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Non-reimbursable Investment Application-CWCB Construction Fund <br /> Form Revised August 8,2003 <br /> Engineering,and Construction costs,if known: <br /> Estimated Planning/Study Costs: $ <br /> Estimated Engineering Costs: $ <br /> Estimated Construction Costs: $ <br /> Estimated Total Costs: $,150,000 authorized yearly_ <br /> 10. What amount are you requesting? $ 100,000 to refresh the account <br /> Where will the rest of the funding come from? <br /> Federal Grants/Programs (estimated) <br /> Local/other Cost Share(estimated) <br /> Part C. -Project Sponsor Financial Information <br /> The CWCB Construction Fund is primarily a revolving loan fund. Non-reimbursable Investments <br /> are approved only when the project or study is of Statewide interest and benefits a wide range of <br /> people. The following information is requested to assist the CWCB in a preliminary assessment of <br /> the applicant's financial capacity. It is also requested that the project sponsor submit with this <br /> application copies of the two most recent annual reports, financial statements, corporate reports or <br /> other current documentation of financial condition and operations. <br /> 1. List any existing liability or indebtedness that exceeds one thousand dollars. For example, <br /> bank loans, government agency loans, bond issues, accounts payable, etc. Include names <br /> and addresses of lenders, amounts, due dates and maturity dates. (You may attach a separate <br /> schedule if you wish): <br /> Lender Total Annual Maturity <br /> Name/Address Amount Payment Date <br /> 2. Are any of the above liabilities now in default, or been in default at any time in the past? <br /> 4 <br />