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Emergency Loan Application and Feasibility StudyCONSOLIDATED HOME SUPPLY DITCH & RESERV <br />Agency/Company Information <br />Name: Consolidated Home Supply Ditch & Reservoir Company — Refer to previous application — C150375 <br />Address: P. O. Box 1548, Berthoud, CO 80513 <br />Phone: ( 970- 622 -2212 ) Email: mlee@ncwcd.org <br />Organization Type: [ ] Ditch Co, [ ] Irrigation District, or Incorporated: YES or NO <br />Incorporation Date: In good standing with the Secretary of State: YES or NO <br />Number of acres irrigated Number of [ ] Shares/ [ ] Taps <br />Avg. Water Diverted/Yr acre -feet <br />Number of Shareholders? Current Assessment $ 210 /share <br />Projected Assessment $ 220 /share <br />Contact Information <br />Contact/Title ®( <br />Address: <br />Phone: ( ) Email: <br />Engineer: <br />Phone: ( ) Email: <br />Attorney: <br />Phone: ( ) Email: <br />Project • • n Information <br />County: Water District: <br />River Basin: Water Source: <br />Project <br />Project Type: (circle one or more) (Diversion Structure) / Dam / Well /( Ditch Rehabilitation) / Other <br />Estimated Engineering Costs:$35,000 Estimated Construction Costs:$330,000 <br />Other Costs (Describe Above):$9,000; contingency $70,000 Estimated Total Project Costs: $444,000 <br />Requested Loan Amount: Date Funding is Needed? 12/01/13 <br />Possible other funding sources: <br />Attachments <br />[ ] Last two years Financial Statements <br />[ ] Shareholders List <br />[ ] Articles of Incorporation/ By -laws <br />[ ] Location Map /Service Area <br />[ ] Shareholder Resolution (submit prior to contracting) <br />[ ] Attorney Opinion Letter (submit prior to contracting) <br />