ࡱ>  @ dbjbjqq x p]&<<<<<<<$\\\P]]A{_Daaaab6b$#c'r)r)r)r5^rfvnz$}RUTzi<gbbggz<<aazjjjgv<a<a'rjg'rjjj[<<+ka_ ]F\ hkk,{0A{#kh+k`dT<<<<<+k7c+djdee17c7c7czz;T$rjTDrinking Water Revolving Fund (DWRF) Loan Application PART II - PROGRAM INFORMATION Questions about Part II should be directed to your DEQ project manager. Please carefully read the attached instructions before completing the Project Cost Worksheet. The Authorized Representative must sign page II-4 after reviewing the covenants and assurances. DWRF Project Name FORMTEXT       DWRF Project No. FORMTEXT       A. Project Cost Worksheet (Please do not write in the shaded area) Budget ItemIncurred Project CostsEstimated Project CostsCost Support Documents AttachedDEQ Approved Project Costs 1. Planning Costs  FORMTEXT        FORMTEXT      % YES  2. Revenue System Development Costs  FORMTEXT        FORMTEXT      % YES  3. Design Engineering Costs  FORMTEXT        FORMTEXT      % YES  4. Legal/Financial Service Fees  FORMTEXT        FORMTEXT      % YES  5. Administrative Costs  FORMTEXT        FORMTEXT      % YES  6. Bond Counsel Fees  FORMTEXT        FORMTEXT      % YES  7. Bond Advertisement Costs  FORMTEXT        FORMTEXT      % YES  8. Bid Advertisement Costs  FORMTEXT        FORMTEXT      % YES  9. Capitalized InterestDEQ will complete this line upon receipt of your Part III application.  10. Land Acquisition/Relocation Costs  FORMTEXT        FORMTEXT      % YES  11. Land Purchase Costs  FORMTEXT        FORMTEXT      % YES  12. Construction Engineering Costs  FORMTEXT        FORMTEXT      % YES  13. Construction Costs (bid contracts)  FORMTEXT        FORMTEXT      % YES  14. Construction Costs (force account)  FORMTEXT        FORMTEXT      % YES  15. Equipment Costs  FORMTEXT        FORMTEXT      % YES  16. Other Project Costs  FORMTEXT        FORMTEXT      % YES  17. Project Cost Subtotal (sum of Line 1 through Line 16)  18. Project Contingency (6% of Line 17 the amount needed to round Line 20 to the nearest $5,000)  19. LESS Non-DWRF Funding (other federal or state grants or loans, cash on hand, etc.)  20. Approved Project Cost to be Funded by DWRF Assistance (sum of Lines 17 and 18 minus Line 19)  B. Provide a status of land, easements, and leasing arrangements necessary for DWRF project construction. Prior to loan award, the applicant must have sufficient rights to the project land to ensure undisturbed building and operation of the project for its useful life. C. Covenants, Assurances, and Certifications The authorized representative for this project will be asked to certify that the applicant will abide by the following covenants, assurances, and certifications, which will be incorporated into the DWRF loan agreement. Please read all of them carefully and contact your DEQ project manager if you have any questions. 1. The applicant has the legal, managerial, institutional, and financial capability to build, operate, and maintain the project. 2. The applicant certifies that no undisclosed fact or event, or pending litigation, will materially or adversely affect the project, the prospects for its completion, or the applicant's ability to make timely repayments to the Drinking Water Revolving Fund. 3. The applicant agrees that the rates and charges for the services of the project will be established, levied, or collected in an amount sufficient to pay the expenses of administration, operation, and maintenance of the project and to pay the principal and interest requirements on all bonds payable from revenues of the project. 4. The applicant agrees to provide all moneys in excess of bond proceeds necessary to complete the project and to maintain adequate revenues from a user-based source to fund the operation of the project. 5. To the extent permitted by law, the applicant shall take all actions within its control and shall not fail to take any action as may be necessary to maintain the exclusion of interest on its bond from gross income for federal income tax purposes, including but not limited to, actions relating to the rebate of arbitrage earnings and the expenditure and investment of bond proceeds and moneys deemed to be bond proceeds. 6. The applicant will take no action which would cause its bonds to be classified as private activity bonds. The applicant will make no use of bond proceeds which would make its bonds federally guaranteed. 7. The applicant agrees to maintain complete books and records relating to the construction, operation, and financial affairs of the project in accordance with generally accepted accounting principles (GAAP) and generally accepted government auditing standards (GAGAS). 8. The applicant will have an audit of its entire operations prepared by a recognized independent certified public accountant for each year in which the applicant receives $500,000 or more in federal assistance. The audit shall be prepared in conformance with the requirements of the Single Audit Act of 1984 as amended, (31 U.S.C. 7501 et seq.) and Office of Management and Budget Circular No. A-133. The applicant will mail a copy of such audit to the Local Government Audit Division of the Michigan Department of Treasury and to the Michigan Municipal Bond Authority (hereafter referred to as the "Authority"). 9. The applicant agrees that all municipal contracts related to the project will provide that the contractor and any subcontractor may be subject to a financial audit and must comply with generally accepted accounting principles (GAAP) and generally accepted government auditing standards (GAGAS). 10. The applicant will maintain and carry insurance on all physical properties of the project, of the kinds and in the amounts normally carried by municipalities engaged in the operation of similar water supply systems. All moneys received for losses under any such insurance policies shall be applied to the replacement and restoration of the property damaged or destroyed or for repayment of the bond held by the Authority. 11. The applicant will notify the DEQ and the Authority within 30 days of the occurrence of any event which, in the judgment of the applicant, will cause a material change in the financial condition of the project, or, if the applicant has knowledge, of the waterworks system of which the project is a part. Such events include the receipt of funding from another state or federal program for project costs financed by the Drinking Water Revolving Fund. 12. The applicant agrees to provide any necessary written authorizations to the DEQ and the Authority for the purpose of examining the physical plant or for examining, reviewing, or auditing the operational or financial records of the project. The applicant also agrees to require similar authorizations from all contractors, consultants, or agents with which the applicant negotiates an agreement. 13. The applicant agrees that all pertinent records shall be retained and available to the DEQ and the Authority for a minimum of three years after the actual initiation of operation of the project and that if litigation, a claim, an appeal, or an audit is begun before the end of the three-year period, records shall be retained and available until the three years have passed or until the action is completed and resolved, whichever is longer. 14. The applicant has, or will have prior to the start of construction, all applicable state and federal permits required for construction of the project and will comply with the conditions set forth in such permits. 15. The applicant agrees to comply with the anti-discrimination provisions of Section 602, Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d), Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), and Section 303, Title III of the Age Discrimination Act of 1975 (42 U.S.C. 6102) whereby the applicant will not discriminate on the basis of race, color, national origin, sex, handicap, or age in any activity related to the project. 16. The applicant agrees to comply with the disadvantaged business participation provisions of Executive Order 11625 (October 13, 1971) and Executive Order 12138 (May 18, 1979) whereby the applicant will report on its efforts to utilize Minority Business Enterprises (MBEs) and Women's Business Enterprises (WBEs) on the forms, and in the manner, prescribed by the DEQ and, if directed by the DEQ, will follow the affirmative action steps set forth in 40 CFR 31.36(e). 17. The applicant agrees to comply with the equal employment opportunity provisions of Executive Order 11246 (September 24, 1965), as amended by Executive Order 11375 (October 13, 1967) and supplemented by U.S. Department of Labor regulations (41 CFR Part 60), whereby the applicant will include the seven clauses set forth in 40 CFR 8.4(b) in its construction contracts that exceed $10,000 and, as applicable, will direct its contractors and subcontractors to comply with the affirmative action mandates set forth in 40 CFR 8.8. 18. The applicant agrees to comply with the political activities restrictions of the Hatch Act (5 U.S.C. 1501 et seq.) whereby the applicant will ensure that municipal employees whose principal employment activities are funded in whole or in part with moneys from the Drinking Water Revolving Fund comply with the prohibitions set forth in 5 CFR Part 151. 19. The applicant agrees to comply with the procurement prohibitions of Section 306 of the Clean Air Act Amendments of 1970 (42 U.S.C. 7606) as implemented by Executive Order 11738 (September 10, 1973) whereby the applicant certifies that goods, services, and materials for the project will not be procured from a supplier on the List of Violating Facilities published by the U.S. Environmental Protection Agency. 20. If the project involves the acquisition of an interest in real property or the displacement of any person, business, or farm operation, the applicant agrees to comply with the land acquisition and relocation assistance requirements of the Uniform Relocation Assistance and Real Properties Acquisition Policies Act of 1970 (42 U.S.C.4601 et seq.) whereby the applicant will follow procedures set forth in 49 CFR Part24. 21. If the project involves construction or property acquisition in a special flood hazard area, the applicant agrees to comply with the flood insurance purchase requirements of the Flood Disaster Protection Act of 1973 (Pub.L. 93-234) whereby the applicant will purchase flood insurance in conformance with the National Flood Insurance Program (42 U.S.C. 4001-4128). 22. If historic or archeological artifacts or remains are discovered during project construction, the applicant agrees to immediately contact the State Historic Preservation Officer and the DEQ. The applicant further agrees to discontinue work in the vicinity of the discovery until the State Historic Preservation Officer has determined the general limits and potential significance of the site. If human remains are discovered during project construction, the applicant agrees to immediately contact the State Police. 23. The applicant certifies: (i) if it is the owner or operator of an oceangoing vessel or a non-ocean-going vessel, that it is in compliance with the requirements of 3103a of the NREPA, 1994 PA 451, as amended, MCL 324.3103a, and is on an applicable list prepared under MCL 324.3103a(4); and (ii) if it has contracts for the transportation of cargo with an oceangoing or non-ocean-going vessel operator that operator(s) is/are on an applicable list prepared under MCL 324.3103a(4). 24. The applicant agrees to construct and operate the project in compliance with all other applicable state and federal laws, executive orders, regulations, policies, and procedures. 25. The applicant agrees that the project shall proceed in a timely fashion and will exercise its best efforts to complete the project in accordance with the estimated date of initiation of operation set forth in this application. 26. The applicant will provide written notification to the DEQ identifying the actual initiation of operation of the project within 30 days of its occurrence. The actual initiation of operation is the date when the project becomes capable of operation for the purposes for which it was planned, designed, and built. 27. The applicant will maintain the project in good repair, working order, and operating condition. 28. The applicant agrees to not sell, lease, abandon, dispose of, or transfer its title to the project or any part thereof, including lands and interest in lands, by sale, mortgage, lease, or other encumbrances, without an effective assignment of obligations and the prior written approval of the DEQ and the Authority. 29. If the project is segmented, as provided in Section 5406 of the NREPA, 1994 PA 451, being Section 324.5406 of the Michigan Compiled Laws Annotated, the applicant agrees that the remaining segments shall be completed with or without additional financial assistance from the Drinking Water Revolving Fund. 30. The applicant certifies that the project is not primarily to accommodate future development or primarily for fire protection. C. Please complete and sign the attached EPA Form 4700-4, Preaward Compliance Review Report. I certify that I am the authorized representative designated by the governmental unit that will issue the bond(s) for this project and that the Part II Program Information being submitted is complete and accurate to the best of my knowledge. I further certify that _________________________________________________ (legal name of applicant) agrees to and will abide by the covenants, assurances and certifications stipulated in Section B above. _____________________________________________________________________________________ Name and Title of Authorized Representative (Please Print or Type) _____________________________________________________________________________________ Signature of Authorized Representative (Original Signature Required) Date In accordance with the date in your signed milestone schedule, please return Part II with a completed EPA Form 4700-4 and the specified attachments to: REVOLVING LOAN AND OPERATOR CERTIFICATION SECTION ENVIRONMENTAL SCIENCE AND SERVICES DIVISION MICHIGAN DEPARTMENT OF ENVIRONMENTAL QUALITY MAILING ADDRESS DELIVERY ADDRESS PO BOX 30457 CONSTITUTION HALL 3RD FLOOR SOUTH LANSING MI 48909-7957 525 W ALLEGAN, LANSING MI 48933 United States Environmental Protection Agency Washington, DC 20460 Preaward Compliance Review Report For All Applicants Requesting Federal Financial Assistance FORM Approved OMB No. 2090-0014 Note: Read instructions on reverse side before completing form.I. A. Applicant (Name, City, State) B. Recipient (Name, City, State)C. EPA Project No. II. Brief description of proposed project, program or activity. III. Are any civil rights lawsuits or complaints pending against applicant and/or recipient? If "Yes," list those complaints and the disposition of each complaint.  ( Yes ( No IV. Have any civil rights compliance reviews of the applicant and/or recipient been conducted by any Federal agency during the two years prior to this application for activities which would receive EPA assistance? If "Yes," list those compliance reviews and status of each review.  ( Yes ( No V. Is any other Federal financial assistance being applied for or is any other Federal financial assistance being applied to any portion of this project, program or activity? If "Yes," list the other Federal Agency(s), describe the associated work and the dollar amount of assistance.  ( Yes ( No VI. If entire community under the applicant's jurisdiction is not served under the existing facilities/services, or will not be served under the proposed plan, give reasons why. VII. Population CharacteristicsNumber of People1.A. Population of Entire Service Area B. Minority Population of Entire Service Area2.A. Population Currently Being Served B. Minority Population Currently Being Served3.A. Population to be Served by Project, Program or Activity B. Minority Population to be Served by Project, Program or Activity4.A. Population to Remain Without Service B. Minority Population to Remain Without ServiceVIII. Will all new facilities or alterations to existing facilities financed by these funds be designed and constructed to be readily accessible to and usable by handicapped persons? If "No," explain how a regulatory exception (40 CFR 7.70) applies.  ( Yes ( No IX. Give the schedule for future projects, programs or activities (or of future plans), by which service will be provided to all beneficiaries within applicant's jurisdiction. If there is no schedule, explain why. X. I certify that the statements I have made on this form and all attachments thereto are true, accurate and complete. I acknowledge that any knowingly false or misleading statement may be punishable by fine or imprisonment or both under applicable law. A. Signature of Authorized Official B. Title of Authorized OfficialC. DateFor the U.S. Environmental Protection Agency ( Approved ( DisapprovedAuthorized EPA OfficialDate EPA Form 4700-4 (Rev. 1/90) Previous editions are obsolete. Instructions General Recipients of Federal financial assistance from the U.S. Environmental Protection Agency must comply with the following statutes. Title VI of the Civil Rights Act of 1964 provides that no person in the United States shall, on the grounds of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance. The Act goes on to explain that the title shall not be construed to authorize action with respect to any employment practice of any employer, employment agency, or labor organization (except where the primary objective of the Federal financial assistance is to provide employment). Section 13 of the 1972 Amendments to the Federal Water Pollution Control Act provides that no person in the United States shall on the ground of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under the Federal Water Pollution Control Act, as amended. Employment discrimination on the basis of sex is prohibited in all such programs or activities. Section 504 of the Rehabilitation Act of 1973 provides that no otherwise qualified handicapped individual shall solely by reason of handicap be excluded from participation in, be denied the benefit of, or be subjected to discrimination under any program or activity receiving Federal finance assistance. Employment discrimination on the basis of handicap is prohibited in all such programs or activities. The Age Discrimination Act of 1975 provides that no person on the basis of age shall be excluded from participation under any program or activity receiving Federal financial assistance. Employment discrimination is not covered. Age discrimination in employment is prohibited by the Age Discrimination in Employment Act administered by the Equal Employment Opportunity Commission. Title IX of the Education Amendments of 1972 provides that no person on the basis of sex shall be excluded from participation in, be denied the benefit of, or be subjected to discrimination under any education program or activity receiving Federal financial assistance. Employment discrimination on the basis of sex is prohibited in all such education programs or activities. Note: an education program or activity is not limited to only those conducted by a formal institution. The information on this form is required to enable the U.S. Environmental Protection Agency to determine whether applicants and prospective recipients are developing projects, programs and activities on a nondiscriminatory basis as required by the above statutes. Submit this form with the original and required copies of applications, requests for extensions, requests for increase of funds, etc. Updates of information are all that are required after the initial application submission. If any item is not relevant to the project for which assistance is requested, write "NA" for "Not Applicable." In the event applicant is uncertain about how to answer certain questions, EPA program officials should be contact for clarification. EPA Form 4700-4 (Rev. 1/90) Reverse ITEMS IA. "Applicant" means any entity that files an application or unsolicited proposal or otherwise requests EPA assistance. IB. "Recipient" means any entity, other than applicant, which will actually receive EPA assistance. IC. Self-explanatory. II. Self-explanatory. III. "Civil rights lawsuits" means any lawsuit or complaint alleging discrimination on the basis of race, color, national origin, sex, age or handicap pending against the applicant and/or entity which actually benefits from the grant. For example, if a city is the named applicant but the grant will actually benefit the Department of Sewage, civil rights lawsuits involving both the city and the Department of Sewage should be listed. IV. "Civil rights compliance review" means any review assessing the applicant's and/or recipient's compliance with laws prohibiting discrimination on the basis of race, color, national origin, sex, age or handicap. If any part of the review covered the entity which will actually benefit from the grant, it should be listed. V. Self-explanatory. VI. 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The "community" might be a university or laboratory campus, or a community within a large city. If there is a significant disparity between minority and nonminority populations to receive service, not otherwise satisfactorily explained, the Regional office may require a map which indicates the minority and nonminority population served by this project, program or activity. VII. This information is required so that reviewers may determine if a disparity in the proposed provision of services will exist in the event the application is approved for funding. Give population of recipient's jurisdiction, broken out by categories as specified. In the event the applicant cannot provide the requested information because the funds will be distributed over a wide demographic area which is yet to be determined, an explanation may be provided on a separate sheet. For example, a State applying for a capitalization grant under the State Revolving Fund program may not know which cities and counties will apply for, and receive, SRF loans. VIII. Self-explanatory. IX. "Jurisdiction" means the geographical area over which applicant has the authority to provide service. X. Self-explanatory. "Burden Disclosure Statement" EPA estimates public reporting burden for the preparation of this form to average 30 minutes per response. This estimate includes the time for viewing instructions, gathering and maintaining the data needed and completing and reviewing the form. Send comments regarding the burden estimate, including suggestions for reducing this burden, to Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W., Washington, D.C. 20460; and to the office of information and Regulatory Affairs, Office of Management and Budget, Washington, D.C. 20503.  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