Royalties for the Regions - Round 4
Expression of interest
Please ensure all relevant sections of this form are completed. Please refer to the Royalties for the Regions
Program Guidelines when completing this form.
All figures in this form must exclude GST.
Following the assessment process, applicants will be notified in writing of the outcome of all applications.
Should you have any questions or require any assistance, please contact the Royalties for the Regions
program team on (07) 3452 7377 or 13 QGOV (13 74 68).
Part A: Applicant details
Council
Part B: Project details
500 character constraint
Project title
1000 character constraint
Project description
Indicate which best describes the project:
Water/sewerage/waste infrastructure (e.g. water supply, sewerage systems, landfills)
Social infrastructure (e.g. multipurpose health facilities, childcare centres)
Cultural, sports and recreational infrastructure (e.g. museums, parks, sporting complex)
Roads and transport infrastructure (e.g. local roads, causeways, road upgrades, sealings, airports)
Flood mitigation infrastructure (e.g. levees, floodgates, dams, drainage improvements)
Other infrastructure (e.g. agricultural, communications, energy, economic infrastructure)
Is this project:
New infrastructure
Upgrade of existing infrastructure
Replacement of existing infrastructure
Other (please specify):
Chainage
(Required for
Roads projects
only)
Please list all chainage details for all works relevant to this project. Please include all
chainage locations, including start work and end work points, width, length, etc.
Road Classification
(Required for
Roads projects
only)
For example, local roads of regional significance, district roads, locally controlled roads
and other eligible road classifications.
Estimated project timeframe
Commencement date
Completion date
Part C: Project contact
Please provide a contact person from the council for correspondence and enquiries regarding this project and
application for funding.
Title
First name
Surname
Position
Phone
Mobile
Fax
Email
Postal address
Street address
Town/suburb
Postcode
Part D: Project site
Project site address
Street address
Town/suburb
Postcode
For GIS spatial mapping purposes, please attach either an ESRI Shape File or MapInfo Tab File for this project
site (if available) OR complete the Real Property Description fields below.
ESRI Shape file
Attach file:
MapInfo TAB file
Attach file:
Other GIS file
Attach file:
Real Property description of the project site:
Lot
Parish
Registered Plan
County
Title Reference
Please provide all the relevant longitude and latitude coordinates for all work sites relevant to this project, i.e.
start and finish coordinates.
Longitude
Start:
Longitude
Finish:
Longitude range is numeric between 0.0 and 180.0
Latitude
Start:
Latitude
Finish:
Latitude range is numeric between -90.0 and 0.0
Are there any land issues which need to be addressed for this project to proceed (e.g. land ownership, native
title, a road reserve, strategic cropping land issue etc)?
Yes
No
* If yes, please provide an explanation and supporting documentation.
Character limit 1000
Part E: Project costings
Provide a breakdown of the proposed financial contributions to the project.
Royalties for the Regions funding sought
(ex GST)
Council contribution
How much will council contribute towards this project (not including in-kind contributions or ongoing
costs such as maintenance and repair costs)?
(ex GST)
Other financial contributions
Please detail all proposed or confirmed financial support that will be provided by any other
organisations (in-kind contributions are not to be included)
Funding
contributor
Category
Queensland
Government;
Australian
Government;
Industry; Other
Name of
organisation
Total contributions
Contribution
description
Amount
(ex GST)
For example, Name of
government grant or
purpose of funding.
Funding
status
Funding
status details
Confirmed or
not confirmed
Please provide
details if any
special
conditions
apply or when
funds are likely
to be confirmed
$
Please note the total estimated project cost equals the total amount of funding being sought
plus total council contribution plus total other financial contributions.
TOTAL ESTIMATED PROJECT COST
(ex GST)
Part F: Response to assessment criteria
1. What need, issue or opportunity will this project address?
Please summarise the problem, need, or opportunity this project is designed to address. Where possible
please quantify the scale of the problem/need.
Character limit 2000
Please describe the current road conditions (for roads projects only):
Crash History
500 character constraint
AADT (per cent of
Heavy Vehicles)
(Date):
500 character constraint
Deficiencies
500 character constraint
Future safety
assessment
Does the proposed scope of work make any aspect of the road less safe? For
example, traffic moved closer to hazards, or approach speed to a tight curve
increase) 500 character constraint
Other Information
500 character constraint
2. How will this project address the problem, need or opportunity?
Where possible, benefits should be quantified. For example: new jobs created; estimated value of new
investment; increased flood immunity; protection of built environment; higher level of community safety;
reduced costs; improved community access; improved amenity; more reliable infrastructure.
Character limit 1000
3. How will this project improve the regional economy and/or liveability, e.g. job growth, new industry
opportunities, increased flood immunity, protection of the built environment, community safety,
amenity, accessibility to services etc?
Please describe how this project will impact the local economy and generate future economic growth and/or
improve liveability.
Character limit 1000
4. Please outline any further evidence to support your case, including any community or regional
support for the project. Evidence may include letters of support, traffic history data or reports, or
flood history data etc.
If community consultation has previously occurred, existing supporting documentation may be attached or
where available online, the relevant hyperlinks provided.
Character limit 1000
5. Does the project align with existing planning? Is the project currently prioritised in state, local or
regional planning material?
Please describe how the project aligns with existing planning and identify any planning documents that
prioritise the project or its aims.
Character limit 1000
6. Have other solutions been considered?
Yes
(provide details)
No
(provide details)
500 Character constraint
7. Why is this project the preferred option?
Character limit 1000
8. Are approvals, permits and/or licences required for this project?
Yes
No
In progress
9. Does council have a plan in place to manage and fund the ongoing costs of this project (such as
maintenance and repair costs)?
Yes
No
10. Does this project link to an infrastructure or social impact mitigation strategy from a project
environmental impact statement?
Yes
No
11. How have you determined the cost of this project?
For example, costs identified by quantity surveyor.
Character limit 500