NOTICE OF INTENT – PRE-APPLICATION ELIGIBILITY AND SCORING WORKSHEET FOR THE FEMA HAZARD MITIGATION GRANT PROGRAM - FEMA-4229-DR-CO MITIGATION 5% PROJECT PROPOSALS Some mitigation activities are difficult to evaluate using FEMA-approved cost-effectiveness methodologies. Up to 5 percent of the total HMGP funds may be set aside by the Grantee to pay for such activities. These funds are not eligible to be used in situations where the mitigation activities can be evaluated under FEMA-approved cost-effectiveness methodologies but do not meet the required BCA threshold. Review HMA Guidance pages 84 and 85 for details. Applicant/Organization: Applicant Type: Proposed Activity Title: _______________________________________________ State Agency Tribal Government Local Government Private Non-Profit Organization Primary Contact: _____________________________________ Primary Contact Title: ________________________________________________ Address: ____________________________________________ City: _____________________ County: ________________ Zip: ____________ Phone #: ____________________________________________ FAX # ____________________________________________________________ Email Address: __________________________________________________________________________________________________________ Alternate Contact: _____________________________________ Alternate Contact Title: ___________________________________________ Phone #: _____________________________________________ Email Address: __________________________________________________ If a Tribal or local government is the proposed applicant, does the Tribal or local government have a current FEMA approved, locally adopted multihazard mitigation plan OR if a state agency or private nonprofit organization is the proposed applicant, is the proposed project located totally within a jurisdiction with a FEMA approved, locally adopted hazard mitigation plan? No Yes If unsure, please check with the County or City Emergency Manager. If yes, name of plan: ___________________________________________________________________________________ If no, is the local jurisdiction developing or updating a local hazard mitigation plan? Yes No Not Applicable Proposed Project: The use, evaluation, and application of new, unproven mitigation techniques, technologies, methods, procedures, or products Equipment and systems for the purpose of warning citizens of impending hazards Hazard identification or mapping and related equipment for the implementation of mitigation activities GIS software, hardware, and data acquisition whose primary aim is mitigation Public awareness or education campaigns about mitigation Evaluation of model building codes in support of future adoption and/or implementation Other (please specify) _______________________________________________________________________________________________ Is this project part of a larger project or larger effort? Hazard(s): Yes No Avalanche Debris Flow Drought Earthquake Erosion Expansive Soils Flood Landslide Lightning Rock Fall Subsidence Tornado Wildfire Winter Weather Other: ______________ Brief Description of the Proposed Project: ________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________ Location of project or recipients: ____________________________________________________________________________________________ Page 1 of 2 Describe the population directly benefitting from the proposed activity. Include quantities in the description and how they benefit: ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ Estimated Total Cost: _______________________ Federal Share: _________________________ Non-Federal Share: ______________________ Proposed Sources of funds for the Non-Federal Share: ____________________________________________________________________________ Please return completed NOI to Scott Baldwin (scott.baldwin@state.co.us) and Sean Settle (sean.settle@state.co.us) Page 2 of 2