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NON-REIMBURSABLE INVESTMENT APPLICATION <br /> Colorado Water Conservation Board - CONSTRUCTION FUND <br /> COLORADO FIflOD RESPONSE PROGRAM(FUND REFRESH) -S160,000 <br /> Instructions: This application form should be typed, or printed neatly with black ink. You may <br /> attach additional sheets as necessary to fully answer any question, or to provide additional <br /> information that you feel would be helpful in evaluating this application. If you have difficulty with <br /> any part of the application, please contact the Water Supply Planning and Finance Section <br /> (Colorado Water Conservation Board)for assistance, at(303) 866-3426. <br /> Generally,the applicant is also the prospective owner and sponsor of the proposed project. If this is <br /> not the case,please contact the CWCB staff before completing this application. <br /> Part A. -Description of the Applicant(Project Sponsor or Owner); <br /> 1.Name of applicant(s): Colorado Water Conservation Board <br /> Mailing address: 1313 Sherman Street,Rm. 721,Denver, CO 80203 <br /> Taxpayer ID# email address: larry.lang @state.co.us <br /> Telephone numbers: Business (303) 566-3959 <br /> Home (303)421-7975 <br /> Fax (303) 566-4474 <br /> 2. Person to contact regarding this application, if different from above: <br /> Name: Tom Browning or Larry Lang <br /> Position/title: CWCB Flood Protection Section <br /> Mailing address: same <br /> 3. Type of organization (Ditch Co., Irrigation District, Municipality, Private Owner, etc.): <br /> State Government <br /> 4. Is the organization incorporated in the State of Colorado? YES_X_ NO <br /> (If"YES", please include a copy of the articles of incorporation, and the Bylaws with this <br /> application form.) <br /> 5. Please provide a brief description of the owner's existing water supply facilities. <br /> 6. For existing facilities indicate: <br /> (a)The number of shareholders , or (b) the number of customers served <br /> (c) Current Assessment per share$ (d)Number of shares <br />