Forms
-
Ranking Form
This document is a pre-addressed self-mailer version. Upon completion, just fold, staple, stamp, and mail.
- Facilities Plan Checklist/Guidance
-
Loan Application Form (NDWILF11)
For projects ranked on the DWSIRLF Intended Use Plan (IUP) Priority List, this document must be completed and submitted by the Loan Application Package deadline in the IUP.
-
2010 Required Contract Document Provisions
NSHDW175d
-
Supplemental General Conditions for Construction of Drinking Water Systems
NDWI077, July 2010
-
Procurement Certification (NDWILF74)
This document is a Related Item which must be completed and included as part of a complete loan application package.
-
Debarment/Suspension Certification (NDWILF88)
This document is a Related Item which must be completed and included as part of a complete loan application package.
-
Legal Certification (NDWILF69)
This document is a Related Item which must be completed and included as part of a complete loan application package.
-
Pre-award Compliance Review Report (EPA Form 4700-4)
This document is a Related Item which must be completed and included as part of a complete loan application package.
-
Taxpayer ID Number Request/Certification (IRS Form W-9)
This document is a Related Item which must be completed and included as part of a complete loan application package.
-
Sample User Charge Ordinance/Resolution (NDWILF39)
This document is an example to assist in preparation of a Related Item which must be prepared and included as part of a complete loan application package.
-
Engineering Services Contracts Checklist (NDWILF44)
This document contains guidance to assist in preparation of a Related Item which must be prepared and included as part of a complete loan application package.
-
Sample Authorizing Resolution (NDWILF7)
This document is an example to assist in preparation of a Related Item which must be prepared and included as part of a complete loan application package.
- Plans, Specifications, and Contract Documents: Checklist/Guidance
- Plans, Specifications, and Contract Documents: Required Contract Provisions
- Plans, Specifications, and Contract Documents: Advertisement Memorandum
-
Payment Request Form (NDWILF8)
This document must be used to request reimbursement of DWSIRLF loan eligible costs.
To view/print pdf documentation you will need Adobe Acrobat Reader
Mississippi State Department of Health • 570 East Woodrow Wilson Drive • Jackson, MS 39216 • 866-HLTHY4U • web@HealthyMS.com
