HomeMy WebLinkAbout20111529.tiffRESOLUTION
RE: GRANT PERMIT FOR TEMPORARY ASSEMBLY TO ASOCIACION DE CHARROS
DIVISION DEL NORTE A.C. - JULY 10, 2011
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, Asociacion de Charros DivisiOn Del Norte A.C., 5660 West Virginia Avenue,
Lakewood, Colorado 80226, has 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 10:00 a.m., until 8:00 p.m., on July 10, 2011,
on property described as follows:
36716 County Road 22, Roggen, Colorado, 80652,
being more fully described as 6 acres of the
following property: Being part of the W1/2 of
Section 17, and part of the E1/2 of Section 18,
Township 2 North, Range 62 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 Asociacion de Charros Division Del Norte A.C.,
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
WHEREAS, any violation to said terms and conditions shall be cause for revocation of
said permit and forfeiture of bond, and
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that said Weld County Permit for Temporary Assembly on
July 10, 2011, be, and hereby is, granted to Asociacion de Charros DivisiOn Del Norte A.C., to
conduct a temporary assemblage at the hereinabove described location, conditioned upon the
performance of the additional conditions stated herein.
(e,.. 50, ApPI
2011-1529
LC0022
PERMIT FOR TEMPORARY ASSEMBLY - ASOCIACION DE CHARROS DIVISION DEL
NORTE A.C.
PAGE 2
BE IT FURTHER RESOLVED by the Board that said approval and issuance of the Weld
County Permit for Temporary Assembly herein is subject to the following conditions to be
completed no later than June 27, 2011:
A. The applicant shall submit a Traffic Control Plan, prepared by a certified Traffic
Control Supervisor, which also identifies locations for parking.
B. The applicant shall submit an Incident Action Plan to the Office of Emergency
Management, for review and approval.
C. The applicant shall provide copies of the State Food and Sales Tax Licenses for
all food vendors.
D. The applicant shall provide documentation of a contract with the Weld County
Paramedic Service to be on standby for the dates of the event.
E. The applicant shall provide documentation of arrangements for a local
veterinarian practicing in Weld County to be on the site in case any animals are
injured at the event.
F. The applicant shall provide, to the Clerk to the Board, a Certificate of Insurance,
in the amount of $1 million, in addition to proof that a bond, in the amount of
$3,000.00, have been paid for the dates of the event, prior to July 8, 2011.
G. The applicant shall provide an identified location of liquor sales, similar to a beer
garden. This will be an area where minors will not be allowed and alcoholic
beverages will be prohibited outside the boundaries of the area. This will assist
with limiting underage consumption of alcohol.
H. The applicant shall comply with the requirements of the Department of Building
Inspection, and obtain any necessary permits.
I. The applicant shall ensure adequate drinking water and sanitary provisions for
the participants and public attending the event.
J. The number of persons admitted to the event shall not exceed five hundred
(500). If the permitted amount of 500 people is exceeded, the Sheriff's Office is
authorized to enforce against the applicant and shut down the event.
2011-1529
LC0022
PERMIT FOR TEMPORARY ASSEMBLY - ASOCIACION DE CHARROS DIVISION DEL
NORTE A.C.
PAGE 3
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said Permit.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 22nd day of June, A.D., 2011.
ATTEST:
Weld County Clerk to the
BY:
fi
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COOL RADO
�) T / 11,��r
arbara Kirkmeyerr Chair
CUSED
can P. Conway, Pro-Tem
Deputy Clerk to the Board EXCUSED
APROVal AS TO
County Attorney
Dougla adema er
Date of signature: a
m F. Garcia
avid E. Long
2011-1529
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 22nd day of June, 2011, 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 held from 10:00 a.m., until 8:00 p.m., on July 10, 2011, on property described
as:
36716 County Road 22, Roggen, Colorado, 80652, being more
fully described as 6 acres of the following property: Being part of
the W1/2 of Section 17, and part of the E1/2 of Section 18,
Township 2 North, Range 62 West of the 6th P.M., Weld County,
Colorado.
This permit authorizes Asociacion de Charros Division Del Norte A.C., 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 WITH CONDITIONS this 22nd day of June, 2011.
BOARD OF COUNTY COMMISSIONERS
ATTEST:
Weld County Clerk to th
BY:
Deputy Clerk to the Boar
APPROVE T fz RM:
my Attorney
Date of signature: ig/Z#//
WELD COUNTY, C • ORADO
Kirkmey
/EXCUSED
Sean P. Conway, Pro-Tem
EXCUSED
illiam F. Garcia
Eonavid E. Long
ouglaademacher
NOTE: THIS PERMIT MAY BE REVOKED AND THE BOND FORFEITED FOR FAILING TO
MEET THE CONDITIONS SET FORTH HEREIN.
2011-1529
LC0022
MAILING ADDRESS: v`
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.
NAME: JuItin De go%/e AGE: Se/
RESIDENCE: 5out i I vRRG-lr/& A✓lc iFFI fWa'P Ce, i� 22(c
MAILING ADDRESS: `\
NAME: efrf 'Dt ��blec AGE: 247
RESIDENCE: SLA4 1J. Vitt-it/0-
MAILING ADDRESS:
RJE AA ICF Itrowp C 0
?oz a�
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: 3latie WELD Cdi'IIf11 rokJ 22
c7'Ir',) Pde ao&acZ
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: i'i Cigt CCE,ece ()kb()
RESIDENCE: ASSI 6. C-4.1ufelef te. bOZz.3
it
NAME: 1-tLftfde 17-Ok3VLZ
RESIDENCE: I o S 7 5. &d-fpt i'
MAILING ADDRESS:
ben✓et Co. got' -3
If
2011-1529
M:\CTB\CTB F0RMS\Foasmbly.wpd
2. Nature or nurnnsec of the assembly: `rho 5 e'rc.A 4` �, .h2 FDr-
eit /tfrc CmViet/ 1-/doan4 a, [5, t$ a c,vl ,t,t evd4 f.
3. Dates and hours durino which the assembly is to be eld:
4. Maximum number of persons to be allowed at assembly at any one time: .50°
5. The maximum number of tickets to be sold, if any: 500
6. Identify plans to limit number of persons to the maximum identified above: - I ti odd er
nllm6K of „Per5p4s 4o 500, @fre1. r'a
env 4 4L 4 'Et CK£4-. Tr A. rlorI- J-1oKt4 tn- 1-44,t1.4L
no orv. &w Wig br, Qi(leWtd 4-, .
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:
N Stag Wit -k drvrlclns‘ W r fa( Lytle will be on 5i9n1-
771 sre colke J rarer wll 1aJ r, Srt W i 11 be j I I tc - 1 & n A 4 isv--c/
�f. J
�h+fQ. Nil �-L -1'rA✓Sh GLg5 �I7„Ce. for iSIa51*9 WI��"L.
8. Identify the plans for holding, collecting, and disposing of solid waste materials:
C� s Ci4m5 Wild be- ?Itcced g4rsoghov4— 1-1&-
Pete, M- ULU I -h @Ar5%ne'1( tJIli-CI-in ) W4.5% S<, if-
e1tV.n ee of PLr4y
9. Identify the plans for providing separate toilet facilities for males and females, including the
source, number, and location. tvoe and the means of disposing of wastes f deposited:
&rc an (l be . �-Arg'- 1°'4x6/c tni /t f5 For in#, /6s An/
three- Far Ft/Yu-its, PimnF&ai-, e,,\/ d,sln5\vl Of W4,)ks a/u.,s*✓
will hi- wait/ by a. cortperd, ,i, - Pert ik 4>I/to Lift r do
0c,atel O. 2t'nb SoJyh gawk- urctr of 4\ a \04 Wr,trt. }i"—
Grtm} J\11 \r. ,•Pi�, e.hlnd -1-La- Arend..
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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:
e?culcn►,rk Qtercel-4'c- Strr\ru5 v-& Nip et/611624c Co WO
1� Sy i' Mt- PscvJilt CdloctA0 oast w,fI bt eoni111-4Jd
}� etef t;MbJ Irx,nee 0 -AA eccaune6 c3 4o Om- e,uvn, -.
11. Identify the plans, if any, to illuminate the location of the ssembly, including the source and
amount of power, and the location of lamps:
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:
atu vr'tcl1s w i h ens +I.00✓y\, Ida id Airy coca R.1. In it
Q erg+ufl r'oaJ onttr, frovafl 14uF will I�/ +, he Rrt.L aF
"P. P.�t1k't Y�M,/L 44i /Ifl ls, Then/'�`i" F\✓v tl-C its ftn4 will 6L
Ufuf fp(' FurKinl9
13. Identify the plans for communications with hospital, police, and fire services, including the
source, amount, and location of communication equipment: it) ocf u- I-. to IOUyl aft
1
y\ e.rvcN Servi O;4 we. W in Hod` eeldltr ptioncs a r Arun
oC- 14 .
14. Identify the plans for camping facilities, if any:
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15. Identify the plans for fire protection: eitno Ishi/Ps wit( bt ayai),pbit
tr brkr for f art Cc-Ott/101\
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: C.O\0 .d o (Apt, I, I 444 k- SPe.e ipt - L1.t w\+'h
itIdertM, Isa 31 to \)U'4,&. CO. 89L 4 tin II be einkrat
art, at h'Grd.,rgt o e ' Sttur i i-'4 . A utl tivon, 6,C �S g darci5 w \ If kt
anSlat4f
17. Identify the plans for sound control and sound amplification, if any, including number,
location, and power of amplifiers and speakers: '(1wt} u , I' is. I qv, v4f -
P�mQ a.nd `i 5 q it1r15 'lw-{ W IN bL e I&r=tS 3016 6 r }ht
Arcnw.
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:
1 I
19. Identify the plans, if any, for an electrical system: R (It/iv/at/A-sr wilt It- PelidedCr 4t^P. Proci l f 1t- Ivad }OLd!/Kl6i . ,T + V 111 bL ease/ 4'ag/A(,41.tr
Sao l.N of 0,4 a..rti\L
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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: Ca tut Iu4- alien )'he olseysobty
kt \H b I. k& 1 I 'nth m *r/u, , emir ro C , Ant tr-er s
fled °to 61, un diyl-Wka {Ntl1 bt FtncP.r:
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.
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 12-1-30.8.14
of the Weld County Code, to protect against injury to persons or property occurring as a
result of such an assembly.
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.
M:\CTB\CTBFORMS\Foasmbly.wpd
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.
Applicant's signature
Rol De gLi s
Applicant's printed name
VICE F,egsiDr
Applicant's position
SUBSCRIBED AND SWORN to before me this 3/S7 -day of m7
20 // .
Witness my hand and official
My commission expires:
COMM EX t8t'f2C t
M:\CTB\CTBFORMS\Foasmbly.wpd
Parker -Douglas Insurance, Inc.
1630 Main St, 102 . Longmont, CO 80501
INSURANCE
Parker
19555 East Parker Square Drive
Parker, CO 80134
(303) 841-2904
Denver
1330 Leyden Street
Suite 124
Denver, CO 80220
(303)471-5646
Lonemont
1630 Main Street
Suite 102
Longmont, CO 80501
(303) 682-9859
May 31, 2011
To whom it may concern,
The purpose of this letter is to inform of our intent to provide the bond and insurance for
Asociacion de Charros Division del Norte.
The bond and insurance are currently being solicited for July 9 & 10 on location 36706
Weld County Road 22, Roggen, CO 80652
The amount of insurance shall be no less than 500,000 agreggate. The bond shall be our
standard city and county bond.
If there are any questions or concerns please contact Yesenia Salomon at 303-682-9859.
Sincerely,
Yesenia Salomon
Parker -Douglas Insurance Agency, Inc.
Tel 303-682-9859
Fax 303-682-9858
salomoy@nationwide.com
Baker Insurance Group, LLC./Parker-Douglas Insurance, Inc/Five Star Insurance Agency, Inc.
Phone: 303-682-9859 Fax: 303-682-9858 E-mail: salomoy@nationwide.com
LEASE AGREEMENT
This lease is between Manuel Guardado and Leobardo Rodriguez (owners) and
Asoc. De Charros Division del Norte (Lessee).
Manuel Guardado and Leobardo Rodriguez owners of 36706 Weld County road
22 Rogen Co. 80652, agree to rent 6 acres of the northwest side of the property to Asoc.
De Charros Division del Norte. The property will be used to build an arena which will be
used for recreational purposes. The owners agree to allow the Lessee to practice and have
events on this property.
This contract shall commence January 5`h 2002 and shall continue indefinitely unless
either of the two parties decides to terminate the lease giving a minimum of three months
notice. Rent shall be $1,500.00 a year and shall be payable to the owners.
c. De Charros Division Del Norte
Juan De Robles
(Lessee)
Leobardo Rodriguez
(Owner)
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36706 Weld County Road 22, Roggen, CO 80652 - Google Maps
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5/24/2011
Colorado Secretary of State - Summary
Page 1 of 1
Colorado
Secretary of State, Scott Cressler
Business Division
For this Record...
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19961042527
ASOCIACION DE CHARROS DIVISION DEL NORTE A.C.
Registered Agent:
Registered Agent Street Address:
Registered Agent Mailing Address:
JUAN DE ROBLES
5660 W. VIRGINIA AV., LAKEWOOD, CO 80226, United States
Principal Street Address:
Principal Mailing Address:
5660 W. VIRGINIA AV., LAKEWOOD, CO 80226, United States
Status:
Form:
Jurisdiction:
Formation Date:
Term of Duration:
Periodic Report Month:
Good Standing
Nonprofit Corporation
Colorado
03/27/1996
Perpetual
November
You may:
• View History and Documents
• Obtain Certificate of Good Standing
• File a Document
• Subscribe to E-mail Notification Regarding this Record
• Unsubscribe from E-mail Notification Regarding this Record
Previous Pepe
Search I Accessibility I Privacy statement I Terms of use 1700 Broadway, Denver CO 80290 I 303-894-2200 I sos.business@sos.state.co.us
http://www.sos.state.co.us/biz/BusinessEntityDetail.do?quitButtonDestination=BusinessEn... 5/19/2011
OFFICE OF THE SECRETARY OF STATE
OF THE STATE OF COLORADO
CERTIFICATE
1, Scott Gessler, as the Secretary of State of the State of Colorado, hereby certify that, according to the
records of this office,
ASOCIACION DE CHARROS DIVISION DEL NORTE A.C.
is a Nonprofit Corporation formed or registered on 03/27/1996 under the law of Colorado, has complied
with all applicable requirements of this office, and is in good standing with this office. This entity has
been assigned entity identification number 19961042527.
This certificate reflects facts established or disclosed by documents delivered to this office on paper
through 05/17/2011 that have been posted, and by documents delivered to this office electronically
through 05/19/2011 @ 14:36:11.
I have affixed hereto the Great Seal of the State of Colorado and duly generated, executed, authenticated,
issued, delivered and communicated this official certificate at Denver, Colorado on 05/19/2011 @
14:36:11 pursuant to and in accordance with applicable law. This certificate is assigned Confirmation
Number 7950308.
Secretary of State of the State of Colorado
•**sees**************************************End ofCertificate******s*********************•**********•****
Notice: A certificate issued electronically from the Colorado Secretary of State's Web site is fully and immediately valid and effective. However,
as an option, the issuance and validity of a certificate obtained electronically may be established by visiting the Certificate Confirmation Page of
the Secretary of State's Web site, http://www sos state.co us/biz/CertificateSearchCriteria.do entering the certificate's confirmation number
displayed on the certificate, and following the instructions displayed. Confirming the issuance of a certificate is merely optional and is not
necessary to the valid and effective issuance of a certificate. For more information, visit our Web site, http://www.sas.state.co.us/click Business
Center and select "Frequently Asked Questions."
CERT GS D Revised 08/20/2008
DEPARTMENT OP
Bran
OPC-nate)
14)
CERTIFICATE•
,, MARY ESTILL BUCHANAN, Seote,ta/ty; of Ask of Me
Mate of Volotado fete cer49 Mal Me fi teguAileo leYe Me
iaoaamce of /44 cesalicale have leen /t9I&d in con0/lance
cell law and ate Auind to confoiin to law.
Jive co/t co/taia*, lie co uta pnea; __ _ value of ll e acctlao2ily
stedeel-in-me-itlate2,-heiterly- 44ueb Certrfi-carte of Incorporation-
4.1
ASOCIACION DE CHARROS LA DIVISION DEL NORTE, INC., a Nonprofit corporation.
DATED: March 7, 1978
\
, etc. ` c,).C„I a..ct.yc.
SECRETARY OF STATE
ARTICLES OF 1NCORrORATION,-
* a n
'70
ASOCIACION DE CHARROS LA DIVISION DEL NCRTE,"INC.
KNOW ALL MEN BY THESE PRESENTS, that :we, Manuel Huerta, „
David Buena, Jesse Salazar, Jesus Vargas, Tony Ramos, Lorenzo
Cordova, Horst Bartsch, and Arnulfo Bujanda, have associated
ourselves together for the purpose of forming a non-profit
corporation under the provisions of CRS 1963 31-24-1 et seq.,
as amended; and in accordance with the provisions of said
statutes, do hereby make and execute, in duplicate, this
certificate to that effect.
1.00 NAME AND DURATION:
The name of this organization shall be "ASOCIACION DE
CHARROS LA DIVISION DEL NORTE, INC." its duration shall be per-
petual.
2.00 PURPOSES, OBJECTS, AND POWERS:
The objects and purposes of this organization are::
2.01 to represent the Mexican -American people of
Colorado with pride and dignity and to promote
goodwill among all Americans at every opportunity
through the sporting event of horsemanship.
2.02 To have and exercise each and every power set
forth in CRS ]963 31-24-$ et seq., as amended.
2.03 To own, hold, convey, transfer, and otherwise
deal with any real or personal property.
2.04 This organization is not formed for the pecuniary
profit of any of its members or directors; nor
may it issue stock nor declare nor distribute
•
i
dividends' and no part of its net income shall
inure directly or indirectly to the benefit of
any director, officer, or other member. Any
balance,. -of money or assets remaining after the
full payment of corporate obligations of all and
every kind shall be devoted solely to the edu-
cational'and benevolent purposes of the organi-
zation.
3.00 REGISTERED OFFICE AND REGISTERED AGENT.
The registered office and registered agent of the
organization shall be as follo:Cs:
3.01 The registered agent shall be Manuel Huerta
3.02 The registered office shall be 724 Osceola Street
-ljenver, coforadh, o02UT.
303±heprincipal office- off ce- of the organization- may
be different thaft its registered office.
' o
•
4.00 MEMBERSHIP AND DUE2:
Membership in th organization and amount of dues shall
he determined as follows:
4.01 Membership shall e open to any person of good
character who sub tribes to the principles and
purposes of this organization and whose dues
are maintained in a current status.
4.02 The amount and time of payment of dues shall be as
fixed by the directors.
4.03 Payment of dues to this organization shall not
fulfill any member's obligation to any other
organization, or conflict therewith.
5.00 BOARD OF DIRECTUR1S:
5.01 The management, control, and government of
this organization shall be vested in a Board of
Directprs consisting of not less than four, nor
more than ten members.
5.02LA quorum of said Board shall consist of three;
and a majority of such quorum shall be sufricient
to act upon any business.
5.03 The initial Board of Directors shall consist of
four members, who shall serve until their
successors are elected and qualified, and shall
be: Manuel Huerta
David Buena Lorenzo Cordova
Jesse --Salazar -M-ar --H-.-Baru-ch-
Jesus Vargas Arnulfo Bujanda
Ant.ni-o--Ramos
1
5.04 The term of offiiie of directors shall be one year.
The directors are the thameas the incorporators
5.05 There shall be one annual meeting of the Board, _
at such time an place as the Board may determine,
and such special meetings as may, in addition,
be called.
6.00 OFFICERS: \��
6.01 The officers of the organization shall consist of
a president, Vice President, Secretary, and
Treasurer, and such other officers as the Board
may deem necessary.
6.02 Officers shall be elected by the Board for terms
not exceeding three years; and shall hold office
6.03 Any officers not members of the Board shall
'become ex -officio members thereof without vote
upon election.
7,.00 FINAL LIQUIDATION:
Upon final liquidation, all assets of the organization
shall be distributed as provided under CRS 1963 31-24-52, as
amended.
TN WITNESS WHEREOF WE HAVE HEREUNTO'SET OUR HANDS AND SEALS
THIS- tlo
f!y ,DAY OF ,% jl_C��L . 1978
aADDRESS-MidGQ, S:7j__
--- t. � o/ LDDRESS e5g/_f/a/e r
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,
Christie Peters
From: Wendy Kanzler [wkanzler@rtebb.net]
Sent: Thursday, June 16, 2011 10:20 AM
To: Christie Peters
Subject: Planned Roggen Event
Attachments: Kanzler response 062011.doc
Hello
Here is our comments of concern in the attatchment. If you have any other
questions or information, please let me know.
Thank You
Rich & Wendy Kanzler
303-961-1456
Mrs. Peters
Mr. Roy D had stopped and visited with Rich Kanzler about the upcoming event
concerning what they could do to make the situation better for everyone. Rich had
mentioned the dust needed to be taken care of on the road due to the numerous vehicles
and stock trailers that make the dust unbearable for us to be outside. The farm has many
animals that can't be under that kind of stress with dust. Roy had asked if a water truck
would work and Rich agreed that would be fine. Rich said that it would have to be
watered multiple times throughout the day just because of all the dust with the traffic.
Rich also informed Mr. Roy D that there had been an abundance of trash left behind not
only on the road but that had been thrown out from vehicles and then blown in the fields
on each side of the county road in the past events. Previously the people had been very
disrespectful and disruptive up and down the road. (Speeding and peeling out and
flipping you off as they drive by). We are very concerned about our children and animals
so we would greatly appreciate that they would keep their speeds down and water the
road for the dust. We own the property from the corner of Weld County Road 22 and
Weld County Road 73 down to the driveway of their entrance.
Thank you in advance for hearing us out about the concerns we have listed.
Rich & Wendy Kanzler
36259 WCR 22
Roggen CO, 80652
303-961-1456
MEMORANDUM
WEL'$W7O NTY
u
TO: Christie Peters, Clerk to the Board DATE: 06/15/11
FROM: Janet Carter E.I., Public Works
SUBJECT: Temporary Assembly & Special Event Association de Charros
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 500 vehicles will require parking on the property
3. Please submit a Traffic Control Plan (TCP) prepared by a certified Traffic Control Supervisor (TCS)
4. This area is in a Special Flood Hazard Area (SFHA) as determined by the Federal Emergency
Management Agency (FEMA).
5. Please submit an Incident Command Plan for the Office of Emergency Management.
Page - 1 - of l June 15, 2011
C:\Documents and Settings\cmpeters\Local Settings\Temporary Internet Files\Content.Outlook\ZXAOSESATemp Assembly Special Event Association de Charms
(2).DOC
ittlt Memorandum
WinTO: CLERK TO THE BOARD
CFrom: Dan Joseph, Environmental Health
• Specialist
COLORADO
DATE: 06/17/2011
SUBJECT: Temporary Assembly Permit for LC0022
In response to your request, Environmental Health Services has reviewed the Temporary
Assembly Permit, LC0022, for the Association De Charros Del Norte, located at 36706
WCR 22, in Roggen, 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.
Should you have any questions regarding this matter, please contact me at extension 2206
or via e-mail at diosephna,co.weld.co.us.
Thank you.
cc: Cindy Salazar, Environmental Health Services
Deb Adamson, Environmental Health Services
Note: I contacted Roy Rubles on June 16, 2011, and discussed who was going to provide
food for the event. Mr. Rubles stated that there was one company out of Denver that was
going to provide food and that they were in the process of getting a State food license and
that he would fax that to Weld County once he had obtained it.
fit.
COLORADO
MEMORANDUM
DATE: June 20, 2011, 2011
TO: Christie Peters, Deputy Clerk to the Board
FROM: Jonathan Gesick, Plans Examiner/Building Inspector
SUBJECT: Temporary Assembly Inquiry and Special Events Permit Inquiry
The following applicant has submitted a request for a Temporary Assembly Permit and Special
Events Permit Inquiry, LC0022.
There are no buildings involved or being erected. The generator will need to be installed to the
manufactures instruction and grounded as such. No permits are required at this time.
Dates of the event
July 9 and 10, 2011
Applicant
Asociacion de Charros Del Norte
5660 W. Virginia Avenue
Lakewood, Colorado 80226
Address of Special Event
36706 County Road 22
Roggen, Colorado 80652
Thank you.
Jonathan Gesick
Plans Examiner
Weld County Building Department
�IdCny
Interoffice Memo
To: BOCC
From: Roy Rudisill
Date: June 17, 2011
Subject: Application for Temporary Assemble Robles
Dear BOCC, after reviewing the application from Mr. Robles and meeting with
representatives from Planning (Code Enforcement), Sheriffs Office and Animal Control.
The following recommendations are requested of Mr. Robles, prior to approval of the
assembly permit;
1. Development of a traffic plan with the identified locations for parking
2. Provide an identified location for Liquor Sales, Similar to a beer garden. This will be
an area where minors would not be allowed. This would assist with limiting underage
consumption of alcohol.
3. Provide documentation of an on call Vet in case any animals are injured.
4. Provide a licensed Security company for the event. This will help with limiting any
unauthorized alcohol brought onto the property, utilizing security check points.
5. Provide a list of events that you are hosting (bull riding, roping, etc)
6. Provide documentation of licenses for all food vendors.
7. Provide documentation of contract with Paramedics.
8. Provide documentation of the location where the animals will be kept and how they
will be provided food and water.
I talked to Mr. Roy Robles about these items on June 16th, 2011 and he is aware of the
requests. Based on the number of people attending the event, I don't believe an Incident
Action Plan will be required. If the permit is authorized I will provide information to
Chief Tom Beach with Southeast Weld Fire and determine any additional needs he might
have.
Director Roy Rudisill
Office of Emergency Management
FROM THE DESK OF
ROY RUDISILL
DIRECTOR OEM
WELD COUNTY SHERIFF'S OFFICE
1950 O STREET
GREELEY, CO 80631
970-356-4015 EXT. 3990
Wipe
COLORADO
MEMORANDUM
To: Christie Peters, Deputy Clerk to the Board June 14, 2011
From: Bethany Salzman, Zoning Compliance Officer, Dept. of Planning Services
Subject: LC0022
Review of the following Temporary Assembly Permit and Special Events Permit by the Department of Planning
Services shows the following:
Applicant:
Asociacion de Charros Del Norte
5660 W. Virginia Avenue
Lakewood, Colorado 80226
Address of Special Event:
36706 County Road 22
Roggen, Colorado 80652
Property Owner Information:
Manuel Guardado & Leobardo Rodriquez
1957 S Galapago St
Denver, Colorado 80223
Zone District: A (Agricultural)
Property Information:
1301-17-0-00-017 consists of approximately 396.36 +/- Acres
Comments:
Therefore, the total number of LIVESTOCK (i.e. horses, cattle, etc) could not exceed 1585 (396.36 acres x 4 =
1585).
The Special Events application calls out July 9, 2011 and July 10, 2011
The Temporary Assembly application calls out July 10, 2011 and July 11, 2011
No actual contract copies provided in packets.
Application spoke about "food, tacos" and "TBD", but listed no vendor license numbers.
Property History:
VI -0500265 A complaint was received concerning rodeo events without first obtaining the proper zoning
permits. The property assured staff rodeo events would not occur without property permits.
SERVICE, TEAMWORK, INTEGRITY, QUALITY
Christie Peters
From:
Sent:
To:
Subject:
Ed Cordes [Ed@cordesco.com]
Monday, June 13, 2011 5:03 PM
Christie Peters
RE: Notice of application for Assembly Association de Charros Del Norte Docket 2011-41
Thank you, it was very kind of you to e-mail it to save me a trip to Greeley
ed
From: Christie Peters Jmailto:cmpeters@co.weld.co.usj
Sent: Monday, June 13, 2011 3:55 PM
To: Ed Cordes
Cc: Esther Gesick
Subject: RE: Notice of application for Assembly Association de Charros Del Norte Docket 2011-41
Ed,
Here is the case file you requested. Please contact us with any questions.
Thank you,
Christie Peters
Deputy Clerk to the Board
915 10th Street, Greeley, CO 80631
970-356-4000, ext: 4228
cmpeters@co.weld.co.us
u
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: Esther Gesick
Sent: Monday, June 13, 2011 2:22 PM
To: Christie Peters
Subject: FW: Notice of application for Assembly Association de Charros Del Norte Docket 2011-41
Christie,
Would you please reply to this? Thanks!
Esther E. Gesick
1
Deputy Clerk to the Board/Office Manager
915 10th Street
Greeley, CO 80631
tel: (970) 336-7215 X4226
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: Ed Cordes Jmailto:Ed@cordesco.coml
Sent: Monday, June 13, 2011 9:08 AM
To: Esther Gesick
Cc: Dave Epple
Subject: Notice of application for Assembly Asociacion de Charros Del None Docket 2011-41
Good Morning
I own the adjoining parcel of land to the north of the proposed assembly location and wondered if the complete case file
is available electronically so I can avoid having to drive to Greeley to review it
Thank You
Ed Cordes
President
Cordes & Company Financial Services
2
ASOCIACION DE CHARROS
DIVISION DEL NORTE
To whom this may concern:
Our organization will be holding an event at 36706 Weld County Road 22,
Roggen, Co 80652. The event being hosted is a Charriada (Mexican Rodeo). A
Charriada is a competition between several teams and consists of nine diffrent
tasks performed by males, and one performed by females. The tasks are performed
in the following order:
1. Cala (Reining)
2. Piales ( Horse Heel Catches)
3. Colas (Bull wrestling)
4. Jineteo de Toro ( Bull Riding)
5. Terna (Bull Roping)
6. Jineteo de yegua ( Bronc Riding)
7. Manganas a Pie (Foreleg Horse Catching on Foot)
8. Manganas a Caballo (Foreleg Horse Catching from Horseback)
9. Paso de La Muerte (Death Pass or Bronc Vault)
10. Escaramuza (Women mounted drill team)
At this competition there will be six teams participating. If there is any further
questions about this event please contact me at 303-598-4947
Roy De Robles T.
Vice President
5660 W. Vriginia Ave. Lakewood Co. 80226
Ph: 303-936-4554 Fax: 303-936-1321
ASOCIACION DE CHARROS
DIVISION DEL NORTE
To whom this may concern:
Our organization will be holding a rodeo event (Charriada) at 36706 Weld
County Road 22, Roggen, Co 80652. The animals for this event will be kept in
corrals at located north of the arena being used. The corrals will have large water
buckets and feeders for the animals. If there is any further question about the
handling of livestock please contact me at 303-598-4947
Roy De Robles T.
Vice President
5660 W. Vriginia Ave. Lakewood Co. 80226
Ph: 303-936-4554 Fax: 303-936-1321
. .36706 Weld County Road 22, Roggen, CO - Google Maps
Page 1 of 1
Google maps
To see all the details that are visible on the
screen, use the "Print" link next to the map.
http://maps.google.com/maps?ie=UTF-8&h1=en&tab=wl 6/21/2011
ACORD CERTIFICATE OF LIABILITY
INSURANCE
o6ii9i2o i
PRODUCER
Parker -Douglas Insurance Agency, Inc.
1630 Main St Ste 102
Longmont, CO 80501
Yesenia Salomon (303) 682-9859
THIS CERTIFICATE IS ISSUED AS A MATTER OF NFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC#
INSURED
Asociacion de Charros Division del Norte
5660 W Virginia Ave
Lakewood, CO 80226
INSURER'S: United States Liability Insurance Group
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
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 WHICH 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
DER
LTR
ADO'L
MGRS
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE IMWDDIYYI
POLIC'IEXRRAL-ION
DATEMMIDDIYYI
LASTS
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
323947
07/10/2011
07/10/2012
EACH OCCURRENCE
$ 1,000,000
PRREEMIISE$(ERe ienall
$ 100,000
CLAIMS MADE X OCCUR
MED EYE (Anyone person)
$ 1,000
PERSONAL SADV INJURY
1000000
$ , ,
GENERAL AGGREGATE
$ 2'000'000
G�EINLAGGREGATE LIMIT APPUES PER:
PRODUCTS- COMP/OP AGG
$ 2,000,000
I POLICY f jE& fl Lac
AUTOMOSILELIABILTY
AN'IAVTO
A
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE
LIABILITY
ANY AUTO
AUTO ONLY- EA ACCIDENT
$
OTHER THAN EA ACC
$
AUTO ONLY: AGG
$
EXCEBSNMBRELLA MESHY
EACH OCCURRENCE
$
OCCUR CLAIMS MADE
AGGREGATE
$
D
$
$
WORKERSCOMPENSATOR AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR,PARTNEREXECUTIVE
OFFICER/MEMBER EXCLUDED?
Rye., desenbe under
SPECIAL PROVISIONS below
I WC STATU- IOTH-
TORY! NITS FR
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
§
E.L. DISEASE - POLICY UNIT
$
OTHER
Liquor Liability
323947
07/10/2011
07/10/2012
EA
alAggreOccurrenga $1,000,000
General Aggregate $2,000,000
General 2,
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
Weld County is listed as additional insured.
CERTIFICATE HOLDER
CANCELLATI
SHOULD ANY OF TIE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EIPRATION
DATE THEREOF, THE ISSUNG INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON2I!(E INSURER, 118 AGENTS OR
REPRESENTATIVE
Weld County
PO Box 758
Greeley, CO 80632
AUTHORIZED
ACORD 25 (2001108)
®ACORD CORPORATION 1988
Jun 30 2011 1:32PM Parker-Dou6las Insurance 303-682-9858
P.1
•
License and Permit Bond
KNOW ALL MEN BY THESE PRESENTS
That we, AsocuClon de Clairol Dev:swn del Nonc
Nabonwite Mutual Insurance Cornpar.v
Bond Department
1 100 Locust Department 2006
Des Moines, IA 50391-2006
Bond No. 7900373604
of Lakewood , State of co , as Principal. and Nationwide Mutual Insurance Company ,
a corporation duly licensed to do business in the State of Colorado , as Surety, are held and firmly bound unto
Weld Coumy
State of Colorado ,Obligee, in the penal sum of Three Thousand Dollars
($ 3,000 00 ) DOLLARS, lawful money of the United States, to be paid to the said Obligee, for which paymen:
well and truly to be made, we bind ourselves and our legal representatives, jointly and severally by these presents
THE CONDITION OF THE ABOVE OBLIGATION IS SUCH, That whereas, the said Principal has been issued a
license or permit described as follows Assembly permit by
the said Obligee.
NOW THEREFORE, if the said Principal shalt faithfully perform the duties and in all things comply with the laws
and ordinances, including all Amendments thereto, appertaining to the license or permit described then this
obligation to be void, otherwise to remain in full force and effect from June 29th , 2011 , until
June 28th 2012 , unless extended by Continuation Certificate.
This bond may be terminated at any time by the Surety upon sending notice in writing, to the clerk of the Political
Subdivision with whom this bond is filed and to the Principa:, at the last known address, and at the expiration of
thirty (30) days from the mailing of said notice, this bond shall ipso facto terminate and the Surety shall thereupon
be relieved from any liability for any acts or omissions of the Principal subsequent to said date.
Dated th:s 29th day of June 2011
Shall save and keep harmless the weld Count}
from all loss or damage which it may sustain or for which it may become liable on account of the issuance of said
license or permit
Asoctecion de CharosJr)rvision
By
Nationwide Mutual Insurance Compnr•
Principal
Erik Baker, Attorney -in -Fact
Jun 3O 2011 1:32PM
Parker -Douglas Insurance 3O3-682-9858
P-2
Bond Number 7900373604
<NOW ALL MEN BY THESE PRESENTS -HAT. Insurance n wa Nationwide Mutual Insurance Company. en Ohio commotion WOO
Property and Casualty an Iowa Insurance an Iowa corporation
rarmland Mutua Insurance Company, an Iowa corporation
AlliedVeiornede Agrbusiress Insurance Company, an Iowa corporation Depositors Insurance Company, an Iowa corporat,on
neretnefler referred to severally as to 'Company' ard collectively as do 'Companies.' each does hereby make constitute and appoint
Power of Attorney
Erik Baker
each. in their indiv'doat capacity. Its We and lawkialbmey-.n-tact, with full power and authority to sign, seal and execute on its behalf any and al: bonds and uncertakings.
and other obligatory msiuments of similar nature. In penalties not exceeding the sum of
Three Thousand Dollars (53,000.00)
and w blnd the Company thereby. as fully and to the same extent as a such instruments were signed by the duly authorized officers of the Company. and all acts of said
Attorney pursuant to the authority given we hereby ratified and conernted
Ths power of attorney is made and executed pursuant to and by authority of the Wowing resolubon duly adopted by the board at directors of the Company.
'RESOLVED, that the presidentor any vice president be, and each hereby is, authorized ard empowered to appoint attorneys
-in -tact of the l ensue Company, and to
solarize them to execute and deliver on behalf of the Company any and as bonds, forms.
a d�u ttion s.or pmemoatetrust,a nd other writings obligatoryrecognizance.,
h hatch. mat s the
fers
contracts of ndemrity,policies, contracts guaranteeing the (Welty of persons holding pout public
business of the Company may require; and to modify or revoke, with or without cause, any such appointment or authority, provided. however, that the authority granted
hereby shah in no way limit theeutholty of other duly authorized agents to sign and ceunteraigr any of sod documents on behalf of the Corpany' liver any and all such documents nd to ind the 'RESOLVED FURTHER.limitations
ions ft the power-ofals orney issued toave lull p hem,and to affix the seal d the Cauthority to execute and ompany thereto: provided, howeve' that aid seal shall not be
nfor
teems validly
ofany s dtdocome
necessary to the signed d and such documents a -
Ttia power of attorney is and sealed under ant by the ofpwMhq bylaws duly adopted by the board of directors of the Company approved
y to n or d d Inumne't, Any vice president, p i any hhcon neecint on with the opeor ration of the oustant s 'ess of the company in addition to thurer shall Neve the power and echai an of attest all the chief
documents,d cer, president, resnPol sr ono secretary,
weeded, however, the signature of any of them may be printed. engraved, or stamped on any approved document
executive officer. Measurer or uheQetery,
contract instrument, or other papers or the Company.
IN WITNESS WHEREOF, the Company has caused this Instrument to be sealed and duly attested by the signature of Its officer the
at day coastal, 2078
l i
Gary A. Douglas, President and ChM Operating Officer of Nationwide Agribusiness Insure -ice Company
and Farmland Mi. teal insurance C Company ended ice CasualtyPreidnsutrof Nationwide tioMutual
any, anal ins xa rice nacre Insurance
ompany
AMCO Insurance Company. Property
Company
sleet
/4'Od F' •e
tire
ACKNOWLEDGMENT
STATE OF IOWA, COUNTY OF POLK. ss
}a.rr+ • On this 1_'' day of /Waust .2909, Defore me came the eoove+amed dice, for the Companies aforesaid. to
=�%v- me personally known to be the officer described in and who executed the pieced rig ''nauumert and he
.gait aduow'edged the execution of the some, and being by me duly sworn. deposes ard says, that he is the
�j� officer of the Companies aforesaid, that the seals affixed hereto are the oorpaae seals of said Companies,
and the said corporate seals and his signature were duly affixed and subscribed to said instrument by the
'Mk. authority and direction of said Companies
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�� CERTIFICATE Mach 24, 2014
\ -- certify Nat the foregoing is mull, We sr correct copy of the odgirel power d attorneylssued by
the Kathy RCompany;
Richards, a Assistant mock a then n Lahpanbs, do hereby ol the meetings of the boards of
irectors and the same has not Deer
Ced or amended ,the insa ty ma ine atnadMay A oud as as on tth dal of tr hhe execcutition of the foregoing power d al ok rney the duly elected officer o' the
revoked aandtne come in any manner, that said fiery a Dough
Campenles, a'd d attorney is still in full force ands and he attest officer were duly affixed and subscribed to the said lost -Limpet by the authority of said board of cif rectors: and the
foregoing power29111 day
W TNESS WHEREOF, have hereunto subscribed my name as Ass start Secretary, anc axed the corporate seals d said Companies th s
era %•., I97 I97><.
of lust 2011—
Assistant Secretary
00084716
BDJ I (DB/091
:Lt1-ti-2811 15:53 F,+C'^:
13339361321
a/.wp Aral gassy Swa PUC
3765 West "O" Street • Greeley, CO 80631 ph. 970-351-7045 • N. 970-351-7044
Rodeo Contract:
Contracted on -grounds vet service for July 9's, 201 I. Roggen, CO
For Asociation De Charms Division Del Norte
S500 for the day of being on grounds Flom I Oam to 8pm.
Josh Zacharias, DVM, MS, DACVS
**Dig
ViiVt
COLORADO
MEMORANDUM
DATE: June 20, 2011, 2011
TO: Christie Peters, Deputy Clerk to the Board
FROM: Jonathan Gesick, Plans Examiner/Building Inspector
SUBJECT: Temporary Assembly Inquiry and Special Events Permit Inquiry
The following applicant has submitted a request for a Temporary Assembly Permit and Special
Events Permit Inquiry, LC0022.
There are no buildings involved or being erected. The generator will need to be installed to the
manufactures instruction and grounded as such. No permits are required at this time.
Dates of the event
July 9 and 10, 2011
Applicant
Asociacion de Charros Del Norte
5660 W. Virginia Avenue
Lakewood, Colorado 80226
Address of Special Event
36706 County Road 22
Roggen, Colorado 80652
Thank you.
Jonathan Gesick
Plans Examiner
Weld County Building Department
Christie Peters
From:
Sent:
To:
Subject:
Christie,
Dan Joseph
Wednesday, June 29, 2011 1:24 PM
Christie Peters
Association de Charros
Have everything for mobile vendor except an original of license application. He is good to go however (we should get
original in mail this week).
I believe this is the events only food vendor.
Dan
Dan Joseph CP-FS
Food Program Coordinator
Weld County Department of Public Health and Environment
1555 North 17th Avenue
Greeley, CO 80631
phone: 970.304.6415 x 2206
fax: 970.304.6411
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.
1
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1677 W EVANS AVE DENVER CO
80223-3813
STATE
COLORADO
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LICENSE VALID
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4101 MALAYA ST
DENVER CO 80249-8001
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APPLICATION
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41
Single Event r'.1ti1?tiple Event
.„/
e:II'sr
0140.750 (999)
I Declare under penalty of perjury in the second degree
that the statements made in this application are true and
complete to the best of my knowledge.
(Signature required below)
n•• a :. . • a.e •afae. S S J
a: Se unr. q ` • : F. :, a if applicable
scc,,ji ..n'y re F-•;•,
TOTAL $
Christie Peters
From:
Sent:
To:
Subject:
Kathy Baxley
Thursday, July 07, 2011 3:36 PM
Christie Peters
Standby
Christie,
We did received payment of $1500 to pay for the rodeo standby for 7-10-11 that Ray
DeRobles scheduled.
Thanks,
Kathy Baxley, Office Manager
Weld County Paramedic Services
1121 M Street
Greeley CO 80631
970-353-5700 x3203
Fax 970-304-6408
kbaxlev@co.weld.co.us
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.
1
WELD COUNTY PARAMEDIC SERVICES
1121 M STREET
GREELEY, COLORADO 80631
PHONE (970) 353-5700 EXT 3201
FAX: (970) 304-6408
June 23, 2011
Roy De Robles
2891 W archer PI
Denver, CO 80219
Dear Mr. De Robles:
Per your phone call on 6-23-11, you are requesting our service to standby for your rodeo on July
10`h from 11:00 a.m. to 6:00 p.m. The cost of this ambulance and crew is $150 an hour and must
be paid in advance. The charge for the 7 hours will be $1050. If the event runs longer, you will
be billed for the additional amount or if it is shorter, you will be refunded the amount that is over
paid.
Please make payment as soon as possible so we can schedule a crew for your standby. Payment
can be made by credit card or check made out to Weld County Paramedic Services.
I will notify our Operations Manager, Mitch Wagy, of your request for standby
Please let me know if you have any questions.
Sincerely,
Kathy Baxley, Office Manager
Weld County Paramedic Services
Unite a Services of Colorado, Inc.
6015E 58TH AVE
Commerce City. CO 80022
Toll Free. 888-232-0001
Local. 303-985-0164
Fax. 303-985.1428
Quote No.: 403-2868
Sell To: ROY DEROBLES
ROY DEROBLES
2891 W ARCHER PL
DENVER. CO 80219
Cast. #: DEN -24505
Phone: 303936-4554
Comments 8 Special Instructions
EVENT IN ON JULY 10, 2011
United
SITE SERVICES
Site Service Quotation
Quote Date: 06'21 1 1
Salesperson Contact
BRETT L. ANGELL
Mobile: 303.917 3994
Office: 888-232 0001 x3624
Fax 303-985.1428
brettangell@unitedslteservices.com
Quote Expires: 09:21 11
Ship To: ROY DEROBLES
RODEO EVENT
36706 WELD COUNTY RD 22
ROGGEN, CO 80652
Terms: Due On Receipt
DELIVERY WILL BE ON THURSDAY. JULY 7 2011 (NOON - 4PM)
PICKUP WILL BE ON MONDAY. JULY 11 2011
DRIVER WILL CALL ONE HOUR PRIOR TO ARRIVAL TO MEET FOR EXACT SPOT.
"'SEE GOOGLE MAPS FOR SITE LOCATION*"
ROY 303-598-4947
JUAN 303.472-7718
Item Unit Quantity From Thru Unit Price Total Price
Deluxe Restrooms with Hand Sanitizer EA 5 07/07/11 07/11/11 90.00 450.00 one time
Damage Waivers EA 5 07/0711 07/11/11 10.00 50.00 one time
ADA Restrooms with Hand Sanitizer EA 1 07/07/11 07/11/11 130.00 130.00 one 6me
Damage Waiver EA 1 07/07/11 07/11/11 10.00 10.00 one time
Hand Wash Stations EA 3 07/07/11 07/11/11 90.00 270.00 one lime
Damage Waivers EA 3 07/07/11 07/11/11 10.00 30.00 one time
Total: 940.00
Accepted: Date:
Remit To: United Site Services, PO Box 53267, Phoenix, AZ 85072-3267
NOTE. Total prices have been calculated for I billing period only. Damage Waiver is optional Please read the
terms and conditions on the last page of this document for more:ntormation
United Site Services
Westborough
Date: 07/01/11
Cashier:
Visa
Ref.#: 000000007766
Tran #: 0011827719564
Total: 940.00
Credit Card Authorize (Card Not Present)
@ 0012 NO MATCH
Customer Copy
ASOCIACION DE CHARROS
DIVISION DEL NORTE
To whom this may concern:
This letter is to inform that we will not be using a generator for our event
being held this Sunday July 10th 2011 at 36716 Weld County rd. 22 80652. If you
have any further concerns please contact me at 303-598-4947
Roy De Robles T.
Vice President
5660 W. Vriginia Ave. Lakewood Co. 80226
Ph: 303-936-4554 Fax: 303-936-1321
Christie Peters
From:
Sent:
To:
Subject:
Jonathan Gesick
Friday, July 08, 2011 7:28 AM
Christie Peters
RE: Assoc de Charros
Hi Christie,
FYI -We are ok with this event.
Thanks
Jonathan D Gesick
Plans Examiner/Building Inspector
Planning
1555 N 17th Ave
Greeley, CO 80631
tel: (970) 353-6100 x3532
W FF i4c'o` a -N - r
uL
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: Christie Peters
Sent: Thursday, July 07, 2011 5:03 PM
To: Roy Rudisill
Cc: Bethany Salzman; Gary Schwartz; Jeremy Frey; Esther Gesick; Dan Joseph; Jonathan Gesick
Subject: RE: Assoc de Charros
Roy,
Roy DeRobles has provided his Certificate of Insurance with the increased amount. He said he will not be using a
generator on the premises, he will be sending this statement via e-mail. Other than that, he's provided everything we
need!
Thanks,
Christie Peters
Deputy Clerk to the Board
915 10th Street, Greeley, CO 80631
970-356-4000, ext: 4228
cmpeters®co.weld.co.us
1
W ECC../COU NlY
u
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: Roy Rudisill
Sent: Thursday, July 07, 2011 4:00 PM
To: Christie Peters
Cc: Bethany Salzman; Gary Schwartz; Jeremy Frey
Subject: RE: Assoc de Charros
Christie, I believe everything is in order in reference to paperwork. The only items I'm not sure about is the increase on
the insurance and how they will be providing water to the animals. I will have our animal control follow up on the day of
the event. The other item is the permit for the use of the generator.
Roy
Director
Weld County Sheriffs Office
Office of Emergency Management
Terrorism Liaison Officer
970-304-6540 Office
970-381-0417 Cell
www. weldsheriff com
anirgera
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: Christie Peters
Sent: Thursday, July 07, 2011 3:48 PM
To: Roy Rudisill
Subject: Assoc de Charros
Roy,
Just wanted to check -in with you to see if there are any outstanding issues. Roy has provided everything we need on our
end. How about yours? If everything looks good, let me know so he can swing by the office and pick-up his permits.
Thanks,
2
Christie Peters
Deputy Clerk to the Board
915 10th Street, Greeley, CO 80631
970-356-4000, ext: 4228
cmpeters®co.weld.co.us
W E L&/COU N -V
u
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.
3
Colorado Consultant Specialist LLC
P.O. Box 39201 Denver, CO 80239
E -Mail, H7ptstarq(a�yahoo.com
720 436-1168
Contract Agreement for the following services:
Colorado Consultant Specialist LLC has agreed to provide the following services for
Association De Charros Del Norte LLC, 5660 W. Virginia Ave. Lakewood, CO 80226.
Represented by 'Vice President", Roy De Robles organization phone # 303 — 598-4947
George Herrera is recognized by the Colorado Department of Revenue, Liquor
Enforcement as a Responsible Vendor under "Liquor License Professionals" as a
Qualified Trainer for Responsible Servers and Sellers of Alcohol.
This program is a comprehensive examination of the laws and responsibilities for those
who work, manage/own at a licensed premise in which patrons visit to eat or enjoy
entertainment under the Colorado Liquor Code. The training program focuses on
preventing the consequences of suspension or revocation of the liquor license by
serving or selling alcohol in a safe and responsible manner.
Your training date is scheduled for, Tuesday June 21, 2011 at 11:00 am this will be in
conjunction with several other licensed businesses. Names of attendees and a copy of
the liquor license or special event permit need to be provided in order for everyone to be
given credit for attendance to the City and State.
Fee for this Training is $250.00 paid week in advance to training. (June 14, 2011)
CCSLLC will also be providing (6) armed security for your Rodeo Event located at �) i
36706 Weld County Rd 22 in Rogen, CO 80652 Weld County, on July 9th & 10t 2011 3 iv
As agreed the hours of service for security is from 10: 00 am to 8:00 pm 10 hr shifts for
each security guard. Each security staff will work a total of 20 hours each for this event.
In the case there is an emergency and security staff works extra hours this will be billed
separate from the original agreed rate of $1,500.00 each day. you will pay
the additional hours worked on the same day of work preformed.
If there is the need for additional security due to a larger crowd then expected max
(500) or violence the rate for call in is billed at $35.00 per hour per man with a minimum
of 4 hours each additional security. -f
A 50% deposit is required for the Rodeo Event upon signing this agreement. Balance
will be paid on July 10, 2011before the Rodeo Event.
In the event there is a cancellation of the event within 1 week (July 2, 2011) before the
event date the deposit is forfeited.
If there is an unforeseen natural disaster that causes a cancellation 50% of deposit will
be refunded unless the event is rescheduled for a later date.
Agreed s
X
Roy De les, Vice Presid nt
Associ on De Charros el Norte
X
Geofge Herrera/Owner
CCSLLC
h
K't stir y
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 Centennial Center,
915 10th Street, First Floor, 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 Centennial Center, 915 10th Street, Third Floor, 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 #: 2011-41
DATE: June 22, 2011
TIME: 9:00 a.m.
APPLICANT:
Asociacion de Charros Del Norte
5660 West Virginia Avenue
Lakewood, Colorado 80226
REQUEST: Application for a temporary assembly of more than 350 persons on July 9 and 10,
2011
LEGAL DESCRIPTION: 6 acres of the following property: Being part of the W1/2 of Section
17, and part of the E1/2 of Section 18, Township 2 North, Range 62 West of the 6th P.M., Weld
County, Colorado. Beginning at the NW Corner of the NE1/4 of Section 18 S89D55'E 50' to
Point of Beginning S89D55'E 2516.68' S89D39'E 2647.72' S00D33'E 2638.02' S00D33'E 1319'
N89D47'W 2639.40' S89048'W 1309.25' S89D48'W 103.75' N00D00'E 1208.78' N31D17'E
710.04' N16042'W 417.06' N90D00'W
LOCATION: 36716 County Road 22
Roggen, Colorado 80652 (See Legal Description for precise location.)
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
DATED: June 10, 2011
PUBLISHED: June 15, 2011, in the Fort Lupton Press
PROOF OF PUBLICATION
FORT LUPTON PRESS
STATE OF COLORADO
COUNTY OF WELD SS.
I, Allen Messick, do solemnly swear that I am the Publisher
of the Fort Lupton Press that the same is a weekly
newspaper printed and published in the County of Weld,
State of Colorado, and has a general circulation therein;
that said newspaper has been published continuously and
uninterruptedly in said county of Weld for a period of more
than fifty-two consecutive weeks prior to the first
publication of the annexed legal notice or advertisement;
that said newspaper has been admitted to 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 weekly newspaper duly
qualified for publishing legal notices and advertisements
within the meaning of the laws of the State of Colorado.
That the annexed legal notice or advertisement was
published in the regular and entire issue of every number
of said weekly newspaper for the period of ONE
consecutive insertion(s); and that the first publication of
said notice was in the issue of newspaper, dated 15th day
of JUNE 2011, and the last on the 15th day of JUNE
2011
K
Publisher, Subs and sworn
I
NOTICE OF APPLICATION FOR
TEMPORARY ASSEMBLY
Pursuant td 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 Centennial
My Commission Expires : al
Center, 915 10th Street, First Floor,
. 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 Centennial Center, 915
10th Street, Third Floor, 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 #: 2011-41
DATE: June 22, 2011
TIME: 9:00 a.m.
APPLICANT:
Asodadon de Charros Del Node
5660 West Virginia Avenue
Lakewood, Colorado 80226
REQUEST: Application for a
temporary assembly of more than
350 persons on July 9 and 10, 2011
LEGAL DESCRIPTION: 6 acres of
the following property: Being part
of the W1/2 of Section 17, and part
of the E1/2 of Section 18, Township
2 North, Range 62 West of the
6th P.M., Weld County, Colorado.
Beginning at the NW Corner of the
NE1/4 of Section 18 S89D55'E 50'
to Point of Beginning S89D55'E
2516.68' S89D39'E 2647.72'
S00D33'E 2638.02' S00D33'E 1319'
N89D47'W 2639.40' S89D48'W
1309.25' S89D48'W 103.75'
N00D00'E 1208.78' N31D17'E
710.04' N16D42'W 417.06'
N90O00'W
LOCATION: 36716 County Road
22
Roggen, Colorado 80652 (See Legal
Description for precise location.)
BOARD OF COUNTY
COMMISSIONERS -
WELDCOUNTY,COLORADO
DATED: June 10, 2011
PUBLISHED: June 15, 2011, in the
Fort Lupton Press
CERTIFICATE OF MAILING
The undersigned hereby certifies that a true and correct copy of the foregoing Notice of
Hearing, Docket #2011-41, was placed in the United States mail, first class mail, postage prepaid,
addressed to the following property owners.
DATED this 9th day of June, 2011.
CORDES & COMPANY FINANCIAL
SERVICES INC
STE 815
5299 DTC BLVD
GREENWOOD VILLAGE CO 80111
DONNIE & KELLEY GILLILAND
2675 COUNTY ROAD 41
HUDSON CO 80642-9024
RICHARD AND WENDY KANZLER
36259 COUNTY ROAD 22
ROGGEN CO 80652
MICHAEL LINNEBUR RETAINED
TRUST INC AND BERTHA LINNEBUR
RETAINED TRUST INC
PO BOX 145
ROGGEN CO 80652-0145
TIMOTHIE AND GREGORY MOORE
PO BOX 3
ROGGEN CO 80652-0003
PRESTON RANCH MINISTRIES INC
8747 COUNTY ROAD 75.5
ROGGEN CO 80652
AM TAYLOR LTD PARTNERSHIP
RICARDO TAYLOR
ANNA MARIA TAYLOR TRUST NO 1
PO BOX 597
BRIGHTON CO 80601
WOERNER REALTY INC
PO BOX 820
FOLEY AL 36536
Deputy Clerk to the Bid
AFFIDAVIT OF INTERESTED LAND OWNERS Page 1 of 2
AFFIDAVIT OF INTERESTED LAND OWNERS
SURFACE ESTATE
Subject Parcel: 130117000017
THE UNDERSIGNED, states that to the best of his or her knowledge the attached list is a true and
accurate list of the names, addresses, and the corresponding Parcel Identification Number assigned by
the Weld County Assessor of the owners of the property (the surface estate) within 500 feet of the
property being considered. This list was compiled utilizing the records of the Weld County Assessor
available on the Weld County Internet Mapping site, http://www.co.weld.co.us, and has not been
modified from the original. The list compiled from the records of the Weld County Assessor was
assembled within thirty days of the application's submission date.
Signature
OWN
Date
Property Owners Within 500 ft. of Parcel# 130117000017
NAME
MAILING ADDRESS
PARCEL
IDENTIFICATION #
CORDES & COMPANY FINANCIAL
SERVICES INC
5299 DTC BLVD STE 815
GREENWOOD VILLAGE,CO
80111
130107400015
5299 DTC BLVD TE 815
CORDE c PANY FINA AL
RV ES INC
8000004
GREE OOD VILLAGE,
80111
5299 DTC BLVD STE 815
CO ES & CO ANY FINN CL L
SER ICE C
GREENWOOD VILLAG , O
80111
GILLILAND DONNIE S
Additional Owners:
2675 COUNTY ROAD 41
HUDSON,CO 806429024
130107400018
GILLILAND KELLEY JO
KANZLER RICHARD JAMES
Additional Owners:
36259 CR 22
ROGGEN,CO 80652
130107300019
KANZLER WENDY LEA
LINNEBUR MICHAEL RETAINED
INC TRST
Additional Owners:
P 0 BOX 145
ROGGEN,CO 80652-0145
130117000012
LINNEBUR BERTHA RETAINED INC
http://maps2.merrick.com/website/weld/setsql.asp
6/9/2011
AFFIDAVIT OF INTERESTED LAND OWNERS
Page 2 of 2
TRST
PO BOX 3
O2 IMO1-->I ts&
ROGGEN,CO 80652
MOORE TIMOTHIE S
Additional Owners:
POBOX3
BOX 3
ROGGEN,CO 80652-0003
130107000014
MOORE GREGORY N
PRESTON RANCH MINISTRIES INC
8747 CR 75 1/2
ROGGEN,CO 80652
130120200011
TAYLOR ITED
P O BOX 597
BRIGHTON,CO 80601
PA RSHIP
TAYLOR RICARDO D
Additional Owners:
C/O A M TAYLOR LTD
PARTNERSHIP
P O BOX 597
BRIGHTON,CO 80601
130117000016
TAYLOR ANNA MARIA TRUST NO 1
WOERNER REALTY INC
PO BOX 820
FOLEY,AL 36536
130118000001
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7005 1820 0003 5225 0549
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CERTIFIED MAIL,,,, RECEIPT
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102595-02-A415C0
U.S. Postal ServiceTM
CERTIFIED MAIL,„ RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
Postage
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(Endorsement Required)
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❑ Express Mall
❑ Return Receipt for Merchandise
❑ C.O.D.
4. Restricted Delivery? (Extra Fee)
(Transfer from service 7005 1820 0003 5225 2624
O Yes
PS Form 3811, February 2004
Domestic Retum Receipt
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SENDER: COMPLETE rHIS SECTION
• Complete Items 1, 2, and 3. Also complete
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■ Print your name and address on the reverse
so that we can return the card to you.
• Attach this card to the back of the mailpiece,
or on the front If space permits.
COMPLETE HP, SECTION ON DELIVERY
D. Is delivery
1. Article Addressed to:
If YES,
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01 Box Y'17
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C. Date of Delivery
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JUN 13 2011
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Merchandise
4. Restricted Delivery? = Fee) O Yes
2. Article Number
(Tmnsfer hem sante late°
PS Form 3811, February 2004
7005 1820 0003 5225 0617
Domestic Return Receipt
I025er-o2.M-1540
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CERTIFIED MAIL RECEIPT
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Restricted Delivery Fee
(Endorsement Required)
Total Postage & Fees
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SENDER: COMPLETE THIS SECTION
• Complete items 1, 2, and 3. Also complete
Item 4 If Restricted Delivery is desired.
• Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to: if YES, enter delivery address below: O No
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COMPLETE THIS SECTION ON DELIVERY
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3. Type
Mail
❑ Registered
❑ Insured Mail
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O Retum Receipt for Merchandise
❑ C.O.D.
4. Restricted Delivery? (Extra Fee)
Yes
2. Article Number
(Transfer from service label)
PS Form 3811, February 2004
7005 1820 0003 5225 0594
Domestic Return Receipt 102595-02-M-1540
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Return Receipt Fee
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Restricted Delivery Fee
(Endorsement Required)
Total Postage 8 Fees
Sent To
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• Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery Is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the malipiece,
or on the front if space permits.
1. Article Addressed to:
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2. Article Number
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PS Form 3811, February 2004
C. Date of Delivery
D. Is delivery address different from item 1? O Yes
if YES, enter delivery address below: O No
Service Type
Mall ❑ Express Mall
O Registered ❑ Return Receipt for Merchandise
❑ Insured Mail O C.O.D.
4. Rustle ted Delivery? (Extra Fee)
7005 1820 0003 5225 0587
Domestic Return Receipt 102595-02-Ih1690 ;
U.S. Postal Service,.
CERTIFIED MAIL,, RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
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■ Complete Items 1, 2, and 3. Also complete
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■ Print your name and address on the reverse
so that we can return the card to you.
• Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
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2. Article Number
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Agent
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B. Received by (Printed Name)
uCiSte
C. Date of Delivery
D. Is delivery address different from Item 19 0 Yes
If YES, enter delivery address below: 0 No
Type
Mall ❑ Express Mall
D Registered 0 Return Receipt for Merchandise
inured Mall ❑ C.O.D.
4. -:..::,: ,:. Delivery? (Extra Fee)
7005 1820 0003 5225 0570
PS Form 3811, February 2004
Domestic Return Receipt
102595-02-M-1590
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U.S. Postal Service,.,
CERTIFIED MAILTM RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
Postage
Certified Fee
Return Receipt Fee
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
Total Postage & Fees
•
• Complete Items 1, 2, and 3. Also complete
Item 4 If Restricted Delivery is desired.
• Print your name and address on the reverse
so that we can return the card to you.
• Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
�ICFlH� AM) lttieiva?l1.4N21.E,E
3(025`7 Cc2UNTY, D 22.
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2. Article Number
(Transfer from smoke label)
PS Form 3811, February 2004
Postmark
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O Addressee
C. Date of Delivery
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D. Is delivery address different from item 17 O Yes
If YES, enter delivery address below: ❑ No
Type
fled Mall
❑ Registered
O Insured Mail
❑ Express Mall
❑ Retum Receipt for Merchandise
❑ C.O.D.
4. Restricted Delivery? (Extra Fee) O Yes
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Domestic Retum Receipt
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