Water Boards
STATE WATER RESOURCES CONTROL BOARD
Division of Financial Assistance
P. O. Box 944212, Sacramento, CA 94244-2120
GENERAL INFORMATION PACKAGE
The General Application and attachments may be submitted in one of three ways. Applicants are encouraged to utilize the Financial Assistance Application Submittal Tool (FAAST) to streamline the application submittal and review process, but if that will create a hardship, email or mail can be utilized instead:
1.) Apply online via the FAAST: https://faast.waterboards.ca.gov To submit a DWSRF Application in FAAST, you must complete all the tabs in FAAST and attach (at minimum) the General Information Package. (Note: Once the DWSRF Application has been uploaded, you must still complete the application by clicking on the "Submit" button.) Once the DWSRF Application is submitted in FAAST, a project manager will be assigned to help the applicant complete the application process.
To submit additional documents for the same project, do not start a new application. Instead, click on the Submitted Applications link on the Main Menu and choose the project from the list of previously submitted applications. Open the Attachments tab, and then the Post-Submission sub-tab. Choose a document from the Attachment Category dropdown list and then select the file to upload. The project manager will receive an email notification letting them know you have submitted additional information for review.
If you need assistance, you can also contact the FAAST Help Desk, which is staffed Monday through Friday 8am through 5pm, at 1-866-434-1083 or [email protected].
2.) To submit a DWSRF Application via email, please use the following email address:
3.) To submit a DWSRF Application via mail, please use the following address:
State Water Resources Control Board
Division of Financial Assistance
P.O. Box 944212
Sacramento, CA 94244-2120
Financial Assistance Application Page 1 of 11 General Information Package (Rev. 10/2020) Drinking Water State Revolving Fund
General Application Instructions
Check the box to indicate the type of project (planning or construction) needing financial assistance.
Section I - Applicant Information
Applicant Name - Enter the entity that will be the legal signatory to a financing agreement.
Street Address, City, State, Zip - Enter the applicant's physical street address. The Zip+4 Code can be found at https://tools.usps.com/go/ZipLookupAction.
Mailing Address, City, State, Zip - Enter the applicant's mailing address, if different from the street address.
Applicant Total Population - Enter the total applicant service area population.
Applicant Total Number of Service Connections - Provide the total number of active service connections that are currently and directly served by the water system. This includes all domestic, residential, industrial, commercial, and other connections.
Current year median household income (MHI) - Enter the current year median household income of the applicant or project service area.
Congressional Districts) - Enter the Congressional districts) where the project will be physically located.
If the project will span multiple Congressional Districts (i.e., a pipeline project), list all affected districts. A map of California Congressional Districts can be found at https://www.house.gov/representatives/find-your- representative.
State Senate Districts) & State Assembly Districts) - Enter the State Senate districts) and State Assembly districts) where the project will be physically located. Refer to http://findyourrep.legislature.ca.govl.
Data Universal Numbering System (DUNS) No. - If you do not already have a DUNS number, you can get more information at https://fedgov.dnb.com/webform/index.jsp. This number is required to receive DWSRF financing.
Federal Tax ID No. - Enter the Federal tax identification number of the applicant.
Authorized Representative Name, Title - Identify the person who has the authority to represent the applicant and sign documents pertaining to the funding application. If the applicant is a public agency or has a governing board, the application must include a copy of a resolution adopted by the governing body designating its authorized representative and authorizing the submission of an application. If the applicant does not have a governing board, then it must provide documentation supporting the authorization of the authorized representative. It is advisable to designate the title of the position authorized to sign and submit an application rather than naming a specific person. The funding application must be signed by the authorized representative.
Auth. Rep. Phone & Email - Enter the authorized representative's telephone number and email address.
Contact Person Name - Enter the name of the person who is the day-to-day contact for the project. This person should be able to answer general questions about the project and application.
Financial Assistance Application Page 2 of 11 General Information Package (Rev. 10/2020) Drinking Water State Revolving Fund
Contact Person Phone & Email - Enter the contact person's telephone number and email.
Local Counsel Name - Enter the name of the applicant's general counsel.
Local Counsel Phone & Email - Enter the local counsel's telephone number and email.
Section II - Project Information and Proposed Schedules Project Title - Enter the title or name of the project.
Project Description and Objectives - Provide a brief description of the project and its objectives.
Current Status of Plans and Specifications - Provide the current status in percent complete.
Amount of Financial Assistance Requested - Provide the amount of financial assistance requested.
Total Project Cost (If More Than the Amount of Assistance Requested) - Provide the total project cost.
Water Supply Permit Number - Enter permit number and attach a copy of the water supply permit, along with any enforcement orders (label as Attachment G1).
Population Served by Project - Enter the population served by the Project.
Estimated Project Schedule - Provide an estimated or actual date for the following:
• Adopt Environmental Documents
• 100% Plans & Specifications
• Start of Construction/Implementation
• Complete Construction/Implementation
Consultation with Other Agencies - Provide the following:
• Name of other federal or state agencies involved in this project (e.g. planning, CEQA/NEPA consultation, funding, etc.)
• Contact information for the named agencies
• Brief descriptions of the status of these consultations Partnering Agencies - Provide the name and contact information of all other agencies that have an interest in the project, their contact information if known, and brief description of their roles.
Other Funding Sources - Provide a list of other funding sources for this project. Include the amount and an estimate date on which the funding will be available.
Section II! - Managerial Information
Classification of Water System - Check the box that represents your type of system. If you are unsure of the classification of your system, refer to the system's domestic water supply permit or refer to the Decision Tree for Classification of Water Systems flow chart located at https://www.waterboards.ca.gov/drinking water/certlic/drinkingwater/documents/publicwatersystems/Decisio nTreeforClassifyingWaterSystems Detailed 08-2012.pdf.
Ownership of the Water System - Check the boxes) that corresponds to the ownership of your water yStem, Non-community water systems are only eligible for DWSRF funding if they qualify as a non-profi entity. Non-profit owners of non-community water systems must include the appropriate IRS non-profit ID Financial Assistance Application Page 3 of 11 eneral Information Packag (Rev. 10/2020) rinking Water State Revolving Fu
number and Tax-Exempt Status form IRS 501(c). Privately owned systems must include a copy of the fictitious name statement. Corporations must provide a copy of their Articles of Incorporation (label as Attachment G2), and a list of officers and directors. If applicable, the applicant must submit a list of shareholders.
Submit copies of all of the ownership documents that correspond to the water system's ownership type. The following is a list of ownership documents for different types of for-profit or non-profit private water systems:
Limited Liability Corporation
• IRS K-1 Corporation Documentation
• Articles of Organization
• Bylaws/Executed Operating Agreements)
Partnership
• Partnership Agreements)
• IRS K-1 Corporation Documentation (if applicable)
• Majority owner's last three years of personal tax returns For-Profit Corporation
• Articles of Incorporation
• Bylaws/Executed Operating Agreements)
• Filing documents for Fictitious Business Name (DBA)
Non-Profit Corporation
• Articles of Incorporation
• Bylaws/Executed Operating Agreements
• IRS Tax Exempt Determination IRS 501 C
• Filing documents for Fictitious Business Name (DBA)
Sole Proprietorship
• Fictitious Name Certificate
• Schedule "E" or "C" of tax returns
Other
• Grant deeds, quitclaim deeds, etc. on land
Municipalities - If the Applicant is a Municipality, indicate if the Applicant is a Charter City.
Corporations - If your water system is a Corporation (i.e. incorporated mutual water company), Limited Liability Company, or Limited Partnership, list your water system's California Secretary of State Entity Number as well as your water system's filing status with the California Secretary of State. Information relating to a Corporation's, Limited Liability's, Limited Partnership's or Incorporated Mutual filing with the Secretary of State can be found at the following website: https://sos.ca.gov/business- programs/business-entities/.
Does the California Public Utility Commission (CPUC) regulate your system? - Indicate whether your water system is regulated by the CPUC. A list of all matters relating to your water system that are currently pending before the CPUC must be provided with your application for DWSRF funding (label as Attachment G3). Water systems regulated by the CPUC must obtain CPUC approval to enter into a funding agreement for DWSRF Names, titles and duties of key officers - Provide the name, title, and duties of key officers of the water system. Submit an organization chart showing the names, titles, and the reporting relationship of all key persons Financial Assistance Application General Information Package (Rev. 10/2020) Drinking Water State Revolving Fund
involved with the operation of the water system (label as Attachment G4). The organization chart does not need to describe all personnel employed by the system, only those persons that have primary responsibilities for making decisions that affect the operation of the water system.
Is there any pending litigation? - Indicate if there is any litigation pending relative to the operation of the water system or the proposed project. If yes, submit a description of the litigation and the potential costs (label as Attachment G5).
Is the applicant leasing land or major water system facilities? - Indicate if the applicant is leasing land or any major water system facilities. If yes, describe the terms of the lease and submit a copy of the lease agreement (label as Attachment G6). If the lease is critical to the location or operation of the proposed project facilities, the term of the lease must be equal to or greater than the loan repayment period of the DWSRF financing.
Include a general map of the service area/boundaries (label as Attachment G7) Does the applicant have a contract with a private firm or another agency? - Indicate if the applicant has a contract with a private firm or another agency for the operation of the facility to be financed. If yes, indicate the name of the firm or agency and term (in years) of the agreement and submit a copy of the agreement (label as Attachment G8).
Prior to the State Water Board's approval of the project, specific water conservation and urban water management requirements must be achieved.
1. Urban Water Suppliers - Urban Water Suppliers (detined as a water supplier, either publicly or privately owned, that directly provides potable municipal water to more than 3,000 end users or that supplies more than 3,000 acre-feet of potable water annually at retail for municipal purposes) must fulfill one of the following (label as Attachment G9):
i. Water Conservation Program
ii. Proof that you signed the "Memorandum of Understanding Regarding Urban Water Conservation in California"
ili. Proof that you submitted an Urban Water Management Plan (UWMP) to the Department of Water Resources (DWR) per Division 6, Part 2.6 of the Water Code (commencing at section 10610)
2. Certification for Compliance with Water Metering Form - Water Code section 529.5 requires urban water purveyors to meet metering requirements. If you are an urban water supplier (i.e., supply to more than 3,000 customers or supplying more than 3,000 acre-feet annually), you must comply with this requirement. Please consult with your legal counsel and review section 529.5 of the Water Code before completing this certification (Attachment G10).
Potential Flags - To avoid potential delays later in the application process, it is required that the applicant complete and submit this worksheet to alert the Division staff of any issues that may potentially affect the application review. (Attachment G11)
Section IV - Attachments
G1 - Water Supply Permit and Enforcement Orders
G2 - Ownership Documentation
Financial Assistance Application Page 5 of 11 General Information Package (Rev. 10/2020) Drinking Water State Revolving Fund
G3 - CPUC Documentation (if applicable)
G4 - Organization Chart (if applicable)
G5 - Pending Litigation (if applicable)
G6 - Lease Agreement (if applicable)
G7 - Service Area Map
G8 - Operating Agreement (if applicable)
G9 - Urban Water Supplier Conservation Document (if applicable) G10 - Certification for Compliance with Water Metering Form (if applicable) G11 - Potential DWSRF Flags Worksheet
Certification and Signature of Authorized Representative • Print the name and title of the authorized representative. • Sign and date the application.
Financial Assistance Application Page 6 of 11 General Information Package (Rev. 10/2020) Drinking Water State Revolving Fund
General Application Package
• PLANNING A CONSTRUCTION
APPLICANT INFORMATION
Applicant Name: CITY OF GONZALES
Street Address: 147 FOURTH STREET City: GONZALES • State: CA Zip+4 Code: 93926 Mailing Address: PO BOX 647 City: GONZALES Zip+4 Code: 93926 . State: CA
Applicant Total Population: 8576
Applicant Total Number of Service Connections: 1900
Current year median household income (MHI): $69,136
Congressional Districts): 20TH DISTRICT OF CALIFORNIA
State Senate Districts): DISTRICT 12
State Assembly Districts): DISTRICT 30
Data Universal Numbering System (DUNS) No.: Federal Tax ID No.:
Authorized Representative Name: Trevin Barber Title: City Manager Phone No.: 831-675-5000 Email Address: [email protected] Contact Person Name: Patrick Dobbins, PE, Public Works Director Phone No.: 831-675-5000 Email Address: [email protected] Local Counsel Name: Michael Rodriquez, City Attorney
Phone No.: (510) 238-1406 Email Address: [email protected] II. PROJECT INFORMATION AND PROPOSED SCHEDULE
Project Title: ALPINE CAMP SYSTEM CONSOLIDATION
Project Description and Objectives:
The Alpine Camp on-site water system has been in violation of the drinking water standard for nitrate and the on-site septic system is reaching the end of its service life. System consolidation would connect the property's utilities to the City of Gonzales municipal water and sewer systems. The existing water system is permitted as River Road WS #25..
Current Status of Plans & Specifications, Percent (%): 100% Estimated Amount of Financial Assistance Requested:
Total Project Cost (If More Than the Amount of Assistance Requested):
Water Supply Permit Number (Attachment G1): City of Gonzales CA2710007, River Road WS #25 CA2701063 Population Served by Project: 65
Estimated or Actual Date
Currently Estimated
Project Schedule: Adopt Environmental Documents: August 29, 2022 100% Plans & Specifications: NOVEMBER 2022
Start of Construction/Implementation: Summer 2023
Complete Construction/Implementation: Fall 2023
Financial Assistance Application Page 7 of 11 General Information Package (Rev. 10/2020) Drinking Water State Revolving Fund
Consultation with Other Agencies
Please list other federal and state agencies that have been involved in this project (e.g. planning, CEQA/NEPA consultation, funding, etc.), their contact information if known, and estimated dates for resolution of any issues.
LAFCO of Monterey County has approved an out-of-area service extension from the Clty to Alpine Camp. POC is Darren McBain, (831) 754-5302, [email protected] Partnering Agencies
Please list all other agencies that have an interest in this project, their contact information if known, and brief descriptions of their roles.
Monterey County Environmental Health Bureau requested that the City extend services to Alpine Camp due to the failing well in River Road WS #25. POC is Cheryl Sandoval, (831) 755-4552, [email protected] Other Funding Sources
List any other funding sources for this project, along with the amount of additional funding and date of availability III. MANAGERIAL INFORMATION
Classification of Water System:
12 Community [Non-transient non-community I Transient non-community • Not currently classified as a public water system
Indicate the Ownership of the Water System (check all that apply):
Include the ownership documentation (See instructions for further information) (label as Attachment G2)
Public Ownership
• Municipality • County Agency • Special District L State Agency Public School Other:
Private Ownership
- Corporation • Limited Liability Corporation • Partnership • Sole Proprietorship + Non-profit Organization I Other:
If the water system is privately-owned, indicate the name and title of the individual with authority to engage the water system in a DWSRF financing agreement. Click or tap here to enter text • Ifthe Water System is a Municipality, is the Water System a Charter City? DYes No •Ifthe Water System is a Corporation, Limited Liability Company, or Partnership, complete the following:
A. California Secretary of State Entity Number:
Financial Assistance Application Page 8 of 11 Drinking Water late Retonig and (Rev. 10/2020)
Status with California Secretary of State:
• Active I Suspended •Forfeited Dissolved
Is the Water System regulated by the California Public Utilities Commission (CPUC)? [ Yes [No If yes, the Water System must obtain CPUC approval. Attach a list and a description of all matters) relating to your Water System that are currently pending before the CPUC (label as Attachment G3).
List the names, titles and duties of key officers and attach an organization chart providing this information (label as Attachment G4).
City of Gonzales
Mayor - Jose Rios
City Manager - Carmen Gil
Public Works Director - Patrick Dobbins, PE
Public Works Supervisor - Tiffany Twisselmann
Is there any litigation pending relative to the operation of the water system or the proposed project? • Yes I No
If yes, attach a description of the litigation and the potential costs (label as Attachment G5).
Is the Water System leasing land or major water system facilities? EYes [No If yes, describe the terms of the lease or attach a copy of the lease agreement (label as Attachment G6). (NOTE: If the lease is critical to the location or operation of the proposed project facilities, the term of the lease must be equal to or greater than the loan repayment period.)
Include a general map of the service area/boundaries (label as Attachment G7):
LAFCO map of the City of Gonzales is attached
[For Construction Projects Only] Does the Water System have a contract with a private firm or another agency for the operation of the facility to be financed? Yes No
If yes, provide the name of the firm or agency and term. (in years) of the agreement and attach a copy of the agreement (label as Attachment G8)
Water Conservation
1. Are you an urban water supplier as defined in Water Code Section 10608.12? •YES ENO
Urban water suppliers must submit one of the following (Label as Attachment G9):
• Water Conservation Program
• Signed the Memorandum of Understanding regarding urban water conservation in California • Urban Water Management Plan per Water Code Section 10653 inancial Assistance Applicatiol Page 9 of 11 Drinking Water Sale Revo grand Rev. 10/2020
2. Attach Certification for Compliance with Water Metering Form (label as Attachment G10).
IV. ATTACHMENTS
G1 - Water Supply Permit and Enforcement Orders
G2 - Ownership Documentation
G3 - CPUC Documentation (if applicable)
G4 - Organization Chart
G5 - Pending Litigation (if applicable)
D G6 - Lease Agreement (if applicable)
G7 - Service Area Map
G8 - Operating Agreement
G9 - Urban Water Supplier Conservation Document (if applicable) G10 - Certification of Compliance with Water Metering Form (if applicable) G11 - Potential DWSRF Flags Worksheet
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: Title:
Signature of Authorized Representative: Date:
Attachment G10
Financial Assistance Application Page 10 of 11 General Information Package (Rev. 10/2020) Drinking Water State Revolving Fund
Attachment G4
City of Gonzales
FY 2022 - 2023
Council Member Mayor Pro Tem Mayor Council Member Council Member Liz Silva Scott Funk Jose L. Rios Lorraine Worthy Paul Miller Executive Asst to the City Manager/ City Attomey
Deputy City Clark City Manager/City Clerk/Successor Agency Director (Contracted) Mary Villegas Michael Rodriquez
Assistant City Manager Depputy City Maneger/
Mark Hartunian Special Profects Dir.
Vacant
Admin. Assistant i
Noemi Gregorio
Bidg. Officlal (Contr.) Communiy Dev. Director Public Works Director/ Police Chief Finance Director (Contr.) Fire Chief Dir. of Community Engagement Vacant Taven Kinison Brown City Engineer Keith Wise Green's Accounting Jason Muscio & Stratego Partneratipo Patrick Dobbins Mike Howard Carmen Gil
Development Services
Tech./Admin Analyst Admin. Assistant !! Captain Sr Accounting Techniolen Recreation Coord/ Alejandra Flores Anabel Almanza Juan Mendoza Vacant Fire Lieutenants Admin. Analyst Kyler Monares Jessica Olmedo
Pubic Works Supervisor Boss. Aest. to the chee Police Services Tech. David Achen Tiffany Twisslemann Records Supervisor Andrea Zepeda David Vasquez Lifeguards/Ree Alds Andrea Casillas Seasonal/Part-Time
Lead Worker Sergeants Firefighters
Frank Valladarez Admin. Assistant I Santiago Melgoza Erik Prader Sports & Senior Techniclan Esther Valdez Herbert Bowen Christian Avina Program Coordinator Andrew Lujan Vacant Isabel Navarro
Corporals
Mechanic Cesar Castillo Volunteer Firefighters Youth Program Coord.
Raymundo Vasquez Maintenance Workers Nathan Cordoba Part time (3) Julie Douglas
1. Martin Espinoza
David Martinez Officers Ald Power Academy
Roverto Zavala Alfonso Carrillo i Part-Time
Jaime Vasquez Alex Pruneda i
Curtis Snively Eric Serrano Domm. Hoalth Workore
Frankie Nava Miguel Perez Guillermina Flores
Ulyses Fierros Monica Rico
Vacant (3)* Maria Flores
Lizette De Leon
Jose Chavez
* Two conditional offers out and one in the backround phase Attachment G7
OLD STAGE RD
ASSOCIATED LN FANE RD-
JOHNSON CYN RD
101
CORDA RD ALTA ST
IVERSON RD
GLORIARD
GONZALES RIVER RD
Alpine Camp/
River Road Water System #25
Salinas River
City Limits
¡ Sphere of Influence
Permanent Agricultural
Edge (2014)
LAFCO of Monterey County CITIES
LOCAL AGENCY FORMATION COMMISSION
GONZALES
P.O. Box 1369 132 W. Gabilan St., Suite 102 2,000 4,000 Salinas, CA 93902 Salinas, CA 93901 Last LAFCO-Approved Change: 09/22/2014 Telephone (831) 754-5838 FAX (831) 754-5831 Feet Map Prepared: 09/25/2014 Attachment G10
CERTIFICATION FOR COMPLIANCE WITH WATER METERING
REQUIREMENTS FOR FUNDING APPLICATIONS
1100K0I
Water Board
Funding Agency Name: State Water Resources Control Board Funding Program Name: Drinking Water State Revolving Fund Applicant (Agency Name): City of Gonzales
Please check one of the boxes below and sign and date this form.
As the authorized representative for the applicant agency, I certify under penalty of perjury that the agency 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 agency, I certify under penalty of perjury that the applicant agency 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 Agency 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 Agency may withhold disbursement of project funds, and/or pursue any other applicable legal remedy.
Name of Authorized Representative: Title: City Manager
Signature of Authorized Representative: Date:
Financial Assistance Application Page 11 of 11 Dinking Water State Revolving rund (Rev. 10/2020)