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Wildfire Prepared Property Assessment Application Form

Elk Creek Inter Canyon

Instructions: Fill out the application form (either electronically or print and write legibly in blue or black ink). Applications must be filled out and signed by either the property owner or the property owner’s legal representative. Renters are not eligible to apply.
Send your completed and signed application by:
Submitting the application online here via the "Submit Application" button
Email (scanned copy of your application to your fire protection district): mitigation@elkcreekfire.org OR mitigation@evergreenfirerescue.com OR ddalton@geneseefire.org
Mail (hard copy of your application): Elk Creek: P.O Box 607 11993 Blackfoot Road Conifer, CO 80433 OR Evergreen: 1802 Bergen Pkwy Evergreen CO 80439 OR Genesee: 23455 Currant Drive Golden, Colorado 80401
For any questions, contact: Benjamin Yellin (Elk Creek) 303-816-9385; OR Paul Amundson (Evergreen) 303-674-3145 OR Dorie Dalton (Genesee) 303-526-1230 ext. 4

General Information

Applicant Name
Property Address (to be assessed)
Applicant's Email Address
In which community is the property located?
Type of Property
Parcel ID

Applicant Contact Information

Are you the property owner or a legal representative?
If a legal representative, is the property owner(s) aware of this application?
   
Applicant Mailing Address (if different than property to be assessed):
Applicant Preferred Phone Number
Applicant Alternative Phone Number

Property Profile

For single family applicants: are you a year-round or part-time resident in Elk Creek, Evergreen, or Genesee FPDs?
For duplex applicants: do you have a party-wall agreement?
   
For all applicants: what is the nature of the residence? (check all that apply)
Note: In order to be eligible, all duplex parties must individually apply for and be accepted into the program. Both property owners (or the authorized representative) must be present at the same time for both the assessment and the inspection.
For multi-family applicants: how many units are there?
Note: In order to determine eligibility for multi-family applicants, we will call you to further discuss the number of units and the property management structure.

Property Mitigation and Maintenance

Does this property have a wood shake roof or wood shake siding? (check all that apply)
If yes to any above, please provide a detailed description of current roof and/or siding material and condition
If yes to any above, are you willing to replace your roof and siding as part of participating in the Wildfire Prepared Wildfire Prepared program? (check all that apply)
Are you willing to create defensible space as required by your Wildfire Prepared mitigation specialist (assessor) and based on the Colorado State Forest Service guidelines?
   
Do you commit to implementing and maintaining mitigation measures for this property (for the length of your legal responsibility or ownership)?
   
Note: Property Owners who join the Wildfire Prepared program may be asked to complete defensible space work and fire-resistant construction retrofits to their home in order to qualify for a Wildfire Prepared certificate. These mitigation actions are strictly voluntary, but may be required in order to earn a program certificate. Property Owners must seek and attain all required permits and/or HOA approval before removing trees from their property and/or initiating new construction or alterations to their homes. Preparing for wildfires is an ongoing, long-term effort that requires maintenance and upkeep and does not guarantee home survival. More information on defensible space guidelines are available at: http://static.colostate.edu/client-files/csfs/pdfs/FIRE2012_1_DspaceQuickGuide.pdf

Program Liability Waiver and Applicant Signature(s)

RIGHT OF ENTRY/HOLD HARMLESS AGREEMENT
As a Wildfire Prepared program participant, I understand that I am required to permit and participate in a wildfire property assessment on my property with a Wildfire Prepared Assessor. Based upon the results of the property assessment, the Wildfire Prepared Assessor will work with me to take steps that may reduce the risk of wildfire damage to my property. I acknowledge and agree to the following:
RIGHT OF ENTRY: I certify that I am the owner or the owner’s authorized agent of the above described property, and that I have the legal authority to enter into this Agreement. I grant freely and without coercion the right of access and entry to my property to Wildfire Prepared, its agents and authorized Contractors at a mutually agreed upon date and time to assess my property for the risk of wildfire damage, to develop a customized wildfire mitigation report designed to reduce the risk of wildfire damage, to mark vegetation for removal with paint and to make follow up visits to my property to make sure I am fully prepared for future wildfires.
RELEASE AND HOLD HARMLESS: I understand that this Agreement/Permit is not an obligation upon Wildfire Prepared to perform any work my property. I hereby release, waive, discharge and hold harmless Wildfire Prepared, Elk Creek Fire Protection District, Evergreen Fire Protection District, Genesee Fire Protection District, Inter-Canyon Fire Protection District, its elected and appointed officials, and its employees, agents and representatives, and Wildfire Mitigation Specialists from all claims, liabilities, damages, losses, or expenses on account of damage to property, bodily injury, or death resulting from my participation in the Wildfire Prepared program. By participating in the Wildfire Prepared program and by executing this agreement, it is my express intention and I hereby waive any and all claims which I might have to bring in any form, whether legal or equitable, arising out of my participation in the Wildfire Prepared program and any incidence relating to, but not limited to, the performance of Assessment, Inspection and Educational Work by any released party herein.
DISCLOSURE OF PROPERTY OWNER INFORMATION: I understand that Wildfire Prepared will collect data regarding my property in order to prepare a customized fire mitigation plan and may publish countywide maps of certified Wildfire Prepared homes (names and addresses will not be included on maps). With the exception of local fire districts mentioned below, Wildfire Prepared will not share this data with third parties. I further understand that to the extent the data is public information, disclosure may be subject to the Colorado Open Records Act (C.R.S. 24-72-201 et seq.) and other legal requirements. Wildfire Prepared will not disclosure to third parties, except as required by law, any personal information they may collect in connection with my participation in the program. Wildfire Prepared will share program information with program funders as part of normal program reporting. I further acknowledge that Wildfire Prepared will disclose the name, address and status of program participants to their local fire protection district. Additionally, I understand that if a participant in Wildfire Prepared (including myself) wants to know which of his or her neighbors are also participating in the program in order to help coordinate wildfire mitigation efforts, Wildfire Prepared will provide this information to those program participants.
DISCLAIMER: I have read and understand the following Disclaimer: While the purpose of the Wildfire Prepared Property Assessment is to reduce the risk of fire damage to your home or property, following the requirements in the Assessment report does not guarantee prevention of such damage. Wildfire mitigation work around your home can give firefighters the best chance to defend and protect your property from wildfires, and can also substantially increase your safety and reduce the risk to life and property. However, wildfire is unpredictable and can be impossible to stop or control, regardless of what mitigation efforts you have taken. Wildfire Prepared makes no warranties, guarantees or representations of any kind with respective to the effectiveness of any mitigation efforts you undertake in connection with your participation in the Wildfire Prepared program.
I/we (name of property owner(s) or legal representative as entered above ) agree to accept the terms as outlined in this application and the Wildfire Prepared program liability waiver in order to be eligible for the program. I/we understand that we can withdraw from the program at any time through written notification submitted to the program coordinator. Withdrawal from the program will result in my/our ineligibility to receive a Wildfire Prepared certificate.
I/we agree to be bound by the terms above
   
Submit Application

The Wildfire Ready program is administered by the Community Wildfire Planning Center, a 501(c) 3 non-profit organization based in Colorado. The program engages local residents, realtors, fire protection districts and other community members seeking to reduce wildfire risk to homes and property.