16
TGM 2019 Grant Application Transportation and Growth Management Program grant application for the year 2019. Be sure to download and review the 2019 application packet before filling out this grant application. Additional resources and examples of successful applications can be found on the TGM planning grants page. You can save your progress by clicking the "Save" button at the bottom of the form. Type of grant Category 1: Transportation System Planning ODOT region (1-5): 1 Primary applicant jurisdiction: City of Canby Project title: Transportation System Plan Update Mailing address: 222 NE 2nd Avenue, Canby, Oregon 97013 Contact person name: Matilda Deas, AICP Contact person title: Senior Planner Contact phone: (502) 266-0723 Contact email: [email protected] List other local jurisdictions providing match: NA Summary description of project: Canby's Update of our 2010 TSP will address compliance with new and/or amended federal, state, and local plans, policies, goals and regulations. Substantial development has occurred in Canby since 2010: 1,125,148 sf (120+ acres) of industrial development; 311 new apartment units; a 58,000 sf mixed use development and a 35,000 sf civic building have been constructed in our downtown commercial core; 201 acres of land zoned for residential development have been annexed into the City Limits; and 20 residential subdivisions (630 lots) have been approved. The Update will also incorporate the 2015 N. Redwood Development Concept Plan, the 2017 Canby Transit Master Plan, the 2019 Alternate Otto Rd TSP amendment, several zone changes, the 2019 Canby Land Needs Analysis, Trost Elementary's Safe Routes to School Plan, the S. Ivy STIP project, Canby's Quiet Zone (2020), and the 104 acre parkland /trail acquisition (2018). Project cost table TGM funds requested Consultant: $ Consultant 158,000 Local reimbursement: $ Local Reimbursement

TGM 2019 Grant Application - Oregon City... · 2019-12-16 · TGM 2019 Grant Application Transportation and Growth Management Program grant application for the year 2019. Be sure

  • Upload
    others

  • View
    3

  • Download
    0

Embed Size (px)

Citation preview

Page 1: TGM 2019 Grant Application - Oregon City... · 2019-12-16 · TGM 2019 Grant Application Transportation and Growth Management Program grant application for the year 2019. Be sure

TGM 2019 Grant ApplicationTransportation and Growth Management Program grant application for the year 2019.

Be sure to download and review the 2019 application packet before filling out this grant application. Additional resources and examples of successful applications can be found on the TGM planning grants page.

You can save your progress by clicking the "Save" button at the bottom of the form.

Type of grantCategory 1: Transportation System Planning

ODOT region (1-5):1

Primary applicant jurisdiction:City of Canby

Project title:Transportation System Plan Update

Mailing address:222 NE 2nd Avenue, Canby, Oregon 97013

Contact person name:Matilda Deas, AICP

Contact person title:Senior Planner

Contact phone:(502) 266-0723

Contact email:[email protected]

List other local jurisdictions providing match:NA

Summary description of project:Canby's Update of our 2010 TSP will address compliance with new and/or amended federal, state, and local plans, policies, goals and regulations. Substantial development has occurred in Canby since 2010: 1,125,148 sf (120+ acres) of industrial development; 311 new apartment units; a 58,000 sf mixed use development and a 35,000 sf civic building have been constructed in our downtown commercial core; 201 acres of land zoned for residential development have been annexed into the City Limits; and 20 residential subdivisions (630 lots) have been approved. The Update will also incorporate the 2015 N. Redwood Development Concept Plan, the 2017 Canby Transit Master Plan, the 2019 Alternate Otto Rd TSP amendment, several zone changes, the 2019 Canby Land Needs Analysis, Trost Elementary's Safe Routes to School Plan, the S. Ivy STIP project, Canby's Quiet Zone (2020), and the 104 acre parkland /trail acquisition (2018).

Project cost tableTGM funds requestedConsultant: $ Consultant

158,000

Local reimbursement: $ Local Reimbursement

Page 2: TGM 2019 Grant Application - Oregon City... · 2019-12-16 · TGM 2019 Grant Application Transportation and Growth Management Program grant application for the year 2019. Be sure

Total TGM funds requested $ Total TGM Funds Requested158,000

Local match12% minimum (calculated) $ 12% Minimum

21,545

Match to be providedLabor, supplies and services during project: $ Labor, supplies and services

during project

Payment when Intergovernmental Agreement is signed:

$ Check at time of IGA signing22,000

CertificationsThis application was prepared by staff of the primary applicant or staff of one of the involved jurisdictions.

Consultant name (if applicable):

UntitledBy checking this box, I certify that my organization listed above supports the proposed project, has the legal authority to pledge matching funds, and has the legal authority to apply for Transportation and Growth Management funds. I further certify that matching funds are available or will be available for the proposed project. I understand that all State of Oregon rules for contracting, auditing, underwriting (where applicable), and payment will apply to this project.

Date5/20/2019

Eligibility requirements

The following three eligibility requirements are reviewed on a pass/fail basis. Applications found to not meet each of these requirements will not be scored against the award criteria and will not be awarded a grant.

1. Clear transportation relationship

A proposed project must have a clear transportation relationship and produce transportation benefits. A project must entail analysis, evaluation and selection of alternatives, development of implementation actions, and public involvement that results in a long range transportation plan, land use plan, or other product that addresses a transportation problem, need, opportunity, or issue of local or regional importance.

1. Clear Transportation Relationship

Page 3: TGM 2019 Grant Application - Oregon City... · 2019-12-16 · TGM 2019 Grant Application Transportation and Growth Management Program grant application for the year 2019. Be sure

Canby's TSP provides guidance to City decision makers by providing a degree of certainty and predictability for siting new roadways, transit, and bicycle and pedestrian facilities. Coordinating land use and transportation facility planning helps reduce costs and enables the City to more efficiently and effectively allocate scare transportation dollars. The TSP identifies needed code revisions that help Canby continue to provide a safe, efficient transportation system that enhances livability. We base our transportation funding strategies on the financially constrained list of improvements identified in the TSP. We have implemented the majority of the projects identified in our 2010 TSP Update, and need to re analyze and update the list.

2. Adoption of products to meet project objectives

A proposed project must include preparation of an adoption-ready product or products that lead to a local policy decision and that directly address the project objectives, such as a transportation system plan, comprehensive plan amendment, land use plan, code amendment, implementation program, or intergovernmental agreement. Projects are expected to include adoption hearings (or equivalent) by the governing body or to prepare products which will be adopted as part of a larger project.

2. Adoption of Products to Meet Project ObjectivesThe completed draft TSP Update, and any accompanying proposed amendments to Canby's Development Code, Comprehensive Plan, Roadway Standards, or Capital Improvement Program, will be made available to all interested parties and posted on the City's website. The draft TSP and any amendments will be presented to the Planning Commission at a public hearing for recommendation to the City Council. Upon receipt of the Planning Commission's recommendation, the City Council will hold a public hearing to adopt the Transportation System Plan Update, and any proposed amendments necessary to implement the Updated TSP.

3. Support of local officials

A proposed project must clearly demonstrate that local officials, both the primary applicant and any co-applicants, understand the purpose of the grant application and support the project objectives. A resolution of support, meeting minutes, or authorized letter from the governing body of all applicants (e.g. City Council, Board of Commissioners, or Transit Board) must be submitted with the application to meet this requirement.

Upload your resolution, minutes or authorized letter from governing body of applying jurisdiction(s) here:Letter from the Mayor.pdf

Award criteriaApplications will be scored on the following criteria. Instructions for responding to these criteria can be found in the application packet.

TGM may award up to 10 bonus points for innovation.

1. Proposed project addresses a need and supports TGM objectives (up to 40 points)

Page 4: TGM 2019 Grant Application - Oregon City... · 2019-12-16 · TGM 2019 Grant Application Transportation and Growth Management Program grant application for the year 2019. Be sure

The project clearly and effectively addresses a local or regional transportation or transportation-related land use issue, problem, need, or opportunity and will achieve one or more of the TGM objectives.

1. Proposed project addresses a need and supports TGM objectives (up to 40 points)Goals and Objectives: Canby's TSP Update will incorporate and analyze development projects, Development Plans,a TSP amendment, rezones and park land acquisitions that have occurred since our 2010 TSP Update. The result of this analysis will be recommendation(s) to implement measures to assure connectivity, accessibility and transportation options will be available to all members of the community. This is particularly important for two newly developed areas: the 4 story residential/commercial development in our downtown core, and the 311 unit apartment complex adjacent to our Pioneer Industrial Park. Neither were anticipated in our 2010 TSP Update.

Canby's 2013 Visioning Project cited maintaining the livability of our community as high a priority. Livability includes but is not limited to safe and convenient walking and bicycling opportunities to promote a healthily lifestyle,as well as access to public transportation. GOALS & OBJECTIVES : 1.1 & 1.4

The 58,000 s.f. downtown mixed used development provides opportunities to live, work and shop. Providing functional, convenient connections to these activities addresses GOALS & OBJECTIVE: 2.1.

The S Ivy STIP project will provide safe walking and bicycling access to and from our centrally located schools, Senior Housing, Adult Center, Swim Center and Parks. The TSP will help identify how best to connect this new bike and pedestrian facility to adjoining neighborhoods and our commercial district. GOALS & OBJECTIVE: 2.2

The extension of Walnut Street from our Canby Pioneer Industrial Park (CPIP) to OR 99E is a critical connection to ensure the future viability of the CPIP. Our industrial park has the most acres of available land zoned for industrial development in Clackamas County. The TSP will evaluate our Industrial park circulation and connectivity based in part on this new connection, and on the new 531,148 sf bottle distributing company, the new traffic light being installed at Hazel Dell and Sequoia Parkway, and the new 311 unit apartment complex adjacent to the CPIP. GOALS & OBJECTIVE: 3.2

The City has adopted several residential development concept plans since 2010. Integrating the adopted plans into the TSP Update and re-evaluating the street functions and connectivity, will support the City's ongoing effort to accommodate growth within our UGB. The N Redwood Development Concept Plan utilized Density Transfer to preserve a valuable stream and associated wetlands and riparian areas for wildlife and public recreation. Two other plans preserve riparian areas for public paths. The TSP will incorporate these plans and recommend circulation and connection strategies for these areas. GOALS & OBJECTIVES: 4.4; 5.1

2. Proposed project is timely and urgent (up to 25 points)

The application demonstrates timeliness and urgency. The project is needed now to:

address pressing local transportation and land use issues

make amendments to local plans or regulations necessitated by changes in federal regulations, state requirements, or regional plans

make amendments to local plans or regulations necessitated by changes that were not anticipated in previous plans including growth or lack of growth, changes in land use patterns, or changes in

Page 5: TGM 2019 Grant Application - Oregon City... · 2019-12-16 · TGM 2019 Grant Application Transportation and Growth Management Program grant application for the year 2019. Be sure

available funding

build on, complement, or take a necessary step toward completing or implementing other high-priority community initiatives, including supporting a Governor's Regional Solutions team priority

resolve transportation or land-use-related issues affecting the project readiness of local, regional or state transportation projects for which funding is expected to be obligated within the near future.

2. Proposed project is timely and urgent (up to 25 points)Canby's current TSP is 9 years out of date. Significant public and private development has occurred and is expected to continue into the foreseeable future. This is due primarily to Canby's location being within 30 miles from either the Portland or Salem Metro Areas. This is both an opportunity and a challenge for Canby. We currently have a strong employment base and livable neighborhoods, but managing growth to maintain that livability is daunting. The new 531,148 s.f. bottle distributing company locating in our Industrial Park will bring increased employment but also increased truck and commuter traffic. The TSP will assess circulation in our Industrial park and help identify projects that best address traffic, traffic circulation and access. Canby continues to grow. With new residents come expectations for safe and convenient travel choices. The TSP can provide guidance for the City to help us provide those choices without compromising livability.

Canby's Industrial Park provides traded sector jobs, and an up-to-date TSP helps us to maintain a strong multi-modal transportation network to retain and attract new traded sector industries. (A Regional Solutions Team priority).

3. Proposed project approach is reasonable (up to 20 points)

The application demonstrates a clear approach to achieving the expected outcome and includes consideration for adoption. Where substantial coordination with other local, regional, and state planning efforts will need to occur, the mechanisms and responsibilities for the coordination are clear.

3. Proposed project approach is reasonable (up to 20 points)The TSP Update will include at a minimum the following major tasks:

1) Identify project management team members (PMT);clarify PMT responsibilities; develop project schedule; create a public involvement program (PIP); establish a technical advisory committee (TAC) and a citizen advisory committee (CAC). 2) Review relevant plans, studies, reports, regulations etc; collect data; inventory existing conditions; review current TSP to determine deficiencies etc.; develop future forecast document; develop future needs analysis; conduct industrial connectivity analysis.

3) Perform alternatives analysis

4) Draft TSP preparation, presentations and revisions.

5) Adoption-Planning Commission and City Council public hearings.

Page 6: TGM 2019 Grant Application - Oregon City... · 2019-12-16 · TGM 2019 Grant Application Transportation and Growth Management Program grant application for the year 2019. Be sure

Throughout the process the PMT will meet with the CAC and TAC members and conduct public meetings as determined by the approved schedule from the final Scope of Work.

4. Proposed project has community support (up to 5 points)

The application demonstrates that there is local support for project objectives, a commitment to participate, and a desire to implement the expected outcome.

4. Proposed project has community support (up to 5 points)The TSP Update has the support of the Canby City Council, Canby Area Transit, Canby Area Chamber of Commerce,the Canby Bicycle and Pedestrian Committee, the Canby Traffic Safety Commission and the Canby Parks and Recreation Advisory Board.Their letters of support are attached. Each entity submitting a letter of support has also agreed to provide a representative to participate on the Citizen Advisory Committee (CAC).

Upload letters of support from stakeholders here:Letter from CAT.pdf

Letter from Parks.pdf

Letter from Traffic Safety Comm.pdf

TSP Update Letter of Support-Chamber.jpg

Letter from the Mayor.pdf

Letter from Bike and Ped.pdf

5. Proposed project sponsor readiness and capacity (up to 10 points)

The application demonstrates that the local government is ready and able to begin the project within the TGM timetable and that there is local commitment and capability to manage and complete the project. The application demonstrates, if applicable, successful performance on previous TGM projects.

5. Proposed project sponsor readiness and capacity (up to 10 points)The City of Canby has funds available and senior staff dedicated to the project. The City of Canby has been the beneficiary of several TGM grants and has experience to successfully execute and manage the project through to adoption. Below are a few of our more recent TGM supported projects. These projects were successfully executed and adopted. 2010 TSP Update2012 OR 99E Corridor and Gateway Design Plan2015 N Redwood Development Concept Plan

Upload supplemental application materialsProject area map (optional):Comp Plan Map Nov 2018.pdf

Title VI: Racial & Ethnic Impact Statement formRacial-Ethnic-Impact-Statement.pdf

Download the Racial & Ethnic Impact Statement here

Page 7: TGM 2019 Grant Application - Oregon City... · 2019-12-16 · TGM 2019 Grant Application Transportation and Growth Management Program grant application for the year 2019. Be sure

If you encounter any issues with the submittal process, please contact:

Abigail EricksonPlanning Section Web [email protected]

Page 8: TGM 2019 Grant Application - Oregon City... · 2019-12-16 · TGM 2019 Grant Application Transportation and Growth Management Program grant application for the year 2019. Be sure
Page 9: TGM 2019 Grant Application - Oregon City... · 2019-12-16 · TGM 2019 Grant Application Transportation and Growth Management Program grant application for the year 2019. Be sure

May 16, 2019

Mr. Glen Bolen, AICP

ODOT Region 1, TGM Program Planner

123 NW Flanders

Portland, OR 97209

Dear Mr. Bolen,

This letter is written in support of the City of Canby’s Transportation and Growth

Management (TGM) grant application, which if awarded, would be a valuable and critical

resource in the City’s effort to update its Transportation System Plan.

Canby Area Transit is one of Clackamas County’s five transit service providers. We

believe that you will concur with us the importance for the City of Canby—and all public

transportation providers in the county—to identify and plan for efficient, safe, and

accessible transit connections between Canby and surrounding communities.

A TSP that reflects up-to-date growth patterns and transportation needs is not only useful

for rural systems like ours, but will also give the region a blueprint which addresses both

rural and urban public transit. The Transportation System Plan Update will help the city

implement the Transit Master Plan policies reflective of transit discussions, inside and

outside the TriMet district, as well as inside and outside the Metro Area. We see this as an

opportunity to provide the necessary improvements to our service in Canby, and Clackamas

County where growth is occurring at a rapid pace.

We are eager to participate in the City of Canby’s Transportation System Plan update, and

thank you for considering our recommendation of support. We encourage you to fund this

important project.

With Warm Regards,

Julie Wehling

Transit Director

Canby Area Transit - City of Canby

Phone: 503.266.4022

Fax: 503.263.6284

canbyareatransit.org City of Canby Canby Area Transit

PO Box 930

Canby, OR 97013

Page 10: TGM 2019 Grant Application - Oregon City... · 2019-12-16 · TGM 2019 Grant Application Transportation and Growth Management Program grant application for the year 2019. Be sure
Page 11: TGM 2019 Grant Application - Oregon City... · 2019-12-16 · TGM 2019 Grant Application Transportation and Growth Management Program grant application for the year 2019. Be sure
Page 12: TGM 2019 Grant Application - Oregon City... · 2019-12-16 · TGM 2019 Grant Application Transportation and Growth Management Program grant application for the year 2019. Be sure
Page 13: TGM 2019 Grant Application - Oregon City... · 2019-12-16 · TGM 2019 Grant Application Transportation and Growth Management Program grant application for the year 2019. Be sure
Page 14: TGM 2019 Grant Application - Oregon City... · 2019-12-16 · TGM 2019 Grant Application Transportation and Growth Management Program grant application for the year 2019. Be sure
Page 15: TGM 2019 Grant Application - Oregon City... · 2019-12-16 · TGM 2019 Grant Application Transportation and Growth Management Program grant application for the year 2019. Be sure

$

$

$

$

$

$

$

IVY

Molalla

River

Park

TERRIT

ORIAL

Park

13TH

Park

PINE

Willow Creek

P

Molalla River

Molal

la Rive

r

LI

Pudd

ing Ri

ver

Baker

Pra

irie

C

em

eta

ry

LOGGING ROAD TRAIL

Baker

Pra

irie

JUNIPER

LDR

Can

by S

kat

epar

k

See

CPA/

ZC

15-01

Mola

lla R

iver

Sta

te P

ark

Wil

lam

ett

e V

alley

C

ountr

y C

lub

Wil

lam

ett

e W

aysid

e P

ark

& O

pen S

pace

Eco-

Park

Cla

ckam

as C

ounty

Fair

& E

vent

Cente

r

Can

by

Com

munit

yPar

k

Knights Brid

ge Park

Legacy Park

Zio

n M

em

ori

al

Cem

eta

ry

Maple

Str

eet

Park

Wil

low

C

reek

Park

Wait

Park

19th

Loop

Park

Arneson Garden

Futu

re P

ark

Northwoods

Locu

st S

t.

Fais

t

LI

LDR

Mixe

d Den

sity

Resid

entia

l

LDR

PR

HI

LDR

P

LI

LDR

P

LDR

P

LI

PLD

R

P

FL

HCFL

HDR MD

R

CMP

P

HI

HDR

LI

CM

DC

MDR

LI

LI

HDR

HDR

MDR

P

LDR

RC

MDR

FLLD

RHD

R

MDR

HC

HC

MDR

MDR

P

HDR

LDR

HDR

HDR

MDR

P

MDR

LDR

HDR

HC

P

RC

RC

LI

MDR

HDR

FL

FL

IVY

HOLLY

TOWN

SHIP

BARLOW

MULIN

O

TERRIT

ORIAL

KNIGH

TS BR

IDGE

IVY

FIR

MAPLE

HOLLY

1ST

PINE

MULINO

GRANT

TOW

NSHI

P

4TH

2ND

10TH

LOGGING ROAD TRAIL

WALNUT

3RD

HAINES

6TH

BERG

BAKER

8TH

9TH

CEDAR

13TH

SEQU

OIA

JUNIPER

OAK

16TH

7TH

ELM

BIRCH

11TH

17TH

ASH

OTTO

21ST

LOCUST

5TH

15TH

MANZANITA

KNIG

HTS

BRID

GE

34TH

14TH

12TH

20TH

KNOTT

REDWOOD

LARCH

HAZE

L DEL

L

DOUGLAS

ASPEN

TEAKWOODVINE

CARR

IAGE

18TH

ALDER

COUNTRY CLUB

19TH

SPITZ

MEADOW SPRINGS

PONDEROSA

HAWTHORNE

LAURELWOOD

LUPINE

LOGGING RAOD TRAIL

23RD FA

IRWAY

FORES

T

ELMWOOD

DAHL

IA

30TH NO

BLE

31ST

PLUM

TERR

ACE

29TH

GREE

NVIEW

12TH

ELM

15TH

LOCUST

7TH

13TH

PONDEROSA

5TH

13TH

GRANT

16TH

6TH

7TH

1ST

HOLLY

BIRCH

7TH

6TH

MAPLE

11TH

ASH

14TH

9TH

JUNIPER

HOLLY

12TH

ASPEN

21ST

8TH

6TH

FIR

4TH

12TH

1ST

OAK

11TH

11TH

15TH

8TH

5TH

LOCUST

REDWOOD

8TH

14TH

13TH

WALNUT

LUPINE

LUPINE

KNOTT

12TH

LAURELWOOD

10TH

PONDEROSA

PINE

7TH

ASPEN

5TH

20TH

REDWOOD

13TH

GRANT

3RD

CEDAR

ASH

KNOTT

11TH

20TH

12TH

13TH

16TH

14TH

9TH

5TH

10TH

14TH

10TH

OAK

10TH

FIR

9TH

17TH

1ST

5TH

3RD

NOBLE

LOCUST

3RD

19TH

ELM

10TH

14TH

BIRCH

OAK

2ND

7TH

BAKER

REDWOOD

11TH

14TH

9TH

21ST

LUPINE

LUPINE

11TH

14TH

TEAKWOOD

13TH

5TH

4TH

PINEMAPLE

2ND

DOUGLAS

6TH

ASPEN

ASPEN

8TH

SEQUOIA

15TH

10TH

2ND

OAK

7TH

13TH

FIR

KNOTT

PINE

4TH

13TH

11TH

ELM

12TH

3RD

6TH

17TH

CEDAR

16TH

14TH

4TH

12TH

19TH

Lee

Trost

Knigh

t

Eccles

Acker

man

Canb

y High

Scho

ol

Cit

y of

Can

by

Cit

y of

Can

by

Comp

rehen

sive

Plan M

ap

City L

imits

Urba

n Gow

th Bo

unda

ryPa

rksLD

R-Lo

w De

nsity

Res

identi

alMD

R-Me

dium

Dens

ity R

eside

ntial

HDR-

High D

ensit

y Res

identi

alMi

xed D

ensit

y Res

identi

alRC

-Res

identi

al Co

mmerc

ialDC

-Dow

ntown

Com

merci

alHC

-High

way C

omme

rcial

CM-C

omme

rcial/

Manu

factur

ingLI-

Light

Indus

trial

HI-H

eavy

Indu

strial

P-Pu

blic

PR-P

rivate

Rec

reatio

nFL

-Floo

d Pron

e/Stee

p Slop

es

´No

vemb

er 20

18Th

e info

rmati

on de

picted

on th

is ma

p is f

or ge

neral

refer

ence

only.

The C

ity of

Can

by c

anno

t acc

ept a

ny re

spon

sibility

for

errors

, omi

ssion

s, or

posit

ional

accu

racy.

Howe

ver, n

otific

ation

of er

rors w

ould

be ap

precia

ted.

00.5

10.2

5Mi

les

Williamette

River

Page 16: TGM 2019 Grant Application - Oregon City... · 2019-12-16 · TGM 2019 Grant Application Transportation and Growth Management Program grant application for the year 2019. Be sure

RACIAL AND ETHNIC IMPACT STATEMENT This form is used for informational purposes only and must be included with the grant application.

Chapter 600 of the 2013 Oregon Laws require applicants to include with each grant application a racial and ethnic impact statement. The statement provides information as to the disproportionate or unique impact the proposed policies or programs may have on minority persons1 in the State of Oregon if the grant is awarded to a corporation or other legal entity other than natural persons.

1. The proposed grant project policies or programs could have a disproportionate or unique positive impact onthe following minority persons:

Indicate all that apply:

Women Asians or Pacific Islanders Persons with Disabilities American Indians African-Americans Alaskan Natives Hispanics

2. The proposed grant project policies or programs could have a disproportionate or unique negative impact onthe following minority persons:

Indicate all that apply:

Women Asians or Pacific Islanders Persons with Disabilities American Indians African-Americans Alaskan Natives Hispanics

3. The proposed grant project policies or programs will have no disproportionate or unique impact on minoritypersons.

If you checked numbers 1 or 2 above, please provide below the rationale for the existence of policies or programs having a disproportionate or unique impact on minority persons in this state. Further provide evidence of consultation with representative(s) of the affected minority persons.

By checking this box, I hereby certify the information contained on this Dated: form is true, complete, and accurate to the best of my knowledge.

Printed Name: Title:

Agency Name:

1 “Minority person” are defined in SB 463 (2013 Regular Session) as women, persons with disabilities (as defined in ORS 174.107), African Americans, Hispanics, Asians, or Pacific Islanders, American Indians and Alaskan Natives.