For the WIFIA Application Instructions
The U.S. Environmental Protection Agency (EPA) will invite selected applicants to submit an application for Water Infrastructure Finance and Innovation Act (WIFIA) loans. Unsolicited applications will not be considered. Following selection, each selected applicant will be assigned a transaction team led by an underwriter. The transaction team can answer the applicant's questions regarding the application form, its attachments, and the project review, negotiation, and closing processes. 

The applicant should answer all questions in this form. It may indicate if a requirement is not applicable to its project. Narrative answers can reference source documents by including the name of the document and relevant pages or sections and providing any referenced documents as attachments. The applicant must sign the Certification in the appropriate space and submit a scanned version of the signature pages to EPA. If the applicant anticipates a delay in one or more source documents, it should discuss the situation with its transaction team and indicate the anticipated date of submitting that document in the application. Additionally, the applicant is required to notify and submit to EPA any updated application materials that become available during the review period. EPA may request additional items from applicants on a case-by-case basis.

Resources regarding WIFIA program eligibility; completing a letter of interest and application; how loans are selected and closed; as well as post-close expectations are available in the WIFIA program handbook. It is highly recommended to use this document as a companion when developing your letter of interest. For general information about WIFIA, consult the WIFIA website (www.epa.gov/wifia). Additional information specific to the current project selection round can be found in the NOFA, and questions may be submitted to the WIFIA program office at wifia@epa.gov. 

The applicant may assert a Confidential Business Information (CBI) 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 applicant 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 applicant. More information about CBI is available in the WIFIA program handbook and frequently asked questions (FAQ) available at http://www.epa.gov/wifia.

The applicant must submit a non-refundable application fee. The application fee is $25,000 for an application for a project serving small communities (population of not more than 25,000 people). For all other project applications, the application fee is $100,000. For further information regarding the application fee, as well as the credit processing fee which will be charged at loan closing, and any other applicable fees, please see the WIFIA fee rule.
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WIFIA Application Submission
The final application submission must include:
 Completed application form;
 All attachments requested and referenced in this form; and 
 The application fee.
The applicant should reference the supporting document checklist provided on page 4 to ensure all needed information is provided in the application submission. Upon receipt of the application fee and materials, EPA will provide a confirmation email. 

Application Form and Attachment Submittal: When finished, the application form and attachments must be uploaded to EPA's SharePoint site.  To be granted access to the WIFIA SharePoint site, the applicant should email the WIFIA Underwriter assigned to the applicant with the names and emails of all staff that need access. 

Application Fee Submittal: The applicant should use of Pay.gov to make electronic payments to EPA. In Pay.gov, the applicant can track its payments to EPA and schedule recurring or automatic payments. Although it is not mandatory to register for a user id to access and use Pay.Gov, registration is recommended to have access to all Pay.gov system functionality. To use Pay.gov, follow these instructions:
 Access the Pay.gov system by going to https://www.pay.gov and search for WIFIA or click on the following hyperlink to directly launch the WIFIA Loan Collection & Fees Form.
 Provide the following information on the payment to ensure proper credit:
 Remitter's contact phone number
 Company/Organization Name as it appears on EPA document
 Complete address, including city, state, zip code
 Project Name
 Loan Number: this is EPA WIFIA Loan number, NOT the remitter's number
 From the "Payment Type" drop down menu select "Application Fee (Fee01)" 
 Other Description: please enter the EPA WIFIA Loan number followed by -FEE01, for example 16123DC-FEE01
 Follow the remaining on‐screen instructions to successfully process the payment to EPA.
 Send an email to OCFO-OC-ACD-WIFIA@epa.gov and wifia_portfolio@epa.gov informing that a payment has been made.

The application fee may also be paid via FEDWIRE; for questions about payments, email to OCFO-OC-ACD-WIFIA@epa.gov and wifia_portfolio@epa.gov. For detailed payment instructions, contact the WIFIA program. 
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Burden
The public reporting and recordkeeping burden for this collection of information is estimated to average 200 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, including 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 the Environmental Protection Agency. 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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Additional information is available at https://epa.gov/wifia and by contacting wifia@epa.gov.

SUPPORTING DOCUMENT CHECKLIST
The applicant should submit its completed application form plus all relevant supporting documents listed in the checklist as attachments or links.
Question
Supporting Document(s)
Included
Not Applicable
Application Fee  -  Refer to fee instructions on page 2

Section A:  Key Applicant and Loan Information (No Supporting Documents)

Section B:  Applicant Background

2. Alternate Legal Entity
 Authorizing or organizational documents relating to such entity.
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4. Statistical Information
 Comprehensive Annual Financial Report or similar
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5. Capital Improvement Planning Process
 Current Capital Improvement Plans
 Current Year Capital Budget
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6. System Condition
 System Master Plan
 System Condition Assessment
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Section C:  Financing Plan

2. Rate Setting Process
 Rate Studies
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4. Preliminary Rating Letter
 Preliminary Rating Letter
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5. Audited Financial Statements 
 Audited Financial Statements (2 years)
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6. Cash flow pro forma(s)
 Cash flow pro forma
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7. Sample Documentation
 Master Indenture or Master Bond Resolution
 Most Recent Bond Issuance
 Most Recent SRF Loan Agreement (if co-funding with SRF)
 Outstanding loan agreements 
 Major water/sewer purchase agreements 
 Major wholesale water/sewer agreements 
 Terms of any customer assistance program
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Section D:  Federal Requirements 

1.Other Federal Agency National Environmental Policy Act (NEPA) Documentation
 Environmental Assessment (Draft or Final)
 Environmental Impact Statement (Draft or Final)
 Supporting Documentation
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2. PEA
 WIFIA Programmatic Environmental Assessment Questionnaire
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3. SRF Environmental Review
 SRF Findings
 SRF Consultation Documentation
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4. Federal Environmental Cross-Cutting Authorities 
 National Historic Preservation Act
 Endangered Species Act
 Essential Fish Habitat 
 Other:
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7. Tribal Consultation and Coordination
 Tribal Correspondences
   
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9. Additional Forms
 EPA 6600-06  -  Certification Regarding Lobbying
 SF-LLL  -  Disclosure of Lobbying Activities
 EPA 4700-4  -  Preaward Compliance Review Report
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Section E:  Contract Information (Refer to Supplemental Spreadsheet)

Complete Section E of spreadsheet and indicate which of the following attachments are included:
 Project Map
 Preliminary Engineering Report
 Preliminary Design Report
 Planning Document
 Executed Contract Documents
 Procurement Documents
 Detailed project schedule(s)
 Engineer's Cost Estimate associated with detailed project scope
 Existing Operation and Maintenance Plan
 Professional Service Contract or similar evidence of new Operation and Maintenance Plan to be developed
 Risk Mitigation Plan/Matrix
 Project Management Plan
 Evidence of Experience with similar projects
 Draft of Final Bid Specifications with required language
 Sample of Final Bid Specifications with required language


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Certifications with signature
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APPLICATION FORM
Provide the following information in this form. Narrative answers can reference source documents (include the name of the document and relevant pages or sections). Provide any referenced documents as attachments or links. Please refer to the WIFIA Program Handbook for support in answering these questions. If your question is not covered in the Handbook or is specific to your project, please reach out to your assigned underwriter for pre-application assistance. 
Section A: Key Applicant and Loan Information
 a.  Legal name of prospective applicant:
      b.  If a different entity is proposed to enter into the WIFIA loan documents as the borrower on behalf of the applicant, provide the legal name of such entity:

 Project name (for purposes of identification assign a short name to the project):

 Provide a brief description of the project(s) seeking financing. Limit the description to the elements included in the estimated total projects costs in Question A-7. 

 Describe the project's or projects' purpose(s) (including quantitative or qualitative details on public benefits the project will achieve). If the loan contains more than one project, the projects must serve a common purpose. Describe the common purpose that the projects share (e.g. addressing sanitary sewer overflows or improving drinking water quality).

 Describe any changes to the project description or purpose since LOI submission:

 Requested amount of the WIFIA loan (in dollars): 

 Total Eligible Project Costs

 Estimated total eligible project costs (in dollars): 

 Amount by which eligible project costs have changed since the letter of interest submittal (if applicable):

 Anticipated Closing Date and any factors driving such date:  

 Applicant Contact Information
Team Member
Name and Title
Email
Phone Number
Authorized Signatory



WIFIA Point of Contact



Financial Advisor



Bond Counsel



Project Manager 



Environmental Review Contact:



Engineering Contact 



Other:  



Other: 




 Employer/taxpayer identification number (EIN/TIN):
 
 Unique Entity Identifier (previously Dun and Bradstreet Data Universal Number) number:

 Is the applicant registered in the System for Award Management (SAM) with an active status?
 Yes
 No
      At loan closing, borrower will need to provide a PDF or JPEG screenshot that shows evidence of the SAM registration and an "active status" for the entity receiving the WIFIA loan
      

Section B:  Applicant Background
 Describe the authorizing actions and additional documentation required by the applicant in order to enter into a loan agreement with the WIFIA program (e.g. one or two readings by board/council/commission; any local/voter/bondholder approvals; any applicable waiting periods; supplemental ordinance/resolution). 

 If the applicant intends to use another legal entity to enter into the WIFIA loan documentation, such as a joint powers authority, financing authority/corporation, cooperative, or other similar arrangement, provide the authorizing or organizational documents relating to such entity.

 Disclose any current, threatened, or pending litigation involving the applicant related to permitting, public involvement, environmental irregularities, construction defects, securities fraud, conflict of interest, failure to perform under a State or Federal contract, or other charges which may reflect on the applicant's financial position or ability to complete the project(s).

 Statistical information regarding the borrower and its service area will be required to underwrite the loan. Examples include historic water and sewer rates, pension and OPEB liabilities, outstanding debt, population, median household income, average customer bill, customer breakdown (i.e., residential, commercial, industrial) and concentration among top users. Please indicate the name and location of the publicly available document (e.g. CAFR, etc.) where this information can be found.  If no such document exists, please contact your underwriter for further guidance. 

 Describe the applicant's capital improvement planning process. Include a capital improvement plan and current year capital budget. 

 Provide the latest system condition assessment report or master plan available for the water and/or wastewater system this project supports. If a report or plan is unavailable, provide a brief description of significant facilities (e.g. pump stations or treatment plants) within the system, including construction and major rehabilitation dates, and any asset management processes utilized for the system.

 If applicable, describe community outreach efforts conducted to date and planned for the project(s).  Include community meetings, outreach sessions and groups contacted.

 Provide a description of the environmental, societal, or quality of life benefits to the community as a result of the project, such as (but not limited to), improving system resiliency, mitigating climate change, supporting small and/or disadvantaged communities, improving access to safe water, addressing contaminants, developing the water workforce.

 Will the project assist in complying with applicable regulatory requirements?
 Yes
 No
      If yes, describe how the project assists with regulatory compliance.
Section C: Financing Plan
In preparing this section, please consult with your assigned underwriter to ensure all questions are answered completely and accurately. 
 Provide a sources and uses of funds table for the proposed project(s).
Sources Category
Estimated Dollar Value 
1. WIFIA Loan (cannot exceed 49% of eligible costs)

2. Bonds

3. SRF Loan

4. Borrower Cash

5. Other (please specify) 

6. Other (please specify)

TOTAL SOURCES

Uses Category
Estimated Cost
1.  Planning (from Column Q of Section E)

2.  Design (from Column R of Section E)

3.  Construction (from Column S of Section E)

4.  Project Management[a] (from Column U of Section E)

 Land Acquisition 

6.  Additional Contingency [b]

7.  Total Capital Costs

8.  Financing Costs

9. Other (please specify)  

10. Other (please specify)  

TOTAL USES


[a] Costs related to the management and oversight of the project, not factored elsewhere
[b] Additional contingency include cost factors (separate from the construction contingency included in the estimated cost for Construction) that contribute to your total capital costs. This may include adjustments to market conditions or additional project contingency considerations.  


 Describe the rate setting process, including regulations governing rate setting, approval requirements, timing for implementation, and specify if recommended rate adjustments were ever rejected. Please attach the most recent rate study, if available.




 Complete the following table of proposed credit terms of the WIFIA loan.   
 
Credit Term
Proposed Credit Term for WIFIA loan
Source(s) of Repayment and Security Pledge for the WIFIA loan
[e.g., combined sewer and water revenues of the utility]

Lien Priority
 Senior Lien: all debt for the project (including WIFIA) will be senior/first lien debt.

 Subordinate Lien: all debt for the project (including WIFIA) will be subordinated/second lien debt.

 Subordinate with Springing Lien*: project debt may include debt senior to WIFIA loan. 
Evidence of WIFIA debt obligation
    Bond
    Promissory Note
    To be determined
    Other (explain):
WIFIA Loan Maturity Date

      * Springing lien means that while the WIFIA debt will be subordinated/second lien debt at closing, upon a bankruptcy related event, the WIFIA debt will automatically spring to parity with the borrower's senior/first lien debt.
 If a credit rating was not provided with the letter of interest, or if a newer credit rating is available, please attach it. Indicate below if the credit rating provided with the letter of interest should be used for the application. The rating should match the proposed credit terms in question C-3.

 Provide the year-end audited financial statements for the applicant for past two (2) years, as an attachment or provide a link to where they can be found (e.g., borrower website, EMMA). Please include an explanation of any anomalies such as nonrecurring expenses, revenue windfalls, or new revenue sources. 

 Attach the financial model for the project(s) security structure. All amounts should be expressed on a cash (year-of-expenditure) basis and should clearly show assumptions used to arrive at such estimates.  Please include an explanation of any anomalies such as nonrecurring expenses, revenue windfalls, or new revenue sources. A sample pro forma can be found here along with additional guidance in the WIFIA Handbook. 

 If applicable, provide copies of the following documents:
 Governing debt issuance documents, such as a master bond resolution or indenture (including all amendments)
 Most recent bond issuance documents (e.g. offering statement; supplemental)
 If an SRF loan is expected for the project, a copy of the most recent SRF loan agreement with terms and conditions similar to what is expected for the project SRF loan;
 Copies of any other outstanding loan agreements that have been utilized to finance system capital projects (e.g. USDA or bank debt)
 Major water/sewer purchase agreements (or key terms)
 Major wholesale water/sewer agreements (or key terms)
 Terms of any customer assistance program

Section D: Federal Requirements Compliance

 Has the project completed or is in the process of completing an environmental review in accordance with the National Environmental Policy Act (NEPA) led by another federal agency, such as Bureau of Reclamation or U.S. Army Corps of Engineers?    
 Yes
 No
If yes, identify the lead federal agency for the NEPA review, and provide an agency staff contact name/email/phone number, and if applicable, include supporting documentation as attachments.

 If applicable, please complete and attach the Programmatic Environmental Assessment (PEA) Questionnaire. If you do not know if this is applicable to your project, please consult your assigned underwriter.

 Has the project completed or is in the process of completing an environmental review through state authority due to financing from the SRF?
 Yes
 No
         If yes, provide SRF agency staff contact information, and if applicable and include supporting documentation as attachments.
         
 Identify if any of the following federal environmental cross-cutting authority reviews have been previously completed or are in progress and include supporting documentation as attachments. (Check all that apply) 
 None have been previously completed or are in progress
 National Historic Preservation Act Section 106 consultation with the State Historic Preservation Officer
 Endangered Species Act Section 7 consultation with Fish and Wildlife Service or National Marine Fisheries Service
 Essential Fish Habitat Consultation Process under the Magnuson-Stevens Fishery Conservation and Management Act with National Marine Fisheries Service
 Other: __________________

 Has construction/ground disturbance begun on any portion of the project(s)? Identify work that has been completed to date.

 Provide a list of ongoing, in progress or planned environmental studies or environmental technical reports. If no studies are ongoing or planning, please state this.

 Has tribal consultation or coordination that has taken place on the proposed project(s)? If yes, include supporting documentation as attachments. 

 Does the project involve a new or relocated discharge of effluent to surface or groundwater? For purposes of this question, relocated discharge refers to discharge of effluent into a different water body or the discharge to the same receiving water body at a different location.
 Yes
 No
 Not Applicable
 Select the correct response to indicate the implementation of federal requirements for past projects. Please refer to Borrower Guide containing federal requirement language. https://www.epa.gov/wifia/wifia-borrower-guide-federal-requirements

 Applicant has implemented similar federal requirements in the past for other federally funded projects. 
 Applicant does not have previous experience with federal requirements implementation.

 Additional forms will need to be completed and submitted prior to closing the WIFIA loan. All forms are available at https://www.epa.gov/grants/epa-grantee-forms. Check all that are included with the application:

Form Number
Purpose
Included
Not Applicable
EPA 6600-06
Certification Regarding Lobbying


SF-LLL
Disclosure of Lobbying Activities


EPA 4700-4
Preaward Compliance Review Report




 Confirm whether the project(s) include acquisition of real property. Note that the borrower must comply with the Uniform Relocation Assistance and Real Property Acquisition Policies Act (Uniform Act).
 Yes
 No

Section E: Contract Information 

Complete the "Section E: Supplemental Spreadsheet." Instructions for each column are available on the first tab labeled "Instructions  -  Section E". Provide answers for each project in the application using separate rows designated, "Contract 1, Contract 2, etc." Additional resources on federal requirements can be found in the Borrower Guide to Federal Requirements.

CERTIFICATIONS 

 National Environmental Policy Act:  The applicant acknowledges that any project receiving credit assistance under this program must comply with all provisions of the National Environmental Policy Act of 1969 (42 U.S.C. 4321 et seq.)
 American Iron and Steel:  The applicant 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.
 Buy America Preference: The prospective borrower acknowledges that any project receiving credit assistance under this program for the construction, alteration, maintenance, or repair of a project may only use domestic iron/steel, manufactured produces and construction materials produced or manufactured in the United States and must comply with all applicable guidance.
  National Historic Preservation Act: The applicant acknowledges that any project receiving credit assistance under this program must comply with all provisions of the National Historic Preservation Act as amended (54 U.S.C. § 300101 et seq.: Historic Preservation).
 Endangered Species Act:  The applicant acknowledges that any project receiving credit assistance under this program must comply with all provisions of the Endangered Species Act (16 U.S.C. §§ 1531, et seq.).
 Prevailing Wages:  The applicant 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).
 Credit Ratings:  This applicant has received a preliminary rating opinion letter(s) on the project's senior debt instrument (which may be the WIFIA credit assistance), from one or more rating agencies, indicating the potential to achieve an investment-grade rating. These letters or ratings are attached.
 Credit Processing Fees:  The undersigned certifies that it will reimburse EPA for any and all fees and expenses incurred by EPA (including legal, financial and other consultant fees and expenses) in connection with the evaluation of the application materials, and the preparation, negotiation, and closing of the credit agreement and related documents, irrespective of whether the credit agreement is executed.
 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. 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 applicants 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 applicant, 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 applicant 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 the applicant has fully complied with its verification obligations under 2 C.F.R. Part 180 and confirms that, to its knowledge, neither applicant nor any of its principals (as defined in 2 C.F.R. Part 180.995 and Part 1532.995) 
 is debarred, suspended or voluntarily excluded from participating in any Federal programs, Government contracts, procurement or non-procurement matters; 
 is present indicted for or otherwise criminally or civilly charged by a governmental authority with commission of 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); or 
 has, within the three (3) year period preceding the date of the application, 
 has been convicted for or had a civil judgment rendered against the applicant for any of the above-mentioned offenses within such period or 
 had any public transactions (Federal, state, or local) terminated for cause or default.
 Default/Delinquency:  The undersigned further certifies that neither the applicant 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 applicant 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-federal-compliance-requirements.
 Signature:  By submitting this application, the undersigned certifies on behalf of the applicant that the facts stated and the certifications and representations made in this application are true, to the best of the applicant's knowledge and belief after due inquiry, and that the applicant has not omitted any material facts. The undersigned is an authorized representative of the applicant.
Signature:  _________________________________________________________________________
Date Signed: ________________________________________________________________________
   Name:  		____   _______________________   ________________________
   Title:  		______________________________________________________
   Organization:  	______________________________________________________
   Street Address:  	______________________________________________________
   City/State/Zip:  	______________________________   ____   _________________
   Phone:  		_________________________
   E-mail:  		______________________________________________________

