Local Government Limited Gaming Impact Fund (Lglgif) Cost Recovery Form -State Of Colorado Department Of Local Affairs printable pdf download

Local Government Limited Gaming Impact Fund (Lglgif) Cost Recovery Form -State Of Colorado Department Of Local Affairs

STATE OF COLORADO

Revised 1/99

DEPARTMENT OF LOCAL AFFAIRS

LOCAL GOVERNMENT LIMITED GAMING IMPACT FUND (LGLGIF)

COST RECOVERY FORM

Attach to Project Application Form Due April 15

This form converts gaming impact costs identified in the LGLGIF Service Delivery Report

(SDR) into specific expenditure categories . The information contained herein is an

annual summary of the documented gaming impacts for SDR categories. The SDR

categories include: County Road and Bridge/Municipal Streets, County Social Services,

Emergency Medical Services, Jails, Fire Protection, Law Enforcement, Judicial System,

Non-profit Human Service Agencies, Planning and Water Quality Management. A

separate CRF must be completed for each service category.

The process to

document gaming impacts has been adopted by the Local Government Limited Gaming

Impact Advisory Committee. Costs are represented within three categories: personnel,

operating and capital.

The form does not convert data collected through the Water Quality Management and

Planning SDRs into costs. Therefore, jurisdictions claiming impact costs in these service

areas must assign costs within any or all of the three categories below and must provide

reasonable justification in Section C. below.

The form can only be completed properly when documentation is provided through the

periodic SDR reporting process.

General Information:

Reporting Entity (County, Municipality or Special District):

County of

Contact Person:

Name

Title

Phone Number

Address

Service Category (i.e. EMS, Jails, Social Services etc)

Gaming Impact Cost Conversion (For Water Quality Management and Planning

SDRs, enter cost estimates and provide justification in Section C.)

1 (a).

Enter Cumulative "Personnel Cost of Gaming" amount from

SDR $________. This amount should be the sum of all monthly, quarterly or

annual reports generated by your jurisdiction through the applicable SDR.

Indicate in the space provided how these funds would be used (e.g. Hire an

additional policeman and offset 20% of one dispatcher's salary).

1 (b). Are these personnel costs represented in the project application form?

(Please check) Yes___ No___.

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Local Government Limited Gaming Impact Fund (Lglgif) Cost Recovery Form -State Of Colorado Department Of Local Affairs