Nifa Water Expansionla - _ 60 -5 -
For Office use only: NIFA #: Date Received:
NEBRASKA INVESTMENT FINANCE AUTHORITY
Governor's Executive Order
Unified Volume Cap Allocation Application
/5-6 O a o o a me r' d e4 p e,. ✓ /e ilf F'ro rr� C-4 d f i 11%v
Amount of Allocation Request $ a 2 88E} �98 90,8W4:R,�-fer-tg&prey-$�5;ggg,ggg a Eae sralid
waste component of renewable fuel projects,)
2, Governmental Unit Reauestina Allocation
Contact: Rodney Storm, City Administrator
Name: City of Blair, Nebraska
Address:218 S. 16th Street Blair NE 68008
Phone: (402) 426-6693
3. Pro'ect
Name of Project: Water Treatment Plant Expansion
Contact: Rodney Storm, City Administrator
Address: 218 South 16th Street, Blair NE 68008
Phone: (402)426-6693
Project Address: 742 Fairview Drive, Blair, NE 68008
Project Description (attach additional sheets if necessary): See Attachment 1
Project Category: Single Family Housing
Student Loans
Multi -Family Housing
First Time Farmer Projects
Industrial or Manufacturing (attach page 2) (Municipal) XX
Solid Waste (attach page 2)
4. The following must accompany application:
(a Non-refundable application fee of $150
(b) Reservation Deposit $ 120,000.00
(Greater of $5,000 or 1% of "Amount of Allocation Requested" in item 1. above, and
refundable as set forth below)
(c) Copy of Inducement Resolution from issuing authority
(d) Letter of approval (including a statement that all necessary ordinances and licensing
requirements will be met) from governing authority where project will be located
6, The following will be provided by Applicant to NIFA after the allocation is granted:
(a) IRS Form 8038
(b) Actual amount of bonds issued
(c) Payment to NIFA (or offset of Reservation Deposit as described below) of expenses incurred approving
allocation (i.e. conference call)
This allocation will expire 120 days from the "Date Allocation Granted" below unless extended by NIFA. Requests
for extension must include reasons for extension.
The APPLICANT hereby acknowledges that in the event the above allocation expires unused, the Reservation Deposit (or if
the allocation used is less than the amount stated in item 1., a proportionate amount of the Reservation Deposit) will be
forfeited by the applicant. The Reservation Deposit Is refundable only to the extent and in the proportion'that the allocation
is used within the relevant time frame and upon receipt by NIFA of IRS Form 8038 as filed with the IRS. (Unpaid expenses
noted in item .(c) a e may beMoffyFA a Inst the refundable portion of the Reservation Deposit.)
S' tura of Ap ant Date
In accordance with the Governor's Executive Order, it is hereby certified that the above allocation granted meets the
requirements of §146 of the Internal Revenue Code of 1986 relating to the Nebraska State Ceiling for private activity bonds
and that such allocation has not been Jnade in consideration of any bribe, gift, gratuity, or direct or indirect contribution to
any
Officer
%%d✓� `iti c�! Z.
Date Allocatidn Granted
Dafe AI cation Expires