HPP Committee: Colorado Parks and Wildlife Habitat Partnership Program Habitat Project Application DWM: I. CONTACT INFORMATION Landowner/Manager Name Mailing Address Daytime Phone # Secondary Phone # Email: II. PROPERTY and PROJECT INFORMATION Property Name and Address Project Location Property and Project Acreage Information Project Name County UTM Township N or S E Range Private Total Acres Owned Irrigated Public Acres N E or W ¼ Sec Section Total Project Acres Dryland Woodland BLM USFS CPW SLB ____________ III. PROPOSED PROJECT FUNDING 1. TOTAL HPP Contribution Being Requested 2. Project Cooperators/Partners Landowner/Land Manager GRAND TOTAL (1+2) HPP is paying for labor materials or reimbursing the landowner $ Match $ In Kind $ $ $ $ $ $ $ $ $ $ $ Hours Hours $ - real dollars paid to a 3rd party as a part of the cooperator’s contribution In Kind $ - the value of services or labor that the landowner or cooperator contributes as determined by them. Hours – the amount of time that a cooperator contributes to the project as their partnership contribution. Do not count kind $ and in kind hours for the same work. both in NOTE: Your local committee may have specific project requirements, ie. before and after photos, soils test for fertilizer requests, ‘wildlife friendly’ fence specifications, minimum acreage, hunting allowed, DWM review, etc. Please check with them to see if your property and your project meet their specific conditions. NOTE: The US Fish and Wildlife Service has listed the Gunnison Sage Grouse as a ‘threatened species’. On page 2, indicate if your project is within any federal or state designated habitat. If so, your project must be reviewed and approved by the FWS or CPW, which could delay the start of your project. Please talk with your DWM about this. HPP cannot approve your project until needed reviews and approvals are in place. EVALUATION AND JUSTIFICATION OF PROPOSED PROJECT By State law, the purpose of the HPP program is to resolve conflicts between big game (deer, elk, pronghorn, moose) and agricultural operators or to help CPW meet game management objectives. In order to be considered, your project should address one or both of these requirements. Please describe what you want to do for your project. Please explain the need for this project. What are the conflicts? Describe how the project will be monitored for success. What are the benefits to the landowners? What are the benefits to wildlife and/or habitat? Will your project change biggame distribution? Describe. Will your project reduce or eliminate game damage or the filing of claims? Explain. If on private land, does the landowner allow hunting? Additional comments - use additional page(s) if needed. Is your project within US Fish and Wildlife Service and/or CPW designated or mapped habitat for Gunnison Sage Grouse? Yes No Explanation: Conflict Wildlife Elk Deer Pronghorn Ag Crop Aspen Mtn Shrub Pinyon/Juniper Moose Conifer Forest Irrigated Hay Meadow Habitat Type Winter Habitat Use Riparian Summer Sagebrush Fall Wetland Spring Elk Deer Pronghorn Moose Please mark the box that best describes your proposed habitat project: Seeding Fire Weed control Spot spray? Grazing Mgmt Tree/Shrub control type of machine Fertilization Water Development pond cleaning tank(s) spring solar pump well pipe # of Acres or Water Developments Involved in Project that HPP is being asked to pay for # of Acres or Water Developments Involved in Project that other Partners are paying for. This is in addition to whatever is being paid for by HPP. What are you asking HPP to buy for your project? Quantity (lbs/hrs/gal/ acres) Unit Description (lbs/gal/ Unit Cost (type and amount per acre if applicable) /acres/box) Amount TOTAL (Must Match HPP Cost #1 from page 1) Tentative Start Date: $ Probable Completion Date: Landowner/Land Manager/Applicant Signature and Date: I understand that HPP is only providing funding. Local, state and/or federal permits may be required for this project and it is my responsibility to have the appropriate permits in place prior to the project starting. DWM Review/Approval: HPP Committee Review/Approval/Comments: Final Approval if different from Request: Project Notes: Does Project Estimate match Vendor Quote: Preferred Vendor: Is Vendor a former or current state employee? Y N