APPLICATION FOR LOAN OR GRANT FROM THE
COSTILLA COUNTY CONSERVANCY DISTRICT
An applicant for a third-party loan or grant from the Costilla County Conservancy District (“CCCD”)shall provide the following information as part of the application process:
1.Name and address of the individual(s)/organization/business entity requesting such funds:
2.Location of the project or proposed project (“Project”)for which the funds will be used:
(a)Describe its location.
(b)Is the project physically located within the exterior boundaries of the Costilla County Conservancy District?
3.Describe the purpose of the project.
4.Describe how the amounts requested will be used and/or incorporated into the project.
(a)Will any of the requested amounts not be used in the project? If so, specify the amounts not intended for use in the project and the intended use of those amounts.
5.Describe the current status of the project (e.g., not yet started, partially completed, or totally completed.)
(a)If not yet started, what is the contemplated date to start?
(b)If partially completely, set forth the percentage of the total project that has been completed.
(i)Describe specifically what has been completed.
(ii)Describe what needs to be done to complete the project?
(iii)State the anticipated completion date.
(b)If totally completed, the date that it occurred.
6.If a written cost estimate has been prepared for this project, or any phase of it, please attach the cost estimate.
(a)Submit a current detailed cost estimate of materials, labor, and/or third-party contractor costs for the project.
(b)State the total cost of the project.
7.Has any other entity or person provided funds for the project?
8.If the project is partially completed, state the total amount that has been spent on the project to date. As to each amount, state:
(a)Source(s) of those funds.
(b)Date or dates the amounts were spent.
(c)How such amounts were used.
9.If monies are allocated by CCCD for this project pursuant to this application, will this be a one-time request?
(a)If not, please explain.
10.Explain the means of accounting that is or will be utilized by applicantas tofunds received and disbursals made for the project.
11.If funds are advanced by CCCD for this project, does the applicant have the ability to provide to CCCD:
(a)The manner the disbursals from CCCD will be incorporated into the project.
(b)Receipts for materials purchased and evidenceof labor used on the project.
(c)Evidence of payment to third-party contractors for the project.
12.If a third-party contractor(s)is intended to be, or has been used to provide services, labor or materialsfor this project, submit each name of the third-partycontractor and provide:
(a)The name, address and telephone number of the third-party contractor(s).
(b)Describe the contemplated services, labor, or materials eachthird-party will provide.
(c)The estimated costs to the projectfor using each third-party contractor.
(d)Will competitive bids be made for third-party contract services?
13.As to this project, state the responsible person who will provide:
(a)General oversight for the project.
(b)Financial accounting oversight for the project.
(i)Will the financial accounting person(s) provide an accounting to CCCD for the project uponCCCD’s request?
14.If CCCD makes a loan to applicant for this project, what assets will applicant,or others that benefit from the project, beable to provide to CCCD as security for the loan?
15.State any potential beneficiaries of the project that have funding sources to pay for all or part of it.
16.State if any third-party financial commitments or other financial sources are, or are contemplated to be, in place to fund the project, and as any such source or commitment:
(a)State the third-party entity or person making the commitment or providing the source.
(b)State the amount of each commitment, if any has been made.
(c)State the amount of each source, if any has been made.
17.Is the project contemplated to be done in phases?
(a)If the project is contemplatedto be done in phases, state the estimated cost of each phase.
18.Has applicant previously requested funds from CCCD for this project?
(a)If so, on what date?
(b)State the total amount of funds requested.
19.If applicant has requested fundsfrom CCCD in the past for one or more projects, aside from the project subject to this request, please state the date of each request, the amount requested for each project, and the disposition of the request by CCCD.
20.State ifanon-profit or governmental source may be available to provide loans or grants to fund the project.
(a) State all such non-profit or governmental entities that have been contacted, or are intended to be contacted, by applicant.
(b)State the date and disposition of any contact that has been made.
21.Provide applicant’s position as to whether funding of the project by CCCD will make it sustainable, if funds are provided.
(a)Once built or improved, what is the project’sprojected life?
(b)Is applicant’s request for monies for the project a temporary or permanent resolution of the conditions that are intended to be remedied by such funds?
22.Describe the problems/considerations relating to the need for CCCD funds for the project?
23.If applicant contends that an incorporated/unincorporated ditch will be benefitted by the project, state the name of the ditch and describe how and in what manner the ditch will be benefited.
(a)Are there any other beneficiaries to the project aside from applicant?
(i)If the answer is yes, state the name and describe how and in what manner other third parties will be benefitted.
(b)If a ditch will be benefitted by the project, do the persons owning the ditch or its shareholders have their own financial resources that could be used for the project?
(i) Explain the basis for your response.
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