Florida Department Of Environmental Protection

Summary

Florida Department of Environmental Protection
REQUEST FOR INCLUSION ON THE
DRINKING WATER PRIORITY LIST
Drinking Water State Revolving Fund Program
Douglas Building, 3900 Commonwealth Blvd, Tallahassee, Florida 32399-3000
The information contained in this Request for Inclusion (RFI) application is used to determine project eligibility and priority scoring

The priority score is used to rank projects for placement on the State Revolving Fund (SRF) priority list. Only projects placed on the
fundable portion of the priority list receive consideration for a loan. Please note that costs incurred before the adoption of the project
on the fundable portion of the priority list at a public meeting are not eligible for reimbursement. The loan service fee, based on a
percentage of the loan amount, will be determined in accordance with 62-552.200(18), F.A.C

Please Note: This application must be completed in its entirety before it can be processed to determine sponsor eligibility

1. Applicant's Name and Address

Project Sponsor: Contact Person: Title:
(street address)
(city) (county) (zip code)
(telephone) (ext.) (e-mail)
Contact Person Address (if different):
(street address) (city) (state) (zip code)
2. Name and Address of Applicant's Consultant (if any)

Firm: Contact Person: Title:
(street address)
(city) (zip code)
(telephone) (ext.) (e-mail)
3. Type of Loan Requested in this Application. Select only one loan category

Planning Loan Design Loan Planning and Design Loan Construction Loan
Select Type of Project: Design/Bid/Build Design/Build (D/B) Construction Manager at Risk (CMAR)
Eligibility for a Loan. In order to be considered for a priority listing, the following conditions must be met:
• The respondent to this solicitation must qualify as a “project sponsor” as defined in 62-552.200(26), F.A.C.;
• The minimum construction loan amount is $75,000;
• The project sponsor must agree to submit biddable plans and specifications within 1-year after being placed on the fundable
portion of the priority list to qualify for a combined planning and design loan; and
Form RFI-DW1; Incorporated in paragraph 62-552.300(1)(a), F.A.C. Page 1 of 5 GCA reformatted 2-21-18 Effective Date: July 2017
REQUEST FOR INCLUSION ON THE DRINKING WATER PRIORITY LIST
• The project is part of a public water system as defined in 62-552.200(27), F.A.C., and may include drinking water supply,
storage, transmission, treatment, disinfection, distribution, residuals management, and appurtenant facilities

4. Principal Forgiveness Percentage (PF%). Is project sponsor eligible for a loan with principal forgiveness? Yes No
(see eligibility requirements below). All applicants must complete a. and b. below

a. Is project sponsor applying for a planning and/or design loan with principal forgiveness? Yes No . If yes, then PF 50%

Only a sponsor that directly qualifies as a financially disadvantaged small community is eligible for a planning and/or design loan
with principal forgiveness

b. Is project sponsor applying for a construction loan with principal forgiveness? Yes No . If yes, then calculate PF%
using the formula: PF% = 1760/9 – 160 x (MHI/SMHI) – 7/4500 x P. All applicants must complete 1. through 5. below

1. Median household income (MHI): (per recent ACS 5-yr estimate U.S. Census Bureau or verifiable estimates)
2. State median household income (SMHI): (per recent ACS 5-year estimate U.S. Census Bureau)
3. Population (P) served: (no. of service connections x persons/connection, include proposed connections)
4. Calculated PF% for a construction loan: 195.56%
20% principal forgiveness if MHI < SMHI and P > 10,000 or 0% if MHI > SMHI, unless sponsor is specifically exempted

A maximum of 50% principal forgiveness if the sponsor is connecting a disadvantaged community or has a separate water
system as defined below

5. Select Type of Project Sponsor:
Disadvantaged/Small Disadvantaged Only Separate or Connecting Disadvantaged/Small Other
Please note that the calculated PF% is an estimate and the actual percentage will be determined by the Department. The
maximum principal forgiveness percentage for a construction loan is 90% and the minimum is 20%. A qualifying sponsor is
eligible to receive a maximum 50% principal forgiveness for the costs to complete an asset management plan in accordance
with 62-552.700(7), F.A.C., if part of a construction loan. The amount of loan available with principal forgiveness for a
project is dependent upon allocated funds for the fiscal year

Eligibility for a loan with principal forgiveness. In order to be considered for a loan with principal forgiveness, the following
conditions must be met:
• The project sponsor must qualify as a financially disadvantaged small community public water system as defined in Rule 62-
552.200, F.A.C., unless the sponsor is specifically exempted from this requirement

• The median household income (MHI) of the sponsor’s service area must be less than the state median household income
(SMHI) as reported from the most recent census data or from verifiable estimates, unless the sponsor is specifically exempted
from this requirement

• The population (P) of the sponsor’s service area must be less than 10,000 (including future connections proposed by the
project), unless the sponsor is specifically exempted from this requirement

• The project sponsor shall have only one open loan with principal forgiveness. A loan shall be considered open until the final
disbursement has been paid by the department

• A sponsor that connects less than 250 residential private wells or connects an existing public water system with less than 250
service connections is eligible for a construction loan with principal forgiveness up to a maximum of 50% if the connected
community qualifies as financially disadvantaged

• A sponsor that owns and operates a separate, non-interconnected, public water system that qualifies as a financially
disadvantaged small community, regardless of the number of systems owned and operated by the sponsor, is eligible for a
construction loan with principal forgiveness for that system up to a maximum of 50%

• A financially disadvantaged community with a population of 10,000 or more is eligible for a construction loan with 20%
principal forgiveness if dollars are available after funding all eligible financially disadvantaged small community systems

5. Interest Rate Percentage

The interest rate for a loan with the Department is determined using the formula:
% of MR = 40 x (MHI/SMHI) + 15
% of MR = Percentage of Market Rate

Calculate and complete the % of MR below:
% of MR for a loan: 15.00%
(35% < % of MR < 75%)
Form RFI-DW1; Incorporated in paragraph 62-552.300(1)(a), F.A.C. Page 2 of 5 Effective Date: July 2017
REQUEST FOR INCLUSION ON THE DRINKING WATER PRIORITY LIST
Please note that the calculated % of MR is an estimate and the actual interest rate will be determined by the Department. The
market rate shall be established using the Thomson Publishing Corporation’s “Bond Buyer” 20-Bond GO Index. Projects with a
drinking water supply component as defined in 403.8532(9)(a), F.S. or a water conservation component per 62-552.300(1)(e)1.d.;
and sponsors with an accepted/implemented asset management plan may qualify for additional interest rate reductions in
accordance with 62-552.300(6)(b), F.A.C. Interest rate reductions are also available for implementation of EPA’s Davis-Bacon
(DB) and American Iron & Steel (AIS) requirements. The interest rate for a loan shall not be less than zero percent

6. Base Priority Score. Each project shall receive a base priority score (BPS) dependent on the weighted average of its
components. The BPS shall be determined using the below formula where CPS means the component priority score and CCC
means component construction cost

BPS = [CPS1 x CCC1 + … + CPSn x CCCn]/Total Construction Cost
Select each component and component score in Table 1 below that applies to the project, fill in the estimated construction cost,
and calculate the base priority score

• Component priority scores that are based on contaminant levels must be justified by sample analytical data (see exception in
notes at bottom of Table 1). The date that samples were collected must be less than 24-months from the date of submittal of a
Request for Inclusion. The sampling data must show an ongoing and current problem with a drinking water quality standard

• The project sponsor must provide documentation demonstrating that contaminant levels (e.g. disinfection byproducts) cannot
be reduced by adjusting system operations, if applicable

• A compliance-1 category component score of 400 points, if selected in Table 1, must be supported by documentation
demonstrating the need for the project; otherwise, a component score of 300 points shall be assigned

Table 1
Project Component Component Component
(Check all items that apply) Priority Score Construction Cost
Acute Public Health Risk
1a. E-Coli or Fecal Coliform Exceed MCL (62-550.310(5), F.A.C.) 800 points
1b. Nitrate, Nitrite, or Total Nitrogen Exceed MCL (62-550.310(1), F.A.C., Table 1)
1c. Lead or Copper Exceed Action Level (62-550.800, F.A.C)
1d. Surface Water Filtration and Disinfection Noncompliance (62-550.817(2), F.A.C.)
Potential Acute Public Health Risk
2a. Nitrate, Nitrite, or Total Nitrogen 50% of MCL (62-550.310(1), F.A.C., Table 1) 700 points
2b. Microbiologicals Exceed MCL (62-550.310(5), F.A.C.)
2c. Surface Water Enhanced Filtration and Disinfect. Noncompliance (62-550.817(3), F.A.C.)
2d. State Health Certification of Acute Health Risk, Unregulated Microbiological Contaminant
2e. Violation of Disinfection Requirement (62-550.310(2), F.A.C., Table 2)
Chronic Public Health Risk
3a. Inorganic or Organic Contaminant Exceed MCL (62-550.310(1 & 4), F.A.C., Tables 1,4,5) 600 points
3b. Disinfection Byproducts Exceed MCL (62-550.310(3), F.A.C., Table 3)
3c. Radionuclides Exceed MCL (62-550.310(6), F.A.C)
Potential Chronic Public Health Risk
4a. Inorganic or Organic Contaminant 50% of MCL (62-550.310(1 & 4), F.A.C., Tables 1,4,5) 500 points
4b. Disinfection Byproducts 80% of MCL (62-550.310(3), F.A.C., Table 3)
4c. State Health Certification of Chronic Health Risk, Unregulated Chemical Contaminant
Compliance-1/System does not meet or requires the following:
5a. Infrastructure upgrade to facilities undersized, exceed useful life, or with equipment failures 400 points
5b. Insufficient water supply source, treatment capacity, or storage
5c. Water distribution system pressure less than 20 psi
5d. Eliminate dead ends and provide adequate looping in a distribution system
5e. Replace distribution mains to correct continual leaks, pipe breaks, and water outages
5f. New water system or extension of existing system to replace contaminated/low yield wells
5g. Lack of significant safety measures (e.g. chemical containment)
Form RFI-DW1; Incorporated in paragraph 62-552.300(1)(a), F.A.C. Page 3 of 5 Effective Date: July 2017
REQUEST FOR INCLUSION ON THE DRINKING WATER PRIORITY LIST
5h. Secondary Contaminant MCL Exceedance (62-550.320, F.A.C.)
5i. Drinking water supply project as defined in 403.8532(9)(a), F.S

Compliance-2/System does not meet or requires the following:
6a. Treatment, Storage, Power, and Distribution Requirements (62-555.320, F.A.C) 300 points
6b. Minimum Required Number of Wells (62-555.315(2), F.A.C)
6c. Well Set-back and Construction Requirements (62-555.312 and 62-555.315, F.A.C)
6d. Cross-Connection Control Requirements (62-555.360, F.A.C)
6e. Physical Security Project Documented in a Vulnerability Analysis
6f. Consolidation or regionalization of public water systems
6g. Water/Energy Conservation Project
All Other Projects 100 points
Note: If item 2d. or 4c. of Table 1 is selected, then a State Health Officer must complete the form “Certification of a Public Health Risk”. If 50% or
more of residential wells meet contaminant levels indicated in Table 1, then check the appropriate public health risk category that applies

Flooded wells and wells under the direct influence of surface water are considered an unregulated microbiological potential acute public health
risk and require substantiated documentation of occurrence in lieu of sampling data

7. Affordability Score. The extent of affordability existing in a small community to be served by the project shall be reflected in the
priority score. Points shall be awarded based upon two affordability criteria: namely, median household income (MHI) and
service area population (P). These points are to be added to the base priority score. Calculate the affordability score using the
following formula:
Affordability Score = (MHI Score + Population Score)
MHI Score = 100 x (1.00 – MHI/SMHI)
Zero < MHI score < 75, rounded to nearest whole number
Population Score = 50.0 - (P/200)
Population score > zero, rounded to nearest whole number
8. Water Conservation Score. A project sponsor with a qualifying water conservation project is eligible to receive an additional
100 points added to their priority score if the sponsor provides a water conservation plan in accordance with EPA’s Water
Conservation Plan Guidelines web site https://www3.epa.gov/watersense/pubs/guide.html, document number EPA-832-D-98-001

The sponsor must also demonstrate that the proposed project meets the objective of the conservation plan

9. Total Priority Score. The total priority score equals the base priority score plus the affordability score and water conservation
score. Calculate and complete a. through d. below

a. Base priority score: points

b. Affordability score: points

c. Water conservation score: points

d. Total priority score: 0 points (sum of items a. through c.)
10. Estimated Project Cost. Complete a. through k. below, including loan amount requested

(Indicate $0 if activity is not applicable)
Project Activity Cost
a. Planning

b. Design (not applicable if a D/B project)

c. Technical services per 62-552.300(3)(h), F.A.C., for planning and design

d. Administration before bid opening (only include if not part of procurement in ‘f’ below)

e. Eligible land (necessary land divided by total land times purchase price)

f. Constr., equip., material, demo. & related procurement (include design if D/B project)

g. Administration during construction and after bid opening

h. Construction contingency (10% of ‘f’, only applicable for Design/Bid/Build projects)

i. Technical services during construction and after bid opening

Form RFI-DW1; Incorporated in paragraph 62-552.300(1)(a), F.A.C. Page 4 of 5 Effective Date: July 2017
REQUEST FOR INCLUSION ON THE DRINKING WATER PRIORITY LIST
j. Asset management plan per 62-552.700(7), F.A.C

k. Total project costs (sum of a. through j.). $0
Loan amount requested by the sponsor in this RFI (assume no principal forgiveness)

List all funding sources for this project:
11. Project Schedule. Complete a. through d. below

Project Activity (MM/DD/YY)
a. Submit planning documents

b. Submit design/bid documents or RFQ/RFP for CMAR & D/B projects

c. Start construction

d. Complete construction

12. Project Information. Provide the following information, if applicable

(Check all items that are attached to this RFI)
Project description, location with lat/long (degrees), water system PWS ID, and project need (this is a required attachment)

Map of city/county limits, existing/proposed service area, and project area (this is a required attachment)

Lab data, lab data w/operational records, or substantiated documentation in lieu of lab data for public health risk projects

The form “Certification of a Public Health Risk” completed by a State Health Officer

Supporting documentation for projects identified under the compliance-1 categories of Table 1

DWSRF business plan for a design or construction loan, not a planning or combined planning/design loan

Detailed project schedule showing plans/specs completion in 1-year of loan execution for a combined planning/design loan

MHI supporting documentation if MHI not taken from the most recent ACS 5-yr estimate of the U.S. Census Bureau

Water Conservation Plan, including demonstration that project meets plan objectives

13. Certification by an Authorized Representative. I certify that this form and attachments have been completed by me or at
my direction and that the information presented herein is, to the best of my knowledge, accurate and true

(signature) (date) (e-mail)
(print name) (print title)
Email the completed RFI form with attachments to SR[email protected] or mail to the Florida Department of
Environmental Protection, State Revolving Fund Program, 3900 Commonwealth Blvd, Tallahassee, Florida 32399-3000

Total Total
Project % of Attachments RFI
Priority Project Pop MHI SMHI PF%
Number MR Complete? Complete?
Score Cost
For DEP
Use Only DW Yes No Yes No
DEP
Comments:
Form RFI-DW1; Incorporated in paragraph 62-552.300(1)(a), F.A.C. Page 5 of 5 Effective Date: July 2017

Form RFI-DW1; Incorporated in paragraph 62-552.300 (1)(a), F.A.C. Page 3 of 5 Effective Date: July 2017 . Please note that the calculated % of MR is an estimate and the actual interest rate …

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