<p> California Department of Public Health Safe Drinking Water State Revolving Fund American Recovery and Reinvestment Act Funding 1B APPLICANT’S CHECKLIST FOR ARRA FUNDING</p><p>Water System Name: ______Project Number: ______- ______Data Universal Numbering System (DUNS) Number: ______See Enclosure #11 for instructions on obtaining a DUNS # Principal Contact: ______Name and Title ______Phone Number and Email Address</p><p>This checklist must be completed and submitted to the CDPH with the application in order for the project to be considered for funding. The applicant should refer to the APPLICATION GUIDELINES AND INSTRUCTIONS for detailed information on the listed requirements. CDPH reserves the right to determine the adequacy of the information submitted. COMPLETE PLANS AND SPECIFICATIONS SENT TO CDPH WERE POSTMARKED ON ______(DATE) CONSTRUCTION OF THE PROJECT CAN BEGIN WITHIN 60 DAYS OF THE EXECUTION OF THE FUNDING AGREEMENT COMPLETED APPLICATION FOR CONSTRUCTION FUNDS FORM (including the following attachments listed in Part F of the application) (Part A.6) Resolution designating the authorized representative and authorizing that individual to apply for a SDWSRF loan (Part B.2) Appropriate ownership documents as stated in the guidance (Part B.6) A description of pending litigation, its current status, and the potential costs Not Applicable (Part B.7) Agreement for operation of the facility Not Applicable (Part B.8) Lease of land or major water system facilities Not Applicable (Part B.9) Water rights documentation (Part C.3) Map of the service area and location of water system facilities (Part C.6) ARRA Applicant Engineering Report Date receipt of invitation: ______</p><p>Project costs incurred before October 1, 2008, are listed separately (Part C.7) COMPLETE CEQA DOCUMENTS SENT TO CDPH WERE POSTMARKED ON ______(DATE) The following environmental documentation is attached to assist in CDPH federal consultation </p><p>Biological Survey or reports for consultation with US Fish and Wildlife Service entitled: ______</p><p>Cultural Resources survey for consultation with the State Historic Preservation Officer entitled:______</p><p>(Part D.4) Water system rate structure for the last three years and calculations showing the average household water rate (Part D.9) Last three years of financial statements or tax returns, and a balance sheet for the current calendar year or fiscal year. (Part D.10) A description of all long-term indebtedness Not Applicable A completed TMF Capacity Assessment Form and documents listed in the ARRA Engineering Report</p><p>Revision May 20, 2009</p>