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OHIO State of Ohio <br />PUBLIC WORKS Public Works Commission <br />FM YOU Application for Financial Assistance <br />IMPORTANT: Please consult "Instructions for Financial Assistance for Capital Infrastructure Projects" for guidance in completion of this form. <br />Applicant: Clty of North Olmsted Subdivision Code: 035-56882 <br />M District Number: 1 County: Cuyahoga Date: <br />a <br />Q- Contact: Pietro A. DiFranco, P.E. Phone: (216) 377-3813 <br />Q (The individual who will be available during business hours and who can best answer or coordinate the response to questions) <br />Email: pdifranco6d�rlba.com FAX: (216) 491-8053 <br />District Recommendation (To be completed by the District Committee) <br />Funding Type Requested <br />(Select one) <br />❑ State Capital Improvement Program <br />❑ Local Transportation Improvement Program <br />❑ Revolving Loan Program <br />❑ Small Government Program <br />District SG Priority: <br />For OPWC Use Only <br />STATUS <br />Project Number: C <br />C <br />Release Date: <br />OPWC Approval: <br />SCIP Loan - Rate: -% Term: Yrs Amount: .00 <br />RLP Loan - Rate: % Term: Yrs Amount: .00 <br />Grant: Amount: .00 <br />LTIP: Amount: .00 <br />Loan Assistance / Credit Enhancement: Amount: <br />Grant Amount: .00 Loan Type: ❑ SCIP ❑ RLP <br />Loan Amount: .00 Date Construction End: <br />Total Funding: .00 Date Maturity: <br />Local Participation: % Rate: % <br />OPWC Participation: % Term: Yrs <br />Form OPWC0001 Rev. 8.11 Page 1 of 6 <br />Project Name: Butternut Ridge Road Resurfacing <br />Zip Code: <br />44070 <br />Subdivision Type <br />Project Type <br />Funding Request Summary <br />(Select one) <br />(Select single largest component by $) <br />(Automatically populates from page 2) <br />v <br />d <br />❑ 1. County <br />❑X 1. <br />Road <br />Total Project Cost: <br />1,550,000 .00 <br />.� <br />❑X 2. City <br />❑ 2. <br />Bridge/Culvert <br />1. Grant: <br />310.000 .00 <br />a <br />❑ 3. Township <br />❑ 3. <br />Water Supply <br />2. Loan: <br />310,000 .00 <br />❑ 4. Village <br />❑ 4. <br />Wastewater <br />3. Loan Assistance/ <br />0 .00 <br />❑ 5. Water (6119 Water District) <br />❑ 5. <br />Solid Waste <br />Credit Enhancement: <br />❑ 6. <br />Stormwater <br />Funding Requested: <br />620,000 .00 <br />District Recommendation (To be completed by the District Committee) <br />Funding Type Requested <br />(Select one) <br />❑ State Capital Improvement Program <br />❑ Local Transportation Improvement Program <br />❑ Revolving Loan Program <br />❑ Small Government Program <br />District SG Priority: <br />For OPWC Use Only <br />STATUS <br />Project Number: C <br />C <br />Release Date: <br />OPWC Approval: <br />SCIP Loan - Rate: -% Term: Yrs Amount: .00 <br />RLP Loan - Rate: % Term: Yrs Amount: .00 <br />Grant: Amount: .00 <br />LTIP: Amount: .00 <br />Loan Assistance / Credit Enhancement: Amount: <br />Grant Amount: .00 Loan Type: ❑ SCIP ❑ RLP <br />Loan Amount: .00 Date Construction End: <br />Total Funding: .00 Date Maturity: <br />Local Participation: % Rate: % <br />OPWC Participation: % Term: Yrs <br />Form OPWC0001 Rev. 8.11 Page 1 of 6 <br />