Attachment E_FinancialInformation_ToDetermineDisadvantagedStatus_11062024.xlsm
XLSM spreadsheet 120 KB Posted
- Solicitation number
- AS27-124
- Issued by
- Utah
About this file
This document is a financial worksheet attachment from the State of Utah Division of Drinking Water (DDW) designed to determine disadvantaged status for public water systems seeking assistance with emerging contaminant remediation. The worksheet is provided for informational purposes only and vendors are not required to complete or submit it in response to the RFP for the Emerging Contaminants Technical Assistant Provider contract. The five-year contract, to be awarded to the responsive and responsible vendor with the highest score, requires vendors to guarantee pricing for a minimum of one year. The worksheet itself is not a bid document but rather a tool to assess the financial condition of water systems applying for project assistance.
The financial worksheet collects comprehensive data on existing water system debt (revenue bonds and general obligation bonds), current service area demographics (population and connections), equivalent residential connections based on water consumption, annual operating expenses across multiple categories, annual income sources, and the median adjusted gross income (MAGI) for the service area. Water systems must document all outstanding financial obligations and demonstrate whether current income meets current expenses. The MAGI data, obtained from Federal Income Tax Form 1040 information, is used by DDW staff to determine the maximum affordable water bill for each service area. Completion of this worksheet enables the state to evaluate financial need and disadvantaged status, though it is not a submission requirement for the RFP itself.
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Other files
| File | Type | Posted |
|---|---|---|
| 3-Att.-A-Agency-Terms-and-Conditions-GS (18).docx | DOCX document | |
| 4-Attachment B Scope of Work.docx | DOCX document | |
| 6-Attachment D - Service Log Template Informational Only.pdf | ||
| 5-AS27-124 Score Sheet - Informational Only.xls | XLS spreadsheet | |
| 2-Vendor Prerequisites - RFP Agency.pdf | ||
| 7-2026 Attachment C EC TA Provider - Cost Proposal Sheet.xlsx | XLSX spreadsheet | |
| 1-Claim of Business Confidentiality Updated.pdf.pdf |
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Text version
PWS Financial Worksheet
| ATTACHMENT INCLUDED FOR INFORMATIONAL PURPOSES; VENDORS ARE NOT |
| REQUIRED TO COMPLETE OR SUBMIT THIS DOCUMENT IN RESPONSE TO RFP |
Fill In All Boxes Highlighted In YELLOW
| UTAH DDW EMERGING CONTAMINANT REMEDIATION |
| FINANCIAL WORKSHEET TO DETERMINE DISADVANTAGED STATUS |
| Name of Water System: |
| Public Water System ID: |
| Your name: |
| Date: |
| Email: |
| Phone Number: |
1 EXISTING WATER SYSTEM DEBT (BEFORE NEW PROJECT)
| a. | List all outstanding WATER REVENUE BONDS and attach amortization schedules. | ||||||
| Revenue Bond Name | Interest Rate | Years | Original Amount | Balance Remaining | Required Annual Payment | Maturity Date |
| 0.00% | 0 | $ - 0 | $ - 0 | $ - 0 | mm/dd/yy |
| 0.00% | 0 | $ - 0 | $ - 0 | $ - 0 | mm/dd/yy |
| 0.00% | 0 | $ - 0 | $ - 0 | $ - 0 | mm/dd/yy |
| 0.00% | 0 | $ - 0 | $ - 0 | $ - 0 | mm/dd/yy |
| 0.00% | 0 | $ - 0 | $ - 0 | $ - 0 | mm/dd/yy |
| 0.00% | 0 | $ - 0 | $ - 0 | $ - 0 | mm/dd/yy |
| 0.00% | 0 | $ - 0 | $ - 0 | $ - 0 | mm/dd/yy |
| 0.00% | 0 | $ - 0 | $ - 0 | $ - 0 | mm/dd/yy |
Total Current Annual Payments for Water Revenue Bonds $ - 0
b. List all outstanding GENERAL OBLIGATION BONDS related to WATER and attach amortization schedules.
| G.O. Bond Name | Interest Rate | Years | Original Amount | Balance Remaining | Required Annual Payment | Maturity Date | |
| 0.00% | 0 | $ - 0 | $ - 0 | $ - 0 | mm/dd/yy | ||
| 0.00% | 0 | $ - 0 | $ - 0 | $ - 0 | mm/dd/yy | ||
| 0.00% | 0 | $ - 0 | $ - 0 | $ - 0 | mm/dd/yy | ||
| 0.00% | 0 | $ - 0 | $ - 0 | $ - 0 | mm/dd/yy | ||
| 0.00% | 0 | $ - 0 | $ - 0 | $ - 0 | mm/dd/yy | ||
| 0.00% | 0 | $ - 0 | $ - 0 | $ - 0 | mm/dd/yy | ||
| 0.00% | 0 | $ - 0 | $ - 0 | $ - 0 | mm/dd/yy | ||
| 0.00% | 0 | $ - 0 | $ - 0 | $ - 0 | mm/dd/yy |
Total Current Annual Payment for Water-related General Obligation Bonds $ - 0
c. Describe any other financial obligations which encumber the water system.
What is the current Annual Payment for these other financial obligations ?
2 CURRENT SERVICE AREA (Required)
a. Population
What is the current population of your service area ?
| b. | Connections | ||
| Number of Residential Connections** | |||
| Number of Commercial Connections | |||
| Number of Other Connections | Describe: |
**Number of Year Round Connections
Total Connections - 0
c. Equivalent Residential Connections
If you have water use data for your system, please complete the following:
In a typical year, how much water do ALL of your RESIDENTIAL connections consume? gallons gal/mo/conn.
In a typical year, how much water do ALL of your COMMERCIAL and OTHER connections consume? gallons gal/mo/conn.
| Commercial users use X times as much water | |||
| Equivalent Residental Connections (ERC) Analysis | |||
| Residental Connections | |||
| ERC of "Commercial" and "Other" Connections | - 0 | ||
| Total Equivalent Resident Connections for Entire System | - 0 |
3 CURRENT ANNUAL WATER SYSTEM EXPENSES (Required)
Please enter your annual expenses in the format given below. The information you enter below should be consistent with your latest financial statement.
| Purchase of Water | $ - 0 | |
| Pumping | $ - 0 | |
| Maintenance/Labor | $ - 0 | |
| Treatment/Utilities/Materials | $ - 0 | |
| Equipment Replacement | $ - 0 | |
| Other | $ - 0 | Describe: |
| Other | $ - 0 | Describe: |
| Other | $ - 0 | Describe: |
| Other | $ - 0 | Describe: |
| Other | $ - 0 | Describe: |
Subtotal $ - 0
Annual Payments on Current Debt (Total of Items 2a, 2b and 2c, above) $ - 0
Total Expenses $ - 0
4 CURRENT ANNUAL WATER SYSTEM INCOME (Required)
Please enter your annual income in the format given below. The information you enter below should be consistent with your latest financial statement.
| From Residential Customers | $ - 0 | gal/mo/conn. | ||
| From Non-Residential Customers | $ - 0 | gal/mo/conn. | ||
| From Taxes | $ - 0 | Specify tax(es): | ||
| From Connection Fees | $ - 0 | |||
| From Impact Fees | $ - 0 | Commercial users are charged X times as much money | ||
| From Interest Earned | $ - 0 | |||
| From Sales to Other Water Systems | $ - 0 | |||
| From Permit and Inspection Fees | $ - 0 | |||
| Other | $ - 0 | Describe: | ||
| Other | $ - 0 | Describe: | ||
| Other | $ - 0 | Describe: |
Total Annual Income $ - 0
DOES YOUR CURRENT INCOME EQUAL YOUR CURRENT EXPENSES ?
| Current Income From Item 4, above | $ - 0 |
| Current Expenses from Item 3, above | $ - 0 |
Difference - 0
If there is a significant difference between your INCOME and your EXPENSES please explain:
5 MISCELLANEOUS INFO ABOUT YOUR SERVICE AREA
a. Median Adjusted Gross Income (MAGI)
DDW staff uses the MAGI to determine the "maximum affordable water bill" for your service area. The higher the MAGI, the higher the water bill your customers should be able to afford.
| MAGI data originates from Federal tax forms. See line 37 of . . . | |
| Federal Income Tax Form 1040 | |
| The MAGI for your service area is simply the "median" of the "adjusted gross incomes" for your residents. "Median" means half are above, and half are below, the published figure. |
| The latest MAGI figures are available on DDW's web site. Click the link shown below and browse to the heading "Maximum Affordable Water Bill". | |
| DDW Construction Assistance |
Please determine the MAGI for your service area from the web site and enter it below:
| If you have any comments on the published MAGI, or if you are unable to find data for your service area, please note |
| below: |
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