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Virgin Islands Department of Planning and Natural Resources Drinking Water Capital Improvements Grant Division of Environmental Protection Pre-Application Public Water System Supervision Program February 2008 VIRGIN ISLANDS CAPITAL IMPROVEMENT GRANT PRE-APPLICATION FORM DPNR Use only Project Tracking No. Project Name PWS ID # Tax ID # Estimated Cost Population Served Pre-Application for V.I. Drinking Water Capital Improvements Grant (VIDWCIG) Please fill out all information requested in full. Any pre-applications that are not filled out completely will not be considered for a drinking water capital improvements grant. CONTACT INFORMATION DATE PREPARED: Month Day Year Name of Public Water System Contact Person (If different from manager) Public Water System I.D. number Title Owner / Manager’s name Telephone number and Fax number Telephone Number and Fax number E-mail Name of Consulting Engineering Co. Physical Address Telephone Number and Fax Number Mailing Address Physical Address Island and Zip Code Mailing Address Organization’s Tax I.D. Number Island and Zip Code Design Engineers Company’s Tax I.D. Number Public Water System Information: Type of Public Water System: (a) Community (b) Non-Community Tax Status of System: (a) For Profit (b) Not for Profit Governmental Status: (a) V.I. Government (b) Federal Age of Public Water System: Population Served by Public Water System: Virgin Islands Department of Planning and Natural Resources Drinking Water Capital Improvements Grant Division of Environmental Protection Pre-Application Public Water System Supervision Program February 2008 CAPACITY DEVELOPMENT ASSESSMENT Water system capacity is the ability to plan for, achieve, and maintain compliance with applicable drinking water to the public. Before a drinking water capital improvements grant can be awarded to a public water system, the system must demonstrate that it has adequate technical, financial, and managerial capabilities (TFM). Public water systems that do not have adequate TFM are not eligible to be funded unless the public water system agrees to make appropriate changes in operation (management, rate structure, maintenance, consolidation, alternative supplies, etc.) that will ensure the long-term capacity of the system. Your answers to the following questions will serve to demonstrate your system’s capacity for determining eligibility for receiving a Drinking Water Capital Improvements Grant. TECHNICAL CAPACITY Technical capacity is the physical and operational ability of a water system to deliver safe drinking water and to meet SDWA requirements. Technical capacity refers to the physical infrastructure of the water system, including the adequacy of source water and the adequacy of treatment, storage, and distribution infrastructure. It also refers to the ability of system personnel to adequately operate and maintain the system and to otherwise implement requisite technical knowledge. What is the source of water for the public water system? Is the source of water reliable, generally good quality and adequately protected? Can the system provide water that meets SDWA standards? Yes No What is the condition of the system’s infrastructure, including the following: Wells(s) or sources of water intakes? Treatment unit(s)? Storage facility(ies)? Distribution system? What is the infrastructure’s life expectancy? Does the system have a capital improvement plan? Yes No If yes, please explain it or attach a copy of it to this form. Virgin Islands Department of Planning and Natural Resources Drinking Water Capital Improvements Grant Division of Environmental Protection Pre-Application Public Water System Supervision Program February 2008 Does the system have an effective operation and maintenance program? Please describe it. Does the system’s operator(s) have documented training and knowledge of drinking water treatment technology and the operation of drinking water systems? Please describe training. Does the operator(s) have sufficient knowledge of applicable drinking water standards? Please describe education and experience. Can the operator(s) effectively implement this technical knowledge? Yes No FINANCIAL CAPACITY Financial capacity is a water system’s ability to acquire and manage sufficient financial resources to allow the system to achieve and maintain compliance with the SDWA requirements. Do revenues cover the cost of water and costs to operate and maintain the system in compliance with SDWA standards? How does the system manage its revenues effectively? Please explain. Is the system financially healthy? Does it have access to capital through public or private sources? Are adequate books and records maintained? Are appropriate budgeting, accounting, and financial planning methods used? What methods are used? Are capital improvements to the system included in the financial planning? Please describe. Virgin Islands Department of Planning and Natural Resources Drinking Water Capital Improvements Grant Division of Environmental Protection Pre-Application Public Water System Supervision Program February 2008 MANAGERIAL CAPACITY Managerial capacity is the ability of a water system to conduct its affairs in a manner enabling the system to achieve and maintain compliance with the SDWA requirements. Managerial capacity refers to the system’s institutional and administrative capabilities. Are the system owners clearly identified? Can they be held accountable for the system? Please list them. Are the system operator(s) and manager(s) clearly identified? Please list them. Is the system properly organized and staffed? Please describe organization and staffing positions. Do personnel understand the management aspects of regulatory requirements and system operations? Do personnel have adequate expertise or training to manage water system operations? Describe expertise and training below. Virgin Islands Department of Planning and Natural Resources Drinking Water Capital Improvements Grant Division of Environmental Protection Pre-Application Public Water System Supervision Program February 2008 PROJECT INFORMATION Name of Water System: Location of Project: Project Description (if necessary, continue description on a new page and attach it to the pre-application): Population Served by Water System: Population Served by Project: How does this project facilitate compliance with the National Primary Drinking Water Standards or further health protection objectives of the SDWA (if necessary, continue explanation on a new page and attach it to the pre- application): Are there other sources of funds anticipated for this project: Yes No If yes, can they be used in conjunction with a Capital Improvements Grant: Yes No Please attach a separate page, which provides information on the source of funding, type of funding, amount of funding, and letter of confirmation. PROJECT COST ESTIMATE (If necessary, continue cost schedule on a new page and attach it to the pre-application) Materials Materials Costs $ Construction Construction $ Equipment Equipment Costs $ Other Other Expenses $ $ $ Project Costs ---------------------------------------------------------------------------------------------- $ Design Allowance (see table below)------------------------------------------------------------------- $ Sub-Total of amount to finance------------------------------------------------------------------------- $ Other funding source (subtract this amount)---------------------------------------------------------- $ Total amount to finance (Grant amount):-------------------------------------------------------------- $ ACTIVITY DATES: Duration of engineering / design preparation (in weeks): When will all technical submittals be completed? Date: / / Duration of construction (in weeks): Virgin Islands Department of Planning and Natural Resources Drinking Water Capital Improvements Grant Division of Environmental Protection Pre-Application Public Water System Supervision Program February 2008 Maximum Design Allowance Project Cost Allowance for Planning and Design as a Percentage of Construction Cost Up to $5,000 14% or up to $650 $5,001 to $20, 000 13% or up to $2,400 $20,001 to $35,000 12% or up to $3,850 $35,001 to $50,000 11%or up to $5,125 $50,001 to $75,000 10.25% or up to $7,313 $75,001 to $100,000 9.75% or up to $9,250 $100,001 to $150,000 9.25% or up to $13,200 $150,001 to $200,000 8.8% or up to $16,800 $200,001 to $300,000 8.4% or up to $24,450 $300,001 to $400,000 8.15% or up to $31,200 $400,001 to $500,000 7.8%%or up to $37,500 $500,001 to $750,000 7.5%or up to $54,375 $750,001 to $1,000,000 7.25% or up to $70,000 Over $1,000,000 7%