US Environmental Protection Agency OMB Control No. 2040-0292
WIFIA Program EPA Form No. 6100-032
Application Approval expires XX/XX/XXXX ____________________________________________________________________________________
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.
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 [email protected] and [email protected] informing that a payment has been made.
The application fee may also be paid via FEDWIRE or by check sent to US EPA; Las Vegas Finance Center; 4220 S. Maryland Pkwy, Bldg C, Ste 503; Las Vegas NV 89119. For questions about payments, contact the US EPA Las Vegas Finance Center at (702)798‐2485 or [email protected]. 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 [email protected].
The applicant should submit its completed application form plus all relevant supporting documents listed in the checklist as attachments.
Question |
Supporting Document(s)* |
Included |
Application Fee – Refer to fee instructions on page 2 |
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Section A: Key Applicant and Loan Information* (No attachments) |
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11. System for Award Management (SAM) registration |
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Section B: Applicant Background |
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5. Capital Improvement Planning Process |
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7. Liabilities |
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8. System Condition |
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10. Organization Chart |
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Section C: Financing Plan |
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4. Preliminary Rating Letter |
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5. Audited Financial Statements |
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6. Cash flow pro forma(s) |
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7. Rate Setting Process |
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8. Flow of Funds |
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9. Loan Agreement |
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Section D: Federal Requirements |
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1.NNational Environmental Policy Act (NEPA)/ Programmatic Environmental Assessment Questionnaire |
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2. SRF Environmental Review |
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4. Cross-Cutter Consultation Agencies |
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5. Additional Permits |
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7. Additional Forms |
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8. Uniform Act |
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Section E: Contract Information (Refer to Supplemental Spreadsheet) |
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Complete Section E of spreadsheet and indicate which of the following attachments are included:
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Certifications |
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*Required
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.
Legal name of prospective borrower:
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Project name (for purposes of identification assign a short name to the project):
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Estimated total eligible project costs (in dollars):
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☐ Check here if total eligible project costs have changed since the letter of interest submittal
Requested amount of the WIFIA loan (in dollars):
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Applicant Contact Information
Team Member |
Name and Title |
Phone Number |
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Authorized Signatory |
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WIFIA Point of Contact |
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Financial Advisor |
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Bond Counsel |
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Project Manager |
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Environmental Review Contact |
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Will the project financed by the WIFIA loan create pre- and post-construction jobs?
Additional notes for loan agreement: Click or tap here to enter text.
Section D: Federal Requirements Compliance
Describe the status of the environmental review in accordance with the National Environmental Policy Act (NEPA). If applicable, submit the Programmatic Environmental Assessment (PEA) Questionnaire form, Environmental Assessment (draft or final), or Environmental Impact Statement (draft or final),
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Describe the status of the SRF environmental review, if applicable. Submit the available SRF Findings and/or SRF consultation documentation.
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If the environmental review for the project is underway or complete, complete the following table to identify the anticipated impacts and mitigations. Mark a “X” in the appropriate column to identify the impacts anticipated for each resource type and, if applicable, provide a short explanation of the mitigations.
Resource Type |
Anticipated Impacts |
Mitigations |
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No Impact |
Less Than Significant Impact |
Potentially Significant Impact |
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Water |
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Biological |
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Cultural |
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Others as Applicable |
Identify any agencies with which cross-cutter consultations have been undertaken for the project and include supporting documentation as attachments. (Check all that apply)
☐ State Historic Preservation Officer
☐ Fish and Wildlife Service
☐ National Marine and Fisheries Service
☐ Coastal Zone Management Agency
☐ Other Click or tap here to enter text.
Describe the status of any additional permits and approvals that the project(s) may require. Add additional rows as needed. If providing permit information as attachments, list the filenames below.
Major Permits or Approvals Required |
Approving Authority |
Status |
Expected Approval Date |
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Enter date here. |
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Enter date here. |
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If applicable, specify if a new or relocated discharge, either permanent or temporary, to surface or groundwater is expected or new or relocated water intakes are expected.
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Additional forms will need to be completed and submitted prior to closing the WIFIA loan. Check all that are included with the application:
☐ Civil Rights Pre-Award Compliance Review Report: EPA Form 4700-4
☐ Certification regarding lobbying: EPA Form 6600-06
☐ Disclosure of Lobbying Activities: SF-LLL
If the project(s) include acquisition of real property, identify how the project complies or will comply with Uniform Relocation Assistance and Real Property Acquisition Policies Act (Uniform Act).
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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.”
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.
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, from one or more rating agencies. These letters or ratings are attached.
Credit Processing Fees: The undersigned certifies that it will reimburse EPA for its costs incurred in negotiating the credit agreement, 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 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 from participating in any Federal programs; 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 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-resources#complianceanchor.
Name:
Title:
Organization:
Street Address:
City/State/Zip:
Phone:
E-mail:
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.
Signature: _________________________________________________________________________
Date Signed: ________________________________________________________________________
Administrator means the Administrator of EPA.
Applicant means the entity submitting the application for WIFIA credit assistance. Only prospective borrowers that are invited to submit a WIFIA application become applicants. The following entities are eligible to receive credit assistance: a corporation, a partnership, a joint venture, a trust, a Federal, State, or local government, a tribal government or consortium of tribal governments, and a State infrastructure financing authority.
Community water system has the meaning given the term in section 1401 of the Safe Drinking Water Act (42 U.S.C. 300f).
Credit assistance means a secured loan or loan guarantee under WIFIA.
Credit agreement means a contractual agreement between EPA and the project sponsor (and the lender, if applicable) that formalizes the terms and conditions established in the term sheet (or conditional term sheet) and authorizes the execution of a secured loan or loan guarantee.
Eligible project costs mean amounts, substantially all of which are paid by, or for the account of, a applicant in connection with a project, 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.
Investment-grade rating means a rating category of BBB minus, Baa3, bbb minus, BBB (low), or higher assigned by a nationally recognized statistical rating organization (NRSRO) to project obligations offered into the capital markets.
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.
Nationally Recognized Statistical Rating Organization (NRSRO) means a credit rating agency identified and registered by the Office of Credit Ratings in the Securities and Exchange Commission.
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)), notwithstanding the public ownership requirement under paragraph (1) of that subsection.
1 or more activities described in section 1452(a)(2) of the Safe Drinking Water Act (42 U.S.C. 300j–12(a)(2)).
A project for enhanced energy efficiency in the operation of a public water system or a publicly owned treatment works.
A project for repair, rehabilitation, or replacement of a treatment works, community water system, or aging water distribution or waste collection facility (including a facility that serves a population or community of an Indian reservation).
A brackish or sea water desalination project including chloride control.
A managed aquifer recharge project, a water recycling project, or projects to provide alternative water supplies to reduce aquifer depletion.
Acquisition of real property or an interest in real property—
If the acquisition is integral to a project described in paragraphs (1) through (5); or
Pursuant to an existing plan that, in the judgment of the Administrator or the Secretary, as applicable, would mitigate the environmental impacts of water resources infrastructure projects otherwise eligible for assistance under this section.
A project to prevent, reduce, or mitigate the effects of drought, including projects that enhance the resilience of drought-stricken watersheds.
A combination of projects, each of which is eligible under paragraph (1) or (2), for which a State infrastructure financing authority submits to the Administrator a single application.
A combination of projects secured by a common security pledge, each of which is eligible under paragraph (1), (2), (3), (4), (5), (6), or (7), for which an eligible entity, or a combination of eligible entities, submits a single application.
Public entity means:
a Federal, State, or local Governmental entity, agency, or instrumentality; or
a Tribal Government or consortium of Tribal Governments.
Publicly sponsored means the applicant can demonstrate, to the satisfaction of the Administrator that it has consulted with the affected State, local or Tribal Government in which the project is located, or is otherwise affected by the project, and that such government supports the proposed project. Support can be shown by a certified letter signed by the approving municipal department or similar agency, mayor or other similar designated authority, local ordinance, or any other means by which local government approval can be evidenced.
Small Community means a community with a population of no more than 25,000 individuals.
State means any one of the fifty states, the District of Columbia, Puerto Rico, or any other territory or possession of the United States.
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).
Term sheet means a contractual agreement between EPA and the project sponsor (and the lender, if applicable) that sets forth the key business terms and conditions of a Federal credit instrument. Execution of this document represents a legal obligation of budget authority.
Treatment works has the meaning given the term in section 212 of the Federal Water Pollution Control Act (33 U.S.C. 1292).
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.
1 Applicants must have an active registration in SAM to do business with the Federal Government. Registration information is available at https://sam.gov/SAM/.
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