Required Project Blank Forms

Unless noted otherwise for specific items such as traffic counts, all policies and forms apply to both the “Dirt and Gravel” and “paved Low Volume Road” portions of the Program.

• Traffic Count Validation (111 KB): Form for recording traffic counts to insure that paved Low Volume Roads have traffic counts of ≤500 vehicles per day in order to be eligible for funding.
  • Traffic Count Validation Instructions (131 KB): Instructions to complete the traffic count validation form.
• Stream Crossing Eligibility Determination: Visit for specific forms related to Stream Crossings.
• Driving Surface Aggregate: Visit for specific forms related to DSA.

• Grant Application: One-page application submitted by the road-owning entity to the Conservation District. This, along with the work plan, becomes “Attachment A” to the contract between the Conservation District and the Grant recipient.
• Work Plan: Project sketch detailing proposed work. Can be on the back of the grant application.
• Expenditure Sheets: Two optional sheets, one for grant requested funds and one for inkind contributions, that can be attached to the grant application if needed.
• Grant Application Packet (892 KB): Includes the four forms mentioned above. Note that this form is a fillable pdf and is not meant for completing by hand.
  • Grant Application Instructions (1.62 MB): Instructions to complete the above forms.
  • Non-fillable Grant Application Packet (947 KB): The non-fillable version of the Grant Application. Use this for completing by hand.

• 2-page Contract (105 KB): Legal contract between the conservation district and the grant recipient.
  • Contract Instructions (98.6 KB): Instructions to complete a contract.
• Contract Attachments:
  • Attachment A (683 KB): Grant application and work plan (see above)
  • Attachment B (24.5 KB): General Contract Provisions – General legal provisions pertaining to the contract.
  • Attachment C (35.2 KB): Statement of Policy (incorporated into contract by reference) – State Conservation Commission Statement of Policy, incorporated into contract by reference.
  • Attachment D: QAB Standards (Visit a specific Conservation District page for QAB policies.)
  • Attachment E (126 KB): Schedule of Payments (see below)
  • Attachment F (145 KB): Prevailing Wage Notification Letter (see below)
  • Attachment G (20.3 KB): Prevailing Wage Certification of Compliance – (provided by contractors who are subject to prevailing wage)
• Contract Amendment (184 KB): Simple amendment form that can be used to increase the funding amount or extend the completion date of an existing contract. (funding can be increased by 40% (or more with SCC approval) over original contract).
  • Amendment Attachment (193 KB): Required attachment for amendments that require SCC approval.
  • Contract Amendment Instructions (100 KB): Instructions to complete a contract amendment.
• Schedule of Payments (126 KB): Single page form that outlines the procedure in which funding will be distributed to a successful grant applicant. This becomes “Attachment E” to the contract between the Conservation District and the Grant recipient.

• Project Completion Report (1.32 MB): Report used to summarize a completed project. Continues a summary of both financial information and the practices implemented on the project. It is recommended that conservation districts and grant recipients jointly complete this form as part of the final inspection.
  • Project Completion Report Instructions (246 KB): Instructions to complete a project completion report.