STATE OF CALIFORNIA PRINT SAVE Division of Financial Assistanc STATE WATER RESOURCES CONTROL BOARD lean Water State Revolving Fun P. O. Box 944212, Sacramento, CA 94244-2120
PLANNING OR DESIGN
FINANCIAL ASSISTANCE APPLICATION
I. APPLICANT INFORMATION
Applicant (Entity) Name: City of Gonzales
Entity Type: × Public - Local Public - State • Indian Tribe • Nonprofit • Other: Specify Charter City/County: Yes No
Street Address: 147 4th Street City: Gonzales State: CA Zip+4 Code: 93926 Mailing Address: P.O. Box 647 City: Gonzales State: CA Zip+4 Code: 93926 Congressional Districts): 20th
State Senate Districts): 12th
State Assembly Districts): 30th
County (or Counties): Monterey
Regional Water Board: • 1 (North Coast) •2 (San Francisco Bay) x 3 (Central Coast) • 4 (Los Angeles)
• 5 (Central Valley) •6 (Lahontan) L 7 (Colorado River) 8 (Santa Ana) L 9 (San Diego) Federal ID No.: 946000341 Data Universal Numbering System (DUNS) No.: 004948303 Authorized Representative Name, Title: Patrick Dobbins, Public Works Director Phone No.: (831 ) 675-5000 Email Address: [email protected] General Contact Person Name:
Phone No.: ( Email Address:
Financial Contact Person Name: Mike Howard
Phone No.: ( 831) 647-5562 Email Address: [email protected] Legal Counsel Name: Michael Rodriquez
Phone No.: ( 510) 238-1406 Email Address: [email protected] Bond Counsel Name (if applicable):
Phone No.: ( ) Email Address:
II. PROJECT INFORMATION
Project Title: Gonzales WWTP Improvements
CWSRF Planning/Design Financing Amount Requested: $5,000,000 III. PROJECT SERVICE AREA DEMOGRAPHICS
Active Service Connections Not Applicable
Projected Monthly Service
Connection Type Number of Connections Current Monthly Service Charge Charge at Planning Completion* Residential 1,779 $ $
Commercial 143 $ $
Industrial 39 $ $
Other $ • $
TOTAL 1,961 $ $
*Rate increase effective date for projected monthly service charges:
State Use Only
CWSRF Project #
Project Manager
Date Received
Financial Assistance Application Page 1 of 6 Clean Water State Revolving Func (Planning or Design
(Rev. 09/2017)
Date of the most recent Proposition 218 public hearing:
Current Year Median Household Income: $ 69,136 Current Year Estimated Population Served: 8,576 Are less than 50% of residences permanently occupied? Yes No IV. REGULATORY INFORMATION
NPDES Permit and/or WDR Order No.: R3-2006-0005
Has enforcement action occurred as a result of the water quality problem? • Yes • No V. COMPLIANCE WITH URBAN WATER MANAGEMENT AND WATER RIGHTS REQUIREMENTS Are you an Urban Water Supplier*? • Yes • No
• If yes, have you submitted an Urban Water Management
Plan to the Department of Water Resources? • Yes • No
*An Urban Water Supplier provides water for municipal purposes either directly or indirectly to more than 3,000 customers or supplies more than 3,000 acre-feet of water annually. The Urban Water Management Planning Act, Water Code, Section 10631.5, requires every urban water supplier to prepare and adopt an Urban Water Management Plan that includes specific elements.
Is your entity a water diverter and subject to section 5103 of the Water Code? • Yes • No VI. DISCUSSION OF MATERIAL EVENTS, MATERIAL OBLIGATION CONDITIONS, AND ANY DEBT LIMIT Identify any current, prior or pending material events such as bankruptcy, defaults, litigation, grant jury findings, unscheduled draws on reserve funds, substitution of insurers or their failure to perform, unscheduled draws on credit enhancements, actions taken in anticipation of filing Chapter 9, rating changes, relevant conditions in material obligations, and any local debt limit.
The City does not have any outstanding debt obligations to the Wastewater Enterprise Fund.
Please provide website link or PDF copy of your Debt Management Policy:
VIl. ATTACHMENTS
1 - Plan of Study
2 - Certification for Compliance with Water Metering Form 3 - Regional Water Quality Control Board Requirements
4 - Authorizing Resolution/Ordinance
5 - Relevant Service, Management, Operating or Joint Powers Agreements 6 - Audited Financial Statements (3 years)
7 - Rate Adoption Resolution/Ordinance
The following attachments are not required for Small Disadvantaged Communities applying for 100% grant. If a loan determination applies, applicant must submit all attachments. • 8 - Budgets or Projections (2 years)
9 - Pledged Revenues and Fund(s) Resolution/Ordinance
10 - Related Debt or no Debt Letter
11 - Debt Management Policy
CERTIFICATION AND SIGNATURE OF AUTHORIZED REPRESENTATIVE To the best of my knowledge and belief, I certify that I am authorized to submit this application; the information provided in this application is true and correct; the documentation has been duly authorized by the governing body of the applicant; and the entity possesses the legal authority to apply for the financing and enter into a financing agreement with the State Water Resources Control Board and to finance and construct the proposed facilities.
Name of Authorized Representative: TRIC/ DOBENS Tite:PUBLIC WORKS DIRECTOR Signature of Authorized Representative: RAMRICK DOBBINS Date: 11/22/2022.
Financial Assistance Application Page 2 of 6 Clean Water State Revolving Fund (Planning or Design) (Rev. 10/2017)
ATTACHMENT 2
CERTIFICATION FOR COMPLIANCE WITH WATER METERING
REQUIREMENTS FOR FUNDING APPLICATIONS
ITE OF CALFOND Water Boards
Funding Entity name: City of Gonzales
Funding Program name: Clean Water State Revolving Fund
Applicant (Entity name): City of Gonzales
Please check one of the boxes below and sign and date this form.
As the authorized representative for the applicant Entity, I certify under penalty of perjury that the Entity is not an urban water supplier, as that term is understood pursuant to the provisions of section 529.5 of the Water Code.
As the authorized representative for the applicant Entity, I certify under penalty of perjury that the applicant Entity has fully complied with the provisions of Division 1, Chapter 8, Article 3.5 of the California Water Code (sections 525 through 529.7 inclusive) and that the ordinances, rules, or regulations submitted with this certification as listed below have been duly adopted and are in effect as of this date.
I understand that the Funding Entity will rely on this signed certification in order to approve funding and that false and/or inaccurate representations in this Certification Statement may result in loss of all funds awarded to the applicant for its project. Additionally, for the aforementioned reasons, the Funding Entity may withhold disbursement of project funds, and/or pursue any other applicable legal remedy.
PARTICK DOZEiNS PUBLIC WORKS DIPECTOR
Name of Authorized Representative Title
(Please print)
PATRICK DOEDENNS 11/22/2022
Signature of Authorized Representative Date
Financial Assistance Application Page 3 of 6 Clean Water State Revolving Fund (Planning or Design) (Rev. 10/2017)
ATTACHMENT F4
AUTHORIZING RESOLUTION/ORDINANCE
RESOLUTION NO:
WHEREAS _RESOLVED BY THE
(insert appropriate findings) (insert name of Governing Board of the Entity) OF THE (the "Entity"), AS FOLLOWS:
(insert Entity name)
The (the "Authorized Representative") or designee is
(insert Title of Authorized Representative)
(insert Project Name)
This Authorized Representative, or his/her designee, is designated to provide the assurances, certifications, and commitments required for the financial assistance application, including executing a financial assistance agreement from the State Water Resources Control Board and any amendments or changes thereto.
The Authorized Representative, or his/her designee, is designated to represent the Entity in carrying out the Entity's responsibilities under the financing agreement, including certifying disbursement requests on behalf of the Entity and compliance with applicable state and federal laws.
CERTIFICATION
I do hereby certify that the foregoing is a full, true, and correct copy of a resolution duly and regularly adopted at a meeting of the held
(insert name of Governing Board of the Entity)
on
(Date)
(Name, Signature, and Seal of the Clerk or Authorized Record Keeper of the Governing Board of the Agency) Financial Assistance Application Page 4 of 6 Clean Water State Revolving Fund (Planning or Design) (Rev. 10/2017)
ATTACHMENT F9
PLEDGED REVENUES AND FUND(S) (PRF) RESOLUTION
WHEREAS
(insert appropriate findings regarding intent, authority, and procedure) THEREFORE BE IT RESOLVED, the (the "Entity") hereby
(insert Entity name)
dedicates and pledges
(insert exact name of revenue stream and designated fund containing those revenues) to payment of any and all Clean Water State Revolving Fund and/or Water Recycling Funding Program financing for (the "Project"). The
(insert Project name and 4-digit CWSRF Project number)
Entity commits to collecting such revenues and maintaining such fund(s) throughout the term of such financing and until the Entity has satisfied its repayment obligation thereunder unless modification or change is approved in writing by the State Water Resources Control Board. So long as the financing agreements) are outstanding, the Entity's pledge hereunder shall constitute a lien in favor of the State Water Resources Control Board on the foregoing fund(s) and revenues) without any further action necessary. So long as the financing agreements) are outstanding, the Entity commits to maintaining the fund(s) and revenues) at levels sufficient to meet its obligations under the financing agreements).
CERTIFICATION
I do hereby certify that the foregoing is a full, true, and correct copy of a resolution duly and regularly adopted at a meeting of the
(insert name of Governing Board of the Entity)
on
(Date)
(Name, Signature, and Seal of the Clerk or Authorized Record Keeper of the Governing Board of the Agency) Financial Assistance Application Page 5 of 6 Clean Water State Revolving Fund (Planning or Design) (Rev. 10/2017)
ATTACHMENT F10
RELATED DEBT
The following related debts are senior to the proposed CWSRE financing:
Name of Debt Debt
Lender and Security or Debt Service Original Term &
Title of Debt or Source of Coverage Debt Current Payment Interest Maturity Loan Number Revenue Requirement Rating Amount Balance Amount Rate Date $ $ $
$ $ $ /
$ $ /
The following related debts are on parity to the proposed CWSRF financing:
Name of Debt Debt
Lender and Security or Debt Service Original Term &
Title of Debt or Source of Coverage Debt Current Payment Interest Maturity Loan Number Revenue Requirement Rating Amount Balance Amount Rate Date $
$ $ $ /
$ $ $
$ $ $
The following related debts are subordinate to the proposed CWSRF financing:
Name of Debt Debt
Lender and Security or Debt Service Original Term &
Title of Debt or Source of Coverage Debt Current Payment Interest Maturity Loan Number Revenue Requirement Rating Amount Balance Amount Rate Date $ $ $
$ $ $ 1
$ $ $ /
$ $ $
Attach copies of the debt documents associated with the above debts.
Financial Assistance Application Page 6 of 6 Clean Water State Revolving Fund (Planning or Design) (Rev. 10/2017)