Final Intended Use Plan for the New York State Drinking Water State Revolving Fund

Attachment V

Applicant Name:	________________	Date Prepared:	________________
DWSRF Project No.	________________	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.