04-23-2020
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04-23-2020
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US Environmental Protection Agency OMB Control No. 2040-0292 <br /> WIFIA Program EPA Form No. 6100-032 <br /> Application Approval expires XX/XX/XXXX <br />____________________________________________________________________________________ <br />4 <br />SUPPORTING DOCUMENT CHECKLIST <br />The applicant should submit its completed application form plus all relevant supporting documents <br />listed in the checklist as attachments. <br />Question Supporting Document(s)* Included <br />Application Fee – Refer to fee instructions on page 2 <br />Section A: Key Applicant and Loan Information* (No attachments) <br />11.System for Award Management <br />(SAM) registration •Screen shot verifying active SAM <br />registration1* <br />☒ <br />Section B: Applicant Background <br />5.Capital Improvement Planning <br />Process •Current year and previous 3 years <br />Capital Improvement Plans <br />☒ <br />7.Liabilities •Liabilities Description ☒ <br />8.System Condition •System Master Plan <br />•System Condition Assessment <br />☐ <br />☐ <br />10.Organization Chart •Organization Chart ☒ <br />Section C: Financing Plan <br />4.Preliminary Rating Letter •Preliminary Rating Letter*☒ <br />5.Audited Financial Statements •Audited Financial Statements (3 years)*☒ <br />6.Cash flow pro forma(s)•Cash flow pro forma*☒ <br />7.Rate Setting Process •Rate Studies <br />•Rate Schedules <br />☐ <br />☐ <br />8.Flow of Funds •Flow of Funds ☒ <br />9.Loan Agreement •Master Indenture <br />•Bond Ordinance <br />☒ <br />☐ <br />Section D: Federal Requirements <br />1.National Environmental Policy Act <br />(NEPA)/ Programmatic Environmental <br />Assessment Questionnaire <br />•Environmental Assessment (Draft or <br />Final) <br />•Environmental Impact Statement (Draft <br />or Final) <br />•Supporting Documentation <br />•Programmatic Environmental <br />Assessment Questionnaire <br />☒ <br />☒ <br />☒ <br />☒ <br />2.SRF Environmental Review •SRF Findings <br />•SRF Consultation Documentation <br />☐ <br />☐ <br />4.Cross-Cutter Consultation Agencies • State Historic Preservation Officer <br />•Fish and Wildlife Service <br />•National Marine and Fisheries Service <br />•Coastal Zone Management Agency <br />•Other: Click or tap here to enter text.. <br />☒ <br />☒ <br />☐ <br />☐ <br />☐ <br />5.Additional Permits •Click or tap here to enter text.☒ <br />1 Applicants must have an active registration in SAM to do business with the Federal Government. Registration information is <br />available at https://sam.gov/SAM/.
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