The information required by Env-Dw 1106.01(a) shall be as follows:

1. (a) The water system’s name and PWS identifier;
2. (b) Whether the applicant is a governmental or non-governmental eligible entity;
3. (c) The water system’s mailing address, including street name and number or post office box number, city or town, and zip code with 4-digit extension;

4. (d) The name, title, email address, and daytime telephone number including area code of the applicant’s contact for:

   1. (1) Questions regarding the final application; and
   2. (2) Repayment billing;
5. (e) A short title for the project;
6. (f) The primary location where the work will be done;
7. (g) A concise explanation of the need for the proposed project, including how it will address public health protection, compliance with the federal SDWA, whether it includes any energy or water efficiency components, and whether any alternatives have been considered;

8. (h) An estimate of the following project costs:

   1. (1) Estimated construction costs;
   2. (2) A construction contingency of 10%;
   3. (3) Estimated planning and engineering costs;
   4. (4) The amount and a description of any other costs; and
   5. (5) The total estimated costs;
9. (i) The amount of the loan being requested;
10. (j) The term requested based on Env-Wq 1107.04(c), table 1107-1;
11. (k) The current residential water rate per single family home per year;

12. (l) The tentative project schedule, including:

    1. (1) The actual or anticipated date the applicant was or will be authorized by its governing body to borrow funds for the project;
    2. (2) The actual or anticipated date the design was or will be started;
    3. (3) The anticipated date the construction contract will be awarded; and
    4. (4) The anticipated date the project will be completed;
13. (m) The applicant’s data universal numbering system (DUNS) number or, if the applicant does not have a DUNS number, the DUNS number obtained by the applicant from the Dun & Bradstreet (D&B) website at http://www.dnb.com/duns-number.html;
14. (n) A state vendor code number obtained pursuant to the vendor code requirements established by the New Hampshire department of administrative services, currently Adm 603;
15. (o) For a non-governmental applicant, whether the applicant received the threshold amount or more in U.S. federal contracts, subcontracts, loans, grants, subgrants, or cooperative agreements, or any combination thereof as required for prime recipient executive compensation reporting in accordance with Public Law 109-282, the Federal Funding Accountability and Transparency Act of 2006 as amended;
16. (p) The name and title of the individual authorized by the applicant to sign the application on behalf of the applicant;
17. (q) For governmental applicants, a letter signed by an authorized representative stating whether or not the applicant has any debt outside the NH Municipal Bond Bank and, if the debt is rated, the rating;
18. (r) For non-governmental applicants, documentation of the extent of the applicant’s existing debt; and
19. (s) A copy of the applicant’s latest annual report or financial statements.

Source. (See Revision Note #1 and Revision Note #2 at chapter heading for Env-Dw 1100) #13160, eff 1-20-21