Drinking water infraestructure

       Wastewater infraestructure

       Water Conservation

       Pollution control/reduction

       Remediation project

Solid Waste management

Landfill construction

Closure or rehabilitation of landfill

      or open-air dumpsite

Recycling & waste reduction

Industrial or hazardous waste

Air quality

Public transportation

Planning & municipal development

Clean Energy

Efficient energy

       Other environmental/human health-related project (specify):

  2.    NAME OF ORGANIZATION:

       Name of Contact Person: (title:) (First name:) (Last Name:)

       Position:

       Address:

       City: State: Zip:

       Phone No.: Fax:

       E-mail Address:

  3.   LOCATION OF PROJECT SITE:

  4.   POPULATION BENEFITED: (Approximated value, only numbers)

  5.   PROVIDE A BRIEF PROJECT DESCRIPTION:

(Remaining characters)

  6.   DESCRIBE THE ANTICIPATED ENVIRONMENTAL AND HUMAN HEALTH BENEFITS OF THE PROJECT:

(Remaining characters)

  7.   PROJECT DEVELOPMENT STATUS:

       Describe the status of project development completed to date and list any related documents:

(Remaining characters)

       If the project will require land acquisition, please describe the status of this process:

(Remaining characters)

       Describe any pending legal/regulatory issues for the project:

(Remaining characters)

       If available, provide anticipated construction period, with estimated start-up and completion dates

  9.    ESTIMATED PROJECT COST (US$): (only numbers)

  10.   AMOUNT NADB FINANCING REQUESTED (US$): (only numbers)

  11.   ANTICIPATED REVENUE SOURCE FOR CAPITAL INVESTMENT AND OPERATIONS:

  12.   ANTICIPATED GUARANTY/COLLATERAL TO BE PROVIDED:

(Remaining characters)

  13.   OTHER SOURCES OF PROJECT FUNDING IDENTIFIED:

  15.   THE FOLLOWING DOCUMENTATION MUST BE SUBMITTED IN ORDER FOR THE NADB LOAN APPLICATION TO BE

           PROCESSED. CHECK THE BOX NEXT TO EACH ITEM INCLUDED WITH THE APPLICATION:

   Financial statements for the last 3 years.

   Statement of outstanding debt segregated by type, with a consolidated schedule for each, showing total annual

        repayment requirements.

   Statement of prior loan defaults, if any, with an explanation of circumstances surrounding defaults on debt.

   Pro-forma finacial statements for the next 3 years. (Provide explanation if this item is not available.)

   A loan application fee of US$1,500 or US$2,500 will be required upon acceptance of your project into the formal loan

   process. Form more information about the applicationfee and the NADB Loan Program, please visit:

http://www.nadb.org/programs/descriptions/loan_guaranty.html

  I acknowledge that BECC/NADB resources are intended to supplement other available funding sources for completing project development and construction activities. I am aware that financial support and commitment *1 for the project must be provided by the appropiate governing body or authority, and shall include the following assurances:

• Sufficient revenues for operation and maintenance of the project will be allocated by the project sponsor. *2
• Required project financing (debt and grant/other) will be obtained by the project sponsor.

  I hereby certify that the information provided is true and correct. I am aware that any false information or omission of information may subject the project to disqualification from further consideration in the BECC/NADB process and eliminate opportunities for funding.

*1 A formal commitment by the appropiate governing body or authority in the form of a resolution will be required for all projects selected for funding opportunities.

*2 A user rate increase may be required to obtain sufficient revenues to sustain the project.