Sub-Project Concept Form

Barangay : _____________ Municipality: Gubat

Province : SORSOGON Region: V
Total number of Household (HH) in the barangay: ________
Total Population: _________ Male: ____ (____%) Female: ____ (___%)

A. GENERAL INFORMATION

Name of proposed sub-project:

Basic Social Services: Basic Access Infrastructure Community Production, Economic Support
_____ Sub-Projects: ____ and Common Service Facilities :___

Category Environmental Protection & Skills Training and Capability Others: ______
: Conservation Sub-Projects: Sub-Projects: _________
_____

Problem Statement:

Project Purpose
Project Beneficiaries and Expected Benefits: (disaggregate by estimated number, sex, & type of benefit)

Total Number of HH Beneficiaries: _____

Total Male Beneficiaries: ____ Total Female Beneficiaries: ____ Total Population: ____

Pantawid Pamilya HH Beneficiaries of SP: ___ SLP HH Beneficiaries of SP: ___ IP HH Beneficiaries of SP: N/A

Pantawid Pamilya Families Beneficiaries of SP: ___ SLP Families Beneficiaries of SP ___

B. DESCRIPTION OF PROJECT COMPONENTS

1. Physical/Infrastructure component (Program of Works)

Physical Target: Cost Parameter:

Persons who assisted in the preparation of technical proposal:

Proposed scope of works to be undertaken:

Labor/Workforce requirement/sources: (disaggregate by skill level and sex)

Equipment requirement/sources: N/A

Procurement Method/s to be adopted:

2. Training component (disaggregate by training topics and estimated number of women and men participants)

3. Women-specific component (mention strategies to remove barriers to women’s participation)

4. Management component (disaggregate by estimated number of management positions and sex of

prospective staff)
C. SAFEGUARD CONCERNS

Any displacement or relocation of community members during Yes _______ No ________

implementation? (disaggregated by sex and income class)

Acquisition of proposed site/location? Deed of Sale Donated __ LGU Owned Other: (specify)
(sex of owner) Owner: __ __

Proposed site within the reservation Yes ____ No __

area?

Necessary permit/s accomplished? (e.g. Yes ____ No ____ ESMP and ESSC ____
ECC, CNC)

Mitigating measures to be undertaken for the environmental impact of the sub-project?

D. FINANCIAL ECONOMIC ASPECT

Local Counterpart Contribution (LCC)

Cost Items Per Total CDD
Community Othe Total
Component Cost Grant BLGU MLGU PLGU
Men Women rs LCC

Total Estimated Cost –

POW (Infrastructure)

Training

Women-Specific

Management

Others, Specify

Total

E. SUB-PROJECT SUSTAINABILITY

Is there an existing O&M group or does it still has to be organized?

What are the major Operations and Maintenance (O&M) components of the sub-project?

How do we plan to maintain the completed sub-projects?

Is the community willing to pay for tariff and by how much?

Other sources of funds for the operation and maintenance activities?

Identified capability building requirements for O&M group?

Prepared by : Approved for endorsement to the MDRRMC

________________________ _______________________ ____________________

Head, Project Preparation Team BDRRMC Head BDC-TWG Chairperson

Approved for Endorsement to RPMO Technical Verification by:

(SP TITLE)

___________________________
_________________ _______________________
MDRRMC Head/Municipal Mayor
Area Coordinator MIAC Representative