City of Evans Colorado - ADA Compliance

ADA Compliance

In accordance with the requirements of Title II of the American with Disabilities Act of 1990 (“ADA”) and Section 504 of the Rehabilitation Act of 1973, the City of Evans (the “City”) will not discriminate against qualified individuals with disabilities on the basis of disability in its facilities, services, programs, or activities.

Note: the following information is necessary to assist the City in processing a complaint. If any person interested in filing a complaint needs assistance, including sign language assistance, documents in Braille or other ways of making information and communications accessible, please contact the
City’s ADA Coordinator in HR Safety & Risk Management
Monday – Friday, 8 a.m. – 5 p.m. via
hr@evanscolorado.gov
or by calling 970-475-1121

*1. Date of incident resulting in complaint

*2. Complaint's First Name

Last Name

Phone

Email Address

Address

City

State/Province

Postal Code

3. Person Discriminated against (if someone other than complainant)

Phone Number

Email Address

Address

City

Zip Code

4. City of Evans agency, facility, department or program complaint is about:

*Name of agency/facility/department/program

*5. In your own words, describe the circumstances leading to this complaint. What happened and who was responsible? If possible, provide names of the individuals involved.

6. If you have not already provided this in response to number 5 above, where did the incident take place? Please provide as much information about the location as possible

7. Were there any witnesses to the incident? YES / NO If yes, please provide as much information as possible about any witness(es).

Name of Witness

Phone Number

Name of Witness

Phone Number

8. Have any efforts been made to file or resolve this complaint through the internal grievance procedure of any City of Evans department? YES / NO If yes, what is the status of the grievance?

9. Have you filed a complaint about this same incident with any other federal, state or local governmental agency or with a federal or state court? Please check any that apply:

Federal Agency

Federal Court

State Agency

State Court

Local Agency

Other

10. Please provide the contact information of the person with the agency/court/other:

Name

Address

City

Zip Code

Phone Number

Date Filed

*By typing your name you reconogize that you are signing the complaint form.

Attach any documents you believe support your complaint.

Confirm

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Contact Info

1100 37th Street
Evans, Colorado 80620
970-475-1170

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