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LOAN APPLICATION <br />(1) SUBMITTAL. Submit the application and attachments to the Department of Environmental Protection, MS 3505, State <br />Revolving Fund Program, Marjorie Stoneman Douglas Building, 3900 Commonwealth Boulevard, Tallahassee, Florida <br />32399-3000. The application (and supporting documentation) may be submitted electronically to the Department's <br />Project Manager. <br />(2) COMPLETING THE APPLICATION. <br />(a) This application consists of five parts: (I) ADMINISTRATIVE INFORMATION; (II) PROJECT INFORMATION; (III) <br />FINANCIAL INFORMATION; (IV) AUTHORIZATION AND ASSURANCES; and (V) SUPPLEMENTARY <br />INFORMATION. <br />(b) All information provided on this application must be printed. Monetary amounts may be rounded. <br />(c) Forms and attachments to be submitted are denoted with italic print. <br />(3) ASSISTANCE. Completing this application may require information that can be obtained from the Drinking Water <br />State Revolving Fund Program staff. Please email SRF Reporting(�iAep.state.fl. LIS for assistance in completing this <br />application. <br />PART I - ADMINISTRATIVE INFORMATION <br />(1) <br />(2) <br />(3) <br />PROJECT SPONSOR City of Casselberry <br />Federal Employer Identification Number 59-1056912 <br />DUNS Number 064803513 <br />AUTHORIZED REPRESENTATIVE (person authorized to sign or attest loan documents). <br />Name Rebecca J. Bowman Title Finance Director <br />Telephone (407) 262-7700 Email rbowman@casselberry.org <br />Mailing Address 95 Triplet Lake Drive, Casselberry, FL 32707 <br />PRIMARY CONTACT (person to answer questions regarding this application). <br />Name Rebecca J. Bowman Title Finance Director <br />Telephone (407) 262-7700 Email rbowman@casselberry.org <br />Employer City of Casselberry <br />Mailing Address <br />95 Triplet Drive, Casselberry, FL 32707 <br />(4) ADDITIONAL CONTACTS. If more than one additional person is to receive copies of Department correspondence, attach <br />the information (Attachment # 1 ). <br />Name Tara Lamoureaux Title Waster Resources Manager <br />Telephone (407) 262-7700 <br />Employer City of Casselberry <br />Mailing Address <br />Email <br />tlamoureaux@casselberry.org <br />95 Triplet Lake Dr., Casselberry, FL 32707 <br />(5) PROJECT NUMBER (listed on the Department's priority list). <br />59033 <br />(6) INTERIM FINANCING. A local government project sponsor that has interim financing may be subject to certain <br />conditions regarding such financing. <br />Is the project currently being funded with interim financing? ❑ Yes © No <br />Form Application DW -1 <br />Incorporated in 62-552.430(1)(a), F.A.C. Page 1 of 9 Effective Date July 2017 <br />