Neb. Admin. Code PUBLIC SERVICE COMMISSION, tit. 291, ch. 9, Municipal Rate Negotiations Revolving Loan Fund
Application Form
Date:
Applicant City/Cities:
Primary Contact Person:
Please include: Name, Title, Address, Telephone Number, Fax Number and Email address.
Jurisdictional Utility Name and Rate Case Docket Number:
Loan Amount Requested:
Budget Statement:
Please include or attach a budget statement identifying all costs for which loan funds will be used, if the loan application is approved. If any consultants, attorneys or other service providers have been selected, please identify them and describe how they were selected. If the applicant has not yet selected any consultants, attorneys or other service providers, please provide a description of the manner in which a selection would be made.
At minimum, please provide the amounts budgeted for the following categories of costs:
* Attorney Fees
* Consultant Fees
* Travel Expenses
* Other Expenses
Timeline for Negotiations:
Please provide a proposed timeline for negotiations, within the parameters of the State Natural Gas Regulation Act.
NOTE: Only one loan may be made for each rate filing made by a jurisdictional utility, pursuant to Neb. Rev. Stat. § 66-1839. If more than one loan application is filed on a given rate case, all applicants for funds will be notified of the identity and contact information of other applicants and will be given a limited number of days to coordinate and determine whether to make a joint application.
If all applicants do not reach a mutual agreement, the Commission will use the following criteria to determine which application will be granted:
Total points possible: 25
Budget Statement (15 points total):
Thoroughness (10 points)
Reasonableness ( 5 points)
Timeline (10 points total):
Thoroughness ( 5 points)
Reasonableness ( 5 points)
BEFORE THE NEBRASKA PUBLIC SERVICE COMMISSION AFFIDAVIT OF APPLICANT
________________________________________________ being duly sworn deposes and says:
______________________________________________________________________
Full name of Applicant
______________________________________________________________________
Address: Street, P.O. Box, City, State, Zip Code
I certify that all statements made and matters set forth in the application are true and correct to the best of my knowledge, information and belief.
__________________________________
SUBSCRIBED AND SWORN to before me this _____ day of ___________, 20___.
__________________________________
Notary Public
Neb. Admin. Code PUBLIC SERVICE COMMISSION, tit. 291, ch. 9, Municipal Rate Negotiations Revolving Loan Fund