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Page 1 of 2 CITY OF DOUGLAS SIDEWALK , CURB & GUTTER REPLACEMENT COST SHARE APPLICATION/AGREEMENT This 50/50 Cost sharing program is designed to help with the cost of repairing damaged, cracked, and heaved public sidewalks. In order to qualify for the utilization of this program, you must provide two quotes from contractors licensed with the City of Douglas. Please be aware that the City has a minimum amount of funds available each fiscal year for this program; qualifying projects are completed on a first-come, first-serve basis. Also, be aware that if there are no funds at the time of your application, you must reapply once funds are available again. Required paperwork is available at Public Works, 420 W. Grant Street, or on the City’s website at www.cityofdouglas.org under the “Departments” tab. Applications are approved by the Project Coordinator and then must be taken to Douglas City Hall, Finance Dept., 101 N. 4th Street, where payment for your costs must be made. Once payment is made, you are required to bring your application and receipt back to Public Works for finalization of your application. The Program Coordinator will make all necessary copies and distribute them, and then your project may commence. Questions? Contact Steve Martinez, Project Coordinator/Streets & Alleys Supervisor at [PHONE REDACTED]. PLEASE COMPLETE THE FOLLOWING INFORMATION. APPLICATION MUST BE PRINTED, SIGNED, AND SUBMITTED TO PROGRAM COORDINATOR. Property Owner: Address of Property: Mailing Address (if different from above): Telephone: Email: I, to participate in a joint sidewalk, curb and gutter rehabilitation program with the City of Douglas. I understand that no preference shall be given to any application due to geographic location, zoning, or proximity to other construction. I understand that applications shall be considered on a first-come, first-serve basis and subject to budget availability, provided the property meets the necessary deterioration criteria as outlined in the City of Douglas Sidewalk, Curb & Gutter Rehabilitation Policy. I understand that as a participant in the rehabilitation program, I am required to remit to the City of Douglas Finance Department fifty percent (50%) of the estimated total cost of sidewalk rehabilitation. Upon payment, the owner will present proof of payment to the Public Works Department and the property shall be placed on the list for construction. I understand that property owners participating in the cost-share program may use a City contractor or a licensed contractor of their choice, subject to the approval of the Program Coordinator. ---PAGE BREAK--- Page 2 of 2 I understand that work must be performed only on those sections approved by the Coordinator. I understand that work shall be limited to replacement of existing sidewalk, curb and gutter and associated incidentals (e.g. saw-cutting, replacement of sod, etc.). I understand that following completion of construction and acceptance of work by both the City and the property owner, the completed work will be measured. Based on these measurements and the Contract Unit Prices for the various items of work, a final determination of costs will be made. Should the final determination be less than the original estimate, the property owner shall remit fifty percent (50%) of the coverage to the City. Signature of Applicant: Date: Proposed Contractor: DO NOT WRITE BELOW THIS LINE PROGRAM COORDINATOR ACTION Date Application Received: Verification of Deterioration: Description of Rehabilitation Needs: Area Measurements: Contractor Quote Per Square Foot: Contractor Quote Per Lineal Foot: Estimated Cost of Construction: 50% Cost-Share: Receipt Number From Finance Dept. (Attach Copy): Date Completed: Actual Measurement: Actual Cost: Credit Due Property Owner: Balance Due From Property Owner: Date Finance Dept. Advised of Credit/Balance: SIGN