NGO Funding Request


The recipient entity's full legal name:  Monterey Rural Water System, Inc.

The recipient entity's physical address:
           6541 Hwy 565 Monterey, LA 71354

The recipient entity's mailing address (if different):
           P O Box 157 Monterey, LA 71354

Type of Entity (for instance, a nonprofit corporation):  Non-Profit Corporation

If the entity is a corporation, list the names of the incorporators:
          M.A. Forman, Jr., Clyde Moreland, Robert Hamilton Sr., Willie Bryan Jr., Wayne Wade

The last four digits of the entity's taxpayer ID number:  8753

What is the dollar amount of the request?  $206,400

What type of request is this?  Capital Outlay Appropriation

Is this entity in good standing with the Secretary of State?  Yes

Provide the name of each member of the recipient entity's governing board and officers:
           (1)Milton Sanders,president, 3773 Hwy 129 Jonesville, LA.
(2)Brad Lipsey, vice-president, 10118 Hwy 129 Monterey, LA.
(3)David Wade, director, 1654 Hwy 565 Jonesville, LA.
(4)James Jernigan, director, 1217 Loop Road Jonesville, LA.
(5)Van Strebeck, director, 276 Hwy 3203 Monterey, LA.
(6)Marilyn Green, secretary/treasurer, 208 Hwy 906 Monterey, LA
(7)Lorne Green, manager, 208 Hwy 906 Monterey, LA.


Provide a summary of the project or program:
           Replace failing 21,000 gallon galvanized water ground storage tank with new glass-lined tank. It has pin holes and patched areas leaking caused by corrosion creating an emergency situation. Tank failure will stop water service to 1,875 customers.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $17,200
          Contracts . . . . . . . . . . . $172,000
          Acquisitions . . . . . . . . . $0
          Major Repairs . . . . . . . $0
          Operating Services. . . . $0
          Other Charges. . . . . . . $17,200

Does your organization have any outstanding audit issues or findings?  No

If 'Yes' is your organization working with the appropriate governmental agencies to resolve those issues or findings?
          

What is the entity's public purpose, sought to be achieved through the use of state monies?
          Replace leaking galvanized water ground storage tank with a glass-lined 21,000 gallon ground storage tank in order to continue to provide quality, safe potable water to 1,875 customers and get back into compliance with DHH OPH.

What are the goals and objectives for achieving such purpose?
          Goal: Provide quality, safe potable water by replacing failing water storage tank.
Obj: Obtain Capital Outlay funding totaling $206,400 to pay for new tank. Tasks: Apply for funding by Nov. 1, 2015
Obj: Replace old tank with new tank in 2017. Tasks: Engineer produce plans & specifications, and obtain DHHOPH permit; Advertise bid & award construction contract; demolish old tank and build new tank.


What is the proposed length of time estimated by the entity to accomplish the purpose?
           12 months from time of C.O. funding received

If any elected or appointed state official or an immediate family member of such an official is an officer, director, trustee, or employee of the recipient entity who receives compensation or holds any ownership interest therein:
     (a) If an elected or appointed state official, the name and address of the official and the office held by such person:
                 none
    
     (b) If an immediate family member of an elected or appointed state official, the name and address of such person; the name, address, and office of the official to whom the person is related; and the nature of the relationship:
                 n/a

     (c) The percentage of the official's or immediate family member's ownership interest in the recipient entity, if any:
                 0

     (d) The position, if any, held by the official or immediate family member in the recipient entity:
                  n/a

If the recipient entity has a contract with any elected or appointed state official or an immediate family member of such an official or with the state or any political subdivision of the state:
(a) If the contract is with an elected or appointed state official, provide the name and address of the official and the office held by such person: 
               none

(b) If the contract is with an immediate family member of an elected or appointed state official:
          Provide the name and address of such person:
               n/a

          Provide the name, address, and office of the official to whom the person is related:
                n/a

          What is the nature of the relationship? 

(c) If the contract is with the state or a political subdivision of the state, provide the name and address of the state entity or political subdivision of the state:
                 n/a

(d) The nature of the contract, including a description of the goods or services provided or to be provided pursuant to the contract:
               n/a


Contact Information
name:  Lorne Green 
                                       address:  208 Hwy 906, Monterey, LA 71354
                                       phone:  318-421-0270
                                       fax:  318-386-2283
                                       e-mail:  monwater@bellsouth.net
                                       relationship to entity:  manager