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2016-R-31
RESOLUTION NO. 2016-R-31 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF EDGEWATER, VOLUSIA COUNTY, FLORIDA, AUTHORIZING THE CITY MANAGER TO SUBMIT AN APPLICATION TO THE FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION FOR FINANCIAL ASSISTANCE UNDER THE STATE REVOLVING FUND FOR POINT SOURCE WATER POLLUTION CONTROL FOR THE DESIGN OF THE RECLAIMED WATER MAIN EXTENSION PHASES I,II AND III;IDENTIFYING REVENUES PLEDGED FOR REPAYMENT OF LOAN FUNDS; REPEALING RESOLUTIONS IN CONFLICT HEREWITH, PROVIDING FOR SEVERABILITY, AN EFFECTIVE DATE AND FOR ADOPTION. WHEREAS, the City Council of the City of Edgewater has made the following determinations: WHEREAS, City staff has recommended that the City of Edgewater apply for financial assistance under the State Revolving Fund Point Source Water Pollution Control Program administered by the Florida Department of Environmental Protection for design of the Reclaimed Water Main Extension Phases I, II and III; and WHEREAS, City Council concurs with staffs recommendations and desires to authorize the submission of an application for financial assistance for the Reclaimed Water Main Extension Phases I, II and III; and WHEREAS,Florida Department of Environmental Protection requires a resolution authorizing the local government to apply for assistance as part of the loan application; and NOW,THEREFORE,BE IT RESOLVED by the People of the City of Edgewater, Florida as follows: PART A. STIPULATIONS. Section 1. The City Manager of the City of Edgewater,Florida,is hereby authorized to submit an application to the Florida Department of Environmental Protection for financial assistance under the State Revolving Fund Point Source Water Pollution Control Program for the design of the Reclaimed Water Main Extensions. #2016-R-31 I 1 Section 2. The State Revolving Fund(SRF) loans are secured by a junior lien on and pledge of the net revenues of the water and sewer system. Section 3. The City Manager is authorized to provide assurances, execute the loan agreement, and represent the City of Edgewater in carrying out responsibilities under the loan agreement. PART B. SEVERABILITY AND APPLICABILITY. If any section,subsection,sentence,clause,phrase,or portion of this Resolution,or application hereof,is for any reason held invalid or unconstitutional by any Court,such portion or application shall be deemed a separate,distinct,and independent provision,and such holding shall not affect the validity of the remaining portions or applications hereof. PART C. CONFLICTING PROVISIONS. All resolutions, or parts thereof that are in conflict are hereby repealed. PART D. EFFECTIVE DATE. This resolution shall become effective immediately upon its adoption. PART E. ADOPTION. During the September 6, 2016 Council meeting, a motion to approve was made by with Second by . The vote on this resolution is as follows: AYE NAY Mayor Michael Ignasiak Councilwoman Christine Power N Councilwoman Gigi Bennington 3SE:A1 T Councilman Dan Blazi N Councilman Gary Conroy PASSED AND DULY ADOPTED this 6th day of September,2016. #2016-R-31 2 ATTEST: CITY COUNCIL OF THE CITY OF EDGEWATER, FLORIDA By:/ /4/4 41*j Robin L. Matusick Michael Isnasiak City Clerk/Paralegal Mayor For the use and reliance only by the City of Approved by the City Council of the City of Edgewater,Florida. Approved as to form and Edgewater at a meeting held on this 6th day of legality by: Aaron Wolf September, 2016 under Agenda Item No. City Attorney ( . Doran Sims Wolfe&Ciocchetti #2016-R-31 3 BRAD T.BLAIS,P.E. Quentin L. Hampton Associates, Inc. TELEPHONE:(386)761-6810 DAVID A KING.P E. P FAX:(386)761-3977 ANDREW M.GIANNINI,P.E. Consulting Engineers EMAIL:glha©glha.corn KEVIN A.LEE,P E. P.O.DRAWER 290247 PORT ORANGE,FLORIDA 32129-0247 October 6, 2015 Brenda Dewees Email:bdweesPcityofedyewater.org City of Edgewater Hard Copy Mailed Only on Request P.O. Box 100 Edgewater, FL 32032 CITY OF EDGEWATER RECLAIMED WATER MAIN EXTENSION PHASES 1,2 AND 3 -SCOPE OF SERVICES AND FEE ESTIMATE- Dear Ms. Dewees, We appreciate the opportunity to offer this proposal for professional services associated with the above referenced project. The enclosed Scope of Services and Fee Estimate details proposed design elements, permitting requirements and ancillary work necessary to prepare bid documents. Please review the enclosed and notify our office if acceptable. Do not hesitate to contact our office if you have any questions. Sincerely, QUENTIN L;, ► P ON ASSOCIATES, INC. Br. �: .'� E. tvin A. Lee, P.E. Preside t Project Manager BTB/KAL:bf cc: Randy Coslow, PE Enclosures: Scope of Services Figure 1,Vicinity Map EW113 RWM Extensions Phase 1_23 Proposal•Revised 10.6,15 CITY OF EDGEWATER RECLAIMED WATER EXTENSION PHASES 1, 2 AND 3 SCOPE OF SERVICES AND FEE PROPOSAL GENERAL- This Scope of Services and Fee Proposal is in conformance with the Continuing Services Agreement between the City of Edgewater (City) and Quentin L. Hampton Associates, Inc (QLH). BACKGROUND The attached figure shows the City's existing reclaimed water distribution system and three (3) proposed extensions.These extensions will expand the system west along SR 442 and north to the City's proposed Public Works Facility. The First phase will consist of approximately 6,000 If of 12" pipe to the proposed Public Works Facility at Dale Ave. The site plan for the Public Works Facility includes an 8 acre reclaimed storage pond with an outfall to adjacent wetlands for augmentation of fresh surface waters. Subsequent phases of the project will include extension of the existing reclaimed water main further west on SR 442. The second phase of reclaimed water main extensions would be from Willow Oak Dr. to Coral Trace. This 16" reclaimed main extension will serve existing and proposed developments with reclaimed water distribution systems. The third phase will extend the system west of 1-95 for future developments and additional wetland outfall/aquifer recharge. Project costs for all three (3) phases of the reclaimed main extensions are estimated to total $3,946,800. TASK 1-SURVEY AND GEOTECHNICAL Coordinate survey with sub-consultant of the topography within rights-of-way and property boundaries. A geotechnical sub-consultant will perform sub-surface investigations. TASK 2 -DESIGN PHASE The Engineer shall complete design and permitting for Phases 1, 2 and 3.Authorization for design shall be issued concurrently for all (3) phases, or individually. The Phase 1 project involves approximately 6,000 if of pipe and sitework at the City's proposed Public Works facility. Permitting for this project will require biological work to include jurisdictional surveys and off-site investigations for effluent discharge. The City will engage their biological sub-consultant independently for this work. Additional laboratory analysis of background water quality and/or effluent may also be required. The City has a contract laboratory who can accomplish sampling and testing. QLH will coordinate this work, City will contract directly with laboratory. The conceptual construction cost estimate for Phase 1 is approximately$1.1M. Phase 2 requires construction of approximately 10,000 if of 16" reclaimed water main to Coral Trace subdivision. The conceptual cost estimate is $1.5M. Phase 3 is an additional 6,000 If of 16" water main to serve(2) future subdivisions west of I-95.The conceptual cost EW113 RWM Extensions Phase 1_2_3 Proposal-Revised 10.6.15 estimate is approximately $1.OM. This connection will enable utilization of virtually all effluent from the City's water reclamation facility. Permit applications to FDEP (sewer) and SJRWMD (stormwater) will be prepared and submitted at the 90%deliverable. Permit application fees are not included in this proposal. If subsequent authorizations for phases 2 and/or 3 are issued more than 90 days from authorization for phase 1,the Engineer reserves the right to modify the fee proposal. TASK 3 - BIDDING PHASE Advertisement- QLH will assist the City in the advertisement for bids. QLH will distribute copies of the project documents to bidders, answer questions from bidders, issue addendums as necessary,attend the pre-bid conference and attend the bid opening. Bid Evaluation - QLH will evaluate all submitted bids for accuracy/completeness and prepare bid tabulation. The qualifications of the low bidder(s) will be evaluated. QLH will deliver the bid tabulation and a Recommendation of Award letter to the City. Documentation required for concurrence in award by the Bureau of Facility Funding will be prepared and submitted. TASK 4-CONTRACT ADMINISTRATION AND INSPECTION Contract administration and inspection are not included at this time. These items will be addressed in a future proposal. EXCLUSIONS: The scope of work does not include easement acquisition, title search services, groundwater monitoring/remediation, wetland/ecological assistance, laboratory testing and/or legal services,or any other task not identified in the scope. Cost-A breakdown of fees is included below: Phase 1 Phase 2 Phase 3 Task 1-Survey and Geotechnical $ 25,000 $ 29,500 $ 20,000 Task 2- Design and Permitting $ 82,800 $ 98,112 $ 65,376 Task 3 - Bidding Assistance $ 5,250 $ 5,250 $ 5,250 Totals $113,050 $132,862 $ 90,626 *Total Phases 1, 2 and 3 $336,538 *Note: If bids for any phases are combined,a single fee will be charged for bid assistance. Prepared by: QUENTIN L. HAMPTON ASSOCIATES, INC. -Consulting Engineers- October 6, 2015 EW113 RWM Extensions Phase 1_2_3 Proposal-Revised 10.6.15 . o LAK 'C FINDLEY n 3R SR 44 v G N '3 o 41N f p3 0 0 A7 m 5 ft 1 N ltJ v Z R .g , A 6('t 3 o s. a°6 CD m 151 15A p 0° o QPtGE 0 v m Jr- vZ o 2.0 0 'v tp N 0 ° 71N 0 • OR• p -I A - i 0 Z �i<<S 1011 Z KNpPp \ 0 OS1ER •9A YELKCF \, 0 -1. -o 3 OPS\4 v 3 Rt0�1' `n<— v 0 v_ I E� c-1.=4, yz o PHASE 1: MI C51 N 3 T. 12"RWM -n = m •-•3 c„ to Public Works Facility m o o tis ,t1G ROIi\ &8 Acre Reclaimed Reservoir 0 - - ---- MA ' T. EE m rt a 0 NC , \• 01 o I:. v pRK , o ©Co• \a C RELt. RANN c 1.'f'..,•.7„ \ mos- g ,OYCE . 0 .= \ se'( { � \ IAA' LONE PINE A % <<, Oo 3 - z wp WILOWOOD z .c 16, , CO O ' \ m t0 mOT N � \FLYING M pv MpG \ ,,t, ,R -k C. P. A -F r \ ivA y12TH t,.n m .37 1oN,Z r \ LOOS ♦ r,CrUr;i; TIVr♦� BAR cc W o \ OpK v i`♦ t '•\` t4EGENT EATON ¢ % 7 • , t, IN .411 16TH 16TH rJ ":41 � —7 -33 v ` '� ff w�rY4' • PHASE 2: , • `• •,• ‘71'�;` 1tS♦•�6��;i+�,TH %` 1ON 16"RWM Extension .WS ' `r • •4.14 �,�•+10 j • •• •• :r S441'PINE . Willow Oak Dr. to z v o► t Xt 1;R,,,': ':. `i 'i• , , Coral Trace ° z�'�'1,r-9t ;V•• ;,+��,4 t` �. E v `n z n o tt t• • tt;t`t Ai t tt 22ND Tic.-- ,- V.• m ` t • `t t ,i-;:t;t trIr ry LEE r o ` i • •q• • , I i i �;• • • . r n D� OAK 2lw'St$ (•cc.t• . • !•:;Q!4.k5 `i m .„ ♦ i t 4 •`• • H x 0 t •,t•• • ` • Legend -;- .m • • t `. • �I. , Reuse k1 O POSSUM CAMP A.\3 4 • ; :�i• Existing n EELS GRovi- t t:VAI; ; ♦•, - Phase 1 PHASE 3: \`‘‘‘-~, ".', "••— Phase 2 16"RWM Extension ',, ,\, `, t LCoral Trace to W. of 1-95 .�, •.�,'•% , Phase 3 t:•'•t:•L '4 t1t:t%;%.\ttt Oo:•raenf Pen S IEMEWI 10 Cost SMre G,sot Apple.VrmstProduNoMO••y.I00WI 10 Redamed Co•f sham'OVERALL ror 0D-70 FS m 0 t 1 • M•7 • • • • . • • . • • • QUENTIN L.HAMPTON ASSOCIATES,INC. CITY OF EDGEWATER FIGURE 1 CONSULTING ENGINEERS RECLAIMED WATER FLORIDA CERTIFICATE OF AUTHORIZATION NUMBER:626 RECLAIMED WATER MAIN FAX: 386.761.3977 MAIN EXTENSIONS P 0 DRAWER 290247 PORT ORANGE.FL 32129-0247 PHASES 1, 2 & 3 EXTENSIONS PHONE.386.761.6810 STATE OF FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION STATE REVOLVING LOAN PROGRAM for Point Source Water Pollution Control LOAN APPLICATION . . ALS wousiommumempumpumpummumpummipmpper Florida Department of Environmental Protection State Revolving,Fund Program Twin Towers Office Building 2600 Blair Stone Road,MS 3505 Tallahassee,FL 32399-2400 Form Application I Incorporated in 62-503.430(I)(a),F.A.C. Effective Date 4-22-14 TABLE OF CONTENTS Page Number LOAN APPLICATION (1) SUBMITTAL 1 (2) COMPLETING THE APPLICATION 1 (3) ASSISTANCE 1 PART I-ADMINISTRATIVE INFORMATION (1) PROJECT SPONSOR 1 (2) AUTHORIZED REPRESENTATIVE (3) PRIMARY CONTACT (4) ADDITIONAL CONTACTS 1 (5) PROJECT NUMBER 1 (6) INTERIM FINANCING PART II-PROJECT INFORMATION A. PRECONSTRUCTION PROJECT (1) ACTIVITIES 2 (2) SCHEDULE 2 (3) COST 2 B. CONSTRUCTION PROJECT (1) ACTIVITIES 2 (2) SCHEDULE 3 (3) COST 3 PART III-FINANCIAL INFORMATION (1) PRINCIPAL 3 (2) TERMS AND REPAYMENT 3 (3) ANNUAL FUNDING LIMIT 3 (4) INFORMATION ON LIENS 3 (5) ACTUAL AND PROJECTED REVENUES 4 (6) AVAILABILITY OF PLEDGED REVENUES 4 (7) LOAN SERVICE FEE 4 PART IV-AUTHORIZATION AND ASSURANCES (1) AUTHORIZATION 4 (2) ASSURANCES 4 PART V-SUPPLEMENTARY INFORMATION SCHEDULE OF PRIOR AND PARITY LIENS 7 SCHEDULE OF ACTUAL REVENUES AND DEBT COVERAGE g SCHEDULE OF PROJECTED REVENUES AND DEBT COVERAGE 9 LIST OF ATTACHMENTS 10 Form Application 1 Incorporated in 62-503.430(1)(a),F.A.C. Effective Date 4-22-14 LOAN APPLICATION (1) SUBMITTAL. Submit the application and attachments to the Department of Environmental Protection,MS 3505, State Revolving Fund Program,2600 Blair Stone Road,Tallahassee,Florida 32399-2400. The application(and backup)may be submitted electronically to the Department's Project Manager. (2) COMPLETING THE APPLICATION. (a) This application consists of five parts: (I) ADMINISTRATIVE INFORMATION; (II) PROJECT INFORMATION; (III) FINANCIAL INFORMATION; (IV) AUTHORIZATION AND ASSURANCES; and (V) SUPPLEMENTARY INFORMATION. (b) All information provided on this application must be printed. Monetary amounts may be rounded. (c) Forms and attachments to be submitted are denoted with italic print. (3) ASSISTANCE. Completing this application may require information that can be obtained from Clean Water State Revolving Fund Program staff. Please email SRF_Reporting@dep.state.fl.us for assistance in completing this application. PART I-ADMINISTRATIVE INFORMATION (1) PROJECT SPONSOR City of Edgewater Federal Employer Identification Number 59-6000314 DUNS Number 782080501 (2) AUTHORIZED REPRESENTATIVE(person authorized to sign or attest loan documents). Name Tracey T.Barlow Title City Manager Telephone 386-424-2400 x.1201 FAX 386-424-2421 Email ttbarlow@cityofedgewater.org Mailing Address 104 N.Riverside Drive,Edgewater,FL 32132 (3) PRIMARY CONTACT(person to answer questions regarding this application). Name Brad T.Blais Title President Telephone 386-761-6810 FAX 386-761-3977 Email bblais@qlha.com Employer Quentin L.Hampton Associates,Inc. Mailing Address P.O.Drawer 290247,Port Orange,FL 32129 (4) ADDITIONAL CONTACTS. If more than one additional person is to receive copies of Department correspondence,attach the information(Attachment# ). Name Brenda Dewees Title Environmental Services Director Telephone 386-424-2400 FAX 386-424-2480 Email bdewees@cityofedgewater.org Employer City of Edgewater Mailing Address 104 N Riverside Dr.,Edgewater,FL 32132 (5) PROJECT NUMBER(listed on the Department's priority list). WW64053 (6) INTERIM FINANCING. A local government project sponsor that has interim financing may be subject to certain conditions regarding such financing. Is the project currently being funded with interim financing? ri Yes ® No Form Application 1 Incorporated in 62-503.430(1)(a),F.A.C. Page 1 of 10 Effective Date 4-22-14 PART II-PROJECT INFORMATION If you are applying for a planning,design,or SSES loan for a project that will involve construction,complete only Subpart A below. If you are applying for a loan to construct a project that is already planned and designed. complete only Subpart B below. A. PLANNING,DESIGN OR SSES PROJECT Information should be provided for each separate facility to be planned and designed as appropriate. For design/build projects (not eligible for design loans)or those where multiple facilities, segments,or phases are involved, please attach information for activities,schedule,and cost for each. Wastewater Facility Plan approved by FDEP on 07/11/16. (1) ACTIVITIES. Attach a brief description of the scope of planning and design activities to be financed by this loan. Include a list of any specialized studies to be performed. (Attachment #1) Are these activities the same as those scheduled on the Request for Inclusion Form? ®Yes ❑No. If"No",please explain. (Attachment# (2) SCHEDULE. (a) Provide proposed completion dates for the items. (Please call Department staff to discuss time frames needed to complete required tasks.) Planning documentation 12/15/15 Engineering work 11/30/16 Certification of site availability 11/30/16 Permit 12/31/16 (b) Do you anticipate that an interlocal agreement with another party will be necessary to implement ❑ Yes ® No the project? If"Yes",please explain. (Attachment# ) (c) Is this a design/build project? ❑ Yes ® No (3) COST. Is the cost information submitted for the planning,design or SSES loan priority list current? ® Yes ❑ 1\o If"No", please explain and submit revised cost information using the appropriate page of the Request for Inclusion Form. (Attachment # ) Note that the disbursable amount will be limited to the priority list amount. PRECONSTRUCTION LOAN APPLICANTS PROCEED TO PART III. B. CONSTRUCTION OR I/I REHABILITATION PROJECT (1) ACTIVITIES. (a) Attach a brief description of construction or I/I rehabilitation activities to be financed by this loan. Include a list of the contracts(by title)corresponding to the plans and specifications accepted by the Department(Attachment# ). Are these contracts the same as those scheduled on the Request for Inclusion Form? ❑ Yes ❑ No If"No-,please explain. (Attachment ) (b) Have any of the contracts been bid? ❑ Yes ❑ No If"Yes",indicate which contracts have been bid. (Attachment# (c) Was planning,design,or SSES for this project financed in another SRF loan? ❑ Yes ❑ No If"Yes",give the SRF loan number. (d) Does this project involve an interlocal agreement with other local governments or other entities? ❑ Yes ❑ No, If"Yes",attach a copy of the Department letter accepting the interlocal agreement. (Attachment# ) Is the interlocal agreement,as accepted by the Department,fully executed and enforceable? ❑ Yes ❑ No If"No",please explain(Attachment# ). Form Application 1 Incorporated in 62-503.430(1)(a),F.A.C. Page 2 of 10 Effective Date 4-22-14 (2) SCHEDULE. (month and year) (a) Anticipated notice to proceed for first construction contract. (b) Anticipated completion of all construction contracts. (3) COST. Is the cost information submitted for the priority list current? ❑ Yes ❑ No If"No",please explain and submit revised cost information using the appropriate page of the Request for Inclusion Form. (Attachment# ) Note that the disbursable amount will be limited to the priority list amount. PART III-FINANCIAL INFORMATION Estimates of the capitalized interest,project useful life for financial hardship loans,financing rate,pledged revenue coverage, limitations on annual loan amounts for large projects, applicability and amount of repayment reserves, amount of the loan service fee and any other information may be obtained by contacting staff in the State Revolving Fund Management Section. (1) PRINCIPAL. The requested amount of the loan which does not include capitalized interest is S336,500 Note that the disbursable amount will be limited to the priority list amount and must be consistent with the project information provided under PART Ii of this application. Also note that the capitalized interest is an inexact estimate,and it is subject to adjustment by the Department to reflect actual disbursement timing. The principal amount of the loan does not include the loan service fee. (2) TERMS AND REPAYMENT. (a) Loans to local government project sponsors are amortized over the lesser of useful life of the project or 20 years unless the project is to serve a small community qualifying as having a financial hardship. Loans to financial hardship communities may be amortized over the lesser of useful life of the project or 30 years.Loans to non-governmental project sponsors are amortized over the lesser of the useful of the project or 20 years. Finance charges and principal are paid semiannually. What is the useful life of the project? 25 (years) Over how many years would you like to amortize the loan? 20 (years) (b) List all revenues that are to be pledged for repayment of this loan. Water,Sewer and Impact Fee Revenues. (c) Pledged revenue receipts or collections by the project sponsor must exceed the amount of the repayments due to the Department unless there are other collateral provisions. The excess revenue, or coverage, generally is 15% of each repayment. What coverage is proposed for the loan? 15% (coverage percentage) (d) Is any other financial assistance being applied to this project? ❑ Yes ® No If"Yes",please list. (Attachment# ) (3) ANNUAL FUNDING LIMIT. Large project funding (generally, loans in excess of$10 million) may be provided in increments pursuant to the initial loan agreement and subsequent amendments. Each increment shall have a separate financing rate as established in the agreement or amendment providing that increment. (4) INFORMATION ON LIENS. (a) Describe, if applicable, all debt obligations having a prior or parity lien on the revenues pledged to repay this loan. (Attachment r2 For example: City Name,Florida,Water and Sewer System Revenue Bonds,Series 1996,issued in the amount of$10,000,000,pursuant to Ordinance No. 93-104,as amended and supplemented by Ordinance No.96-156. (b) Using the Part V,Schedule of Prior and Parity Liens,provide debt service information,if applicable,on each prior and parity obligation. (c) For the listed obligations,provide a copy of the ordinance(s),resolution(s),official statement(s),or pages thereof,setting forth the definitions, use of proceeds, debt service schedule, pledged revenues, rate covenants, provisions for issuing additional debt,provisions for bond insurance,and debt rating. (Attachment 4 ). Form Application 1 Incorporated in 62-503.430(1)(a),F.A.C. Page 3 of 10 Effective Date 4-22-14 (d) Describe any other notes and loans payable from the revenues pledged to repay this loan.(Attachment ). (5) ACTUAL AND PROJECTED REVENUES. (a) Complete the Part V,Schedule of Actual Revenues and Debt Coverage for the past two fiscal years. (b) Complete the Part V,Schedule of Projected Revenues and Debt Coverage, demonstrating the availability of pledged revenues for loan repayment. (6) AVAILABILITY OF PLEDGED REVENUES. All sources must be supported by a written legal opinion. (Attachment #.)The opinion must address the following: (a) Availability of the revenues to repay the loan. (b) Right to increase rates at which revenues shall be collected to repay the loan. (c) Subordination of the pledge if pledged revenues are subject to a prior or parity lien. (7) LOAN SERVICE FEE. A loan service fee is assessed on each loan.The fee is not part of the loan. The fee along with interest thereon will be deducted from the first available repayments after the final amendment to the loan agreement. PART IV—AUTHORIZATION AND ASSURANCES (1) AUTHORIZATION. Provide an authorizing resolution of the Applicant's governing body or other evidence of authorization(Attachment 04)for the following: (a) Pledging revenues to repay the loan. (b) Designation of the Authorized Representative(s)to file this application,provide assurances,execute the loan agreement, and represent the Applicant in carrying out responsibilities(including that of requesting loan disbursements)under the loan agreement. (2) ASSURANCES. The.Applicant agrees to comply with the laws,rules,regulations,policies and conditions relating to the loan for this project. Applicants should seek further information from the Clean Water State Revolving Fund Program staff as to the applicability of the requirements if the necessity for the assurances is of concern. Specifically, the Applicant certifies that it has complied, as appropriate, and will comply with the following requirements, as appropriate,in undertaking the Project: (a) Assurances for capitalization grant projects. 1. Complete all facilities for which funding has been provided. 2. The Archaeological and Historic Preservation Act of 1974,PL 93-291,and the National Historic Preservation Act of 1966,PL 89-665,as amended,regarding identification and protection of historic properties. 3. The Clean Air Act,42 U.S.C. 7506(c),which requires conformance with State Air Quality Implementation Plans. 4. The Coastal Zone Management Act of 1972,PL 92-583,as amended, which requires assurance of project consistency with the approved State management program developed under this Act. 5. The Endangered Species Act, 16 U.S.C. 1531, et seq., which requires that projects avoid disrupting threatened or endangered species and their habitats. 6. Executive Order 11593,Protection and Enhancement of the Cultural Environment,regarding preservation,restoration and maintenance of the historic and cultural environment. 7. Executive Order 11988,Floodplain Management,related to avoiding,to the extent possible,adverse impacts associated with floodplain occupancy,modification and development whenever there is a practicable alternative. 8. Executive Order 11990,Protection of Wetlands,related to avoiding,to the extent possible,adverse impacts associated with the destruction or modification of wetlands and avoiding support of construction in wetlands. 9. The Fish and Wildlife Coordination Act,PL 85-624,as amended,which requires that actions to control natural streams or other water bodies be undertaken to protect fish and wildlife resources and their habitats. 10. The Safe Drinking Water Act, Section 1424(e), PL 93-523,as amended,regarding protection of underground sources of drinking water. Form Application 1 Incorporated in 62-503.430(1)(a),F.A.C. Page 4 of 10 Effective Date 4-22-14 11. The Wild and Scenic Rivers Act,PL 90-542,as amended,related to protecting components or potential components of the national wild and scenic rivers system. 12. The federal statutes relating to nondiscrimination,including: The Civil rights Act of 1964.PL 88-352,which prohibits discrimination on the basis of race, color or national origin; the Age Discrimination Act, PL 94-135, which prohibits discrimination on the basis of age; Section 13 of the Federal Water Pollution Control Act, PL 92-500,which prohibits sex discrimination;the Rehabilitation Act of 1973,PL 93-112,as amended,which prohibits discrimination on the basis of handicaps. 13. Executive Order 11246,Equal Employment Opportunity,which provides for equal opportunity for all qualified persons. 14. Executive Orders 11625 and 12138, Women's and Minority Business Enterprise, which require that small, minority, and women's business and labor surplus areas are used when possible as sources of supplies,equipment, construction and services. 15. The Coastal Barrier Resources Act, 16 U.S.C. 3501 et seq.,regarding protection and conservation of the coastal barrier resources. 16. The Farmland Protection Policy Act,7 U.S.C.4201 et seq.,regarding protection of agricultural lands from irreversible loss. 17. The Uniform Relocation and Real Property Acquisition Policies Act of 1970, PL 91-646,which provides for fair and equitable treatment of persons displaced or whose property is acquired as a result of federal or federally assisted programs. 18. The Demonstration Cities and Metropolitan Development Act of 1966, PL 89-754, as amended, which requires that projects be carried out in accordance with area wide planning activities. 19. Section 306 of the Clean Air Act, Section 508 of the Clean Water Act and Executive Order 11738, which prohibit manufacturers,firms,or other enterprises on the EPA's list of Violating Facilities from participating in the Project. 20. Executive Order 12549, Debarment and Suspension, which prohibits any award to a party which is debarred or suspended or is otherwise excluded from,or ineligible for,participation in federal assistance programs. 21. Minority and Women's Business Enterprise participation in project work using numerical goals,established by the U.S. Environmental Protection Agency,and to be set forth in the specifications for construction and materials contracts. (b) Assurances for other projects. 1. Chapter 161,Part I,F.S.,"Beach and Shore Preservation Act"and Part III,"Coastal Zone Protection Act of 1985" which regulate coastal zone construction and all activities likely to affect the condition of the beaches or shore. 2. Chapter 163,Part II,F.S.,the"Local Government Comprehensive Planning and Land Development Regulation Act" which requires units of local government to establish and implement comprehensive planning programs to control future development. 3. Chapter 186,F.S.,State and Regional Planning,which requires conformance of projects with Regional Plans and the State Comprehensive Plan. 4. Chapter 253,F.S.,"Emergency Archaeological Property Acquisition Act of 1988"which requires protection of archaeological properties of major statewide significance discovered during construction activities. 5. Chapter 258,Part III,F.S.,which requires protection of components or potential components of the national wild and scenic rivers system. 6. Chapter 267,F.S.,the"Florida Historical Resources Act"which requires identification,protection,and preservation of historic properties,archaeological and anthropological sites. 7. Chapter 287,Part I.F.S.,which prohibits parties convicted of public entity crimes or discrimination from participating in State-assisted projects and which requires consideration of the utilization of Minority Business Enterprises in State- assisted projects. 8. Chapter 372.F.S.,the Florida Endangered and Threatened Species Act which prohibits the killing or wounding of an endangered,threatened,or special concern species or intentionally destroying their eggs or nest. 9. Chapter 373,Part IV,F.S.,Florida Water Resources Act of 1972,which requires that activities on surface waters or wetlands avoid adversely affecting: public health,safety,welfare,or property;conservation of fish and wildlife, including endangered or threatened species or their habitats;navigation or the flow of water;the fishing or recreational values or marine productivity; and significant historical and archaeological resources. Form Application 1 Incorporated in 62-503.430(1)(a),F.A.C. Page 5 of 10 Effective Date 4-22-14 I 10. Chapter 380,Part I,F.S.,Florida Environmental Land and Water Management Act of 1972 as it pertains to regulation of developments and implementation of land and water management policies. II. Chapter 381,F.S.,Public Health,as it pertains to regulation of onsite wastewater systems. 12. Chapter 403,Part I,F.S.,Florida Air and Water Pollution Control which requires protection of all waters of the state. 13. Chapter 582,F.S., Soil and Water Conservation Act which requires conformance with Water Management District's regulations governing the use of land and water resources. 14. Governor's Executive Order 95-359,which requires State Clearinghouse review of project planning documentation and intergovernmental coordination. I.the undersigned Authorized Representative of the Applicant,hereby certify that all information contained herein and in the attached is true,con•ect,and complete to the best of my knowledge and belief. I further certify that I have been duly authorized to file the application and to provide these assurances. Signed this / �C- Day oft�.(�' 20 / Authorized Re resentative P Tracey T.Barlow 77)/ (signature) (name typed or printed) Attachments Form Application 1 Incorporated in 62-503.430(1)(a),F.A.C. Page 6 of 10 Effective Date 4-22-14 PART V—SUPPLEMENTARY INFORMATION SCHEDULE OF PRIOR AND PARITY LIENS (EXCLUDING SRF LOANS) List annual debt service beginning two years before the anticipated loan agreement date and continuing at least three additional fiscal years. Use additional pages as necessary. #1 #2 #3 Identify Each Obligation Lease Refunding Note Capital Improvement Utility System Refunding Series 2013 Revenue Note Revenue Note Series 2014 Series 2016 Coverage 100 % 100 % 115 % Insured? X Yes No X Yes No X Yes No Total Debt Fiscal Annual Debt Service(Principal Plus Interest) Total Service Incl. Year #1 #2 #3 Debt Service Coverage 2014 S571,692 $ S S571,692 $571,692 2015 $604,393 $145,982 S 5750,375 $750,375 2016 $637,329 S148,559 $497,000 $1,282,888 $1,357,438 2017 $672,471 $148,667 $856,000 $1,677,138 $1,805,538 2018 $692,880 $146,702 $876,000 $1,715,582 $1,846,982 2019 $692,850 $146,714 $896,000 $1,735,564 $1,869,964 2020 $463,153 $148,653 $916,000 $1,527,806 $1,665,206 2021 $ $149,472 $938,000 $1,087,472 $1,228,172 2022 $ $148,194 $959,000 $1,107,194 $1,251,044 2023 $ $147,869 $981,000 $1,128,869 S1,276,019 2024 $ $147,470 $1,004,000 $1,151,470 S1,302,070 2025 $ $ $1,027,000 $1,027,000 $1,181,050 2026 $ $ $1,050,000 $1,050,000 $1,207,500 2027 $ $ $ $ $ 2028 $ $ $ $ $ 2029 $ $ $ $ $ 2030 $ $ $ $ $ 2028 S $ S S $ 2029 S $ S S $ 2030 S S S S $ 2031 $ S $ $ $ 2032 $ $ $ $ $ 2033 $ $ $ $ $ 2034 $ $ $ $ $ 2035 $ $ $ $ $ 2036 $ $ $ $ $ 2037 $ $ $ $ S Form Application 1 Incorporated in 62-503.430(1)(a),F.A.C. Page 7 of 10 Effective Date 4-22-14 PART V—SUPPLEMENTARY INFORMATION SCHEDULE OF ACTUAL REVENUES AND DEBT COVERAGE (Provide information for the two fiscal years preceding the anticipated date of the SRF loan agreement.) FY 2014 FY 2015 (a) Operating Revenues(Source) Water and Sewer Sales $ 7,914,976 $ 8,198,901 Fees and Services $468,830 $452,417 (b) Interest Income $ 5,909 $6,216 (c) Other Income or Revenue (Identify) Miscellaneous Income (Other Operating Revenue) S 75,983 $ 116,235 Development Fees $ 102,105 $ 183,385 (d) Total Revenues $8,567,803 $8,957,154 (e) Operating Expenses(excluding interest on debt, depreciation, and other non-cash items) $5,348,671 $5,288,285 (f) Net Revenues [(f)=(d)—(e)] $3,219,132 $3,668,869 (g) Debt Service(including any required coverage) $943,843 S 1,194,516 (h) Attach audited annual financial report(s), or pages thereof,or other documentation necessary to support the above information. Include any notes or comments from the audit reports regarding compliance with covenants of debt obligations having a prior or parity lien on the revenues pledged for repayment of the SRF Loan. (Attachment#5) (i) Attach worksheets reconciling this page with the appropriate financial statements(for example, backing out depreciation and interest payments from operating expenses). (Attachment# ) (j) If the net revenues were not sufficient to satisfy the debt service and coverage requirement, please explain what corrective action was taken. (Attachment# ) Form Application 1 Incorporated in 62-503.430(1)(a),F.A.C. Page 8 of 10 Effective Date 4-22-14 STATE OF FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION STATE REVOLVING LOAN PROGRAM for Point Source Water Pollution Control LOAN APPLICATION ,,, v.,. 15,4r Florida Department of Environmental Protection State Revolving Fund Program Twin Towers Office Building 2600 Blair Stone Road,MS 3505 Tallahassee,FL 32399-2400 Form Application I Incorporated in 62-503.430(1)(a),F.A.C. Effective Date 4-22-14 TABLE OF CONTENTS Page Number LOAN APPLICATION (1) SUBMITTAL 1 (2) COMPLETING THE APPLICATION 1 (3) ASSISTANCE 1 PART I-ADMINISTRATIVE INFORMATION (1) PROJECT SPONSOR 1 (2) AUTHORIZED REPRESENTATIVE 1 (3) PRIMARY CONTACT 1 (4) ADDITIONAL CONTACTS 1 (5) PROJECT NUMBER. 1 (6) INTERIM FINANCING 1 PART II-PROJECT INFORMATION A. PRECONSTRUCTION PROJECT (1) ACTIVITIES 2 (2) SCHEDULE 2 (3) COST 2 B. CONSTRUCTION PROJECT (1) ACTIVITIES 2 (2) SCHEDULE 3 (3) COST 3 PART III-FINANCIAL INFORMATION (1) PRINCIPAL 3 (2) TERMS AND REPAYMENT 3 (3) ANNUAL FUNDING LIMIT 3 (4) INFORMATION ON LIENS , 3 (5) ACTUAL AND PROJECTED REVENUES 4 (6) AVAILABILITY OF PLEDGED REVENUES 4 (7) LOAN SERVICE FEE 4 PART IV-AUTHORIZATION AND ASSURANCES (1) AUTHORIZATION 4 (2) ASSURANCES 4 PART V-SUPPLEMENTARY INFORMATION SCHEDULE OF PRIOR AND PARITY LIENS 7 SCHEDULE OF ACTUAL REVENUES AND DEBT COVERAGE 8 SCHEDULE OF PROJECTED REVENUES AND DEBT COVERAGE 9 LIST OF ATTACHMENTS 10 Form Application I Incorporated in 62-503.430(1)(a). F.A.C. Effective Date 4-22-14 LOAN APPLICATION (1) SUBMITTAL. Submit the application and attachments to the Department of Environmental Protection,MS 3505,State Revolving Fund Program,2600 Blair Stone Road,Tallahassee,Florida 32399-2400. The application(and backup)may be submitted electronically to the Department's Project Manager. (2) COMPLETING THE APPLICATION. (a) This application consists of five parts: (I) ADMINISTRATIVE INFORMATION; (II)PROJECT INFORMATION; (III) FINANCIAL INFORMATION; (IV) AUTHORIZATION AND ASSURANCES; and (V) SUPPLEMENTARY INFORMATION. (b) All information provided on this application must be printed. Monetary amounts may be rounded. (c) Forms and attachments to be submitted are denoted with italic print. (3) ASSISTANCE. Completing this application may require information that can be obtained from Clean Water State Revolving Fund Program staff. Please email SRF_Reporting@dep.state.fl.us for assistance in completing this application. PART I-ADMINISTRATIVE INFORMATION (1) PROJECT SPONSOR City of Edgewater Federal Employer Identification Number 59-6000314 DUNS Number 782080501 (2) AUTHORIZED REPRESENTATIVE(person authorized to sign or attest loan documents). Name Tracey T.Barlow Title City Manager Telephone 386-424-2400 x.1201 FAX 386-424-2421 Email ttbarlow@cityofedgewater.org Mailing Address 104 N.Riverside Drive,Edgewater,FL 32132 (3) PRIMARY CONTACT(person to answer questions regarding this application). Name Brad T.Blais Title President Telephone 386-761-6810 FAX 386-761-3977 Email bblais.glha.com Employer Quentin L.Hampton Associates,Inc. Mailing Address P.O.Drawer 290247,Port Orange,FL 32129 (4) ADDITIONAL CONTACTS. If more than one additional person is to receive copies of Department correspondence,attach the information(Attachment# ). Name Brenda Dewees Title Environmental Services Director Telephone 386-424-2400 FAX 386-424-2480 Email bdewees@cityofedgewater.org Employer City of Edgewater Mailing Address 104 N Riverside Dr.,Edgewater,FL 32132 (5) PROJECT NUMBER(listed on the Department's priority list). WW64053 (6) INTERIM FINANCING. A local government project sponsor that has interim financing may be subject to certain conditions regarding such financing. Is the project currently being funded with interim financing? Yes ® No Form Application 1 Incorporated in 62-503.430(1)(a),F.A.C. Page 1 of 10 Effective Date 4-22-14 PART II—PROJECT INFORMATION If you are applying for a planning,design,or SSES loan for a project that will involve construction,complete only Subpart A below. If you are applying for a loan to construct a project that is already planned and designed, complete only Subpart B below. A. PLANNING,DESIGN OR SSES PROJECT Information should be provided for each separate facility to be planned and designed as appropriate. For design/build projects (not eligible for design loans) or those where multiple facilities, segments, or phases are involved, please attach information for activities,schedule,and cost for each. Wastewater Facility Plan approved by FDEP on 07/11/16. (1) ACTRVITIES. Attach a brief description of the scope of planning and design activities to be financed by this loan. Include a list of any specialized studies to be performed. (Attachment #1) Are these activities the same as those scheduled on the Request for Inclusion Form? ®Yes ❑No. If"No",please explain. (Attachment# ) (2) SCHEDULE. (a) Provide proposed completion dates for the items. (Please call Department staff to discuss time frames needed to complete required tasks.) Planning documentation 12/15/15 Engineering work 11/30/16 Certification of site availability 11/30/16 Permit 12/31/16 (b) Do you anticipate that an interlocal agreement with another party will be necessary to implement ❑ Yes ® No the project? If"Yes",please explain. (Attachment# ) (c) Is this a design/build project? ❑ Yes ® No (3) COST. Is the cost information submitted for the planning,design or SSES loan priority list current? ® Yes ❑ No If"No". please explain and submit revised cost information using the appropriate page of the Request for Inclusion Form. (Attachment # ) Note that the disbursable amount will be limited to the priority list amount. PRECONSTRUCTION LOAN APPLICANTS PROCEED TO PART III. B. CONSTRUCTION OR I/I REHABILITATION PROJECT (1) ACTIVITIES. (a) Attach a brief description of construction or I/I rehabilitation activities to be financed by this loan. Include a list of the contracts(by title)corresponding to the plans and specifications accepted by the Department(Attachment# ). Are these contracts the same as those scheduled on the Request for Inclusion Form? ❑ Yes ❑ No If"No",please explain. (Attachment# ) (b) Have any of the contracts been bid? ❑ Yes ❑ No If"Yes",indicate which contracts have been bid. (Attachment# ) (c) Was planning,design,or SSES for this project financed in another SRF loan? ❑ Yes ❑ No If"Yes",give the SRF loan number. (d) Does this project involve an interlocal agreement with other local governments or other entities? ❑ Yes ❑ No If"Yes",attach a copy of the Department letter accepting the interlocal agreement. (Attachment# ) Is the interlocal agreement,as accepted by the Department,fully executed and enforceable? ❑ Yes ❑ No If"No",please explain(Attachment a ). Form Application 1 Incorporated in 62-503.430(1)(a),F.A.C. Page 2 of 10 Effective Date 4-22-14 (2) SCHEDULE. (month and year) (a) Anticipated notice to proceed for first construction contract. (b) Anticipated completion of all construction contracts. (3) COST. Is the cost information submitted for the priority list current? ❑ Yes ❑ No If"No",please explain and submit revised cost information using the appropriate page of the Request for Inclusion Form. (Attachment# ) Note that the disbursable amount will be limited to the priority list amount. PART III-FINANCIAL INFORMATION Estimates of the capitalized interest,project useful life for financial hardship loans,financing rate,pledged revenue coverage, limitations on annual loan amounts for large projects, applicability and amount of repayment reserves, amount of the loan service fee and any other information may be obtained by contacting staff in the State Revolving Fund Management Section. (1) PRINCIPAL. The requested amount of the loan which does not include capitalized interest is S336,500 Note that the disbursable amount will be limited to the priority list amount and must be consistent with the project information provided under PART II of this application. Also note that the capitalized interest is an inexact estimate,and it is subject to adjustment by the Department to reflect actual disbursement timing. The principal amount of the loan does not include the loan service fee. (2) TERMS AND REPAYMENT. (a) Loans to local government project sponsors are amortized over the lesser of useful life of the project or 20 years unless the project is to serve a small community qualifying as having a financial hardship. Loans to financial hardship communities may be amortized over the lesser of useful life of the project or 30 years.Loans to non-governmental project sponsors are amortized over the lesser of the useful of the project or 20 years. Finance charges and principal are paid semiannually. What is the useful life of the project? 25 (years) Over how many years would you like to amortize the loan? 20 (years) (b) List all revenues that are to be pledged for repayment of this loan. Water,Sewer and Impact Fee Revenues. (c) Pledged revenue receipts or collections by the project sponsor must exceed the amount of the repayments due to the Department unless there are other collateral provisions. The excess revenue, or coverage, generally is 15% of each repayment. What coverage is proposed for the loan? 15% (coverage percentage) (d) Is any other financial assistance being applied to this project? ❑ Yes ® No If"Yes",please list. (Attachment# (3) ANNUAL FUNDING LIMIT. Large project funding (generally, loans in excess of$10 million) may be provided in increments pursuant to the initial loan agreement and subsequent amendments. Each increment shall have a separate financing rate as established in the agreement or amendment providing that increment. (4) INFORMATION ON LIENS. (a) Describe, if applicable, all debt obligations having a prior or parity lien on the revenues pledged to repay this loan. (Attachment#2 For example: City Name,Florida,Water and Sewer System Revenue Bonds, Series 1996,issued in the amount of$10,000.000,pursuant to Ordinance No.93-104,as amended and supplemented by Ordinance No.96-156. (b) Using the Part V,Schedule of Prior and Parity Liens,provide debt service information,if applicable,on each prior and parity obligation. (c) For the listed obligations,provide a copy of the ordinance(s),resolution(s),official statement(s),or pages thereof,setting forth the definitions, use of proceeds, debt service schedule, pledged revenues, rate covenants, provisions for issuing additional debt,provisions for bond insurance,and debt rating. (Attachment# ). Form Application 1 Incorporated in 62-503.430(lxa),F.A.C. Page 3 of 10 Effective Date 4-22-14 (d) Describe any other notes and loans payable from the revenues pledged to repay this loan.(Attachment# ). (5) ACTUAL AND PROJECTED REVENUES. (a) Complete the Part V,Schedule of Actual Revenues and Debt Coverage for the past two fiscal years. (b) Complete the Part V,Schedule of Projected Revenues and Debt Coverage, demonstrating the availability of pledged revenues for loan repayment. (6) AVAILABILITY OF PLEDGED REVENUES. All sources must be supported by a written legal opinion. (Attachment #1)The opinion must address the following: (a) Availability of the revenues to repay the loan. (b) Right to increase rates at which revenues shall be collected to repay the loan. (c) Subordination of the pledge if pledged revenues are subject to a prior or parity lien. (7) LOAN SERVICE FEE. A loan service fee is assessed on each loan.The fee is not part of the loan. The fee along with interest thereon will be deducted from the first available repayments after the final amendment to the loan agreement. PART IV—AUTHORIZATION AND ASSURANCES (1) AUTHORIZATION. Provide an authorizing resolution of the Applicant's governing body or other evidence of authorization(Attachment#4)for the following: (a) Pledging revenues to repay the loan. (b) Designation of the Authorized Representative(s)to file this application,provide assurances,execute the loan agreement, and represent the Applicant in carrying out responsibilities(including that of requesting loan disbursements)under the loan agreement. (2) ASSURANCES. The Applicant agrees to comply with the laws,rules,regulations,policies and conditions relating to the loan for this project. Applicants should seek further information from the Clean Water State Revolving Fund Program staff as to the applicability of the requirements if the necessity for the assurances is of concern. Specifically, the Applicant certifies that it has complied, as appropriate, and will comply with the following requirements, as appropriate,in undertaking the Project: (a) Assurances for capitalization grant projects. 1. Complete all facilities for which funding has been provided. 2. The Archaeological and Historic Preservation Act of 1974,PL 93-291, and the National Historic Preservation Act of 1966,PL 89-665,as amended,regarding identification and protection of historic properties. 3. The Clean Air Act,42 L".S.C.7506(c),which requires conformance with State Air Quality Implementation Plans. 4. The Coastal Zone Management Act of 1972,PL 92-583. as amended, which requires assurance of project consistency with the approved State management program developed under this Act. 5. The Endangered Species Act, 16 U.S.C. 1531, et seq., which requires that projects avoid disrupting threatened or endangered species and their habitats. 6. Executive Order 11593,Protection and Enhancement of the Cultural Environment, regarding preservation,restoration and maintenance of the historic and cultural environment. 7. Executive Order 11988,Floodplain Management,related to avoiding,to the extent possible,adverse impacts associated with floodplain occupancy,modification and development whenever there is a practicable alternative. 8. Executive Order 11990,Protection of Wetlands,related to avoiding,to the extent possible,adverse impacts associated with the destruction or modification of wetlands and avoiding support of construction in wetlands. 9. The Fish and Wildlife Coordination Act,PL 85-624.as amended,which requires that actions to control natural streams or other water bodies be undertaken to protect fish and wildlife resources and their habitats. 10. The Safe Drinking Water Act, Section 1424(e),PL 93-523,as amended, regarding protection of underground sources of drinking water. Form Application I Incorporated in 62-503.430(1)(a),F.A.C. Page 4 of 10 Effective Date 4-22-14 11. The Wild and Scenic Rivers Act,PL 90-542,as amended,related to protecting components or potential components of the national wild and scenic rivers system. 12. The federal statutes relating to nondiscrimination,including: The Civil rights Act of 1964.PL 88-352,which prohibits discrimination on the basis of race, color or national origin; the Age Discrimination Act,PL 94-135, which prohibits discrimination on the basis of age; Section 13 of the Federal Water Pollution Control Act, PL 92-500,which prohibits sex discrimination;the Rehabilitation Act of 1973,PL 93-112,as amended,which prohibits discrimination on the basis of handicaps. 13. Executive Order 11246,Equal Employment Opportunity,which provides for equal opportunity for all qualified persons. 14. Executive Orders 11625 and 12138, Women's and Minority Business Enterprise, which require that small, minority, and women's business and labor surplus areas are used when possible as sources of supplies,equipment, construction and services. 15. The Coastal Barrier Resources Act, 16 U.S.C. 3501 et seq.,regarding protection and conservation of the coastal barrier resources. 16. The Farmland Protection Policy Act,7 U.S.C.4201 et seq.,regarding protection of agricultural lands from irreversible loss. 17. The Uniform Relocation and Real Property Acquisition Policies Act of 1970. PL 91-646, which provides for fair and equitable treatment of persons displaced or whose property is acquired as a result of federal or federally assisted programs. 18. The Demonstration Cities and Metropolitan Development Act of 1966. PL 89-754, as amended, which requires that projects be carried out in accordance with area wide planning activities. 19. Section 306 of the Clean Air Act, Section 508 of the Clean Water Act and Executive Order 11738, which prohibit manufacturers,firms,or other enterprises on the EPA's list of Violating Facilities from participating in the Project. 20. Executive Order 12549, Debarment and Suspension, which prohibits any award to a party which is debarred or suspended or is otherwise excluded from,or ineligible for,participation in federal assistance programs. 21. Minority and Women's Business Enterprise participation in project work using numerical goals,established by the U.S. Environmental Protection Agency,and to be set forth in the specifications for construction and materials contracts. (b) Assurances for other projects. 1. Chapter 161,Part I,F.S.,"Beach and Shore Preservation Act"and Part III,"Coastal Zone Protection Act of 1985" which regulate coastal zone construction and all activities likely to affect the condition of the beaches or shore. 2. Chapter 163,Part II,F.S.,the"Local Government Comprehensive Planning and Land Development Regulation Act" which requires units of local government to establish and implement comprehensive planning programs to control future development. 3. Chapter 186,F.S.,State and Regional Planning,which requires conformance of projects with Regional Plans and the State Comprehensive Plan. 4. Chapter 253,F.S.,"Emergency Archaeological Property Acquisition Act of 1988"which requires protection of archaeological properties of major statewide significance discovered during construction activities. 5. Chapter 258,Part III,F.S.,which requires protection of components or potential components of the national wild and scenic rivers system. 6. Chapter 267,F.S.,the"Florida Historical Resources Act"which requires identification,protection,and preservation of historic properties,archaeological and anthropological sites. 7. Chapter 287,Part I,F.S.,which prohibits parties convicted of public entity crimes or discrimination from participating in State-assisted projects and which requires consideration of the utilization of Minority Business Enterprises in State- assisted projects. 8. Chapter 372,F.S.,the Florida Endangered and Threatened Species Act which prohibits the killing or wounding of an endangered,threatened,or special concern species or intentionally destroying their eggs or nest. 9. Chapter 373,Part IV,F.S.,Florida Water Resources Act of 1972,which requires that activities on surface waters or wetlands avoid adversely affecting: public health,safety,welfare,or property;conservation of fish and wildlife, including endangered or threatened species or their habitats;navigation or the flow of water;the fishing or recreational values or marine productivity; and significant historical and archaeological resources. Form Application 1 Incorporated in 62-503.430(1)(a),F.A.C. Page 5 of 10 Effective Date 4-22-14 10. Chapter 380,Part I,F.S.,Florida Environmental Land and Water Management Act of 1972 as it pertains to regulation of developments and implementation of land and water management policies. 11. Chapter 381,F.S.,Public Health,as it pertains to regulation of onsite wastewater systems. 12. Chapter 403,Part I,F.S.,Florida Air and Water Pollution Control which requires protection of all waters of the state. 13. Chapter 582,F.S.,Soil and Water Conservation Act which requires conformance with Water Management District's regulations governing the use of land and water resources. 14. Governor's Executive Order 95-359,which requires State Clearinghouse review of project planning documentation and intergovernmental coordination. I,the undersigned Authorized Representative of the Applicant,hereby certify that all information contained herein and in the attached is true,con•ect,and complete to the best of my knowledge and belief. I further certify that I have been duly authorized to file the application and to provide these assurances. Signed this / 166 Day of 4--(/--- , 20 Authorized Representative /17 � Tracey T.Barlow (signature) (name typed or printed) Attachments Form Application 1 Incorporated in 62-503.430(lxa),F.A.C. Page 6 of 10 Effective Date 4-22-14 PART V—SUPPLEMENTARY INFORMATION SCHEDULE OF PRIOR AND PARITY LIENS (EXCLUDING SRF LOANS) List annual debt service beginning two years before the anticipated loan agreement date and continuing at least three additional fiscal years. Use additional pages as necessary. #1 #2 #3 Identify Each Obligation Lease Refunding Note Capital Improvement Utility System Refunding Series 2013 Revenue Note Revenue Note Series 2014 Series 2016 Coverage 100 % 100 % 115 % Insured? X Yes No X Yes No X Yes No Total Debt Fiscal Annual Debt Service(Principal Plus Interest) Total Service Incl. Year #1 #2 #3 Debt Service Coverage 2014 $571,692 $ $ $571,692 $571,692 2015 $604,393 $145,982 $ $750,375 $750,375 2016 $637,329 $148,559 $497,000 $1,282,888 $1,357,438 2017 $672,471 $148,667 $856,000 $1,677,138 $1,805,538 2018 $692,880 S146,702 $876,000 $1,715,582 $1,846,982 2019 $692,850 S146,714 $896,000 $1,735,564 $1,869,964 2020 $463,153 S148,653 $916,000 $1,527.806 S1,665,206 2021 $ 5149,472 $938,000 $1,087,472 S1,228,172 2022 $ $148,194 $959,000 $1,107,194 $1,251,044 2023 $ $147,869 $981,000 $1,128,869 $1,276,019 2024 $ $147,470 $1,004,000 $1,151,470 S1,302,070 2025 $ $ $1,027,000 $1,027,000 S1,181,050 2026 $ $ $1,050,000 $1,050,000 S1,207,500 2027 $ $ $ $ $ 2028 $ _ $ $ $ $ 2029 $ $ $ $ $ 2030 $ $ $ $ $ 2028 $ $ $ $ $ 2029 $ $ $ $ $ 2030 $ $ $ $ $ 2031 $ $ $ $ $ 2032 $ $ $ $ $ 2033 $ $ $ $ $ 2034 $ $ $ $ $ 2035 $ $ $ $ $ 2036 $ $ $ $ $ 2037 $ $ $ $ $ Form Application 1 Incorporated in 62-503.430(1)(a),F.A.C. Page 7 of 10 Effective Date 4-22-14 PART V—SUPPLEMENTARY INFORMATION SCHEDULE OF ACTUAL REVENUES AND DEBT COVERAGE (Provide information for the two fiscal years preceding the anticipated date of the SRF loan agreement.) FY 2014 FY 2015 (a) Operating Revenues(Source) Water and Sewer Sales $7,914,976 $ 8,198,901 Fees and Services $468,830 $452,417 (b) Interest Income $5,909 $ 6,216 (c) Other Income or Revenue(Identify) Miscellaneous Income (Other Operating Revenue) S 75,983 $ 116,235 Development Fees S 102,105 $ 183,385 (d) Total Revenues S 8,567,803 $8,957,154 (e) Operating Expenses(excluding interest on debt,depreciation, and other non-cash items) S5,348,671 $5,288,285 (f) Net Revenues [(f)=(d)—(e)] S 3,219,132 $3,668,869 (g) Debt Service(including any required coverage) $943,843 $ 1,194,516 (h) Attach audited annual financial report(s),or pages thereof, or other documentation necessary to support the above information. Include any notes or comments from the audit reports regarding compliance with covenants of debt obligations having a prior or parity lien on the revenues pledged for repayment of the SRF Loan. (Attachment#5) (i) Attach worksheets reconciling this page with the appropriate financial statements(for example, backing out depreciation and interest payments from operating expenses). (Attachment# ) (j) If the net revenues were not sufficient to satisfy the debt service and coverage requirement,please explain what corrective action was taken. (Attachment# ) Form Application 1 Incorporated in 62-503.430(lxa),F.A.C. Page 8 of 10 Effective Date 4-22-14