MAJOR PROJECT REQUEST FOR CONFIRMATION OF ASSISTANCE UNDER ARTICLES 39 TO 41 OF REGULATION (EC) No 1083/2006

EUROPEAN REGIONAL DEVELOPMENT FUND/COHESION FUND

INFRASTRUCTURE INVESTMENT

[Project title]

CCI No […]

A. ADDRESSES AND REFERENCES

A.1. Authority responsible for the application (i.e., managing authority or intermediate body). In case of major project co-financed by more than one Operational Programme, the responsible authorities of each Operational Programme concerned shall be mentioned.

A.1.1. Name:

A.1.2. Address:

A.1.3. Contact:

A.1.4. Telephone:

A.1.5. Telex/Fax:

A.1.6. E-mail:

A.2. Organisation, or organisations in case of major project co-financed by more than one Operational Programme, responsible for project implementation (beneficiary)

A.2.1. Name:

A.2.2. Address:

A.2.3. Contact:

A.2.4. Telephone:

A.2.5. Telex/Fax:

A.2.6. E-mail:

B. PROJECT DETAILS

B.1. Title of project/project phase:

B.2. Categorisation of project activity (1)

Code

Percentage

B.2.1. Code for the priority theme dimension

B.2.2. Code for the form of finance dimension

B.2.3. Code for the territorial dimension

B.2.4. Code for the economic activity dimension (2)

B.2.4.1. NACE Code (3)

B.2.5. Code for the location dimension(s) (NUTS/LAU) (4)

(1) Annex II to Regulation (EC) No 1828/2006 unless otherwise specified.

(2) Where a project involves more than one economic activity, multiple codes may be indicated. In that case the percentage share for each code should be indicated with the total not exceeding 100 %.

(3) NACE-Rev.2, 4 digit code: Regulation (EC) No 1893/2006 of the European Parliament and of the Council (OJ L 393, 30.12.2006, p. 1).

(4) Regulation (EC) No 1059/2003 of the European Parliament and of the Council (OJ L 154, 21.6.2003, p. 1). Use the most detailed and relevant NUTS code. Where a project affect multiple individual NUTS/LAU 2 level areas, consider encoding the NUTS/LAU1 or higher codes.

B.3. Compatibility and coherence with the Operational Programme(s)

B.3.1. Title of the related Operational Programme(s):

B.3.2. Common Code for Identification (CCI) No of Operational Programme(s)

B.3.3. Fund

In case of major project co-financed by more than one Operational Programme, specify the Fund for each Operational Programme separately.

ERDF

Cohesion Fund

B.3.4. Title of the priority axis or priority axes in case of major project co-financed by more than one Operational Programme

B.4. Project description

B.4.1. Project (or project phase) description:

(a) Provide a description of the project (or project phase).

(b) Where the project is a phase of an overall project, provide a description of the proposed stages of implementation (explaining whether they are technically and financially independent). In case of major project co-financed by more than one Operational Programme indicate the parts falling under each Operational Programme or pro-rata allocation.

(c) What criteria have been used to determine the division of the project into phases?

B.4.2. Technical description of the investment in infrastructure

(a) Describe the proposed infrastructure and the work for which assistance is being proposed specifying its main characteristics and component elements.

(b) In respect of the work involved, identify and quantify the key output indicators and, where relevant, the core indicators to be used:

(c) Main beneficiaries of the infrastructure (i.e. target population served, quantified where possible):

(d) Is the construction of the infrastructure to be delivered through a public-private partnership (PPP)?

Yes

No

If yes, describe the form of the PPP (i.e., selection process for private partner, structure of PPP, infrastructure ownership arrangements, risk allocation arrangements, etc.):

Give details of how the infrastructure is to be managed after the project is completed (i.e., public management, concession, other form of PPP).

(e) Does the project form part of a Trans-European Network agreed at Union level?

Yes

No

B.5. Project objectives

B.5.1. Current infrastructure endowment and impact of the project

Indicate the extent to which the region(s) is/are at present endowed with the type of infrastructure covered by this application; compare it with the level of infrastructure endowment aimed for by target year 20. (i.e., according to the relevant strategy or national/regional plans, where applicable). Indicate the foreseeable contribution of the project to the strategy/plan objectives. Specify potential bottlenecks or other problems to be resolved.

B.5.2. Socio-economic objectives

Indicate the project’s socio-economic objectives and targets.

B.5.3. Contribution to the achievement of the Operational Programme(s)

Describe how the project contributes to the achievement of the priorities of the Operational Programme(s) (provide quantified indicators per operational programme where possible).

C. RESULTS OF FEASIBILITY STUDIES

C.1. Provide a summary of the main conclusions of the feasibility studies conducted

Give precise references if ERDF, Cohesion Fund, ISPA or other Union assistance is/was involved in the financing of the feasibility studies.

C.1.1. Demand analysis

Provide a summary of the demand analysis, including the predicted utilisation rate on completion and the demand growth rate.

C.1.2. Options considered

Outline the alternative options considered in the feasibility studies.

D. TIMETABLE

D.1. Project timetable

Give below the timetable for the development of the overall project.

Where the application concerns a project stage, clearly indicate in the table the elements of the overall project for which assistance is being sought by this application:

Start date

(A)

dd/mm/yyyy

Completion date

(B)

dd/mm/yyyy

1. Feasibility studies:

2. Cost-benefit analysis (including financial analysis):

3. Environmental impact assessment:

4. Design studies:

5. Preparation of Tender documentation:

6. Expected launch of tender procedure(s) (*):

7. Land acquisition:

8. Construction phase/contract:

9. Operational phase:

(*) Specify for each tender

Please attach a summary schedule of the main categories of works (i.e., a Gantt chart, where available).

D.2. Project maturity

Describe the project timetable (D.1) in terms of the technical and financial progress and current maturity of the project under the following headings:

D.2.1. Technical (feasibility studies, etc.):

D.2.2. Administrative (authorisations, EIA, land purchase, invitations to tender, etc.):

D.2.3. Financial (commitment decisions in respect of national public expenditure, loans requested or granted, etc. - give references):

D.2.4. If the project has already started, indicate the current state of works:

E. COST-BENEFIT ANALYSIS

This section should be based on the Guidelines on the methodology for carrying out the cost-benefit-analysis of major projects. In addition to the summary elements to be provided, the full cost-benefit analysis document shall be provided in support of this application as Annex II.

E.1. Financial analysis

The key elements from the financial analysis of the CBA should be summarised below.

E.1.1. Short description of methodology and specific assumptions made

E.1.2. Main elements and parameters used in the CBA for financial analysis

Main elements and parameters

Value Not discounted

Value Discounted

(Net Present Value)

1. Reference period (years)

2. Financial discount rate (%) (1)

3. Total investment cost excluding contingencies (in euro, not discounted) (2)

4. Total investment cost (in euro, discounted)

5. Residual value (in euro, not discounted)

6. Residual value (in euro, discounted)

7. Revenues (in euro, discounted)

8. Operating costs (in euro, discounted)

Funding gap calculation (3)

9. Net revenue = revenues – operating costs + residual value (in euro, discounted) = (7) – (8) + (6)

10. Investment cost – net revenue (in euro, discounted) = (4) – (9) (Article 55(2))

11. Funding gap rate (%) = (10) / (4)

(1) Specify if the rate is real or nominal. If the financial analysis is conducted in constant prices, a financial discount rate expressed in real terms shall be used. If the analysis is conducted in current prices, a discount rate in nominal terms shall be used.

(2) Investment cost should here exclude contingencies in accordance with working document number 4.

(3) This does not apply: 1) for projects subject to the rules on State aids in the meaning of Article 107 of the Treaty (see point G.1), pursuant to Article 55(6) of Regulation (EC) No 1083/2006 and 2) if operating costs are higher than revenues the project is not considered as revenue generating in the sense of Article 55 of Regulation (EC) No 1083/2006, in which case, ignore items 9 and 10 and set funding gap to 100 %.

Where VAT is recoverable, the costs and revenues should be based on figures excluding VAT.

E.1.3. Main results of the financial analysis

Without Union assistance

(FRR/C)

A

Without Union assistance

(FRR/K)

B (1)

1. Financial rate of return (%)

FRR/C

FRR/K

2. Net present value (euro)

FNPV/C

FNPV/K

(1) For the calculation of the project profitability without (‘/C’) and with (‘/K’) Union assistance, refer to the guidance provided by the Commission in line with Article 40 of Regulation (EC) No 1083/2006.

E.1.4. Revenues generated over its lifetime

If the project is expected to generate revenues through tariffs or charges borne by users, please give details of charges (types and level of charges, principle or Union legislation on the basis of which the charges have been established).

(a) Do the charges cover the operational costs and depreciation of the project?

(b) Do the charges differ between the various users of the infrastructure?

(c) Are the charges proportional

(i) To the use of the project/real consumption?

(ii) To the pollution generated by users?

If no tariffs or charges are proposed, how will operating and maintenance costs be covered?

E.2. Socio-economic analysis

E.2.1. Provide a short description of methodology (key assumptions made in valuing costs and benefits) and the main findings of the socio-economic analysis:

E.2.2. Give details of main economic costs and benefits identified in the analysis together with values assigned to them:

Benefit

Unit value

(where applicable)

Total value

(in euro, discounted)

% of total benefits

Cost

Unit value

(where applicable)

Total value

(in euro, discounted)

% of total costs

E.2.3. Main indicators of the economic analysis

Main parameters and indicators

Values

1. Social discount rate (%)

2. Economic rate of return (%)

3. Economic net present value (in euro)

4. Benefit-cost ratio

E.2.4. Employment effects of project

Provide an indication of the number of jobs to be created (expressed in terms of full-time equivalents (FTE)).

Number of jobs directly created:

No (FTE)

(A)

Average duration of these jobs

(months) (1)

(B)

1. During implementation phase

2. During operational phase

(1) In case of permanent jobs, instead of duration in months, type ‘permanent’.

[NB: indirect jobs created or lost are not sought for public infrastructure investments.]

E.2.5. Identify the main non-quantifiable/non valuable benefits and costs:

E.3. Risk and sensitivity analysis

E.3.1. Short description of methodology and summary results

E.3.2. Sensitivity analysis

State the percentage change applied to the variables tested: …

Present the estimated effect on results of financial and economic performance indexes.

Variable tested

Financial Rate of Return variation

Financial Net Present Value variation

Economic Rate of Return variation

Economic Net Present Value variation

Which variables were identified as critical variables? State which criterion is applied.

Which are the switching values of the critical variables?

E.3.3. Risk analysis

Describe the probability distribution estimate of the project’s financial and economic performance indexes. Provide relevant statistical information (expected values, standard deviation).

F. ANALYSIS OF THE ENVIRONMENTAL IMPACT

F.1. How does the project:

(a) contribute to the objective of environmental sustainability (European climate change policy, halting loss of biodiversity, other …);

(b) respect the principles of preventive action and that environmental damage should as a priority be rectified at source;

(c) respect the ‘polluter pays’ principle.

F.2. Consultation of environmental authorities

Have the environmental authorities likely to be concerned by the project been consulted by reason of their specific responsibilities?

Yes

No

If yes, please give name(s) and address(es) and explain that authority's responsibility:

If no, please give reasons:

F.3. Environmental Impact Assessment

F.3.1. Development consent (5)

F.3.1.1. Has development consent already been given to this project?

Yes

No

F.3.1.2. If yes, on which date

F.3.1.3. If no, when was the formal request for the development consent introduced:

F.3.1.4. By which date is the final decision expected?

F.3.1.5. Specify the competent authority or authorities, which has given or will give the development consent.

F.3.2. Application of Council Directive 85/337/EEC on Environmental Impact Assessment (EIA) (6)

F.3.2.1. Is the project a class of development covered by:

Annex I to that Directive (go to question F.3.2.2)

Annex II to that Directive (go to question F.3.2.3)

Neither of the two annexes (go to question F.3.3)

F.3.2.2. When covered by Annex I to that Directive, include the following documents:

(a) the information referred to in Article 9(1) of that Directive;

(b) the non-technical summary (7) of the Environmental Impact Study carried out for the project;

(c) information on consultations with environmental authorities, the public concerned and, if applicable, with other Member States.

F.3.2.3. When covered by Annex II to that Directive, has an Environmental Impact Assessment been carried out for this project?

Yes

in which case, include the necessary documents listed under point F.3.2.2

No

in which case, explain the reasons and give the thresholds, criteria or case by case examination carried out to reach the conclusion that the project has no significant environmental effects:

F.3.3. Application of the Strategic Environmental Assessment Directive 2001/42/EC of the European Parliament and of the Council (8) (SEA-Directive)

(5) The decision of the competent (national) authority or authorities which entitles the developer to proceed with the project. In cases where the project submitted is part of a wider operation, the development consent should refer only to the project submitted to the Commission. In cases where more than one development consent decisions are required, please repeat the information as many times as necessary.

(6) OJ L 175, 5.7.1985, p. 40.

(7) Prepared under Article 5(3) of Directive 85/337/EEC.

(8) OJ L 197, 21.7.2001, p. 30.

F.3.3.1. Does the project result from a plan or programme falling within the scope of the SEA Directive?

No in which case please provide a short explanation:

Yes in which case, in order to appreciate if wider potential cumulative effects of the project have been addressed, please provide either an internet link to or an electronic copy of the non-technical summary (9) of the Environmental Report carried out for the plan or programme.

F.4. Assessment of effects on NATURA 2000 Sites

F.4.1. Is the project likely to have significant negative effects on sites included or intended to be included in the NATURA 2000 network?

Yes in which case

(1) Please provide a summary of the conclusions of the appropriate assessment carried out according to Article 6(3) of Council Directive 92/43/EEC (10).

(2) In case, compensation measures were deemed necessary according to Article 6(4), please provide a copy of the form ‘Information on projects likely to have significant negative effect on NATURA 2000 sites, as notified to the Commission (DG Environment) under Directive 92/43/EEC (11)’.

No in which case attach a completed Appendix I declaration filled in by the relevant authority.

F.5. Additional environmental integration measures

Does the project envisage, apart from Environmental Impact Assessment, any additional environmental integration measures (e.g. environmental audit, environmental management, specific environmental monitoring)?

Yes

No

If yes, specify

F.6. Cost of measures taken for correcting negative environmental impacts

If included in total cost, estimate proportion of cost of measures taken to reduce and/or to compensate for negative environmental impacts

%

Explain briefly:

F.7. In case of projects in the areas of water, waste water and solid waste:

Explain whether the project is consistent with a sectoral/integrated plan and programme associated with the implementation of Union policy or legislation (12) in those areas:

(9) Prepared under Annex I (j) to Directive 2001/42/EC.

(10) OJ L 206, 22.7.1992, p. 7.

(11) Document 99/7 rev. 2 adopted by the Habitats Committee (established under Directive 92/43/EEC) at its meeting on 4 October 1999.

(12) In particular, Directive 2000/60/EC of the European Parliament and of the Council (Water Framework Directive) (OJ L 327, 22.12.2000, p. 1) Council Directive 1991/271/EC (Urban Waste Water Treatment Directive) (OJ L 135, 30.5.1991, p. 40), Article 7 of Directive 2006/12/EC of the European Parliament and of the Council (Waste Framework Directive) (OJ L 114, 27.4.2006, p. 9), Council Directive 1999/31/EC (Landfill of Waste Directive) (OJ L 182, 16.7.1999, p. 1).

G. JUSTIFICATION FOR THE PUBLIC CONTRIBUTION

G.1. Competition

Does this project involve State Aids?

Yes

No

If yes, please give in the table below the amount of aid, and, for approved aid the state aid number and the reference of the approval letter, for block-exempted aid the respective registry number, and for pending notified aid the state aid number (13).

Sources of aid (local, regional, national and Union):

Amount of aid euro

State Aid number/ registry number for block-exempted aid

Reference of approval letter

Approved aid schemes, approved ad hoc aid, or aid falling under a block exemption regulation:

Aid foreseen under pending notifications (ad hoc aid or schemes):

Aid for which a notification is outstanding (ad hoc aid or schemes)

Total aid granted:

Total cost of the investment project

G.2. Impact of Union assistance on project implementation

For each affirmative answer, give details:

Will Union assistance:

a) accelerate implementation of the project?

Yes

No

b) be essential to implementation of the project?

Yes

No

H. FINANCING PLAN

The decision amount and other financial information in this section must be coherent with the basis (total or public cost) for the co-financing rate of the priority axis. Where private expenditure is not eligible for financing under the priority axis it shall be excluded from the eligible costs; where private expenditure is eligible it may be included.

(13) This application does not replace notification to the Commission under Article 108(3) of the Treaty. A positive decision by the Commission on the major project under Regulation (EC) No 1083/2006 does not constitute state aid approval.

H.1. Cost breakdown

Euro

Total Project costs

(A)

Ineligible costs (1)

(B)

eligible costs

(C) = (A) – (B)

1. Planning/design fees

2. Land purchase

3. Building and construction

4. Plant and machinery

5. Contingencies (2)

6. Price adjustment (if applicable) (3)

7. Technical assistance

8. Publicity

9. Supervision during construction implementation

10. Sub-Total

11. (VAT (4))

12. Total

(5)

(1) Ineligible costs comprise (i) expenditure outside the eligibility period, (ii) expenditure ineligible under national rules (Article 56(4) of Regulation (EC) No 1083/2006), (iii) other expenditure not presented for co-financing. NB: The starting date for eligibility of expenditure is the date of receipt of the draft operational programme by the Commission or 1 January 2007, whichever is the earlier.

(2) Contingencies should not exceed 10 % of total investment cost net of contingencies. These contingencies may be included in the total eligible costs used to calculate the planned contribution of the funds – Section H2.

(3) A price adjustment may be included, where relevant, to cover expected inflation where the eligible cost values are in constant prices.

(4) Where VAT is considered as eligible, give reasons.

(5) Total cost must include all costs incurred for the project, from planning to supervision and must include VAT even if VAT is considered non-eligible

H.2. Total planned resources and planned contribution from the Funds

The funding gap rate was already presented under Section E.1.2. This should be applied to the eligible cost to calculate the ‘amount to which the co-financing rate for the priority axis applies’ (Article 41(2) of Council Regulation (EC) No 1083/2006). This is then multiplied by the co-financing rate of the priority axis to determine the Union contribution.

H.2.1. Union contribution calculation

Value

1. Eligible cost (in euro, not discounted) (Section H.1.12(C))

2. Funding gap rate (%), if applicable = (E.1.2.11)

3. Decision amount, i.e. the ‘amount to which the co-financing rate for the priority axis or priority axes (1) applies’ (Article 41(2)) = (1)*(2).

If H.2.1.2 not applicable, the decision amount must respect the maximum public contribution according to state aid rules

3.1. In case of major project co-financed by more than one Operational Programme, indicate the share of the Decision amount corresponding to each Operational Programme

4. Co-financing rate of the priority axis or priority axes (1) (%)

5. Union contribution (in euro) = (3)*(4)

(1) In case of major project co-financed by more than one Operational Programme.

H.2.2 Sources of co-financing

In the light of the results of the financing gap calculation (where relevant) the total investment costs of the project shall be met from the following sources:

Source of total investment costs (€)

Of which

(for Information)

Total investment cost

[H.1.12.(A)]

Union assistance

[H.2.1.5]

National public

(or equivalent)

National private

Other sources

(specify)

EIB/EIF loans:

(a) = (b)+(c)+(d)+(e)

(b)

(c)

(d)

(e)

(f)

H.2.3. Expenditure already certified

Have expenditure for this major project been already certified?

Yes

No

If yes, state the amount: … EUR.

If yes and in case of major project co-financed by more than one Operational Programme, under which Operational Programmes have the expenditure been certified?

Title of the related Operational Programme(s):

CCI number:

Amount concerned in the Operational Programme: … EUR

H.3. Annual financing plan of Union contribution

The Union contribution (H.2.1.5) shall be presented below in terms of the share of annual programme commitment. In case of major project co-financed by more than one Operational Programme, the annual financing plan shall be presented separately for each Operational Programme.

(in Euro)

2007

2008

2009

2010

2011

2012

2013

[CF/ ERDF - specify]

I. COMPATIBILITY WITH UNION POLICIES AND LAW

With regard to Article 9(5) of Regulation (EC) No 1083/2006 provide the following information:

I.1. Other Union financing sources

I.1.1. Has an application been made for assistance from any other Union source (TEN-T Budget, LIFE+, R&D Framework Programme, other source of Union finance) for this project?

Yes

No

If yes, please give details (financial instrument concerned, reference Nos, dates, amounts requested, amounts granted, etc.):

I.1.2. Is this project complementary to any project already financed or to be financed by the ERDF, ESF, Cohesion Fund, TEN-T Budget, other source of Union finance?

Yes

No

If yes, give details (provide precise details, reference Nos, dates, amounts requested, amounts granted, etc.):

I.1.3. Has an application been made for loan or equity support from EIB/EIF for this project?

Yes

No

If yes, please give details (financial instrument concerned, reference Nos, dates, amounts requested, amounts granted, etc.):

I.1.4. Has an application been made for assistance from any other Union source (including ERDF, ESF, Cohesion Fund, EIB, EIF, other sources of Union finance) for an earlier phase of this project (including feasibility and preparatory phases)?

Yes

No

If yes, please give details (financial instrument concerned, reference Nos, dates, amounts requested, amounts granted, etc.):

I.2. Is the project subject to a legal procedure for non-compliance with Union legislation?

Yes

No

If yes, please give details:

I.3. Publicity measures

Give details of the proposed measures to publicise Union assistance (for example, type of measure, brief description, estimated costs, duration, etc.):

I.4. Involvement of JASPERS in project preparation

I.4.1. Has JASPERS technical assistance contributed to any part of the preparation of this project?

Yes

No

I.4.2. Describe the elements of the project where JASPERS had an input (e.g. environmental compliance, procurement, review of technical description).

I.4.3. What were the principal conclusions and recommendations of the JASPERS contribution and were these taken into account in the finalisation of the project?

I.5. Public procurement

In cases where contracts have been advertised in the Official Journal of the European Union, give reference.

Contract

Date

Reference

J. ENDORSEMENT OF COMPETENT NATIONAL AUTHORITY

I confirm that the information presented in this form is accurate and correct.

Name: …

Signature: …

Organisation: …

(Managing authority and in case of major project co-financed by more than one operational programme the responsible authorities)

Date: …

Appendix I

DECLARATION BY AUTHORITY RESPONSIBLE FOR MONITORING NATURA 2000 SITES

Responsible Authority …

Having examined the project application …

Which is to be located at …

Declares that the project is not likely to have significant effects on a NATURA 2000 site on the following grounds:

Therefore an appropriate assessment required by Article 6(3) was not deemed necessary.

A map at scale of 1:100.000 (or the nearest possible scale) is attached, indicating the location of the project as well as the NATURA 2000 sites concerned, if any.

Date (dd/mm/yyyy):…

Signed: …

Name: …

Position: …

Organisation: …

(Authority responsible for monitoring NATURA 2000 sites)

Official Seal:

MAJOR PROJECT REQUEST FOR CONFIRMATION OF ASSISTANCE UNDER ARTICLES 39 TO 41 OF REGULATION (EC) NO 1083/2006

EUROPEAN REGIONAL DEVELOPMENT FUND/COHESION FUND

PRODUCTIVE INVESTMENT

[Project title]

CCI No […]

A. ADDRESSES AND REFERENCES

A.1. Authority responsible for the application (i.e., managing authority or intermediate body). In case of major project co-financed by more than one Operational Programme, the responsible authorities of each Operational Programme concerned shall be mentioned.

A.1.1. Name:

A.1.2. Address:

A.1.3. Contact:

A.1.4. Telephone:

A.1.5. Telex/Fax:

A.1.6. E-mail:

A.2. Organisation, or organisations in case of major project co-financed by more than one Operational Programme, responsible for project implementation (beneficiary)

A.2.1. Name:

A.2.2. Address:

A.2.3. Contact:

A.2.4. Telephone:

A.2.5. Telex/Fax:

A.2.6. E-mail:

B. PROJECT DETAILS

B.1. Description of the project

B.1.1. Name of the project/project phase:

B.1.2. Name of the undertaking:

B.1.3. Is the undertaking an SME (1)?

Yes

No

B.1.4. Turnover:

value million euro

B.1.5. Total number of persons employed: value

B.1.6. Group structure:

Are 25 % or more of the capital or voting rights of the undertaking owned by one enterprise or a group of enterprises falling outside the definition of an SME?

Yes

No

Indicate the name and describe the group structure.

(1) Commission Recommendation 2003/361/EC (OJ L 124, 20.5.2003, p. 36).

B.2. Categorisation of project activity (2)

Code

Percentage

B.2.1. Code for the priority theme dimension (3)

B.2.2. Code for the form of finance dimension

B.2.3. Code for the territorial dimension

B.2.4. Code for the economic activity dimension

B.2.4.1. NACE Code (4)

B.2.4.2. Nature of the investment (5)

B.2.4.3. Product concerned (6)

B.2.5. Code for the location dimension(s) (NUTS/LAU) (7)

B.3. Compatibility and coherence with the Operational Programme(s)

B.3.1. Title of the related Operational Programme(s):

B.3.2. Common Code for Identification (CCI) No of Operational Programme(s)

B.3.3. Fund

In case of major project co-financed by more than one Operational Programme, specify the Fund for each Operational Programme separately.

ERDF

Cohesion Fund

B.3.4. Title of the priority axis or priority axes in case of major project co-financed by more than one Operational Programme:

B.4. Project description

B.4.1. Project (or project phase) description:

(a) Provide a description of the project (or project phase).

(b) Where the project is a phase of an overall project, provide a description of the proposed stages of implementation (explaining whether they are technically and financially independent). In case of major project co-financed by more than one Operational Programme indicate the parts falling under each Operational Programme or pro-rata allocation.

(c) What criteria have been used to determine the division of the project into phases?

(2) Annex II to this Regulation unless otherwise specified.

(3) Where a project involves more than one economic activity, multiple codes may be indicated. In that case, the percentage share for each code should indicated with the total not exceeding 100%.

(4) NACE-Rev. 2, 4 digit code: Regulation (EC) No 1893/2006.

(5) New construction = 1; extension = 2; conversion/modernisation = 3; change of locality = 4; creation by take-over = 5.

(6) Combined Nomenclature (CN), Council Regulation (EEC) No 2658/87 (OJ L 256, 7.9.1987, p. 1).

(7) Regulation (EC) No 1059/2003. Use the most detailed and relevant NUTS code. Where a project affects more than three individual Nuts – Lau 2 level areas, consider encoding the NUTS/LAU1 or higher codes.

B.4.2. Technical description of the productive investment

Fully describe:

(a) The work involved, specifying its main characteristics and component elements (use quantified indicators where possible).

(b) The establishment, main activities and main elements of the financial structure of the enterprise.

(c) The objectives of the investment and main aspects of the new construction, extension, conversion/modernisation, change of locality, creation by take-over covering the investment.

(d) Describe the production technology and equipment.

(e) Describe the products.

B.5. Project objectives

B.5.1. Current infrastructure endowment and impact of the project

Indicate the extent to which the region(s) is/are at present endowed with the type of production facilities or activities covered by this application. Indicate the foreseeable contribution of the project:

B.5.2. Contribution to the achievement of the Operational Programme(s)

Indicate how the project contributes to the achievement of the priorities of the Operational Programme(s) (provided quantified indicators per operational programme where possible).

C. RESULTS OF FEASIBILITY STUDIES

C.1. Provide a summary of the main conclusions of the feasibility studies (or business plan) conducted

C.1.1. Demand analysis

C.1.1.1. Describe the target markets, broken down, where appropriate, by Member State and, separately, by third countries considered as a whole:

C.1.1.2. Provide a summary of the demand analysis including the demand growth rate broken down, where appropriate, by Member State and, separately, by third countries considered as a whole:

C.1.2. Capacity considerations

C.1.2.1. Capacity of the firm before investment (in units per year):

C.1.2.2. Reference date:

C.1.2.3. Capacity after investment (in units per year):

C.1.2.4. Estimate the capacity utilisation rate:

D. TIMETABLE

D.1. Project timetable

Give below the timetable for the development of the overall project.

Where the application concerns a project stage clearly indicate in the table the elements of the overall project for which assistance is being sought by this application:

Start date

(A)

dd/mm/yyyy

Completion date

(B)

dd/mm/yyyy

1. Feasibility study/Business plan:

2. Cost-benefit analysis:

3. Environmental impact assessment:

4. Land acquisition:

5. Construction phase:

6. Operational phase:

Please attach a summary schedule of the main categories of works (i.e., a Gantt chart, where available).

D.2. Project maturity

Describe the project timetable (D.1) in terms of the technical and financial progress and current maturity of the project under the following headings:

D.2.1. Technical (feasibility studies, etc.);

D.2.2. Administrative (authorisations, EIA, land purchase, etc.);

D.2.3. Financial (commitment decisions in respect of national public expenditure, loans requested or granted, etc. - give references)

D.2.4. If the project has already started, indicate the current state of works:

E. COST-BENEFIT ANALYSIS

This section should be based on the Guidelines on the methodology for carrying out the cost-benefit analysis of major projects. In addition to the summary elements to be provided below the full cost-benefit analysis document shall be provided in support of this application as Annex II.

E.1. Financial analysis

The key elements from the financial analysis of the CBA should be summarised below.

E.1.1. Short description of methodology and specific assumptions made

E.1.2. Main elements and parameters used in the CBA for financial analysis

Main elements and parameters taken into account in calculation of expected profitability

1. Reference period (years)

2. Financial discount rate (%)

3. Total investment cost (in euro)

4. Estimated increase in annual turnover realised by this investment (in euro)

5. % change in turnover per person employed (only in the case of expansion of an activity)

E.1.3. Main results of the financial analysis

Without Union assistance

(FRR/C)

A

With Union assistance

(FRR/K)

B (1)

1. Financial rate of return: (%)

FRR/C

FRR/K

2. Net present value (euro)

FNPV/C

FNPV/K

(1) For the calculation of the project profitability without (“/C”) and with (“/K”) Union assistance, refer to guidance provided by the Commission in line with Article 40 of Regulation (EC) No 1083/2006.

E.2. Socio-economic analysis

E.2.1. Provide a short description of methodology (key assumptions made in valuing costs and benefits) and the main findings of the socio-economic analysis:

E.2.2. Please give details of main economic costs and benefits identified in the analysis together with values assigned to them:

Benefit

Unit value

(where applicable)

Total value

(in euro, discounted)

% of total benefits

Cost

Unit value

(where applicable)

Total value

(in euro, discounted)

% of total costs

E.2.3. Main indicators of the economic analysis

Main parameters and indicators

Values

1. Social discount rate (%)

2. Economic rate of return (%)

3. Economic net present value (in euro)

4. Benefit-cost ratio

E.2.4. Employment effects of project

(a) Provide an indication of the number of jobs to be created (expressed in terms of full-time equivalents (FTE))

No (FTE)

(A)

Average duration of these jobs

(months) (1)

(B)

No of jobs directly created:

1. During implementation phase

2. During operational phase

No of jobs indirectly created

3. During implementation phase

4. During operational phase

(1) In case of permanent jobs, instead of duration in months, type “permanent”.

(b) Jobs safeguarded

Estimate the number of jobs (full time equivalents) that would be lost if the investment is not realised:

Explain the reasons:

(c) Inter-regional employment impact

What impact is the project expected to have on employment in other regions of the Union?

Positive/neutral/negative impact

Give details:

E.2.5. Identify the main non-quantifiable/non-valuable benefits and costs:

E.3. Risk and sensitivity analysis

E.3.1. Short description of methodology and summary results

E.3.2. Sensitivity analysis

State the percentage change applied to the variables tested: …

Present the estimated effect on results of financial and economic performance indexes.

Variable tested

Financial Rate or Return variation

Financial Net Present Value variation

Economic Rate or Return variation

Economic Net Present Value variation

Which variables were identified as critical variables? State which criterion is applied.

Which are the switching values of the critical variables?

E.3.3. Risk analysis

Describe the probability distribution estimate of the project’s financial and economic performance indexes. Provide relevant statistical information (expected values, standard deviation).

F. ANALYSIS OF THE ENVIRONMENTAL IMPACT

F.1. How does the project:

(a) contribute to the objective of environmental sustainability (European climate change policy, halting loss of biodiversity, other …);

(b) respect the principles of preventive action and that environmental damage should as a priority be rectified at source;

(c) respect the “polluter pays” principle.

F.2. Consultation of environmental authorities

Have the environmental authorities likely to be concerned by the project been consulted by reason of their specific responsibilities?

Yes

No

If yes, please give name(s) and address(es) and explain that authority's responsibility:

If no, please give reasons

F.3. Environmental Impact Assessment

F.3.1. Development Consent (8)

F.3.1.1. Has development consent already been given to this project?

Yes

No

F.3.1.2. If yes, on which date

F.3.1.3. If no, when was the formal request for the development consent introduced:

F.3.1.4. By which date is the final decision expected?

F.3.1.5. Specify the competent authority or authorities, which has given or will give the development consent

F.3.2. Application of Council Directive 85/337/EEC on environmental impact assessment (EIA) (9)

F.3.2.1. Is the project a class of development covered by:

Annex I to that Directive (go to question F.3.2.2)

Annex II to that Directive (go to question F.3.2.3)

Neither of the two annexes (go to question F.3.3)

F.3.2.2. When covered by Annex I to that Directive, include the following documents:

(a) The information referred to in Article 9(1) of that Directive

(b) The non-technical summary (10) of the Environmental Impact Study carried out for the project;

(c) Information on consultations with environmental authorities, the public concerned and, if applicable, with other Member States.

F.3.2.3. When covered by Annex II to that Directive, has an Environmental Impact Assessment been carried out for this project?

Yes

in which case include the necessary documents listed under point F.3.2.2

No

in which case explain the reasons and give the thresholds, criteria or case by case examination carried out to reach the conclusion that the project has no significant environmental effects:

F.3.3. Application of the Strategic Environmental Assessment Directive 2001/42/EC of the European Parliament and of the Council (11) (SEA-Directive)

(8) The decision of the competent (national) authority or authorities which entitles the developer to proceed with the project. In cases where the project submitted is part of a wider operation, the development consent should refer only to the project as submitted to the Commission. In cases where more than one development consent decisions are required, please repeat the information as many times as necessary.

(9) OJ L 175, 5.7.1985, p. 40.

(10) Prepared under Article 5(3) of Directive 85/337/EEC.

(11) OJ L 197, 21.7.2001, p. 30.

F.3.3.1. Does the project result from a plan or programme falling within the scope of the SEA Directive?

No in which case please provide a short explanation:

Yes in which case, in order to appreciate if wider potential cumulative effects of the project have been addressed, please provide either an internet link to or an electronic copy of the non-technical summary (12) of the Environmental Report carried out for the plan or programme.

F.4. Assessment of effects on NATURA 2000 sites

F.4.1. Is the project likely to have significant negative effects on sites included or intended to be included in the NATURA 2000 network?

Yes in which case

(1) Please provide a summary of the conclusions of the appropriate assessment carried out according to Article 6(3) of Directive 92/43/EEC (13)

(2) In case, compensation measures were deemed necessary according to Article 6(4), please provide a copy of the form “Information on projects likely to have significant negative effect on NATURA 2000 sites, as notified to the Commission (DG Environment) under Directive 92/43/EEC (14)”

No in which case attach a completed Appendix I declaration filled in by the relevant authority.

F.5. Additional environmental integration measures

Does the project envisage, apart from Environmental Impact Assessment, any additional environmental integration measures (e.g. environmental audit, environmental management, specific environmental monitoring)?

Yes

No

If yes, specify

F.6. Cost of measures taken for correcting negative environmental impacts

If included in total cost, estimate proportion of cost of measures taken to reduce and/or to compensate for negative environmental impacts

%

Explain briefly:

G. JUSTIFICATION FOR THE PUBLIC CONTRIBUTION

G.1. Competition

Does this project involve State Aids?

Yes

No

(12) Prepared under Annex I(j) to Directive 2001/42/EC.

(13) OJ L 206, 22.7.1992, p. 7.

(14) Document 99/7 rev. 2 adopted by the Habitats Committee (established under Directive 92/43/EEC) at its meeting on 4 October 1999.

If yes, please give in the table below the amount of aid, and, for approved aid the State aid number and the reference of the approval letter, for block-exempted aid the respective registry number, and for pending notified aid the State aid number (15)

Sources of aid

(local, regional, national and Union):

Amount of aid

euro

State Aid number/registry number for block-exempted aid

Reference of approval letter

Approved aid schemes, approved ad hoc aid, or aid falling under a block exemption regulation:

Aid foreseen under pending notifications (ad hoc aid or schemes):

Aid for which a notification is outstanding (ad hoc aid or schemes)

Total aid granted:

Total cost of the investment project

G.2. Impact of Union assistance on project implementation

For each affirmative answer, give details:

Will Union assistance:

a) accelerate implementation of the project?

Yes

No

b) be essential to implementation of the project?

Yes

No

H. FINANCING PLAN

The decision amount and other financial information in this section must be coherent with the basis (total or public cost) for the co-financing rate of the priority axis. Where private expenditure is not eligible for financing under the priority axis, it shall be excluded from the eligible costs; where private expenditure is eligible it may be included.

(15) This application does not replace notification to the Commission under Article 108(3) of the Treaty. A positive decision by the Commission on the major project under Regulation (EC) No 1083/2006 does not constitute State aid approval.

H.1. Cost breakdown

Euro

Total project costs

(A)

Ineligible costs (1)

(B)

Eligible costs

(C) = (A) – (B)

1. Planning/design fees

2. Land purchase

3. Building and construction

4. Plant and machinery

5. Contingencies (2)

6. Publicity

7. Supervision during construction implementation

8. Sub-Total

9. (VAT (3))

10. Total

(4)

(1) Ineligible costs comprise (i) expenditure outside the eligibility period, (ii) expenditure ineligible under national rules (Article 56(4) of Regulation (EC) No 1083/2006), (iii) other expenditure not presented for co-financing. NB: The starting date for eligibility of expenditure is the date of receipt of the related draft Operational Programme by the Commission or 1 January 2007, whichever is the earlier.

(2) Contingencies should not exceed 10% of total investment cost net of contingencies. These contingencies may be included in the total costs used to calculate the financial contribution of the funds.

(3) Where VAT is considered as eligible, give reasons.

(4) Total cost must include all costs incurred for the project, from planning to supervision and must include VAT even if VAT is considered non eligible.

H.2. Total planned resources and planned contribution from the Funds

H.2.1. Union contribution calculation

Value

1. Decision amount, i.e., the “amount to which the co-financing rate for the priority axis or priority axes (1) applies” (Article 41(2) of Regulation (EC) No 1083/2006) (respecting the maximum public contribution according to state aid rules and the exclusion of ineligible expenditure)

1.1 In case of major project co-financed by more than one Operational Programme, indicate the share of the Decision amount corresponding to each Operational Programme

2. Co-financing rate of the priority axis or priority axes (1) (%)

3. Union contribution (in euro) = (1)*(2)

(1) In case of major project co-financed by more than one Operational Programme.

H.2.2. Sources of co-financing

In the light of the results of the grant calculation (H.2.1 consistent with the rules on State aid) the total investment costs of the project shall be met from the following sources:

Source of total investment costs (€)

Of which

(For Information)

Total investment cost

[H.1.10.(A)]

Union assistance

[H.2.1.3]

National public

(or equivalent)

National private

Other sources

(specify)

EIB/EIF loans

(a) = (b) + (c) + (d) + (e)

(b)

(c)

(d)

(e)

(f)

H.2.3. Expenditure already certified

Has expenditure for this major project been already certified?

Yes

No

If yes, state the amount: … EUR.

If yes and in case of major project co-financed by more than one Operational Programme, under which Operational Programmes have the expenditure been certified?

Title of the related Operational Programme(s):

CCI number:

Amount concerned in the Operational Programme: … EUR

H.3. Annual financing plan of Union contribution

The Union contribution (H.2.1.3) shall be presented in terms of the share of annual programme commitment. In case of major project co-financed by more than one Operational Programme, the annual financing plan shall be presented separately for each Operational Programme.

(in Euro)

2007

2008

2009

2010

2011

2012

2013

[CF/ERDF - specify]

I. COMPATIBILITY WITH UNION POLICIES AND LAW

With regard to Article 9(5) of Regulation (EC) No 1083/2006 provide the following information:

I.1. Other Union financing sources

I.1.1. Has an application been made for assistance from any other Union source (TEN-T Budget, LIFE+, R&D Framework Programme, other source of Union finance) for this project?

Yes

No

If yes, please give details (financial instrument concerned, reference Nos, dates, amounts requested, amounts granted, etc.):

I.1.2. Is this project complementary to any project already financed or to be financed by the ERDF, ESF, Cohesion Fund, TEN-T Budget, other source of Union finance?

Yes

No

If yes, give details (provide precise details, reference Nos, dates, amounts requested, amounts granted, etc.):

I.1.3. Has an application been made for loan or equity support from EIB/EIF for this project?

Yes

No

If yes, please give details (financial instrument concerned, reference Nos, dates, amounts requested, amounts granted, etc.):

I.1.4. Has an application been made for assistance from any other Union source (including ERDF, ESF, Cohesion Fund, EIB, EIF, other sources of Union finance) for an earlier phase of this project (including feasibility and preparatory phases)?

Yes

No

If yes, please give details (financial instrument concerned, reference Nos, dates, amounts requested, amounts granted, etc.):

I.2. Is the project subject to a legal procedure for non-compliance with Union legislation?

Yes

No

If yes, please give details:

I.3. Publicity measures

Give details of the proposed measures to publicise Union financial assistance (i.e. type of measure, brief description, estimated costs, duration, etc.):

I.4. Involvement of JASPERS in project preparation

I.4.1. Has JASPERS technical assistance contributed to any part of the preparation of this project?

Yes

No

I.4.2. Describe the elements of the project where JASPERS had an input (e.g. environmental compliance, procurement, review of technical description).

I.4.3. What were the principal conclusions and recommendations of the JASPERS contribution and were these taken into account in the finalisation of the project?

I.5. Previous history of the recovery of assistance

Has the benefiting undertaking previously been, or is it currently, the subject of a procedure (16) to recover Union assistance following the transfer of a productive activity within a Member State or toward another Member State?

Yes

No

J. ENDORSEMENT OF COMPETENT NATIONAL AUTHORITY

I confirm that the information presented in this form is accurate and correct.

Name: …

Signature: …

Organisation: …

(Managing authority and in case of major project co-financed by more than one operational programme the responsible authorities)

Date: …

(16) Under Article 57(3) of Regulation (EC) No 1083/2006.

Appendix I

DECLARATION BY AUTHORITY RESPONSIBLE FOR MONITORING NATURA 2000 SITES

Responsible Authority …

Having examined the project application …

Which is to be located at …

Declares that the project is not likely to have significant effects on a NATURA 2000 site on the following grounds:

Therefore an appropriate assessment required by Article 6(3) was not deemed necessary.

A map at scale of 1:100.000 (or the nearest possible scale) is attached, indicating the location of the project as well as the NATURA 2000 sites concerned, if any.

Date (dd/mm/yyyy): …

Signed: …

Name: …

Position: …

Organisation: …

(Authority responsible for monitoring NATURA 2000 sites)

Official Seal: