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Five-Star Certification Program Business Interest Form

  1. 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.

    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.

  2. Business Information

  3. What best describes your business?*

  4. 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.*

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

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

  6. Program Information

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

    Select all that apply.

  8. What best describes how you heard about the program?*

  9. Business Acknowledgement

  10. 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.

  11. 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.

  12. Leave This Blank:

  13. This field is not part of the form submission.