Introduction: State infrastructure financing authorities, herein referred to as "State Revolving Fund Programs," seeking Water Infrastructure Finance and Innovation Act (WIFIA) credit assistance under the State Revolving Fund WIFIA (SWIFIA) program must complete and submit a letter of interest to the U.S. Environmental Protection Agency (EPA). Based on the information provided in the letter of interest, EPA will invite selected State Revolving Fund Programs to apply for WIFIA credit assistance. 
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Purpose: State Revolving Fund Programs submit the letter of interest materials to provide EPA with the necessary information to: 1) validate the eligibility of the prospective borrower and the projects to be included in the loan; 2) perform a preliminary creditworthiness assessment; 3) perform a preliminary engineering feasibility assessment; and 4) evaluate the prospective borrower and proposed loan against the selection criteria. ___________________________________________________________________________________
Format: To be considered for WIFIA credit assistance, State Revolving Fund Programs must submit a letter of interest that: 1) describes its program; 2) outlines the proposed financial plan for the loan; 3) provides key program documents; and 4) identifies how the loan meets the selection criteria of the WIFIA program. Please reference the latest Notice of Funding Availability (NOFA), the WIFIA program handbook, and frequently asked questions (FAQ) available at http://www.epa.gov/wifia for additional instructions and information.

Responses to the all questions should be included in this form unless otherwise specified in the question's instruction. Upon completion, the total length of the letter of interest form should not exceed 30 pages, excluding any attachments. Font size should not be smaller than 11-point Calibri.
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Submission: Letters of interests must be submitted to EPA by the deadline stated in the Notice of Funding Availability (NOFA). Source documents may be draft or preliminary. Please provide the most recent version available at the time of submission. 

The documents may be submitted in two ways: 
 Email the documents as attachments to wifia@epa.gov. 
 Upload the documents to EPA's SharePoint site.  To be granted access to the SharePoint site, prospective borrowers can request access to SharePoint by emailing wifia@epa.gov.  Requests to upload documents must be made in advance of the deadline as outlined in the NOFA.

Upon receipt, EPA will provide a confirmation email. If you have questions on completing this letter of interest, please consult the WIFIA website (www.epa.gov/wifia) or contact the WIFIA program office at wifia@epa.gov. 
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Confidential Business Information (CBI): A prospective borrower may assert a business confidentiality claim covering part or all of the information submitted to EPA as part of its letter of interest, in a manner consistent with 40 C.F.R. 2.203, 41 Fed. Reg. 36902 (Sept. 1, 1976), by placing on (or attaching to) the information a cover sheet, stamped or typed legend, or other suitable form of notice employing language such as trade secret, proprietary, or company confidential. The prospective borrower should also state whether it desires confidential treatment until a certain date or until the occurrence of a certain event.  Information covered by a business confidentiality claim will be disclosed by EPA only to the extent and only by means of the procedures set forth under 40 C.F.R. Part 2, Subpart B.  Information that is not accompanied by a business confidentiality claim when it is received by EPA may be made available to the public by EPA without further notice to the prospective borrower.

More information about CBI is available in the WIFIA program handbook and frequently asked questions (FAQ) available at http://www.epa.gov/wifia.
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Burden: The public reporting and recordkeeping burden for this collection of information is estimated to average 45 hours per response.  Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, included through the use of automated collection techniques to the Director, Regulatory Support Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address. ___________________________________________________________________________________
Warning: Falsification or misrepresentation of information or failure to file or report information required to be reported may be the basis for denial of financial assistance by EPA. Knowing and willful falsification of information required to be submitted and false statements to a Federal Agency may also subject you to criminal prosecution.  See, for example, 18 U.S.C. §1001.
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SWIFIA LETTER OF INTEREST FORM
Provide the requested information in the response boxes. Narrative answers can reference source documents (include the name of the document and relevant pages or sections). Provide any referenced documents as attachments.

Section A: Loan Information

 Legal name of prospective borrower:

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 Other names under which the prospective borrower does business: 

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 Business street address: 

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 Program website: 

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 Employer/taxpayer identification number (EIN/TIN):

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 Dun and Bradstreet Data Universal Number System (DUNS) number:

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 Requested amount of the WIFIA loan (in dollars): 

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 Estimated total eligible costs (in dollars): 

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 Describe quantitative or qualitative benefits the loan will achieve. (Word limit: 500).

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 Requested loan structure (select only one):
         ☐ OPTION 1: WIFIA program adopts SRF program's existing indenture
         ☐ OPTION 2: SRF program accepts WIFIA program's standard terms

 For OPTION 1, answer the following questions: 
   
 Will the WIFIA loan be at parity with all SRF outstanding debt obligations?
         
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 What is the requirement of the additional bonds test in your existing indenture?
         
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 Is all the debt in your existing indenture at parity?
         
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 Does your indenture require a debt service reserve?
         
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 For OPTION 2, answer the following questions: 
   
 Does the SRF program have an existing indenture?
         
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 Does the SRF program have existing debt? If yes, explain. 
         
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 Provide information about the underlying loans included in the total eligible costs:
 Percentage backed by a general obligation pledge: Click or tap here to enter text.
         
 Percentage backed by a revenue pledge: Click or tap here to enter text.

 Are borrowers required to have an additional bonds test? Click or tap here to enter text.


 Complete the following sources and uses of funds table, including the proposed WIFIA assistance. 

Sources Category
Estimated Dollar Value 
1. WIFIA Loan
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2. Revenue Bonds
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3. Borrower Cash
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4. Federal Grant
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5. Interest
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6. Principal Repayments
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7. Other (please specify) Click or tap here to enter text.
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8. Other (please specify) Click or tap here to enter text.
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TOTAL SOURCES
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Project Name
Estimated Cost
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TOTAL USES
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 Describe the proposed credit terms of the WIFIA assistance:
 Identify the security pledge: Click or tap here to enter text. 
 Identify the maturity date (term):  Click or tap here to enter text. 
 Identify the amortization structure:  Click or tap here to enter text.        


Section B: Supporting Documents

Provide the most recent versions of the following documents as attachments. The document is required unless otherwise noted:

 Attachment 1: Intended Use Plan
 Attachment 2: Annual Report to EPA Region
 Attachments 3-5: Audited program financials for the previous 3 years
 Attachment 6: SRF Sample loan agreement
 Attachment 7:  Projected Revenue Certificate, which includes pledged loan repayments, annual debt service, and debt service coverage for all outstanding debt until maturity (for SRF programs with existing debt) OR the projected revenue from loan repayments for the life of the SRF loan (for SRF programs with no debt).
 Attachment 8: Existing rating agency reports (if available)
 Attachment 9: Procedures for reviewing project's Preliminary Engineering Report (PER)
 Attachment 10: Procedures for the conducting the state environmental review
 Attachment 11: Documentation of SRF program's priority setting system
 Attachment 12: Bond Indenture (if applying for OPTION 1)
 Attachment 13: Most recent Official Statement (if applying for OPTION 1)


Section C: Project List
Complete the following table for the projects that are included in the total eligible project costs. Add or delete rows as needed. Alternatively, this information may be provided in Excel spreadsheet marked as attachment 14.

No.
Borrower
Project Name
Brief Description (1-2 sentences)
City
County
Population
Loan Amount
Status and Finding of State Environmental Review
Design Start and End Date
Construction Start and End Date
Estimated Loan Closing Date
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Section F: Contact Information 
 Primary point of contact 
      
   Name:  Click or tap here to enter text.
   Title:  Click or tap here to enter text.
   Organization:  Click or tap here to enter text.
   Street Address:  Click or tap here to enter text.
   City/State/Zip:  Click or tap here to enter text.
   Phone:  Click or tap here to enter text.
   E-mail:  Click or tap here to enter text.
      

 Secondary point of contact

   Name:  Click or tap here to enter text.
   Title:  Click or tap here to enter text.
   Organization:  Click or tap here to enter text.
   Street Address:  Click or tap here to enter text.
   City/State/Zip:  Click or tap here to enter text.
   Phone:  Click or tap here to enter text.
   E-mail:  Click or tap here to enter text.
 
Section G: Certifications
Please sign in the appropriate space and submit a scanned version of the signature page to EPA with your electronic Letter of Interest submission.

 National Environmental Policy Act:  The undersigned acknowledges that EPA will not approve a loan until a final agency determination, such as a Categorical Exclusion (CATEX), Finding of No Significant Impact (FONSI), or a Record of Decision (ROD), has been issued.
 American Iron and Steel:  The undersigned acknowledges that any project receiving credit assistance under this program for the construction, alteration, maintenance, or repair of a project may only use iron and steel products produced in the United States and must comply with all applicable guidance.
 Prevailing Wages:  The undersigned acknowledges that all laborers and mechanics employed by contractors or subcontractors on projects receiving credit assistance under this program shall be paid wages at rates not less than those prevailing for the same type of work on similar construction in the immediate locality, as determined by the Secretary of Labor, in accordance with sections 3141-3144, 3146, and 3147 of Title 40 (Davis-Bacon wage rules).
 Lobbying:  Section 1352 of Title 31, United States Code provides that none of the funds appropriated by any Act of Congress may be expended by a recipient of a contract, grant, loan, or cooperative agreement to pay any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, or an employee of a Member of Congress in connection with the award or making of a Federal contract, grant, loan, or cooperative agreement or the modification thereof. The EPA interprets this provision to include the use of appropriated funds to influence or attempt to influence the selection for assistance under the WIFIA program.
WIFIA prospective borrowers must file a declaration: (a) with the submission of an application for WIFIA credit assistance; (b) upon receipt of WIFIA credit assistance (unless the information contained in the declaration accompanying the WIFIA application has not materially changed); and (c) at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the information contained in any declaration previously filed in connection with the WIFIA credit assistance.
The undersigned certifies, to the best of his or her knowledge and belief, that:
 No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.
 If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
 The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.
         This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
 Debarment:  The undersigned further certifies that it is not currently: 1) debarred or suspended ineligible from participating in any Federal program; 2) formally proposed for debarment, with a final determination still pending; or 3) indicted, convicted, or had a civil judgment rendered against it for any of the offenses listed in the Regulations Governing Debarment and Suspension (Governmentwide Nonprocurement Debarment and Suspension Regulations: 2 C.F.R. Part 180 and Part 1532).
 Default/Delinquency:  The undersigned further certifies that neither it nor any of its subsidiaries or affiliates are currently in default or delinquent on any debt or loans provided or guaranteed by the Federal Government.
 Other Federal Requirements:  The undersigned acknowledges that it must comply with all other federal statutes and regulations, as applicable.  A non-exhaustive list of federal cross-cutting statutes and regulations can be found at: https://www.epa.gov/wifia/wifia-resources#complianceanchor. 
 Signature:  By submitting this letter of interest, the undersigned certifies that the facts stated and the certifications and representations made in this letter of interest are true, to the best of the prospective borrower's knowledge and belief after due inquiry, and that the prospective borrower has not omitted any material facts. The undersigned is an authorized representative of the State Revolving Fund Program.

Signature: ____________________________________________________________________________


Date Signed: Click or tap to enter a date.

Name:  Click or tap here to enter text.
Title:  Click or tap here to enter text.
Organization:  Click or tap here to enter text.
Street Address:  Click or tap here to enter text.
City/State/Zip:  Click or tap here to enter text.
Phone:  Click or tap here to enter text.
E-mail:  Click or tap here to enter text.


KEY DEFINITIONS

 Administrator means the Administrator of EPA.

 Credit assistance means a secured loan or loan guarantee under WIFIA.

   
 Eligible project costs mean amounts, substantially all of which are paid by, or for the account of, an prospective borrower, including the cost of:
 Development-phase activities, including planning, feasibility analysis (including any related analysis necessary to carry out an eligible project), revenue forecasting, environmental review, permitting, preliminary engineering and design work, and other preconstruction activities;
 Construction, reconstruction, rehabilitation, and replacement activities;
 The acquisition of real property or an interest in real property (including water rights, land relating to the project, and improvements to land), environmental mitigation (including acquisitions pursuant to section 33 U.S.C. §3905(7)), construction contingencies, and acquisition of equipment; and
 Capitalized interest necessary to meet market requirements, reasonably required reserve funds, capital issuance expenses, and other carrying costs during construction.
   
 Iron and steel products means the following products made primarily of iron or steel: lined or unlined pipes and fittings, manhole covers and other municipal castings, hydrants, tanks, flanges, pipe clamps and restraints, valves, structural steel, reinforced precast concrete, and construction materials.

 Project means:
 1 or more activities that are eligible for assistance under section 603(c) of the Federal Water Pollution Control Act (33 U.S.C. 1383(c)).
 1 or more activities described in section 1452(a)(2) of the Safe Drinking Water Act (42 U.S.C. 300j - 12(a)(2)).
         
 State infrastructure financing authority means the State entity established or designated by the Governor of a State to receive a capitalization grant provided by, or otherwise carry out the requirements of, title VI of the Federal Water Pollution Control Act (33 U.S.C. 1381 et. seq.) or section 1452 of the Safe Drinking Water Act (42 U.S.C. 300j - 12).

 WIFIA means the Water Infrastructure Finance and Innovation Act of 2014, Pub. L. 113-121, 128 Stat, 1332, codified at 33 U.S.C. §§ 3901-3914.

