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Name of Applicant::Cc":*z of Fia-eFsT;p­iE- <br />Date Received: i Z S/ -2 o f c. <br />Grant Amount: is 34. -12-?-. 151:5- <br />HB <br />S <br />HB 05-1254: Evaluation Checklist for Entities <br />For Applicants: <br />Yes <br />No <br />Comments: <br />Is the applicant a covered entity? <br />Air <br />�2a <br />w 2oI; <br />Does the applicant have a state approved water conservation plan in <br />✓ <br />SPTi�7 <br />accordance with statutory revision 37-60-126? (HB 04-1365)? <br />(If answered no to the above question) then, Does the covered entity <br />have a locally adopted water conservation plan with defined water <br />saving goals? <br />If the applicant is a covered entity, have they fully complied withs�� <br />HB1051 requirements? <br />Did the applicant provide a written statement from the entity's <br />governing board, stating the entity's commitment to the project and the <br />cc�ve7r_- L-0T7e� <br />entity's commitment to implementing long-term water saving measures <br />and programs (w/authorized signature)? <br />Did the applicant provide a cover letter with the entity's: name, contact <br />information, and a signature of an individual with the authority to <br />commit the resources of the entity? <br />Did the applicant provide a list of people and/or organizations that will <br />be involved in assisting with the grant project (list of who will be utilizing <br />I - 2 <br />the grant money)? <br />Characterizing Water System: <br />----- <br />----- <br />------------ <br />Did the entity provide their annual retail water demand (Metered Water <br />✓ <br />PG, <br />Use for the past five years (in acre ft. or million gallons)? <br />Did the entity identify their retail water delivery (Distributed Water) for <br />each of the past five years (in acre feet or million gallons)? <br />(Not required, but preferred), Did the applicant provide information <br />characterizing past water use by sector, (e.g. residential, commercial, <br />✓ <br />P�, 3 <br />and industrial) and the source (e.g. surface water, groundwater, etc). <br />Did the entity provide current (and if available past) per capita water <br />�' 7 <br />use for the last five years and the basis for this calculation? <br />Did the entity provide their past, current, and predicted future <br />✓ <br />p, 3. 4 <br />population served by the entity, (and the source of this information)? <br />_7AP,L- 2 <br />Did the entity state the water savings that was accomplished in the past <br />S <br />five years through water conservation efforts? <br />Did the entity state water savings goals to be achieved through the <br />4 <br />implementation of the "project"? <br />Adequacy, Stability, and reliability of the entity's water system <br />*to be measured and examined by staff through analysis <br />Description of Project: <br />------ <br />----- <br />------ ------ <br />Did the applicant write a paragraph stating the purpose and the primary <br />features of the project? <br />Did the applicant provide a detailed Scope of Work (tasks to be <br />