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+ checkbox checkbox Finance
2 Resolution Authorizing DWSRF Application and Agreement for Project Financing* checkbox checkbox Finance
3 Municipal Bond Resolution(s)      
  a.    Bond Resolution (Certified Copy) checkbox checkbox Legal
  b.    Proof of Publication of Permissive
       Referendum (if applicable)
checkbox checkbox Legal
  c.    Proof of Publication of Estoppel Notice checkbox checkbox Legal
4 Engineering/Technical Report checkbox checkbox Engineering
5 Department of Health's Approval of Engineering/Technical Report checkbox checkbox Engineering
6 Environmental Review Documents and Findings (SERP)+
Environmental Review Questionnaire*
checkbox checkbox Engineering
7 Minority and Women's Business Enterprise - Equal Employment Opportunity Program Documents+  
  a.    Work Plan (Policy Statement, Officer,
       Goals)*
checkbox checkbox Program Management
  b.    Project Description* checkbox checkbox Program Management
8 Financial Information      
  a.    Current Adopted Capital and Operating
       Budgets
checkbox checkbox Finance
  b.    For Applicants other than counties, cities,
        towns and villages, financial statements
        (audited if available) for the three (3) most
        recent fiscal years
checkbox checkbox 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 checkbox checkbox checkbox Engineering
10 Department of Health's Approval of Plans and Specifications checkbox checkbox checkbox Engineering
11 Permits and Other Regulatory Approvals (submit to DOH)        
  a.    DOH Permit Status Checklist* checkbox checkbox checkbox Engineering
  b.    DEC Permit Screening Form* checkbox checkbox checkbox Engineering
  c.    OPRHP SHPO Project Review
       Checklist*
checkbox checkbox checkbox Engineering
  d.    _____________________________ checkbox checkbox checkbox Engineering
  e.    _____________________________ checkbox checkbox checkbox Engineering
12 Certification as to Title to Project Site* checkbox checkbox checkbox Legal
13 Engineer's Certification of Technical Requirements* checkbox checkbox checkbox Engineering
14 Consolidation Plan, Agreements and Approval* checkbox checkbox checkbox Engineering
15 Lease Agreement to Project Site checkbox checkbox checkbox Legal
16 Municipal Service Agreement        
  a.    Intermunicipal Agreements checkbox checkbox checkbox Legal
  b.    Private Operating Agreements checkbox checkbox checkbox Legal
  c.    Private Use Agreements checkbox checkbox checkbox Legal
17 Force Account Proposal(s)+        
  a.    Technical checkbox checkbox checkbox Engineering
  b.    Administrative checkbox checkbox checkbox Engineering
18 Agreements for Professional Services        
  a.    Engineering Planning Services checkbox checkbox checkbox Engineering
  b.    Engineering Design Services checkbox checkbox checkbox Engineering
  c.    Engineering Construction Services checkbox checkbox checkbox Engineering
  d.    Local Counsel checkbox checkbox checkbox Finance
  e.    Bond Counsel checkbox checkbox checkbox Finance
  f.    Financial checkbox checkbox checkbox Finance
  g.    Other checkbox checkbox checkbox Finance
19 Executed Construction Contracts checkbox checkbox checkbox Engineering
20 Notice to Proceed checkbox checkbox checkbox Engineering
21 Certification of Project Completion+ checkbox checkbox checkbox Engineering
22 Prefinancing/Co-Funding Documentation checkbox checkbox checkbox Engineering
23 Other Financial Information  
  a.    Applicant's Official Statement or
        other offering document for most
        recent debt issuance
checkbox checkbox checkbox 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
checkbox checkbox checkbox Finance
  c.    Applicant's Audited Financial
        Reports for the three (3) most recent
        fiscal years
checkbox checkbox checkbox Finance
  d.    Submittal to Office of the State
        Comptroller for Improvement
        District formation, if submitted
        within the last two (2)years
checkbox checkbox checkbox Finance
  e.    Financial Reports for the System
        for the three (3) most recent
        fiscal years (if available)
checkbox checkbox checkbox Finance
24 For refinancing of existing debt, please attach the following supporting documents as applicable:  
  a.    Municipal Resolution Authorizing
       Debt (Original)
checkbox checkbox checkbox Finance
  b.    Bond Anticipation Note (BAN) checkbox checkbox checkbox Legal
  c.    Opinion of Bond Counsel checkbox checkbox checkbox Legal
  d.    Official Statement checkbox checkbox checkbox Finance
  e.    Refunding Resolution (Copy) checkbox checkbox checkbox Legal
  f.    Proof of Publication of Estoppel
       Notice for Resolution
checkbox checkbox checkbox Legal
  g.    Cost Documentation (Refinancing) checkbox checkbox checkbox Finance
  h.    Statement Specifying Net Interest
       Earned Or Anticipated
checkbox checkbox checkbox Finance
25 For Reimbursement of Interfund Borrowings:  
  a.    Municipal Interfund Borrowing
       Resolution (Copy)
checkbox checkbox checkbox Legal
  b.    Cost Documentation (Interfund
       Borrowings)
checkbox checkbox checkbox Finance
*  Form included in Application Package.
+  Guidance included in Application Package.