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i= <br /> General Questions Concerning the Entity <br /> What type of services does the entity provide? (check the applicable services) <br /> _ Police Electric Cemetery <br /> Street Maint. _ Traffic Control _ Sewer <br /> Fire Health Parks & Recreation <br /> Pest Control Trash Removal _ Street Lighting <br /> Water X Other— Water Conservancy District <br /> 2. Does the entity provide services in cooperation with any other governmental unit(i.e., mutual <br /> aid or intergovernmental agreements)? Yes No X N/A <br /> If so, list service and name of other government entity. <br /> Is the entity financially accountable for any other organizations? <br /> Yes No X N/A <br /> • <br /> Note: Financially accountable is defined by governmental standards as, The level of accountability that exists if a primary <br /> government appoints a voting majority of an organization's governing board and is either able to impose its will on that organization <br /> or there is a potential for the organization to provide specific financial benefits to, or impose specific financial burdens on. the <br /> primary government." <br /> If so, what are the names of the other organizations? <br /> 3. Pension Information: <br /> a) How many employees does the entity have? None Volunteers? None <br /> 2) Please indicate amount of pension contributions applicable to the following <br /> employee;volunteer plans: <br /> Employer/Local <br /> Contribution <br /> Social Security S <br /> Public Employees <br /> Retirement Assn. <br /> (PERA) S <br /> Fire and Police <br /> Pension Assn. (FPPA) S <br /> * Other S <br /> *Please provide a plan name and description if"Other" employee/volunteer pension <br /> plan is indicated above. <br /> 1) If the State contributes to local fire and police pension plans, please indicate the amount. <br /> S <br /> See Accountants' Report <br /> Application for Exemption from Audit - Revised 9/00 B-10 <br />