Container Deposit Scheme Infrastructure Grants Application Form Important information: The CDS Infrastructure Grant Guidelines provides information that will help you to answer each of the questions in this application. Please refer to this when you are filling out this form. The Northern Territory Government implemented a Container Deposit Scheme (CDS) on 3 January 2012. The scheme allows a 10 cent deposit refund to consumers for regulated beverage containers. The aim of the Container Deposit Scheme (CDS) is to minimise litter and environmental pollution through the recovery, re-use and recycling of beverage containers. This is made possible by providing communities throughout the Territory, as far as practicable, access to facilities for the collection of empty containers and the refund of the deposit. The CDS is administered by the NT Environmental Protection Authority (NT EPA) and the activities are regulated under the Environment Protection (Beverage Containers and Plastic Bags) Act. The CDS Infrastructure Grants Program is designed to support the establishment of the CDS throughout the NT. The program provides funding for the purchase of equipment or infrastructure to assist with establishing CDS Collection Depots or Collection Points throughout the NT. The NT EPA encourages eligible businesses and organisations within the community to apply. The CDS Infrastructure Grants provide one-off funding in 2015-16 for a recommended amount of $30 000 for businesses and organisation in the Northern Territory to purchase CDS equipment or infrastructure. All projects must be completed within 12 months. The total funding is limited so applicants are encouraged to limit their applications to $30 000. All complete applications will be assessed on their merit against the assessment criteria detailed in the CDS Infrastructure Grant Guidelines. Projects will only be funded if the assessment criteria are met and funds are available. Submission details Completed applications may be submitted in one of the following ways: 1. Email: Containerdepositgrants@nt.gov.au (Preferred option) 2. Post: Waste and Resource Recovery Team - CDS Northern Territory Environment Protection Authority GPO Box 3675 DARWIN NT 0801 The Avenue Level 2, Suite 201 12 Salonika Street PARAP NT 0820 3. Hand deliver: Once your application has been received by our office, we will send you a confirmation email. If you have not received this email within seven days, please phone the Waste and Resource Recovery Team on 1800 752 632. NORTHERN TERRITORY ENVIRONMENT PROTECTION AUTHORITY 1 Container Deposit Scheme Infrastructure Grants Section A – Applicant Information 1. Name of business or organisation a) Does your business conduct all or most of its work in the Northern Territory? Yes No If yes, estimate what percentage of your work is in the NT, indicate what you have based this on (e.g. percentage of employees based in NT)and outline the locations that your business conducts work b) Does your business or organisation have audited accounts? Yes No c) Does your business or organisation have an annual report? Yes No d) Does your business or organisation have any funding from previous NT EPA or Northern Territory Government grants that has not yet been acquitted? Yes No If yes please provide reasons why: NORTHERN TERRITORY ENVIRONMENT PROTECTION AUTHORITY Container Deposit Scheme Infrastructure Grants 2. Contact details Project Officer Street address First name Town/suburb Surname State Phone Postcode Postal address Fax Mobile Town/suburb Email State Position Postcode GST Registered? Yes No ABN or ACN 3. Type of organisation (select one or more) Private enterprise/business; Incorporated non-profit organisation; Aboriginal or Torres Strait Islander Organisation; Education institution, training provider or school; Committee established by legislation; Local government; Other (please specify) 4. Is the infrastructure intended for a Collection Point or a Collection Depot? a) A Collection Point (no 10 cent refund per container provided to those dropping off containers for donation) Yes (see below) No (Go to Q 4b) If yes, provide details of how the Collection Point will operate? (E.g. who you anticipate will donate the approved containers to the collection point; how the approved containers might be collected from donors; how you will access a Collection Depot to collect the $0.10 refund for each of the approved containers collected; who will manage the collection point etc.). NORTHERN TERRITORY ENVIRONMENT PROTECTION AUTHORITY Container Deposit Scheme Infrastructure Grants OR b) A Collection Depot (operator will pay a refund amount of $0.10 per approved container to individuals or businesses that take them to the Collection Depot) If a Collection Depot, have you submitted an application to operate a CDS Collection Depot? Yes No If yes, please provide details including but not limited to your application submission date or approval number; If no, please provide details of when it will be submitted and outline how the depot will operate (container handling, storage, transport etc.) You may provide information about the depot operation in the form of an attached business plan or extract. NORTHERN TERRITORY ENVIRONMENT PROTECTION AUTHORITY Container Deposit Scheme Infrastructure Grants 5. Landholder permission Please confirm whether you are the land or lease holder for the location where you intend conduct your project. If applicable please confirm that have permission from the land holder to use the location to conduct your project (i.e. operate your Collection Point or Collection Depot)? Landholder Lease holder (provide details) Permission for project granted by landholder (provide details) Please note if you are not the landholder or the holder of the lease where you intend to conduct your project you will require written consent to operate your Collection Point or Collection Depot. You may also be required to provide a copy of this by request from the assessment panel. The NT EPA recognises that much of the land in the NT is subject to the provisions under the Aboriginal Land Rights (Northern Territory) Act (ALRA). If this is the case for the land on which your operations will be held, you will need to ensure that you are compliant with the ALRA and that you consult with the relevant land council (e.g. Central Land Council, Northern Land Council, Anindilyakwa Land Council or Tiwi Land Council) NORTHERN TERRITORY ENVIRONMENT PROTECTION AUTHORITY Container Deposit Scheme Infrastructure Grants Section B - Project summary 6. Amount of grant requested (indicate GST exclusive and GST amounts separately) 7. Location of infrastructure Address: Name of Community / Town: Council or Shire: Names of other communities able to access the infrastructure: 8. Type of equipment or infrastructure to be purchased/constructed 9. What infrastructure is already on site? NORTHERN TERRITORY ENVIRONMENT PROTECTION AUTHORITY Container Deposit Scheme Infrastructure Grants Section C – Additional Project Information 10. How will the new infrastructure assist you in operating your Collection Point or Collection Depot? 11. How will your operation encourage or provide an opportunity for the community to participate in the Container Deposit Scheme? (E.g. describe planned activities such as marketing to promote community participation; or involvement in community events or programs; or how you will interact with the community as applicable) 12. Will your operation create or contribute to creating long-term facilities for the future collection of other recyclable material? If yes, explain how. (E.g. describe the types of materials that could be collected and the timeframe for incorporating additional materials) NORTHERN TERRITORY ENVIRONMENT PROTECTION AUTHORITY Container Deposit Scheme Infrastructure Grants 13. Does your operation have community support? If yes, supply documents or other information from the community that demonstrate this. (Support documents from the community may be listed here and included as attachments to your application) 14. General employment and Indigenous employment and participation Will there be opportunities for people to be employed (directly or indirectly) in your project? Yes No If yes: Number people directly involved Number of people indirectly involved Explain their involvement If yes, do you anticipate your project will contribute to employment (directly or indirectly) of Indigenous people? Yes No If yes, then please note how many of the above total number of positions you anticipate will be filled by Indigenous people, and where applicable indicate which of these positions will be targeted specifically for Indigenous people, e.g. as part of a ‘special measures’ program. Number of Indigenous people directly involved Number of Indigenous people indirectly involved Explain their involvement NORTHERN TERRITORY ENVIRONMENT PROTECTION AUTHORITY Container Deposit Scheme Infrastructure Grants 15. Will your operation provide services to regional/remote communities that are not currently serviced comprehensively by the program? If yes, describe how these services will be provided and to which communities. 16. What commitments have you and/or partners made to or plan for the operation? This could include: an existing Business Plan (attach if applicable); committed business partners and/or funding; in-kind contributions or support; ongoing involvement; and timeframe for delivering your commitments/ contributions in your project proposal including any commitments/ contributions already made. NORTHERN TERRITORY ENVIRONMENT PROTECTION AUTHORITY Container Deposit Scheme Infrastructure Grants Section D – Project budget and account details 17. Funding from other sources Have you or are you intending to apply for funding for this project from another source? Yes No If yes, please specify source and purpose: 18. Project partners Name of Organisation or Department Contact name $ Contribution (GST exc.) GST 19. Proposed budget for the project Examples of infrastructure that can be purchased under this grants program includes balers, bins, bags, cages, shipping (or other materials) containers, fencing and security equipment (e.g. chains and padlocks), concrete slabs, signs, roadways, trailers, built structures (e.g. shed, admin office) and labour/salaries for installation of infrastructure. Note: Ongoing service contracts for transport and labour/salaries will not be funded. Activity / budget item Grant contribution In-kind or other contribution Total cost (GST exc.) NORTHERN TERRITORY ENVIRONMENT PROTECTION AUTHORITY GST Note/comment Container Deposit Scheme Infrastructure Grants 20. Approved Account Details Please ensure you provide the correct bank account details to allow us to release the funds to your approved account should your application be successful Bank Name: BSB No: Account Name: Account No: Section E - Authorisation By submitting your application you are declaring that: you have acquitted all previous grants (with expired acquittal due date(s)) from the NT EPA and the NT Government; the proposed project will not duplicate funding already provided under other funding sources for the purpose intended; and that the project does not duplicate existing facilities in the community (where duplication is not necessary). Signature of person declaring the above: Name and date NORTHERN TERRITORY ENVIRONMENT PROTECTION AUTHORITY