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Name of Applicant: 5AsT cuEp-tui cRrs-K V4u.ey wsP <br /> Date Received: 'z-/t / .2-vi <br /> Grant Request: it.281 8-2-S— <br /> HB <br /> 2SHB 04-1365: (Plans) Evaluation Checklist for Covered Entities <br /> Applicant Demonstrates: Yes No Comments: <br /> Has the applicant fully complied with HB1051 requirements? Tb 'e'""'T <br /> Re> <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 s(G.N# w.AP-E d-1 <br /> commitment to the "plan" and the implementation of long-term water ✓ " `ivrr <br /> savings measures and programs(w/authorized signature) S°"^' , I <br /> Disclosure of organizational structure/chart <br /> Current retail water demand (metered water use)for each of the past five / 4 <br /> years(in acre ft. or million gallons) <br /> A list of people and/or organizations that will be involved in assisting with / Pc., <br /> putting the plan together(list of who will be utilizing the grant money) "I <br /> Not required, but preferred, Information characterizing past water use by �� 4- <br /> sector, <br /> sector, (e.g. residential, commercial, industrial) and the source (e.g. surface <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 <br /> Past, current, and predicted future population served by the entity, (and the <br /> 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 conservation ,v/7- <br /> efforts <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 j — <br /> _to create a water conservation plan <br /> A detailed Scope of Work(related to the plan &water efficiency measures <br /> \/ <br /> w/land use planning requirement) <br /> Schedule with start&end dates; also state the estimated dates when Er, , s <br /> progress reports will be submitted to CWBC staff (50%,75%&final <br /> completion) <br /> ?9-06./piwh t <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 ✓/ To,-"'-= S4-7,V3-1 <br /> services, or a combination thereof? - R X04 3i2 <br /> Did the entity provide their location with respect to SWSI recommendations? ✓ pa. 4-- <br />