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Name of Applicant: cA-ry oF Date Received: (o /' I / 201 Grant Amount: 42_) *(S' HB 05-1254: Evaluation Checklist for Entities For Applicants: Yes No Comments: Is the applicant a covered entity? Does the applicant have a state approved water conservation plan in accordance with statutory revision 37-60-126? (HB 04-1365)? ✓ 9--01S" (If answered no to the above question) then, Does the covered entity have a locally adopted water conservation plan with defined water saving goals? If the applicant is a covered entity, have they fully complied with HB1051 requirements? Did the applicant provide a written statement from the entity'sFt 1� governing board, stating the entity's commitment to the project and the entity's commitment to implementing long-term water saving measures v/ and programs (w/authorized signature)? Did the applicant provide a cover letter with the entity's: name, contact information, and a signature of an individual with the authority to \Z- commit the resources of the entity? Did the applicant provide a list of people and/or organizations that will be involved in assisting with the grant project (list of who will be utilizing \./ the grant money)? Characterizing Water System: Did the entity provide their annual retail water demand (Metered Water Use)for the past five years (in acre ft. or million gallons)? Did the entity identify their retail water delivery (Distributed Water) for each of the past five years (in acre feet or million gallons)? (Not required, but preferred), Did the applicant provide information Pc, 4 characterizing past water use by sector, (e.g. residential, commercial, and industrial) and the source (e.g. surface water, groundwater, etc). - Did the entity provide current (and if available past) per capita water ✓ 3 s use for the last five years and the basis for this calculation? Did the entity provide their past, current, and predicted future ✓, pc, L, population served by the entity, (and the source of this information)? Ftc,,,a-- - 2- Did the entity state the water savings that was accomplished in the past j five years through water conservation efforts? ✓ Did the entity state water savings goals to be achieved through the implementation of the "project"? Adequacy, Stability, and reliability of the entity's water system *to be measured and examined by staff through analysis Description of Project: Did the applicant write a paragraph stating the purpose and the primary / c, 'o- I2 features of the project? �/ Did the applicant provide a detailed Scope of Work (tasks to be ✓ pt, ti- 14