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Name of Applicant: Mo�fri of A'oiJ <br /> Date Received: 312--/2-1a)(g <br /> Grant Request: *3a,000 <br /> HB 04-1365: Evaluation Checklist for Non-Covered Entities <br /> Applicant Demonstrates: Yes No Comments: <br /> Will the entity soon become a covered entity? <br /> Did they provide a reasonable engineering estimate of future annual e-PG, <br /> Tlt T.� t.,1) Tw <br /> retail demand for the next 3-5 yrs., all based on population q--$1 <br /> projections, building permits, expected new taps, and or some other <br /> creditable information that would show that the entity would become 2.2 <br /> a "covered" entity? <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 /> five years (in acre ft. or million gallons) <br /> A list of people and/or organizations that will be involved in assisting 2 <br /> with putting the plan together (list of who will be utilizing the grant a� <br /> money) <br /> Not required, but preferred, Information characterizing past water use 'PC 4 <br /> by sector, (e.g. residential, commercial, industrial) and the source (e.g. <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 /> years and the basis for this calculation `/ �__ c>. c - c tc <br /> Past, current, and predicted future population served by the entity, j <br /> (and the source of this information) <br /> List estimated water savings goals to be achieved through the -7 <br /> implementation of the "Plan", based on water system, the past ✓ -W./ t_ <br /> conservation efforts and the future water needs cx/ a y9-‘, <br /> Adequacy, Stability, and reliability of the entity's water system ✓ % -I <br /> Paragraph stating the purpose and the primary features of the entity's ✓ Sow - Fc I <br /> desire to create a water conservation plan <br /> A detailed Scope of Work of tasks to be performed with grant monies <br /> (related to the plan &water efficiency measures w/ land use planning ✓ <br /> requirement) <br /> The "Plans"timeline, stating milestones with dates and end products <br /> with dates; also state the estimated dates when progress reports will <br /> be submitted to CWCB staff (50% & 75%completion) <br />