HomeMy WebLinkAboutIowa Department of Transportation-9/19/2011 (6)i®lowa Department Of Transportation
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1 Form 231027 (02-11)
Iowa Safe Routes to School
Noninfrastructure Grant Application
For a SRTS Study or Plan
CONTACT INFORMATION SHEET
Complete the information below and include this page as the first page of your application.
The person identified as the Contact will be the main point of contact for Iowa DOT staff.
Organization (check one) School ❑ District ❑ City A County ❑ State ❑ Other ❑
Project Title: Waterloo Safe Routes Education & Encouragement Campaign
Contact Name: Sandie Greco
Contact Title: Superintendent of Traffic Operations
Organization: City of Waterloo
Mailing Address: 408 E. 6th St.
City, State, Zip: Waterloo, IA 50703
Best Phone # to Call: (319) 291-4440
Contact E-mail: SANDIE.GRECO@WATERLOO-IA.ORG
Contact Fax: (319) 291-4094
Amount of SRTS Funding Requested: $65,000.00
School District: Waterloo School Name: Waterloo Schools
Brief Description of Your Project and Location: (one or two lines only) The proposed project is to
educate children and parents in the Waterloo School District in an effort to encourage walking/bicycling
to and from school through educational contests and prizes.
The award of Safe Routes to School funds; any subsequent funding or letting of contracts for design, construction,
reconstruction, improvement or maintenance; and the fumishing of materials for this project shall not involve direct or indirect
interest of any state, county or city official, elective or appointive. All of the above are prohibited by Iowa Code Sections 314.2,
362.5 or 331.342. Any award of funding or any letting of a contract in violation of the foregoing provisions shall invalidate the
award of Safe Routes to School funding and authorize a complete recovery of any funds previously disbursed.
Certification
To the best of my knowledge and belief, all information included in this application is true and accurate, including the
commitment of all physical and financial resources. This application has been duly authorized by the applicant. I understand
the following OFFICIAL ENDORSEMENT binds the applicant to assume responsibility for adequate maintenance of any new or
improved facilities.
I understand that, although this information is sufficient to secure a commitment of funds, an executed contract between the
applicant and the Department is required prior to authorization of funds.
Representhe Cit of Waterloo
Signature
Ernest G. Clark, Mayor
Typed Name and Title
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Date
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Date
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Iowa Department of Transportation
Form 105101 (02-11)
MINORITY IMPACT STATEMENT
Pursuant to 2008 Iowa Acts, HF 2393, Iowa Code Section 8.11, all grant applications submitted to the state of Iowa
that are due beginning January 1, 2009 shall include a Minority Impact Statement. This is the state's mechanism
for requiring grant applicants to consider the potential impact of the grant project's proposed programs or policies
on minority groups.
Please choose the statement(s) that pertains to this grant application. Complete all the information
requested for the chosen statement(s). Submit additional pages as necessary.
❑ The proposed grant project programs or policies could have a disproportionate or unique positive impact on
minority persons.
Describe the positive impact expected from this project.
Indicate which group is impacted:
❑ Women ❑ Persons with a disability ❑ Blacks ❑ Latinos ❑ Asians
❑ Pacific Islanders ❑ American Indians ❑ Alaskan Native Americans ❑ Other
❑ The proposed grant project programs or policies could have a disproportionate or unique negative impact on
minority persons.
Describe the negative impact expected from this project.
Present the rationale for the existence of the proposed program or policy.
Provide evidence of consultation with representatives of the minority groups impacted.
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Indicate which group is impacted:
❑ Women ❑ Persons with a disability ❑ Blacks ❑ Latinos ❑ Asians
❑ Pacific Islanders ❑ American Indians ❑ Alaskan Native Americans ❑ Other
The proposed grant project programs or policies are not expected to have a disproportionate or unique impact
on minority persons.
Present the rationale for determining no impact. The proposed project will serve to educate students and parents of
all ages and ethnicities. Therefore, no disproportionate or unique impacts on minority person are anticipated.
I hereby certify that the information on th's form is complete and accurate, to the best of my knowledge:
Signature: Ernest G. Clark
Title: Mayor
Definitions
"Minority Persons," as defined in Iowa Code Section 8.11, means individuals who are women, persons with a
disability, Blacks, Latinos, Asians or Pacific Islanders, American Indians, and Alaskan Native Americans.
"Disability," as defined in Iowa Code Section 15.102, subsection 7, paragraph "b," subparagraph (1):
b. As used in this subsection:
(1) "Disability" means, with respect to an individual, a physical or mental impairment that substantially limits
one or more of the major life activities of the individual, a record of physical or mental impairment that
substantially limits one or more of the major life activities of the individual, or being regarded as an
individual with a physical or mental impairment that substantially limits one or more of the major life
activities of the individual.
"Disability" does not include any of the following:
(a) Homosexuality or bisexuality.
(b) Transvestism, transsexualism, pedophilia, exhibitionism, voyeurism, gender identity disorders not
resulting from physical impairments or other sexual behavior disorders.
(c) Compulsive gambling, kleptomania, or pyromania.
(d) Psychoactive substance abuse disorders resulting from current illegal use of drugs.
"State Agency," as defined in Iowa Code Section 8.11, means a department, board, bureau, commission, or other
agency or authority of the state of Iowa.
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