Final Intended Use Plan for the NYS Drinking Water State Revolving Fund

Attachment V


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


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

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

(for more information)

1 Application Form+
Finance
2 Resolution Authorizing DWSRF Application and Agreement for Project Financing*
Finance
3 Municipal Bond Resolution(s)      
  a.    Bond Resolution (Certified Copy)
Legal
  b.    Proof of Publication of Permissive
       Referendum (if applicable)
Legal
  c.    Proof of Publication of Estoppel Notice
Legal
4 Engineering/Technical Report
Engineering
5 Department of Health’s Approval of Engineering/Technical Report
Engineering
6 Environmental Review Documents and Findings (SERP)+
Environmental Review Questionnaire*
Engineering
7 Minority and Women's Business Enterprise - Equal Employment Opportunity Program Documents+  
  a.    Work Plan (Policy Statement, Officer,
       Goals)*
Program Management
  b.    Project Description*
Program Management
8 Financial Information      
  a.    Current Adopted Capital and Operating
       Budgets
Finance
  b.    For Applicants other than counties, cities,
        towns and villages, financial statements
        (audited if available) for the three (3) most
        recent fiscal years
Finance

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 Contacts

(for more information)

9 Plans and Specifications
Engineering
10 Department of Health's Approval of Plans and Specifications
Engineering
11 Permits and Other Regulatory Approvals (submit to DOH)        
  a.    DOH Permit Status Checklist*
Engineering
  b.    DEC Permit Screening Form*
Engineering
  c.    OPRHP SHPO Project Review
       Checklist*
Engineering
  d.    _____________________________
Engineering
  e.    _____________________________
Engineering
12 Certification as to Title to Project Site*
Legal
13 Engineer's Certification of Technical Requirements*
Engineering
14 Consolidation Plan, Agreements and Approval*
Engineering
15 Lease Agreement to Project Site
Legal
16 Municipal Service Agreement        
  a.    Intermunicipal Agreements
Legal
  b.    Private Operating Agreements
Legal
  c.    Private Use Agreements
Legal
17 Force Account Proposal(s)+        
  a.    Technical
Engineering
  b.    Administrative
Engineering
18 Agreements for Professional Services        
  a.    Engineering Planning Services
Engineering
  b.    Engineering Design Services
Engineering
  c.    Engineering Construction Services
Engineering
  d.    Local Counsel
Finance
  e.    Bond Counsel
Finance
  f.    Financial
Finance
  g.    Other
Finance
19 Executed Construction Contracts
Engineering
20 Notice to Proceed
Engineering
21 Certification of Project Completion+
Engineering
22 Prefinancing/Co-Funding Documentation
Engineering
23 Other Financial Information  
  a.    Applicant's Official Statement or
        other offering document for most
        recent debt issuance
Finance
  b.    Applicant's Annual Financial
        Reports submitted to the Office of
        the State Comptroller for three (3)
        most recent fiscal years, only if
        requested
Finance
  c.    Applicant's Audited Financial
        Reports for the three (3) most recent
        fiscal years
Finance
  d.    Submittal to Office of the State
        Comptroller for Improvement
        District formation, if submitted
        within the last two (2)years
Finance
  e.    Financial Reports for the System
        for the three (3) most recent
        fiscal years (if available)
Finance
24 For refinancing of existing debt, please attach the following supporting documents as applicable:  
  a.    Municipal Resolution Authorizing
       Debt (Original)
Finance
  b.    Bond Anticipation Note (BAN)
Legal
  c.    Opinion of Bond Counsel
Legal
  d.    Official Statement
Finance
  e.    Refunding Resolution (Copy)
Legal
  f.    Proof of Publication of Estoppel
       Notice for Resolution
Legal
  g.    Cost Documentation (Refinancing)
Finance
  h.    Statement Specifying Net Interest
       Earned Or Anticipated
Finance
25 For Reimbursement of Interfund Borrowings:  
  a.    Municipal Interfund Borrowing
       Resolution (Copy)
Legal
  b.    Cost Documentation (Interfund
       Borrowings)
Finance

*  Form included in Application Package.
+  Guidance included in Application Package.