Bushfire Recovery Grants for Apple ProducersApplication Form

ELIGIBILITY CHECKLIST

The applicant must answer ‘yes’ to the following questions.

The applicant is an apple grower with an orchard that was in active production immediately prior to the bushfire.

☐ Yes ☐ No

The applicant has a primary production business (as defined in the Income Tax Assessment Act 1997).

☐ Yes ☐ No

The applicant has an apple orchard that suffered direct damage by bushfires since August 2019.

☐ Yes ☐ No

The land on which eligible activities are proposed suffered direct damage by bushfires since August 2019.

☐Yes ☐ No

The property(ies) is/are located in one or more of the eligible local government areas.

☐ Yes ☐ No

The applicant is a property owner, share farmer or lease holder in the apple industry.

☐ Yes ☐ No

The applicant operates as a sole trader, partnership, trust or private company.

☐ Yes ☐ No

The applicant holds an Australian Business Number (ABN) that was active at the time of the eligible disaster and is registered for GST.

☐Yes ☐ No

The applicant is a legal entity capable of entering into a legally binding agreement with the Minister for Primary Industries and Regional Development and/or Delegate.

☐ Yes ☐ No

The applicant will contribute a minimum of 50 per cent of the total budgeted cost of the eligible project activity costs through in-kind and / or cash contributions.

☐Yes ☐ No

The applicant will commence the project within 6 months of receiving funding approval with the project completed and all grant funding expended by 30 June 2023.

☐ Yes ☐ No

The applicant has met the terms and conditions of any previous South Australian Government funding.

☐ Yes ☐ No

The project activities outlined in this application form have not received and will not receive funding from another Australian or South Australian government program.

☐ Yes ☐ No

Funding for the activities applied for in this application are either not covered by, or are in excess of, the amount covered by insurance.

☐ Yes ☐ No

Eligible Local Government Area (please tick)

☐ Adelaide Hills

☐ Coorong

☐ Kangaroo Island

☐ Kingston

☐ Mid Murray

☐ Mount Barker

☐ Murray Bridge

☐ Southern Mallee District

☐ Yorke Peninsula

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Section 1 - Applicant Details

NAME OF LEGAL ENTITY

ABN

ADDRESS

Suburb/Town Postcode

POSTAL ADDRESS(if different to site address) Suburb/Town Postcode

Contact Person

Title FIRST NAME SURNAME

POSITION IN BUSINESS

PREFERRED CONTACT NUMBER

EMAIL ADDRESS

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Previous AssistanceHave you previously applied for an Emergency Bushfire Response in Primary Industries Grant?

☐ Yes ☐ No

If yes, please provide your reference number

Reference No BF2020-_ _ _ _

If you have already provided information and documents under the Emergency Bushfire Response in Primary Industries Grant do you agree that the Department of Primary Industries and Regions may access this documentation if it is of relevance to this application?

☐ Yes ☐ No

Section 2 - Business Overview Please outline the applicant’s Corporate Structure (ownership and governance structure) and confirm that the owner is a primary production business (as defined in the Income Tax Assessment Act 1997).

Are there any other business entities that are financially linked to the Applicant/Enterprise?

☐ Yes ☐ No

If yes, please provide details below.

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Section 3 - Property Information

Please list all properties directly impacted by the 2019-2020 bushfire disaster events for which funds are being sought for re-establishing damaged or destroyed apple orchards. Please list all land titles (these details can be found on your Council Rate Notices).

Property 1Land Title Reference Volume Folio Hundred Total Land Title

Area (ha)ExampleCT (Certificate of Title) CL (Crown Lease)

5852 761 Hundred of Mount Barker

15 ha

Road Address

Property Ownership

☐ Property Owner ☐ Share Farmer ☐ Lease Holder

Property 2Land Title Reference Number Folio Hundred Total Land Title

Area (ha)

Road Address

Property Ownership

☐ Property Owner ☐ Share Farmer ☐ Lease Holder

If you have further properties that you are proposing to complete activities on, please copy the above tables and paste directly under each one.

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Section 4 - Details of your primary production enterprise and direct damage incurred

Please provide a description of the direct damage that occurred to your apple orchard business.

If as part of your Emergency Bushfire Response in Primary Industries (Bushfire) Grant application you have already provided this information and it remains up to date, you do not need to provide a response.

Provide a brief description of key business activities for the applicant/enterprise, including property size, apple variety (ies) grown, annual turnover and how long you have been in operation. (approx. 50 words)

Section 5 - Insurance

Has a claim for insurance been made in relation to the direct damage caused by the disaster?A copy of the outcome of your insurance claim must be provided to Primary Industries and Regions SA once determined (refer to checklist on page one).

If as part of your Emergency Response in Primary Industries (Bushfire) Grant application you have already provided the information requested, and it remains up to date, you do not need to provide a response. If the information previously provided remains up to

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date, please ensure you agree to PIRSA using this information for the purpose of assessing this application (See Section 1- Previous Assistance).

◯ Yes – please provide insurance details below

◯ No – please indicate why

Insurance Company

◯ Uninsured (please explain below)

Policy / claim no. ◯ My/our policy does not provide cover for the items damaged or damage caused by the eligible disaster (please attach insurance policy)

Claim manager name

Claim manager phone no.

◯ Other (briefly detail below)

Additional Insurance / other details:

Section 6 - Crop Information

Please provide details of apple varieties that you are seeking funding to repair or relace

Pro

perty

(e.g

. 1,

2 et

c)

Apple Variety (immediately prior to bushfire)

Hectares in active

production immediately

prior to bushfire disaster event

Y/N

Hectares damaged or destroyed by bushfire

disaster event (ha)

Proposed hectares to be re-

established(ha)

Please add additional rows if you have further apple crop varieties that you are seeking funding to repair or replace.

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Section 7 - Project Approvals

Do your proposed activities require development approval?

☐ Yes ☐ No

If yes, please provide further details in the table below.

Required Approval Status of Approval(e.g. development application to be submitted, development application

submitted)

Expected timeline for Approval

(months)

Note: The Program appreciates that it may not be possible to finalise development approvals before submitting your application. However, you can refer to the status of actions underway.

If the project involves replacing infrastructure, please attach documentation to show that the Applicant has the legal right to install such infrastructure (e.g. previous development approval).

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Section 8 - Budget and Activity Timeline

Please provide the total budgeted, GST exclusive cost of each project activity (add more rows to table as necessary) in the Budget Table below.

Funding is linked to the achievement of the milestones defined in the Grant Agreement, which must be completed within a specified timeframe. Milestones will be based on the achievement or delivery of an activity or set of activities - not based solely on dates.

Payments will be made in arrears (that is, evidence-based reimbursements including copies of invoices, receipts and photos).

Milestones will be agreed between the applicant and PIRSA during grant negotiations. The Grant Agreement must be executed within two months of the date of the letter of offer.

An activity describes a measured task that contributes to a project outcome (e.g. order materials, install/ plant materials). For details of ineligible project activities, please refer to the Guidelines.

The proposed completion date is the date by which an activity will be successfully completed. This date is not the payment date or the date that you will receive payment for those activities from the Program. You should consider the business’s cash flow when completing the Budget Table.

Activities and proposed completion dates are used to populate a Grant Agreement for successful applicants.

Written quotes or cost estimates or invoices from third-party suppliers will need to be included with the application. Any quotes or invoices provided to support an application, or requests for payment of grant funds should reflect current market prices for the goods or services being purchased

To be eligible for funding under the Program, the applicant must make a minimum of 50% contribution to the total activity cost including cash and in-kind. This contribution can include funding received from eligible activity insurance claims.

Any in-kind contributions must be reasonable and calculated using current market rates. The value of all in-kind contributions are required to be GST exclusive.

Eligible activities undertaken following the 2019-2020 bushfire disaster events (eligible events commencing August 2019) are eligible for funding.

Eligible activities undertaken prior to the Program commencement will be considered ‘pre-approved’ activities and eligible for funding.

Eligible activities undertaken after the Program commencement will be deemed new activities and will require grant approval before activities can commence. Any project works commenced/completed prior to the Grant Agreement being fully executed will be at the applicant’s own risk.

When identifying a completion date, please note that this is not the date that payment will be made to you. You should consider your business’s cash flow when completing this table. You can include a number of actual/proposed completion dates to support business continuity.

In-kind contributions for activities already completed can be an estimate. For activities that are yet to be completed and that will include an in-kind contribution please complete the table in Section 8b.

No. Activity *Actual / Ha Funding per 10

Section 8a – Budget Table

*Proposed Completion

Date

Hectare (max $120,000/ha)

Example1 Purchase (supply, delivery and planting) for replacement apple

trees Replacement of damaged irrigation Repair of damaged irrigation infrastructure Repair of damaged poles, trellises and netting Replacement of damaged poles, trellises and netting Clean-up of damaged infrastructure and other site preparation

dd-mm-yyyy 5 $100,000

Property 1

TOTAL

Property 2

TOTAL*Notes: Program Funding Sought - is up to a maximum of $120,000 (ex GST) per hectare for eligible businesses

Actual Completion Date - for eligible activities undertaken between August 2019 and 31 August 2020, please insert actual completion date. Proposed Completion Date - for eligible activities to be undertaken after 31 August 2020 please

insert proposed completion dates.Cash/ in-kind Contributions - must be a minimum of 50% of the Program Funding Sought (ex

GST)

Section 8b - In-Kind Contributions TableFor activities yet to be completed please complete the table below. 11

No. ActivityNote: Activities can be cross-referenced to activities listed in budget tableExample

Own labour used – planting apple trees Use of own plant and equipment – installation of new netting

Property 1

Total In-Kind – Property 1

Property 2

Total In-Kind – Property 2

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Section 9 - Application Checklist

Please provide the following documents to support your application:

☐ Documentary evidence of cash contribution☐ Letters from financial institutions confirming contribution (documents should include

the value and nature of the commitment and any conditions relating to this commitment and be signed by the authorised representative); and/or

☐ Copies of bank statements; and☐ Copy of concessional loan agreement (s).

☐ Past 2 financial years of Financial Statements for your primary production business. If you have not completed your financial statements for the last financial year, please provide copies of your financial statements for the two prior financial years.

☐ Evidence of ownership structure for the land parcels for the project (registered owners, share farmers or lease holders

☐ If you are the property owner – a copy of most recent Council Rate Notice

☐ If you are a share farmer – a copy of share farming agreement

☐ If you are a lease holder – a copy of lease agreement.

☐ Written quotes or cost estimates or invoices from third-party suppliers for supply of goods and services.

This information is mandatory and a minimum requirement for submitting a complete application.

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Section 10 – Declaration and Authorisations

Please tick () the boxes below to acknowledge that you declare and understand that:

☐ Application is complete and in all sections and has been signed by an authorised officer of the applicant.

☐ Grant funds are to be applied to assist in paying for the eligible activities directly lined with re-establishing damaged or destroyed apple orchards as outlined under section 3 of the Guidelines.

☐ Information provided in this application is true and correct ☐ Deliberately giving false or misleading information is a serious offence under the Oaths Act

1936 (SA) and may lead to prosecution incurred☐ Assistance claimed and received under this scheme is non-assessable and non-exempt

income for tax purposes☐ Assistance received cannot be claimed for tax deduction purposes.

I/We are authorised to submit this application form.

I/We have read and understood the Bushfire Recovery Grants for Apple Producers Program Guidelines and have obtained clarification and advice where needed.

I/We agree that, subject to approval of our application for the Bushfire Recovery for Apple Producers Grant Program that we will be required to enter into a Grant Deed with the Minister for Primary Industries and Regional Development that sets out the terms and conditions under which support will be advanced.

If the project is approved for funding, all necessary and appropriate approvals will be obtained from the relevant Commonwealth, State and/or Local governments, and the organisation making this application undertakes to manage the proposed Project in accordance with relevant laws and regulations.

I/We agree that neither the Minister for Primary Industries and Regional Development nor the Department of Primary Industries and Regions will be liable to reimburse any losses that may result from this application or the subsequent entering into a Grant Deed.

I/We acknowledge that this application, including attachments and supporting documents, once submitted to the Department of Primary Industries and Regions will become subject to the operation of the Freedom of Information Act 1982 (SA), and could, subject to the provisions of that Act, be released pursuant to a request made under that Act.

I/We authorise the Minister for Primary Industries and Regional Development, acting through the Department of Primary Industries and Regions to disclose any information contained in this application, and any attachments and supporting documents, to any other agency of the South Australian Government or to any agency of any other State or Commonwealth for the purpose of or in connection with the administration of the Bushfire Recovery for Apple Producers Grant Program.

I/We acknowledge that the Minister for Primary Industries and Regional Development acting through Primary Industries and Regions (PIRSA) may seek information regarding expenditure on, and outcomes from, clean-up and reinstatement activities. This information may include photographs, quotations, tax invoices, receipts, bank statements or other similar records.

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I/We understand that we may seek independent legal, accounting, taxation or other expert advice on any aspect of this application.

Full Name of Authorised Representative of Applicant

Position in Enterprise

Signature

Date

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How to applyPlease submit your completed application including all supporting documents to [relevant state Applicants must submit an Application together with all supporting documentation to PIRSA by 31 December 2020. Applications may be submitted by:

Email to PIRSA.GrantsEnquiries@sa.gov.auPosting to: Bushfire Recovery Grant

PIRSA – Rural Solutions SAGPO Box 1671 Adelaide SA 5001

postmarked no later than 5.00pm (ACDT) 31 December 2020.

By visiting one of the PIRSA offices listed below:Office AddressAdelaide Level 14, 25 Grenfell Street, Adelaide

Clare 155 Main North Road, Clare

Kangaroo Island Shop 7, The Mall, 56 Dauncey Street, Kingscote

Loxton 1801 Bookpurnong Road, Loxton

Mount Gambier 7-9 Krummel Street, Mount Gambier

Murray Bridge Bremer Road, Murray Bridge

Nuriootpa 571 Research Road, Nuriootpa

Struan 74 Struan House Road, Struan

If you are unable to obtain a copy of the application form or submit electronically, you are welcome to visit your local PIRSA office where staff will provide you with a hard copy of the form.Enquiries Further information on the program is available through:

Department of Primary Industries and Regions Telephone: 1800 931 314Email: PIRSA.Recovery@sa.gov.auWebsite: pir.sa.gov.au/recoverygrants

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