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Home My WebLink About20130757.tiffRESOLUTION RE: GRANT PERMIT FOR TEMPORARY ASSEMBLY ON APRIL 13 AND 14, 2013 (ALTERNATE DATES ARE APRIL 20 AND 21, 2013, IN THE EVENT OF POOR WEATHER) - MARTIN AND BERTA GUTIERREZ WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, Martin and Berta Gutierrez, 7717 County Road 31, Fort Lupton, Colorado 80621, have presented to the Board of County Commissioners an application for a Permit for Temporary Assembly on land within the unincorporated portion of the County of Weld, State of Colorado, to be held from 11:00 a.m., until 5:00 p.m., on April 13 and 14, 2013 (alternate dates April 20 and 21, 2013 in the event of poor weather), on property described as follows: 7717 County Road 31, Fort Lupton, Colorado, 80621; being further described as Lot B of Recorded Exemption #3375; being part of the E1/2 of Section 28, Township 2 North, Range 66 West of the 6th P.M., Weld County, Colorado WHEREAS, said applicant has paid Weld County the sum of ONE -HUNDRED DOLLARS ($100.00) for said Weld County Permit for Temporary Assembly, and WHEREAS, having examined said application, the Board deems it appropriate to grant a Weld County Permit for Temporary Assembly to Martin and Berta Gutierrez, and WHEREAS, said permit shall be issued subject to compliance with the terms and conditions as set forth in the application materials and upon the express condition and agreement that the temporary assemblage will be conducted in strict conformity to all laws of the State of Colorado and the Weld County Code, and WHEREAS, any violation to said terms and conditions shall be cause for revocation of said permit and forfeiture of bond. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that said Weld County Permit for Temporary Assembly on April 13 and 14, 2013 (alternate dates April 20 and 21, 2013 in the event of poor weather), be, and hereby is, granted to Martin and Berta Gutierrez to conduct a temporary assemblage at the hereinabove described location. 2013-0757 LC0022 3bn PERMIT FOR TEMPORARY ASSEMBLY — MARTIN AND BERTA GUTIERREZ PAGE 2 The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 20th day of March, A.D., 2013. BOARD OF COUNTY COMMISSIONERS WELD COS1(VTY, COLORADO ATTEST: Weld County Clerk to the Board ounty Attorney Date of signature: MAR 2 7 2013 Ga?eia- Chaiir ^ j (c% IoTe mh✓ ouglas Rademac er, Pro-Tem p �^ _ _ an P. Conway ----- ke Freeman - 2013 -0757 LC0022 WELD COUNTY PERMIT FOR TEMPORARY ASSEMBLY By action of the Board of County Commissioners of the County of Weld, State of Colorado, taken this 20th day of March, 2013, IT IS HEREBY GRANTED a permit for a temporary assemblage on land within the unincorporated portion of the County of Weld, State of Colorado, to be from 11:00 a.m., until 5:00 p.m., on April 13 and 14, 2013 (alternate dates April 20 and 21, 2013, in the event of poor weather), on property described as: 7717 County Road 31, Fort Lupton, Colorado, 80621; being further described as Lot B of Recorded Exemption #3375; being part of the E1/2 of Section 28, Township 2 North, Range 66 West of the 6th P.M., Weld County, Colorado This permit authorizes Martin and Berta Gutierrez to hold such an assemblage so long as it is in accordance with Chapter 12 of the Weld County Code and all other applicable State and County statutes and regulations. This permit is subject to compliance with the terms and conditions as set forth in the application materials and to additional conditions set forth by the Board and attached hereto. PERMIT APPROVED this 20th day of March, 2013. BOARD OF COUNTY COMMISSIONERS WELD COUWDY, COLORADO ATTEST: Weld County Clerk to the Board c William F. Garcia, air Poexi l4. > uglaRademac arbara Kirkmeyer 1 NOTE: THIS PERMIT MAY BE REVOKED AND THE BOND FORFEITED FOR FAILING TO MEET THE CONDITIONS SET FORTH HEREIN. 2013-0757 LC0022 NOTICE OF APPLICATION FOR TEMPORARY ASSEMBLY Pursuant to the Weld County Code, a public hearing will be held in the Chambers of the Board of County Commissioners of Weld County, Colorado, Weld County Administration Building, 1150 O Street, Assembly Room, Greeley, Colorado 80631, at the time specified. If a court reporter is desired, please advise the Clerk to the Board, in writing, at least five days prior of the hearing. The cost of engaging a court reporter shall be borne by the requesting party. In accordance with the Americans with Disabilities Act, if special accommodations are required in order for you to participate in this hearing, please contact the Clerk to the Board's Office at (970) 336-7215, Extension 4226, prior to the day of the hearing. The complete case file may be examined in the office of the Clerk to the Board of County Commissioners, Weld County Administration Building, 1150 O Street, Greeley, Colorado 80631. E -Mail messages sent to an individual Commissioner may not be included in the case file. To ensure inclusion of your E -Mail correspondence into the case file, please send a copy to egesick@co.weld.co.us DOCKET #: 2013-19 DATE: March 20, 2013 TIME: 9:00 a.m. APPLICANT: Berta and Martin Gutierrez 7717 County Road 31 Fort Lupton, CO 80621 REQUEST: Application for a temporary assembly of more than 350 persons on April 13 and 14, 2013 (alternate dates April 20 and 21, 2013 in the event of poor weather) LEGAL DESCRIPTION: Lot B of the Recorded Exemption #3375, being part of the E112 of Section 28, Township 2 North, Range 66, West of the 6th P.M., Weld County, Colorado LOCATION: 7717 County Road 31, Fort Lupton, Colorado 80621 (See Legal Description for precise location.) BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO DATED: March 11, 2013 PUBLISHED: March 14, 2013, in the Greeley Tribune 2013-0757 Affidavit of Publication NOTICE OF APPLICATION FOR TEMPORARY ASSEMBLY Pursuant to the Weld County Code, a public hearing will be held in the Chambers of the Board of County Commissioners of Weld County, Colorado, Weld County Administration Building, 1150 O Street, Assembly Room, Greeley, Colorado 80631, at the time specified. If a court reporter is desired, please advise the Clerk to the Board, in writing, at least five days prior of the hearing:. The cost of engaging a court reporter shall be borne by the request- ing party. In accordance with the Americans with Disabilities Act, if special accommodations are required in order for you to par- ticipate in this hearing, please contact the Clerk to the Board's Office at (970) 336-7215, Extension 4226, prior to the day of the hearing. The complete case tile may be examined in the office of the Clerk to the Board of County Commissioners, Weld County Administration Building, 1150O Street, Greeley, Colo-. redo 80631. E -Mail messages sent to en individual Commis- sioner may not be included in the case file. To ensure inclusion of your E -Mail correspondence into the case file, please send a -copy to egesick@co.weld.co.us DOCKET 4: 2013-19 DATE: March 20, 2013 TIME: 9:00 a.m. APPLICANT: Berta and Martin Gutierrez 7717 County Road 31 ' Fort Lupton, CO 80621 REQUEST:. Application for a temporary assembly of more than 350 persons on April 13 and 14, 2013 (alternate dates April 20 and 21, 2013 in the event of poor weather) LEGAL DESCRIPTION: Lot B of the Recorded Exemption #3375, being part of the E1/2. of Section 28, Township 2 North, Range 66, West of the 6th P.M., Weld County, Colorado LOCATION: 7717 County Road 31, Fort Lupton, Colorado 80621 (See Legal Description for precise location.) hOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO DATED: March 11, 2013,. The Tribune March 14, 2013 STATE OF COLORADO County of Weld, I Jennifer Usher ss. of said County of Weld, being duly sworn, say that I am an advertising clerk of THE GREELEY TRIBUNE, that the same is a daily newspaper of general circulation and printed and published in the City of Greeley; in said county and state; that the notice or advertisement, of which the annexed is a true copy, has been published in said daily newspaper for consecutive (days): that the noticewas published in theregular and entire issue of every number of said newspaper during the period and time of publication of said notice, and inthe newspaper proper and not in a supplement thereof; that the first publication of said notice wascontained in the Twenty-seventh day of March A.D. 2013 and the last publication thereof: in the issue of -said newspaper bearing the date of the Twenty-seventh day of March A.D. 2013 that said The Greeley Tribune has been published continuously and uninterruptedly during the period of at least six months next prior to the first issue thereof contained said notice or advertisement above referred to; that said newspaper has been admittedto the United States mails as second-class matter under the provisions of the Act of March 3,1879, or any amendments thereof; and that said newspaper is a daily newspaper duly qualified for publishing legal notices and advertisements within the meaning of the laws of the State of Colorado. March 27, 2013 Total Charges: $10.38 27th day of March, 2013 My Commission Expires 6P,, ROBERT LITTLE NOTARY PUBLIC NOTARY ID COLORADO0440844 MY COMMISSION EXPIRES JUNE 14, 2017 APPLICATION FOR TEMPORARY ASSEMBLY INSTRUCTIONS TO APPLICANT: Complete each section and mark "N/A" where not applicable. Additional sheets may be attached and maps, sketches or drawings may be substituted for the verbal description of plans for the assembly site. All required information must be furnished before the application will be processed. P)),1,10_ I NAME: all f - nA t.(4I N el ll tl 'C YYGZ AGE:5 / /(O+ RESIDENCE: '7/11/1 C R 31 f- t�D . Lc p for\ 1Cc� (o ill MAILING ADDRESS: S& nits 4 Ca,baki 63) Q3—Lo55- NAME: AGE: RESIDENCE: MAILING ADDRESS: NAME: AGE: RESIDENCE: MAILING ADDRESS: NAME: AGE: RESIDENCE: MAILING ADDRESS: (This must list all partners in a partnership, officers of an unincorporated association, society or group, or, if there are no officers, by all members of such association, society or group. IF A CORPORATION, ATTACH A CERTIFIED COPY OF THE ARTICLES OF INCORPORATION.) 1. Address and legal description of all property upon which the assembly is to be held: 77/7 C23tf.L(AP ToJ3 1 CO. BCloc3 I_o+ 8 . VA 9+ 5Ce--gon ag, nioa Tn tQa,Y�t 4)(O ( L1 ,A-1- A P 4- k e (a r'- P. m. LA -l2 -td- Cry t c rt . (0 ra el 0 A. Name, residence and mailing address of the record owners of such property (Attach a notarized statement by the record owners of such property consenting to the assembly if application is not made by all of the record owners.) NAME: RESIDENCE: MAILING ADDRESS: NAME: RESIDENCE: MAILING ADDRESS: o:n00`000000aoe0000000,000000 2. Nature or purposes of the assembly: 140ft6C k4C'A nq g-uc%n4 PLlrpOcie ie lL°, erovin e Cl7na an Per ,r n is fck,mi tr es rz_YtfelYft, rite -14- 3. Dates and hours during which the assembly is to b held: Arri 1 13 rt `i" 14*r` X013 111'0O a, tr. '(-o5 OCp.0�. L dc.-tcCRrc cl - ail 1al 2013) 4. Mpximum number of persons to be allowed at assembly at any one time: lift fox irtot-ely i,Sbc ( npan 4 cid 5. The maximum number of tickets to be sold, if any: Nib!) 6. Identify plans to limit number of persons to the maximum jdentified above: S rI-iyy Au.uard�; will he. IYtShfueAeci. 40 -Lose. an -I -,'y 604-e; onte_. 4 -hr rna_k r m tkrn has h cc A mkt A fJ c?�n-try � 4-icke} Hit . f1f 11 be 9;den t,Y1 en""(ere; n5 ' `-Ilkey e e. r 1<er f'; n3 1Frt.cic o c nor rnbec o f pe of le ci eI/w ' . 7. Identify plans for supplying potable (drinking) water, including the source, number, and location of facilities, and type and means of disposing of waste deposited: t3oi-flea WO: e/ ,,I; t/ he. provide -el. *Ivoushot4 area - the% w.Lt MP. f fewt.-iti of hrashca AG (to ;A1?o.c a eta vvt.pc,itt r 42-0( cd 14 posy n J 4 of -Leask &Lind `_Atkin/ jdo fflr s 8. Identify the plans for holding, collecting, and disposing of solid waste materials: —11(li-S cans *ix irOck ra1- Kea. 6 ne✓ he (csetti i ie --G1". i oTy.eje eixn fe/ cup-zt-1. 9. Identify the plans for providing separate toilet facilities for males and females, including the source, number, and location, type and the means of disposing of wastes deposited: . Uri ffzd 51 -he S'eyoIccc. witI la to.. IVOL,i t i 'stiese. 5eWIC-CC. e, will be L,,mtsvx (Po - et_ -j6rr5)• Cor pitn1 Is -t- o Sr rb e n lug curt -a- p r t -k: �t t e m,, li r cL [di 1!J 4-e I 4e fat 1' % c LLc Lc. ail- . 5e -G fLtc.k n' 'P r 0:`0 000 0000 00 0`00000000.000000 10. Identify the plans to provide for medical facilities, including the location and construction of any structures, the names, addresses, and hours of availability of emergency medical technicians and nurses and provisions for emergency ambulance service: See c( r vte ck. 11. Identify the plans, if any, to illuminate the location of the assembly, including the source and amount of power, and the location of lamps: /t%/1{ CVa)-r To o Hebb bwai&G rmayti14-ours- , 12. Identify the plans for parking vehicles, including size and location of lots, points of highway access and interior roads, including routes between highway access and parking lots: pkoc,Q. See_ rb ( { c>f . ✓v, tend .0- (g? ) 13. Identify the plans for communications with hospital, police, and fire services, including the source, amount, and location of communication equipment: pG YG 111 Gd,i c 5 0,&L J t' omA ht&Ve.: h G rrAmu n G r a art. .0 t4Af1611P.44 ✓e-tcc. ire ct. 14. Identify the plans for camping facilities, if any: 0 :1:100'0000000 0170000000.a00000 15. Identify the plans for fire protection: 1—014- 15 I.5 meJe6 ronn e-mk Mw e will be no n pail 42 -ii It OA - fin R ct b) 6"i -P f c - 16. Identify the plans for security, including the number of guards, their deployment, their names, addresses, credentials and hours of availability and description of peer group control, if any: J( LS(n (biof- e_ (IAA r 17. Identify the plans for sound control and sound amplification, if any, including number, location, and power of amplifiers and speakers: ti//fl 18. If applicable, identify plans for meeting County health standards for food concessions and concessionaires who will be allowed to operate on the grounds, including the names and addresses of all concessionaires and their license permit numbers: u -1 l rood tje-rdo4t4 w of l tie_ rr& U i feet 'l —e be- t ;c e4 19. Identify the plans, if any, for an electrical system: (t%/%7 0 A100'00000070'd0000000.000000 20. Identify the plans to ensure that trees, underbrush, large rocks, and other natural features shall be left intact and undisturbed, and natural vegetative cover retained, protected and maintained so as to facilitate drainage, prevent erosion, and preserve the scenic attributes; and the plans to abate dust on the site: /J/fi (PEA) r f LD 21. Attach a statement by a bonding company licensed to do business in the State of Colorado indicating its intent to furnish a bond required in Section 12-1-30.6.13 of the Weld County Code to ensure performance by the applicant of each of the terms and conditions of the temporary assemblage permit. f �G F} MeNT I (O 22. Attach a statement by an insurance company licensed to do business in the State of Colorado stating its intent to provide liability insurance, as required by Section 12-1-30.B.14 of the Weld County Code, to protect against injury to persons or property occurring as a result of such an assembly. A TA-c t{ figN ( to 23. Submit $100.00 fee for each event where three -hundred fifty (350) or more people assemble or can reasonably by anticipated to assemble at any one (1) location, unless the location is properly zoned for such assembly, in which case one permit shall be required for the total number of events scheduled for that location for the reminder of the calendar year, not to exceed ten (10) events per year. As used herein, the term event means an assembly or anticipated assembly which is scheduled to last for three (3) consecutive days or less. BY THIS APPLICATION, APPLICANT(S) AGREES TO INDEMNIFY AND HOLD HARMLESS WELD COUNTY OR ANY OF ITS AGENTS, OFFICERS, SERVANTS, AND EMPLOYEES FROM ANY LIABILITY OR CAUSES OF ACTION WHICH MIGHT ARISE BY REASON OF GRANTING OF A TEMPORARY ASSEMBLAGE PERMIT, AND FROM ANY COSTS INCURRED IN DEFENDING AGAINST SUCH ACTIONS OR IN CLEANING UP ANY WASTE MATERIAL PRODUCED OR LEFT BY THE ASSEMBLY. 0:'000'00000000'QUUU0000,0U000D The applicant, and each of them, swears, (affirms) that, to the best of his knowledge, the statements contained in the application are true and correct. APQI1-s sign, 1V)a 4-r p �7u�i erre� Cup pi cc s pr;nfca °Lune/ v\a.in a p&nal is osi-ii; o -n SUBSCRIBED AND SWORN to before me this 20 07 . Witness my hand and official seal. My commission expires: 9 3 Applicant's signature �Je r' - e r /ems Applicci o printed name owner Applicant's position day of brUa-it Notary Public TAMMY LEE WATERS NOTARY PUBLIC STATE OF COLORADO NOTARY ID 20124078542 MY COMMISSION EXPIRES DECEMBER E. 201:: M'.\CTB\CTBF0RMS\F0ASMBLY. DOCtloc United Site Services of Colorado, Inc. Customer Service: 1-800-864-5387 Bill RANCHO CAPORAL To: MARTIN GUTIERREZ 7717 CR 31 FORT LUPTON, CO 80621 Items Rented I Item / Description DXR Deluxe Restrooms With Hand Sanitizer DELIVER BETWEENN **3 PM - 5 PM** FRIDAY *CALL MARTIN ON SITE TO CONFIRM SPOTS* PICKUP ANY TIME MONDAY DW Damage Waiver ADA ada Restrooms With Hand Sanitizer DWP Damage Waiver 2SS 2 Station Sinks DW Damage Waiver SPC-ALL Event Service Sun (6-9am) United SITE SERVICESI ORDER Ship To: Customer ID: Order No: Order Date: Terms: P.O. No: Salesperson: Cust. Serv. Rep.: RANCHO CAPORAL HORSE EVENT 7717 CR 31 FORT LUPTON, CO 80621 Quantity Rental Term From / Thru Remit To: United Site Services, PO Box 53267, Phoenix, AZ 85072-3267 10 Each 10 Each 2 Each 2 Each 3 Each 3 Each 15 Each Page: 1 DEN -05637 0-285347 02/11/13 Due Upon Receipt BRETT L. ANGELL Unit Price Total Price 04/12/13 75.00 750.00 04/15/13 04/12/13 10.00 100.00 04/15/13 04/12/13 115.00 230.00 04/15/13 04/12/13 10.00 20.00 04/15/13 04/12/13 75.00 225.00 04/15/13 04/12/13 10.00 30.00 04/15/13 04/14/13 21.95 329.25 04/15/13 Subtotal: Total: 1,684.25 1,684.25 Signature Date: «_I -C 7J20.72' 2 .4 Nwring- WIr _E y c !" cw &-.U4Sa,09) Tr UVJM ApL110.9 07,711 — —V !ate&2 N— — — — QLEZ 26-Rst a G30110338 a1 _ <W:1333U IV ,IN:1I3SY /S _ « 179_97' / 2 ■� /. 1/ &/ /4 / 0019.58" E422.31'• I -�G 7- ( L 4— : ,!1_r,= 2= 2640.05' 2658.11' • 0 V V LL U- 2 9 0 Q o.• 0 3 1.C er0 NOT DRAWN TO SCALE wc`I N W w o co L.L U ALL DEVICES TO CONFORM TO THE M. U.T.C.D r C LaTh al] 0 O o a w 00 CC F U F a Z Z °o O > • = ro o mo O w ?~ JO0Oo ▪ OOITQm �ZOQW W 0Ore mZFF ad'JWZZ d w J W W w >-a¢m>> cot w w 2 ▪ O= w 0 COLu OFWU W (Z� m ooaoF Q UooeA O = o - o J J o• o ww w a o g° - U o O • N V F- LJ W w W it -c F - W C_ 99 AMH w J.J. ESCORT & SECURITY, INC 6475 South Cody Street Littleton, Colorado 80123 February 11 2013 303-933-4544 720-922-2904 fax Ref: Event April 13 and 14 2013 Mr. Martin Gutierrez , J.J. Escort & Security Inc. will provide Security for your event on April 14 ,15 2012 Our company will provide ten armed officers with radios and cell phones .Four officers will speak Spanish Our officers have First Aid CPR training .I have been in contact with the Weld County Sheriff Office about the number of officers we will have at the event. Please post the No Firearms or Alcohol allowed signs at the gates. We are License, Bonded and Insured .A deposit has been paid for this event and the balance due. at time of service. The Weld County Sheriff Office knows of our company. If you have any questions please contact us at 303 933 4544 JJ Escort & Security Inc. CR.a ames A. Swaen CEO Feb 21 13 03:40p TACOS JUNIOR INC Wit LIGUAJ rnU 14:S4 FAX ntM� WvP f• • 8`i* COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENV LICENSE TO OPERATE A RETAIL FOO ACCOUNT NUMBER water M nimnw8 01416636500 Ten LICE -MIA MUST BE POEMAT711E FOLLOWING LOCATION: TACOS JUNIOR MOBJLB UNIT WELD COUNTY, CO $0631 r tin TACOS JUNIOR INC WELD COUNT: DBPARTMIafr OF Mat MALTA MO] BNVIIDOIeaaNT fx 3039344895 .• > 1 1 PLACE A Detach Here • 02-21-2013 04:18 BERM R GUTIERREZ 3038578587 PAGE1 A=--3 -g l CERTIFICATE '`�/ OF LIABILITY INSURANCE DATE (MM/OO/YYYY) 02-21-2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL the terms and conditions of the policy, certain policies certificate holder in lieu of such endorsementts). INSURED, may require the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to an endorsement. A statement on this certificate does not confer rights to the PRODUCER DAVID SIMON INSURANCE 420 Court Place Brighton, CO 80601 CON FACT NAME PHA/ONE a ND Eat) (303)659-9065 IiAfic, No) .(800)726-3179 AoRESSbizbrighton@gmail.com PRODUnER ID.. INSURER(S) AFFORDING COVERAGE NAIC/V INSURED Martin Gutierrez 7717 County Road 31 Fort Lupton, CO 80621 INSURER A Scottsdale Insurance Company INSURER B. INSURER C INSURER D INSURER E INSURER F VERAGE CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO NMICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR A TYPE OF INSURANCE ADDL Rimy SURR WVD POLICY NUMBER POLICY EFF (MM/DDNYYY) POLICY EXP (MM/DD/YYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY Ell OCCUR APP122143166 04-13-2013 04-14-2013 EACH OCCURRENCE $ 1,000,000 PREMISES (Ea E occurrence) $ 100,000 _-I CLAIMS -MADE MED EXP (Any oneperson) $ 5,000 PERSONAL &ADM INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES POLICY n JECOT PER PRODUCTS - COMP/OP AGG $ 2,000,000 / [I LOC $ AUTOMOBILE LIABILITY ANY AUTO ALLOWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAR EXCESS LIAR OCCUR EACH OCCURRENCE CLAIMS -MADE AGGREGATE S DEDUCTIBLE RETENTION S I— $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Orli ER/MEMBER EXCLUDED? (Ma datory in NH) If ye describe under DESCRIPTION OF OPERATIONS YIN NIA r1 I WC STATLL 1 IOTH- TORY LIMITS ER EL EACH ACCIDENT $ E. L. DISEASE -EA EMPLOYEE 5 below E DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS /LOCATIONS (VEHICLES (Alta h ACORD 101, Additional Remarks Schedule, if morespace is required) Special Events Policy Two Day Horse Race Event 4-13-2013 and 4-14-2014 held at 7717 County Road 31 Fort Lupton CO 80621 CERTIFICATE HOLDER CANCELLATION Martin Gutierrez 7717 County Road 31 Fort Lupton,CO 80621 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE David Simon © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD25 (2009/09) The ACORD name and logo are registered marks of ACORD DEDICATED AMBULANCE SERVICES AGREEMENT (#0314-03-37688) THIS DEDICATED AMBULANCE SERVICES AGREEMENT (this "Agreement") is made and entered into as of the signature dates set forth below, to be effective as of April 13, 2013 (the "Effective Date"), by and between BANNER HEALTH, an Arizona nonprofit corporation, d/b/a North Colorado Medical Center ("Banner") and Martin Gutierrez, an individual ("Client"). RECITALS: WHEREAS, Banner by and through its operation provides ambulance services and Advanced Life Support to residents within the county of Weld and throughout northern Colorado; and WHEREAS, Banner will dedicate ambulances and Advanced Life Support personnel to certain one-time events, when doing so is within Banner's capabilities ("Dedicated Ambulance Services"); and WHEREAS, Client desires to engage Banner to provide Dedicated Ambulance Services at a horse racing event in Fort Lupton, Colorado, on April 13 and 14, 2013 ("the Event"); and WHEREAS Banner desires to be so engaged to provide the Dedicated Ambulance Services in accordance with the terms and conditions set forth herein. NOW, THEREFORE, in consideration of the mutual covenants contained herein, the receipt and sufficiency are hereby acknowledged, it is understood and agreed to by the parties as follows: AGREEMENT: Dedicated Ambulance Services and Rates. Client engages Banner to perform the Dedicated Ambulance Services, as more particularly described in Exhibit A, attached hereto and incorporated herein by this reference, at the rates and pricing set forth in Exhibit A, during days and at times as specified herein. If applicable, any conflict between the terms and conditions set forth in Exhibit A and the terms of this Agreement, excluding Exhibit A, the terms and conditions of this Agreement, excluding Exhibit A, shall govern and control. 2. Term and Termination. The Agreement shall commence at 12:01 am on April 13, 2013 and shall terminate at 11:59 PM on April 14, 2013, unless terminated sooner as provided for herein. Client may terminate this Agreement at any time prior to its commencement without penalty. Should Client choose to terminate this Agreement during the event, then Client shall be responsible for payment for the minimum number of hours for which the Dedicated Ambulance Services were scheduled. Banner may terminate this Agreement upon Notice to Client, if, but only if, there is a declared emergency in the County of Weld, or the City of Greeley, which might impair Banner's ability to dedicate Dedicated Ambulance Services solely to Client. Banner would nonetheless, be available to respond to emergency calls at the Event should the need arise. 3. Insurance. Banner has in force at all times and during the term of this Agreement (a) comprehensive general liability insurance, including blanket contractual liability, (b) automobile insurance, and (c) complete operations insurance, all with minimum limits of One Million Dollars ($1,000,000.00) per occurrence and Three Million Dollars ($3,000,000.00) in the annual aggregate, and workers' compensation insurance, as required by law. Banner shall, upon request, provide Client with a certificate(s) of insurance, stating Y:\sttslegal\WR\Colorado Region Facility Contracts & Matters \NCMC\Ambulance Service\Martin Gutierrez Ambulance Services Agt 201 3.agl.doc that the above coverages are in force, and shall continue in force, throughout the term of this Agreement. 4. Mutual Indemnification. Each party shall indemnify and save harmless the other party for, from and against all actions, liabilities, losses, damages, claims and demands whatsoever, including costs, expenses and attorneys' fees, resulting, or claimed to have resulted solely from the intentional or negligent acts or omissions of the indemnifying party or its employees, subcontractors or agents engaged in the work under this Agreement at the time of the event or occurrence upon which such actions, claims or demands are based. 5. Compliance with Regulations and Policies. Banner shall comply with all standards applicable to the Dedicated Ambulance Services, including, but not limited to, the standards of (a) any accreditation programs, (b) federal, state and local government laws, rules and regulations, and (c) third party payors. Whenever providing services or goods pursuant to this Agreement on the premises of the Event. 6. Compliance with Employment Laws. Banner agrees to comply with all federal, state, and local laws, regulations, ordinances, and orders governing immigration, equal employment opportunity, and affirmative action that are applicable to Banner, including 42 U.S.C. Sec. 2000(e) et seq., the Civil Rights Act of 1964, the Civil Rights Act of 1991, Sections 503 and 504 of the Rehabilitation Act of 1973, the Vietnam Era Veterans' Readjustment Assistance Act of 1974, the Immigration Reform Act of 1986, the Americans with Disabilities Act, Executive Order 11246 of September 24, 1965, Executive Order 13496 of January 30, 2009, and all amendments and applicable regulations pertaining to any of them, including 41 C.F.R. 5§ 60.1.4(a)(7), 60-250.5, 60-300.5 and 60-741.5 (imposing anti- discrimination and affirmative action requirements) and 29 C.F.R. Part 471, appendix A to subpart A. 7. Conflict of Interest Disclosure. Client represents and warrants that none of Client, any affiliate of Client, or any officers, directors, employees, partners, members, owners or shareholders of Client or any affiliate of Client, is related to, affiliated in any way with, or employs (or otherwise has a compensation interest with) any officer, director or employee of Banner. 8. No Federal Exclusion. Banner hereby represents and warrants that Client and all personnel providing any Dedicated Ambulance Services under this Agreement are not, and at no time have been, excluded from participation in any federally funded health care program, including Medicare and Medicaid and that no such action is pending. 9. Independent Contractor Status. Banner shall at all times be deemed to be an independent contractor of Client. Banner's employees shall not be regarded as employees or agents of Client for the payment of any employer taxes such as FICA, unemployment, and workers' compensation, and Client shall not be responsible for those taxes or any fringe benefits for Client's employees. Further, the employees of Banner shall not be regarded as employees of Client with respect to any intentional or negligent activity in which they may be involved or for any other purpose. 2 Y:\shslegal\WR\Colorado Region Facility Contracts & Matters \NCMC\Ambulance Service\Martin Gutierrez Ambulance Services Agt 2013.ag 1.doc 4 10. Change in Law. If any new federal or state law, regulation or rule is enacted or if there is a change in any federal or state law, regulation or rule that affects this Agreement, the activities of either party under this Agreement, or either party's performance or ability to perform under this Agreement, or any change in the judicial or administrative interpretation of any such law, regulation, or rule, and either party reasonably believes in good faith that such change shall have a substantial adverse effect on such party's business operations or its rights or obligations under this Agreement, then such party may, upon written notice, require the other party to enter into good faith negotiations to renegotiate the terms of this Agreement. If (a) the parties are unable to reach an agreement concerning the modification of this Agreement within the earlier of (i) forty-five 145) days after the date of the notice seeking renegotiation or (ii) the effective date of the change, or (b) the change is effective immediately, then either party may immediately terminate this Agreement upon written notice of such termination to the other party. 11. Regulatory Termination. If, prior to the expiration of the term of this Agreement, any federal, state or local regulatory body, including, but not limited to, the Centers for Medicare and Medicaid Services, the Department of Health and Human Services ("HHS"), or the Internal Revenue Service determines that this Agreement is illegal or jeopardizes the tax exempt status of Banner or the Hospital, then either party may give the other party such notice as is reasonable in the circumstances and shall make available a reasonable period within which to cure. During such period, the parties shall negotiate in good faith to agree upon an appropriate cure. If no cure is implemented by the parties, then either party, in its discretion, may terminate this Agreement with such notice to the other party as is reasonable under the circumstances. 12. Retention and Inspection of Records. Banner shall keep all records related to this Agreement on file for a period of four (4) years from the date the record is made. Banner shall, upon reasonable notice, give Client or its authorized representative the privilege, at a reasonable time, of inspecting, examining, and auditing, during normal business hours, such of Banners business records that are directly relevant to this Agreement, including, without limitation, the financial arrangement between the parties. The cost of such inspection, examination, and audit shall be at the sole expense of Client, and such inspection, examination, and audit shall be conducted where said records are normally maintained. 13. Access to Records for Government Inspection. Banner agrees, until the expiration of four (4) years after the furnishing of the Dedicated Ambulance Services to be provided under this Agreement, to make available, upon request, to the Secretary of HHS, the Comptroller General of the United States of America, or any of their duly authorized representatives, the contracts, books, documents and records that are necessary to certify the nature and extent of reimbursable costs under the Medicare laws. If Client carries out any of the agreements under this Agreement through a subcontract with a value or cost of Ten Thousand Dollars ($10,000.00) or more over a twelve (12) month period with a related organization, such subcontract shall contain a requirement identical to that set forth in the preceding sentence. 14. Assignment. This Agreement may not be assigned by either party without the prior written consent of the other party. If consent to an assignment if obtained, this Agreement is binding on the successors and assigns of the parties to this Agreement. Notwithstanding any provision of this Agreement to the contrary, Banner shall have the right to assign or otherwise transfer its interest under this Agreement to any "related entity." For the purposes of this Section 14, a related entity shall be deemed to include a parent or subsidiary of Banner, any entity that acquires all or substantially all of Banner's assets or 3 V:\shslegal\WR\Colorado Region Facility Contracts & Matters\NCMC\Ambulance Service\Martin Gutierrez Ambulance Services Agt 2013. ag 1. doc • operations relating to this Agreement, and the surviving entity of any merger or consolidation involving Banner. Any assignment to a related entity shall not require the consent or approval of Client in order to be effective. 15. Corporate Authority. The individualls) executing this Agreement on behalf of, or as a representative for, a corporation or other person, firm, partnership or entity, represents and warrants that he/she is duly authorized to execute and deliver this Agreement on behalf of such corporation, person, firm, partnership or other entity and that this Agreement is binding upon such entity in accordance with its terms. 16. Waivers. No waiver of the enforcement or breach of any agreement or provision herein contained shall be deemed a waiver of any preceding or succeeding breach thereof or of the enforcement of any other agreement or provision herein contained. No extension of time for performance of any obligations or acts shall be deemed an extension of the time for performance of any other obligations or acts. 17. Severability. If any provision of this Agreement, or any application thereof to any person, shall be invalid or unenforceable to any extent, the remainder of this Agreement, and the application thereof to other persons or circumstances, shall not be impaired, and shall be enforced to the fullest extent permitted by law. 18. Force Majeure. Neither party shall be liable for any delay or failure in performance hereunder caused, in whole or in part, by reason of force majeure, which shall be deemed to include the occurrence of any event beyond the control of the parties, war (whether an actual declaration thereof is made or not), sabotage, insurrection, riot and other acts of civil disobedience, action of a public enemy, laws, regulations or acts of any national, state or local government (or any agency, subdivision or instrumentality thereof), judicial action, labor dispute, accident, fire, explosion, flood, storm or other act of God. 19. Counterparts. This Agreement may be executed in one or more copies or counterparts, each of which when signed shall be an original, but all of which together shall constitute one instrument. 20. Governing Law. This Agreement shall be governed by the internal substantive law of the State of Colorado, without regard for conflicts of laws. 21. Integration and Amendment. This Agreement, including any attachments and documents specifically incorporated herein by reference, contains the entire agreement between the parties. All prior negotiations between the parties are merged in this Agreement, and there are no understandings or agreements other than those incorporated herein. This Agreement may not be modified except by written instrument signed by both parties. 22. Notice. Any notice required to be given under this Agreement shall be in writing, and shall be deemed delivered when personally delivered or three (3) days after the same is sent by certified mail, postage prepaid as follows: If to Client: Martin Gutierrez 7717 WCR 31 Fort Lupton, Colorado 80621 4 Y:\shslegal\WR\Colorado Region Facility Contracts & Matters \NCMC\Ambulance Service\Martin Gutierrez Ambulance Services Agt 2013.ag1 .doc If to Banner: with a copy to: Banner Health d/b/a North Colorado Medical Center 1801 16' Street Greeley, Colorado 80631 Attn: Chief Executive Officer Banner Health 1801 16th Street Greeley, Colorado 80631 Attn: Legal Department 23. No Physician Ownership. Client hereby expressly represents and warrants to Banner that no physician, no physician organization and no member of a physician's immediate family owns or holds an ownership or financial interest in Client, including any affiliated or related entity or person, that is not the subject of an exception or "safe harbor" under applicable law, such as the exception for publicly -traded securities under 42 CFR 411.356(a). IN WITNESS WHEREOF, the parties have executed this Agreement individually or by signature of their duly authorized representative as of the signature dates set forth below, to be effective as of the Effective Date. Banner: CLIENT: BANNER HEALTH d/b/a Martin Gutierrez, Individual North Colorado Medical Center By: Name: Rick Sutton Title: Chief Executive Officer Date: B Name:/V%/9A)/('/I! 6.Olt CR/fL2— Title Date: 3 -- 7- 2.e/; FEIN: WA-(_‘4 aC7o-:_5nt GN` 5 Y:\shslegal\WR\Colorado Region Facility Contracts & Matters\NCMC\Ambulance Service\Martin Gutierrez Ambulance Services Agt 2013. ag 1.doc EXHIBIT A DEDICATED AMBULANCE SERVICES AND RATES Dedicated Ambulance Services: Banner shall provide the Dedicated Ambulance Services during the Event. Rates: Client shall compensate Banner at the rate) of One Hundred Fifty and No/100ths Dollars (8150.001 per hour/ per "crew" for each hour that Banner provides Dedicated Ambulance Services at said Event (Crew: one (1) ambulance rig and two (2) ambulance personnel). Other Compensation: To the extent Banner provides any medi al treatment(s) or transport(s) during the Event, Banner will bill the patient or the patient's insurer, as appropriate for such treatment and transport services. Client is in no way responsible for payment to Banner for said patient transports. Invoicing: Banner shall invoice Client for its services?performed during the,Event as agreed upon by the Parties. Each invoice shall be itemized and of sufficient detail for Client to verify the validity of the invoice. Client shall remit payment within thirty (30) days of the receipt of such invoice. Client's obligation to pay for services rendered by Banner under this Agreement shall survive expiration or termination of this Agreement. Y:\shslegal\WR\Colorado Region Facility Contracts & Matters \NCMC\Ambulanc Services Agt 201 3.agl .doc Service\Martin Gutierrez Ambulance T39dd L8S8LS8£0£ Z3aa3IlfS U ETa38 S2:90 £T02-90-20 NORTH DCNVCR ANIIML CLINIC /O Whew? i r 44y CCer-fir 7150 LAFAYETTE ST. OENVER, C0 80229 303-2998200 3 -‘-/3 X wi// c ri "G�-c4 if P rye�rc/ verer; �7ar,cti A- iearl-) ourrie,rL .l Apr:) /3 cvii H. There wit/ che tare _Coale races 6114 Cco re, al 4; 3 /'4t re4 f'ro f err/ rI,c s e GC�urS 411 Oer- a re 2.1er-%r,s Coirz cT Z 44,dc beer 4/!arri,n's as ye4'rs , ci re ,0// O glee . S1/Icete /1,7- lam'?%- L0/T0 39Vd 1WWINV a3AN3a HlaON L0E488ZE8E bZ:ET ETOZ/90/E0 0 -o 0 Cr) O o 0 �maD a)IO ° o c -0 Y m a) a a U 2 a0 tA RECEIVED FROM ADDRESS vaS RECEIPT DATE *a -?-13 No.86856 Yna h� GIvEttrre 4 tutC- FOR HOW PAID CASH tot CHECK N0HEY MEMORANDUM Tammy Waters, Deputy Clerk to the Board March 6, 2013 From: Bethany Salzman, Zoning Compliance Officer, Dept. of Planning Services Subject: LC0022 Review of the following Temporary Assembly Permit by the Department of Planning Services shows the following: Applicant and Location of Event: Berta & Martin Gutierrez 7717 County Road 31 Fort Lupton, Co 80621 Zone District: A (Agricultural) My records indicate that Mr. & Mrs. Gutierrez own 2 (two) separate adjacent properties: 1309-28-1-00-058 (consists of approximately 10 acres) 1309-28-1-00-059 (consists of approximately 36.19 acres) Therefore, total number of LIVESTOCK (i.e. horses, cattle, etc) could not exceed 184 (46 acres x 4 = 184). No active violations were noted. SERVICE, TEAMWORK, INTEGRITY, QUALITY To: Weld County Board of Commissioners From: Deputy Lisa Carpenter Date: March 6, 2013 RE: Martin Gutierrez/Horse Racing Event Dear Commissioners, I have researched and found no reported calls for service to 7717 WCR 31, Fort Lupton, CO 80621 for the Calendar year of 2012 to present day. I find no grounds for disapproval for the Temporary Assembly Permit. Respectfully' Submitted, Deputy Lisa Carpenter Community Resource Officer Weld County Sheriffs Office 1950 "O" Street Greeley, CO 80631 TEMPORARY ASSEMBLY REVIEW FORM Date: February 22, 2013 TO: Lisa Carpenter FROM: CTB — Tammy Waters SUBJECT: Temporary Assembly Review Please review all records on the following property for any associated reports during the last year and return your report to the Weld County Clerk to the Board's Office within seven days. Your report will be used by the Board of County Commissioners in considering issuance of a Temporary Assembly Permit. PLEASE RESPOND NO LATER THAN: March 8, 2012 EVENT INFORMATION: Berta and Martin Gutierrez 7717CR31 Fort Lupton, CO 80621 EVENT DATE: April 13 & 14, 2013, FROM 11:00 A.M. - 5:00 PM ******************************************************************************************************** No concerns Deputy's Initials The Sheriffs Office had a concern and the deputy has mutually worked with the property owner/event manager to correct the concern. (Complete Attached Worksheet) Unresolved concerns exist requiring a Probable Cause Hearing scheduled by the Board of County Commissioners. (Complete Attached Worksheet) *********************«********************************************************************************* Please notify at Extension Board of Commissioner's Temporary Assembly hearing. of the date and time of the Temporary Assembly Worksheet The following concerns are noted: The property owner and the Sheriffs Office have collectively agreed to implement the following to correct concerns noted above: (A time line and corrective action should be listed for each concern) Property Owner, Please Print Date Property Owner Signature beputyi Signature Use another sheet of paper or attach separate proposal to this packet if needed. Attach copies of all reports associated with this property for the last year. Both the Deputy and the Event Manager will be required to attend the Temporary Assembly Hearing to testify to the above agreement. Tammy Waters From: Roy Rudisill Sent: Monday, March 11, 2013 9:28 AM To: Tammy Waters; Dan Joseph; Janet Carter Cc: Bethany Salzman; Lisa Carpenter Subject: RE: Temp Assembly Review - Gutierrez Attachments: image005.jpg; image006.jpg; image002.jpg Hi Tammy, we had a planning meeting last week and have a few recommendation that will be included within the Incident Action Plan. I will be attending the BOCC meeting to address these. Thanks Director Roy Rudisill Weld County Office of Emergency Management 1150 O St. Greeley Co. 80632 970-304-6540 Office 970-381-0417 Cell Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Tammy Waters Sent: Wednesday, March 06, 2013 9:27 AM To: Dan Joseph; Janet Carter; Roy Rudisill Subject: FW: Temp Assembly Review - Gutierrez Friendly reminder © responses are due on Friday please. Thank you Tammy Waters Deputy Clerk to the Board 1150 O Street(P.O. Box 758(Greeley, CO 80632 tel: (970) 336-7215 X5226 1 Tammy Waters From: Sent: To: Subject: Sorry Tammy. Jonathan Gesick Tuesday, March 12, 2013 1:44 PM Tammy Waters RE: Temp Assembly Review - Gutierrez The building department has no issues. Jonathan Gesick Plans Examiner Combination Building Inspector Weld County Building Department 1555 N 17th Ave Greeley, CO 80631 970-353-6100 ext. 3532 From: Tammy Waters Sent: Tuesday, March 12, 2013 8:42 AM To: Jonathan Gesick; Dan Joseph Subject: FW: Temp Assembly Review - Gutierrez Importance: High Hello, sorry to be a pest but I still haven't received your referral back for this permit. Please let me know if I can assist you in any way. Thanks, Tammy Waters Deputy Clerk to the Board 1150 O Street P.O. Box 758)Greeley, CO 80632 tel: (970) 336-7215 X5226 1 Memorandum TO: Tammy Waters From: Dan Joseph DATE: March 12, 2013 SUBJECT: Martin Gutierrez Temporary Assembly Request In response to your request, Environmental Health Services has reviewed the Temporary Assembly Permit, LC0022, for Martin Gutierrez, located at 7717 WCR 31, in Fort Lupton, Colorado. After reviewing the application, the following is the recommendation made by this Department: 1) Temporary hand washing stations should be located outside the portable toilets. We recommend that there be one hand washing station for every two portable toilets (provided the toilets are in close proximity to one another). If the portable toilets are spread throughout the facility we recommend one hand washing facility per toilet. Based on number of toilets being provided (12) we recommend having 6 hand washing stations. The 3 dual sinks being provided may meet this requirement provided that portable toilets are located within close proximity to one another. In addition, the Department reviewed our complaint database and did not find any complaints filed for that address or for the applicant. Should you have any questions regarding this matter, please contact me at extension 2206 or via e-mail at dioseph(a)co.weld.co.us. Thank you. cc: Cindy Salazar, Environmental Health Services Deb Adamson, Environmental Health Services MEMORANDUM TO: Tammy Waters, Clerk to the Board DATE: 03/15/13 FROM: Janet Carter, Public Works SUBJECT: Temporary Assembly Gutierrez Horse Racing Event The Weld County Public Works Department has reviewed this proposal. Our requirements are as follows: REQUIREMENTS: 1. No parking will be allowed on Weld County Roadways. 2. Approximately 1,500 vehicles will require parking on the property 3. This area is not in a Special Flood Hazard Area (SFHA) as determined by the Federal Emergency Management Agency (FEMA). 4. The applicant submitted an acceptable Traffic Control Plan (TCP) prepared by a certified Traffic Control Supervisor (TCS) 5. Please submit an Incident Action Plan for the Office of Emergency Management. 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