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Name of Applicant: — g_u" w ase, <br />Date Received: 9/2:1 / 2016 <br />Grant Request: V34 1(-0 <br />HB 04-1365: (Plans) Evaluation Checklist <br />Applicant Demonstrates: <br />Yes <br />No <br />Comments: <br />Is the applicant a covered entity? <br />If answered "no" to the above question, then is it an entity which will <br />soon become a covered entity? <br />(Only answer this question if the applicant is NOT currently a <br />"covered" entity) Did they provide a reasonable engineering estimate <br />of future annual retail demand for the next 3-5 yrs. , all based on <br />`��, Z; <br />population projections, building permits, expected new taps, and or <br />some other creditable information that would show that the entity will <br />become a "covered" entity <br />If the applicant is a covered entity, have they fully complied withE�T'�- <br />✓!� <br />HB1051 requirements? <br />�* �'`�^^ T�0 <br />Cover letter with the entities: name, contact information , and a <br />signature of an individual with the authority to commit the resources <br />of the entity <br />Application Requirements: <br />A written statement from the entity's governing board, stating the <br />entity's commitment to the "plan" and the implementation of long- <br />term water savings measures and programs (w/authorized signature) <br />Disclosure of organizational structure/chart <br />Current retail water demand (metered water use) for each of the past <br />/ <br />_ 4 <br />five years (in acre ft. or million gallons) <br />�/ <br />A list of people and/or organizations that will be involved in assisting <br />with putting the plan together (list of who will be utilizing the grant <br />✓ <br />f6, 1—� <br />money) <br />Not required, but preferred, Information characterizing past water use <br />by sector, (e.g. residential, commercial, industrial) and the source (e.g. <br />q <br />surface water, groundwater, etc). <br />Characterization of the water system: <br />Current (and if available past) per capita water use for the last five <br />✓ <br />�� <br />years and the basis for this calculation <br />Past, current, and predicted future population served by the entity, <br />(and the source of this information) <br />List estimated water savings goals to be achieved through the <br />implementation of the "Plan", based on water system, the past <br />�G $ <br />conservation efforts and the future water needs <br />Adequacy, Stability, and reliability of the entity's water system <br />*to be measured and examined by staff through analysis <br />Paragraph stating the purpose and the primary features of the entity's <br />`� <br />desire to create a water conservation plan <br />