Spreadsheet: 0c5fc1c8-79a1-460e-9f74-5f1381e4d405
Sheet: Sheet1

Unnamed: 0 | Unnamed: 1 | Unnamed: 2 | Unnamed: 3
 | Public Art Eligibility Form
 | This form is administered by OMF in accordance with Chapter 5.74 and subsequent rules. When submitting CIP budget documents to the Office of Management and Finance, each project in its first budget year shall include a Public Art Eligibility Form. Bureau CIP budgets and budget revisions that do not contain a Public Art Eligibility Form for each Capital Project will not be considered complete by OMF.
 | Project Title: |  | Bureau:
 | Project Manager: |  | Ext:
 | Is this a priliminary budget or a final budget? |  | □ Prelim  □ Final
 |  | If preliminary, please submit the Public Art Eligibility Form as preliminary.
 |  | If final, please submit the Public Art Eligibility Form as final.
 | Is this project associated with a building, structure, park, public utility, street, sidewalk or parking facility or any portion thereof? |  | □ Yes  □ No
 |  | If no, you do not need to complete the contribution calculation below.
 | Is this project maintenance and/or repair? |  | □ Yes  □ No
 |  | If yes, please breifly describe the maintenance and/or repair:
 |  | You do not need to complete the contribution calculation.
 | Is this projects's capital cost more than $50,000? |  | □ Yes  □ No
 |  | If no, you do not need to complete the contribution calculation.
 | Is your bureau contributing more than $50,000 in funding? |  | □ Yes  □ No
 |  | If no, you do not need to complete the contribution calculation.
 | Is your project funded wholly by ineligible funds? |  | □ Yes  □ No
 |  | If yes, you do not need to complete the contribution calculation. Ineligible costs are: Local Improvement District revenue, Water Operating Fund revenue, Water Construction Fund revenue, Sewer Systems Operating Fund revenue, Sewer Systems Construction Fund revenue and revenue from any other funding source subject to legal restrictions which preclude Public Art as an object for expenditure
 | Is this project debt financed? |  | □ Yes  □ No
 |  | If yes, please state the revenue source that will pay for art administration
 |  | costs and maintenance costs.
 | State and Federal Grants
 |  | Expending State and Federal Grants could meet the intent of Chapter 5.74. If grant precludes Public Art, grant language demonstrating preclusion may be requested.
 | Contribution Calculation
 | Total Estimated Project Costs (all years) |  | 0
 | Exempt Costs
 |  | Administration Costs
 |  | Building Demolition Costs
 |  | Design Costs
 |  | Engineering Costs
 |  | Environmental Testing Costs
 |  | Fees and Permits
 |  | Indirect Costs (list)
 |  | 1.
 |  | 2.
 |  | 3.
 |  | 4.
 |  | Land Acquisition Costs
 |  | Non-construction contingency
 |  | Relocation of Tenants Costs
 | Exempt Cost Subtotal |  | 0
 | Net Eligible Costs |  | 0
 | Total Estimated Project Funds (all years) |  | 0
 | Exempt Funds
 |  | Federal Grants that preclude Public Art as an object for expenditure
 |  | State Grants that preclude Public Art as an object for expenditure
 |  | Federal or State Grant local matching funds
 |  | Local Improvement District (LID) Revenue
 |  | Private Development Revenue
 |  | Sewer Systems Operating Fund
 |  | Sewer Systems Construction Fund
 |  | System Development Charges
 |  | Water Operating Fund
 |  | Water Construction fund
 | Exempt Funds Subtotal |  | 0
 | Net Eligible Funds |  | 0
 | [NAME] of the Two Net Values |  | 0
 | To Qualify, Net Value Greater Than or Equal to $50,000 |  | 0
 | Times Percent for Art (2%) |  | 0.02
 | Estimated Dollars for Art |  | 0