Forms

• PDF [44KB] 
  Facilities Plan Checklist/Guidance PDF [44KB] 
• DOC [63KB] 
  Loan Application Form (NDWILF11) DOC [63KB] 
  For projects ranked on the DWSIRLF Intended Use Plan (IUP) Priority List, this document must be completed and submitted by the Loan Application Package deadline in the IUP. [info]
• PDF [2MB] 
  DWSIRLF Request for Ranking and Consideration for Funding PDF [2MB] 
  Form 1298, March 14, 2022
• PDF [425KB] 
  Davis Bacon Certification PDF [425KB] 
  March 8, 2022
• PDF [265KB] 
  Application for Federal Assistance SF-424 PDF [265KB] 
• PDF [319KB] 
  Application for Federal Assistance SF-424 Instructions PDF [319KB] 
• PDF [347KB] 
  Supplemental General Conditions for Construction of Drinking Water Systems PDF [347KB] 
  HDWI077 - April 27, 2016
• PDF [309KB] 
  Required Contract Document Provisions Drinking Water Systems Improvements Revolving Loan Fund Projects PDF [309KB] 
  HDWI75 - April 27, 2016
• DOCX [37KB] 
  FFY2021-FFY2023 DWSIRLF Request for Ranking and Consideration for Funding Form DOCX [37KB] 
• PDF [226KB] 
  Supplemental General Conditions for Construction of Drinking Water Systems, Attachment 1 - EPA DBE-WBE Directory PDF [226KB] 
  HDWI077 - June22, 2017
• DOC [28KB] 
  Procurement Certification (NDWILF74) DOC [28KB] 
  This document is a Related Item which must be completed and included as part of a complete loan application package.
• DOC [39KB] 
  Debarment/Suspension Certification (NDWILF88) DOC [39KB] 
  This document is a Related Item which must be completed and included as part of a complete loan application package.
• DOC [27KB] 
  Legal Certification (NDWILF69) DOC [27KB] 
  This document is a Related Item which must be completed and included as part of a complete loan application package.
• PDF [85KB] 
  Pre-award Compliance Review Report (EPA Form 4700-4) PDF [85KB] 
  To view this form download it to your device and view with the latest Adobe Acrobat Reader. This document is a Related Item which must be completed and included as part of a complete loan application package.
• DOC [42KB] 
  Sample User Charge Ordinance/Resolution (NDWILF39) DOC [42KB] 
  This document is an example to assist in preparation of a Related Item which must be prepared and included as part of a complete loan application package.
• DOC [80KB] 
  Engineering Services Contracts Checklist (NDWILF44) DOC [80KB] 
  This document contains guidance to assist in preparation of a Related Item which must be prepared and included as part of a complete loan application package.
• DOC [28KB] 
  Sample Authorizing Resolution (NDWILF7) DOC [28KB] 
  This document is an example to assist in preparation of a Related Item which must be prepared and included as part of a complete loan application package.
• PDF [26KB] 
  Plans, Specifications, and Contract Documents: Checklist/Guidance PDF [26KB] 
• DOC [45KB] 
  Payment Request Form (HDWILF8) DOC [45KB] 
  This document must be used to request reimbursement of DWSIRLF loan eligible costs.