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DRINKING WATER STATE REVOLVING FUND
LOAN AGREEMENT
02-65102-031
CITY OF MARYSVILLE
PART I:ENTIRE AGREEMENT
/D)IE C rE 0 \VIle Ii))\
Ifll JUl 11 2003 IIDI
City 01 Marysyille
Public Works
This agreement,and incorporated attachments,contains all terms and conditions agreed to by the PUBLIC
WORKS BOARD and the BORROWER,and no other statements or representations written or oral, shall be deemed
a part thereof.This contract consists of nine pages and five attachments.ATTACHMENT I:SCOPE OF
WORK,consists of a description of local project activities,certification of the project's useful life, and
identification of estimated project costs and fund sources and is,by this reference,incorporated into this
agreement as though set forth fully herein.In addition,ATTACHMENT II:ATTORNEY'S CERTIFICATION,
ATTACHMENT ill:FEDERAL AND STATE REQUIREMENTS,ATTACHMENT N:SMALL AND
DISADVANTAGED BUSINESS UTILIZATION REQUIREMENTS,and ATTACHMENT V:
CERTIFICATION REGARDING DEBARMENT,SUSPENSION,AND OTHER RESPONSIBILITY
MATTERS,are by this reference incorporated into this agreement.
The PUBLIC WORKS BOARD and the BORROWER have executed this agreement as of the date and year last
written below.
PUBLIC WORKS BOARD
John LaRocque,Executive Director
Public Works Board
Title
Date
APPROVED AS TO FORM ONLY
This 3rd Day of April, 2003
Christine O.Gregoire
Attorney General
CITY OF MARYSVILLE
Print Name
--lY\0,ul-.l.0ur _
Title I
~-ll ~03
Date
By Signature on File
Jeanne A.Cushman
Assistant Attorney General
Federal Taxpayer Identification Number
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PART II:INTRODUCTION
This loan agreement is made and entered into by and between the PUBLIC WORKS BOARD, or its successor, a
department of the state ofWashington, and the City of Marysville (referred to as the "BORROWER").
Acting under the authority ofRCW 70.119A.170 and 43.155.040, the BOARD has selected the BORROWER to
receive a Drinking Water State Revolving Fund loan for an approved project. The BORROWER will be a sub-
recipient of funds provided by the United States Environmental Protection Agency, CFDA Number 66.468,.
Title: Safe Drinking Water State Revolving Fund, award year: 2002.
PART III:PURPOSE
The BOARD and the BORROWER have entered into this agreement to undertake a local project that furthers the
goals and objectives of the Washington State Drinking Water State Revolving Loan Fund Program. The project
will be undertaken by the BORROWER and will include the activities described in ATTACHMENT I: SCOPE
OF WORK. The assisted project must be undertaken in accordance with PART IV:TERMS AND
CONDITIONS and all applicable federal, state and local laws and ordinances, including but not limited to those
.specifically enumerated in ATTACHMENT III.
PART IV:TERMS AND CONDITIONS
The parties to this agreement agree as follows:
4.01 Rate and Term of Loan
The BOARD, using funds received from the Drinking Water Assistance Account, shall loan the BORROWER a
sum not to exceed Four Million Eighty Thousand Dollars ($4,080,000). The interest rate shall be One and One
Half Percent (1.5%) per annum on the outstanding principal balance. The term of the loan shall not exceed
Twenty (20) years,withthe final payment due October I, 2023.
4.02 Disbursement of Loan Proceeds and Required Documentation
Warrants shall be issued to the BORROWER for payment of allowable expenses incurred by the
BORROWER while undertaking and administering approved project activities in accordance with
ATTACHMENT I: SCOPE OF WORK. The total Drinking Water State Revolving Fund Loan shall not
exceed One Hundred Percent (100%)of the eligible actual project costs.
The loan funds will be disbursed to the BORROWER as follows:
The disbursement ofloan proceeds shall be initiated by the BORROWER on a Washington State Invoice
Voucher form. All expenses must have been incurred by the BORROWER at the time of voucher submittal.
Disbursement requests must be supported by bills or receipts as evidence that costs have been incurred.
Expenses incurred after March 3, 2003, are eligiblefor reimbursement.
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A loan fee will be assessed in the following manner:
The first request for reimbursement shall include a loan fee of $80,000,which is 2%of $4,000,000.This fee
shall not be reduced,regardless of the actual final loan amount.If the total loan amount is increased through
an amendment,an additional loan fee equal to 2%of the additional loan amount will be assessed at contract
close-out.
In no case shall loan funds be disbursed for construction activities until the following conditions have been
met:
•The BORROWER issues a Notice to Proceed which follows the formal award of a construction contract;
•The BORROWER has completed the State Environmental Review Process;
•The Washington State Department of Health (DOH)has approved a project report and related construction
documents for all applicable activities described in ATTACHMENT I:SCOPE OF WORK.
•The project includes installation of source meters,if applicable,per WAC 246-290.
At the time of project completion,a Close-out report (refer to section 4.10 for Close-out Report)shall be
submitted to the BOARD by the BORROWER certifying total actual project costs.The Close-out Report
shall include a copy of the Certification of Construction Form from the Washington State Department of
Health.
The final Drinking Water State Revolving Fund loan disbursement for project activities shall not bring the
total loan in excess of One Hundred Percent (100%)of the eligible project costs.The Close-out Report shall
serve as a contract AMENDMENT for determining the final loan amount.
4.03 Time of Performance
The BORROWER shall begin the activities identified within ATTACHMENT I:SCOPE OF WORK no later
than ninety (90) days after loan agreement execution,and reach project completion no later than thirty-six (36)
months after the date of agreement execution.
Failure to perform within the time frame described in the preceding paragraph may constitute default of this
agreement.In the event of extenuating circumstances,the BORROWER may request, in writing,that the
BOARD extend the deadline for project completion.The BOARD may,by a two-thirds vote,extend the time of
completion.
The term of this agreement shall be for the entire term of the loan,irrespective of actual project completion,
unless terminated sooner as provided herein.
4.04 Historical and Cultural Artifacts
The BORROWER agrees that if historical or cultural artifacts are discovered duringconstruction,the BORROWER
shall innnediately stop construction and notify the local historical preservation officer and the state's historical
preservation officer at the Washington State Office of Archeology and Historic Preservation.
The BORROWER shall require this provision to be contained in all contractsfor work or servicesrelated to
ATTACHMENT I: SCOPE OF WORK.
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4.05 Repayment
The first loan repayment under this agreement is due October 1,2004,and subsequent installments are due on
October I of each year during the term of the loan. The first repayment under this agreement shall consist of
interest only at the rate of One and One Half Percent (1.5%) per annum, calculated on a 360-day year of twelve
30-day months, applied to funds received. Interest will begin to accrue from the date each warrant is issued.
Subsequent repayments shall consist of the principal due divided by the loan term remaining plus interest on the
unpaid balance ofthe loan. The final payment shall be an amount sufficient to bring the loan balance to zero.
The BORROWER has the right to repay the unpaid balance of the loan in full at any time, and the right to repay
at a faster rate than is provided in this agreement, provided that any such payment must equal or exceed the
principal amount normally due on an annual basis.
The BORROWER will repay the loan in accordance with the preceding conditions through the use of a check,
money order, or equivalent means made payable to the Department of Community,Trade and Economic
Development, or its successor, and sent to:
Department of Community,Trade and Economic Development
Administrative Services DivisionlFiscal Unit
906 Columbia Street SW
P.O.Box 48300
Olympia,Washington 98504-8300
or to such other address as may be specified from time to time by the Department of Community,Trade and
Economic Development,or the PUBLIC WORKS BOARD, or the successor or either, by notice to the LOCAL
GOVERNMENT.
4.06 Repayment Account
The BORROWER shall repay the loan accordingto the optiondesignatedin Section4.08 Loan Security. The name
of the fund, account, or sub-account shall be kl b'I'lit Eu n d .
4.07 Default in Repayment
Loan repayments shall be made on the loan in accordance with Section 4.05 of this agreement.A payment not
received within thirty (30) days of the due date shall be declared delinquent.Delinquent payments shall be
assessed a daily penalty beginning on the thirty-first (31) day past the due date. The penalty will be assessed
on the entire payment amount. The penalty will be twelve percent (12%)per annum calculated on a 360-day
year.
The LOCAL GOVERNMENT acknowledges and agrees to the BOARD'S right,upon delinquency in the
.payment of any annual installment, to notify any other entity, creditors, or potential creditors of the LOCAL
GOVERNMENT of such delinquency including, without limitation, the state government and the United States
of America or its agencies, credit rating agencies, and the municipal finance market. The LOCAL
GOVERNMENT shall pay the costs and reasonable legal fees incurred by the BOARD in any action undertaken
to enforce its rights under this section.
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4.08 Loan Security
The BORROWER must select one of the following options for securing repayment of the loan.Please initial
the appropriate option.
1.
OR
___General Obligation:This loan is a general obligation of the BORROWER.
2.IJJ.,,)Revenue Obligation:This option may be used only if the entire project is a domestic water
project.
This loan is a revenue obligation of the BORROWER payable solely from the net revenue of the utility system
indicated below. Payments shall be made from the net revenue of the utility after the payment of the principal
and interest on any revenue bonds, notes,warrants or other obligations of the utility having a lien on that net
revenue. As used here,"net revenue"means gross revenue minus expenses of maintenance and operations.
The BOARD grants the BORROWER the right to issue future bonds and notes that constitute a lien and
charge on net revenue superior to the lien and charge of this loan agreement.
If selecting the revenue obligation,please choose and initial one of the following utility systems:
J!J./Water
___Combined Water Utility
(Water/Sewer;Water/Sewer/Irrigation;etc.)
OR
3.Local Improvement District:This loan is payable from special assessments collected
from a Local Improvement District, Local Utility District or any other similar special assessment district
created for the purpose of making the improvements fmanced by this loan. The name of the special
assessment district is ------------------'
Nothing in this section shall absolve the BORROWER of its obligation to make loan repayments when due,
and to adjust rates, fees, or surcharges,if necessary, to meet its obligations under this agreement.
4.09 Project Completion
The BOARD will require and notify the BORROWER to initiate a Close-out Report when the activities
identified in ATTACHMENT I: SCOPE OF WORK are completed.In the report, the BORROWER will
provide the following information to the BOARD:
l.A certified statement of the actual dollar amounts spent, from all fund sources, in completing the project
as described.
2. Certification that all costs associated with the project have been incurred. Costs are incurred when
goods and services are received and/orcontract work is performed.
3. Copy ofCertification of Construction Form from the Washington State Department of Health.
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4.10 Final Draw and Close-out Requirements
At the time of project completion,the BORROWER shall submit a Close-out Report to the BOARD.The
Close-out.Report shall serve as a contract amendment for determining the final loan amount.The BOARD
shall provide the Close-out Report form to the BORROWER.
4.11 Recordkeeping and Access to Records
The BOARD,the BOARD's agents, and duly authorized officials of the State and Federal governments shall
have full access and the right to examine,copy,excerpt,or transcribe any pertinent documents,papers,records,
and books of the BORROWER and of persons,firms, or organizations with which the BORROWER may
contract,involving transactions related to this project and this agreement.
The BORROWER agrees to retain these records for a period of six years from the date that the debt was retired.
If any litigation,claim or audit is started before the expiration of the six (6)year period,the records shall be
retained until all litigation,claims or audit findings involving the records have been resolved.
4.12 Reports
The BORROWER,at such times and on such forms as the BOARD may require,shall furnish the BOARD with
such periodic reports as it may request pertaining to the activities undertaken pursuant to this agreemerit
including,but not limited to,quarterly progress reports,MWBE status, the Close-out Report,and any other
matters covered by this agreement.Failure to file periodic reports as requested may result in termination of this
agreement as per Section 4.16.
4.13 Indemnification
It is understood and agreed that this Agreement is solely for the benefit ofthe parties to the Agreement and gives
no right to any other party. The BORROWER agrees that the BOARD is acting only as lender and is not
directing or controlling its business as a manager,partner,owner,principal,or any other capacity. It is
understood and agreed that no joint venture or partnership is formed as a result ofthis Agreement.Each party
hereto agrees to be responsible and assume liability for its own negligent acts or omissions,or those of its
officers, agents, or employees to the fullest allowed required by law, and agrees to save,indemnify,defend and
hold the other parties harmless from any such liability.In the case ofnegligence ofmore than one party,any
damages allowed shall be levied in proportion to the percentage ofnegligence attributable to each party; and
each party shall have the right to seek contribution from each ofthe other parties in proportion to the percentage
ofnegligence attributed to each ofthe other parties..
4.14 Amendments,Modifications,and Waivers
The BORROWER may request an amendment of this agreement for the purpose of modifying the SCOPE OF
WORK or for extending the time of performance as provided for in Section 4.03.No modification or
amendment resulting in an extension of time shall take effect until a request in writing has been received and
approved by the BOARD in accordance with Section 4.03.No amendment or modification shall take effect until
approved in writing by both the BOARD and the BORROWER and attached hereto. No conditions or
provisions ofthis agreement may be waived unless approved by the BOARD in writing.
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4.15 Temrination for Cause
If the BORROWER fails to comply with the terms of this agreement, or fails to use the loan proceeds only for
those activities identified in ATIACHMENT I: SCOPE OF WORK, the BOARD may terminate the agreement
in whole or in part at any time. The BOARD shall promptly notify the BORROWER in writing of its
determination to terminate, the reason for such termination, and the effective date of the termination.Nothing in
this section shall affect LOCAL GOVERNMENT obligations to repay the unpaid balance ofthe loan.
4.16Terminationfor Convenience
The BOARD may terminate this agreement in the event that federal or state funds are no longer available to the
BOARD, or are not allocated for the purpose of meeting the BOARD'S obligations under this agreement.
Termination will be effectivewhen the BOARD sends written notice of termination to the BORROWER. Nothing
in this section shall affect LOCALGOVERNMENT obligationsto repay the unpaid balance ofthe loan.
4.17 Governing Law and Venue
This agreement shall be construed and enforced in accordance with, and the validity and performance hereof
shall be governed by, the laws of the state of Washington;Venue of any suit between the parties arising out of
this agreement shall be the Superior Court of Thurston County,Washington. The prevailing party is entitled to
recover costs in accordance with Washington State Law (Chapter 4.84 RCW).
4.18 Severability
If any provision under this agreement or its application to any person or circumstances is held invalid by any
court of rightful jurisdiction,this invalidity does not affect other provisions of the agreement which can be given
effect without the invalid provision.
4.19 Audit
Audits of the BORROWER'S project activities may be conducted by the Office of the State Auditor.Audit
costs are eligible project costs.
The BORROWER shall maintain its records and accounts so as to facilitate the audit requirements of the
Department of Community,Trade and Econornic Development,or its successor.
The BORROWER is responsible for any audit exceptions incurred by its own organization.The BOARD
reserves the right to recover from the BORROWER all disallowed costs resulting from the audit.
BORROWERS expending $300,000 or more in any fiscal year in federal funds from all sources, direct and
indirect, are required to have an audit conducted in accordance with Office of Management and Budget
(OMB)Revised Circular A-l33 "Audits of Institutions of Higher Education and Other Non-Profit
Institutions."The audit may be due nine months after the end ofthe fiscal year in which $300,000 or more in
federal funds were expended.BORROWERS are advised to consult with private counsel to determine the
rules appropriate to them.
BORROWERS expending less than $300,000 or more in any fiscal year in federal funds from all sources,
indirect and direct, may have audits conducted by the Office of State Auditor (OSA) on the normal cycle used
byOSA.
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4.20 Project Monitoring and Inspection
The BOARDandthe WashingtonStateDepartmentofHealthreservethe rightto enterthepremisesduringbusiness
hoursto monitorproject activities throughoutthe contractperiodto assessprogress,reviewexpendituresand
documentation,to reviewfiles,andto inspectthe systemthroughouttheperiodoftheAgreement.
4.21 Project Signs
If the BORROWER displays, during the period covered by this agreement, any signs or markers identifying
those entities participating financially in the approved project, the sign or marker must identify the Washington
State Public Works Board Drinking Water State Revolving Fund, and the Washington State Department of
Health, as participants in theproject.
4.22 Utilization ofMinoritv and Women Business Enterprises CMWBE)
As mandated by the U.S. Environmental Protection Agency, The BORROWER is required to follow the steps
identified in ATTACHMENT IV:SMALL AND DISADVANTAGED BUSINESS UTILIZATION
REQUIREMENTS.The BORROWER is required to furnish the BOARD with such periodic reports as it may
request pertaining to the utilization of disadvantaged businesses.The goals for the utilization of disadvantaged
businessesarestatedbelow.
Construction lO%MBE 6%WBE
Supplies 10%MBE 6%WBE
Equipment lO%MBE 6%WBE
Purchased Services lO%MBE 6%WBE
4.23 Utilization of Small Business In Rural Areas CSBRA)
The BORROWER is required to follow the steps identified in ATTACHMENT IV: SMALL AND
DISADVANTAGED BUSINESS UTILIZA nON REQUIREMENTS.The "Fair Share"percentage for SBRAs
is 0.5%.
4.24 Nondiscrimination Provision
The BORROWER shall comply with all federal and state nondiscrimination laws, including, but not limited to
Chapter 49.60 RCW,Washington's Law Against Discrimination,and 42 U.S.C. 12101 et seq, the Americans
with Disabilities Act (ADA) in connection with this Agreement.
In the event of the BORROWER'S noncompliance or refusal to comply with any applicable nondiscrimination
law, regulation, or policy, this contract may be rescinded, canceled, or terminated in whole or in part, and the
BORROWER may be declared ineligible for futther contracts with the BOARD. The BORROWER shall,
however, be given a reasonable time in which to cure this noncompliance.
4.25 Transfer of Ownership
During the term of this loan, any change in ownership of the water system(s)improved with funds received by
the BORROWER under this loan agreement must be approved in writing by the BOARD.As a condition of
approval, the BOARD reserves the right to demand payment in full of the outstanding principal balance of the
loan.
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PART V:SPECIAL ASSURANCES
The BORROWER assures compliance with all applicable federal, state and local laws,requirements,and
ordinances as they pertain to the design,implementation,and administration of the approved project.Of
particular importance are the following:
5.01 Bidding Requirements
The BORROWER shall comply with the provisions of RCW 43.155.060 regarding competitive bidding
requirementsfor projects assisted in whole or in part with money from the Drinking Water State Revolving Fund
program.
5.02 Eligible Project Costs
The BORROWER assures compliance with WAC 399-30-030(3) which identifies eligible costs for projects
assisted with this loan..
5.03 Prevailing Wage
The project funded by this Agreement may be subject to the state prevailing wage law Chapter 39.12 RCW. The
BORROWERis advisedto consultthe Washington State Department of Labor and Industries and/or private counsel
to determine whether prevailing wages must be paid. The BOARD is not responsible for determining whether
prevailing wage law applies to the project or for any prevailing wage payments that may be required by law.
BORROWERis responsible for notifying all sub-contractorswho are awarded funds as the result of activitiesunder
this Agreement.
5.04 Federal and State Requirements
The BORROWER assures compliance with all applicable Federal and State requirements,including but not
limited to those listed in Attachment ill and IV.
5.05 Suspension and Debarment
The BORROWER certifies itis not presently suspended or debarred from receiving federal funds. The
.BORROWER has satisfactorily completed the EPA Certification contained in Attachment V:Certification
Regarding Debarment,Suspension,and Other Responsibility Matters.
The BORROWER shall require all contractors and subcontractors receiving contracts of$100,000 or more for
work listed in AITACHMENT I, SCOPE OF WORK,to certify that the federal government has not suspended
or debarred them from receiving federal funds.Suspension and debarment certification forms shall be provided
by the BOARD.
The BORROWER agrees to keep debarment and suspension documentation on file in project records.
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5.06 No Waiver
Waiver of any covenant,term, or condition of this Agreement by any party shall not be deemed a waiver of any
subsequent breach ofthe same covenant,tenn,or condition. No waiver of any default or breach by any party
shall be implied from any failure to take action upon such default or breach,ifthe default of breach persists or
repeats.
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J )
DRINKING WATER STATE REVOLVING FUND
ATTACHMENT I: SCOPE OF WORK
LOAN NUMBER 02-65102~031
MARYSVILLE
(Recipient)
STILLAGUAMISH WATER SYSTEM IMPROVEMENTS
(Project Title)
1. Provide a clear description of the project to be financed in part by a Drinking Water
State Revolving Fund loan. (Attach additional sheets if necessary):
This project will include the installation of a new filtration system.The
filtration system the City will be implementing is A ZeeWeed Membrane System which i.
is a reinforced,imm."ersed,outside....in;hollow fiber ultrafiltra.tion membrane ~-.'
System..By comparison with membrane .systems that have their membranes installed
within canisters,which are fed water under pressure,the ZENON membrane system
can he subjected to extremely hich concentrations of solids with no significant
depreciation in membrane performance or treated water quality.The design of the
immersed membrane modules is inherently suitable for handling solids and
seasonal fluctuations in water quality that can occur at the Stillaguamish
source.
illnstall approximately 7,000 linea~L feet of water ·line and appurtenences will
also be installed with this project.
Replace agiilgsubmersible pumps and mot or s ,which will eliminate mercury seals tJ.,.
that,should they fail,are a potential health risk to the service population.
Replace aglinorroded metal at the source;(i.e.ladders,platforms,and
supports inside caisson).
Replace outdated motor control center and upgrade telemetry to meet peak
demand..
2. The term ofthis loan will be based on an engineer's certification of the expected
useful lite of the improvements, as stated below, or 20 years,whichever is less. If
the recipient prefers the term of its loan to be lessthan either 20 years or the useful
life of the improvements, the preferred loan term should be
.indicated: 20 years.
(360)651-5100Telephone:
Date:
'Signed:
'3.I,Kevin M.Nielsen,PE ,licensed engineer, certify
that the average e ected useful rle for the improvements described above
~W Y ~.
•
))
Scope of Work,DWSRF Loan Agreement Number 02-65102-031
Page Two
DWSRFLoan
C. DWSRF CONSTRUCTION LOAN (for project costs)
DWSRF LOAN FEE (2% of construction loan)
TOTAL DWSRF LOAN
$4,000,000.00
$.80,000.00
$4,080,000.00
Attachment ill
Federal and State Requirements
1)Environmental Authorities
a)Archeological and Historic Preservation Act of 1974, Public Law 86-523 as amended
b)Clean Air Act,Public Law 84-159 as amended
c) Coastal Barrier Resources Act,Public Law 92-583 as amended
d)Endangered Species Act, Public Law 93-205 as amended
e)Environmental Justice,Executive Order 12898
f)Floodplain Management,Executive Order 11934 as amended by Executive Order 12148
g)protection of Wetlands,Executive Order 11990
h)Farmland Protection Policy Act,Public Law 97-98
i)Fish and Wildlife Coordination Act,Public Law 85-624 as amended
j)National Historic Preservation Act of 1'966,Public Law 89-665 as amended
k) Safe Drinking Water Act, Public Law 93-523 as amended
1) Wild and Scenic rivers Act,Public Law 90-542 as amended
2)Economic and Miscellaneous Authorities
a)Demonstration Cities and Metropolitan Development Act of 1996,Public Law 89-754 as
amended,Executive Order 12372
b)Procurement Prohibitions under Section 306 of the Clean air Act and Section 508 of the
Clean Water Act,including Executive Order 11738,Administration of the Clean Air Act
and the Federal Water Pollution Control Ac with Respect to Federal Contracts, Grants, or
Loans
c)Uniform Relocation and Real Property Policies Act, Public Law 91-646 as amended
d)Debarment and Suspension,Executive Order 12549
3)Social Policy Authorities
a) Age Discrimination Act ofl975,Public Law 94"135
b)Title VI of the Civil Rights Act of 1964,Public Law 88-352
c)Section 13 of the Federal Water Pollution Control Act Amendments of 1972,Public Law
92-500 (the Clean Water Act)
d)Section 504 ofthe Rehabilitation Act of 1973,Public Law 93-112 (including Executive
Orders 11914 and 11250).
e) Equal Employment Opportunity,Executive Order 11246
f)Women's and Minority business Enterprise,Executive Orders 11625, 12138 and 12432
g)Section 129 of the Small Business Administration Reauthorization and Amendment Act
of1988,Public Law 100-590
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Attachment ill
4)State Laws
a)Chapter 36.70A RCW,Growth Management Act
b)Chapter 39.80 RCW,Contracts for Architectural and Engineering Services
c)Chapter 39.12 RCW,Washington State Public Works Act
d)Chapter 43.20 RCW, State Board of Health
e)Chapter 43.70 RCW,Department of Health
f)Chapter 70.116 RCW, Public Water Systems Coordination Act of 1977
g)Chapter 70.119 RCW, Public Water Supply Systems Certification and Regulation of
Operations
h)Chapter 70.119A RCW,Public Water Systems, Penalties &Compliances
i)Chapter 246-290 WAC, Group A Public Water Systems
j)Chapter 246-291 WAC, Group B Public Water Systems
k)Chapter 246-292 WAC,Waterworks Operator Certification Regulations
I)Chapter 246-293 WAC,Water Systems Coordination Act
m)Chapter 246-294 WAC,Drinking Water Operating Permits
n)Chapter 246-295 WAC,Satellite System Management Agencies
0)Chapter 173-160 WAC,Minimum Standards for Construction &Maintenance of Wells
p)Title 173WAC,Department of Ecology Rules
q)Title 40 Part 141 Code of Federal Regulations, Federal National Primary Drinking Water
Regulations (Section Adopted by Reference)
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Attachment IV
SMALL AND DISADVANTAGED BUSINESS UTILIZATION REQUIREMENTS
Affmnative steps shall include:
1.Placing qualified small and minority businesses and women's business enterprises on
solicitation lists';
2. Assuring that small and minority businesses, and women's business enterprises are solicited
whenever they are potential sources;
3.Dividing total requirements,when economically feasible, into smaller tasks or quantities to
permit maximum participation by small and minority business, and women's business
enterprises;
4. Establishing delivery schedules, where the requirement permits, which encourage
participation by small and minority business, and women's business enterprises;
5. Using the services and assistanceof the Small Business Administration, and the Minority
Business Development Agency of the Department of Commerce;and
6. Requiring the prime contractor,if subcontracts are to be let, to take the 5 affirmative steps
listed above.
i Qualified Women and Minority business enterprises may be found on the Internet at
www.omwbe.wa.govorbycontactingthe Washington State Office of Minority and Women's
Enterprises at 360-704-1181.
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ATTACHMENT V
&EPA
.United States Environmental Protection Agency
Washington,D.C.
Certification Regarding
Debarment,Suspension,and Other Responsibility Matters
The prospective participant certifies to the best of its knowledge and belief that it and its principals:
(a)Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily excluded from
covered transactions by any Federal department or agen.cy;
(b)Have not within a three year period preceding this proposal been convicted of or bad a civil judgement rendered
against them for commission of fraud or a criminal offense in connection with obtaining.attempting to obtain,or
performing a public (Federal,State,or local)transaction or contract under a public transaction;violation of Federal
or State antitrust statutes or commission of embezzlement.theft,forgery,bribery,falsification or destruction of
records,making false statements,or receiving stolen property;
(c)Are not presently indicted for or otherwise criminally or civilly charged by a government entity (Federal.State,or
local)with cemmlsslen of any efthe offenses enumerated in paragraph (l)(b)of this certification;and
(d)Have not within a three-year period preceding this application/proposal had one or more public transactions
(Federal,State,or local)terminated for cause or default.
I understand that a false statement on.this certification may be grounds for rejedion oHbis proposal or termination of the
award.In addition,under 18 USC Sec. 1001, a false statement may result in a fine of up to $10,000 or imprisonment for
up to 5 years,or both.
'6-1 h23
Date
D I am unable to certify to the above statements.My explana'tio~is attached•
.EPA Form 57011-49(11-88)
Washington State
Public Works Board
Washington State Department of
Health
Environmental Health Programs
Division of Drinking Water
Drinking Water State Revolving Fund
2002 Funding Cycle
Application Form
Submittal Deadline: May 13, 2002*
LOAN TERMS
Loan Limit:
Loan Term:
Interest Rate:
Local Match:
Loan Fee:
$4,000,000 per jurisdiction
$8,000,000 for jointly-owned projects or satellite management agencies
doing consolidation projects (contact DOH for more information)
20 years or the life ofthe project (whichever is less)
0.0%- 1.5%(linked with local income level)
No local match is required
2.0%(paid when the first loan draw is made)
*Application must be postmarked by midnight or
hand-delivered by 5:00p.m., May 13, 2002
Submit one (l)original and four (4)copies
Mailorshipto:
WashingtonStateDepartment of Health
DrinkingWater Division
DWSRFProgram
PostOffice Box47822
Olympia,Washington 98504-7822
Handdeliverto:
WashingtonStateDepartment of Health
DrinkingWater Division
DWSRFProgram
7171Cleanwater Lane,Bldg #3
Tumwater,Washington 98501
Drinking Water State Revolving Fund
2002 Loan Application Form
SECTION I:APPLICANT INFORMATION
Borrower:City of Marysville
Water System Name:
--
Stillaguamish Water System Improvements
PWSID Number:
-----~_:...._-~-j
S1900C
Federal Tax ID #:
City:
Project Title:
Project Description:
9~1 -I 6 i o OJ sj
98270
the influence of Surface Water. To meet Department of Health requirements the City has elected'
to construct a Filtration Facility. The City has already conducted a pilot study of two systems
and has entered into a purchase and sale agreement with the preferred vendor.
j Total DWSRF Request:$4,000,000.00
j Legislative District:
['"'lww.leg.\Va.gov/commonlim~~es/statedisprofile.gi.~.__."_.L_~~~__~,_",__~~
7 '
Snohomish
2 I Watershed Resource Inventory Area (see Guidelines,pg 32):
~---=--~----1~-=-~-':-::--:---~
Robin Nelson
--------'----~-~...,....--~--
i Congressional District:
i Contact Person:
,County:
98270iZip Code:State:!WA
80 Columbia Street
80 Columbia Street
----~~•._-~,----~.,~.~-~---_._..-~-,---,.-,~~.--------~.~.._~,-_.._--_.__._~---"-,.-_._-,----~-~------
i Marysville,City:
,Street Address:
!Mailing Address:
i (360 )6S1-Sl 00rFAX;--T360-)6ti=-5182---L---;-E;;-.ail;L----;;;-~~~@ci:;;;,;;y;-;;;n~~~~---~-"
i DYES [g]NO
,Telephone:
,Did consultant prepare
i this application:_l-,,__,,~~__'
,If "YES",Name of Firm:
Contact Person:
-----",-,--------------
i'------------'---e----'-------------------~-----~--------------------,---,--------,---~-~-----------------i City,State,Zip:
-------,-------------------------------------------------------------,--~-----------~-------
Application Forms- 2002
DWSRFLoanProgram
SECTION I:APPLICANT INFORMATION
i OWNERSHIP/SYSTEM TYPE:
i~O;-;;~;-hipTyp~~;~T~sfp~licly-o~;;~d-~~--T[fpri';~t~Fo~::-Profit-~-~-T[rpri';~~Nonp~~~fitT[rTribal'
!Water System Type:i [2J Group "A"
.Conununity
i D Group "A"Transient,
Nonconununity
i D Group "A"Nontransient,
Nonconununity
_.._._---~~-~.._~._.._------~
,D Group "B":D Individual Water Supply :D Creating a New Group "A".
1_~.._.~_~~_L_..__~~__l ~...L_._§yst~_._....~__J
i ifthe water system is classified as a nonprofit noncommunity public water system,attach a photocopy ofthe federal '
!nonprofit certification document.
LIjJltI!.P!:2i~CfJflig!l.t..cr!!.Cl!.e a n,,-wJi.':'!11P.:!J.':"~sY§J.e.'!'L£,!I!J{I--'~!..!ltI!.QQH Regi<Jnal Office._~_~.__.__.~_.__.i
,STATUS OF WATER SYSTEM PLAN:
fD~~;th;-';;t~~~ystem h~ve -;;'~-;;;:-~e;;t DOH~;pp~o--';;d~W;i;~-Sy~t;~pi;;-;;?-~-T[2J YES--tfNO '--~-'~--l
i I
I Does th;-~;t;r~~ystem have a curre;;tDOii.-~ppro~edSmall Water System !·tj-'¥Es'lZi NO-'--~--1
I Management Program?__.__.,..._..._...._..._..._.._...-1
!The water system must have a current water system pl:n or small water system management program that has been '
i approved by DOH by December 31,2002 in order to qualify for a DWSRF loan during this loan cycle.Failure to meet this
i requirement will result in the project being removed from the fundable project list.ifa new or updated plan is required,,
,sufficient time must be allowed for review and necessary revisions prior to final DOH approval (which typically is a
:minimum ofsix months for new water system plans).Applicants should contact their DOH regional office immediately to
i discuss their planning requirements.
i Is the proposed project inclnded in a DOH-approved plan?
,,
..."-_.•.•_._..__._------_..,--•..~..~---~..._._._._-"-"_..~-_._----~-~
[2J YES D NO
STATUS OF PROJECT REPORT:
[2J YES D NOIHasaProjectReportbeencom"p!eted for the ~~~o~s~ed~~r~o~'e~c~t?,-.--"--'='-'='---'='---"=_
._~_._._--~._._..__._-_._.._.-.~._----_..~._-----
I COMPLIANC!'SIATUS:~.~__~.....~
i Compliance:U.s..tjJj~.~teII!.in c0!!1plia~~~_witl!DQH regllire.rp.~nts?i D YE~S---,[2J"",--,N'-'.O",-_
,I Ie no, will this project bring the system into compliance?~T~jrYES D NOiif"NO ",explain how and when the system will come into compliance.~
Application Forms- 2002 2 DWSRF Loan Program
SECTION I:APPLICANT INFORMATION
r-----·-----------------·--·-~·~·------"'·-·--"--··,·-----..-----.,---.--.--.---.~-----~-._-.__..,--.,--.--..-._-.-----.----'--.---------------.-------_i OPTIONAL BONUS POINTS:
!._~.'l~~!I!.e.!y_~!tl.Il!.~~.I':!!.'l_~~_c~n~!tl~~_~!!i(}.':_:...__..._______.._....._........_.._
!The Growth Management Act planning point?-T~--Yl'-S--·O NO----
i if "YES,"one (1)bonus point will be awardedfor applicants that attach documentation verifying
i applicant participated in county-wide planning policies under GMA relating to provision ofpublic
,i
L~qJer.__. .__....._'__.'___._~__.__..._._..i ..__.__.__._
L'fhe'~'\!I0-~d~bilitY';-~OiIlt~-?-----------··-·-··-----····----------------------TO-YES---~NO
i If "YES",what is the proposed average annual water rate per EquivalentR~sid~.:;tialirnit ."$
i (ERU)after project is constructed?;
I ERU calculqtions are shown in the Guideli12es,App'".n!JiJcJ:,pqge}L ..LI --'
--------------_..-_.._•._,.__.~-_._------,_.._-~----_._-,-------_._,----_.-------The "Restructuring Benefit"points?-.---.---.-...-.-0 YES
if "YES ", list system names and public water system identification numbers (PWSIDs) on page 8.
Note: A project that will result in physically restructuring (consolidating)water systems will
receive three (3)bonus points for each system being eliminated by the project, up to a maximum of ;
jift.'".erz(l~2ints,_._
cg]NO
:"The "Region-;;IB-e;;'~f;t;'pol';-ts?'-----------------------------------TD-yES--~-NO··
i if "YES",list system names and public water system identification numbers (PWSIDs) on page 8.'
.Note:A project that will benefit more than one water system will receive one (l)bonus
[point p!r.~aclJ._SJl.S:.~emIze...n.e.fi!irtg b1'.J1H!J)roj~~t,_up'!o a maximumo[jjv!'J~2.p()in~~_
NO
NO
IZI NO
·····------OYES --------The "Service Meter"points?
Applicants must have service meters on all services, with the following exceptions:
1)System is a transient,noncommunity water system;.
2)System serves a mobile horne park or apartment complex and has a master meter;
3) On a case by case basis,ijDOH determines that the cost ofthe meters is prohibitive for the
.:DWSRF project as a whole and waiving the meter requirement is necessary to move the project
i forward and promote priority public health issues. Note: the applicant must request this waiver
!below. Very few projects will be granted waivers.Applicants must enter estimated service meter
i costs in the application on page 9,Section IlL Estimated Project Costs.ifapplicant is granted a
i waiver, the DWSRF loan request will be reduced by the amount ofthe service meter costs. It is
I important to note that two (2)bonus points will be awarded to projects that include installing
i se.rvice meters on unmetered services.._
i Does the water system have service meters on all existing services?
If the system is not fully metered and the project does not include metering,please check applicable box:
i 0 The system is a transient,noncommunity water system
.0 The system serves a mobile home park or apartment complex and has a master meteroTheapplicantisrequestingDOHtowaivetheservicemeterrequirement
Application,Forms-2002 3 DWSRF Loan Program
SECTION I: APPLICANT INFORMATION
SOURCE METER INFORMATION:
Will the project add any new sources,e.g,interties,new wells, etc.?
Will this project complete the metering of all existing and new sources?
If "No,"contact the DOH Regional Office before submitting this application.
10 YES rg]NO
Are all existing sources-m-e.t-e-r-ed=?--------.---.----.--.---.------~-y-E-S--DNo---·
-----------..------------------------..--.-_.-.-.--...-..-.-...-~--...-..---._______1
rg]YES 0 NO I
I
NUMBER OF LOAN APPLICATIONS:
How many applications are beinz submitted?I One
Note:Contact the DOH Regional Office Ifyou are uncertain about the number ofapplications you should submit.
A separate application must be submitted for each project, with the following exceptions:
• A group ofprojects necessary to solve a single problem must be contained in a single application.
Example:Project isfor disinfection, therefore,system needs to install chlorination facilities.reservoir for contact
time. etc.
• A group ofprojects all required to bring a water system into compliance with all applicable federal and state
enforcement actions must be contained within a single application.
Exception:Service meters cannot be a project in itselfand must be included in a project that contains a capital
construction component.
lfthe water system is submitting one DWSRF application that willfinance more than one project,explain here why each
project is not submitted as a separate application.Ifmore then one project is included in a single application.explain here
how they meet the exceptions. (See note above). Each application will be scored and ranked separately.Funding one
application does not guarantee funding ofthe others.
Application Forms-2002 4 DWSRF Loan Program
Installation of Source Meters
Installation of Service Meters
Installation of Distribution Reservoir (new/additional)
Installation of Water Main &Other Distribution lmprovements
Installation of Pressure Reduction Device(s)
Installation of Backflow Prevention Device(s)
Installation of Security Measures (cameras, lighting, motion detectors,fencing,lab equipment,redundancy
(systems &power),securing chemical and fuel storage,backflow prevention devices,pressure reduction devices,
security hatches on reservoir/tank access panels and vents,other protective measures as necessary through a
SECTION II:PROJECT INFORMATION
A:PURPOSE OF PROPOSED PROJECT:Check all that apply.(See Guidelines,Appendix E for
Scoring Information)
RISK CATEGORY1:Proposed project will eliminate Microbial Risk (includes only disinfection projects, sonrce
projects and covering, repair, replacement or other improvements to existing distribution reservoirs) by:
i 0 New Source
1 ~Source Reconstruction
1 ~Disinfection lmprovements
I ~Filtration
i 0 Reservoir Improvement/Replacement
LO Other,Sp",ec':'.'i~fy~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
RISK CATEGORY2:Project will eliminate Primary InorgamcChemical Risk (ex: antimony, arsenic, asbestos,
barium, beryllium, cadmium, chromium, copper, cyanide, fluoride, lead, mercury, mckel, nitrate,mtnte,selenium,
thallium)by:
i 0 New Source
10 Source Reconstruction
I ~Treatment
lD_Qther,sp~ifJ::,=~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~=
RISK CATEGORY3:Project will eliminate Other Primary Chemical Risk (ex: trihalomethanes, radionuclides,
organic chemicals) by:'.-
i 0 New Source
i ~Treatment
i 0 Other,specify:===============================
RISKCATEGORY4:Project will eliminate Secondary Chemical/Sea Water Intrusion Risk (ex: chloride, fluoride,
iron, manganese, silver, sodium, sulfate, zinc) by:o New Source
~TreatmentoOther, s eci
RISK CATEGORY5:Proposed project will provide Infrastructure Replacement or other Distribution Improvements
by:
.~10
i O
!~I~
I~
II cross-connection control program),
i 0 Installation of Treatment Plant Discharge lmprovements
lD Othe!,,-,,s1':pec'."".'ify)i~:,============================~--!
Application Forms-2002 5 DWSRF Loan Program
SECTION II: PROJECT INFORMATION
B. PROJECT NEED:
I Describe in detail the problem(s)or need(s)that reqnires the water system to propose this project.Describe in
I specific terms the threat to public health and safety that the project will avert, or describe the opportunity the
I system wishes to capture by taking the proposed action at this time. The project need statement is not scored, but
'I whenever possible,applicants are required to identify:
I
••The number of people who are or will be affected by the problem;
The impacts that the existing situation has or will have on the system's operation and expenses;
I.The impacts that the existing situation has or will have on the environment and endangered species; andI.Any other information that will put the need for the project in clear perspective.~(Use a separate sheet of paper if the room provided here is inadequate.
I The City of Marysville developed a Ranney Collector in the Stillaguamish River in 1978.It consists of a central concrete
I caisson (collector well)constructed on a gravel bar with seven horizontal well screens (70-100ft in length)extending
I laterally beneath the river.These "laterals"collect the water and transport it back to the caisson. The collector has
I capacity to supply 3.2 million gallons per day (MGD)entitled by water rights, to the north end of the Marysville service
I area. The City relies on the Stilly Ranney Collector to supply approximately 10,000 residential customers as well as the
;commercial/industrial customers in the north end of the City's service area. The average daily flow form the
i Stillaguamish source is approximately a million gallons.
I
!On March 7, 2000 the Department of Health issued a GWl Determination for the City of Marysville for the Stillaguamish i
1 River Ranney Well water source. The source is now subject to the Surface Water Treatment Rule (SWTR). The SWTR i
I requires the City to achieve 99.9% removal and/or inactivation of Giardia lambia cysts and 99.9%removal and/or i
I inactivation of viruses through disinfection,filtration, and operation by qualified personnel at the facilities by May 2005.i
i The source will have turbidity spikes as high as 6.0 NTU throughout the year far exceeding the 1.0 NTU requirement.I These turbidity levels from the source prohibit operation of the facility during approximately 5 months of the year (i.e.
i winter and spring).
Application Forms-2002 6 DWSRF Loan Program
SECTION II:PROJECT INFORMATION
C.PROJECT SCOPE:I Describe in specific terms what will be done as part of this project.List materials to be used in approximate termsItoavoidlimitingflexibility(Examples:Install new filtration system or replace approximately 8,000 lineal feet of
I water line.)I ..--------------------1,
•
•
•
•
•
This project will include the installation of a new filtration system. The filtration system the City will be
implementing is a ZeeWeerf"Membrane System which is a reinforced, immersed, outside-in, hollow
fiber ultrafiltration membrane system. By comparison with membrane systems that have their I
membranes installed within canisters, which are fed water under pressure, the ZENON membrane
system can be subjected to extremely high concentrations of solids with no significant depreciation in
membrane performance or treated water quality. The design of the immersed membrane modules is
inherently suitable for handling solids and seasonal fluctuations in water quality that can occur at the
Stillagumaishsource.I
Install approximately 7,000 linear feet of water line and appurtenances will also be installed with this I
~~I
I
Replaceaging submersible pumps and motors, which will eliminate mercury seals that, should they fail,I
are a potential health risk to the service population.i
Replaceall corroded metal at the source. (i.e. ladders, platforms, and supports inside caisson).
Replaceoutdated motor control center and upgrade telemetry to meet peak demand.
D.USEFUL LIFE OF THE IMPROVEMENTS IS 20_YEARS.
Application Forms- 2002 7 DWSRF Loan Program
E.HOW DOES THE PROJECT ADDRESS THE NEED:
I Describe in detail how the project addresses the needs and/or opportunities outlined in Section II-B,Project Need.
!lfthe project does not address all of the needs,explain what will be done to complete that effort.(Use a separate
i sheet of paper ifthe room provided here is inadequate.)
i
f-.~-~~~-----_..
!This project will bring the Stilllagumish Ranney Well Collector source into compliance with the
i Surface Water Treatment Rule. The improvements will allow the City to achieve the 99.9%removal
!and/or inactivation of Giardia larnblla cycts and the 99.9%requirement of removal and/or inactivation
I of viruses.
i The City is also completing a Water Shed Plan to address source protection at the Stillaguamish,
i Source.
1I The additional improvements will provide the following:
• The water line installation will support the installation of the filtration plant.
• Replacing aging submersible pumps and motors will eliminate mercury seals, that have a
history of leaking, and thus removing a potential health risk to the customers in the service
area.
• Replacing corroded metal will provide safer working conditions for the operators of the facility.
• Replacing the motor control center will provide up to date circuitry for equipment operation.
•Upgrading telemetry will furnish the facility with up-to-date monitoring instrumentation.
!This project will bring the City into compliance with the Surface Water Treatment Rule for the
!Stillaguamish source. This upgrade will provide a reliable source for the north service area of
i Marysville for the next 20 years.
Application Forms- 2002
7 DWSRF Loan Program
SECTION II:PROJECT INFORMATION
F.WATER RIGHTS:I Does system currently have sufficient water rights for the project?
If "No,"how and when will the rights be acquired?
G.REQ_!L!llliD PERMITS:_____________~~_
i List the permits required for the proposed project,including DOH project and construction documents,if
i applicable,and indicate the status of each permit (e.g.,applied for,pending,issued,etc.)If no permits are required,
L.!'!plain why.
Permit i Date submitted 1 Date issued!--_~,_..__.._,.~~_.........;..-_,~,,_,~,__.__~___.0 "."__.--1 ._.~_~,._,_~_~~~~~""
1.Conditional Use i Pending 'Pending
'T----DOITApp;:~~~ic.;;;:~t;;~ti;;;:---IP~;;ding~-----------------~----;----------------P-e-nding--------
13:---Right-~fW~y---------Tp~~cii;;g -------------.--------~-p_;;;;di;;g----
____,~,_,_~,__._,~_,_,_,_.,____i ._..,____"_", . .__.~.• _
14.
H.RESTRUCTURING BENEFIT:
!D~;~p~~j;c~han~~~~~-;~~h~Ofo;;:~i;~;-;~~~-;y~tms?_LO-~S]2J~NO-~~~~~~~~~~=~=~~-===-----
i If "Yes,"identify up to five systems involved by name and public water system identification number (PWSID):
I Name:I PWSID#:
1Name:-PWSID#:
I Name:,PWSID#:
i Name:i PWSID #:
~---~~,___-------~,-------~-_i_.......--;
!Name:!PWSID#:
[
'A project that will result in physically restructu;t;;g (consolid~ting)water systems will~~~;iv---;'-three bonus points for each -
system bei!,:g eliminated b~roiect,up to a maximum offifleeYlJ!l!int~,__---'
I.REGIONAL BENEFIT:
----~---~---
I Does this project have a regional benefit?i 0 YES [gJ NO
!If "Yes,"identify up to five systems involved by name and public water systemidentification number (PWSID):
---~----------~-~---:
--------~-------...;
I PWSID#:
I
i!PWSID#:,
-------------+---------~~-------.~~
Name:
c---------~~~
I PWSID#:
---------------------------------------------------ipWSID #:
;-.-------.--.---~_._,-~-~--_._'"
I Name:,
I Name:
I Name:
!Name::PWSID#:
i A project that will benefit more than one water system will receive one bonus point for each system benefiting by the
i proiect, up to a maximum offive points.~_
Application Forms-2002 8 DWSRF LoanProgram
SECTION III:FINANCIAL INFORMATION:
A.ESTIMATED PROJECT COSTS:
Design engineering
Land/ROW acquisition
Sales or use taxes
o
$495,000
$250,000
$280,500
$ 15,000
$ 412,00
$50,000
$0
$0
$
$240,150
$2,000,000
$1,300,000
Financing costs
Service meter costs
Other fees
Contingency C5%)
Construction
1.Other (specify _Purchase
Equipment .)
2.Other (specify )$
TOTAL ESTIMATED PROJECT COSTS $5,043,150
Construction inspection
Start-up costs
Relocation costs
B.CONSTRUCTION SCHEDULE:
Describe the project's proposed construction schedule:
Activitv ,:Current Statns I Com letion Date
.Preliminary engineering
Site/ROWacquisition
..................!'!.Cl<:~e<lillg.
Proceeding
June 2002
May 2002
Design documents July 2002 March 2003
Construction contract award March 2003 May 2003
Construction begins May 2003 May 2004
Project completion May 2004 August 2004
C.SYSTEM IS APPLYING FOR RETROACTIVE FINANCING:o YES ~NO
Application Forms-2002 9 DWSRFLoan Program
SECTION III:FINANCIAL INFORMATION:
D.DOES SYSTEM WANT TO BE CONSIDERED FOR LOW-INCOME STATUS?D YES ~NO
If "Yes ", an income survey may be conducted by the Public Works Board Staffprior to contract
negotiations.
E.LOAN FEE AND TOTAL LOAN REQUEST:
(a)$_4,000,000__InputDWSRFloanrequest.
X .02 Multiplysub-totalby .02.
(b) $__80,000 Thisis the DWSRFloanfee.
Add(a) and (b).
(c)$4,080,000_Thisis the totalDWSRFloan request.
F.FUNDING SOURCES AND STATUS:
Willthe DWSRFloanfullyfinancetheproject?
if "No ",rovidethefollowin informationabouthow the balance ofthe
DYES IZ1 NO
•..._~..____L •.......__c _..L.___..--..L--+.___ .._-+
i i .:.'.!___,_......l,_.~~__i ._~.____~~_~~+___~_~~
-'------~_.__._--_......-'._-~
::I__~_~~_,~~,~~~_..J
Funding Source =Federal Program,StateProgram,Bank,Water System,orOther
Type of Funding =Grant,Loan,or Revenue
Status =In-Hand,Proposed,or Planned
•Funds are in-hand ifa formal notice of approval or contract for the funds is in place with the funding
source. Local revenue must be in an approved budget to be considered in-hand.
• Funds are proposed if a formal application has been submitted to a funding source,and the funding
source considers the application or funding request as having been submitted.
• Funds are planned if they are found in a formally adopted water system plan/small water system
management program or its equivalent.
Agreement Date =The date when the agreement for the financing was signed or is expected to be signed.
Application Forms-2002 10 DWSRF Loan Program
SECTION IV:REQUIRED ATTACHMENTS:
Listed below are the various attachments required to complete a DWSRF loan application.
A.REQUIRED ATTACHMENTS FOR ALL WATER SYSTEMS:
•Attach a vicinity map and legal description of the property associated with this project.The legal description
must include Section,Township,and Range of the project's location.
•Section I:APPLICANT INFORMATION:If the applicant wants to apply for the Growth Management Act bonus
point,attach copy of documentation that verifies applicant was party to county-wide planning policies under the
Growth Management Act,relating to provision of public water.
B.IN ADDITION TO THE ABOVE,PRIVATELY OWNED WATER SYSTEMS ARE
REQUIRED TO ATTACH THE FOLLOWING:
•If the water system is under any regulatory or court compliance order,attach a description that includes the date
of issue and date compliance is required.
•If federally approved nonprofit,noncommunity,attach a copy of the federal nonprofit certificate document.
•Section I:APPLICANT INFORMATION:For privately owned for-profit systems,ifUTC regulates the system,
attach a copy of the last annual review submitted to the UTC.
NOTE:All privately owned water system applications that are deemed eligible by the Department ofHealth and rank
high enough on the 2002 DWSRF Prioritized Project Application List for funding,will be required to provide additional
detailed financial information to the Public Works Board staffin September 2002.At a minimum, this will include:
• Copies ofthe water system's tax returns for 1999,2000, 2001
•Balance sheet statement for 1999,2000,2001
• Three Business References
•Financial Capacity Worksheets
ApplicationForms-2002 II DWSRF Loan Program
APPLICANT CERTIFICATION
WHEREAS,(water system name)L City ofM~sville_~=:==_=-I,is
applying to the Washington State Drinking Water State Revolving Fund program for a low-interest loan
for an eligible project; and
WHEREAS,the borrower's governing body has approved submission of this application;and
WHEREAS,it is necessary that certain conditions be met as part of the application process; and
WHEREAS,the local governing body will comply with applicable provision of Public Law 104-182,
The Safe Drinking Water Act (SDWA)Amendments of 1996, Section 1452; EPA general grant
provisions in 40 CFR Part 31; and other applicable state and federal laws; and
WHEREAS,RCW 43.155.060 requires that the project will be advertised for competitive bids and
administered according to standard local procedure; and
WHEREAS,RCW 39.12 requires public works projects use state prevailing wages; and
WHEREAS,the loan will not exceed 100%of eligible costs incurred for the project;and
WHEREAS,any loan arising from this application constitutes a debt to be repaid, and (person/title)
has reviewed and concluded it has___....J
the necessary capacity to repay such a loan; and
WHEREAS,the information provided in this application is true and correct to the best of the
applicant's belief and knowledge and it is understood that the state may verify information,and that
untruthful or misleading information may be cause for rejection of this application or termination of any
subsequent loan agreement.
NOW THEREFORE,(borrower)L Dave Weiser,Mayo!:J certifies
that it meets these requirements,and further, that it intends to enter into a loan agreement with the
Public Works Board,provided that the terms and conditions for a Drinking Water State Revolving Fund
loan are satisfactory to both parties.
DWSRF Loan ProgramApplicationForms-2002
1 Phone Number:
1------------
Legal Description of Property
Parcel Number -31052100300600
Township 31,Range 05,Section 21, Quarter SW
Size 1.92
Parcel Legal Description:
Sec 21 Twp 31 RGE 05 BEG SE COR N Yz NE \4 NE \4 SW \4 TH W ALG S LN THOF
445FT TH N TO N LN SD SUB TH E ALG SD N LN 95FT TO W LN E 350FT SD
SUB TH S 150FT TH E 100FT TH S 150FT TH E TO E LN SD SUB TH S ALG SD E
LNTPB LESS E 30FT CO RD PER 258/161 &AUD FILE 76111701341044/381
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