55B - RESO - CLEAN DRINKING WATER

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If the Division were to set up a technical sponsorship program, would you be interested in providing in -kind technical assistance to another CWSRF applicant in exchange for special financing? Note that checking "Yes" in no way obligates you to participate in this potential program or guarantees that this incentive will be available or offered. Z Yes ❑ No If Yes, please indicate the areas where you would be willing to provide assistance: ❑ Assistance in completing a funding application ❑ Assistance in writing a facilities plan /project report © Assistance in developing a Capital Improvement Plan [Z] Assistance in conducting a water or energy audit ❑ Assistance in building Operations & Maintenance capacity ❑ Other: Specify VI. SUSTAINABILITY A project that supports or incorporates one or more of the following sustainability goals receives one priority point for each area addressed. Label the requested documents as Attachment G1, G2, G3, etc. project supports infill development or results in the reuse or redevelopment of land in an area presently ❑The served by transit, streets, water, sewer and other essential services. G1 — Provide a map highlighting the infill or redevelopment areas. The applicant maintains a Capital Improvement Plan, an Asset Management Plan, or has performed a full -cost Zpricing analysis, or the project incorporates climate change adoption. G2— Provide copies or links to these plan or analysis. The project protects environmental or agricultural resources such as farm, range and forest lends; wetlands and wildlife habitats; recreational lands such as parks, trails, and greenbelts; or landscapes with locally unique features or areas identified by the state as deserving special protection. G3 — Provide a map highlighting the areas that will be protected. ElThe project is cited in one or more regional environmental management plans. G4— Provide copies or links to these plans. project incorporates wastewater or storm water /urban runoff recycling, water conservation, energy ❑The conservation, low impact development, or reduced use of other vital resources. G5 — Explain the reason for the energy savings and the expected energy savings. project uses low- impact treatment for lower Recycle operating costs through reduced energy, chemical, or ❑The other inputs. G6 — Explain the reason(s) for the reduced operating costs. To the best of my knowledge and belief, I certify that I am authorized to submit this application; the information provided in this application is true and correct; the documentation has been duly authorized by the governing body of the applicant; and the entity possesses the legal authority to apply for the financing and enter into a financing agreement with the State Water Resources Control Board and to finance and construct the proposed facilities. Name of Authorized Representative: Nabil Saba of Authorized Title: Water Resources Manager Date: HOW DID YOU HEAR ABOUT THE C WSRF PROGRAM? ❑ California Financing Coordinating Committee (CFCC) Funding Fair ❑ Colleague ❑ State Water Board Letter ❑ Conference /Trade Show /Workshop (Specify): 0 Consultant O Internet Financial Assistance Application (REV. 032015) ❑ Publication ❑Other (Specify): Page 3 of 3 EXHIBIT 5 55B -23 ❑ Employer /Employee General Information Package