Intended Use Plan for the NYS Drinking Water State Revolving Fund

ATTACHMENT V

Application Checklist

Borrower Name: ___________ DWSRF Project No.___________
Date Prepared: _____________ PWSID No.: _____________

APPLICATION CHECKLIST
New York Drinking Water State Revolving Fund (DWSRF)
PUBLICLY-OWNED SYSTEMS

This document lists all of the items which form a complete Drinking Water State Revolving Fund (DWSRF) loan application. A summary of these items can be found in the Description of Application Components.

You should review the Checklist with EFC at the beginning of the application process since all items may not apply to your project. This Checklist should be used to verify that your application package is complete. The completed Checklist must be submitted to EFC as part of the application package.

PART 1

The items in Part I must be submitted by the borrower in order to have a complete application. Check the appropriate boxes below. If these items have already been submitted, please indicate.

No. Item Submitted
Earlier		 Submitted with
this Application
1 Application Form+
2 Resolution Authorizing Signing of Application+
3 Municipal Bond Resolution(s)    
  a.    Bond Resolution
      (Certified Copy)
  b.    Proof of Publication of
      Permissive Referendum
       (if applicable)
  c.    Proof of Publication of Estoppel Notice
4 Engineering/Technical Report
5 Department of Health’s Approval of Engineering/Technical Report
6 Environmental Review Documents and Findings (SERP)**
7 Plans and Specifications
8 Department of Health’s Approval
      Letter of Plans
      and Specifications
9 Permits and Other Regulatory Approvals    
  a.    Permit Status Checklist+
  b.    Permit Screening Form+
  c.    __________________
  d.    __________________
10 Certification as to Title to Project Site+
11 Minority and Women's Business
      Enterprise - Equal Employment
      Opportunity Program Documents*		    
  a.    Work Plan (Policy Statement,
       officer, Goals)
  b.    Project Description
12 Financial Information    
  a.    Borrower’s latest Annual
       Financial Reports submitted
       to the State Comptroller for the
      three most recen fiscal years
  b.    Borrower's current adopted
       capital and operating budgets

PART II

The nature of the borrower's project will determine if the following items are required for a complete application. Please call EFC to discuss whether the following items apply. Check the appropriate boxes below.


No. Item Submitted
Earlier		 Submitted with
this Application		 Not
Applicable
13 Engineer’s Certification of Technical Requirements+
14 Consolidation Plan, Agreements and Approval
15 Lease Agreement to Project Site
16 Municipal Service
      Agreement		    
  a.    Intermunicipal
      Agreements
  b.    Private Operating
      Agreements
  c.    Private Use Agreements
17 Force Account Proposal(s)*    
  a.    Technical
  b.    Administrative
18 Agreements for Professional Services    
  a.    Engineering Planning
      & Design Services
  b.    Engineering Construction
      Services
  c.    Local Counsel
  d.    Bond Counsel
  e.    Financial
  f.    Other (Specify) ____________
19 Performance Bond Information+
20 Executed Construction Contracts
21 Notice to Proceed
22 Certification by loan applicant's consulting
engineer that project was constructed in accordance
with approved plans and specifications.+
23 Prefinancing/Co-Funding Documentation
24 Other Financial Information    
  a.    Borrower's Official
       Statement or other offering
       document for most recent
      debt issuance
  b.    Borrower's Annual
      Financial Reports submitted
      to the Office of the State Comptroller
       for the three (3) most
      recent fiscal years
  c.    Borrower's Audited
      Financial Reports for the
       three (3) most recent
      fiscal years
  d.    Application to Office
       of the State Comptroller
       for Improvement District formation,
      if submitted within
       the last two (2) years
  e.    Financial Reports
       for the System for the
       three (3) most recent fiscal
      years (if available)
25 For refinancing of existing debt, please attach the following supporting documents as applicable:    
  a.    Municipal resolution
       authorizing debt
       (Original)
  b.    Bond Anticipation Note
       (BAN)
  c.    Opinion of bond
       counsel
  d.    Official Statement
  e.    Refunding
       Resolution
       (Copy)
  f.    Proof of publication
       of Estoppel Notice
       for Resolution
  g.    Cost Documentation
      (Refinancing)
  h.    Statement specifying
      net interest earned or
       anticipated during construction
26 For Reimbursement of Interfund Borrowings:    
  a.    Municipal authorizing
      resolution (Copy)
  b.    Cost Documentation
      (Interfund Borrowings)

+  Form included in Application Package.
*  Guidance included in Application Package.
**  Guidance and Questionnaire Included in Application Package