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2. First Name*
4. Last Name*
6. Email*
8. Phone Number
10. Mailing Address
12. Street Number
13. Street Name
14. Street Type
15. Apt #
17. City
18. State
19. Zip
21. Is your property within the geographical boundaries of Clear Creek County?*

    1. Yes
    2. No
    3. Yes, but the mailing address is Jefferson County.
25. Provide information about the site on which you intend to conduct mitigation activities, and information on the type of mitigation you plan to do. This section includes uploading of "before photos" showing the current property condition.
27. Full address of your property where you will conduct wildfire risk reduction activities (street, city, zip code).*
29. What is the legal description of your property? (Lot, Block, Subdivision)*
31. What are you focusing on for your wildfire risk reduction project? (you can select more than one)*

    1. 30-foot defensible space around home
    2. 100-foot space
    3. Removal of dead, dying, or diseased trees
    4. Other
33. Type of wildfire risk reduction (you can select more than one)*

    1. Tree or Brush Thinning (example: pruning, branch removal, branch limbing).
    2. Tree or Large Brush Cutting (Felling trees or large brush; does NOT include disposal).
    3. Tree or Brush Removal (collection, loading, and transport of debris off of your property).
35. Work to be performed and project site plan, including basic data points such as size of area mitigated. These data points include how many trees to be felled and/or limbed, how many bushes removed and/or limbed, and acreage of your property to be mitigated.*
37. What method(s) will you use to conduct risk reduction activities? (you can select more than one)*

    1. Hire a contractor
    2. Rent equipment to do it myself
    3. Do it myself
    4. Other
39. Define how the proposed mitigation work will reduce the wildfire risk to the treated property and neighboring properties.*
41. Plan designating how the wood products will be disposed of or utilized.*
43. Is your property in an area with a CWPIP? You can check out your local CWPIP here: https://www.clearcreekcounty.us/97/Emergency-Management*

    1. Yes
    2. No
    3. I don't know.
45. If you answered "Yes" to question 12, what is the name of your area CWPIP?*
47. Question to acknowledge them providing before and after photos, and providing data we can use.*

    1. Yes
    2. No ((selecting this response disqualifies you from the application process).
49. Upload "Before" site pictures showing the current conditions of the area you plan to mitigate.
51. File number limit: 10 Single file size limit: 10MB Allowed file types: Word, Excel, PPT, PDF, Image, Video, Audio
55. Cost
57. Project total cost proposal to include equipment costs, contractor costs, and labor in-kind hours. (Labor in-kind hours are calculated at the rate of $29.00 per hour). (enter a dollar amount)*
59. Upload your cost estimate documentation. This is intended to show how you determined your cost estimate. (Examples: Did you obtain a price quote from a contractor? Did you estimate the time it would take you to do the work, and multiply that by the accepted volunteer hourly rate of $29.00? Did you obtain a price quote for renting equipment?)
61. File number limit: 4 Single file size limit: 10MB Allowed file types: Word, Excel, PPT, PDF, Image, Video, Audio
65. Noxious Weed Management*

    In accordance with the Clear Creek County Noxious Weed Management Ordinance #7 7-A, participants in the wildfire mitigation project agree to review and comply with said ordinance. Each participant must sign the Weed Management and Project Participation Form(s) and attach said forms as ATTACHMENT B.

    See Attachment B: Weed Management and Project Participation Forms

    I acknowledge my participation in the Clear Creek County WILDFIRE MITIGATION Grant Program and my personal responsibilities in accordance with the grant criteria.

    I have received a website link to the Clear Creek County Weed Management Ordinance #11-A; and understand my responsibilities under the

    Ordinance:

    https://www.clearcreekcounty.us/DocumentCenter/View/889/11_NoxiousWeedManagementPlan?bidId=

    As a participant in the Clear Creek County Community Risk Reduction Wildfire Mitigation Grant Program, I understand my responsibility to manage noxious weeds on my property according to the above identified ordinance. By entering my full name below I acknowledge that I have read the ordinance and agree to my noxious weed management responsibilities. *

    
    

67. Please answer the following in the space below in accordance with the noxious weed management form:
69. Project Name*
71. Property Owner Name*
73. Physical Address of Property:
75. Street Number
76. Street Name
77. Street Type
78. Apt #
80. City
81. State
82. Zip
84. Legal Description (Lot, Block, Subdivision):*
86. Mailing Address:
88. Street Number
89. Street Name
90. Street Type
91. Apt #
93. City
94. State
95. Zip
97. Property Owner Initials:*
99. Date*
103. PARTICIPATION FORM AND LIABILITY WAIVER AGREEMENT

     As WILDFIRE MITIGATION projects may involve active physical participation which may pose potential risk of personal injury and personal property damage, participants in the WILDFIRE f\1/TIGATION Grant Program must fill out and upload the signed Participation Form and Liability Waiver Agreement. The Participation Form and Liability Waiver Agreement for each participant must be completed and submitted with the Grant Application in order to be considered. The Form/Agreement is below in the next section as ATTACHMENT C.

105. I, the "Participant", agrees to participate in the Clear Creek County Community Risk Reduction Program. I understand that this Project may involve active physical participation, which includes a potential risk of personal injury and personal property damage.

     Waiver and Liability: As used in this paragraph, the term "Governmental Entity" means the County of Clear Creek, Colorado. Participant in consideration for participating in the Project, does hereby, on behalf of the Participant and the Participant's heirs, assigns, successors, or any person claiming or attempting to exert a claim against Clear Creek County as a result of Participant's taking part in this Project, expressly waive, discharge, remise and release any claim, right, covenant not to sue, or cause of action whatsoever, and agree to hold harmless for any and all purposes; including but not limited to any claim of negligence, which the Participant or they may have, acquire, or which may accrue in the future, against the Governmental Entity and the Governmental Entity's officers, employees, staff, members, servants, volunteers, or agents, arising in whole or in part from or as a result of the Participant participating in this Project; from any and all liabilities, claims, demands, including but in no way limited to physical, mental, economic, or emotional injuries, or death; or damages, including court costs and attorney's fees and expenses; that may be sustained by me while participating in such activity, while traveling to and from the activity, or while on the premises. I understand this waiver does not apply to injuries caused by intentional or grossly negligent conduct. 

     Indemnity Clause: I am fully aware that there are inherent risks to myself and others involved with this activity, including but not limited to loss of or damage to my property, serious bodily and mental injuries, loss of or damage to organs and limbs, and death, and I choose to voluntarily participate in said activity with full knowledge that the activity may be hazardous to me and my property, and to the person or property of others. I acknowledge there may be physically strenuous activities. I know of no medical reason why I should not participate. I voluntarily assume these risks in order to receive the real and tangible benefits to me of my participation in this activity.

     No Insurance: I understand that the Governmental Entity will not maintain any insurance policy covering any circumstance arising from my participation in this activity or any event related to that participation. As such, I am aware that I should review my personal insurance coverage. This Participation and Liability agreement is subject to and shall be interpreted under the law of the State of Colorado. Court venue and jurisdiction shall exclusively be in the Clear Creek County Court in Georgetown, Colorado.

     Voluntary Signature: In signing this agreement I acknowledge and represent that I have read it, understand it, and sign it voluntarily as my own free act and deed; organizations have not made and I have not relied on any oral representations, statements, or inducements apart from the terms contained in this agreement. I execute this document for full, adequate and complete consideration fully intending to be bound by the same, now and in the future. I understand I can choose not to sign this document and free myself from its terms and the associated risks of the activity by simply not participating in the activity. I further understand this is a voluntary activity. Knowing the risks, I still desire to voluntarily engage in this activity.

     Note: Signing this document involves the waiver of valuable legal rights.

107. Enter your name and address below to sign this document.*
111. Benefits of Risk Reduction - Optional

     This section asks why you want to do mitigation. This is NOT part of the evaluation criteria; it is for background information. Please help us get a better sense of mitigation efforts in the county.

113. Has any wildfire risk reduction been conducted on your property in the past?

     1. Yes
     2. No
115. If you answered "Yes" to the above question, please list the type of wildfire mitigation activities that have occurred on your property.
117. Why do you want to participate in this project?
119. What do you see as the benefit(s) of your participation?
123. Important Dates and Information

     Due date for grant submission: May 10th, 2023 by 5:30pm

     Reward date: June 1st, 2023

     Reimbursement submittal due date: October 31st, 2023 by 5:30pm

     Upon award of this Risk Reduction Grant, we will provide you 50% of your project share (up to $2,500 in total for the overall $5,000 maximum award) so you can begin your mitigation project. You will receive the remaining 50% once the work is complete, we receive 'after' photos of your mitigation project, and all receipts are attached to the reimbursement form you will receive.

     
     

125. By typing your name below, you agree to the above reimbursement requirements if you are a chosen grant recipient.*
Leave This Blank:


127. 1. Receive an email copy of this form.
128. Email address

     This field is not part of the form submission.

129. Submit

* indicates a required field