State Revolving Fund Loan Program Forms

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Forms necessary for both Wastewater & Drinking Water Loans:

• Bidding Review Certification and Checklist for Construction Contracts
• All Bills Paid and Release from Liabilities Certification
• Debarment, Suspension Form (USEPA Form 5700-49)
• Disbursement Request
• Engineering or Professional Services Certification
• Environmental Checklist (PWSLP/WPCLP)
• Five Officer Certification Form
• Line Item Submittal Excel Spreadsheet (Submit by email to your project manager)
• Signage Requirement Certificate of Completion Form
• Tax Certificate
• Tax Certificate Instructions
• Apprenticeship Initiative Forms
  
  • Budget Supplement
    
  • Quarterly Periodic Report
    
  • Waiver Request
    
  • Certification of Compliance (Project Completion)

  DRINKING WATER LOAN PROGRAM FORMS:

  (Specific forms for Drinking Water Loans)

  • Federal Reporting Requirements
  • Funding Nomination Form for Public Water Supply Loan Program - UPDATED 10/12/2023
  • Funding Nomination Form for Lead Service Line Replacement Only - *NEW
  • Loan Application Form Packet
    
  • Loan Application Instructions
    
  • 5 Year Financial Projections for IEPA SRF Loan Application
  • O & M Certificate
  • Plans-Specs Checklist / Front-end Documents (Word version available upon request)
  • Project Plan Submittal Checklist
  • Signature Authorization
  • Useful Life Calculation Worksheet for Loan Terms Greater than 20 Years
  • Lead Service Line Replacement Final Certification