Part 5:
REQUIRED
CERTIFICATIONS/AGREEMENTS
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Funding Use Certification & Local Match Availability
Certification of Loan Repayment
Authorizing Legislation
Cooperation Agreements
Certification of Crash Data
District 3- Franklin County
Funding Use Certification
&
Local Match Availability
(To be completed by Chief Financial/Fiscal Officer)
I understand the staff administrative fee for the SCIP & LTIP programs is funded from a
contribution of up to 1% of the original award. I understand that all communities receiving Round
27 awards will receive an invoice during second quarter of 2014 for Round 27 administrative
services. In addition, I understand that payment for these services must come from local general
funds and not from the award funds.
As the Chief Financial or Fiscal Officer of the Project Applicant making this submission to the
Ohio Public Works Commission for State Capital Improvement Program (SCIP) or Local
Transportation Improvements Program (LTIP) funding, I hereby certify that any funds received
from this program will be used only for additional capital improvement repair/replacement
projects, or to fund new or expansion capital improvement projects. Under no circumstances will
funds received from this program be used to replace other funding normally used for capital
improvements.
I further certify that the required local match indicated in this submission is encumbered or is in
the process of encumbrance and will be available upon project approval.
__________________________________________
Signature Chief Financial/Fiscal Officer (blue ink)
__________________
Date
__________________________________________
Title
PART 5 – District 3 – Form 4
7/2012
Certification of Loan Repayment
I, Finance Director/Clerk/Treasurer of ______________________________, hereby certify that
(Political subdivision name)
______________________________ has/will have/ will collect the amount of $_____________
(Political subdivision name)
in the ____________________________and that this amount will be used to repay the SCIP or
(Name of account/fund)
RLP loan requested for the ______________________________________________________
(Project name)
over a _____________________ term.
(Number of years)
__________________________________________
Signature Chief Executive Officer/Fiscal Officer/Other
(blue ink)
__________________
Date
__________________________________________
Title
PART 5 – District 3 – Form 5
6/2004
Authorizing Legislation
Authorizing the Mayor/City Manager to seek
financial assistance from the OPWC
for funding of various capital infrastructure improvement projects
WHEREAS, pursuant to Article VIII, Section 2K of the Ohio Constitution, the state of Ohio is
authorized to issue bonds and other obligations of the state for the purpose of financing public
infrastructure capital improvements of political subdivisions as designated by law; and
WHEREAS, pursuant to Section 164.06 of the Ohio Revised Code, the District Three Public
Works Integrating Committee has been created to accept, evaluate and recommend applications
for state financing of capital infrastructure improvement projects of political subdivisions in
Franklin County; and
WHEREAS, pursuant to Section 164.05 of the Ohio Revised Code, the Ohio Public Works
Commission has been created to accept and approve applications for state financing of capital
infrastructure improvement projects of political subdivisions in Franklin County; and
WHEREAS, the city/village has conducted a capital inventory and needs assessment and has
determined that it is necessary to submit applications for financial assistance for capital
infrastructure improvement projects.
NOW, THEREFORE, BE IT RESOLVED by the council of the city/village of the state of Ohio and
Franklin County that:
Section 1. The mayor/city manager is hereby authorized to apply to the District Three Public
Works Integrating Committee and the Ohio Public Works Commission for financial assistance for
the following capital infrastructure improvement project(s):
Section 2. The mayor/city manager is further authorized to enter into any agreements as may be
necessary and appropriate for obtaining this financial assistance in conjunction with the
recommendations of the city/village/county engineer, and approved as to form by the city/village
law director, in accordance with all authority granted to and limitations upon by the city/village
director of finance.
Section 3. This resolution is for the preservation of public health, safety and welfare and shall be
in full force and effect immediately upon passage by a majority of the council and upon approval
by the mayor, or otherwise at the earliest time allowed by law.
PASSED:_________________________
__________________________________________
Mayor/City Manager
__________________________________________
Clerk of Council
PART 5 – District 3 – Form 6
6/2003
Sample
Letter of Cooperation
(Required for joint projects)
Michael Miller
Director
Ohio Public Works Commission
65 E. State Street, Suite 312
Columbus, OH 43215
Dear Mr. Miller:
Please accept this correspondence as a letter of cooperation and consent between the
cities/villages of ________________________________ and ______________________ with
regard to the joint application for State Issue 2 Program/Local Transportation Improvement
Program funds for the __________________________________________________ project.
The cities/villages of __________________________ and ___________________________
support this joint project and application for financial assistance and will accept and adhere to
whatever conditions are required for funding the _____________________________________
project.
Sincerely,
________________________________ (signature)
Mayor of
________________________________ (signature)
Mayor of
PART 5 – District 3 – Form 7
6/2008
District 3- Franklin County
Certification of Crash Data
(To be completed by local safety official)
As the local safety official of the project applicant making this submission to the
Ohio Public Works Commission for State Capital Improvement Program (SCIP)
or Local Transportation Improvements Program (LTIP) funding, I hereby certify
that the crash data provided in Part 3, Applicant Evaluation Criteria question A2
is accurate and represents the best crash data available from the Ohio Department of
Public Safety’s database.
____________________________________________
Certify Representative (Type or Print Name & Title)
_________________
Date
__________________________________________
Original Signature (use blue ink)
PART 5 – District 3 – Form 8
6/2011