CAPITAL OUTLAY — Page 1
Capital Outlay Request Form Page 1	Capital Outlay Request Form Page 2	Capital Outlay Request Form Page 3

LEGISLATIVE COUNCIL SERVICE 48TH LEGISLATURE-FIRST SESSION-2007   CAPITAL OUTLAY REQUEST FORM Will project prevent deterioration of asset or correct infrastructure problems of asset? (Yes or No) Is project necessary to address population or client growth, and if so, will it provide direct services to that population or clientele? (Yes or No) Planning Criteria Has project been thoroughly planned? (Yes or No) Is project ready to begin? (Yes or No) If not, when can it begin? _______________________________                             Has project received prior funding? (Yes or No) If yes, list prior funding sources, dates and amounts: ____________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Can project be completed with this legislative appropriation? (Yes or No) Have matching funds or a local share been secured for the project? (Yes or No) If yes, list other funding sources and amounts: _________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Have operational costs for completed project been identified and planned for? (Yes or No) Has the project had public input and buy-in? (Yes or No) Has the project been designed to be energy efficient in its operation? (Yes or No) Can construction of the project be successfully phased, so that Each phase will be operational? (Yes or No)  8.  Is this a nonprofit entity, economic development or non-ICIP project?                     (See additional requirements on page 1 of this form.) If you answer “Yes”, please attach supporting documentation. What is the total estimated cost of the project?  (Please use the most accurate estimate to date, and indicate what portion of the project has been completed.) Planning: _________________________________________________________________ Design: __________________________________________________________________        Construction: ______________________________________________________________ Other (please specify): _______________________________________________________ Total: ____________________________________________________________________ 10.  What is the amount needed to complete the project? (if different than #9)____________________ 11.  Has the land for the project been acquired?  (Yes or No) What entity will be or is the owner of the land? ___________________________________________

Capital Outlay Request Form Page 1

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