"Local Community Loan Application (Design and Construction Projects)" - Oregon

Local Community Loan Application (Design and Construction Projects) is a legal document that was released by the Oregon Department of Environmental Quality - a government authority operating within Oregon.

Form Details:

  • Released on August 1, 2019;
  • The latest edition currently provided by the Oregon Department of Environmental Quality;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Oregon Department of Environmental Quality.

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Clean Water State Revolving Fund
Local Community Loan Application
(Design and Construction Projects)
Contact:
Regional Project Officer
Answer all requests for information in this application. List “N/A” for items that do not apply. Do not leave any section of
this application blank.
DEQ will accept completed applications that are printed, signed and mailed to DEQ, postmarked by the application due
date.
Applicant Information
1.
Public agency/Legal applicant:
Name
Address
City, State
Zip + 4
County
Congressional District(s)
Telephone
Email Address
DUNS Number (9 Digits)
2. Cite your agency’s authority to take on debt, noting the exact Oregon Revised Statute reference located on the
state
website,
3. Only public agencies are eligible for the Clean Water State Revolving Fund. Does your agency meet the
definition of a “public agency” as defined by
ORS
468.423? If you are unsure, contact DEQ at 503-229-LOAN.
Yes
No
4.
Identify your type of public agency:
Tribal government
City
County
Sanitary district/Sanitary authority
State agency
Irrigation district
School district
County service district
Metropolitan service district
Other special district (please specify):
Intergovernmental agency (please specify):
Note: Eligibility includes certification of no disbarment and no suspension through the
System of Award
Management. Certification is required at time of loan signing.
Local Community Loan Application / Updated August 2019 (IIL)
1
Clean Water State Revolving Fund
Local Community Loan Application
(Design and Construction Projects)
Contact:
Regional Project Officer
Answer all requests for information in this application. List “N/A” for items that do not apply. Do not leave any section of
this application blank.
DEQ will accept completed applications that are printed, signed and mailed to DEQ, postmarked by the application due
date.
Applicant Information
1.
Public agency/Legal applicant:
Name
Address
City, State
Zip + 4
County
Congressional District(s)
Telephone
Email Address
DUNS Number (9 Digits)
2. Cite your agency’s authority to take on debt, noting the exact Oregon Revised Statute reference located on the
state
website,
3. Only public agencies are eligible for the Clean Water State Revolving Fund. Does your agency meet the
definition of a “public agency” as defined by
ORS
468.423? If you are unsure, contact DEQ at 503-229-LOAN.
Yes
No
4.
Identify your type of public agency:
Tribal government
City
County
Sanitary district/Sanitary authority
State agency
Irrigation district
School district
County service district
Metropolitan service district
Other special district (please specify):
Intergovernmental agency (please specify):
Note: Eligibility includes certification of no disbarment and no suspension through the
System of Award
Management. Certification is required at time of loan signing.
Local Community Loan Application / Updated August 2019 (IIL)
1
5.
Project contact
Name
Dept./Organization
Title
Telephone
Email Address
6.
Interim financing:
Yes
No
If yes, which agency will provide long-term financing?
7.
CWSRF loan request amount:
8.
Total estimated project cost:
Program Description(s)
Attach additional documentation if necessary
9.
Description of proposed Local Community Loan Program.
Name of program:
10. Describe the proposed loan program briefly, including:
General description:
Local Community Loan Application / Updated August 2019
2
(IIL)
Number of projects:
Number of sub-agreements: between
and
Project objectives:
11. Have you already set up a loan program for your sub-borrowers?
Yes
No
If yes, describe how it operates. If no, explain how this will be accomplished:
Local Community Loan Application / Updated August 2019
3
(IIL)
12. Do you plan to service the loan in-house, or do you plan to sub-contract this to another servicer?
In-house
Sub-contract
If known, who is the sub-contractor:
13. Has this already been completed?
Yes
No
14. Who will be the manager for this effort, and what is their role?
15. What is the method for determining creditworthiness of your loan recipients?
16. Do you have a copy of the proposed loan agreements?
Yes
No
If yes, please provide as an attachment. If no, explain how you will accomplish this:
Local Community Loan Application / Updated August 2019
4
(IIL)
17. What assets are you proposing to secure the CWSRF loan with, in addition to the loan repayments?
Project Description(s)
Attach additional documentation if necessary
Use this section to describe the objectives, components and expected outcomes of the program and project(s). The
loan agreement will refer to this section in defining what expenses can be reimbursed.
18. Project description:
Name of the project:
Describe the project objectives, specifying the water quality and public health objectives to be addressed:
Describe the major project components (for example, type of structures to be built):
Local Community Loan Application / Updated August 2019
5
(IIL)
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