Ariz. Admin. Code § R18-4-607
12. Does the documentation include ownership type?
Select all that apply.
Sole Proprietor
Major Stockholders
Board of Directors
Cooperative
Government Agency or District
Corporation
Limited Liability Corporation
Partnership
Other__________________________
j. Total Operations and
Maintenance Expenses
l. Total Operations and
Maintenance expenditures
plus Replacement
e. Operating Ratio = Operating Expenses £ 1 Operating Revenues
Test 2: Will the proposed water system generate reserves?
The following measurements shall be > 0 at the time submitted:
c. Working Capital = Current Assets - Current Liabilities
Test 3: Are the proposed rates reasonable compared to the median household income of the area to be served?
The following measurement shall be:
Average Annual Rates < Median Household Income* x 2.5%.
* The sources of median household income data include the most recent United States Census Bureau (USCB) data collected by the Department or generated by an impartial third party experienced in collecting income data and supplied to the Department by the applicant seeking viability determinations. Acceptable sources of income data, other than USCB data include feasibility studies, engineering reports, market studies, income surveys, or another source or collection methodology approved by the Department.
An owner may appeal denial of an elementary business plan under A.R.S. § 41-1092 et seq.
Elementary Business Plan Checklist
Technical Capacity
| 11. Does the documentation include an operations and maintenance plan and emergency operation plan to address site-specific component replacement or repair protocols based on manufacturer’s recommendations or engineer’s specifications? | Yes No N/A _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ |
Managerial Capacity
| 21. Does the documentation include the owner’s signed disclosure statement agreeing to comply with the requirements of these Articles and a general disclosure statement agreeing to disclose all information relevant to the operation of the water system to any transferee of ownership? (See Appendix B). | Yes No N/A _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ |
Financial Capacity
| 25. For New CWSs and NTNCWS NOT regulated by ACC, is all information listed in Appendices C and D included? | Yes No N/A _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ |
Drinking Water Capacity Development Statement of Responsibility
Applicant Information:
Name:
Mailing Address:
| Phone Number: Fax Number: E-mail: |
Statement Information:
1) Name of Water System:__________________________________________PWS ID#_____________
2) Ownership Type (Please check all that apply):
____Sole Proprietor ___Major Stockholders ___Board of Directors
____Cooperative ___Government Agency ___District
____Public Entity ___Corporation ___Limited Liability Corporation
____Other (please explain) _________________________________________________________________
3) Name of Owner(s): (Check one) See below Attach a separate sheet if more space is needed
Owner 1:
Owner 2:
Owner 3:
4) Agencies with rules applicable to the Water System: (Please check all that apply)
____Arizona Department of Environmental Quality ____Arizona Corporation Commission
____Arizona Department of Water Resources ____Arizona Department of Real Estate
____Arizona Department of Commerce ____Arizona Department of Agriculture
____Arizona Department of Corrections ____Office of the Fire Marshal
____Arizona Land Department ____Arizona Department of Revenue
____Arizona Department of Transportation ____Maricopa County Environmental Services
____Pima County Department of Environmental Quality ____Environmental Protection Agency Region IX
____Other(s) please specify___________________________________________________________________
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5) Statement of Intent (Select one):
____It IS the intent of the owner or developer of this NEW CWS or NEW NTNCWS to transfer ownership of the water system. As part of the ownership transfer, it is understood that the owner or developer has a responsibility to disclose and transfer ALL information relevant to the construction and operation of the water system to the new owner.
____It is NOT the intent of the owner to transfer ownership of the NEW CWS or NTNCWS within one year of the completion of construction of the water system.
6) Date owner expects to begin operation:
Month_________________ Day _____________ Year______________________
7) Drinking Water Sources used: (Select all that apply)
____Ground Water ____Purchased Ground Water
____Surface Water ____Purchased Surface Water
8) Table of Contents of Systems Elementary Business Plan (Please check one):
____The Table of Contents of the Elementary Business Plan is attached.
____The Table of Contents of the Elementary Business Plan is summarized below.
Summary____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
9) Signature of each current owner: Check if additional signature page is attached.____
I agree to comply with the requirements of 18 A.A.C. 4, Article 6.
Print Name:____________________________Signature:__________________________Date:___________
Print Name:____________________________Signature:__________________________Date:___________
Print Name:____________________________Signature:__________________________Date:___________
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Financial Capacity for New CWSs and NTNCWSs
Worksheet 1
Owner:___________________________________________________________________________________
Completed by:_______________________________________________________Date:___________________
| 5-Year Financial Projection | Year 1 Projection | Year 2 Projection | Year 3 Projection | Year 4 Projection | Year 5 Projection |
| Enter Year: |
| 1. Beginning Cash on Hand |
| a. Unmetered Water Revenue |
| b. Metered Water Revenue |
| c. Other Water Revenue |
| (1a thru 1c) |
| e. Connection Fees |
| f. Interest and Dividend Income |
| g. Other Income |
| (1d thru 1g) |
| i. Additional Revenue Needed |
| Cash Injection (please specify) |
| 2. Total Cash Balance (1h to 1j) |
| 3. Total Cash Available (1+2) |
| 4. Operating Expenses |
| a. Salaries and wages |
| b. Employee Pensions and Benefits |
| c. Utilities |
| d. Chemicals |
| e. Materials and Supplies |
| f. Laboratory |
| g. Contractual Services |
| h. Insurance |
| i. Miscellaneous |
| (4a thru 4i) |
| k. Replacement Expenditures |
| expenditures (4j+4k) |
| Lease Payments |
| n. Loan Interest Payments |
| o. Capital Purchases (specify): |
| (4m thru 4o) |
| 6. Ending Cash Position (3 - 5) |
| 7. Number of Customer Accounts |
| 8. Average Annual User Charge per account (1d/7) |
| (1h-4l)/(4m+4n) |
| 10. Operating Ratio (1d/4l) |
| Cash (6 - 12) |
| 12. End of Year Reserves |
| a. Operating Reserves |
| b. Debt Service Reserve |
| c. Capital Improvement Reserve |
| d. Replacement Reserve |
| e. Other |
| Total Reserves (12a thru 12e) |
Arizona Financial Capacity For New
CWSs and NTNCWSs
Definitions for Worksheet 1
5-Year Financial
| Projection | Year 1 Projection | Year 2 Projection | Year 3 Projection | Year 4 Projection | Year 5 Projection |
| 1. Beginning Cash on Hand | For the current year budget, use the actual cash balance. For all other years, cash on hand should equal item #12 from the previous period. |
| a) Unmetered Water Revenue | All cash received or estimated for water supplied to residential, commercial, industrial and public customers where the customer charge is not based on quantity, but is based on other criteria such as diameter of service pipe, room, or foot of frontage. |
| b) Metered Water Revenue | All cash received or estimated for water supplied to residential, commercial, industrial, and public customers where the charge is based on quantity of water delivered. |
| c) Other water revenues | Other cash received or estimated from sales of water, sales for irrigation, sales for resale, inter-municipal sales, or ad valorem taxes. |
| d) Total Water Revenues | Total 1(a) thru 1(c) |
| e) Connection Fee | All cash received or estimated for connection of customer service during the year. |
| f) Interest and Dividend Income | All cash received or estimated on interest income from securities, loans, notes, and similar instruments, whether the securities are carried as investments or included in sinking or reserve accounts. |
| g) Other income | Other revenues collected or estimated during the period (such as disconnection or change in service fees, profit on materials billed to customers, servicing of customer lines, late payment fees, rents, sales of assets, or ad valorem taxes (infrastructure portion). |
| h) Total Cash Revenues | Add 1(d) thru 1(g) |
| i) Additional Revenues Needed | Additional cash needed to cover cash needs. |
| j) Loans, Grants or other Cash Injections | Includes loans or grants from financial institutions, inter-municipal loans, state or federal sources. |
| 2. Total Cash Balance | Add items 1(h) thru 1(j) |
| 3. Total Cash Available | Add items 1 and 2 |
| 4. Operating Expenses | Use actual amounts paid when completing the prior year. Estimate the amounts for projected years based on prior year amounts, trends, and other known variables. |
| a) Salaries and wages | Cash expenditures made or estimated for salaries, bonuses, and other considerations for work related to the operation and maintenance of the facility, including administration and compensation for officers and directors. |
| b) Employee Pensions and Benefits | Paid vacations, paid sick leave, health insurance, unemployment insurance, pension plan, and other similar liabilities. |
| c) Utilities | Amounts paid or estimated for all fuel or electrical power. |
| d) Chemicals | Amounts paid or estimated for chemicals used in treatment and distribution. |
| e) Materials and Supplies | Amounts paid or estimated for materials and supplies used for operation and maintenance of the new public water system other than those under contractual services. |
| f) Laboratory | Amounts paid or estimated for laboratory and associated services. |
| g) Contractual Services | Amounts paid or estimated for outside engineering, accounting, legal, managerial, and other services. |
| h) Insurance | Amounts paid or estimated for vehicle, liability, worker’s compensation, and other insurance associated with the public water system. |
| i) Miscellaneous | Amounts paid or estimated for all expenses not included elsewhere (such as permit fees, training, and certification fees). |
| j) Total operation and maintenance expenditures | Add amounts in lines 4(a) thru 4(i). |
| k) Replacement expenditures | Amounts paid or estimated for replacement of equipment to maintain system integrity (capital improvement plan). |
| l) Total Operations and Maintenance expenditures plus Replacement expenditures | Add amounts in 4(j) and 4(k) |
| m) Loan Principal, Capital Lease or Loan payment | Include cash payments made or estimated for principal and interest on all loans, including vehicle loans and equipment on time payments, and capital lease payments. |
| n) Loan Interest payments | Include cash payments made or estimated for interest on all loans, including vehicle loans, and equipment on time payments, and capital lease payments. |
| o) Capital Purchases | Amount of cash outlays or estimates for items such as equipment, building, or vehicle purchases and leasehold improvements that were not a part of the initial design of the water system. |
| 5) Total Cash Paid Out | Add amounts in 4(m) thru 4(o) |
| 6) Total Cash Available Minus Expenditures Calculation | Take Amount in 1 and subtract Amount in 5. If this amount is positive, there is operating cash left over after all calculated expenditure obligations have been met. If the number is negative, there are more expenses than there are funds available to pay for the expenses to operate the water system. |
| 7) Number of Customer Accounts | Use most recent system data or expected increases. |
| 8) Average User Charge per Customer | Take amount listed in 1(d) and divide it by amount listed in 7. |
| 9) Coverage Ratio | Take amount in 1(h) and subtract the amount in 4(l). Then divide that amount with the sum of 4(m) + 4(n). The equation looks like this: [1(h) - 4(l)] ) [4(m) + 4(n)] and measures the sufficiency of net operating profit to cover the debt service requirements of the system. A bond covenant might require the debt service to meet or exceed certain limits. |
| 10) Operating Ratio | Take amount in 1(d) and divide it by the amount in 4(l). The equation looks like this: 1(d)) 4(l). This figure measures whether operating revenues are sufficient to cover operation, maintenance, replacement expenses. An operating ratio of 1:0 is the minimum for a self-supporting facility. If there are debt service requirements, the operating ratio would have to be higher. |
| 11) End of Year Operating Cash | All non-reserved cash. Add amounts from 6 thru 12. |
| 12) End of Year Reserves | Do not include depreciation as a reserve unless there is actually a designated depreciation reserve containing cash set aside for future expansion. |
| a) Operating Cash Reserve | Funds set aside to meet cash flow, operating, and seasonal fluctuations. |
| b) Debt Service Reserve | Funds specifically set aside to retire debt as it is scheduled. |
| c) Capital Improvement Reserve | Funds specifically set aside to meet long-term objectives for a major facility expansion, improvement, or the construction of a new facility. |
| d) Replacement Reserves | Funds specifically set aside for the future replacement of equipment needed to maintain the integrity of the facility over the useful life of the equipment. |
| e) Total End of Year Reserves | Add amounts 12 (a) thru 12 (d). |
Water System Financial Viability Tests
Test 1: Will the proposed water system collect sufficient revenues to meet all of its projected expenses?
Measurements:
New Section adopted by final rulemaking effective September 23, 1999; the A.A.R. citation was not available at the time of publication and will appear in Supp. 99-4 (Supp. 99-3). Amended by final rulemaking at 5 A.A.R. 4456, effective September 23, 1999 (Supp. 99-4).