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.)
Municipal Designation:

Other
Name of Point of Contact for all matters relating to this MERF application:

First NameLast Name
Point of Contact Position:
The role that the Point of Contact fulfills for the Covered Municipality.
Point of Contact Email:

Confirmation EmailWhat is the best email for follow-up questions about your application?
Point of Contact Phone #:
What is the best phone number for follow-up questions about your application?Format: (000) 000-0000.
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 complete mailing address:

Street Address

Street Address Line 2

CityState

Zip Code

Project Overview
Sources & Uses #1. Please identify the total estimated project cost for the proposed project (including the cost of obtaining a Level II Energy Assessment, if necessary).
Sources & Uses #2. Please identify the total amount that you are requesting in MERF loan funding.
Sources & Uses. If the total estimated project cost in Sources & Uses #1 exceeds the total loan amount requested in Sources & Uses #2, please identify all funding sources that may be used to cover the gap between the requested MERF loan amount and the total project cost. If the total estimated project cost in Sources & Uses #1 is equal to or less than the total loan amount requested in Sources & Uses #2, please enter "N/A".
Please provide a brief narrative that gives an overview of the proposed project(s).

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

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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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Loan Use Information
Aside from direct implementation costs, what additional expenses do you anticipate incurring in pursuit of this MERF loan opportunity? Select all that apply.

Other
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)

Financial Information
Attestation of Financial Need. Provide a written statement confirming that your municipality cannot fund the proposed energy efficiency project with the budget proposed for the current/upcoming fiscal year, and therefore needs to take out a loan to fund the proposed energy efficiency project.

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Upload your municipality's financial statements from the 3 most recently completed fiscal years. Audits are not required, but are preferred if available. Please note that a valid financial statement must include both a balance sheet and a statement of revenues & expenses.

Additional information may be requested after submission of this application at the department's discretion
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Current Fiscal Year Financial Projections: Provide your projected Property Tax Revenue for the current fiscal year.
Current Fiscal Year Financial Projections: Provide your projected Intergovernmental Revenue for the current fiscal year.
Current Fiscal Year Financial Projections: Provide any projected Other Revenue for the current fiscal year. If none, enter "N/A".
Current Fiscal Year Financial Projections: Provide your projected Total Revenue for the current fiscal year.
Current Fiscal Year Financial Projections: Provide your projected Total Expenses for the current fiscal year.
Upload any other relevant documentation regarding your municipality's current fiscal year financial projections.

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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

Acknowledgements
By checking this box I attest that I have the authority to apply for and enter into agreements on behalf of the named municipality.
By checking this box I certify that all information provided as part of this application is true and correct to the best of my knowledge. I give my consent for this application to use the information provided herein for the purpose of consideration. I will provide any supplemental information that I have indicated in this application to my RPC or to BGS directly.
Should be Empty:

MERF Loan Application

Municipality Information

Project Overview

Building/Project Materials Upload

Loan Use Information

Financial Information

Acknowledgements