HomeMy Public PortalAbout100_041_GEFA-Loan-Application-Part-I - Water Ph2.pdf
GEFA LOAN APPLICATION FORM PART I PROJECT DESCRIPTION *Please complete in its entirety. Items left blank may cause delays in the review and approval process.
Applicant Name City of Tybee Island
Contact Person Diane Schleicher Title City Manager
Street Address OR P. O. Box 1 403 Butler Avenue
Street Address 2
City and Zip Code + 4 Tybee Island, GA (City) 31328 (Zip Code+4) County Chatham
Telephone Number (912) 472-5070 Fax Number (912) 786-5737
Email Address dschleicher@cityoftybee.org (Primary Email)
ahudson@cityoftybee.org (Secondary Email)
Federal EIN 98-6000661 DUNS No. 010689231
Congressional District 1
Project Place of Performance (where the work will occur) 1
Congressional District (of project) 1 FOR SRF Applicants Only Has the applicant initiated or completed the State Environmental Review Process with Georgia EPD for this project?
Metro North Georgia Water Planning District Is your community in the MNGWPD?
If yes, are you in compliance with district plan requirements?
For GEFA and EPD use:
Project number:
GEFA amount requested:
Date received by GEFA:
Date received by EPD:
EPD initial approval:
Consent Order Will this project eliminate a Notice of Violation (NOV), Administrative Order, Consent Order, Court
Order, etc.? If yes, provide a copy of the violation.
WaterFirst or Community of Opportunity Designation If your community has been designated a WaterFirst Community or Community of Opportunity by the Georgia Department of Community Affairs (DCA). If yes, provide documentation of the award(s).
Service Delivery Strategy (SDS) Is the proposed project consistent with or at least not inconsistent with your HB489 Service Delivery Strategy?
(Please attach a copy of the one or two pages from your SDS that document this). NOTE: if you checked yes, you are certifying that the proposed project is consistent with your HB 489 SDS. Plumbing Code Compliance (for cities and counties only) In order to qualify for financing, you must have adopted the high-efficiency plumbing code requirements outlined in O.C.G.A § 8-2-3. Please provide GEFA a copy of the relevant section of your local code.
Please provide the basic information for each of the following questions: 1) Project Name and Project Description You must provide a short description of the proposed project in the box below. Attach a separate sheet if necessary along with a copy of the preliminary engineering report. Project Name: Water Line Replacement
Description: Project consists of a second phase of water line replacement, replacing 7,000 l.f. of old asbestos-cement and lead-jointed pipes with new C-900 PVC pipe.
Please place a check mark in the space(s) next to the project type(s) that best describes the project:
WATER SUPPLY (water) WATER QUALITY (sewer)
2) Easements
Does this project require an easement?
If yes, please indicate how many easements? How many has been acquired?
3) Project Cost Provide an estimated cost outline for the entire project by line item.
Construction Cost: $ 1,027,000.00
Engineering Cost: $ 102,500.00
Contingency Cost: $ 102,500.00
$
$
Total: $ 1,232,000.00 4) Early Project Costs Engineering and design costs incurred prior to the execution of a loan agreement are eligible for reimbursement with a GEFA loan as long as these costs are necessary for the completion of the project and consistent with the final budget. Does your community anticipate seeking reimbursement of engineering or design costs incurred prior to the execution of the loan agreement?
If yes, approximately how much in early costs does your community anticipate submitting for reimbursement under the proposed loan? $100,000.00 5) Funding sources Please list all funding sources that are proposed to be utilized to complete this project. List each source and funding amount. (If a commitment has been secured from any of these funding sources, list the commitment date and attach a copy of the commitment letter.)
Amount being requested from the Georgia Environmental Finance Authority:
$ 1,232,000.00
Other funding source(s): Date available: Amount:
$
$
$
Total Project Funding: $ 1,232,000.00
6) Schedule What is the proposed project schedule? If actual dates are available, please include them in the appropriate column.
ACTION ACTUAL DATE(S) PROPOSED DATE(S)
Complete project planning Click here to enter a date. Click here to enter a date.
Initiated design Click here to enter a date. Click here to enter a date.
Plans & specs submitted to EPD Click here to enter a date. Click here to enter a date.
Bid opening Click here to enter a date. Click here to enter a date.
Notice of award Click here to enter a date. Click here to enter a date.
Notice to proceed with construction Click here to enter a date. Click here to enter a date.
Initiation of construction Click here to enter a date. Click here to enter a date.
Completion of construction Click here to enter a date. Click here to enter a date.
7) Emergency Loan Will this project assist the community in meeting an emergency public health or safety need? If yes, please explain the nature of the emergency and facilities that have failed and what repairs or additions are needed to protect public health or the local environment.
No
8) Project Engineer Provide the following information:
Firm Name Thomas and Hutton
Address 50 Park of Commerce Way
City, State & Zip City: Savannah State: GA Zip Code+4 31419
Engineer Name Chris Stovall
Telephone Number (912) 721-4155 Fax Number (912) 721-4255
Primary Email Address stovall.c@thomasandhutton.com Secondary Email
How did you hear about GEFA? (check all that apply)
Applicant is a returning customer GEFA website – www.gefa.org Conference: ACCG GRWA GMA GAWP GEDA EPD representative Consulting engineer
Other:
I certify that I am authorized to sign this application on behalf of our governing body. Authorized Official Jason Beulterman
I certify that I am authorized to sign this application on behalf of our governing body.
Yes (Enter YES)
Title Mayor
Date
Note: Submit this application for a GEFA loan. Mail to: Georgia Environmental Finance Authority Attn: Water Resources Division 233 Peachtree St, NE Harris Tower, Suite 900 Atlanta, GA 30303-1506 Rev. 2-8-2016