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Program Category: 08 Project # 09 Project # 10 Project # Yes No NA Funding Source Accounting Code FY10 FY11 FY12 FY13 FY14 - - - - - - Budgeted Funds Accounting Code FY10 FY11 FY12 FY13 FY14 A. Land Cost B. Construction Cost C. Contingencies (10% of B) D. Design & Engineering (15% of B) E. Percent for Art of B) F. Equipment Costs G. Other - - - - - - Expense Object Accounting Code FY10 FY11 FY12 FY13 FY14 Personnel Supplies Purchased Services Fixed Charges Capital Outlay Debt Service - - - - - - Responsible Person: Responsible Department: Preparer's Initials Total Score - Project Title: Date Submitted to Finance Today's Date and Time 06/05/2009 9:49 Description of additional operating budget impact: OPERATING BUDGET COSTS Spent in Prior Years Funded in Prior Years REVENUE EXPENSE Is this equipment prioritized on an equipment replacement schedule? Are there any site requirements: How is this project going to be funded: Does this project have any additional impact on the operating budget: How is this project going to be spent: CAPITAL IMPROVEMENT PROGRAM City of Missoula CIP Project Request Form FY 2010-2014 Description and justification of project and funding sources: Spent in Prior Years ---PAGE BREAK--- Program Category: 10 Project # 0 Yes No 1. Is the project necessary to meet federal, state, or local legal requirements? This cri- terion includes projects mandated by Court Order to meet requirements of law or other requirements. Of special concern is that the project be accessible to the handicapped. 2. Is the project necessary to fulfill a con- tractual requirement? This criterion includes Federal or State grants which require local participation. Indicate the Grant name and number in the comment column. 3. Is this project urgently required? Will de- lay result in curtailment of an essential ser- vice? This statement should be checked "Yes" only if an emergency is clearly indi- cated; otherwise, answer "No". If "Yes", be sure to give full justification. 4. Does the project provide for and/or im- prove public health and/or public safety? This criterion should be answered "No" un- less public health and/or safety can be shown to be an urgent or critical factor. Raw Score Total Range Weight Score (0-3) 5. Does the project result in maximum benefit to the community from the 5 - investment dollar? (0-3) 6. Does the project require speedy implementation in order to assure its 4 - maximum effectiveness? (0-3) 7. Does the project conserve energy, cultural or natural resources, or reduce 3 - pollution? (0-2) 8. Does the project improve or expand upon essential City services where such 4 - services are recognized and accepted as being necessary and effective? (0-3) 9. Does the project specifically relate to the City's strategic planning priorities or other 4 - plans? Total Score - CAPITAL IMPROVEMENT PROGRAM (See C.I.P. Instructions For Explanation of Criteria) Qualitative Analysis Comments Project Rating Project Title: Quantitative Analysis Comments