HomeMy WebLinkAboutPIF Jefferson Co Application
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JEFFERSON COUNTY PUBLIC INFRASTRUCTURE FUND
Project Title:
Grant Request Amount: $ Loan Request Amount: $
Contact Information
Agency:
Contact: Date:
Phone #: Email:
Address: City, State,
Zip:
By signing you confirm you have authority to submit this application for PIF funds on behalf of your
organization. I affirm that the information is correct to my knowledge.
Signature:
Printed
Name: Title:
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JEFFERSON COUNTY PUBLIC INFRASTRUCTURE FUND
YOUR PROJECT
What is your “Public Facilities” project?
Please provide a brief description of your project in the explandable box below.
Description:
Where is your project located?
Description/Address:
Also: please attach to the end of your Application:
• a location map, and
• a site map (if applicable).
Which type of Public Facility Is Your Project?
The public facility must be specifically listed under RCW 82.14.370. Please select the
category(ies) which correspond to your project.
☐ Bridges ☐ Sanitary sewer
facilities
☐ Electrical facilities ☐ Telecommunications
infrastructure
☐ Roads ☐ Earth stabilization ☐ Natural gas facilities ☐ Transportation
infrastructure
☐ Domestic water
facilities
☐ Storm sewer facilities ☐ Buildings ☐ Commercial
infrastructure
☐ Industrial water
facilities
☐ Railroads ☐ Structures ☐ Port facilities
☐ Research, testing, training, or incubation facilities in an innovation partnership zone designated under
RCW 43.330.270
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JEFFERSON COUNTY PUBLIC INFRASTRUCTURE FUND
How Will This Project Create Or Retain Business Or Jobs? Use explandable box below.
Number and Types of Jobs or Businesses anticipated?
# of Jobs during Construction:
After Construction: by year 3 by year 5
# and Types of Businesses:
# and Types of Direct Full-time Jobs:
# and Types of Direct Part-time Jobs:
# and Types of Indirect Jobs:
Description:
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JEFFERSON COUNTY PUBLIC INFRASTRUCTURE FUND
What Will Be The Cost Of The Project?
The County Commissioners may disburse funds as both grants and loans. The County
negotiates the terms of each award.
Total Project Cost: $ Total PIF Request: $
☐ Loan Request: $
☐ Grant Request: $
What other funding will you use for this project: What source, how much, & what status?
Funding Source Amount Status
(spent, secured,
applied for, or
future request)
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JEFFERSON COUNTY PUBLIC INFRASTRUCTURE FUND
What Is The Project Phasing?
Articulate the major phases of this project, including the start and completion date, PIF Funds requested for each phase, the eligible PIF expenditure
category(ies) for that phase, and if asking for PIF funds for more than one phase, whether PIF funds could be awarded for each phase, separate from PIF
funding for the other phases.
Eligible PIF Expenditure Categories: The Washington State Attorney General 2001 No.5 opinion states that these funds may only be used for the
following 6 eligible cost categories:
1. project design, including feasibility and marketing studies &
plans, and debt & revenue impact analysis
2. costs of site planning & analysis
3. land use & permitting costs
4. project-specific environmental costs
5. capital facilities costs, including acquisition, construction,
rehabilitation, alteration, expansion, or improvements of
public facilities
6. costs of development & improvement for the public facilities
Phase Start date End date PIF Grant
Request
(if any)
PIF Loan
Request
(if any)
PIF Expenditure
Categories
− write in number(s)
from above.
Can This Phase be
Funded with PIF,
Separate From the
Other PIF Phases?
$ $
$ $
$ $
$ $
$ $
$ $
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JEFFERSON COUNTY PUBLIC INFRASTRUCTURE FUND
Is the project ready to proceed? If not ready, describe what must be completed before the project is ready to
proceed.
What work on this project has already been completed, such as planning, engineering reports, feasibility studies,
permitting, etc., have been prepared, and when?
Description:
Description: