The applicant shall provide the following information for a request for funding for a construction project:

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 including 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, and what 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, which may include application preparation costs;
   4. (4) The amount and a description of any other costs that are necessary for the project to achieve compliance with the PFAS MCLs; and
   5. (5) The total estimated costs;
9. (i) The amount of the loan or grant being requested, of which the amount or proportion of grant shall not exceed the limit stated in RSA 485-H:11, I, reprinted in Appendix C;
10. (j) The term requested, which shall be 5, 10, 15, or 20 years, except that a system serving a community that meets the disadvantaged affordability criteria established in Env-Dw 1405.02 may request a 30-year term, provided the loan term shall not exceed the design life of the improvement for which the loan is being requested;
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) A state vendor code number obtained pursuant to the vendor code requirements established by the New Hampshire department of administrative services, currently Adm 603;
14. (n) The name and title of the individual authorized by the applicant to sign the application on behalf of the applicant;
15. (o) 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;
16. (p) For non-governmental applicants, documentation of the extent of the applicant’s existing debt; and
17. (q) A copy of the applicant’s latest annual report or financial statements.

Source. #13164, eff 1-26-21; ss by #13289, INTERIM, eff 10-30-21, EXPIRES: 4-28-22; ss by #13372, eff 4-21-22