CAPITAL EXPENDITURE REQUEST SUMMARY 5 Year Plan DEPARTMENT / BOARD Name:

Phone (day & evening)

_____________________________________________________________________________ _ This Capital Expenditure Request Summary, 5 Year Plan lists the proposed capital expenditures for the requesting department of fiscal years 2003 through 2007 for capital items of $10,000 and above. Each project and expenditure listed on this Summary should be explained in detail on an accompanying form entitled “Capital Expenditure Proposal”, with one Capital Expenditure Proposal for each project listed on this summary page. Please fill out this form after completing each of your Capital Expenditure Proposal Forms.

Proposed Capital Project FY03

Estimated Cost

FY04

FY05

FY06

FY07

1) 2) 3) 4) 5) Total

INSTRUCTIONS 1) 2)

Please express in current dollars: do not adjust figures for inflation. List the title of each proposed capital project in the first column. FY03 projects should be listed first and later year projects listed below. 3) Project cost should be listed under the fiscal year in which the project is proposed to begin, with the entire cost in the start-up year even if a project will be paid for over several years.

CapitalPlanning-CapitalRequestSummary.doc

4)

For each fiscal year, please note each project’s priority number by entering it next to the estimated cost. (Project priority number should come from the Capital Expenditure Proposal form for that project.) 5) Use another sheet if necessary.

CAPITAL EXPENDITURE REQUEST SUMMARY 10 Year Plan DEPARTMENT / BOARD Name:

Phone (day & evening)

_____________________________________________________________________________ _ This Capital Expenditure Request Summary, 10 Year Plan lists the proposed capital expenditures for the requesting department of fiscal years 2008 through 2012 for capital items of $100,000 and above. Each project and expenditure listed on this Summary should be explained in detail on an accompanying form entitled “Capital Expenditure Proposal”, with one Capital Expenditure Proposal for each project listed on this summary page. Please fill out this form after completing each of your Capital Expenditure Proposal Forms.

Proposed Capital Project FY08

FY09

Estimated Cost FY10

FY11

1) 2) 3) 4) 5) 6) Total

CapitalPlanning-CapitalRequestSummary.doc

FY12

INSTRUCTIONS 1) List the title of each proposed capital project in the first column. FY08projects should be listed first and later year projects listed below. 2) Project cost should be listed under the fiscal year in which the project is proposed to begin, with the entire cost in the start-up year even if a project will be paid for over several years. 3) For each fiscal year, please note each project’s priority number by entering it next to the estimated cost. (Project priority number should come from the Capital Expenditure Proposal form for that project.) CAPITAL EXPENDITURE PROPOSAL DEPARTMENT / BOARD ___________________________________ Project/Expenditure: _________________________________ FY: _____ Cost:________ _____________________ _____________________ Dept. Head/Board Chair: ______________________________ Dept. Priority: _________

1) Description: (Please include any brochures on the product)_______________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ 2) Useful Life (in years): _____________________ 3) Purpose: _____ Scheduled Replacement*

_____ Increased Personnel Efficiency

_____ New/Expanded Service

_____ Replace Obsolete/Unsafe Equipment*

_____ Other (please explain) _____________________________________________ * Please note how old equipment will be disposed of 4) Justification: ___________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ 5) How did you determine the project’s priority? 6) Additional Cost Data (Equipment Only) CapitalPlanning-CapitalRequestSummary.doc

Purchase Price: Less Trade-In: Net Cost:

_______________________ _______________________ _______________________

7) Are non-Town revenues available to reduce cost? 8) What will be the effect on your department if this project is delayed?

CapitalPlanning-CapitalRequestSummary.doc

9) Please describe the effect of this project on your operating budget. Personnel Budget _____ increase _____ decrease _____ no change _____ amount of change

Expense Budget: _____ increase _____ decrease _____ no change _____ amount of change

10) What growth rate does this plan ? ___________________________________ 11) Does this plan a growth rate of 2 ½% per year? _________________________ Detail:___________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ ________________________________________________________________________

CapitalPlanning-CapitalRequestSummary.doc