Updated Combined RRIF TIFIA Application

OMB Control Number: 2105-0569; Expiration Date: September 30, 2029

Application for RRIF and TIFIA Credit Assistance Fiscal Years 2026 - 2030

This form is the application (Application) to be used by an entity (referred to herein as the Borrower) seeking Federal credit assistance under the Transportation Infrastructure Finance and Innovation Act of 1998 (TIFIA) and Railroad Rehabilitation and Improvement Financing (RRIF) credit programs. The Build America Bureau (Bureau) will use the information provided in a completed Application to evaluate recipients for credit assistance in accordance with the applicable RRIF and TIFIA requirements. Borrowers may be asked to provide additional supporting evidence, clarify or quantify details, or update previously submitted information during the Application review process. A Borrower seeking credit assistance under both programs may submit a single Application, except in certain circumstances. Unless the Bureau directs otherwise, completed Applications will be submitted electronically.

The Bureau will only accept Applications from Borrowers whose projects and creditworthiness have met or are likely to meet applicable statutory eligibility requirements, including satisfying a full review of the creditworthiness of the Borrower and the project. A Borrower applying under the TIFIA credit program must submit a Letter of Interest (LOI) to the Bureau before submitting an Application for TIFIA credit assistance. A Borrower applying under the RRIF credit program is encouraged to submit an LOI to the Bureau before submitting an Application for RRIF credit assistance in order to describe its project, demonstrate the proposed Borrower’s ability to meet DOT’s creditworthiness requirements, detail how applicable statutory eligibility requirements are met, and outline the proposed financial plan.

Under the Paperwork Reduction Act of 1995, a Federal agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The valid OMB control number for this information collection is 2105-0569. The Bureau estimates that it will generally take applicants fewer than one hundred (100) person-hours to assemble a single Application.

Details about how to submit are included in Section F. An Application checklist is appended to the form.

DETAILED GUIDANCE WITH RESPECT TO SPECIFIC SECTIONS OF THIS APPLICATION IS AVAILABLE IN THE BUREAU CREDIT PROGRAMS GUIDE. THE CREDIT PROGRAMS GUIDE CAN BE DOWNLOADED HERE.

Summary Information

Borrower Name: Click or tap here to enter text.

Project Name: Click or tap here to enter text (the “Project”)

Project Location: Click or tap here to enter text.

☐ TIFIA Amount Requested: $ Click or tap here to enter text.

Estimate of Eligible Project Costs: $ Click or tap here to enter text.

Credit Instrument Requested: Click or tap here to enter text.

☐ RRIF Amount Requested: $ Click or tap here to enter text.

Estimate of Eligible Project Costs: $ Click or tap here to enter text.

Credit Instrument Requested: Click or tap here to enter text.

SECTION A: Borrower Contact Information

1. Legal Name and Principal Business Address
   Click or tap here to enter text.

2. Authorized Point of Contact. Provide the name, title, and contact information of the person authorized to be the point of contact for all matters related to this Application.
   
   

1. Name and Title: Click or tap here to enter text.

2. Email Address:Click or tap here to enter text.

3. Telephone Number:Click or tap here to enter text.

4. Mailing Address (if different from principal business address) – include for both U.S. mail and courier purposes (i.e., no P.O. Box) address:
   Click or tap here to enter text.
   
   

SECTION B: Borrower Information

This Section B should not exceed 10 pages, excluding attachments.

1. Background Information and Legal Authority

1. Describe the Borrower’s place and date of incorporation or organization and the state(s) and territory(ies) in which the Borrower does business.
   Click or tap here to enter text.

2. Describe the legal authority of the Borrower to carry out the Project activities described in Section C and to levy taxes, issue debt, charge tolls or other fees, and/or receive dedicated funding from another entity, as applicable. Include as Attachment B-1 a copy of the statutory authority under which the entity was created or its incorporation documents.
   Click or tap here to enter text.

3. Include a link to the Borrower’s, or its controlling entities’, web site, if available. Click or tap here to enter text.

2. Organization and Management

1. Describe the Borrower’s management structure, identifying the legal names of key principals (e.g., director and chief financial officer) and any recent or proposed changes to the management structure. Provide a management organizational chart showing the management structure and reporting relationships among individuals as Attachment B-2.
   Click or tap here to enter text.

2. Describe the Borrower’s corporate structure, identifying the relationship between all legal entities in the corporate or quasi-corporate family, including subsidiaries. Provide a company organizational chart showing the ownership relations among legal entities as part of Attachment B-2.
   Click or tap here to enter text.

3. Identify Other Names under which Borrower Does Business.
   Click or tap here to enter text.

3. Past Performance and Experience with Federal Assistance

1. Briefly describe three examples of projects that are similar in size, cost, and scope to the Project that the Borrower (including its parents or subsidiaries, if applicable) has successfully completed or is currently implementing. Indicate whether these projects received Federal financial assistance.
   Click or tap here to enter text.

2. Identify any prior projects for which the Borrower (including its parents or subsidiaries) has received RRIF or TIFIA credit assistance.
   Click or tap here to enter text.

3. Federal Tax Identification Number:
   Click or tap here to enter text.

4. Data Universal Numbering System (DUNS) Number: Click or tap here to enter text.

5. Unique Entity Identifier (UEI) Number: Click or tap here to enter text.

6. Status of Registration in the Federal System for Award Management (SAM):
   ☐ Active
   ☐ Inactive, or not yet registered

4. Borrower Eligibility.

1. Select the Borrower’s entity type.

1. If “Other”: Click or tap here to enter text.

2. Freight railroads only: Identify your revenue class.

TIFIA Borrowers Only Private Borrowers must provide the name, and a brief description of, the public entity sponsoring the Project for state/local planning purposes, as required by Federal planning and programming requirements. See also Section C-7. Click or tap here to enter text.

RRIF Joint Venture Borrowers Only If you selected “Joint Venture” in Section 2.a, provide the following information about the Joint Venture party that is eligible to apply for a RRIF loan (referred to in this section as the “JV eligible applicant”). See the Credit Programs Guide for more information. Identify the legal name and principal business address of the JV eligible applicant: Click or tap here to enter text. Identity the JV eligible applicant’s entity type: Identify the government, state or territory under which the JV eligible applicant is organized or incorporated: Click or tap here to enter text. Describe the overall corporate and management structure of the JV eligible applicant, as applicable. Attach a company organizational chart showing the ownership relations among legal entities as Attachment B-3: Click or tap here to enter text. Provide a link to the JV eligible applicant’s web site, if available. Click or tap here to enter text. Provide the name, title, and contact information of the person authorized to be the point of contact for the JV eligible applicant for all matters related to this Application: Click or tap here to enter text. Describe the nature of the Joint Venture relationship. Attach documentation supporting the existence of the Joint Venture as part of Attachment B-4. Click or tap here to enter text. If your Joint Venture includes parties other than the Borrower and the JV eligible applicant, describe them here. Click or tap here to enter text.

SECTION C: Project Information

This Section C should not exceed 10 pages, excluding the attachments.

1. Project Name. This name should match the summary information identified on page 1 of this Application.
   Click or tap here to enter text.

2. Project Location

1. Describe the location of the Project. Wherever possible, identify: each city and/or county, Metropolitan Statistical Area (MSA), if applicable, and state in which the Project is located; the cities and/or counties that the Project will serve; any major highways, rail or transit routes intersecting the Project; and the Congressional districts impacted by the Project. If the Project will cross state lines, please provide the above information for each state impacted.
   Click or tap here to enter text.

2. Attach a vicinity map or, if available, a shapefile, showing the Project’s location, impacted cities and/or counties and states, and all major highways, rail or transit routes as Attachment C-1. Provide a high-level map, or if available, a shapefile, of the Project showing major design elements as part of Attachment C-1.

3. ☐ Check this box if the Project is a surface transportation project located wholly or partially outside of an urbanized area with a population greater than 150,000 individuals, as determined by the U.S. Census Bureau. Please provide the geographic coordinates of the Project, or if available, a shapefile, so that the Bureau can verify information about the area in which the Project will be implemented and the population. Click or tap here to enter text.

3. Project Description

1. Describe the Project scope, inclusive of all major work activities and design elements, consistent with the detailed Project budget to be provided in Section D. Describe all features to be constructed and construction phases. Identify the anticipated useful life of the Project, the method of Project delivery (e.g., design-bid-build, design-build, etc.), and the key Project agreements. Click or tap here to enter text.

2. ☐ Public-private partnerships. Provide as Attachment C-2 a summary of the value-for-money (or comparable) analysis undertaken by the Project sponsor before deciding to advance the Project as a public-private partnership, including the date such analysis was completed, if conducted. If no such analysis has been done, explain why none was conducted (including if you believe none of the Value for Money requirements described in the Bureau’s guidance apply to the Project).

3. Provide as Attachment C-3 concise conceptual design plans that identify all elements of Project scope.

3. Project Schedule

1. Anticipated Revenue Service Commencement Date: Click or tap to enter a date.

2. Anticipated date to commence procurement of construction contractors for the Project: Click or tap to enter a date.

3. Identify the start and completion dates for each major phase or milestone of the Project including, as applicable: preliminary engineering and environmental documentation, final design, right-of-way acquisition, procurement of construction contracts, construction, vehicle acquisition, start-up and testing, and revenue service. Also, identify the anticipated dates for securing anticipated Federal financial assistance (including closing of the Bureau credit agreement).
   Click or tap here to enter text.

4. Provide as Attachment C-4 a detailed project schedule showing, as a minimum, the milestones identified in Section 4.c.
   Click or tap here to enter text.

5. If you are requesting expedited processing, explain why your Application and Project are suitable candidates for expedited processing. See the Credit Programs Guide for more information.
   Click or tap here to enter text.

3. Project Team

1. Describe the relevant Project parties to include the Borrower, the Project sponsor (if different), the Borrower’s equity sponsors (as applicable), principal project contractors, material subcontractors (e.g., for engineering, rolling stock, tunnel boring, systems, operations and maintenance), financial and legal advisors (as applicable), and lenders.
   Click or tap here to enter text.

2. Provide as Attachment C-5 an organizational chart identifying the relationships between the parties identified in Section 5.a.

3. Local Funding Partners. Identify any local entities that are anticipated to contribute funding, real property, design or construction of discrete elements of Project work, or other valuable consideration to the Project (other than permits or land use approvals, etc.) and the status of such contributions. Provide documentation and evidence of such contributions as part of Attachment C-6.
   Click or tap here to enter text.

3. Transportation Planning and Programming Approvals. If applicable, provide as Attachment C-7 evidence of the Project’s inclusion in the long-range transportation plan, the metropolitan transportation improvement program (TIP), and the approved statewide transportation improvement program (STIP) of each state affected by the Project. Information relating to state freight plans and state rail plans should also be included, if applicable. Only the cover page and applicable page of each document should be provided.

3. Environmental Review

1. Describe the status of the environmental review of the Project and any steps remaining for the Project to obtain a final agency decision. If final agency decision(s) have already been received, provide a copy of the decision(s) as Attachment C-8.
   Click or tap here to enter text.

2. Identify and explain any differences between the Project as analyzed in the applicable environmental document(s) and the Project scope provided in this Application.
   Click or tap here to enter text.

3. Summarize the quantitative or qualitative details of benefits to the public that the Project will achieve, particularly as analyzed in the environmental review document(s).
   Click or tap here to enter text.

3. Project Management and Compliance Monitoring Plan

1. Describe, at a level of detail appropriate to the size and scope of the Project, how the Borrower will ensure delivery of the Project as planned, within budget, and in accordance with Project commitments, terms of any credit agreement, and applicable Federal regulations and provisions of Federal law. This description should include: (a) information on the roles and responsibilities of all entities with decision-making authority for the Project; (b) reporting processes that document status, changes, delays, and potential risks to the Project; and (c) coordination processes that provide for advance notification of potential issues to appropriate agencies (including the Bureau, as required by any credit agreement) and timely resolution of issues.
   Click or tap here to enter text.

2. Provide any technical or independent engineering reports prepared for the Project as Attachment C-9.

3. Risks and Mitigation Strategies. Identify risks to Project completion and sufficiency of revenues in operations (as applicable). Sample risks might include cost escalation, approvals, litigation, construction schedules, ridership and traffic levels, risk related to availability payments, availability of grant funding, and market access and operations. Identify all mitigation strategies and any proposed cost-containment approaches (e.g., design-build, value engineering, guaranteed maximum price and/or completion date, warranties, or other incentive/disincentive clauses).
   Click or tap here to enter text.

3. Litigation. Disclose any current, threatened, or pending litigation that could, if successful, have a material adverse effect on the Project.
   Click or tap here to enter text.

3. Operations and Maintenance Plan

1. Describe the maintenance and operations plan for the Project to be implemented to ensure that the Project assets will be kept in a state of good repair and operated in accordance with Project commitments, terms of the credit agreement, and applicable regulations and provisions of law. The description should address routine maintenance, planned major maintenance, handback provisions (as applicable), and anticipated annual (YOE) costs of maintenance.
   Click or tap here to enter text.

2. Identify any third party that is anticipated to perform operations and maintenance.
   Click or tap here to enter text.

3. Identify all entities currently entitled or anticipated to be entitled to utilize the Project after operations commence and describe the anticipated level of usage and maintenance responsibilities for each entity. Describe legal or contractual arrangements governing such usage.
   Click or tap here to enter text.

TIFIA Borrowers Only

3. Describe any public or private investment generated through partnerships with respect to the Project or activities directly ancillary to the Project.
   Click or tap here to enter text.

RRIF Borrowers Only

14. Describe the present and probable future demand for your or the JV eligible applicant’s (as applicable) rail services or intermodal facilities and the impact of the Project on demand.
    Click or tap here to enter text.

15. Briefly describe how you will take economy and efficiency into consideration in utilizing the asset being financed.
    Click or tap here to enter text.

SECTION D: Financial Plan

Information furnished under Section D may cross-reference materials provided in Section E (Creditworthiness) and, in all instances, must be consistent with those materials.

1. Amount and Type of Credit Assistance Requested. Specify the type of Bureau credit assistance (RRIF, TIFIA or both), total dollar value of credit assistance, and the type of credit instrument requested.
   Click or tap here to enter text.

2. Credit Amount as Percentage of Eligible Project Costs. Specify the value of Bureau credit assistance requested as a percentage of the total eligible project costs. See the Credit Programs Guide for a discussion of eligible project costs under each credit program. Click or tap here to enter text.%

3. Other Federal Assistance. Identify the value of other Federal financial assistance requested (e.g., grants or other loans), separately identifying the non-Federal share for each instance of such assistance. $ Click or tap here to enter text.

4. Combined Federal Assistance as a Total Percentage of Eligible Project Costs. Identify the total value of all anticipated Federal financial assistance, including Bureau credit assistance requested, as a percentage of the total eligible project costs.
   Click or tap here to enter text.%

5. Sources and Uses of Funds

1. Provide a detailed statement of the yearly sources and uses for the Project as Attachment D-1. All estimates should be expressed in year-of-expenditure dollars and should include a narrative describing assumptions used to arrive at such estimates.

2. Sources should include separate line items, as applicable, for revenues, bond proceeds (general obligation, revenue, and others), other borrowing (specify), investment income, private investment (equity or debt), market value of right-of-way dedications, grants, and Federal credit assistance proceeds. For each line item, describe the status of the source (e.g., approved, budgeted, appropriated, applied for, etc.). If funding or financing is not committed, explain why.

3. Uses should include separate line items for, as applicable, feasibility studies, preliminary engineering and environmental reviews, final design, right-of-way-acquisition, vehicle acquisition, unallocated contingency, and capitalized financing costs (including debt service reserve funds, capitalized interest and capital issuance costs). Include other categories as necessary.

2. Uses should distinguish between total Project costs and eligible project costs and any differences between these two cost estimates must be explained. See the Credit Programs Guide for a discussion of eligible costs for each credit program. Provide a similar breakdown for any eligible costs incurred prior to the date of this Application.

6. Proposed Terms for the Requested Credit Instrument. Identify the proposed terms for the credit instrument with respect to: assumed priority, interest rate, timing of disbursements, coverages, pledged security, repayment sources, amortization schedule, and lien position. The proposed terms and conditions should be submitted in the form of a term sheet as Attachment D-2.

☐ Check this box if the Borrower requests that DOT waive the non-subordination requirements associated with Bureau credit programs. Explain how the legal requirements for such a waiver are satisfied. See the Credit Programs Guide for more information on non-subordination requirements.
Click or tap here to enter text.

7. Financial Model. Attach the financial model as Attachment D-3. The financial model should include at the minimum:

1. Project sources and uses statement consistent with the sources and uses provided in Section D.5(a) above. The statement should project cash flows monthly or quarterly.

2. Semiannual projected cash flows through such time as all Project debt is repaid, including separate line items for each category of revenue (such as sales tax proceeds, fares, toll receipts, freight revenues) and expenditure (at a minimum, construction expenditures, operations and maintenance, contributions to reserves and capital replacement funds, debt service, repayments of the RRIF or TIFIA credit instrument, and repayment of other borrowed funds as well as equity dividends or proceeds (as applicable), if any);

2. Estimated debt service coverage ratios, for each tier of debt, separated into Federal, non-Federal (addressing, as applicable, senior and junior lien debt), and illustrating projected combined coverage, as applicable; and

3. Amortization schedule for all Project debt, separated into Federal, non-Federal (addressing, as applicable, senior- and junior-lien debt), and combined components.

The model should be projected on a cash (year-of-expenditure) basis with inflation assumptions described.

TIFIA Borrowers Only

8. Describe the impact of the requested TIFIA credit assistance on the Project’s costs, including lifecycle costs, and schedule.
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9. Identify specific Federal grant assistance for the Project that would not be necessary if the requested Bureau credit assistance were received (does not have to be USDOT grant assistance).
   Click or tap here to enter text.

10. Borrowers seeking TIFIA credit assistance to refinance long-term project obligations or Federal credit instruments:

    1. Identify the project that would be completed, enhanced, or expanded with the additional funding capacity (the Added Capacity Project).
       Click or tap here to enter text.

    2. Provide in Attachment D-4 all the information requested in Section C with respect to the Added Capacity Project.

    3. Describe the funding capacity that would be created pursuant to the requested refinancing and how such funding capacity is necessary for the delivery of the Added Capacity Project.
       Click or tap here to enter text.

    4. How would the Added Capacity Project be impacted if the requested refinancing was unavailable in whole or in part?
       Click or tap here to enter text.

SECTION E: Creditworthiness

Total narrative supporting this Section E should not exceed 10 pages, excluding the attachments.

1. Financial Statements. Provide financial statements, balance sheets or income statements for the past five years as Attachment E-1. All such documents should be audited or otherwise complied or reviewed by an independent Certified Public Accountant).

2. Pledged Revenue Source

1. Describe all revenue sources to be pledged to repay the credit instrument and other Project debt. Specify the nature of the revenue source (dedicated or not dedicated), the expected rate(s), the base to which such rates will be applied (e.g., retail sales, average daily traffic), historical and projected revenues from each source, and projected increases or decreases in such revenues over time.
   Click or tap here to enter text.

2. Detail any proposed flow of funds and any accompanying escrow or trust agreements that would govern the repayment of requested credit instrument and other Project debt.
   Click or tap here to enter text.

3. List existing or anticipated pledges/claims on revenues and summarize all claims on the flow of funds.
   Click or tap here to enter text.

4. Attach documentation (e.g., revenue studies, feasibility studies, traffic studies, and economic forecasts) as Attachment E-2 to provide the basis for projected revenues.

5. Provide the net present value calculation of the proposed repayment stream and material assumptions used in the calculation (e.g., growth rate, discount rate, terminal multiple, etc.)
   Click or tap here to enter text.

3. Other Supporting Information. Provide any other information that supports creditworthiness of the Borrower or the Project, as applicable, such as any proposed rate covenant, coverage requirements, market position, history of user-based repayments for other obligations, or the economic outlook for related commerce.
   Click or tap here to enter text.

TIFIA Borrowers Only

4. Provide as Attachment E-3 one preliminary rating opinion letter that indicates all debt obligations funding the Project, as well as other obligations that will be paid from the same source of repayment for the requested TIFIA credit assistance, have the potential to achieve an investment-grade rating. The preliminary rating must include a preliminary rating opinion on the TIFIA credit instrument.

RRIF Borrowers Only

5. If the Borrower intends to provide a rating as a basis for determining the credit risk premium, provide as Attachment E-3 one preliminary rating that indicates all debt obligations funding the Project, as well as other obligations that will be paid from the same source of repayment for the requested RRIF credit assistance, have the potential to achieve an investment-grade rating. The preliminary rating must include a preliminary rating opinion on the RRIF credit instrument. See the Credit Programs Guide for more information about the credit risk premium.

6. To the extent applicable, provide information concerning any physical collateral offered as security for requested Bureau credit assistance. (Add rows as needed.)

Collateral Description	Value	Valuation Method	Year of Evaluation
	$		Click or tap here to enter text.
Click or tap here to enter text.	$ Click or tap here to enter text.		Click or tap here to enter text.
	$ Click or tap here to enter text.		Click or tap here to enter text.

SECTION F: General Terms and Borrower Certifications

DETAILED GUIDANCE WITH RESPECT TO THE SPECIFIC SECTIONS OF THIS APPLICATION IS AVAILABLE IN THE BUREAU CREDIT PROGRAMS GUIDE. THE CREDIT PROGRAMS GUIDE CAN BE DOWNLOADED HERE.

The following items require certification by an authorized representative of the Borrower requesting credit assistance. The Department may require that Borrowers provide documentation in support of these certifications.

1. Electronic Submission. The Application must be transmitted to the Bureau electronically. When appropriate, the Bureau will provide Borrowers detailed instructions on how to electronically transmit the Application files, including attachments.

2. Information Requests. The Bureau will keep information confidential to the extent permitted by law. We encourage applicants to familiarize themselves with the Department’s Freedom of Information Act (5 U.S.C. § 552) (FOIA) procedures, which can be found at 49 CFR Part 7, as well as helpful guidance issued by the Department of Justice regarding the treatment of confidential commercial or financial information pursuant to Exemption 4 under FOIA.

3. Application Approvals. The provision of credit assistance is subject to the approval of an Application in accordance with the Department’s approval processes and successful negotiation of a credit agreement on terms and conditions satisfactory in all respects to the Department. Please see the Credit Programs Guide for detailed information with respect to the Application approval and credit agreement negotiation process.

4. Fees. Except where an applicant has been notified by the Bureau that fee assistance is available for the Project, the Borrower (or project sponsor(s), as applicable) will be responsible for the costs incurred for services duly provided by the Bureau’s legal, financial or other third-party advisors involved with the evaluation of the LOI, evaluation of this Application, and negotiation of any TIFIA/RRIF credit agreement and related transactional documentation. The applicant (or project sponsor(s), as applicable) will also be responsible for any fees associated with services provided at cost by Department modal agencies or their contractors in connection with LOI and application evaluation. These costs and fees shall be paid, whether or not a credit agreement is executed. Except as otherwise specified in a credit agreement between the Department and the Borrower, any of the Department’s direct costs and fees, including the costs of the Department’s advisors procured through “at-cost” procurements (i.e., other than those paid pursuant to sponsor payment arrangements), not paid within 30 days after the due date for payment thereof as specified in a written invoice from the Bureau shall be considered a delinquent debt, collectible in accordance with 31 U.S.C. §§ 3701-3720A and 49 CFR Part 89. In addition, the Department may initiate suspension or debarment proceedings under 2 CFR Part 180 with respect to the Borrower, any applicable sponsor parties, and any JV eligible applicant in accordance with 2 CFR § 180.630(c). The Department will also consider delinquency in the payment of invoices from Bureau advisors with direct payment arrangements with the applicant or Borrower (i.e., sponsor payment letters) to be a willful failure and violation consistent with 2 CFR § 180.800(b)(1) and (3) and may initiate suspension or debarment proceedings thereunder.

5. Lobbying. The undersigned certifies, to the best of his or her knowledge and belief, that: (a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement; (b) if any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions; and (c) the undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

See 31 U.S.C. § 1352; 49 C.F.R. part 20; Appendix A to Part 20.

6. Debarment and Suspension. Check the applicable box:

☐ By signature below, the undersigned certifies that, to the best of his or her knowledge and belief, the Borrower and its principals: (a) are not presently excluded or disqualified; (b) have not been convicted within the preceding three years of any of the offenses listed in 2 C.F.R. §180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; (c) are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses listed in 2 C.F.R. § 180.800(a); or (d) have not had one or more public transactions (Federal, State, or local) terminated within the preceding three years for cause or default. 2 C.F.R. § 180.335.

☐ The undersigned is unable to make the certification requested and has included an explanation on Attachment F-2.

7. Default/Delinquency. The undersigned certifies that none of the Borrower nor any of its parents, equity sponsors, subsidiaries, or affiliates, as applicable (a) is currently in default or delinquent on any debt or loans provided or guaranteed by the Federal Government, and (b) has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted, or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability.

8. Reporting Subaward and Executive Compensation. The undersigned certifies that the Borrower has or will have the necessary processes and systems in place to comply with the reporting requirements under the Federal Funding Accountability and Transparency Act of 2006 (Pub. L. 109-282; 31 U.S.C. § 6101 note), as amended by the Government Funding and Transparency Act (Pub. L. 110-252, title VI, § 6202(a)), and the related regulations at 2 C.F.R. Part 170, should the undersigned be approved to receive credit assistance from the Department.

9. No False or Misleading Information. It is a crime to knowingly make false statements to a Federal agency. Penalties upon conviction can include a fine and imprisonment per 18 U.S.C. § 1001. Misrepresentation of material facts may also be the basis for denial of financial assistance by the Department.

Signature. By signature below, the undersigned, on behalf of the Applicant and on behalf of the Borrower, to the extent not the same entity: (a) acknowledges and agrees to the general terms and conditions identified in Section F above; (b) certifies that the facts stated and the certifications and representations made in this application are, to the best of the his or her knowledge and belief after due inquiry, true, and the Borrower has not omitted any material facts; and (c) certifies that he or she is authorized by the Borrower to submit this Application, bind the Borrower to the terms and conditions acknowledged and agreed, and make the certifications made by submission of this Application.

Legal Name of Borrower: Click or tap here to enter text.

By: _____________________________________________________________

Name and Title: Click or tap here to enter text.

Date: Click or tap to enter a date.

APPENDIX 1 – APPLICATION CHECKLIST

An Application must include the items identified in this checklist. A completed checklist should be included in the Application packet.

Item	Page Limit
☐ Summary Information Table	N/A
☐ Section A: Borrower Contact Information	N/A
Section B: Borrower Information ☐ 1. Background Information and Legal Authority ☐ Attachment B-1: Organizational Documents – Organic Statute or Certificate of Incorporation/Organization ☐ 2. Organization and Management ☐ Attachment B-2: Organizational Charts - Management Organizational Chart and Corporate Organization Chart ☐ 3. Past Performance and Experience with Federal Assistance ☐ 4. Borrower Eligibility ☐ Attachment B-3: JV Eligible Applicant Organizational Charts - Management Organizational Chart and Corporate Organization Chart for JV Eligible Applicant ☐ Attachment B-4: JV Documentation – Documentation Supporting Existence of Joint Venture	10 (excluding attachments)
Section C: Project Information ☐ 1. Project Name ☐ 2. Project Location ☐ Attachment C-1: Vicinity Map and Project Map ☐ 3. Project Description ☐ Attachment C-2: Value-For-Money Analysis for Public-Private Partnerships ☐ Attachment C-3: Conceptual Drawings ☐ 4. Project Schedule ☐ Attachment C-4: Detailed Project Schedule ☐ 5. Project Team ☐ Attachment C-5: Project Team Organizational Chart ☐ 6. Local Funding Partners ☐ Attachment C-6: Documentation of Local Funding Partner Contributions ☐ 7. Transportation Planning and Programming Approvals ☐ Attachment C-7: Relevant Pages from the Long-Range Plan, TIP and STIP (as applicable) ☐ 8. Environmental Review ☐ Attachment C-8: Environmental Decision Documents (as available) ☐ 9. Project Management and Compliance Monitoring Plan ☐ Attachment C-9: Available Project Reports ☐ 10. Risks and Mitigation Strategies ☐ 11. Litigation ☐ 12. Operations and Maintenance Plan ☐ 13. TIFIA Borrowers Only: Investments Generated Through Partnerships ☐ 14. RRIF Borrowers Only: Anticipated Rail Services Demand ☐ 15. RRIF Borrowers Only: Economy and Efficiency	10 (excluding attachments)
Section D: Financial Plan ☐ 1. Amount and Type of Credit Assistance Requested ☐ 2. Credit Amount as Percentage of Eligible Project Costs ☐ 3. Other Federal Assistance ☐ 4. Combined Federal Assistance as a Total Percentage of Eligible Project Costs ☐ 5. Sources and Uses of Funds ☐ Attachment D-1: Detailed Sources of Uses Statement ☐ 6. Proposed Terms for the Requested Credit Instrument ☐ Attachment D-2: Proposed Terms ☐ 7. Financial Model ☐ Attachment D-3: Financial Model ☐ 8. TIFIA Borrowers Only: Impact of Credit Assistance on Cost and Schedule ☐ 9. TIFIA Borrowers Only: Reduction in Federal Grant Assistance ☐ 10. TIFIA Refinancing Applications Only: Added Capacity Project Information ☐ Attachment D-4: Section C Information for Added Capacity Project	N/A
Section E: Creditworthiness ☐ 1. Financial Statements ☐ Attachment E-1: Financial Statements, balance sheets or income statements ☐ 2. Pledged Revenue Source ☐ Attachment E-2: Documentation Supporting Projected Revenues ☐ 3. Other Supporting Information ☐ 4. TIFIA Borrowers Only: Rating Letter ☐ Attachment E-3: TIFIA Indicative Rating Letter ☐ 5. RRIF Borrowers Only: Rating Letter ☐ Attachment E-3: RRIF Indicative Rating Letter ☐ 6. RRIF Borrowers Only: Physical Collateral Valuation Information	10 (excluding attachments)
Section F: General Terms and Borrower Certifications ☐ 1. Format and Submission ☐ Attachment F-1: Application Checklist ☐ 2. Information Requests ☐ 3. Application Approvals ☐ 4. Fees ☐ 5. Lobbying ☐ 6. Debarment and Suspension ☐ Attachment F-2: Explanation as to why Borrower Is Unable To Submit Certification as to Debarment and Suspension ☐ 7. Default/Delinquency ☐ 8. Reporting Subaward and Executive Compensation ☐ 9. No False or Misleading Information Signature	N/A

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2026-2030