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Name of Applicant: Cr,"xiu IA-451-0 uN r( tiD <br /> Date Received: (Q/4-r 1-7 <br /> Grant Request: %3o1 Gn_ <br /> HB 04-1365: (Plans) Evaluation Checklist for Covered Entities <br /> Applicant Demonstrates: Yes No Comments: <br /> Has the applicant fully complied with HB1051 requirements? ✓' <br /> Cover letter with the entities: name, contact information,and a signature of <br /> an individual with the authority to commit the resources of the entity ✓ <br /> Application Requirements: <br /> A written statement from the entity's governing board, stating the entity's 961-*,,Oa. -, <br /> commitment to the "plan" and the implementation of long-term water s- ski <br /> 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 five <br /> years(in acre ft. or million gallons) V r" <br /> A list of people and/or organizations that will be involved in assisting with <br /> putting the plan together(list of who will be utilizing the grant money) ✓ R', ' <br /> Not required, but preferred, Information characterizing past water use by <br /> sector, (e.g. residential, commercial, industrial) and the source (e.g. surface "Pc, <br /> water,groundwater,etc). <br /> Characterization of the water system: <br /> Current(and if available past) per capita water use for the last five years and �. <br /> the basis for this calculation ✓ fes. `- <br /> Past,current, and predicted future population served by the entity, (and the <br /> source of this information) V +� 202"1 <br /> List estimated water savings goals to be achieved through the Pe <br /> implementation of the "Plan", based on water system,the past conservation ✓ TQrtitt OF <br /> 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 desire / <br /> to create a water conservation plan ✓ <br /> A detailed Scope of Work (related to the plan &water efficiency measures <br /> w/land use planning requirement) <br /> Schedule with start&end dates; also state the estimated dates when <br /> progress reports will be submitted to CWBC staff (50%,75%&final <br /> completion) <br /> List of how the creation of the "plan" will be funded; list grants,entities <br /> funds, and/or in-kind services <br /> Does the applicant demonstrate 25% matching funds? In cash, in-kind <br /> Torok $`14:1,2-1° <br /> services, ora combination thereof? ✓ w-�+�►D= iq,1612 <br /> Did the entity provide their location with respect to SWSI recommendations? ✓ � 4 <br />