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Five-Star Certification Program Business Interest Form

2. Jefferson County Five-Star Certification Program Business Interest Form
   The State of Colorado’s 5-Star Certified Business Variance Program allows businesses to expand operations by implementing safety measures beyond what is already required by public health orders and guidelines to help slow the spread of COVID-19. This is a voluntary local certification program that enables businesses to operate at a sustainable capacity while ensuring compliance with COVID-19 transmission controls and best practices. <br> <br> While we are working to apply to, and receive approval from, CDPHE, we are asking all businesses to submit a Business Interest Form stating your business is willing and able to meet all the criteria to be considered for the Five-Star Certification Program.

   The State of Colorado’s 5-Star Certified Business Variance Program allows businesses to expand operations by implementing safety measures beyond what is already required by public health orders and guidelines to help slow the spread of COVID-19. This is a voluntary local certification program that enables businesses to operate at a sustainable capacity while ensuring compliance with COVID-19 transmission controls and best practices.
   
   While we are working to apply to, and receive approval from, CDPHE, we are asking all businesses to submit a Business Interest Form stating your business is willing and able to meet all the criteria to be considered for the Five-Star Certification Program.

4. Business Information

6. Name of Business*

8. Business Street Address*

10. City*

11. State*

12. Zip Code*

14. Name of Business Contact*

16. Phone Number of Business Contact*

17. Email Address of Business Contact*

19. What best describes your business?*

    1. General Business
    2. Restaurant
    3. Gym and Fitness
    4. Personal Services
    5. Indoor Events

20. How many locations does your business have in Jefferson County? At this point in time, please be aware that you when the Five-Star application process opens, you may need to submit a separate application for each location.*

    1. One location
    2. Two locations
    3. Three locations
    4. Four or more locations

22. What jurisdiction(s) does your business operation in?*

    Select more than one only if you have more than one location.
    
    

    1. Arvada (Jeffco Portion)
    2. Bow Mar (Jeffco Portion)
    3. Edgewater
    4. Golden
    5. Lakeside
    6. Lakewood
    7. Morrison
    8. Mountain View

    1. Westminster (Jeffco Portion)
    2. Wheat Ridge
    3. Superior (Jeffco Portion)
    4. Unincorporated - Conifer
    5. Unincorporated - Evergreen
    6. Unincorporated - Genesee
    7. Unincorporated - Other
    8. Not sure / Not listed
24. Program Information

26. Why do you want to be a certified business? *

    Select all that apply.

    1. Potential for increased customer capacity or more flexible guidelines
    2. Demonstrate safety to customers
    3. Ability to market certification to customers
    4. Ensure our business is following best practices
    5. Provide a framework for our employees
27. What best describes how you heard about the program?*

    1. A media outlet (including local news)
    2. Word of mouth
    3. Social media
    4. Email
    5. An advertisement
    6. My city/town
    7. Jefferson County
    8. My local chamber
    9. Other

29. Please let us know any questions, comments, or suggestions you have for us. We will create a Frequently Asked Questions section on our Five-Star Certification Program web page and continue updating that as we move forward with the program.

31. Business Acknowledgement

33. By checking this box on behalf of my business, I certify that I have read the program overview from the state and am willing and able to meet the certification requirements.*

    I understand that submission of this form only initiates the process, and I am not authorized any increased operational capacity until my business is officially certified. I understand that after becoming certified, that status and any increased operational capacity can be forfeited if my business fails to continue to meet all certification requirements.
    
    

    1. I hereby certify.
35. By checking this box, I acknowledge that I understand this program is not yet active until Jefferson County's program is approved by the State of Colorado.*

    I understand that my business' certification, and any benefits of being certified, will not be active until I am notified by Jefferson County or my local jurisdiction that this program and my business has been approved.
    
    

    1. I understand
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field