Clean Water Wastewater Fund
(CWWF)
Please Prepare a Separate Application for Each Project
Note * - See section 2.3.5 Estimates & Timelines
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Clean Water Wastewater Fund
(CWWF)
FISCAL YEARS 2016/17 to 2017/18*
Office Use
Only Project
Number
Priority # of Municipality
Project Title
1. Contact Information
Legal Name of Applicant
Street Address/P.O. Box
Community/Town/City of
Municipal Tel
Postal Code
Municipal Fax
Contact Name
Municipal Email
Official Title
2. Eligible Project Categories
2.1
Categories
Please select an infrastructure category. If your project covers more than one category, please indicate percentage each
category represents. The highest percentage will determine the category the project is reviewed under
Wastewater
Drinking Water
Stormwater
2.2
Sub-Category(ies)
Must select at least one sub-category and outcome/performance measurement/benefit from list on
attached Schedule “A”. Please enter the number next to the sub-category of the project. (Example: SubCategory # 3.2 and Outcome/performance - a, b, g)
Note * - See section 2.3.5 Estimates & Timelines
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Sub-Category Number(s)
2.3
Outcome/Benefit Number(s)
Identification of Nature of Project
Check the box next to what best describes the project.
New
Rehabilitation
Study
Expansion
Other (Specify)
2.4
Identification of Objectives
Indicate which of the following objectives will be supported by the project:
Increased Capacity of lifespan of the asset
Enhance service
Improved Environmental Outcomes
3 Duty to Consult & Environmental Information
Prior to filing this application, have you made any enquiries regarding
Aboriginal or Treaty rights in relation to this project?
Y / N
To the best of your knowledge, does this project or its location, have any
impact on Aboriginal or Treaty rights?
Y / N
Does this project have the potential to impact fishing, hunting, gathering, or
current use of lands by Aboriginal groups?
Y / N
Will this project involve work or activities on, under, over, through, or across
a beach, or body of water such as a wetland, stream, river, coastline or lake?
Y / N
Will this project require any alteration to land near any beach, or body of
water such as a wetland, stream, river, coastline or lake?
Y / N
Note * - See section 2.3.5 Estimates & Timelines
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4. Project Information
Brief Project Description (Describe the actual work to be carried out with the funds)
Project Location (Street Address or PID)
Municipality
Postal Code
Nearest Start/End Intersections (If not one location)
Signed & Sealed Council Resolution Included?
Y / N
Date of Resolution (must be provided by June 30)
5. Please confirm if this project is able to start in 2016, as soon as approval is received. (If the
project can, please check the box.)
Yes, this project can start in 2016 as soon as we receive approval.
6. Estimated Eligible Costs (Please attach information on how the costing of the project was determined.)
Cost Breakdown
Amount
Design/Engineering
$
Construction/Demolition
$
Contingency
$
Other (Specify)
$
Other (Specify)
$
Other (Specify)
$
Total Eligible Costs $ $0.00
Note * - See section 2.3.5 Estimates & Timelines
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7. Estimated Ineligible Costs
(Please attach information on how the ineligible costing of the project was determined. Engineering
estimates, etc…)
Cost Breakdown
Amount
Land acquisition costs
$
Legal Fees
$
Other (Specify)
$
Other (Specify)
$
Total HST Costs
$
Total Ineligible Costs $ $0.00
TOTAL COST OF PROJECT (6. Total Eligible + 7. Total Ineligible costs)
$ $0.00
****NOTE: FUNDING CONTRIBUTIONS MUST BE BASED ON ELIGIBLE COST TOTALS ONLY.
8. Proposed Sources of Funding
(Projects involving funding from another party require confirmation that the funding has been
approved.)
Project Funding Sources
Confirmed
Amount
Federal CWWF funds requested (50%)
N/A
$
Provincial CWWF funds requested (25%)
N/A
$
Applicant’s Share (Specify & confirm source of funds) (25%)
Y / N
$
Other Provincial Source (Specify)
Y / N
$
Other Federal Source (Specify)
Y / N
$
Other Source (Specify)
Y / N
$
Total $ $0.00
Note * - See section 2.3.5 Estimates & Timelines
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9. Proposed Project Financing (Base the financing on when the claims are most likely to be made.
Remember to include any holdback.)
Year
Provincial
CWWF
Funding (25%)
Applicant’s
Funding
(25%)
Other Funding
Total
Funding
2016-2017
$0.00
2017-2018
$0.00
TOTALS
9.1
Federal CWWF
Funding (50%)
$0.00
$0.00
$0.00
$0.00
$0.00
If your project cannot be completed by March of 2018, please explain why and provide details on
anticipated start and completion date and project financing.
Explain why:
Detail on Anticipated Start and Completion dates (provide dates MM/DD/YY):
Project Financing
Year
Federal CWWF
Funding (50%)
Provincial
CWWF
Funding (25%)
Applicant’s
Funding
(25%)
Other Funding
Total
Funding
2016-2017
$0.00
2017-2018
$0.00
2018-2019
$0.00
TOTALS
$0.00
$0.00
$0.00
$0.00
$0.00
Note * - See section 2.3.5 Estimates & Timelines
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10. Planned Project Timelines (Base the estimated dates on the direction provided by the Guidelines &
Criteria)
Activity
Start Date
Completion Date
Design/Engineering Date
Tender or Request for Quotation Ad Date
Tender or Request for Quotation Award Date
Expected Construction Start/Completion Dates
11. Beneficial Impact of Project
Outline the public benefits/outcomes of the completed project on your municipality based on the outcomes
and benefits selected under 2.1 of the application and found under Schedule “A”, which is located at the end
of the application. Explain how your project will meet the public benefit/outcomes selected.
12. Project Approval Requirements
The following are requirements of the CWWF program:
(All required information must be submitted by the intake date. There will only be this intake for projects for this program.)
Applicant confirms ownership of asset subject to this project, or can provide a long term
lease agreement.
Where necessary, have you provided documentation to show the project qualifies under
its category/sub-category.
Have you included documented information to show the project is necessary to the
sustainability of an asset?
Application contains confirmation of your funding from other sources (bank, other
infrastructure funds, etc…)
Applicant confirms the project would not be able to proceed or would not have been able
to happen this soon without federal/provincial funding support.
Y / N
Y / N
Y / N
Y / N
Y / N
Note * - See section 2.3.5 Estimates & Timelines
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Application includes a signed & sealed Council Resolution supporting the application with
approval to expend the required municipal funds. If resolution is not attached Application
confirms the resolution will be submitted by June 30.
Council Resolution accepts responsibility for the ongoing operational and maintenance
costs resulting from the project.
Y / N
Y / N
Applicant confirms that the proper budgetary process has been followed for this project.
Y / N
Applicant agrees to purchase and install required signage as an eligible project cost.
Y / N
Applicant agrees to participate in a province-wide Asset Management Program.
Y / N
Applicant has submitted information on how the costs were determined.
Y / N
Applicant attached signed Attestation by a senior delegated official of the municipality that
the project meets the incrementality requirement of the program. If not submitted project
will not be reviewed. (Schedule D)
A Project Declaration form signed by a senior delegated official of the municipality and
consultant firm who has prepared the design and/or be providing project management. If
not submitted project will not be reviewed. (Schedule C)
Y/N
Y/N
Note * - See section 2.3.5 Estimates & Timelines
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13. CWWF Applications should be returned to:
Infrastructure Secretariat
P.O. Box 2000, Charlottetown, PE C1A 7N8
Toll Free #: 1-888-240-4411
Tel: 902-620-3380 Fax: 902 620-3383
Email: [email protected]
The Council of the City / Town / Community of
does hereby submit this application to the Clean Water Wastewater Fund.
In providing this submission, the Council declares that the above is, to the best of its
knowledge and belief, true in substance and in fact and if the project receives approval
the applicant is fully prepared to proceed with the project.
MAYOR/CHAIR (Sealed signature)
Date
CHIEF ADMINISTRATIVE OFFICER (Sealed signature)
Date
OR
IF YOU ARE ULTIMATE RECIPIENT OTHER THAN A MUNICIPALITY COMPLETE THE FOLLOWING:
The _______________________________________ of____________________________
does hereby submit this application to the Clean Water Wastewater Fund.
In providing this submission, the Board declares that the above is, to the best of its
knowledge and belief, true in substance and in fact and if the project receives approval the
applicant is fully prepared to proceed with the project.
President (Sealed signature)
Date
Sectary/Treasure (Sealed signature)
Date
Note * - See section 2.3.5 Estimates & Timelines
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SCHEDULE A - ELIGIBLE PROJECT CATEGORIES, SUBCATEGORIES & OUTCOMES
Eligible projects will be for the new, expansion, or study or other of infrastructure for public benefit.
1.0 Eligible Project Categories
i.
ii.
iii.
Water
Wastewater
Stormwater
2.0 Eligible Project Funding sub-category
i.
Capital projects for the rehabilitation of water treatment and distribution systems, and
wastewater and storm water collection, conveyance and treatment systems;
ii. Separation of existing combined sewers and/or combined sewer overflow control;
iii. Initiatives that support system optimization and improved asset management including
studies and pilot projects related to innovative and transformative technologies;
iv. Design and planning for upgrades to wastewater treatment infrastructure to meet
federal regulatory requirements; and
v. New construction projects, including the construction of naturalized systems for
management and treatment of wastewater and storm water, if the projects will be
completed within the program timeframe.
3.0 Outcome / Performance Indicators
CWWF Outcome Indicator
3.1 Water Specific Indicator
a) Number of water treatment facilities that have improved water quality as a
result of funded investments
b) Number of water treatment systems that have met or exceeded applicable
regulations and guidelines as a result of funding
c) Number of drinking water systems that have eliminated a boil water advisory
as a result of funded investments
d) Number of funded water treatment plans and studies that have resulted in
identified capital projects that are either included in capital planning
documents with associated funding or that are in the process of being
Note * - See section 2.3.5 Estimates & Timelines
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implemented
e) Life Cycle Cost of applicable water treatment systems after construction
f)
Average number of years of useful life remaining on applicable water
treatment assets after end of construction
3.2 Wastewater/Stormwater Specific Indicator
a) Number of systems that have improved the quality of wastewater effluent or
storm water discharge as a result of funded investments
b) Number of wastewater systems that have met or exceeded applicable
regulations and guidelines as a result of funding
c) Number of wastewater systems that have increased their level of treatment
as a result of funding
d) Number of funded wastewater plans and studies that have resulted in
identified capital projects that are either included in capital planning
documents with associated funding or that are in the process of being
implemented
e) Life Cycle Cost of applicable wastewater treatment systems after construction
f)
Average number of years of useful life remaining on applicable wastewater
treatment assets after end of construction
g) Average number of years of useful life remaining on applicable storm water
assets after end of construction
3.3 Incrementality
a) Total value of capital expenditures for water and wastewater system projects
for 2016
b) Total value of capital expenditures for water and wastewater system projects
for 2017
Note * - See section 2.3.5 Estimates & Timelines
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SCHEDULE C PROJECT DECLARATION
In the matter of submitting the application titled ________________________________________
(Project Title)
priority number __________ as submitted to the Province of Prince Edward Island, for funding
(Project Priority#)
consideration under the Clean Water Wastewater Fund (CWWF);
I, _____________________________________,_________ __________________ in the County of
(Chief Administrative Officer)
(Title)
(Queens, Kings, Prince) of the Province of Edward Island along with the municipality’s
(Circle one that applies)
consultant identified as _____________________________________________________,
(Name of Consultant)
__________________________________________ declares the following:
(Consulting Firm Name)
1.
We understand that ______________________________________________ must be
(Project Name)
completed by March 31, 2018, if it is approved by the federal government.
1 (a) (Only to be completed if the project cannot be completed by March 2018)
If the project is unable to be completed by March 31, 2018, the project outlined in the
application can be started and completed by the following dates:
start date: ____________________and completion date: ___________________.
(MM/YY)
(MM/YY)
(b)The reason for not being able to meet the March 2018 deadline of the program would be the
following:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
2.
We understand the municipality and consultant, if providing project management, understands that
all claims to the Province must be submitted by June 30, 2018 to be eligible for reimbursement.
3.
We identify the following possible risks to the completion with possible mitigation measures for each
of these risks:
RISK
Mitigation Measure
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4.
We are both duly authorized by the (City/Town/ Community) of _______________
(Circle one that applies)
____________________________________ and _______________________________to provide
(Municipality’s Name)
(Consulting firms Name)
this project declaration.
Dated this __________ day of ____________ 20___.
_________________________
Signature of Municipality, CAO
____________________________
Signature of Consultant
_________________________
Print name of CAO
____________________________
Print name of Conultant
Note * - See section 2.3.5 Estimates & Timelines
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SCHEDULE D – ATTESTATION FOR PROJECT INCREMENTALITY
In the matter of submitting the application titled ____________________
(Project Title)
priority number ______ as submitted to the Province of Prince Edward Island, for funding
consideration under the Clean Water Wastewater Fund (CWWF);
I, ___________________________, _________________________ of the
(Name)
(Title)
(City/Town/Community) of ____________________________________ in the
(Circle the Appropriate Municipal Type)
(Municipality Name)
county of (Queens/Kings/Prince) of the Province of Edward Island declares as follows:
(Circle the appropriate county)
I hold the position of ____________________________________with the
(Position Title)
(City/Town/Community) of______________________________ and as such
the appropriate Municipal Type)
(Circle
(Municipal Name)
have knowledge of the matters set forth in this declaration and believe this declaration to be true.
The _______________________________________ project put forward for consideration meets
(Project Title)
the federal government’s requirement of project incrementality under the Clean Water Wastewater
Fund (CWWF). Under the CWWF project incrementality mean the project would not otherwise have
been undertaken in 2016-17 or 2017/18 or a project that would not have been undertaken without
federal funding.
This condition has been met as of the date of this declaration.
Declared at ___________________ (City/Town/Community), in Prince Edward Island
this ________ day of _________________, 20_____.
_____________________________
(CAO Signature & Sealed)
Note * - See section 2.3.5 Estimates & Timelines
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