Project Application for Level III Construction Funding - Municipal and Rural Domestic Projects

PROJECT APPLICATION FOR LEVEL III CONSTRUCTION FUNDING
FOR MUNICIPAL AND RURAL DOMESTIC PROJECTS

WYOMING WATER DEVELOPMENT COMMISSION
6920 Yellowtail Road
Cheyenne, Wyoming 82002
Telephone: (307) 777-7626 Fax: (307) 777-6819

Funding for projects is based on WWDC recommendations and is appropriated by the legislature from the Water Development Accounts. Legislative authorization is required before the WWDC can begin project work. Applications for all Level III construction projects must be submitted no later than September 1st. It is helpful if the applications are received prior to the deadline.

In order to receive consideration for Level III construction funding, the project sponsor must be an entity of local government with taxing and/or assessment authority. Private corporations and individuals are not eligible for assistance. Note: If you are seeking Level III funding for a project new to the Program, you must provide a feasibility study with detailed cost estimates prepared by a professional engineer registered in the State of Wyoming.

APPLICATION REQUIREMENTS

The person signing the application must have authority to commit the entity to a binding contract.
A notarized copy of a resolution supporting this application passed by the board or other governing body of the entity must be provided.
For new projects, a single check for the combined total of the $1,000.00 application fee and the reimbursement fee of (2,000 taps or less: $1,000.00; 2,001 to 9,000 taps: $2,000.00; or 9,001 or more taps: $3,000.00) must accompany the application or be sent to the office if using an online application. If the application is denied, 75% of the application fee and 100% of the reimbursement fee will be refunded to the applicant. Projects advancing from Water Development Program studies, which were completed within the last 5 years, are exempt from both the application and reimbursement fees.
A project area map (8.5" x 11" preferred) showing district boundaries, project location and features should be provided. Include any reports or other supporting information available.
Written verification from any municipality, county, joint powers board, irrigation district, or special district that is impacted by the project that they understand and accept those impacts.
Written verification that the project will include a minimum of 15 taps with meters on each tap.

ENTITY INFORMATION

(Type of Entity - i.e.: Municipality, County, Joint Powers Water Board, Special District)

Applicant - Name of Entity
Address: Phone:
City/Town: State: Zip Code: County:

(Authorized Official)
(Contact Person)
(Contact Phone)*

*The best time to reach the contact person is from to o'clock on days of the week.
Email for Contact Person

If the application was prepared by someone other than the contact person, please provide:

(Name) (Phone Number) (Email)

PERTINENT INFORMATION

The purpose of this section is to gather information necessary for the development of the financing plan for the Level III construction project. Answer all questions as completely and accurately as possible. If you need help, please call the Water Development Office at 307-777-7626.

A. REQUESTED FINANCING PLAN Provide the following specifics regarding the financing plan you are seeking. Contact the WWDO for questions regarding specifics relating to existing Program criteria.

1. Provide a brief statement describing the project for which you are seeking funding, including the reasons the project is needed. Describe the current situation with your water supply that will be improved by the project. (Attach additional information if you wish):
2. Total funding request (please attach the best available detailed cost estimate):
3. WWDC Grant (Percentage of total WWDC eligible project costs):
4. WWDC Loan (Percentage of total WWDC eligible project costs):
a. Interest rate (presently, the typical rate is 4%):
b. Term of Loan (cannot exceed economic life of project):
5. If you are planning to obtain alternate loans or additional grants from other agencies to supplement your request from the WWDC, please describe your financing plans and the schedule for the acquisition of the funds:
6. Total project costs not eligible for WWDC funding:
7. Please describe your financing plans and the schedule for the acquisition of the costs not eligible for WWDC funding
8. Does the Sponsor have the authority to adequately assess fees or collect funds to cover operation and maintenance expenses related to the water development project? Yes No

B. EXISTING WATER SUPPLY SYSTEM
1. Description of Present Water Supply:
   a. Groundwater - Number of wells: Approximate Depth:
   Primary supply aquifer or formation:
   Approximate Yield in GPM per well:       Total of all wells:
   b. Surface Water - Source Name:
    Type of Diversion (headgate, infiltration gallery, pumps, etc.):
    Approximate Yield:
   c. Springs - Name of springs:       Approximate Yield:

2. Water Storage: Treated (volume and description):
Raw (volume and description):

3. Transmission pipeline - Approx. Distance from Source to Distribution System:
Type of pipe material: Diameter(s):
Age of pipeline: Condition of pipeline:

4. Treatment - None: Chlorination: Filtration: Other:

5. Is water metered? Yes No Do you bill by meters? Yes No

6. Identify unmetered usage (irrigation of parks, cemeteries, fire protection, etc.) and amount of unmetered usage:

7. Do you have an independent raw water irrigation system? Yes No
Raw water system capacity (gallons per day):
Average annual raw water usage (gallons):

8. Are you under any federal (EPA) mandates to improve your system? (eg. Administrative orders, violations, actions taken):

9. Does anyone in the service area haul their drinking water? Yes No

C. FINANCIAL INFORMATION
1. Service Area Information:
    a. Population (2010 Census): Current Estimate:
    b. Does the entity have a comprehensive planning boundary? Yes No
       If so, what is the estimated additional population that may be served in the future?

Pre-Project Post Project

c. Taps served within the entity boundaries?

d. Taps outside the entity boundaries?

e. Names of other water systems served?

f. Are there existing planning reports (municipal or county) addressing growth management in the project area? Yes No

If so, please provide titles and how copies of the reports could be obtained:

2. Water Usage (Potable water system only)

Pre-Project Post Project

a. Total number of gallons produced by the water sources annually:

b. Gallons used per capita per day:

Average Day:

Peak Day:

3. System Capacity (Potable water system only)

Pre-Project Post Project

a. Maximum capacity of the water supply system:

Acre feet per Day:

Gallons per Day:

b. Increased capacity needed:

Acre feet per Day:

Gallons per Day:

c. Estimated system water losses (percentage):

d. Identify the water rights, existing or needed, for the project. Describe the status of these water rights (filings, permits, adjudicated water rights):

e. What is the factor (bottleneck) that is presently limiting your ability to provide water (supply, transmission, treatment, distribution, etc.):

f. What will be the post-project factor (bottleneck) that is will limit your ability to provide water (supply, transmission, treatment, distribution, etc.):

g. Describe water conservation efforts (tiered water rates, lawn watering restrictions, etc.):

4. Rates

Pre-Project Post Project

a. Tap fees:

Residential:

Commercial:

b. Average residential monthly water bill:

c. Water Rates:

        Pre-project rates for all tiers and categories of use:

        Post-project rates for all tiers and categories of use:

d. Identify any local conditions that affect your rates? (Example: flow through for frost prevention, etc.):

5. Financial Statement

Pre-Project Post Project

Annual revenues generated from water sales:

Annual revenues from tap fees:

Annual revenues from other sources:

Total annual revenues:

Annual budget for operation and maintenance expenses:

Annual payments for debt retirement:

Annual payments to a repair and replacement fund:

Annual payments to an emergency fund:

Annual payments for other purposes:

Total annual payments:

Balance in repair and replacement fund:

Balance in emergency fund:

Annual cost of water quality testing:

6. Is the operation of the water supply system self supporting in terms of revenues offsetting costs for operation, maintenance, debt retirement, replacement funds and emergency funds?

If not, how is the difference subsidized?

D. CONSTRUCTION DELIVERY METHOD

1. Please indicate the construction delivery method the Sponsor will use if the project is approved by the legislature. Please talk to your attorney if you have questions about the construction delivery methods.

Design-Bid-Build
Design-Build
Construction Manager At Risk

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Thank you for your participation!
Dept. 3943 | 1000 E. University Ave. | Laramie, WY 82071
Office: (307) 766-6651 email: wrds@uwyo.edu

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PROJECT APPLICATION FOR LEVEL III CONSTRUCTION FUNDING FOR MUNICIPAL AND RURAL DOMESTIC PROJECTS

WYOMING WATER DEVELOPMENT COMMISSION 6920 Yellowtail Road Cheyenne, Wyoming 82002 Telephone: (307) 777-7626 Fax: (307) 777-6819

If you wish to retain a copy of your form, please print this page before pressing the Submit Information button below

PROJECT APPLICATION FOR LEVEL III CONSTRUCTION FUNDING
FOR MUNICIPAL AND RURAL DOMESTIC PROJECTS

WYOMING WATER DEVELOPMENT COMMISSION
6920 Yellowtail Road
Cheyenne, Wyoming 82002
Telephone: (307) 777-7626 Fax: (307) 777-6819