Municipal Climate Recovery Fund

Small System Capacity and Resiliency Program Tier I - Flood Recovery for Water & Wastewater Systems

Applications due Friday, August 23, 2024
Name of Applicant (Governmental Unit)*
Primary Contact*

First NameLast Name
E-mail of Contact*
example@example.com
Phone number of Applicant
Format: (000) 000-0000.
Address of Applicant*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of Loan Requested*

FEMA Endorsed Recovery ProjectNon-FEMA Recovery Project

Small System Capacity & Resiliency Program

Application due Friday, January 5th, 2024
Describe Proposed Use of Financing & Connection to Super Storm 2023*
Amount of Loan Request*
$

Project Sources & Uses*

Summarize FEMA Commitments to the Project; if FEMA reimbursement unlikely, describe need for project*
Estimated First Draw on Loan

MonthDayYear
Date
Estimated Last Draw on Loan

MonthDayYear
Date

Documentation Supporting Requested Loan Amount (eg., contracts, bids, etc...)*

Cancelof
FY 2022 Financial Statement*

Cancelof
FY 2023 Financial Statement*

Cancelof
YTD or 2024 Financial Financial Summary*

Cancelof
Bond Counsel Engagement Letter (evidencing that they are reviewing potential loan)*

Cancelof

Disaster Impact Ratio*

Rows	Water Fund	Sewer Fund
Total Documented Losses
Expected Insurance Payouts
Estimated Own Source Revenue Loss
FY 23 Budget

The information provided in this application is true and accurate and the contact on the application is authorized to submit the application.
I agree to the above statement*

Yes
Should be Empty:

Small System Capacity and Resiliency Program Tier I - Flood Recovery for Water & Wastewater Systems