HomeMy Public PortalAbout2018-08-14_Form_Water Supply Upgrade Lending Program_RegistrationMunicipality of the District of Chester
Water Supply Upgrade Lending ProgramRegistration Form & ChecklistThank you for your interest in the Water Supply Upgrade Lending program administered by theMunicipality of the District of Chester.Your package for this Program includes the following:
o Registration Form and Checklist (this form)
o Financing Agreement
o Certificate of Completion
NOTE:Although all three documents are provided for your reference, you must complete
and submit this Registration Form & Checklist ONLY as your application to this Program.By registering for this program, you are applying for low-interest financing from the Municipality tohelp you complete a Water Supply Upgrade on your property.The Water Supply Upgrade Lending Program operates on a first come, first served basis until theProgram budget for the fiscal year has been allocated.Should there be funding available for your proposed Water Supply Upgrade, you will be required tosign a Water Supply Upgrade Lending Program -Financing Agreement that outlines your rolesand responsibilities as Qualifying Property Owner as well as those of the Municipality.Completing this Registration Form & Checklist is the first step in the Water Supply Upgrade LendingProgram.Please review the Financing Agreement for reference as you fill out this RegistrationForm.
Please complete this Registration Form and submit to the Municipality either in person, orvia mail, or as scanned email attachments (minimum 300 dpi) sent to ccollicutt@chester.ca.
Primary Property Owner Information:First Name:Last Name:Civic Number & Street:Community:RR#:Province:Postal Code:Email:Mailing address (if different from above):
Home Phone:Cell Phone:
Preferred method of Communication:
□Postal Mail □E-Mail □Telephone
Assignment of Agent:Do you wish to assign an agent for this work?□Yes □No Agent: _________________________________
List of Property Owners:(If there are other owners of this property, please list them below.)Property owner #2:Property owner #3:Property owner #4:
Registration Checklist:(Review this check list to ensure you submission is complete.)□The Contractor meets the definition used for this Program (see Definition 1.c of the FinancingAgreement) and is listed on the Department of Environment’s online Licence and CertificationListings database available here: novascotia.ca/nse/cms/search.asp□The quote from Contractor for the proposed Water Supply Upgrade is attached.□Affidavit:in the space below, provide a short statement about your property’s potable waterquantity and/or quality issues that the proposed Water Supply Upgrade will address.
Program Financing Request:If you and your property meet program eligibility requirements, and if there are available fundsin this fiscal year’s program budget, the Director of Finance will create a Water Supply UpgradeLending Program Financing Agreement, including a loan payment schedule,for your review.
Please provide the following:1 -Financing amount request: ______________________________________________________________Amount requested should not exceed the Contractor’s quote or the Maximum Eligible Amountavailable through this program ($10,000)2 -What is your loan repayment schedule preference:□Annual payments □Monthly payments□Other payment schedule: __________________________________________________________________________3 –Proposed repayment period: _____________________________________________________________________The maximum Repayment Period permitted in this period is ten (10) years.
Signature:
Signature: ____________________________________________________Date: ______________________________Property Owner
For Office Use Only:
Registration Form Received By:______________________________________________________________________Date Request Received: _______________________________________________________________________________Loan Amount Requested: _______________________________________________Water Supply Upgrade Project #: ______________________________________
Final Approval:
The Qualifying Property Owner’s registration has been approved on this _____ day of________________________,20___, by the Municipality of the District of Chester, as signed andwitnessed below:Signature: ____________________________________________________Date: ________________________________________Director of FinanceSignature: __________________________________________________Date: _________________________________________Witness
Attachments:□Contractor Quote