECT SUPPORT: Projects submitted to Congressman Bishop must meet all eligibility requirements to be considered for funding. Sponsors whose project(s) are deemed eligible by Rep. Bishop�s staff in consultation with the House Committee on Transportation & Infrastructure, NYSDOT, FHWA, FTA, and FRA will be contacted at a later date to submit at least two (2) letters of support from a state, regional, or local governmental official specifically supporting the project request. This letter should discuss the merits of the project; specify the process to provide the public with an opportunity to comment on the project; and identify the other sources of Federal, state, or private funding that will be used to complete this project or project phase. This letter must contain an explicit statement of support for the project. In consultation with Congressman Bishop�s office, the letter must identify no less than 80 percent of the total estimated cost of the specific segment or activity from specifically designated Federal, state, local, or private funding sources. Please use boldface font to highlight these statements in the letter.