ࡱ> mol @ ;&bjbjqq Ae?       $$$8%<J%r= & &",&,&,&'''4444548<$4?RAT= )''))=  ,&,&,=R,R,R,). ,& ,&4R,)4R,R,:T1,  1,&% аF$)1 P2\B=0r=1.A*A1Db,    A 1''^R,'L5(y'''==$$$B,$Drinking Water Revolving Fund (DWRF) Loan Application PART III - BID INFORMATION Questions about Part III should be directed to your DEQ project manager. DWRF Project Name __________________________________________________________________ DWRF Project No. ____________________ A. Part III Submittal Attachments Please attach the following items to your Part III submittal. ( Attached 1. A copy of each bid advertisement published for this project. ( Attached 2. A copy of the bid tabulations for each construction contract. ( Attached 3. A copy of the bid proposal of each successful bidder. ( Attached 4. A copy of the applicant municipality's resolution of tentative award for each construction contract. A model resolution is attached at the end of Part III for your use. ( Attached 5. A completed and signed debarment certification form ("Certification Regarding Debarment, Suspension, and Other Responsibility Matters") from the applicant municipality and from each contractor who has or will provide a service of $25,000 or more for which the applicant will be requesting DWRF reimbursement. The applicant must submit a signed debarment certification form for itself and for every prime contractor providing a service of $25,000 or more for the project (e.g., each successful bidder, the consulting engineer, the financial advisor, the bond counsel, etc.). B. Contract Bidding and Award Information 1. Have all bidding document addenda been approved by the DEQ? ( YES ( NO If NO, please enclose two copies of each addendum which has not been submitted for DEQ review and approval. 2. Have there been any bid protests? ( YES ( NO If YES, please attach a separate sheet detailing the bid protest(s). If a bid protest arises after you submit this part of your DWRF application, you must immediately alert your DEQ project manager. 3. Have all easements, land, and leasing arrangements necessary for project construction been obtained? ( YES ( NO If NO, please attach a separate sheet detailing your schedule for the completion of this activity. Please note that major building sites must be under ownership or lease before the Order of Approval can be issued. If minor easements still need to be obtained, the schedule must provide for resolution within 60-days of loan closing. C. Application Completion Information 1. Please identify your authorized bonding ceiling for this project: $__________________ 2. Are funds being provided for this project from a financing source other that the Drinking Water Revolving Fund? ( YES ( NO Project costs which will be covered by another source of funding, either public or private, must be excluded from the costs for which you will be requesting DWRF reimbursement. Please identify all sources of funding for costs which will not be financed through DWRF loan assistance. Source of Non-DWRF Funding Amount of Funding ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ 3. Has a final Alternative Justifiable Expenditure (AJE) been submitted for this project? ( YES ( NO ( N/A If NO, please enclose the final AJE or immediately contact your DEQ project manager to arrange an acceptable submittal date, if you have not already done so. 4. Please provide your current project implementation schedule: Construction Start Target Date _______________________________________________ Initiation of Operation Target Date _____________________________________________ Completion of Construction Target Date ________________________________________ D. Estimated Schedule of Disbursements Please identify your estimated schedule for receiving disbursements from the Drinking Water Revolving Fund. The first disbursement should include all DWRF-eligible costs incurred prior to the loan closing date. Please attempt to accurately estimate the monthly disbursements rather than simply subdivide the loan into equal draws. Please note that the estimates you provide will not limit the amount of funds you may receive in a given month. Please use the dollar amount provided by your DEQ project manager to calculate your estimated schedule of disbursements. If circumstance do not allow your DEQ project manager to provide a figure, the dollar amount you use to calculate this schedule should include all eligible project costs plus a 6% contingency but not capitalized interest (if any). Please attach an additional schedule sheet if disbursements will be requested over a period that is longer than two years. Dollar amount used to calculate the schedule below ___________________________________________ MONTH/YEAR AMOUNT REQUESTED MONTH/YEAR AMOUNT REQUESTED 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 III Bid Information being submitted is complete and accurate to the best of my knowledge. ____________________________________________________________________________________ Name and Title of Authorized Representative (Please Print or Type) ____________________________________________________________________________________ Signature of Authorized Representative (Original Signature Required) Date Please return Part III, with completed debarment certification form(s) and specified attachments, as required by the executed project milestone schedule to: REVOLVING LOAN AND OPERATOR CERTIFICATION SECTION ENVIRONMENTAL SCIENCE AND SERVICES DIVISION MICHIGAN DEPARTMENT OF ENVIRONMENTAL QUALITY MAILING ADDRESS PO BOX 30457 LANSING MI 48909-7957 DELIVERY ADDRESS CONSTITUTION HALL 3RD FLOOR SOUTH 525 W ALLEGAN LANSING MI 48933 A RESOLUTION TO TENTATIVELY AWARD A CONSTRUCTION CONTRACT FOR WATER SYSTEM IMPROVEMENTS WHEREAS, the _________________________________________ (legal name of applicant) wishes to construct improvements to its existing water treatment and distribution system; and WHEREAS, the water system improvements project formally adopted on ____________________ (date of final project plan adoption) will be funded through the state of Michigans Drinking Water Revolving Loan Fund (DWRF) program; and WHEREAS, the _________________________________________ (legal name of applicant) has sought and received construction bids for the proposed improvements and has received a low bid in the amount of ___________________ from __________________________________ (name of the contractor); and WHEREAS, the (Villages/Citys/Townships/Countys) engineer, _______________________________ has recommended awarding the contract to the low bidder. NOW THEREFORE BE IT RESOLVED, that the ______________________________ (legal name of applicant) tentatively awards the contract for construction of the proposed water system improvements project to __________________________________ (name of the contractor), contingent upon successful financial arrangements with the DWRF. Yeas: Nays: Abstain: Absent: I certify that the above Resolution was adopted by _______________________________ (the governing body of the applicant) on _________________________. 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