MERF Loan Application FINAL

MERF Loan Application
Municipality Information

Please complete the information below. All fields marked with a red asterisk (*) are required.
Municipality Name:*
Do NOT include the municipal designation (e.g. Town of, City of, Village of, etc., you may include "Fire District" if necessary.)
CityTownIncorporated VillageUnified Towns and GoresFire DistrictOther
Name of Authorized Representative completing this application:*

First NameLast Name
Authorized Representative Position:*
The role that the Authorized Representative fulfills for the Covered Municipality.
Authorized Representative Email:*

Confirmation EmailWhat is the best email for follow-up questions about your application?
Authorized Representative Phone #:*
What is the best phone number for follow-up questions about your application?
VT Regional Planning Commission your municipality is within:*
Select your Regional Planning Commission.
VT County your municipality is within:*
Select your County..
Enter your municipality's Employer Identification Number (EIN#)*
A municipality's EIN (Employer Identification Number) is issued by the IRS. Past tax filings will have your municipality's EIN # present. Check past tax filings (e.g., IRS Form 990 if applicable). If the EIN has been lost, an authorized municipal official can call the IRS Business & Specialty Tax Line at 1-800-829-4933 (available Mon–Fri, 7 a.m.–7 p.m. local time).
Enter your municipality's Unique Entity Identifier (UEI)*
Your municipality’s UEI (Unique Entity Identifier) can typically be found through the SAM.gov website. If not found, your municipality may not be registered in SAM.gov yet, which is required for receiving federal funds. In that case, you’ll need to register to get a UEI through SAM.gov registration.
Enter your municipality's complete mailing address:*

Street Address

Street Address Line 2

CityState

Zip Code

Loan Use Information
Technical Assistance (Project Management, Design, Architectural Planning)Upgrade an existing MERP Energy Resilience Assessment from Level 1 to Level 2Obtain a new Level 2 Energy Resilience Assessment for a previously unassessed building using a provider from the BGS state contract.Using a town-purchased building energy audit (or status Level 2 or higher) for MERF loan application purposes (AUDIT NOT COVERED BY MERF LOAN)None of the aboveOther
If your municipality:

a. Has not received a MERP-provided Level 2 Energy Resilience Assessment for the building,
OR
b. Has only received a MERP-provided Level 1 Energy Resilience Assessment for the building,

then your municipality must first obtain one of the following before applying for a loan to implement audit-recommended measures:

1. A MERP-provided Level 2 Energy Resilience Assessment (you may apply for a loan to cover this assessment as part of this application),
OR
2. A town-funded energy audit, provided it was conducted by a vendor on the BGS-maintained state contract (note: BGS cannot provide a loan for audits conducted outside of this vendor list).
Explain your plan/approach for your chosen options above.*
Please enter line by line. (Example: 1. Project Management: XXXXXXXXX, 2. Design/Architectural Planning: XXXXXXXXXX)

Revenues and Expenditures
Upload your municipality's recent financial audit(s): 1 year minimum; 3 years preferred.*

Additional information may be requested after submission of this application at the department's discretion
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If you have any other supplemental municipal financial statements and materials that you may find relevant to this application, upload them here:

Additional information may be requested after submission of this application at the department's discretion
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Does the borrower participate in the Vermont Municipal Employees' Retirement System (VMERS)? List your proportionate share of net pension liability. If not applicable, type N/A.*
Please upload State of Vermont Auditor's control checklist submitted to governing body. *

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Link to State of Vermont Auditor's control checklist is here: https://auditor.vermont.gov/sites/auditor/files/documents/Internal%20Financial%20Controls%20Checklist%20for%20Municipalities%20v.1%20-%20Fillable%20with%20digital%20signature.pdf
Enter the direct population being served by your proposed project(s):*
Approximation is acceptable.

Building/Project Materials Upload
Download and fill out this spreadsheet with the building and project information your municipality is applying to MERF for. Make sure to complete this sheet with as much detail as possible.

Spreadsheet Link:

https://bgs.vermont.gov/sites/bgs/files/documents/MERF%20Application%20Building%20Info%20%26%20%20ECM%20Spreadsheet.xlsx
Save your completed MERF Application Building Info & ECM Spreadsheet under the file name "MERF_YourMunicipalityName_BuildingInfo" and upload in the field below.*

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Upload PDF versions of the building energy audits used to fill out this application.

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Project Narrative
Is there anything else about your project that has not been addressed in the preceding questions that would be beneficial for reviewers to know as they score your application? If not, type "N/A".*

Word limit - 0/250
Upload any supplemental materials relevant to this application that you may find applicable.

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Acknowledgements
I understand and agree.
I understand and agree.
I understand and agree.
Should be Empty:

MERF Loan Application

Municipality Information

Loan Use Information

Revenues and Expenditures

Building/Project Materials Upload

Project Narrative

Acknowledgements