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LIFE Environment and Resource Efficiency

TECHNICAL APPLICATION FORMS

Part A – administrative information

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LIFE15 ENV/IT/000007

LIFE Environment and Resource Efficiency project application

Language of the proposal:

LIFE EASME ENV TEST 2

Project acronym:


The project will be implemented in the following Member State(s) and Region(s) or othercountries:Italy Toscana

Expected start date: 03/10/2016 Expected end date: 31/12/2017

LIST OF BENEFICIARIES

Name of the coordinating beneficiary: vv

LIST OF CO-FINANCERS

PROJECT BUDGET AND REQUESTED EU FUNDING

Total project budget:

Total eligible project budget:

EU financial contribution requested:

3,000 Euro

3,000 Euro

1,000 Euro (= 33.33% of total eligible budget)

FOR ADMINISTRATION USE ONLY


SECTOR

Water

Project title:

Italiano (it)

LIFE 2015

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LIFE15 ENV/IT/000007 - A2

Coordinating Beneficiary Profile Information

Legal Name vv

Short Name qq Legal Status

VAT No Public body

Legal Registration Private commercial

Registration Date Private non- commercial XPic Number

Legal entity is SME

Employee number

Legal address of the Coordinating Beneficiary

Street Name and No v

Post Code 444 PO Box

Town / City v

Member State Italy

Coordinating Beneficiary contact person informationTitle Mr. Function rr

Surname rr

First Name rr

E-mail address [email protected]%

Department /

Street Name and No rr

Post Code 444 PO Box

Town / City rr

Member State Austria

Telephone No 555 Fax No

Website of the Coordinating Beneficiary

Website http://

Brief description of the Coordinating Beneficiary's activities and experience in the area of the

rrr

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OTHER PROPOSALS SUBMITTED FOR EUROPEAN UNION FUNDING

Please answer each of the following questions:

• Have you or any of your associated beneficiaries already benefited from previous LIFE cofinancing?(please cite LIFE project reference number, title, year, amount of the co-financing, duration, name(s) ofcoordinating beneficiary and/or partners involved):

gg

• Have you or any of the associated beneficiaries submitted any actions related directly or indirectly tothis project to other European Union funding programmes? To whom? When and with what results?

gg

• For those actions which fall within the eligibility criteria for financing through other European Unionfunding programmes, please explain in full detail why you consider that those actions are bettersuited to financing through LIFE and are therefore included in the current project:

ggg

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Part B - technical summary and overallcontext of the project


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LIFE15 ENV/IT/000007 - B1

SUMMARY DESCRIPTION OF THE PROJECT (Max. 3 pages; to be completed in English)

Project title:


Project objectives:

gg

Actions and means involved:

gg

Expected results (outputs and quantified achievements):

ggg

Is your project significantly climate-related? XYes No

ggg

Is your project significantly biodiversity-related? Yes No X

gg

The proposal addresses the following project topic(s):

• Planning and establishment in urban and rural areas of natural water retention measures thatincrease infiltration, storage of water and remove pollutants through natural, or "natural-like"processes and thereby contribute to the achievement of the WFD and the Floods Directive (FD)objectives and to drought management in water scarce regions.

Reasons why the proposal falls under the selected project topic(s):

ggg

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ENVIRONMENTAL PROBLEM TARGETED

gg

PROJECT PILOT / DEMONSTRATION CHARACTER OF THE PROJECT

gg

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SOCIO-ECONOMIC EFFECTS OF THE PROJECT

gg

EFFORTS FOR REDUCING THE PROJECT'S "CARBON FOOTPRINT"

ggg

gg

EU ADDED VALUE OF THE PROJECT AND ITS ACTIONS

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STAKEHOLDERS INVOLVED AND MAIN TARGET AUDIENCE OF THE PROJECT (OTHER THAN PROJECTPARTICIPANTS)

ggg

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EXPECTED CONSTRAINTS AND RISKS RELATED TO THE PROJECT IMPLEMENTATION AND MITIGATIONSTRATEGY

gg

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CONTINUATION / VALORISATION AND LONG TERM SUSTAINABILITY OF THE PROJECT'S RESULTS AFTERTHE END OF THE PROJECT

Which actions will have to be carried out or continued after the end of the project?

gg

How will this be achieved? What resources will be necessary to carry out these actions?

gg

To what extent will the results and lessons of the project be actively disseminated after the end of the project tothose persons and/or organisations that could best make use of them (please identify thesepersons/organisations)?

gg

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Part C – detailed technical description of theproposed actions


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LIFE15 ENV/IT/000007 - C0

LIST OF ALL PROPOSED ACTIONS

A. Preparatory actions (if needed)

B. Implementation actions (obligatory)

B1 IMP

C. Monitoring of the impact of the project actions (obligatory)

C1 MON

D. Public awareness and dissemination of results (obligatory)

D1 PUB

E. Project management (obligatory)

E1 MAN

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LIFE15 ENV/IT/000007 - C1b

DETAILS OF PROPOSED ACTIONS

B. Implementation actions (obligatory)ACTION B.1: IMP

Description and methods employed (what, how, where, when and why):ggg

Beneficiary responsible for implementation:qq

Assumptions related to major costs of the action:gg

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LIFE15 ENV/IT/000007 - C1b

B1's PROJECT DELIVERABLE PRODUCTS

Deliverable name Deadline

B1's PROJECT MILESTONES

Milestone name Deadline

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LIFE15 ENV/IT/000007 - C1c

C. Monitoring of the impact of the project actions (obligatory)ACTION C.1: MON

Description and methods employed (what, how, where, when and why):gg


Assumptions related to major costs of the action:hh

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LIFE15 ENV/IT/000007 - C1c

C1's PROJECT DELIVERABLE PRODUCTS


C1's PROJECT MILESTONES


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LIFE15 ENV/IT/000007 - C1d

D. Public awareness and dissemination of results (obligatory)ACTION D.1: PUB



Assumptions related to major costs of the action:ggg

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LIFE15 ENV/IT/000007 - C1d

D1's PROJECT DELIVERABLE PRODUCTS


D1's PROJECT MILESTONES


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LIFE15 ENV/IT/000007 - C1e

E. Project management (obligatory)ACTION E.1: MAN



Assumptions related to major costs of the action:gggnb

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LIFE15 ENV/IT/000007 - C1e

E1's PROJECT DELIVERABLE PRODUCTS


E1's PROJECT MILESTONES


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DELIVERABLE PRODUCTS OF THE PROJECT

Name of the Deliverable Number of theassociated action Deadline

MILESTONES OF THE PROJECT

DeadlineName of the Milestone Number of theassociated action

ACTIVITY REPORTS FORESEEN

Please indicate the deadlines for the following reports:

• Progress Reports nï¿½1, nï¿½2 etc. (if any; to ensure that the delay between consecutivereports does not exceed 18 months)• Mid term report payment request (for project longer than 24 months or with Eu contibutionof more than EUR300,000)• Final Report with payment request (to be delivered within 3 months after the end of theproject)

Type of report Deadline

Progress report 17/11/2016

Midterm report 13/07/2017

Final report 04/01/2018

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TIMETABLE

Action

Actionnumbe Name of the action

2016

I II III IV

2017

I II III IV

2018

I II III IV

2019

I II III IV

2020

I II III IV

2021

I II III IV

A. Preparatory actions (if needed)B. Implementation actions (obligatory)

B.1 IMPC. Monitoring of the impact of the project actions (obligatory)

C.1 MOND. Public awareness and dissemination of results (obligatory)

D.1 PUBE. Project management (obligatory)

E.1 MAN

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FINANCIAL APPLICATION FORMS

Part F – financial information


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LIFE15 ENV/IT/000007 R1 - Budget

Budget breakdown cost categories Total cost in € Eligible Cost in € % of total eligiblecosts

1. Personnel 1,000 1,000 33.33%

2. Travel and subsistence 0 0 0.00%

3. External assistance 0 0 0.00%

4. Durable goods

Infrastructure 0 0 0.00%

Equipment 0 0 0.00%

Prototype 0 0 0.00%

5. Land Not applicable

6. Consumables 0 0 0.00%

7. Other costs 2,000 2,000 66.67%

8. Overheads 0 0 0.00%

Total 3,000 3,000 100.00%

Contribution breakdown In € % of total % of total eligiblecosts

EU contribution requested 1,000 33.33% 33.33%

Coordinating Beneficiary's contribution 2,000 66.67%

Associated Beneficiaries' contribution 0 0.00%

Co-financers contribution 0 0.00%

Total 3,000 100.00%

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LIFE15 ENV/IT/000007 - R2 - Costs per Action

Cost category in Euro

Project action

Pers

onne

l(D

ays)

Trav

el

Exte

rnal

assi

stan

ce

Infr

astr

uctu

re

Equi

pmen

t

Prot

otyp

e

Cons

umab

les

Oth

er

Total

B1 IMP 1,000

(10)

0 0 0 0 0 0 2,000 3,000

Overheads

Total1,000

(10)

0 0 0 0 0 0 2,000

0

3,000

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LIFE15 ENV/IT/000007 - R2a

Costs per Beneficiary

Short name

Pers

onne

l(D

ays)

Trav

el

Exte

rnal

assi

stan

ce

Infr

astr

uctu

re

Equi

pmen

t

Prot

otyp

e

Cons

umab

les

Oth

er

Ove

rhea

ds

EU c

ontr

ib.

Tota

l elig

ible

cost

s

% o

f tot

alel

igib

le c

osts

qq 1,000

(10)

0 0 0 0 0 0 2,000 0 1,000 3,000 100.00%

Total

Share of totaleligible costs

1,000

(10)

33.33%

0

0.00%

0

0.00%

0

0.00%

0

0.00%

0

0.00%

0

0.00%

2,000

66.67%

0

0.00%

1,000

33.33%

3,000

100.00%

100.00%

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LIFE15 ENV/IT/000007 - FC

Coordinating Beneficiary's contributionCountry code Beneficiary short name Total costs of the

actions in €(includingoverheads)

Beneficiary's owncontribution in €

Amount of EUcontribution

requested in €

Associated Beneficiaries' contributionCountry code Beneficiary short name Total costs of the

actions in €(includingoverheads)

Associatedbeneficiary's owncontribution in €

Amount of EUcontribution

requested in €

TOTAL Associated Beneficiaries

TOTAL All Beneficiaries

Co-financers contributionAmount of co-financing in €Co-financer's name

TOTAL

IT qq 2,000 1,0003,000

0

0 0

2,000 1,0003,000

0

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LIFE15 ENV/IT/000007 - F1

Direct Personnel costs

Calculation => A B A x B

Beneficiaryshort name

Actionnumber Type of contract Category/Role in the project

Daily rate(rounded tothe nearest

Number ofperson-days Direct personnel

costs (€)qq B 1 Permanent staff or

civil servantff 100 10 1,000

TOTAL => 10 1,000

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LIFE15 ENV/IT/000007 - F7

Other costs

Beneficiaryshort name

Actionnumbe Procedure Description Costs (€)

qq B 1 vvv vv 2,000

TOTAL => 2,000

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LIFE15 ENV/IT/000007 - Attachments

Proposal attachments

Included?

Attachment title Attachment type Yes Nosimplified financial statement (Excel file)Simplified financial statement

public body declarationPublic body declaration

project performance indicatorsProject performance indicators

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