ࡱ> RTQq +bjbjt+t+ %lAA',]8 .c e e e = zR$vvc c  n c \09+~M Oregon Transportation Infrastructure Bank ApplicationOregon Department of Transportation434 Transportation BuildingSalem, OR 97310 PLEASE SUBMIT ONE ORIGINAL SECTION 1: APPLICANTApplicant:Address: Contact Person:Phone:Fax No.:Email Address:IRS Employer ID#: PROJECT TITLE:  IN FORMULATING ANSWERS TO THE SPECIFIC QUESTIONS IN THIS APPLICATION, CONSULT THE RELEVANT PROJECT SELECTION CRITERIA. SECTION 2: PROJECT JUSTIFICATION If you have completed a project prospectus, you do not need to complete this section. A. NEED FOR THE PROJECT Explain in detail the need for the project. SOLUTION Explain in detail the proposed solution. SECTION 3: PROJECT BUDGET AND LOAN REQUEST Estimated AmountsSource of FundsPreliminary Engineering$__________________________________Right of Way$__________________________________Construction$__________________________________Equipment$__________________________________Design & Architectural$__________________________________Land Acquisition & Site Preparation$__________________________________Other Capital Costs ___________$__________________________________Contingency _________________$__________________________________Loan Fee (1%) _______________$__________________________________Other _______________________$__________________________________Total Costs:$__________________ Total Amount Requested From OTIB: $__________________ Have you bid the project yet? Yes____ No____Has any equipment been ordered or purchased? If yes, when was it ordered or purchased? Yes____ No____ _________________When would you like to begin payments? _________________Over how long a period would you like to repay your OTIB Loan? _________________Do you expect to use additional debt for this project in the future?Yes____ No____ SECTION 4: SUMMARY OF PLEDGED AND OTHER REVENUE Each loan requires a secure source of repayment. Please specify how you intend to secure the OTIB loan by answering the following questions: What funds or revenues will be pledged to secure the loan? Does the applicant have a credit rating published by any of the three credit rating agencies: Fitch, Moodys, or Standard and Poors? If so, please indicate the ratings and when established and last reviewed. Are there other revenues or security available to repay this loan? Please specify. Would the payment of this loan or other assistance be superior, on a parity basis, or subordinate to other debt that is serviced by the revenues pledged to this loan? SECTION 5: OTHER FINANCIAL INFORMATION Has the Applicant suffered an operating deficit in the last 5 years? If so, what actions were taken? Does the project involve the formation of a local improvement district (LID) or an urban renewal district (URD) or similar entity? If so, provide the status of negotiations with benefited property owners, an engineers report on the district formation and assessments, and any resolutions creating the district. Are the benefited property owners participating in the cost of construction? If yes, list the benefiting property owners and corresponding participation. If no, explain why. How does this project use money new to transportation? What do you identify as innovative sources of financing of this project? What percentages of project funds are innovative versus traditional? Be specific. Summarize any pending litigation that may affect the ability of the Applicant to repay a loan. Has the Applicant ever defaulted on a debt? If so, provide a complete summary of all circumstances relative to the default. How will the ongoing maintenance, operation and replacement of the project be financed? SECTION 6: PROJECT PLANNING & DESIGN 1. The OTIB will fund only projects that conform to local transportation system plans, corridor or other applicable plans, a Metropolitan Transportation Improvement Program, or the Statewide Transportation Improvement Program (STIP). Is this project in the local area transportation plan? Yes____No____ Is this project in the STIP? Yes____No____ Name all plans that contain the project. What stage is the project in these plans (for example, developmental or construction). What cost estimates are shown there? Describe the planning and land use requirements that apply to this project, if any. Discuss where the project is in the approval process. If a land use action is required, when will the approving body issue a decision? 4. Describe the environmental impacts of this project. Does this project qualify for a categorical exclusion? (You may refer to Part 3 of the Project Prospectus as sufficient response to this question.) 5. Specify how this project meets federal-aid eligibility requirements. For example, the project may already be an approved federal-aid project in the Statewide Transportation Improvement Plan. Most OTIB assistance will require the use of federal funds. To be eligible for federal funding, a project must qualify under Title 23 or Title 49 of the Code of Federal Regulations. A road will be eligible if it is part of a federal-aid highway. A federal-aid highway is any street or highway that is open to public travel, except one functionally classified as a local street and/or minor collector. Roads designated as part of the National Highway System are eligible. 6. OTIB will fund only projects that meet highway design standards appropriate to the class of project. Describe the class of job for your project and the standards you have met and, if any, design exceptions and their rationale. When will the project be ready to begin construction? When will the construction be complete? Explain how OTIB funding will make this project possible or advance it. What new work will be done because of this loan? Absent OTIB funding, when would the project go to contract? SECTION 7: OTHER PROJECT INFORMATION How does this project impact safety? What are the current accident rates, if any? What are projected accident rates if improvements are made? Supply data that supports any claimed safety improvements. The OTIB will grant preference to projects that directly improve the States ability to manage its traffic growth. Tell how this project contributes to traffic growth management. How does the project improve livability? Examples of how projects improve livability include: encouraging development designed to allow people to live, work and shop in the same area; making walking, biking and transit convenient and accessible; or assuring accessibility of service to rural communities. How does this project strengthen Oregons economic development? Refer to the goals listed in the economic development criterion. Which of these goals does your project support? Describe how this project impacts Oregons quality of life. What is the current situation? How will this project improve the existing situation? Improvements in air or water quality, lower commute times, reducing vehicle miles traveled, promoting inter-modal connections, and maintaining or improving access for emergency services are examples of ways projects might improve Oregons quality of life. SECTION 8: ATTACHMENTS Attach the following items with the application: 1.For all road projects, one copy of a Project Prospectus, Parts 1, 2 and 3. Yes___No___N/A___2.If available, attach an engineering feasibility analysis, prepared and stamped by a registered professional engineer. Typically, this analysis will include: the name, address, and phone number of the professional engineer. an explanation of the basis for the size and/or capacity of the proposed project; project alternatives considered; detailed cost estimate including all items necessary to complete the project; preliminary drawing of the project; maps showing the general location of the project, tax lots or parcels in the project area, and the specific location of the project; environmental concerns; needed permits and/or licenses to construct the project; what jurisdiction(s) will own, operate and/or maintain the proposed project; anticipated project schedule: project start preliminary engineering/design Construction  Yes___No___N/A___3.A draw down schedule of loan proceeds.Yes___No___N/A___4.Public hearing notice, minutes of the public hearing and minutes of the meeting at which submission of this application was approved. Yes___No___N/A___5.One copy of each of the last three years of the Applicants audited financial statements. Yes___No___N/A___ 6. One copy of the current budget. Yes___No___N/A___7.Copies of any documents creating any fund that may be pledged for repayment of the loan. Yes___No___N/A___8.Copies of any ordinance or resolution which established any debt that is supported by the pledged revenues described in Section 4 of this application. Yes___No___N/A___9.Adopted Capital Improvement Plan (if available) and transportation facilities plans as appropriate. Yes___No___N/A___10.One copy of the Applicants enabling charter or resolution as amended. Yes___No___N/A___ SECTION 9: CERTIFICATION I certify that: The Applicant has the authority to request and incur the debt described in this application and, upon approval, will enter into a contract for the repayment of the loans. The Applicant has held any locally required public hearings or notices and will comply with all applicable state and federal regulations and requirements. To the best of my knowledge all information contained in this application is valid and accurate. The governing body of the undersigned jurisdiction at its _____________________ (date) meeting authorized the submission of this application. 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