Pioneer Canal and Laramie River by Tony Bergantino

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.

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 that has been reviewed and approved by the planning division of the WWDO.

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 (PDF preferred).

  • 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" required, PDF preferred) showing the 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 system includes a minimum of 15 taps with meters on each tap.

  • Application may also be scanned and submitted by PDF if preferred. Please send PDF files to WDO-PayRequest@wyo.gov if this is preferred method of submitting.

I acknowledge that I have read and understand the application requirements as stated above.

  
Authorized Official - Name and Title      Digital Signature of Authorized Official (Typing your name here constitutes a digital signature.)

 

ENTITY INFORMATION

Type of Entity - Municipality, County, Joint Powers Water Board, Special District


Applicant - Name of Entity

                P.O. Box and/or Street Address:

             City/Town:   State:   Zip Code:   County:

        Phone Number:

     (Contact Person)
    *(Contact Phone)

    *The best time to reach the contact person is from:
    (Please include a.m. or p.m.)
to Monday
to Tuesday
to Wednesday
to Thursday
to Friday

    Email for Contact Person:

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


(Name)           (Phone Number)      (Email)

REQUIRED 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 Please provide the following specifics regarding the financing plan you are seeking. Contact the WWDO for questions regarding specifics relating to existing Program criteria.

1. Please 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):



a. What feasibility study is this project originating from?


2. What is the total estimated cost of the project?
a. Attach a current sealed professional engineer's cost update in the format as shown in the last page of application (PDF is preferred).


3. Total project costs eligible for WWDC funding:

4. Total project costs not eligible for WWDC funding:

5. Amount of eligible funding requested from WWDC:

6. WWDC Grant (Percentage of total WWDC eligible project costs):

7. How are you planning to obtain funding for the remainder of the project costs? Both eligible or ineligible? Will this be additional grants or loans from other agencies to supplement your request from the WWDC? Please describe your financing plans:


a. Is the additional funding available at this time? Yes No

b. If not, when will the funding be available? 




8. Is the project eligible for any federal funding? (SRF, RUS, etc.)? Yes No

If yes, please list which funding:

9. Are additional right-of-way, access, or land purchases needed for the project? Yes No

If yes, please describe what may be needed and when it will be obtained:

10. Are there any other items that will have to be completed prior to bidding the project? Yes No

If yes, please describe what may be needed and when it will be completed:

11. Are any environmental assessments or clearances needed for the project? Yes No

If yes, have they been obtained? Yes No

If they have not been obtained when will they be obtained?

12. What is the expected bid date for construction? (design is complete and all required lands, permits, etc. are complete):



13. 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. FINANCIAL INFORMATION

1. Service Area Information:

a. Population (2020 Census):     Current Estimate: 


b. Does the entity have a comprehensive planning boundary? Yes No

If yes, 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

1. 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: 
    

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

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


Pre-Project      Post-Project

d. Increased capacity needed: 
    

e. Estimated system water losses (percentage):
%   %


4. Do you have an independent raw water irrigation system? Yes No

Raw water system capacity (gallons per day): 

Average annual raw water usage (gallons): 


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



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





7. Rates (attach current rates if possible in PDF)


a. Tap Fees
Pre-Project      Post-Project

Residential:
     

Commercial:
    

b. Average residential monthly water bill:
    

c. Water Rates:

Pre-project rates for all tiers and categories of use (if possible please attach PDF):


Post-project rates for all tiers and categories of use (if possible please attach PDF):


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


8. 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 for other purposes:
    

Total annual payments:
$   $

 

Balance in repair and replacement fund:
    

Balance in emergency fund:
    

Annual cost of water quality testing:
    


9. 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? Yes No


If not, how is the difference subsidized?

C. EXISTING WATER SUPPLY SYSTEM

1. Description of Present Water Supply: (fill in all that apply)

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 (gpm): 


c. Springs - Name:     Approximate Yield (gpm): 


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

Raw (volume and description):


3. Transmission Pipeline - Approximate Distance from Source to Distribution System: 

Type of pipe material:     Diameter(s):

Age of pipeline:  years      Condition of pipeline: 


4. Treatment - None: Yes No     Chlorination: Yes No     Filtration: Yes No     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. Are you under any federal (EPA) mandates to improve your system? (e.g. Administrative orders, violations, actions taken)? Yes No


If yes, please describe.


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

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

WWDC PROJECT COST ESTIMATE
PLEASE FILL IN * ITEMS

• For Material Only Projects an itemized list of materials and expected costs is all that is required.•

WWDC ELIGIBLE PROJECT COSTS

*CONSTRUCTION COSTS

$

$

$

$

$

$

$

$

$

$

Cost of Project Components TOTAL
(subtotal #1) $


Construction Engineering Cost (subtotal #1 x 10%)
$

Components + Construction Engineering Costs
(subtotal #2) $


Contingency (subtotal #2 x 15%)
$

Construction Cost Total (subtotal #2 + Contingency)
(subtotal #3) $


PRE-CONSTRUCTION COSTS
Preparation of Final Designs & Specifications (subtotal #1 x 10%)
$

*Site Access Permit Fees (BOR, USFS, etc.)
$

*Title Opinion
$

*Acquisition of Access and Rights of Way
$

Pre-construction Costs Total
(subtotal #4) $


TOTAL WWDC ELIGIBLE PROJECT COST
Total WWDC Eligible Project Cost (subtotal #3 + subtotal #4)
(subtotal #5) $

WWDC INELIGIBLE PROJECT COSTS

*CONSTRUCTION COSTS

$

$

$

$

$

$

$

*Additional Cost for Construction Engineering
$

*Additional Cost for Preparation of Final Designs & Specifications
$

Total WWDC Ineligible Project Costs Total
(subtotal #6) $

TOTAL PROJECT COSTS

Total Project Cost (subtotal #5 + subtotal #6)
$

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

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

BEFORE submitting your form, please use the Upload File form below to upload any documents you wish to include with your application. It is suggested to copy all the files to upload into a folder and then select them all using the Browse button below - After you have uploaded the files, click the Submit Information button below.

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