USVI Public Records

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GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS THE OFFICE OF MANAGEMENT AND BUDGET No. 5041 Norre Gade Emancipation Gardens Station, 2nd Floor Charlotte Amalie, U.S. Virgin Islands 00802 Telephone: (340) 774-0750 Section 1: Applicant Information Organization Name: _________________________________________ Authorized Representative: Name: ____________________________________ Title: _____________________________________ Business Address: Street: ____________________________________ City: ____________ State: ____ ZIP: ________ Email Address: _______________________________ Phone Number: _______________________________ Website (if applicable): _________________________ DUNS/UEI Number: ___________________________ Federal EIN (Tax ID): __________________________ Section 2: Eligibility Information Organization Type: ☐ Nonprofit ☐ For-Profit ☐ Tribal Government ☐ State/Local Government ☐ Public-Private Partnership ☐ Other (please specify): _______________ Is your organization currently registered in SAM.gov? ☐ Yes ☐ No (If yes, please provide CAGE Code: ____________) Have you previously received federal funding for broadband deployment or related services? ☐ Yes ☐ No If yes, please describe: Section 3: Project Proposal Overview Project Title: ______________________________ Brief Project Summary: (Please summarize your proposed project in 200–300 words) Project Location(s): List geographic area(s), counties, or census blocks to be served. Proposed Service Area Type: ☐ Unserved ☐ Underserved ☐ Community Anchor Institutions ☐ Other: ____________________________ Section 4: Project Details Total Funding Requested: $__________________ Total Project Cost: $__________________ (Please include any match or leveraged funds) Matching Funds Source(s) and Amounts (if applicable): Project Start Date: ______________________________________ Estimated Completion Date: ______________________________ Technologies to be Deployed: _____________________________ Section 5: Impact and Outcomes: Estimated Anchor Institutions Served: ________________________ Workforce Development Components: ________________________ Digital Equity & Inclusion Activities: _________________________ Section 6: Required Attachments: Please include the following documents with your application: ☐ Detailed Project Narrative ☐ Project Budget ☐ Timeline & Milestones ☐ Maps of Service Area ☐ Letters of Support (if applicable) ☐ Organizational Chart & Key Personnel Bios ☐ Evidence of Matching Funds (if required) ☐ SAM.gov Registration Confirmation Section 7: Certifications: I hereby certify that all information provided in this application is true and complete to the best of my knowledge. I understand that any false statements may disqualify this application. Authorized Signature: Printed Name: Date: