1. (a) To request a disbursement for eligible costs from the awarded funds, the recipient shall submit a written disbursement request to the department by mail or e-mail.

2. (b) The written request shall include the following, as applicable to the request:

   1. (1) A written request for disbursement that includes the information specified in (c), below, and is signed as specified in (d), below; and

   2. (2) As applicable:

      1. a. Invoices for equipment and materials delivered and properly stored;
      2. b. Invoices for engineering or consulting services;
      3. c. Payment requisitions from the contractor(s); and
      4. d. Invoices for eligible work not covered under a. through c., above.

3. (c) The request for disbursement shall include the following:

   1. (1) The name and mailing address of the recipient;
   2. (2) The total amount of the original loan or grant;
   3. (3) The DWGTF project number and disbursement request number;
   4. (4) Whether the request is for a partial payment or for final payment;
   5. (5) The start and end dates of the period covered by the request;

   6. (6) For each of the following classifications, the amount for the total project, the amount determined to be DWGTF eligible, the amount included in previous requests, and the amount of the current request, as applicable:

      1. a. Administrative costs;
      2. b. Pre-construction costs;
      3. c. Land acquisition;
      4. d. Construction;
      5. e. Construction administration;
      6. f. Equipment;
      7. g. Miscellaneous costs; and
      8. h. Other, with a brief description;
   7. (7) The total for each category of costs identified in (6), above;
   8. (8) The percent of the loan or grant previously disbursed;
   9. (9) The total percent of loan or grant disbursed including the current request; and
   10. (10) The name and title of the authorized representative who is signing the request.
4. (d) The authorized representative shall sign and date the request.

5. (e) The signature provided pursuant to (d), above, shall constitute certification that:

   1. (1) The project costs stated on the request are eligible project costs;
   2. (2) The amount requested is not covered by any previous request; and
   3. (3) The recipient has inspected all work covered by the request and all such work has been performed in accordance with all applicable requirements and to the recipient’s satisfaction.

Source. #12903, eff 10-23-19