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Name of Applicant: City of Northglenn <br /> Date Received: 9/19/2019 <br /> Grant Request: $29,975 <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? x <br /> Cover letter with the entities: name, contact information, and a signature of x <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 <br /> commitment to the "plan"and the implementation of long-term water x <br /> savings measures and programs (w/authorized signature) <br /> Disclosure of organizational structure/chart x <br /> Current retail water demand (metered water use)for each of the past five x <br /> years (in acre ft. or million gallons) <br /> A list of people and/or organizations that will be involved in assisting with x <br /> putting the plan together(list of who will be utilizing the grant money) <br /> Not required, but preferred, Information characterizing past water use by <br /> sector, (e.g. residential, commercial, industrial) and the source (e.g. surface x <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 x <br /> the basis for this calculation <br /> Past, current, and predicted future population served by the entity, (and the x <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 x 11%over 20 yrs or <br /> efforts and the future water needs 300 af/yr <br /> Adequacy,Stability, and reliability of the entity's water system x <br /> *to be measured and examined by staff through analysis <br /> Paragraph stating the purpose and the primary features of the entity's desire x <br /> to create a water conservation plan <br /> A detailed Scope of Work(related to the plan &water efficiency measures x <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 x <br /> completion) <br /> List of how the creation of the "plan" will be funded; list grants, entities x <br /> funds, and/or in-kind services <br /> Does the applicant demonstrate 25% matching funds? In cash, in-kind x Total=$40,040 <br /> services,or a combination thereof? In-kind=$10,065 <br /> Match=25% <br /> Did the entity provide their location with respect to CWP Analysis/Technical x <br /> Update recommendations? <br />