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Non-Reimbursable Application - CWCB Construction Fund ~r <br />Form Revised June 2006 <br />What is the estimated cost of the study/demonstration project? Please include estimated Study, Planning, <br />Engineering, and Construction costs, if known <br />8 <br />Estimated Planning/Study Costs: <br />Estimated Engineering Costs: <br />Estimated Construction Costs: <br />Estimated Total Costs: <br />9. How much funding are you requesting? $33,068 <br />E <br />Part C. -Project Sponsor Financial Information <br />The CWCB Construction Fund is primarily a revolving loan fund. Non-reimbursable <br />investments are approved only when the project or study is of statewide interest and benefits a <br />wide range of people. Provide copies of the two most recent annual reports, fmancial <br />statements, corporate reports or other current documentation of financial condition and <br />operations with this application. <br />2. Provide a brief narrative description of potential sources of funding (in addition to the CWCB) <br />which have been explored or which will be explored for the proposed project or study. <br />(Examples would be Local County and Town Governments, Water Conservancy Districts, <br />USDA Rural Development, The Natural Resources Conservation Service, The U.S. <br />Environmental Protection Agency, Commercial Banks, etc.) <br />The above statements are true to the best of my knowledge: <br />Signature of Applicant: <br />Print Applicant's Name: <br />Project Title: <br />Date: <br />Return this application to: <br />Mr. Mike Serlet, P.E., Chief <br />Water Supply Planning and Finance Section <br />COLORADO WATER CONSERVATION BOARD <br />1580 Logan Street, Suite 750 <br />Denver, CO 80203 <br />To submit applications by Email, send to: rnike.serlet(a)lstate.co.us <br />To submit applications by Fax, send to: (303) 894-2578 <br />For questions, call Telephone No.: (303) 866-3426 <br />• <br />