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Fiscal Year 2017 Application
TIFIA Credit Program
UNITED STATES
DEPARTMENT OF TRANSPORTATION
Fiscal Year 2017 APPLICATION FOR FEDERAL CREDIT ASSISTANCE
Transportation Infrastructure Finance and Innovation Act
Background: This form is to be completed by eligible applicants for Federal credit assistance under the Transportation
Infrastructure Finance and Innovation Act (TIFIA), as amended, invited to submit an application by the U.S. Department of
Transportation (DOT). The TIFIA statute is codified under 23 U.S.C. 601-609. The DOT will use the collected information to
evaluate and select recipients for credit assistance as authorized under TIFIA. Applicants may be asked to provide additional
supporting evidence or to quantify details during the review and negotiation process. If any information submitted, or requested to
be submitted, changes after the application is submitted, the applicant will update its application accordingly. Pursuant to Moving
Ahead for Progress in the 21st Century Act (MAP–21), the DOT announced the availability of $1.75 billion ($750 million in Federal
Fiscal Year (FY) 2013 funds and $1 billion in FY 2014 funds (and any funds that may be available from prior fiscal years)) to
provide TIFIA credit assistance for eligible projects. The Highway and Transportation Act of 2014 has extended MAP-21 funding
levels into FY 2015. Only after a project sponsor has submitted a Letter of Interest and the DOT has determined that a project has
met or is likely to meet all statutory eligibility requirements will the project sponsor be invited to submit an application. MAP–21
contains a timeline for assessing applications for credit assistance.
Charges: The DOT may require reimbursement for expenses related to services provided by the DOT’s outside advisors in
connection with the evaluation of the TIFIA Letter of Interest, evaluation of the TIFIA application, and negotiation of the TIFIA
transaction documents.
Format: Applications must provide all requested information and will not be reviewed if incomplete, which the DOT shall confirm
within 30 days after the date of receipt of the application. Applications should be provided in three-hole punch binders with sections
and tabs following the sequence shown in the application checklist.
Submission: A copy of the completed application form, without attachments, should be sent by email to [email protected].
Hard copies of the completed application (including a computer diskette (CD) containing electronic versions of the entire application
with attachments as well as separate working files for Section D and Exhibit VII – but NOT in PDF or “values” format) should
follow the electronic submission, as further detailed in this section, and should be sent to the attention of Mr. Duane Callender,
TIFIA Joint Program Office, Federal Highway Administration, HITJ, Room E64-301, 1200 New Jersey Avenue, SE, Washington,
DC, 20590. Applicants are advised to utilize an express mail or courier delivery service to ensure delivery confirmation of the
package. The application checklist appearing on the next page of this application form specifies the number of copies (plus original)
required for each section. The DOT requires two original hard copy submission of the complete application package with all
supporting exhibits and related documentation. As noted on the checklist on the following page, three additional hard copies of the
completed application form, without attachments are required. Only after a project sponsor has submitted a Letter of Interest and
the DOT has determined that a project has met or is likely to meet all statutory eligibility requirements will the project sponsor be
invited to submit an application. Please note that an invitation by the DOT to submit an application does not guarantee that a project
will receive TIFIA credit assistance, which remains subject to a project’s continued eligibility. Please check the TIFIA website
regularly to identify updated guidance and application materials.
Selection: The DOT’s selection of a project for participation in the TIFIA program does not imply that the DOT has approved all
elements proposed in the application. For example, the DOT may require changes in the project’s financial plan proposed in the
application. Provision of credit assistance is subject to negotiation of a credit agreement on terms and conditions satisfactory in all
respects to the DOT.
__________________________________________________________________________________________________
Information Requests: If an applicant desires that any information submitted in its application or any supplement thereto not be
released by the DOT upon request from a member of the public or otherwise made publicly available, the applicant must so state
and set forth any reasons why such information is confidential and should not be released, including particulars as to any competitive
harm which would potentially result from the release of such information. The DOT will keep such information confidential to the
extent permitted by law.
__________________________________________________________________________________________________
Warning: It is a crime to knowingly make false statements to a Federal agency. Penalties upon conviction can include a fine and
imprisonment. For details, see 18 U.S.C. 1001. Misrepresentation of material facts may also be the basis for denial of financial
assistance by the U.S. Department of Transportation.
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Fiscal Year 2017 Application
TIFIA Credit Program
APPLICATION CHECKLIST
An application must include the following items.
Item
Page Limit
Section A: Contact Information
Section B: Project Information
___1. Project Name
___2. Location
___3. Project Description
___4. Rural Project Description (If Applicable)
___5. Project Purpose (quantitative/qualitative details)
___6. Project Cost and TIFIA Credit Assistance Request
___7. Project Management and Compliance Monitoring Plan
___8. Maintenance and Operations
Section C: Satisfaction of Eligibility Requirements
___1. Creditworthiness (rate covenant, coverage requirements, investment grade rating(s))
___2. Foster Partnerships that Attract Public and Private Investment
___3. Enable Project to Proceed at an Earlier Date or with Reduced Lifecycle Costs
___4. Reduce the Contribution of Federal Grant Assistance
___5. Environmental Review (NEPA)
___6. Permits and Approvals
___7. Transportation Planning and Programming Process Approvals (STIP and TIP)
___8. Construction Contracting Process Readiness
___9. Project Schedule
Section D: Financial Plan (include Executable Electronic – NOT PDF – files)
___1. Estimated Capital Project Cost, Amount and Type of Credit Assistance Requested
___2. Amount of TIFIA Assistance Requested
___3. Summary Table: Sources and Uses of Funds
___4. Cash Flow Pro Forma
___5. Supplementary Narrative: Other Borrowed Funds
___6. Supplementary Narrative: Revenue Sources (including pledged repayment source)
___7. Proposed Terms for the Requested TIFIA Credit Instrument
___8. Reasons for Selecting the Proposed Type(s) of Credit Instrument
___9. Flexibility in Financial Plan to Support a Reduced Percent of TIFIA Credit
___10. Risks and Mitigation Strategies
Section E: Applicant’s Organizational Structure
___1. Background Information and Legal Authority
___2. Organization and Management
___3. What Entity will Serve as Applicant (public-sector agency or private-sector firm)
___4. Is the Applicant the Same Entity as the Borrower (detail project team members)
___5. Prior Experience
___6. Financial Condition
___7. Litigation and/or Conflicts
Section F: Certifications
___Exhibit I:
___Exhibit II:
___Exhibit III:
___Exhibit IV:
___Exhibit V:
___Exhibit VI:
___Exhibit VII:
___Exhibit VIII:
___Exhibit IX:
___Exhibit X:
___Exhibit XI:
___Exhibit XII:
Project Map
Supporting Documentation: Project Purpose
Supporting Documentation: Financing Documents
Preliminary Rating Opinion Letter(s)/Creditworthiness
Supporting Documentation: Public-Private Partnerships
Supporting Documentation: Other Anticipated Funds
Cash Flow Pro Forma (include electronic files)
Supporting Documentation: Revenue and Cost Projections
Proposed Terms for the Requested TIFIA Credit Instrument
Supporting Documentation: Legal Authority
Organizational Chart
Audited Financial Statements (Three Years)
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Fiscal Year 2017 Application
TIFIA Credit Program
SECTION A: Contact Information
Provide the following information and include this sheet as the first page of the application. If the Applicant is different from
the expected Borrower, please provide information for both parties.
1.
Applicant’s Legal Name:
2.
Other Names under Which Applicant Does Business:
3.
Federal Tax Identification Number (to be used to determine whether the applicant is delinquent or in default on any
Federal debt, in accordance with 31 U.S.C. 3701, et seq. and 5 U.S.C. 552a at note):
4.
Business Address:
5.
Mailing Address (if different from above) – include both U.S. mailing address and courier (i.e., no P.O. Box) address:
6.
Contact Person Name:
7.
Contact Person Title:
8.
Mailing Address for Contact Person (if different from above):
9.
Telephone:
10. Fax:
11. E-mail:
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Fiscal Year 2017 Application
TIFIA Credit Program
SECTION B: Project Information
This section requests narrative information and two exhibits. The list below should be included in the application packet with
responses attached and numbered to correspond to the relevant item. Total narrative supporting Section B should not exceed
8 pages, excluding the exhibits.
1.
Project Name. Assign a short name to the project, for purposes of identification.
2.
Location. Describe the location of the project, including major intersecting highway and rail routes, and attach a map as
Exhibit I. Include the name(s) of the counties that the project will serve.
3.
Project Description. Describe the need for the project, its basic design features, and what it will accomplish. Include an
assessment of the current condition of all transportation facilities relating to the project. If the project’s current scope
differs from what is described in its environmental documents, please explain.
4.
Rural Project Description (If Applicable). If invited to apply for consideration as a rural infrastructure project, describe
how the project meets MAP-21’s definition of a rural infrastructure project. Please also describe whether the project is
located outside of an urbanized area as defined under title 23.
5.
Project Purpose. Describe the project’s purpose, including quantitative or qualitative details on public benefits the project
will achieve. Supporting documentation may be attached as Exhibit II.
6.
Project Cost and TIFIA Credit Assistance Request. Provide a cost estimate for both the entire project and the eligible
project costs under the TIFIA program. Specify the TIFIA credit instrument(s) (i.e., secured loan, loan guarantee, and/or
standby line of credit) requested and the amount of TIFIA credit assistance requested for each credit instrument. If
requesting a secured loan, please provide a brief explanation of how the plan of finance for the project would be impacted
if TIFIA credit assistance was instead provided in the form of a loan guarantee. Please also indicate whether the applicant
intends to use a Master Credit Agreement with contingent commitments for purposes of carrying out a program of
projects. If requesting a Master Credit Agreement, please provide the expected timing and amount of credit assistance
requested for each of the projects in the program. Note that Section D of this application requests a financial plan;
information furnished under this item may be cross-referenced to materials provided in Section D, and in all instances,
including but not limited to dollar amounts, must be consistent with those materials.
7.
Project Management and Compliance Monitoring Plan. Provide a comprehensive project management and monitoring
plan that will assure the DOT of the applicant's ability to deliver the project as planned, fulfill all project commitments,
and ensure compliance with all terms of the credit agreement, including all applicable regulations and provisions of law.
The plan should provide: (a) information on the roles and responsibilities of all entities with decision making authority
for the project; (b) status reporting processes that document not only the status but changes and potential risks; and (c)
coordination processes that provide for advance notification of potential issues to all appropriate agencies and timely
resolution.
8.
Maintenance and Operations. Describe the maintenance and operations plan for the project.
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Fiscal Year 2017 Application
TIFIA Credit Program
SECTION C: Satisfaction of Eligibility Requirements
This section allows the applicant to describe the extent to which the project satisfies the eligibility requirements specified
under 23 U.S.C. 602(a). The applicant should provide relevant quantitative or qualitative data to support its assertions
and to justify the benefits to be derived from TIFIA assistance in satisfying these requirements and advancing the proposed
project. The list below should be included in the application packet with responses and supporting documents attached and
numbered to correspond to the relevant item. Total narrative supporting Section C should not exceed 20 pages, excluding
the three exhibits.
1.
Creditworthiness. Describe the creditworthiness of the project as noted below.
a)
Detail the project’s ability to satisfy applicable creditworthiness standards. Provide information to support the
project’s creditworthiness, such as: the project’s market position; the history of user-based repayments for other
obligations; the economic outlook for related commerce; qualifications of the project team; proposed risk mitigation
strategies, etc. The applicant may refer to other portions of its application, as applicable.
b) Describe the rate covenant, if applicable. Provide a copy of existing financing documents, such as a trust indenture
agreement, including any rating agency credit reports, for other creditors of the project or a term sheet indicating the
proposed features of the anticipated financing documents, as Exhibit III. The information should indicate the Federal
credit instrument’s status in relation to pledged security, coverage, and treatment under an additional bonds test.
Applicants should be aware that when prior financing based on the proposed TIFIA security is already in place
difficult inter-creditor issues often arise in the negotiation of the TIFIA credit instrument.
c)
Demonstrate that adequate coverage requirements are in place to ensure repayment. Provide information concerning
the ability of the applicant (or any significant public or private partners that pledge to repay or provide funding) to
repay all borrowed funds, including any obligations to the Federal Government. Describe the extent to which the
project includes security features, such as a rate covenant and an additional bonds test, to ensure repayment of the
Federal credit instrument.
d) Provide one preliminary rating opinion letter with an investment grade rating on senior debt and a rating on the
TIFIA debt, as Exhibit IV. This letter is a conditional credit assessment from a nationally recognized statistical
rating organization (NRSRO) that must indicate the potential for the senior debt obligations funding the project to
achieve an investment grade rating and also must provide a rating on the TIFIA credit instrument. (The senior debt
has a lien senior to that of the TIFIA credit instrument on the pledged security; if there are no debt obligations senior
to the TIFIA credit instrument, then the TIFIA credit instrument itself must be shown to have the potential to obtain
an investment grade rating). This preliminary assessment by the rating agencies will be based on the financing
structure proposed by the applicant. The letter should provide a preliminary rating assessment of the financial
strength of the overall project and the default risk (i.e., without regard to recovery potential) of the requested TIFIA
instrument. This includes a demonstrated capacity to repay the federal credit assistance as well as a determination
that the project has appropriate security features, such as proper coverage ratios, rate covenants and reserves as
applicable.
The rating opinion letters should not reflect the use of bond insurance or other credit enhancement that does not also
secure the TIFIA instrument. The assessment of the senior obligations’ investment grade potential and the TIFIA
instrument’s default risk should be based on the underlying ratings of debt obligations and the project’s
fundamentals. The DOT will not consider applications without such letters.
Note that Section D of this application requests a financial plan; information furnished under this item may be crossreferenced to materials provided in Section D, and in all instances must be consistent with those materials.
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Fiscal Year 2017 Application
TIFIA Credit Program
2.
Foster Partnerships that Attract Public and Private Investment to the Project. Describe the extent to which the project
fosters innovative public-private partnerships and attracts debt and/or equity investment from private capital. Identify
private partners and provide evidence of commitments, joint venture agreements, lease, or other supporting documents
for the public-private partnerships as Exhibit V. Also, describe the extent to which the project’s debt repayment depends
on user charges.
3.
Enable the Project to Proceed at an Earlier Date or with Reduced Lifecycle Costs. Estimate and explain the effect of
TIFIA assistance on the project’s start and completion dates, the extent to which TIFIA assistance would help the project
to proceed at an earlier date than would otherwise be possible, and any effects of an accelerated project timeline (e.g.,
reduced costs or increased benefits). Document how applicant has been unable to obtain credit assistance from private
sources on reasonable terms. Demonstrate the costs of traditional financing would constrain their ability to deliver the
project, or that delivery of this project through traditional financing approaches would constrain their ability to deliver
additional components of their capital programs.
4.
Reduce the Contribution of Federal Grant Assistance for the Project. Estimate and explain how TIFIA assistance would
reduce the project’s need for Federal grant assistance. Indicate the percentage of the total project costs that will be funded
by Federal grants, Federal credit assistance, and other sources.
5.
Environmental Review. Provide a draft Environmental Impact Statement and Record of Decision unless the project has
received Categorical Exclusion or Finding of No Significant Impact in connection with the project’s compliance with
the National Environmental Policy Act (NEPA). Provide a timeline that illustrates the estimated start and completion
dates for each major phase or milestone of the environmental review documentation and a brief summary of how the
project intends to reach a final agency decision, including (if necessary) a Record of Decision prior to financial close.
Please note the DOT will not obligate funds for a project until the project has done so.
6.
Permits and Approvals. List all major permits and approvals necessary for construction of the project and the date, or
projected date, of the applicant’s receipt of such permits and approvals. The list should include permits and approvals
required under local, regional, state, and Federal laws and regulations. In particular, indicate when outstanding approvals
by state or local government entities are expected. Copies of major permits and approvals will be required upon execution
of a credit agreement with the DOT.
7.
Transportation Planning and Programming Process Approvals. Provide a brief summary as well as certification that the
project is included in both the long-range transportation plan and the approved State Transportation Improvement
Programs (STIP) of each state affected by the project. Describe how the project satisfies planning and programming
requirements of §134 ("Metropolitan Planning") and §135 ("Statewide Planning") under 23 U.S.C. For projects in
metropolitan areas, describe how the project is or can be included in the metropolitan transportation plan.
8.
Construction Contracting Process Readiness. Briefly describe how the project is prepared to proceed with the
construction contracting process within 90 days of executing the TIFIA credit instrument.
9.
Project Schedule. Provide a timeline that illustrates the estimated start and completion dates for each major phase or
milestone of project development, construction and/or acquisition, including, for example: major investment study,
Federal transportation planning requirements, preliminary engineering and environmental documentation, final design,
right-of-way acquisition, construction, and vehicle acquisition. Indicate the applicant’s current status on this timeline.
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Fiscal Year 2017 Application
TIFIA Credit Program
SECTION D: Financial Plan
The following items concern the project’s updated financial plan, incorporating preliminary feedback from the DOT in
connection with the Letter of Interest. This section requests narrative information and four exhibits. Note: For the purposes
of this application, applicants should propose a single financing structure, representing the scenario deemed to have the
greatest likelihood of occurring. While the DOT will evaluate the proposed financial plan, the DOT’s selection of the
project for TIFIA assistance does not imply that the DOT has approved the proposed financial; the DOT may require
modifications to the financial plan after selection and before execution of the credit agreement. For the financial plan,
any combination of the three types of credit assistance offered under TIFIA may be used, provided that the total TIFIA
credit amount is capped at 33 percent of eligible project costs for loan guarantees and lines of credits. In certain
circumstances, projects requesting a direct loan may be eligible for credit assistance up to 49 percent of eligible project
costs. The DOT may ask applicants to develop alternative scenarios, as necessary.
The financial plan should be prepared in accordance with recognized financial reporting standards such as the “Guide for
Prospective Financial Information” of the American Institute of Certified Public Accountants (AICPA). The narrative
descriptions for the financial projections should include the sources of information for the forecasts and the methodology
used for developing the forecasts as well as describe any changes to the project and financial projections since the submission
of the Letter of Interest. The discussion should also identify whether there has been any independent validation of the
forecasts or sensitivity testing. Any documentation that provides the basis for the projected costs/revenues (e.g., revenue
studies, feasibility studies, economic forecasts) should be included as attachments to the plan.
The list below should be included in the application packet with responses attached and numbered to correspond to the
relevant item. Items 1, 2, and 3 below must also be provided on a CD in a spreadsheet format. The DOT must be able to
review and adjust the assumptions in these files; i.e., PDF or “values” copies of the spreadsheet are not acceptable. Total
narrative supporting Section D should not exceed 20 pages. The pro forma(s) and supporting documentation requested under
items 4, 6, and 7 (Exhibits VII, VIII, and IX, respectively) do not count toward the page limit.
1.
Estimated Capital Project Cost.
a)
Provide a detailed capital cost estimate for the project. Distinguish between total and “eligible project costs” as
defined under TIFIA; and describe any costs or activities that may not be TIFIA-eligible.
b) For TIFIA-eligible costs, provide an activity breakdown, as applicable, for: feasibility studies, preliminary
engineering, environmental assessment, right-of-way-acquisition, vehicle acquisition, construction, construction
engineering and inspection, project management, contingencies, and capitalized financing costs (including reserves,
capitalized interest, and capital issuance costs for other project financing). Include other cost categories as necessary.
Note: All cost estimates should be expressed on a cash (year-of-expenditure) basis and should include a narrative describing
assumptions used to arrive at such estimates.
2.
Provide the total amount and type of TIFIA credit assistance requested, including the percentage of total reasonably
anticipated eligible project costs.
3.
Summary Table: Sources and Uses of Funds.
a)
Sources should include separate line items, as applicable, for Federal grants, state grants, local grants, private
investment (equity or debt); any other contributions, market value of right-of-way dedications, bond proceeds
(general obligation, revenue, and others), other borrowing (specify), investment income, revenues, and Federal credit
assistance proceeds. For each line item, describe the status of the source (e.g., requested, committed, and received).
Provide supporting documentation to evidence the status of these funds in Exhibit VI.
--------------------------------------------------------------------------------------------------------------------------------------b) Uses should include separate line items, as applicable, for feasibility studies, preliminary engineering, design,
environmental assessment and mitigation, right-of-way-acquisition, vehicle acquisition, construction, construction
engineering and inspection, insurance, project management, contingency funds, and capitalized financing costs
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Fiscal Year 2017 Application
TIFIA Credit Program
(including debt service reserve funds, capitalized interest, and capital issuance costs for other project financing).
Include other categories as necessary.
Note: Total sources and uses should be equal to one another and equal the estimated total project costs. All estimates
should be expressed in year-of-expenditure dollars.
4.
Cash Flow Pro Forma. Attach the pro forma for the project as Exhibit VII. The pro forma should include both a statement
of sources and uses and a projection of monthly or quarterly cash flows during the construction period and annual cash
flows thereafter. All amounts should be expressed on a cash (year-of-expenditure) basis and should include a narrative
describing assumptions used to arrive at such estimates. The pro forma should include:
a)
Projected cash flows through such time as all project debt is repaid, including separate line items for each category
of revenue (such as sales tax proceeds, fares, toll receipts) and expenditure (at a minimum, construction expenditures,
operations and maintenance, contributions to reserves and capital replacement funds, debt service, repayments of
the TIFIA credit instrument, and repayment of other borrowed funds as well as equity dividends or proceeds (as
applicable), if any);
b) Estimated debt service coverage, separated into Federal, non-Federal (addressing, as applicable, senior and junior
lien debt), and illustrating projected combined coverage, as applicable;
c)
Amortization schedule for all project debt, separated into Federal, non-Federal (addressing, as applicable, seniorand junior-lien debt), and combined components; and
d) Anticipated repayment schedule illustrating the disbursement and repayment of the requested TIFIA credit
instrument.
5.
Supplementary Narrative Information on Sources of Funds: Other Borrowed Funds.
a)
Provide information on the other types of borrowing, including the form of borrowing (e.g., types of bonds to be
issued), the pledged security for such borrowing, its priority with respect to the security pledged to the TIFIA
instrument, details on structuring, rating assumptions, and anticipated timing of receipt of such funds. Information
on amortization schedules, expected interest rates, and coverage calculations should be included in the cash flow
pro forma requested under item D. (4), above.
b) For bond issuances, discuss the anticipated tax-status of the bonds, whether an IRS or bond counsel opinion has
been sought, and contingency plans in the event that the tax-status differs from that which is anticipated.
6.
Supplementary Narrative on Revenue Source(s).
a)
Describe all revenue sources to be used to repay project financing. Specify the nature of the revenue source
(dedicated or not dedicated), the expected rate(s), the base to which such rates will be applied (e.g., retail sales,
average daily traffic), projected revenues from each source, and projected increases or decreases in such revenues
over time.
b) Elaborate on existing or anticipated pledges/claims on revenues and provide a brief summary of all claims on the
flow of funds.
c)
Attach documentation (e.g., revenue studies, feasibility studies, traffic studies, and economic forecasts) as Exhibit
VIII to provide the basis for projected revenues and their respective anticipated rates of change. If independent
revenue projections have not yet been obtained, state when such independent projections will be completed and
identify the consultant engaged to perform the analysis.
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Fiscal Year 2017 Application
TIFIA Credit Program
7.
Proposed Terms for the Requested TIFIA Credit Instrument. Identify the type(s) of TIFIA credit instrument being
requested (secured loan, loan guarantee, standby line of credit) and, at a minimum, the following proposed terms and
conditions for each proposed credit instrument: amount, origination date, final maturity date, estimated interest rate,
timing of disbursements, pledged security, repayment sources, amortization schedule, and lien position. The proposed
TIFIA credit facility, which must be senior or parity lien in the event of bankruptcy, liquidation or insolvency, can be
subordinate as to cash flows absent such an event. Please describe whether a waiver of the nonsubordination requirement
is requested and how the applicant meets the applicable requirements. The proposed terms and conditions should be
submitted as Exhibit IX.
8.
Reasons for Selecting the Proposed Type(s) of Credit Instrument. Describe why you are requesting the specific type(s)
of TIFIA credit instrument. If you are requesting only a direct loan and/or a line of credit, specify the project’s financial
structure if the TIFIA credit assistance was instead in the form of a loan guarantee, including the amount of guaranteed
loan assistance that would be required. If applicable, describe why the project intends to use a Master Credit Agreement.
9.
Flexibility in the Financial Plan to Support a Reduced Percentage of TIFIA Credit Assistance. Explain the flexibility in
the financial plan to finance the project with a reduced percentage of TIFIA credit assistance.
10. Risks and Mitigation Strategies. Identify risks to project completion and sufficiency of revenues. Sample risks might
include cost escalation, approvals, litigation, construction schedules, ridership and traffic levels, availability of grant
funding, and market access. Identify all mitigation strategies and any proposed cost-containment approaches (e.g.,
design-build, value engineering, guaranteed maximum price and/or completion date, warranties, or other
incentive/disincentive clauses).
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Fiscal Year 2017 Application
TIFIA Credit Program
SECTION E: Applicant’s Organizational Structure
This section requests narrative information and three exhibits. The list below should be included in the application packet
with responses attached and numbered to correspond to the relevant item. Total narrative supporting items for Section E
should not exceed 10 pages, excluding exhibits.
1.
Applicant’s Background Information and Legal Authority.
a)
Describe the applicant’s history, ownership, and legal structure (e.g., state governmental agency, local governmental
agency, corporation, or partnership). Include a copy of the statutory authority under which the entity was created as
part of Exhibit X, if applicable.
b) Describe the legal authority of the applicant to carry out proposed project activities described in the application
packet, including levying taxes, issuing debt, charging tolls or other fees, and/or receiving dedicated funding from
another entity. Provide documentation as part of Exhibit X.
c)
2.
Identify whether governmental entities (other than the applicant) must approve the submission of the application
packet, the funding of activities, or the carrying out of activities in the application (other than permits). Provide
documentation as part of Exhibit X.
Organization and Management.
a)
Describe the applicant’s organizational structure and the applicant’s relationship to any subsidiaries or affiliates.
Include the legal names of key principals and staff (e.g., project manager and chief financial officer) and any recent
or proposed changes to the organizational structure.
b) Provide an organizational chart as Exhibit XI, to include the major parties involved in planning, owning, financing,
constructing, operating, and/or maintaining the project. Include the major service contractors that have been, or will
be, retained for the project (e.g., architects, developers, engineers, attorneys, financial advisors and underwriters,
environmental consultants). Note: The DOT may request additional documentation from major parties other than
the applicant as part of the project evaluation and selection process.
3.
Applicant. Describe the entity that will serve as the applicant (i.e., public-sector agency/authority or private-sector firm).
4.
Applicant/Borrower. Will the applicant and borrower be the same? Explain the relationship between the applicant and
the borrower, if they are not the same entities.
5.
Prior Experience. Describe the applicant’s prior experience as it relates to carrying out projects similar to that being
proposed.
4.
Financial Condition. Provide year-end audited financial statements for the past three years, as available, as Exhibit XII.
5.
Litigation and/or Conflicts. 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.
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Fiscal Year 2017 Application
TIFIA Credit Program
SECTION F: Applicant Certifications
The following items require certification by an authorized representative of the applicant requesting TIFIA assistance. The
list below should be included in the application packet with responses attached and numbered to correspond to the relevant
item. The DOT may require that applicants provide documentation of these certifications.
1.
Federal Requirements. This project complies with, and/or will comply with, the requirements of (check all that apply):
Title 23 of the U.S. Code, and implementing regulations._____
Chapter 53 of title 49 of the U.S. Code, and implementing regulations. _____
Section 5333(a) of title 49 of the U.S. Code. _____
If the applicant intends to request waivers to any requirements included in the preceding citations, explain on an attached
sheet.
2.
National Environmental Policy Act. The project complies with, and/or will comply with, all provisions of the National
Environmental Policy Act of 1969 (42 U.S.C. 4321 et seq.).
Yes _____
No ______ If no, explain on an attached sheet.
The project has (check all that apply):
Yes _____
Yes _____
Yes _____
Yes _____
Yes _____
3.
No ______ If no, explain on an attached sheet.
Civil Rights. This project complies with, and/or will comply with, all provisions of Title VI of the Civil Rights Act of
1964 (42 U.S.C. 2000d et seq.).
Yes _____
5.
Received a Categorical Exclusion.
Received a Finding of No Significant Impact (FONSI).
Circulated a Draft Environmental Impact Statement.
Circulated a Final Environmental Impact Statement.
Received its Record of Decision. (If no, provide on an attached sheet the estimated
date for receipt of the Record of Decision.)
Uniform Relocation. This project complies with, and/or will comply with, all provisions of the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970 (42 U.S.C. 4601 et seq.).
Yes _____
4.
No ______
No ______
No ______
No ______
No ______
No ______ If no, explain on an attached sheet.
Other Requirements as Applicable that apply to projects which receive Federal assistance such as the Federal Water
Pollution Control Act as amended by the Clean Water Act (33 U.S.C. 1251 et. seq.), and the Endangered Species Act,
(16 U.S.C. 1531 et. seq.). This project complies with, and/or will comply with, all other applicable provisions of Federal
law.
Yes _____
No ______ If no, explain on an attached sheet.
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Fiscal Year 2017 Application
TIFIA Credit Program
6.
State Transportation Planning and Programming Process.
transportation plan(s) of the affected state(s).
This project is consistent with the long-range state
Yes _____ No ______ If no, explain on an attached sheet.
If located in a metropolitan planning area, this project is included on the metropolitan transportation plan.
Yes _____ No ______ If no, explain on an attached sheet.
This project is listed within the State Transportation Improvement Program (STIP) of the affected state(s).
Yes _____ No ______ If no, explain on an attached sheet and provide estimated date for project listing on the STIP.
7.
Credit Ratings. This applicant has received preliminary rating opinion letter(s) and investment grade ratings on the
senior debt instrument, and if TIFIA is not the senior debt, on the TIFIA credit instrument, from one or more Nationally
Recognized Statistical Rating Organizations. The letter(s) and rating(s) are attached as Exhibit IV.
8.
Charges: The undersigned certifies that it will reimburse the DOT for costs incurred related to services provided by the
DOT’s outside advisors in connection with the evaluation of the TIFIA Letter of Interest, evaluation of the TIFIA
application, and negotiation of the TIFIA transaction documents, irrespective of whether the credit agreement is executed.
9.
Lobbying. Section 1352 of Title 31, United States Code and 49 C.F.R. §20.100, provide 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 DOT interprets this provision to include the use of
appropriated funds to influence or attempt to influence the selection for a secured loan, loan guarantee, or line of credit
under the TIFIA program.
TIFIA applicants must file a declaration: (a) with the submission of an application for TIFIA assistance; (b) upon receipt
of a TIFIA credit instrument (unless the information contained in the declaration accompanying the TIFIA 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 TIFIA
assistance.
A declaration filed in connection with the TIFIA assistance shall contain:
a)
The name of any registrant under the Lobbying Disclosure Act of 1995 who has made lobbying contacts on behalf
of the TIFIA applicant.
b) A certification by the person making the declaration that none of the funds appropriated by any Act of Congress has
been or will be expended to pay any person for influencing or attempting to influence an officer or employee of the
DOT or any Federal agency, a Member of Congress, an officer or employee of Congress, or employee of a Member
of Congress with regard to the TIFIA assistance.
In addition, any person or entity that requests or receives a subcontract from a TIFIA applicant is required to file a
declaration, which shall contain the name of any registrant under the Lobbying Disclosure Act who has made lobbying
contacts and a certification that the person or entity has not made or will not make prohibited payments.
---------------------------------------------------------------------------------------------------------------------------------------
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Fiscal Year 2017 Application
TIFIA Credit Program
--------------------------------------------------------------------------------------------------------------------------------------The undersigned certifies, to the best of his or her knowledge and belief, that: (i) no federally appropriated funds have
been paid or will be paid by or on behalf of the undersigned to influence or attempt to influence an officer or employee
of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with an award of TIFIA assistance; and (ii) if non-federally appropriated funds have been or will
be paid for the above purposes, the undersigned will disclose such payments through the completion and submission of
Standard Form LLL (“Disclosure Form to Report Lobbying”). The applicant shall file Standard Form LLL in accordance
with its instructions. Submission of this statement with the TIFIA application is a prerequisite for obtaining TIFIA
assistance.
Any person who makes an expenditure of appropriated funds prohibited by 31 U.S.C. 1352(a) or fails to file the required
statement or amended statement shall be subject to a civil penalty of not less than $10,000 and not more than $100,000
for each such failure in accordance with 31 U.S.C. 1352(c).
10. Debarment. The undersigned further certifies that neither it nor its principals is currently, or has been in the preceding
three years: 1) debarred, suspended or declared ineligible from participating in any Federal program; 2) formally
proposed for debarment, with a final determination still pending; 3) voluntarily excluded from participation in a Federal
transaction; or 4) indicted, convicted, or had a civil judgment rendered against it for any of the offenses listed in the
Regulations Governing Debarment and Suspension (Government-wide Nonprocurement Debarment and Suspension
Regulations: 49 C.F.R. Part 29.
11. 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.
Signature: By submitting this application, the undersigned certifies 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.
Applicant:
_____________________________________________________________
Signed:
_____________________________________________________________
Name and Title: _____________________________________________________________
Date:
_____________________________________________________________
END OF FORM
Page 13
| File Type | application/pdf |
| File Title | Appendix D-0 - Application Form |
| Author | Ernst & Young LLP |
| File Modified | 2017-07-20 |
| File Created | 2017-07-20 |