830-RICR-10-10-1
830-RICR-10-10-1. Drinking Water State Revolving Fund Loan Policies and Procedures (version Periodic Refile, 12/13/2001 to 03/17/2004)
RHODE ISLAND CLEAN WATER FINANCE AGENCY
LOAN POLICIES AND PROCEDURES II
Loan Policies and Procedures established to govern the lending activities
of the Drinking Water State Revolving Fund.
Revised September, 2001
AUTHORITY: Policies and Procedures adopted in accordance to Chapter 46-12.8 of
the General Laws of Rhode Island and the Safe Drinking Water Act Amendments of 1996.
RHODE ISLAND CLEAN WATER FINANCE AGENCY
LOAN POLICIES AND PROCEDURES II
I.
PURPOSE: The within Loan Policies and Procedures of the Rhode Island Clean Water Finance
Agency (Agency) have been established to govern the lending activities of the Drinking Water State
Revolving Fund (DWSRF) in accordance with Chapter 46-12.8 of the General Laws of Rhode Island,
and the Safe Drinking Water Act Amendments of 1996.
II.
DEFINITIONS: The words and phrases used within these Loan Policies and Procedures have the same
meaning as the words and phrases have in Chapter 46-12.8 of the General Laws of Rhode Island and
the Safe Drinking Water Act Amendments of 1996.
III.
FINANCIAL ASSISTANCE: The objective of these Policies and Procedures is to provide financial
assistance from the DWSRF to those borrowers certified as eligible participants by the Rhode Island
Department of Health, Drinking Water Quality Division (DOH).
Application for debt refinancing, guarantee or purchase of insurance for local debt obligations or for
other non-construction activities such as planning and design will be considered by the Agency based
on the projects’ rank on DOH’s Project Priority List. DOH’s rank will be based on the original purpose
of the project for which the funding is being requested. Refinancing of privately organized water
suppliers is not allowed under the DWSRF program.
In the event that the Agency receives more requests for loans than it has funds available in federal
fiscal year, it will award loans first to those eligible applicants who rank highest in chronological order
on the Project Priority List.
IV.
LOAN APPLICATION: Request for financing should be submitted in writing by the Chief Executive
Officer of the water supplier to the Executive Director of the Agency. The written request must include:
1)
A description of the project(s) to be financed with the projected construction and completion
schedule.
2)
A description of the dedicated source of loan repayment, i.e. general revenues from property
taxes or water system revenues from user fees.
3)
Legal authority or authorities to construct, finance and operate the project, if applicable.
4)
The past five years Audited Financial Statements in accordance with Generally Accepted
Government Accounting Standards or Generally Accepted Accounting Principals; or some other
source of historical information that the Agency, as a lender, deems appropriate.
5)
A copy of the Infrastructure Replacement Plan component of the Water Supply Management
Plan if applicable.
6)
An application that proposes to purchase an existing water system must be accompanied by a
certification of the water system’s integrity by a registered professional engineer. A certification
as to the appraised value of the system must also be provided. The Agency reserves the right
to review this certification and request further data for analysis.
V.
LOAN APPROVAL PROCESS: Project approvals are subject to the issuance and terms of Certificate
of Approval by the DOH. Prior to loan approval, the Agency will conduct a financial capability analysis
based primarily on the soundness of the operating and coverage ratios of the water system.
The following basic criteria shall be applied by the Agency during the loan approval process:
1)
availability of DWSRF funds;
2)
completeness of application including required documents;
3)
accuracy of information, and;
4)
creditworthiness of applicant pursuant to these regulations.
For the determination of creditworthiness, the Agency will require the following information to make its
financial capability assessment:
sources of revenue and financial liquidity;
historical and projected financial operating results;
present and future debt service requirements;
current assignment of water rates and other revenues generated from user fees;
ability to increase water rates and/or secure alternative revenue sources;
cost of the project and estimated completion schedule;
long term capital replacement planning for entire system;
socioeconomic conditions and trends;
board, management and ownership structure, qualifications and experience;
presence of regulator control;
a Consulting Engineer’s Water Facility and Financial Feasibility Report, if applicable;
history of applicant/system;
any other information that the Agency or its Board of Directors may require.
Refer to Attachment A for more information regarding the financial capability analysis to be performed
by this Agency prior to DWSRF loan approval.
Those publicly owned community water systems that have market experience will provide to the
Agency the same information as asked for above, and their most recent Official Statement. The minimum
requirement for satisfaction of the financial capacity threshold is a proforma coverage ratio of at least 125%.
The Agency will also examine historical debt service coverage ratios.
The Agency will individually assess the ability of Privately Organized Community Water Suppliers to
provide loan security and meet debt service requirements of a DWSRF loan. The Agency reserves the right to
limit the amount of financings to Privately Organized Community Water Systems to 5% of the total loans
outstanding in the DWSRF.
If the financial capability analysis indicates that the applicant has the capacity to meet its obligations
over the loan term, the Board of Directors of the Agency will vote to approve the application identifying the
Name of Borrower, Project Description(s), Project Cost(s), the final maturity of the Loan and any other
Conditions of the Loan. The borrowers will have the opportunity to identify potential issues with initial loan
terms at this point. Based on borrowers concession of initial loan terms and the Agency’s Board of Directors'
approval, a Commitment Letter will be issued to the Applicant for its acceptance. Once the Commitment Letter
has been executed, the Agency will meet with the applicant to structure the Loan Agreement as to interest rate,
amortization schedule, source of repayment, security/credit enhancements, and loan covenants.
VI.
TERMS AND CONDITIONS:
1)
Interest Rate - The interest rate for borrowers will be 25% off their market rate of borrowing.
The Agency, in cooperation with its advisors, will determine the borrower’s current market rate
of borrowing. However, the interest rate for small publicly owned community water systems and
small privately organized community water suppliers, those serving fewer than 10,000 persons,
(a “Small Borrower”) may be set by the Agency at 3.0% for Loans up to $300,000.
2)
Interest- Interest will be fixed over the life of the loan; will be calculated on the basis of a 360
day year (twelve thirty day months) on the outstanding loan balance; will be paid on a schedule
to be determined by the Agency (monthly/semi-annually) and may be capitalized during
construction.
3)
Loan Fees- The Agency will charge an Origination Fee of .5% (one half of one percent) of the
face amount of the loan at closing with a minimum of $1,000. All out of pocket closing costs will
be paid by the borrower and may be capitalized as part of the loan as permitted by the
Environmental Protection Agency (EPA). These costs included but are not limited to:
Borrower’s Costs of Issuance including Borrower Counsel and Borrower Financial Advisor;
Agency Costs of Issuance including Agency Counsel, Agency Bond Counsel, and Agency
Financial Advisor;
Agency Underwriting cost and bond insurance costs, and
other closing costs including document printing and binding.
The Agency will also charge an annual Service Fee of .5% (one half of one percent) of the outstanding
principal payable semi-annually at each interest payment date. A late payment fee of 5.0% of the amount of
the payment will be charged for every 15 days that a payment is late.
4)
Amortization- Amortization will begin within one year after completion of construction. Principal
payments will be made annually on September 1st and the schedule of payments will be
structured to meet the debt service and financial assistance needs of the borrower.
5)
Final Maturity- Loans may mature up to twenty years after the completion of a project. The final
maturity of a loan will be a factor in determining the level of financial assistance to a borrower.
6)
Prepayments- The loan may be prepaid by the borrower at any time but may be subject to a
prepayment penalty based on the cost of reinvesting the prepayment, the cost of prepaying
outstanding bonds of the Agency or any other negative financial impact to the Agency.
7)
Security/Credit Enhancement- Loans will have a general pledge of (a) general revenues and/or
water system user fee revenues; and (b) may be secured by any assets and/or credit
enhancements which the Agency deems appropriate to protect the interest of the other
participants in the loan programs of the Agency; bond holders; other creditors of the Agency; or
the finances of the Agency.
8)
Construction Progress Payments- Progress payments for each construction project will be made
through a Construction Proceeds Fund (CPF). Loan proceeds will be transferred monthly from
the CPF for each borrower based upon approved Requisition Forms submitted to the Agency,
(Attachment B). Upon receipt of the Requisition Form, the Agency will verify a) that a Certificate
of Approval has been issued by DOH; b) the vendor is identified in the contract; and c) there is
sufficient availability in the CPF to make the payment. Payments will be made directly to the
vendor and/or the Borrower for reimbursements by the Agency, and a "paid" stamped copy of
the Requisition Form will be sent to the Borrower and DOH.
The DOH will perform periodic project inspections to a) monitor construction progress; b) verify
eligibility of construction costs under the program; and c) insure construction is in conformity with Plans and
Specifications. The DOH will provide a copy of the inspection report to the Agency. Any adverse conditions
will be reported to the Agency who will suspend further payments until the adverse conditions have been
rectified. The DOH will perform a final project inspection before the final payment is made by the Agency.
VII.
REPORTING REQUIREMENTS: Borrowers will be required to provide information to the Agency during
the life of the loan. The Agency may ask for information from the Borrower during the term of
indebtedness that is not listed here:
1)
A copy of its Annual Audited Financial Statements in accordance with Generally Accepted
Government Accounting Standards or Generally Accepted Accounting Principals, annually
within 180 days of end of fiscal year.
2)
An annual analysis of Operating Revenues and Expenses with an emphasis on the status of the
water system user fee revenues and/or general revenues securing the loans and operating
expenses in excess of budget, annually within 180 days of the end of fiscal year.
3)
A copy of the annual budget of the Borrower, within fifteen days of its adoption.
4)
Annual schedule of current and projected short term and long term debt service.
5)
An annual schedule of Infrastructure Replacement Reserves, if applicable.
6)
Copies of reports submitted to DOH, DEM, the EPA, the Rhode Island Public Utilities
Commission and any other regulatory agency relating to the projects financed and the operation
of the water supply facility.
VIII.
LOAN AGREEMENTS: There will be a Loan Agreement for each application outlining the terms and
conditions of the Loan. The Loan will be evidenced by a general obligation pledge, pledge of water
system revenues, note(s) and/or bond(s) in "fully marketable form" or some other source of security
deemed appropriate by the Agency.
IX.
COMPLIANCE WITH STATE AND FEDERAL LAW: Recipients of loans must comply with all
applicable state and federal laws and regulations.
X.
MODIFICATIONS: Where deemed appropriate by the Agency, waiver or variation of any provisions
herein may be made or additional requirements may be added.
XI.
LOAN PORTFOLIO MANAGEMENT AND SERVICING: The Agency will manage and service its loan
portfolio to insure there will be no substantial adverse effect on other participants in the loan programs
of the Agency; bond holders; other creditors of the Agency; or the finances of the Agency. In this
regard, the Agency will:
1)
Maintain its books and records to comply with Federal and State laws and regulations.
2)
Manage its credit reviews, loan approvals, loan documentation, and loan collection to meet
standards established by the Agency Board of Directors, Rating Agencies and Bond Insurers.
3)
Limit the loans to privately organized borrowers to a level which is covered by adequate Debt
Service Reserves, Credit Insurance or other forms of Credit Enhancements. The Agency has
determined this level to be 5% of the total loans outstanding.
4)
Utilize an accounting system which is in compliance with Section VIII of the Agency's
Accounting Policies and Procedures.
5)
Prepare annual Credit Reviews for each borrower to insure compliance with the financial
covenants of the Loan Agreement and to insure there are no adverse changes in a borrower's
financial condition and/or capacity to repay a loan.
____________________________________
Anthony B. Simeone, Executive Director
Public Notice Date: August 18, 2001
Public Hearing Date: August 27, 2001
Filed With Secretary of State: September 26, 2001
Effective Date: October 17, 2001
ATTACHMENT A
SELECTED FINANCIAL INFORMATION
to be
PROVIDED BY THE BORROWER
SAMPLE
RHODE ISLAND CLEAN WATER FINANCE AGENCY
Credit Review for the
SMITHFIELD WATER SUPPLY BOARD
Based on FY2000 Audited Financial Statements
I.
INTRODUCTION
The Town of Smithfield which is primarily a residential community is situated approximately eleven miles northwest
of Providence. The Town of Smithfield was settled in 1636 and incorporated as a town in 1730. Since November 1994,
Smithfield operates under a Council/ Town Manager form of government. The Town Manager is appointed by the Town
Council and serves at its pleasure as the administrative head of government and is responsible for all departments except
the school department. Legislative and policy-making powers are vested in the five member Town Council. Members are
elected at large for two year terms.
Smithfield provides retirement benefits for most of its employees through various retirement funds. As of June 30,
2000, in the Municipal Employees Pension Plan, and in the Police and Fire Pension Plan, Smithfield has contributed 100%
of the Annual Pension Cost.
A.
Litigation
The Town is a defendant in various suits, including tax valuation cases, claims for false arrests, wrongful
death, water and sewer assessments, police brutality, and zoning violations. At the present, the legal counsel for
the Town is unable to predict the outcome of the loss, if any, that may result from these matters. Accordingly, no
provision for any liability has been made in the financial statements for these pending cases.
II. DEBT ANALYSIS
A.
Outstanding Debt and Debt Service Schedule
Table I shows the existing indebtedness of the Town. Smithfield Water Supply Board (SWSB) currently
doesn’t have any loans outstanding and they have not been the recipients of any grants. General Long-Term Debt
as of June 30, 2000 totaled $10,555,483. Moody’s has confirmed an “A1” rating on Smithfield’s General Obligation
Debt. The Town has currently two loans with the Agency. The Town has a 99C loan in the amount of $150,000 and
they have a Facility Plan loan in the amount of $75,000. The Town of Smithfield anticipates borrowing
approximately up to $85,000 for a twenty-year loan term from the Drinking Water SRF.
SAMPLE
Table I
Town of Smithfield
Outstanding Debt
Type Of Debt
Outstanding At
6/30/00
Proforma DWSRF
Loan
Total
General Long Term Debt
$10,220,103
$10,220,103
Enterprise Fund
335,380
85,000
420,380
Total
$10,555,483
$85,000
$10,640,483
B.
Debt Service Schedule
Table II shows the debt service requirements over the next several years for Smithfield’s existing
obligations and the proforma Drinking Water SRF loan.
Table II
Smithfield Water Supply Board
Debt Service Requirements
Year
General
Long-Term
Debt
Enterprise
Funds
Proforma
SRF Loan
Total
2001
$1,472,372
$82,252
$1,554,624
2002
1,414,334
78,977
2,884
$1,496,195
2003
1,365,628
76,285
6,544
$1,448,457
2004
1,313,015
48,286
6,529
$1,367,830
2005
1,240,023
45,974
6,514
$1,292,511
2006
1,143,508
37,417
6,498
$1,187,423
2007-2016
5,688,159
2,684
$101,275
$5,792,118
Total $13,637,039
$371,875
$130,244
$14,139,158
C.
Debt Ratios
Periodically, Moody’s Investors Service publishes a list of medians for water and sewer service providers
which provides a rudimentary basis for examination of an entity’s credit worthiness. These medians allow an entity
to compare certain of its debt value ratios to the nation-wide median for entities of similar size. The ratios provided
by Moody’s include the following:
1.
Operating Ratio- Operating and maintenance expenses of SWSB divided by its total operating
revenues for a given year.
SAMPLE
2.
Debt Service Coverage- Net revenues divided by yearly debt service requirements for the year.
3.
Debt Ratio- Net funded debt divided by the sum of the net fixed assets plus net working capital.
Table III compares SWSB to Moody’s Medians for three performance measurements. SWSB’s operating
ratio was 65.68% in FY 00 compared to Moody’s 1999 Median of 59.4%. The SWSB debt service coverage ratio
was 2.45X in 2000, compared to Moody’s 1999 Median of 1.7X, and SWSB’s debt ratio was 8.94% compared to
Moody’s 1999 Median of 43.2%. The standard deviation for these three ratios respectively are 13.9%, 1.9%, and
29.0%. Please note that Moody’s has not yet published its Year 2000 Medians thusly, the previous years medians
are being used. Please note that in FY 98, Moody’s did not publish medians thusly for comparison purposes
Moody’s 1997 medians are being used.
Table III
Smithfield Water Supply Board
Debt Ratios, Last Four Fiscal Years
Year
Smithfield Water
Operating Ratio
Moody's
Median
Smithfield Water
Debt Service
Coverage
Moody's
Median
Smithfield
Water
Debt Ratios
Moody's
Median
2000
65.68%
59.40%
2.45
1.7 X
8.94%
43.20%
1999
71.49%
59.40%
1.72
1.7 X
9.65%
43.20%
1998
72.30%
63.00%
0.42
2.3 X
10.24%
30.30%
1997
70.70%
63.00%
2.66
2.3 X
10.96%
30.30%
III.
SOURCES OF REVENUE
A.
Cash Flow Analysis
Table IV shows the cash flow position for SWSB for the last four fiscal years. SWSB ended Fiscal Years
1997 through 1999 in a strong cash position however in FY 2000 it had a negative cash balance of $4,025.
According to the Finance Director, Smithfield negative cash balance was only temporary and is due to the fact that
there was an increase in payments being processed at year end and that transfer payments to the General Fund
were being made at year end.
SAMPLE
Table IV
Smithfield Water Supply Board
Cash Flow Analysis
FY 00
FY 99
FY 98
FY 97
Net Cash From Operating Activities
($37,541)
$128,018
$114,223
$228,729
Net Cash (used)From Non-Financial Activities
($47,045)
($28,970)
($39,755)
($41,658)
Net Cash From Capital & Financing Activities
$0
Cash Flow From Investment Activities
$0
($41,989)
($760,077)
($329,408)
Net Increase (Decrease) In Cash
($84,586)
$57,059
($685,609)
($142,337)
Cash At Beginning Of Year
$80,561
$23,502
$709,111
$851,448
Cash At End Of Year
($4,025)
$80,561
$23,502
$709,111
B.
Current Rate Structure
SWSB is not subject to the regulatory authority of the Public Utilities Commission in regards to the setting
of user rates. The Smithfield Water Supply Board charges $1.94 per thousand of gallons of water for its residential
and commercial users. It has approximately 1500 users. Residential and commercial rates have increased 5% from
the previous year while wholesale rates have increased 7.6%; while private fire protection rates remained the
same. Table V below outlines the Board’s current rate structure:
Table V
Smithfield Water Supply Board
Current Rate Schedule
Customer Type
Effective 2001
Effective February 15
2000
Effective
1999
Effective
1998
*Residential
Commercial
$1.94
$1.84
$1.76
$1.76
Wholesale
$1017.00/mg
$945.00/mg
$904.00/mg
$870/mg
Public Fire
Protection
$200/yr
per hydrant
$200/yr
per hydrant
$190.00/yr
per hydrant
$190.00/yr
per hydrant
* Residential and Commercial prices are based on per thousand gallons of water
mg = millions of gallons
IV.
OPERATING PERFORMANCE - Income Statement Trends-
As can be seen from Table VI below, Smithfield Water has shown a positive net income position for the last four
fiscal years. Net income totaled $115,169 at June 30, 2000.
SAMPLE
Table VI
Smithfield Water Supply Board
Income Statement Trends
FY 00
FY 99
FY 98
FY 97
Operating Revenues
$758,936
$723,795
$692,265
$608,959
Operating Expenses
577,425
594,315
569,319
485,974
Operating Income
181,511
129,480
122,946
122,985
Non-Operating Revenues:
(66,342)
(79,701)
(106,224)
(12,287)
Net Income
$115,169
$49,779
$16,722
$110,698
% Net Income/Operating
Revenues
15%
7%
2%
18%
V.
Statistical information for the Town of Smithfield
The ratios examined in Table VII below include Direct Net Debt per Capita and Ratio of Direct Net Debt to
Estimated Full Value for the Town for Fiscal Year 2000 based on year end 1999 valuations ( the most current information
available). The Agency has learned that Moody’s will no longer publish these medians; therefore, the Agency is in the
process of researching alternate sources for this statistical information.
Table VII
Direct Net Debt
(Per Capita in Ratio to Estimated Full Value)
Year
End
12/30
Popu-
lation
Assessed
Value
Ratio
of
Assmt.
Bonded
Debt &
Bans
Estimated
Full Value
Debt
Per
Capita
Ratio
Debt to
F.V.
2000 20,613
$1,076,150,848
99%
$10,555,483
$1,087,248,848
$512.08
0.97%
1999 19,163
$1,112,971,514
99%
$11,582,663
$1,123,747,031
$604.43
1.03%
1998 19,163
$1,077,003,180
99%
$12,370,000
$1,088,019,670
$645.51
1.14%
1997 19,163
$1,050,712,250
99%
$13,970,000
$1,061,366,030
$729.01
1.32%
1996 19,163
$1,023,583,347
99%
$5,940,000
$1,033,672,799
$309.97
0.57%
VI.
SOCIOECONOMIC CONDITIONS
A.
Population:
As can be seen from Table IX, the Town’s population has shown an increase of 7.5% between the 1990
and 2000 census. According to the 2000 census, the Town of Smithfield has a population of 20,613.
SAMPLE
Table IX
Population Trends
Year
Population
2000
20,613
1990
19,163
1980
16,886
1970
13,468
1960
12,031
B.
Employment:
Smithfield is a growing suburb just north of Providence. Although most residents commute throughout the
metro area for work, a developing commercial and industrial sector has increased the Town’s employment base.
The recent location of Fidelity Investments has increased the number of jobs in the area by 1,074, making it the
largest employer within the community. The Town’s unemployment rate, as shown in Table X has been generally
below the State averages; in FY 2000 Smithfield’s unemployment rate was 3.9%.
Table X
Unemployment Rates
Unemployment Rates
1995
1996
1997
1998
1999
2000
Smithfield
7.0%
5.5%
4.2%
4.1%
3.9%
3.9%
Rhode Island
7.0%
4.8%
5.3%
4.9%
4.4%
4.1%
Table XI
Smithfield’s Largest Employers
Employer
Type of Business
Number of Employees
Fidelity Investments
Investment Services
1074
Bryant College
Business College
660
Uvex Safety
Manufacturer
340
Accessories Associates, Inc.
Manufacturer
275
The Stop & Shop., Inc.
Supermarket Operator
225
Prepared By: Anna Coelho
Reviewed By: Anthony Simeone
August 7, 2001
ATTACHMENT B
SAMPLE CONSTRUCTION REQUISITION FORM
SAMPLE
Date:_________________________
Rhode Island Clean Water Finance Agency
235 Promenade Street, Suite 119
Providence, RI 02908
Attention: Anthony B. Simeone, Executive Director
Re:
Borrower
Project
Requisition for Approved Project Costs
Ladies and Gentlemen:
Pursuant to Section 5 of the Loan Agreement dated as of ____________, ______ between the
Rhode Island Clean Water Finance Agency (the “Agency”) and _______________, Inc., (the
“Borrower”), we hereby request disbursement in the amount of $____________________ for
project costs. In connection with this requisition, we hereby represent and certify the following:
1.
This is requisition number ______.
2.
Payments aggregating $______________ have been incurred by the Borrower for
projects costs for the period from __________________ to __________________ as
set forth in Exhibit A hereto. As set forth in Exhibit B hereto, are true copies of vendor,
contractor or supplier invoices, or such other documentation, satisfactory to the Agency,
identifying the payee, and purposes for which such expenditures were incurred.
3.
The aggregate amounts of payments on account of project costs are within the project
definition.
4.
The Certificates of Approval from the Department of Health (“DOH”), together with all
other applicable DOH approvals have been obtained on account of the project.
5.
The amount requested hereby, together with all prior requisitions, does not exceed the
amount of the loan.
6.
In the case of a requisition for the reimbursement of project costs paid in the first
instance by the Borrower, all of such costs are within all applicable guidelines for
reimbursement financing, and none of such costs have been the subject of any prior
requisition.
7.
The representations and warranties contained in Section 2 of the Loan Agreement were
true and correct as of the date of the Loan Agreement and were true and correct as of
the date hereof, with the same effect as if made on this date.
8.
In accordance with the Loan Agreement, the Borrower represents and warrants as
follows:
(I)
it is in compliance in all material aspects with all laws, ordinances and rules and
regulations affecting or relating to the Project;
(II)
it has used all previously disbursed loan proceeds and will use all loan proceeds
to be disbursed to pay a portion of the costs of the Project or to reimburse itself
for costs of the Project which it has paid and which have not been the subject of
any prior disbursement;
(III)
it is not in default hereunder.
_____________________________________
By: Duly Authorized Officer
SAMPLE
EXHIBIT A
DRINKING WATER STATE REVOLVING FUND (“DWSRF”) PROGRAM
PROJECT PAYMENT REQUISITION FORM
DATE:____________________________
APPLICANT: __________________________________________________________________
PROJECT NAME/NUMBER: _____________________________________________________
PERIOD COVERED: _______________________________________________________________
TASK
TOTAL REQUEST
(BORROWER)
TOTAL APPROVED
FOR PAYMENT
(Agency)
COMMENTS
A. Administrative/
Legal Expenses
B. Planning/Design
A/E Fees
C. Basic A/E Fees
D. Other A/E Fees
E. Project Inspections
F. Construction Costs
G. Miscellaneous
H. Total Cost
I. Amount Due this Request
J. Percent Complete
Signature –
Authorized
Official:
Date:
For the Borrower:
Typed Name &
Title:
Telephone:
Signature – A/E
Representative:
Date:
CERTIFICATION: I certify that to
the best of my knowledge and
belief the billed disbursement costs
are in accordance with the terms of
the project; that the reimbursement
represents expenses for which
requisitions have not previously
been made in accordance with
approved project costs.
A/E Representative
Certifying Line H:
Typed Name &
Title:
Telephone:
EXHIBIT B
Attached hereto are true and complete copies of vendor, contractor or supplier invoices, or such other
documentation satisfactory to the Agency, identifying the payee and purposes for which such
expenditures were incurred.
EXHIBIT C
[Description of extent to which representations and covenants made in the Arbitrage and Use of
Proceeds Certificate furnished by the Borrower are no longer true and correct.]
EXHIBIT D
[Description of extent to which representations and warranties of clauses (____) and (____) of
Section _____ of the Loan Agreement are no longer true and correct as of the date of this requisition.]
EXHIBIT E
[Description of extent to which representations and covenants made in any certificate furnished in
connection with the delivery of the Borrower Bonds is no longer true and correct as of the date of this
requisition.]