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Home My WebLink About20071450.tiff RESOLUTION RE: ACTION OF THE BOARD CONCERNING PERMIT FOR TEMPORARYASSEMBLYTO ENRIQUE GUERRERO - JUNE 3, JULY 8, AUGUST 12, SEPTEMBER 2, AND OCTOBER 7, 2007 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, Enrique Guerrero, 3883 Weld County Road 6, Erie, Colorado 80516, 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 on June 3, July 8, August 12, September 2, and October 7, 2007, on property described as follows: 3883 Weld County Road 6, Erie, Colorado 80516; being further described as part of the SE1/4 of Section 22,Township 1 North, Range 68 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 deny said Weld County Permit for Temporary Assembly to Enrique Guerrero,due to concerns regarding the safety and welfare of Weld County residents, and due to improper zoning and lack of an approved Use by Special Review Permit, 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 June 3, July 8, August 12, September 2, and October 7, 2007, be, and hereby is, denied. 2007-1450 LC0022 PERMIT FOR TEMPORARY ASSEMBLY - ENRIQUE GUERRERO PAGE 2 The above and foregoing Resolution was,on motion duly made and seconded,adopted by the following vote on the 21st day of May, A.D., 2007. BOARD OF COUNTY COMMISSIONERS , ;;, EL.() WELNQUNT;', COLOR O ATTEST: iiteli & i ekk C i. ! r t2 avid E. Long, Chair Weld County Clerk to thy'3o d11c, / ^ "LSE( i `o`' 7-1,:intry, Pro-Tem BY: t }-�DC ty CI k to the Bo r William F. Garcia APPR AST EXCUSED obert D. Masden n A orney Douglas ademacher Date of signature: taut 10 7 2007-1450 LC0022 MAR-27-2007 TUE 01:53 PM WELD CO GOVT FAX NO, 9703520242 P. 07 /kPPLICATION 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: Egg Taut. 6 o f l2 i ? l2 a Lt:Ti9Av AGE: RESIDENCE: 3 8 5f 3 w C. R 4 Z Z le F to S o y / 6 MAILING ADDRESS: S.a-n c= 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 v be G held:_ 3 f 5-5 c 2 G £ t/27 C 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: L-•v R 1 ofri. G £ l'e fL Y t/ o 2 v“279.4.- RESIDENCE 3 Fri( 3 2.s .. -j7 4 r r f'z Y C v S- OS/ S/ & MAILING ADDRESS: '' £° NAME: RESIDENCE: MAILING ADDRESS: 3. M:CTtetluORM5Weemnbly 2007-1450 MAR-27-2007 TUE 01 :53 PM WELD CO GOVT FAX NO. 9703520242 P, 08 2. Nature or purposes of the assembly: /L1 E X/cA✓'' N o F O k'E Rolf (A7/FL WE RZDT 444/171 L .' h C oOv/ // i� J?F'�n Lire.tSMvStc ,lib 12 ;e? 3. Dates and hours during which the assembly is to be held: - - G - . L�- fl-o ? r ? -2-o3, - ly- o7-/ 9-2 - 0e, / o 4. Maximum number of persons to be allowed at assembly at any one time: 5 0 0 v{2 /{ SS 5. The maximum number of tickets to be sold if any: /1//l1 4/ OX/ i B. Identify plans to limit number of persons to the maximum Identified above: colt i4, TIL in/tvi 5ec„gry r,,.t/ K P'z5 Sez�.r'fi V 303 — yos- cistez 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: Z h,9vE 3 wood 57//A'S j ytZ J3vi 10_ oYL,Mo'S 64L1 O4/ I)�, h k�`h9 u, 7e/1 F-9oy/ S-4i17 S Fait k4≤7e Dt PUS.t7E-p z hAvs l j 10o b4LL°-" ,1447 TA L CAA/ S Lvi LL 17,4vF 7/7n$h` ji7 5 Obi qG 8. Identify the plans for holding, collecting, and disposing of solid waste materials: Z wtLL p v 7- ALL -772 hi /3/' 0-SeLecv y/ Y 772 o C k /I Ad) 7A it 7tea n c,,N/ f;'/o/ LLoc447Zi) PIA/ DENyeR REGI9A/AL LAND TJ« j`JN/ w, 4R�f 6 # 303- 675- 9 4/5 9. Identifythe plans for providing separate toiletfacilitiesfor males and females,including the source, number, end location, type and the means of disposing of wastes deposited: i/i,'// AAVF L/ foP/db/t flo 57 Coo,"7- s g/ Ave?' S;%H' f I—u/Z til/%� �t tc O d4A✓ -'1 Su'To l� Up, r p /a& , WO-- 2 Fs`1- 6a /OO Su( i/rj ,S TGV f //o.fi , :// 5/tk ?. RLtCc f 75 2 7 O _ 'cscmlowssL i. MAR-27-2007 TUE 01 :54 P11 WELD CO GOVT _ FAX NO. 9703520242 P. 09 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: WI? St, a ANify/ ANc ; t/ 114/0 z (,✓ ,/( Fti - 5 x 11. Identify the plans,if any,to illuminate the location of the meassembly,including the source and amount of power,and the location of lamps: Ai/A DA ONL y 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: 6 ACS n LS /7i pr"o pi:AT ro1Z pA1z•fr,v4- ti0 n.v5 U! ) /l pnn S./Fe -el a t Alt OIL rrr( SzDf Sy ✓l�rfc 13. Identify the plans for communications with hospital,police,and fire services,including the source,amount,and locatlonof communication equipment Z A.v yr y h/tv 5 H e7 f 70 4 R /arte //r77,6C '7. L72 14. Identify the plans for camping facilities, if any: ,/7/4 3 A&R\CfM0TBfoR.isro issmsu 4 wiars\CTBP0RMSfoumW.*W MAR-27-2007 TUE 01:54 PM WELD CO GOVT FAX NO. 9703520242 P. 10 15. Identify the plans for fire protection: 1 12/7 (i- / O.ti O2c/f rontc' v6. /d,c7NA AND w i/ C4 cc ,, ( ,De .fin n./tie'mil' tf eSRry 18. 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: ft .`.I 5 5 C c ci2 ` f Y (1' h -C / A e564 f rif 1 / w // S d/D 3 5 1_75- 4 r La efi 4 �/4r'S 17. Identify the plans for sound control and sound amplification, if any, Including number, location, and power of amplifiers and speakers: /1,71.4- � rc/ l /f4l/S1t f/k 5ft/tfztr'S A-7 /a1/ DPVM ?fl,p/or c 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: //A/ 1NG Co o/I 0th ? Ix-FA/ 13, g 19. Identify the plans, if any,for an electrical system: /ti' U r f/7 A Li_ 4 M.^CTEAC IFORMsFoumbv.cd MAR-27-2007 TUE 01 :54 PM WELD CO GOVT FAX NO, 9703520242 P. 11 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: rnt-0 P 7 127 / IS A 04 A T77124L/ r e /./ Ay 7/fld4-z- �/ ,i,c--7c.-n .v .17 E"O2 host J hit/2 l/S0o 7e--71 rA,.+-k to L-,r9 "Tern 7h £ 11 a.9 /7 to 7/16' 4/284-"f t h.9r ..t'iy ReCcnT /4351? 7ba 7, v/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.B.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.B.14 of the Weld County Code,to protect against injury to persons or property occurring as a result of such an assembly. 23. Submit$100.00 fee for each event where three-hundred fifty(350)or more people assemble or can reasonably by anticipated to assemble at any one(1)location,unless the location Is properly zoned for such assembly,in which case one permit shall be required for the total number of events scheduled for that location for the reminder of the calendar year,not to exceed ten (10) events per year. As used herein,the term event means an assembly or anticipated assembly which is scheduled to last for three(3) consecutive days or less. BY THIS APPUCATION,APPUCANT(S)AGREES TO INDEMNIFY AND HOLD HARMLESS WELD COUNTY OR ANY OF ITS AGENTS, OFFICERS, SERVANTS,AND EMPLOYEES FROM ANY LIABILITY OR CAUSES OF ACTION WHICH MIGHT ARISE BY REASON OF GRANTING OF A TEMPORARY ASSEMBLAGE PERMIT,AND FROM ANY COSTS INCURRED IN DEFENDING AGAINST SUCH ACTIONS OR IN CLEANING UP ANY WASTE MATERIAL.PRODUCED OR LEFT BY THE ASSEMBLY. g n r (P. ar- x. ill ran m Dig -r S 0 5 MAGT/K:TBFORMSVoumM/.wpi MAR-27-2007 TUE 01:54 P11 WELD GO GOVT FAX NO. 9703520242 P. 12 The applicant and each of them,swears, (affirms)that,to the best of his knowledge,the statements contained in the application are true and correct. EA/CI Chu £. & tie-/?R £/z o Applicant's printed name Applicants position A/ 1 SUBSCRIBED AND SWORN to before me tills la jR day of Apf, 201. Witness my hand and official seal. Notary Public My commission expires: Ocb010 3 .' r �°TAys, , I • \ F '� O co- My I:mm x ai6gl1sOBfISR010 t38000dmadoBAIL Thomton,CO 80802 6 M:�CTSCriwORNsiwmep'.t4$ • \\ 3g-g3 ,c,11 6 wire CU &os / [, (PATE _ OUse c p1 of)ffl7 J3 __. r5 TonsN c vs 0 hM7n r y49,5:67 ,t A 0 PEST R 07/11— j .-. r- IX7Z/v6vas/fee5 I N Thvtkr I e TR4Pi. EA s rill L ,.,:,1_.\--7.____ PERT 8040 Atio4yS Cie,, _ CA 4 f c,f 11 i ACESTiReta.rts 4 ea; '''.. ...."------4) I G re I vrslte=2 , 7 I its p IP .� 3 " -a ~ A LA Ott S 'R /I Fgr Ao.ea S • King Security LLC. P.O. Box 1431 Aurora, CO 80040-1431 ' : i (303) 961 —8842 Fax: (303) 366 - 0146 'I T — 3Sr5 3 6. .1, /7 4 rrzr ro s- 05/ • Hora de Hora de Nombre/ Fecha/ inicio/Time Salida/Time Name Date in , out Hrs Total 50 -617 /.'PAI 6:12.41 S 5-2?-07 /,' pit.> 6;p i 5 611-0 ? /.t red 6 /9- r 5 71--0 /; p4-> 4r-/2 7- / fl A 6; r'y 5 5 /0- 1,"/"-7 IRS DEPARTMENT OF THE TREASURY INTERNAL REVENUE SERVICE P.O. BOX 9003 HOLTSVILLE NY 11742-9003 Date of this notice: 05-17-2006 Employer Identification Number: 004100.245212.0012.001 1 MB 0.326 532 20-4731575 IIulilionIIIuIInIIl Form: SS-4 Number of this notice: CP 575 E KING SECURITY LLC ?" OSWALDO REYES SOLE MBR For assistance you may call us at .._. PO BOX 1431 1-800-829-4933 AURORA CO 80040 X4100 IF YOU WRITE, ATTACH THE STUB OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER Thank you for applying for an Employer Identification Number (EIN) . We assigned you EIN 20-4731575. This EIN will identify your business account, tax returns, and documents, even if you have no employees. Please keep this notice in your permanent records. When filing tax documents, please use the label we provided. If this isn't possible, it is very important that you use your EIN and complete name and address exactly as shown above on all federal tax forms, payments and related correspondence. Any variation may cause a delay in processing, result in incorrect information in your account or even cause you to be assigned more than one EIN. If the information isn't correct as shown above, please correct it using tear off stub from this notice and return it to us so we can correct your account. To receive a ruling or a determination letter recognizing your organization as tax exempt, you should complete Form 1023 Revision 1024, Application for Recognition of Exemption at: Internal Revenue Service PO Box 192 Covington, KY 41012-0192 Publication 557, Tax Exempt for Your Organization, is available at most IRS offices or you can download this Publication from our Web site at www.irs.gov. This Publication has details on how you can apply. IMPORTANT REMINDERS: * Keep a copy of this notice in your permanent records. * Use this EIN ana your name exactly as they appear above on all your federal tax forms. * Refer to this EIN on your tax related correspondence and documents. If you have questions, you can call or write to us at the phone number or address at the top of the first page of this notice. If you write, please tear off the stub at the end of this notice and send it along with your letter. Thank you for your cooperation. ACQR CERTIFICATE OF LIABILITY INSURANCE I DATE(MMDD yyyy) PRODUCER 1/19/2007 THE MANINGO GROUP INTL LLC ONLY THIS C AND FICATE IS CONFERS SSUED AS A NO RIGHTSMU UPON THE CERTIFICATE INFORMATION 6600 S BROADWAY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR CENTENNIAL, CO 80121 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 3037948842 INSURERS AFFORDING COVERAGE INSURED OSWALDO REYES NAIC# INSURER A: THE HARTFORD INSURANCE COMPANY DBA KING SECURITY, LLC 1908 LANCY ST INSURER s: PINNACOL ASSURANCE AURORA, CO 80010 INSURER C: SAFECO INSURANCE COMPANY INSURER40: I COVERAGES 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. INSR ADD'L LTR Neap TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIABILITY DATE(MM/DOM') 0 TE(MM/DO/YY) LIMITS GENERALX COMMERCIAL GENERAL LIABILITY ~ EACH OCCURRENCE $ 1,000, 000 PREMISESF(Es occurence) $ CLAIMSMADE OCCUR200, 000 X MED EXP(Any one person) $ 10, 000 34SBARV1670 05/19/06 05/19/07 PERSONAL BADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2, 000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT X ANY AUTO ALL OWNED AUTOS (Ea accident) $ 25,000 SCHEDULED AUTOS BODILY INJURY ' X HIRED AUTOS (Per person) $ 50, 000 Y7293563 11/13/06 05/13/07 NON-OWNEDAUTOS BODILY INJURY . . (Per accident) $ 25, 000 PROPERTY DAMAGE GARAGE LIABILITY (Per accident) $ 50, 000 ANVAUTO AUTO ONLY-EA ACCIDENT $ OTHER THAN EA ACC $ EXCESS/UMBRELLA LIABILITY AUTOONLY: AGG $ IOCCUR pi CLAIMSMADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE $ RETENTION $ - $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY WCSTATp- -OTH- $ ANY PROPRIETOR/PARTNER/EXECUTIVE 9180715TORY LIMITS I ER X OFFICER/MEMBER EXCLUDED? 01/19/07 01/19/08 E.L.EACH ACCIDENT $ '.LDD,ODD HYes,descrMe under E.L.DISEASE-EA EMPLOYEE $ 100, 000 SPECIAL PROVISIONS below OTHER • E.L.DISEASE-POLICY LIMIT $ 500, 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS • ADDITIONAL INSURED AND INSURABLE INTEREST CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.THE ISSUING INSURER WILL EHbEAVOR TO MAIL3O PAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATIO RIABILIT7ANY REPRESENTATIVES. .ND PON THE URER,ITS AGENTS OR _000 AUTHORIZED REPR NT AA I 1CORD25(2001/08) i by i ©ACORD COR 1988 TERN 7070 W Arm 80020 al Events April 25,2007 Enrique: Please find the enclosed contract for services. Please fill out the needed information and return the signed original contract. Please make and keep one copy of the contract for your records. Sincerely, Bob Mason Operations Manger WASE 720-984-4771 7070 W.117t Ave.Unit C Broannekl,CO 80020 303-488-3325 fax 303-48&3380 Special Event Medical Agreement 1. Supplier Responsibilities: Supplier will provide customer with 1 ALS Ambulance, 1ALS provider and 1 BLS provider for the duration of the event. At all time,all coverage shall be in accordance with practice and standards, laws and regulations applicable to medical transportation services. Copies of all licenses and permits necessary to operate a medical transportation service will be kept at Supplier's main office and will be made available to Customer upon request. Supplier will facilitate emergency transportation of spectators or participants. This transport ambulance will not come from the event;rather an additional transport vehicle will be dispatched. 2. Customer Responsibilities: Customer shall use Supplier as a provider of all medical services unless the patient or participant requests another medical provider. 3. Compensation: Customer shall pay Supplier for services rendered according to the following schedule: as Exhibit 1 and incorporated herein by reference. Supplier will invoice Customer,for services rendered. Invoices shall show charges set forth in the rate schedule attached hereto as Exhibit 1. Customer will pay supplier in full at the end of event according to Exhibit 1. 4. Regulatory Requirements: Customer and Supplier will perform the services contemplated by this Agreement at all times in compliance with Federal, State and local law,rules applicable standards of the JCAHO, and all currently accepted and approved methods and practices. The parties expressly agree that nothing contained in this Agreement shall require Supplier to refer any patient to Customer. Notwithstanding any unanticipated effect of any provision of this Agreement,neither party will intentionally conduct itself in such a manner as to violate the prohibition against fraud and abuse in connection with the Medicare and Medicaid programs or other Federal programs. 5. Dates of Service Saturday May 12 2007 13:00 to 18:30 Sunday May 27.200713:00 To 18:30 Signature: 10/ Signature: Name: Bob Mason Name: En Title: Operation Manager WASE_ Title: Date: April 25,2007 Date: Exhibit 1 Rate Schedule for Western Ambulance Special Events Ambulance Coverage $45.00 per hr. Includes 1 Paramedic 1 EMT-B IV 1 ALS Ambulance A ORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMJDDIYYYY)mil o4/12/2007 PRO6UCFR (303)368-5757 FAX (303)368-5863 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION T. Charles Wil son Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 2260 So. Xanadu Way # 280 HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER__ THE COVERAGE AFFORDED BY THE POLICIES BELOW. Aurora, CO 80014 INSURERS AFFORDING COVERAGE NAIC# INSURED Western Ambulance Company, LLC INSURER A Arch Insurance Company 7070 W. 117 Avenue INSURERS - Broomfield, CO 80020-2959 INSURERC INSURER 0 INSURER E. COVERAGES 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 OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSRLTR_A,_00a TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS KLJ DATF IMAINvYYY1 , nATF(hIWDrYYYy GENERAL LIABILITY MAPK06195100 10/01/2006 10/01/2007 EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100 000 PRFMISFS('E._oecurencel r ICLAIMS MAD._ X OCCUR MED DOD(Any one person) $ 5,000 A X Professional Liab PERSONAL&ADV INJURY $ 1,000r000 GENERAL.AGGREGATE s 2,000 000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $ 2,000,000 I POLICY n PRO- pi L(J(: AUTOMOBILE LIABILITY MAPK06195100 10/01/2006 10/01/2007 (:OMBINED SINGLE t_MIT $ j ANY AUTO (E°a"'d°"h 1,000,000 ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) A HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per acadent) ._ - PROPERI_Y DAMAGE $ (Per accident) — �— GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ r ANY AUTO EA ACC S ---- _Y- .... OTHER THAN AUTO ONLY- AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ IOCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE7 $ RETENTION S I 1 •ISS WORKERS COMPENSATION AND I TORY LIMOS I l T EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNERJEXECUTIVE . OFFICER/MEMBER EXCLUDED? E L DISEASE-EA EMPLOYEE $ If yes,describe under —. SPECIAL PROVISIONS below E L DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE AS r / Sandy Lochmandy/SANDY lam, ACORD 25(2001/08) FAX: (303)377-6212 ©ACORD CORPORATION 1988 .` ;L .--�'o_ N•'•��::' ri*i ..��d.we• ri.` i.�.,i� ,"''•T� ?�ti •s`\ i:r i'�.' r f�i r.., i/. r�i►ia.n,�� 1•ij� ��,° n. ` 4 r ♦ r•♦ i O:+ ♦` ��wF• r �+,�.° ►. Irwn,wrrn�� Isr �1.nom .-:":�' b. 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Z O 4---E--CL D � hAIIIH a�er i r 1 U i ce ' f4 F— O N c� V • , . a71 a�i _ \. °6 N !I tIIIC pis.. � ✓ / r" 1\, . �� I .�✓:` 1a 19r✓�N1 l/ w� ;rl 1 f /� 4' ,r��' JEFFERSON COUNTY DEPARTMENT of Di Ill C D II © �� i P la ��,,� Health and Environment �'VI i,, a �\\\�F Z Administrative Services Division � 1 1801 19th Streettin X 7-k- , � i Golden,CO 80401-1798 11///%� /L 3 y = (303)271-5700 �Cf� fir , STATE OF COLORADO ₹ A I�si COUNTY OF JEFFERSON //�� igl LICENSE TO OPERATE AMBULANCE SERVICE rr f(rrQt, Western Ambulance Company 1 1 VAQ\Ili ' Name of Service i,ll/%// I(kli *-�, 7070 W. 117`h Ave., Unit C & < I Address �y'/� Broomfield,CO 80020Ii }" rP City,State,Zip < -- � is licensed until October 2007 to operate an Ambulance Service in Jefferson County in a� accordance with applicable Jefferson County, Colorado Resolutions and Section 25-3.5- i �� a Z 301 et seq.,C.R.S.as amended. \�� ,14. ..„ .!::-F,/ IN TESTIMONY WHEREOF AND PURSUANT TO RESOLUTION NO. 4 l/////j CC95-2 ,the Jefferson County Board of Health has hereunto subscribed �,F &,§ -70i ^ its name by its officer duly authorized this y -$'/ 20th day of October 2006. PEI \�� 1 * I JCDHE: ATTEST: III//h Eli,ii jL" i ,((�i� "J) vim'. :. �C G2 r \\\ Al:' Dlrec r �I/�//% /// Non-transferable " F Post in a Conspicuous Place / - ' \ lit l/Gn \ 1 \.,:.-2- ,, \ =-,--,)-f-i-/ ex--,-4� "11�i`,s \''`'f�m `.7- \..as% ol��m> � /\m % �I IIr\ %(/\1\ -- /,. �,, •.R nn, "�, m /n a\r��/n a�� 1^�__��G�^\i._/ial m bn,� 1P� 1 l✓� ? i✓ ,�ar`� �'x i r ,t +tie'``' '->14 g ' _ ‘11''11‘111: Ili,, tlWpiLw \I t" \11 (/�j \V eskteIt // OWuuuwuwr \\\Ili'l//yamiiY-iiit WIII'11/ Lv1IIq '"III 111-F ; �r i �\l JEFFERSON COUNTY DEPARTMENT of © �� © 4 Illl�////,t� a '^/ j Health and Environment [N ' ";��, I. ,�__ // lll Administrative Services Division I II i\\‘ C ' iii , 1801 19th Street �� 1 Golden,CO 80401-1798 I it (303)271-5700 �� STATE OF COLORADO1.6 4- COUNTY OF JEFFERSON Wit/ - ,,�� ,l LICENSE TO OPERATE AMBULANCE SERVICE Western Ambulance Company 71- \ °I Name of Service///) 1,1 7070 W. 117th Ave.,Unit C IC1-7\i,-1- y/f _;1i Address �� r° 11' Broomfield,CO 80020 liO-. 17 City,State,Zip I r LL \\flj, YD/li is licensed until October 2007 to operate an Ambulance Service in Jefferson County in , ,1_ 1 accordance with applicable Jefferson County, Colorado Resolutions and Section 25-3.5- �� $s It/ 301 et seq.,C.R.S. as amended. f\\�DA�� / . \*\\11 IN TESTIMONY WHEREOF AND PURSUANT TO RESOLUTION NO. p�/4�, v I I'' CC95-2 , the Jefferson County Board of Health has hereunto subscribed 1' �^ 1 n/;): its name by its officer duly authorized this C_ /��yt� 20th day of October 2006. �� '� k \Q � JCDHE: ATTEST: lij/j v,w / x% Cam. 49 `/aw fa i,4\v ,. Direr r x a �� y/�� i1 Non-transferable .f� Post in a Conspicuous Place �A\ 1(L:1 i i & gg \�. � \mil) p__. � rem � , � \ �/\% % / fe� �� - -1/11----- M �� i11��7C7✓� ^i� Ir 11��rnm 1 a !a __..a. a arahzJ_.._Aa. ra:_ra. LZ.:a,._Aihz.._ a'-,_a.��>.J;,ALL—rail .44 O. ^O --' a .411 l\ T.) U O .U `+-+ ti O 1 sdcri ”.a y p p 7 9 s O O y III w oCI .' I 41 ► 141 bilp 00 U gci. a11 -t Lill L� 0 ° Oit iii OO a� ^� RS cj -O v ,.K C , .�II ill rdi 1 () a g' w so 41 �j Cl) � r - c o ct v 'gal h .-, .b .LJ''.:0 n z c.... ►11 —4 p O gl il �' V I' ..0 t ° F i 0 a: la- nnVV � — 'S g. ° o � � rt "o U..E •g, c) - 43 '-an ,5 b. , rs .... Il'il i O CA CA 141, q O C u S.5 ct �O = .O t - U O � � o ti .o y � ti ° E 01 1 �� o � -oo ° H o ° j Z H4° aa0 HU a c = U I�TTVT�-T=T=.��"��ST,�` %`�l-1�:T. 1l TLl�7��L` v..SrL1G�`7L_�—ri.... I fE.p�t \..I I I t11..L L-' VIII I I - - r inn v rat jf J`R. ,9)G DIRECTOROF EXCISE AND LICENSE 1Y - 201 W.COLFAX AVE DEPT#206. _ .. L C, DENVER,COLORADO 80202 StAI:` - - TELEPHONE (720)865-2740 _. BUSINESS PROFESSIONAL LICENSE POST IN CONSPICUOUS PLACE BUSINESS FILE NO.: 1005704 T-NUMBER: 03-3686 OP: CKW ISSUE DATE APPLICATION DATE: 09/27/2003 STATE LIC NO.: 09/15/2005 SEAN R MC MILLAN WESTERN AMBULANCE COMPANY EXPIRES 7070 W 117TH AVE 10/24/2006 BROOMFIELD CO 80020 LICENSE LICFEE APPFEE DATE PAID FUND/ORG REVENUE NIJE EMERGENCY MEDICAL VEHICLE- $200.00 $0.00 09/15/2005 010104001100 353000 EMERG.VEHICLE(4 VEIIIC) EMERGENCY MEDICAL VEHICLE CO- $105.00 $0:00 09/15/2005 01010-4001100 353000 EMERG.MEDICAL/EMERG.VEH:CO. CLERK AND RECORDER ay r ACJDITOR - IT IS THE LICENSEES RESPONSIBILITY TO RENEW PRIOR 2'v uv r, 1:4‘TO THE EXPIRATION DATE,IN ORDER TO AVOID PENALTY OR G `. P� REAPPLICATION FEES ANDADDITIONAL INSPECTIONS. THIS LICENSE DIRECTOR OF EXCISE A ICENS , COVERS ONLY THOSE ACTIVITIES LISTED. COMPLIANCE WITH ARTICLE -�' ' IV OF CHAPTER 28 D.RM.C IS A CONDITION OF THIS PERMIT - AMERICAN FAMILY Brokerage, Inc. April 25, 2007 Joseph Butkovich 006 311 Po Box 873 Broomfield, CO 80038-0873 RE: Enrique Guerrero Risk Location: 3883 Wild Cty Rd#6; Erie, CO 80516 AFBI Account#000411827 Attached is a Special Event quote for Enrique Guerrero. The premium breaks down as follows: Premium 5750.00 Fee 150.00 Taxes 27.00 Total Premium $927.00 Prior to the request to bind coverage,please fax the completed Supplemental application and Terrorism form to AFBI at (608) 243-4907. Please review the quote with the insured, as some of the coverages may differ from those requested. The quote is valid until May 25, 2007. New applications maybe required if the application is dated prior to 30 days before the effective date. In order to bind coverage, you must call American Family Brokerage. Premium must be paid in full by either check or with Visa/MasterCard. We will need the insured's credit card number and the card expiration date to process the credit card transaction. You are responsible for collection and payment of any earned premium including audit premiums. This is your debt. No flat cancellations are given. Feel free to contact us if you have any questions regarding this account. Thanks, Andrew Ault Please remember, you cannot contact vendors directly. You must go through AFBI. American Family Brokerage, Inc 6000 American Parkway Madison,WI 53783-0001 Phone (608)242-4100 (Extension 36339 Option-1) Fax Numbers: (608)243-4907 (608)243-4982 (608)245-8657 ' _ Granite Insurance Services, Inc. 1020 West 124th Ave.,#100 Westminster,CO 80234 (720)872-6406 FAX(720) 872-6405 QUOTATION DO FAX TO: 608-243-4907 PER YOUR SUBMISSION FOR INSURANCE, WE ARE PLEASED TO OFFER THE FOLLOWING: QUOTED WITH: NAUTILUS INSURANCE COMPANY QUOTE NUMBER: 036030- 1 QUOTE IS EFFECTIVE FROM 04/24/07 FOR 30 DAYS EXPIRES 05/24/07 PROD: AMERICAN FAMILY BROKERAGE, INC NAME OF ENRIQUE GUERRERO 6000 AMERICAN PARKWAY APPLICANT: MADISON, WI 53783 ATTN: ANDREW AULT PROD#: 480001 (608) 249-0100 LIABILITY COVERAGES GENERAL AGGREGATE 2,000,000 PRODUCTS-COMPLETED OPERATIONS INCLUDED PERSONAL AND ADVERTISING INJURY 1,000,000 EACH OCCURRENCE 1, 000,000 FIRE DAMAGE (ANY ONE FIRE) 100, 000 MEDICAL EXPENSE (ANY ONE PERSON) 5, 000 LIABILITY PREMIUM $750.00 COVERAGE: COMMERCIAL GENERAL LIABILITY TOTAL PREMIUM $ 150 . 0M&D 150 . 00 SPECIAL EVENT - RODEO POLICY FEE DEDUCTIBLE: $500 BI/PD STATE TAX $ $ 27 . 00 TOTAL $ 927 . 00 EACH CLAIM COMMISSION: 10.00% RATE: #47318/$1.00 BASIS: PER PERSON DEPOSIT: $927.00 MIN. EARNED: $927.00 CONDITIONS: SELECTION OR REJECTION OF TERRORISM INSURANCE COVERAGE UNDER FEDERAL LAW, YOU MAY SELECT OR REJECT THIS OFFER OF COVERAGE FOR ACTS OF TERRORISM, AS DEFINED IN THE ACT. IF YOU SELECT COVERAGE, YOU MUST SUBMIT THE PREMIUM REQUIRED. IF YOU REJECT COVERAGE, YOU WILL NOT BE COVERED FOR LOSSES ARISING FROM ACTS OF TERRORISM, AS DEFINED IN THE ACT. THE ADDITIONAL PREMIUM FOR THIS COVERAGE INCLUDING TAXES AND FEES WILL BE $128.75 ***THE FOLLOWING POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE MUST BE SIGNED BY THE INSURED IN ORDER TO BIND COVERAGE*** FULLY EARNED PREMIUM, FINANCING WILL NOT BE AVAILABLE. WE MUST HAVE YOUR AGENCY CHECK FOR THE PREMIUM IN ORDER TO BIND COVERAGE. CONDITIONS: COVERAGE CONTAINED IN THE TERMS OF THIS QUOTE MAY DIFFER FROM SEE ATTACHED CONDITIONS SUBJECT TO ALL ADDITIONAL REQUESTED INFORMATION, COVERAGE MAY BE BOUND UPON OUR RECEIPT OF DEPOSIT& ORDER TO BIND. IMPORTANT NOTE PLEASE READ CAREFULLY AS THE QUOTE MAY NOT INCLUDE ALL THE CONDITIONS, TERMS OR COVERAGES REQUESTED. NO FLAT CANCELLATIONS. BY: DEBBIE CHIEFFO PRODUCER IS RESPONSIBLE FOR EARNED PREMIUMS. ALL FEES FULLY EARNED. BALANCE DUE WITHIN 30 DAYS OF EFFECTIVE DATE DATE: 04/25/07 WHEN A DEPOSIT PREMIUM IS REQUIRED IT MUST BE BY THE PRODUCER'S TRUST ACCOUNT ONLY (NOT AN INSURED'S CHECK) DC /036030- 1 Page 1 of 2 't\t, Granite Insurance Services, Inc. 1020 West 124th Ave.,#100 Westminster,CO 80234 (720)872-6406 FAX (720)872-6405 QUOTATION [X] FAX TO: 608-243-4907 PER YOUR SUBMISSION FOR INSURANCE, WE ARE PLEASED TO OFFER THE FOLLOWING: QUOTED WITH:NAUTILUS INSURANCE COMPANY QUOTE NUMBER: 036030- 1 QUOTE IS EFFECTIVE FROM 04/24/07 FOR 30 DAYS EXPIRES 05/24/07 PROD: AMERICAN FAMILY BROKERAGE, INC NAME OF ENRIQUE GUERRERO 6000 AMERICAN PARKWAY APPLICANT: MADISON, WI 53783 ATTN: ANDREW AULT PROD# : 480001 (608) 249-0100 ADDITIONAL CONDITIONS: COVERAGE REQUESTED BY YOUR AGENCY. PLEASE REVIEW THE TERMS OF THIS QUOTATION CAREFULLY. **A SIGNED APPLICATION IS REQUIRED TO BIND COVERAGE. ** PREMIUM BASIS FOR GL IS ONE DAY SPECIAL EVENT RODEO WITH 350 IN ATTENDANCE. NO ADDITIONAL INSUREDS INCLUDED. S944J POL JACKET, S944 COMMON POL. DEC. , S005 NOTICE TO POLICYHOLDERS -EPA, E901 FULLY EARNED PREMIUM ENDORSEMENT, S902 SCHEDULE OF FORMS AND ENDTS, S020 SERVICE OF SUIT, IL0017 COMMON POL CONDITIONS, IL0021 NUCLEAR ENERGY LIAB. EXCL.END. , S150 COMMERCIAL GL COVG PART, CG0001 GENERAL LIAB. COVG FORM, L850 DED/ LIABILITY INS [INCLUDING COSTS AND EXPENSES] , S017 EXCL-PUNITIVE/EXEMPLARY DAMAGES, L601 AMENDMENT OF CONDITIONS- PREMIUM AUDIT, S007 CONTRACTUAL-LIMITED,L205 EXCL-INJURY TO EMPLOYEES, CONTRACTORS, VOLUNTEERS AND WORKERS, CG2149 TOTAL POLLUTION EXCL ENDT. , CG2147 EMPLOYMENT RELATED PRACTICES EXCL. , S038 AMENDMENT OF LIQUOR LIAB.EXCL. , CG2175 EXCL OF CERTIFIED ACTS OF TERRORISM AND OTHER ACTS OF TERRORISM. , S006 CLASSIFICATION LIMITATION ENDT. , S261 ASBESTOS EXCL. , CG2196 SILICA OR SILICA RELATED DUST EXCL. , S040 EXCL-CANCER, L213 EXCL- CERTAIN COMPUTER-RELATED LOSSES, S233 EXCL-MICROORGANISMS, BIOLOGICAL ORGANISMS, BIOAEROSOLS OR ORGANIC CONTAMINANTS, CG0067 EXCL-VIOLATION OF STATUTES THAT GOVERN E-MAILS, FAX, PHONE CALLS OR OTHER METHODS OF SENDING MATERIAL OR INFORMATION, E903 POLICY HOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE S009 EXCL-TOTAL LIQUOR LIABILITY ENDT. , S066 EXCLUSION UNSCHEDULED ACTIVITIES OR EVENTS, S035 EVENTS - ADDITIONAL EXCLUSIONS, ***SUBJECT TO THE ATTACHED APPLICATION COMPLETED AND RETURNED. *** DC /036030- 1 Page 2 of 2 NAUTILUS INSURANCE COMPANY LIABILITY ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EVENTS - ADDITIONAL EXCLUSIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILILTY COVERAGE PART The following exclusions are added to Paragraph 2. Exclusions of SECTION I - COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY, COVERAGE B - PERSONAL AND ADVERTISING INJURY LIABILITY and COVERAGE C- MEDICAL PAYMENTS: This insurance does not apply to "bodily injury", "property damage", "personal and advertising injury" or medical payments: (1) To "any person" while practicing for, or participating in, any circus, concert, demonstration, event, exhibition, race, rodeo, show, stunting activity, theatrical performance, any contest, or any activity of an athletic or sports nature; (2) To "any person", authorized or unauthorized, while in the activity area such as, but not limited to, the area known as the pit, track, chute, corral or arena; (3) Arising out of the ownership, maintenance, use, "loading or unloading" of any "auto", watercraft or "mobile equipment" used in prearranged or organized racing, speed or demolition contest, any stunting activity or in practice or preparation for any such contest, unless designated in the Declarations; (4) Arising out of the ownership, use, "loading or unloading", handling or demonstration of domestic or wild animals, including but not limited to mammals, reptiles, insects, birds and fish, unless designated in the Declarations; (5) Arising out of the ownership, maintenance, use, "loading or unloading" of any type of amusement ride or device operated by, or on behalf of, the insured, unless designated in the Declarations; or (6) Arising out of the manufacturing, maintenance, handling, igniting or use of fireworks, flash powder, explosive compositions or combustible substances by "any person", unless designated in the Declarations. The following exclusions are added to Paragraph 2. Exclusions of SECTION I - COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY: This insurance does not apply to "property damage": (1) To property of "any person"; (2) To any "auto", watercraft or"mobile equipment" used in any contest; (3) Arising out of the injury to or destruction of animals; (4) To any building or its contents while leased, rented or occupied by you, or in your care, custody and control; or (5) Liability assumed under any contract you enter into for any building or its contents while leased, rented or occupied by you, or in your care, custody and control for seven or fewer consecutive days. The following definition is added to the DEFINITIONS Section: "Any person" includes, but is not limited to, animal handlers, announcers, attendants, clowns, contestants, entertainers, mechanics, musicians, officials, participants, singers, speakers, stage crews, stock contractors, vendors or their employees, any person employed by or doing volunteer work for you or on your behalf, or any person involved in the promotion, sponsoring or production of the event designated in the Declarations. All other terms and conditions of this policy remain unchanged. S035 (09/03) Includes copyrighted material of Insurance Services Office,Inc.,with its permission. POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE You are hereby notified that under the Terrorism Risk Insurance Act as extended on December 22, 2005, (the "Act"), that you have a right to purchase insurance coverage for losses resulting from acts of terrorism, as defined in Section 102(1) of the Act: The term "act of terrorism" means any act that is certified by the Secretary of the Treasury, in concurrence with the Secretary of State, and the Attorney General of the United States—to be an act of terrorism; to be a violent act or an act that is dangerous to human life, property, or infrastructure; to have resulted in damage within the United States, or outside the United States in the case of an air carrier or vessel or the premises of a United States mission; and to have been committed by an individual or individuals acting on behalf of any foreign person or foreign interest, as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. Coverage under your 0 NEW or 0 RENEWAL policy may be affected as follows: COVERAGES APPLICABLE UNDER THE ACT Important Note: The act applies when terrorism coverage is offered and accepted by the insured for the lines of Commercial Property and Commercial Liability coverages including excess insurance and Directors and Officers liability coverage. The following coverages are no longer included under the Act and terrorism coverage, pursuant to the Act, is no longer offered for: Commercial Auto, Farmowners Multiperil, Burglary and Theft, Surety and Professional Liability coverages. YOU SHOULD KNOW THAT COVERAGE PROVIDED BY THIS POLICY FOR LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM, AS DEFINED UNDER THE ACT, MAY BE PARTIALLY REIMBURSED BY THE UNITED STATES GOVERNMENT UNDER A FORMULA ESTABLISHED BY FEDERAL LAW. UNDER THIS FORMULA, THE UNITED STATES GOVERNMENT PAYS 85% OF COVERED TERRORISM LOSSES EXCEEDING THE STATUTORILY ESTABLISHED DEDUCTIBLE PAID BY THE INSURANCE COMPANY PROVIDING THE COVERAGE. THE PREMIUM CHARGED FOR THIS COVERAGE IS PROVIDED BELOW AND DOES NOT INCLUDE ANY CHARGES FOR THE PORTION OF LOSS COVERED BY THE FEDERAL GOVERNMENT UNDER THE ACT. I hereby elect to purchase coverage, subject to the limitations of the Act, for acts of terrorism, as defined in the Act: A. Through 12/31/07 for a flat premium of $125.00 B. Estimated premium for the period Plus the following taxes and fees: beyond 12/31/07 is $ No Charge. Surplus Lines Tax of $ Surplus Lines Stamping Fee of $ of $ ❑ of $ of $ of $ of $ of $ of $ of $ Total of Premium,taxes and fees is $ and.)cc I hereby decline coverage for terrorism. I understand that I will have no coverage for losses resulting from acts of terrorism. E903(01/07) Page 1 of 2 Possibility Of Additional Or Return Premium. The premium for certified acts of terrorism coverage is calculated based in part on the federal participation in payment of terrorism losses as set forth in the Act. The federal program established by the Act is scheduled to terminate at the end of 12/31/07 unless extended by the federal government. If the federal program terminates or if the level or terms of federal participation change, the estimated premium shown in (B) of above may not be appropriate. If the policy contains a Conditional Exclusion, continuation of the coverage for certified acts of terrorism, or termination of such coverage, will be determined upon disposition of the federal program, subject to the terms and conditions of the Conditional Exclusion. If the policy does not contain a Conditional Exclusion, coverage for certified acts of terrorism will continue. In either case, when disposition of the federal program is determined, we will recalculate the premium shown in (B)above and will charge additional premium or refund excess premium, if indicated. If we notify you of an additional premium charge, the additional premium will be due as specified in such notice. NAUTILUS INSURANCE COMPANY Policyholder/Applicant's Signature Insurance Company Print Name Policy Number Date Named Insured E903(01/07) Page 2 of 2 TERN 4043irii a ,�?y a King Security ue *. . -.NS.. P,. Pretorian Guard �4 Oswaldo Reyes ;++ C...F Owner - � key '' (303)961 4842 P.O.Box 1431 Fax:(303)366-0146 Aurora,CO 80040-1431 i p NOTES RECEI p� ATE '5/i 1�)7 NO. 4 H O CCC��yt, �1 ix cc (V RECEIVED FROM L'1�r i9I,tt /1,ae rvcro 0Ow OCOtnCv ES��y� UWI--- a r1P 0.b14 °CeD $ /fin. O�a H F m O FOR-I•N f L�YLK '�.{ AtalLINj"1i.Li ra- /1 f/ y�+ '�J Da d AMT ACCOUNT J HOW PAID f ^`.' t• I JY� oY CASH, �; V CL N ACCOUNT AMT, ppy�''11 grit ≥O J PAID CHECII iCO to ,'0 x �:° BY ©20071 ® 81808 Page 1 of 1 Jennifer VanEgdom From: Bruce Barker Sent: Thursday, May 03, 2007 12:10 PM To: Jennifer VanEgdom Subject: Temporary Assembly Permit for Enrique Gerrero Lujan I have the following concerns: 1) Section 23: I do not think this property is properly zoned for a Mexican Rodeo, so each event will need a separate permit. 2) No bond, as required by Code Section 12-1-30.6.13. 3) Insurance is just a quotation. Need Certificate of Insurance, as required by 12-1-30.B.14. 4) Agreement with Western Ambulance is for 2 dates in May, 2007, not for any other dates. Additionally, is Western Ambulance licensed to do business within Weld County, as per the requirements of Code Section 7-2- 10. I have to recommend against the Board issuing the permit until and unless these things are done properly and/or provided. Bruce. 5/3/2007 t/f MEMORANDUM ,t V rei To: Jenny VanEgdom, Deputy Clerk to the Board May 10, 2007 WI`Pe From: Bethany Salzman, Zoning Compliance Officer, Dept. of Planning Services COLORADO Subject: L00022 Review of the following Temporary Assembly Permit application by the Department of Planning Services shows the following: Applicant: Enrique Guerrero Lujan 3883 CR 6 Erie, CO 80516 Location of Event: 3883 CR 6 Erie, CO 80516 (Events to take place on June 3, 2007,July 8,2007,August 12,2007, September 2,2007,&October 7,2007) Zone District: Agriculture Since a Use by Special Review(USR)permit is necessary for the following reasons,this property is currently in violation (VI-0700122). ► Exceeding the allowable number of Animal Units. My records indicate they have 6.15+/-acres; therefore they can have 24 horses/cattle at any given time (total). During a telephone conversation, Mr. Guerrero's son indicated on average they bring in at least 30-40 steers(PLUS all the horses). Violation of Sections 23-3-40.B.10, 23-3-40.Q &23-3-50.D (Weld County Code) ► Exceeding 30 trips in and 30 trips out per day (60 total), a Use by Special Review permit is necessary. Violation of Section 23-3-40.Q (Weld County Code) SERVICE,TEAMWORK,INTEGRITY,QUALITY TEMPORARY ASSEMBLY REVIEW FORM Date: May 2, 2007 TO: {DEPUTY} FROM: John Broderius SUBJECT: Liquor License Check 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. A hard copy of the application will be sent to you through inter-office mail. PLEASE RESPOND NO LATER THAN: May 11, 2007 ESTABLISHMENT: ENRIQUE GUERRERO LUJAN 3883 WELD COUNTY ROAD 6 ERIE, COLORADO 80516 ........................................................................................................ No concerns 13 v.1flea& Deputy's Initials The Sheriffs Office had a concern and the deputy has mutually worked with the property owner to correct the concern. (Complete Attached Worksheet) SEE tanAct-VZ.D Unresolved concerns exist requiring a Probable Cause Hearing scheduled by the Board of County Commissioners. (Complete Attached Worksheet) Please notify at Extension of the date and time of the Board of Commissioner's renewal hearing. • Shenff John B. Cooke e a weld ear MY May 9, 2007 To: Clerk to the Board From: Dep. Bill Wagner Ref.: Temporary Assembly Permit/Enrique Guerrero-Lujan As of this date the Sheriff's Office does have concerns about this Temporary Headquarters Assembly Permit and is working with Mr. Guerrero in an attempt to resolve these 1950"0"Street Greeley, CO 80631 issues. Ph. (970)356-4015 Fax(970)304-6467 A concern we have is that alcohol is being brought onto the premise and being consumed by participants and spectators. This is illegal under the liquor code unless it is 3.2 beer. Providing a premise for violations under this statute is only enforceable under the Public Nuisance statutes. There are no penalties under the Public Nuisance Fort Lupton Substation 330 Park Avenue statutes other than the seizure of property. Ft.Lupton, CO 80621 Ph. (303)857-2465 I have spoke to Mr. Guerrero ref. this concern. Mr. Guerrero, I believe, is Fax(303)857-3027 genuinely attempting to resolve this concern by not allowing any alcohol on the premise during an event. In a conversation I had with him on 050807 he stated he would have a security guard at the entrance checking for alcohol and would Southwest Complex confiscate any being brought in. He would mark the alcohol with the owners name 4209 WCR 24 vz and return it when the event was over until it becomes generally known that no Longmont,CO 80504 alcohol would be allowed. Ph. (720)6524215 Fax(720)652-4217 Another concern I have is the general safety of the public, whether it is in Weld County or the City and County of Broomfield. The South side of W.C.R. 6 at the entrance, and South of the entrance is in the City and County of Broomfield. North Jail Complex When exiting the event and accessing W.C.R. 6 to the West Frontage Rd. They are in 2110"0"Street Broomfield's jurisdiction. The information I have is that spectators and participants Greeley, CO 80631 are using the Frontage Rd. South from W.C.R. 6 to the dead end and then accessing I- Eh. (970)3564015 Ent 3922the median with vehicles including pick-ups s Pullin 25 through trailers. This is a P B Fax(970)304-6461 very dangerous situation due to the volume of traffic on I-25. Broomfield P.D. has been contacted and will attempt to have an officer in the area after each of the listed events. I believe Mr. Guerrero's not allowing alcohol on the premise will potentially reduce the number of D.U.I.'s that Broomfield will get, it still won't alleviate the hazard to the public by entering I-25 Southbound through the median, irregardless of /0 / rui ide an whether that person is sober or intoxicated. The only solution to this would be if C- " DOT installed some type of barrier along the median. Mr. Guerrero's feelings about cnrirnnnu'!t! this concern is that he has no control over what happens once someone leaves his de signed /O property, and to an extent he is right. I also do not believe that Mr. Guerrero ntainlam and understands his civil liability by providing a premise for violations under the liquor nhunc c /he code and that person gets involved in a serious accident and is intoxicated. general lieulilt. rel/urc, anc/.tu/c'!t� In closing I would like to state if a permit is not issued Mr. Guerrero will probably hold the events anyway and will keep participants and spectators to under n/ !lx'people a/ 350. II u/i ( 'ntrnh•. Kit ‘,... Memorandum I C TO: CLERK TO THE BOARD From: Dan Joseph, Environmental Health Specialist COLORADO DATE: 05/10/07 SUBJECT: Temporary Assembly Permit for LC0022 In response to your request,Environmental Health Services has reviewed the Temporary Assembly Permit, LC0022, for Enrique Guerrero Lujan, located at 3883 Weld County Road 6, Erie, Colorado. The following are the recommendations made by this Department: 1) Through discussions with Mr. Lujan it was determined that he was not a non-profit and thus would have to obtain a retail food establishment license if he would like to provide the food during the event. It was also discussed that he could have licensed caterers come to the event and serve food. Applications for both situations have been included. 2) Temporary hand washing stations be located outside the portable toilets. (1 for every 2 toilets- drawing attached) Should you have any questions regarding this matter, please contact me at extension 2206 or via e-mail at djoseph(a,co.weld.co.us. Thank you. CC: Cindy Salazar, Environmental Health Services Note: Called and talked with Mr. Lujan on May 9, 2007, and we discussed different food service options. 4 40 m DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT 1555 N. 17th Avenue W I` a Greeley, CO 80631 WEBSITE: www.co.weld.co.us ENVIRONMENTAL HEALTH SERVICES: (970) 304-6415 COLORADO FAX: (970) 304-6411 Vendor's Application to Conduct a Temporary Event Food Booth *Please note this application form has changed. ** Late or incomplete applications will not be approved. Review it carefully and complete all information. A separate application may be required for each event you plan to participate in(separate application is needed if all events were not listed on this form, and/or if your menu/operation has changed significantly). Please return this Vendor's Application along with the enclosed Food Booth Worksheet, Food Booth Layout, License Application, Retail Food Establishment Information Form, Copy of a Current State Sales Tax Licensee and Signed Affidavit and Notarized Identification (if applicable)to the Health Department at least 21 days prior to the event. Food service is not permitted without health department approval. Event Name: Date of Event (see second page to list other events) Event Location: Event Coordinator: Phone Number: Food Booth Name: Food Booth Vendor/Contact Person: Vendor's/Contact Person's phone number: Vendor's/Contact Person's fax number: Booth will be operating: (Date & Time) to (Date &Time) FOR HEALTH DEPARTMENT USE ONLY Health Department Approval: Yes No Specialist Signature: Date: Environmental Health Specialist's Comments: Vendor Application Page 1 Vendor Application Page 2 List all other events that you will be attending (if the event is not listed on this form, a new application must be submitted (page 1 only-provided we received all required information previously and your menu/operation has not changed): Please Provide Date, Time (if known) and Name of other Events Vendors operating at events that are more than one (1) day in length must operate from an approved local commissary within the area. A letter of approval from the commissary must accompany the event application. Utensils must be washed at this site. The Health Department must approve the proposed commissary. (A commissary is not required for vendors who have self-contained concession trailers.) Commissary Name (if applicable): Full Address of Commissary: Phone number of Commissary: Contact Person at Commissary: **Please enclose a copy of the Commissary's current Food License if located outside Weld County** Note: Your commissary may/can be your regularly licensed facility/mobile unit I HEREBY AGREE TO COMPLY WITH ALL SPECIAL EVENT GUIDELINES. WHEN THE SPECIAL EVENT FACILITY IS INSPECTED BY THE HEALTH DEPARTMENT AND FOUND TO BE IN VIOLA HON OF ANY SPECIAL EVENT GUIDELINES, I WILL IMMEDIATELY CEASE OPERATIONS UNTIL AUTHORIZED TO RESUME BY THE HEALTH DEPARTMENT. Applicant Name (Please Print) Applicant Signature: Date FORM MUST BE COMPLETE FOR APPLICATION TO BE ACCEPTED. ret0 DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT 1555 N. 17th Avenue Greeley, CO 80631 WEBSITE: www.co.weld.co.us I ADMINISTRATION: (970) 304-6410 FAX: (970) 304-6412 C PUBLIC HEALTH EDUCATION & NURSING: (970) 304-6420 O FAX: (970) 304-6416 ENVIRONMENTAL HEALTH SERVICES: (970) 304-6415 COLORADO FAX: (970) 304-6411 FOOD BOOTH WORKSHEET Submit on separate sheet of paper. Answer all questions. 1. List all food and drink items to be sewed (includes condiments,main meals, all types of drinks). 2. Describe your process of food preparation that will take place at the event(how does your booth run,walk through your process from cold hold to serve-See example)? 3. What is the source of your food/meat items (from grocery store,restaurant,etc)? What is your source of Water/Ice? 4. List all food items that will be prepared prior to the event(An example of this would be the foods that are prepared at your commissary). 5. How and where will these foods be prepared prior to the event(describe the process-see example)? 6. How and where will each cold food product be stored prior to the event (Detail answer-not just in fridge)? 7. Once cooked, how will hot foods be cooled to 41° F in less than 6 hours? (Describe the process in detail- state what techniques are used-cooler,shallow pan, ice wand...) 8. If reheating cooled foods, how and where will foods be reheated to 165°F (note: cannot be performed in steam table)? 9. While transporting food to the event, what equipment will be used to maintain food at 41°F or below(cooler with ice,refrigerated truck, other)? 10. While transporting food to the event, what equipment will be used to maintain food at 135°F or above (in cambros,no foods transported hot,other)? 11. How will hot food items be stored at 135°F or above at the event site (use a grill, in steam table,crock pot,propane heater,... **Note: sterno will not be allowed)? 12. How will cold food items be stored at 41°F or below at the event site (in coolers with ice, in a refrigerator, other)? Food Booth Worksheet Page 2 13. How will food cook temperatures and food holding temperatures be checked on site? How often will they be checked? 14. What are the proper cook temperatures for potentially hazardous items that you are serving (such as chicken,hamburger,pork)? 15. As foods are sold, how will product be re-supplied to the booth? (Replenishing new product into old product is prohibited.) 16. How will the food product, water and ice be stored on site (note:must be 6 inches off ground unless in a container such as a cooler)? 17. How will waste water, such as wiping cloth water, hand wash water, or water from cooking processes be collected (In a bucket,storage tank,part of your unit,etc..)? 18. Where will waste water be disposed (location on site, at commissary,RV Dump,other)? 19. Describe the hand washing facilities that you will provide on site (do you have soap,paper towels that are dispensed,have a cooler with spigot that provides constant flow of water,powered hand washing sink,etc... Note: Hand sanitizers may not be used as a replacement for hand washing). 20. How will you prevent Bare Hand Contact with ready to eat foods (You cannot touch any product that will not be cooked with bare hands)? 21. What type of Sanitizer are you going to use Bleach/Quaternary Ammonia(products like 409 and Lysol are not approved for use)? 22. Do you have test strips for the sanitizer you are using (bleach should be white,Quaternary Ammonia strips are orange in color)? 23. How will you keep raw and cooked foods separated? 24. If the event is two (2) days or more: a. How will leftover and extra food products be cooled and stored for the next day's use? (List equipment and procedures) b. How and where will utensils be washed, rinsed, sanitized, and air-dried? c. How will leftover food be reheated to 165°F prior to serving the next day? THE COOLING AND REHEATING OF FOODS AT TEMPORARY EVENTS IS STRONGLY DISCOURAGED. Food Booth Layout Drawing of Temporary Food Establishment In the following space, provide a drawing of the Temporary Food Establishment. Identify and describe all equipment including cooking and cold holding equipment, hand washing facilities, work tables, dish washing facilities (if applicable), food and single service storage, garbage containers, and customer service area(a legend if very helpful/label each piece of equipment-see example): FOR OFFICE USE ONLY locratA IN# R#T. I.D. # COLORADO TEMPORARY RETAIL FOOD ESTABLISHMENT INFORMATION FORM OWNER INFORMATION 1.Owner(s)Name 2.Corporation Name(as it appears on Sales Tax License) 3. Owner Address City State Zip 4. Home Phone No.( ) Work Phone No.( ) 5. Owner Mailing Address City State—Zip 6. Driver's License No.: (For Mobile Establishments Only) ESTABLISHMENT INFORMATION 1. Establishment Name 2. Site Address City State Zip 3. Mailing Address City State_Zip 4. Phone Number: ( ) Manager/Contact Person 5. State Sales Tax Number: Seating Capacity 6. Hours of Operation:Days Su M T W Th F Sa Business Hours to / to (circle all that apply) 7. SEND LICENSE/RENEWALS TO: (check Elt) ❑ Owner Mailing Address ❑ Establishment Site Address ❑ Establishment Mailing Address ❑ Or: Date Owner/Operator Signature&Title September 11,2006 Subject: Implementation of C.R.S., 24-76.5-101, et. seq., "Restrictions on Public Benefits" (HB 1023) To Whom It May Concern: You will find an affidavit included with your renewal registration/application. All licenses,certifications, and registrations issued to individual owners or sole proprietors by the Colorado Department of Public Health and Environment must be accompanied by verification of citizenship. This requirement does not apply to you if you are not an individual owner or sole proprietor. Verification includes completing the affidavit and providing a notarized copy of an approved identification. Approved identification includes: • A valid Colorado driver's license or a Colorado identification card; • A United States military card or a military dependent's identification card; • A United States Coast Guard Merchant Mariner card; • A Native American Tribal Document, In addition to the above listed forms of identification,the following will be allowed until March 1, 2007. • A certificate verifying naturalized status issued by an authorized agency of the United States bearing applicant's intact photograph impressed with the raised embossed seal of the issuing agency; • A certificate verifying United States citizenship issued by an authorized agency of the United States bearing applicant's intact photograph impressed with the raised embossed seal of the issuing agency,or; • Other approved State's driver's license or identification card. Not all states verify lawful presence prior to issuing license. Therefore, only those States listed below are deemed acceptable.' You may access a notary in your area by conducting a search through directory assistance for"public notaries." C.R.S., 24-76.5-101, "Restrictions on Public Benefits"became effective August 1,2006,and requires "each agency or political subdivision of the state"to verify the lawful presence in the United States of every applicant for public benefits. The law requires the verification of citizenship in order for persons eighteen years of age or older to receive certain benefits or obtain a license or certification from the department. If the recipient of the benefit is under eighteen years of age,the law does not apply. If you need assistance in complying with this law or if there is additional information you feel we need to be aware of,please do not hesitate to contact me at 2206. Sincerely, Dan Joseph Food Program Coordinator Alabama,Arizona,Arkansas, California, Connecticut,Delaware,District of Columbia,Florida,Georgia,Idaho, Indiana, Iowa,Kansas,Kentucky,Louisiana,Maine,Minnesota,Mississippi,Missouri,Montana,Nevada,New Hampshire,New Jersey,New York,North Dakota,Ohio, Oklahoma,Pennsylvania,Rhode Island, South Carolina, South Dakota, Virginia,West Virginia,and Wyoming; /44;of•C0tfl h of Isis Colorado Department of Public Health and Environment AFFIDAVIT -RESTRICTIONS ON PUBLIC BENEFITS I, , swear or affirm under penalty of perjury under the laws of the State of Colorado that(check one): I am a United States citizen,or I am a Permanent Resident of the United States,or nI am lawfully present in the United States pursuant to Federal law. I understand that this sworn statement is required by law because I have applied for a public benefit. I understand that state law requires me to provide proof that I am lawfully present in the United States prior to receipt of this public benefit. I further acknowledge that making a false, fictitious, or fraudulent statement or representation in this sworn affidavit is punishable under the criminal laws of Colorado as perjury in the second degree under Colorado Revised Statute 18-8-503 and it shall constitute a separate criminal offense each time a public benefit is fraudulently received. Signature Date Firm's Legal Name: Firm's Site Address: Street Unit City Zip TEMPORARY EVENT CHECKLIST FOOD VENDORS USE ONLY VENDORS: DO NOT RETURN WITH APPLICATION. KEEP FOR YOUR OWN USE. 1. Covered thermal insulated container with a SPOUT THAT STAYS ON for washing hands 2. Clean, warm water in the thermal insulated container for washing hands 3. Five gallon bucket to catch waste water from hand washing 4. Hand soap 5. Paper towels 6. Metal, stem food thermometer(0° - 220° F)to monitor food temperatures 7. Thermometer inside each refrigerator to monitor air temperature 8. Labeled Sanitizer and bucket or spray bottle for sanitizing solution 9. Wiping cloths 10. Chemical test kit for sanitizer 11. Adequate number of serving spoons, spatulas, tongs, scoops, ice scoop, etc. 12. Adequate number of tables with washable surfaces 13. Method for elevating food and paper goods 6 inches off the ground 14. Covered trash receptacle with plastic garbage bags 15. Overhead roof or canopy 16. Equipment to maintain cold foods at 41° F or below 17. Equipment to maintain hot foods at 135° F or above 18. Gloves or other items/utensils to prevent Bare Hand Contact. (SEE LAST PAGE FOR DIAGRAM OF HAND WASH STATION) Example Hand Washing Station HANNDWASH STATION TREILMAL A SINGLEtfSE:OWES S GALLONS Of I CLEIRWA81i WAILS. !DOM b�rraa COO DO 8 ,wu.TUT STAYS OK 4 S GALLOP W357L WiTFRBUCSC CR 0002(09/29/06) Departmental Use Only COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT DENVER CO 80246-1530 RETAIL FOOD ESTABLISHMENT LICENSE APPLICATION FOR CALENDAR YEAR This application will be rejected unless all questions are fully answered,proper remittance is attached, and Health Department approval is obtained.The State may convert your check to a one time electronic banking transaction.Your bank account maybe debited as early as the same day received bythe State. If converted,your check will not be retumed.If your check is rejected due to insufficient or uncollected Health Department Approval funds,the Department of Revenue may collect the payment amount directly from your bank account electronically.Make remittance payable to: Type of Ownership ❑Individual(if individual or sole proprietor owner,you must complete the enclosed affidavit and provide a notarized copy of an approved identification.) ❑General Partnership ❑Limited Partnership O Limited Liability Company ❑Limited Liability Partnership ❑Limited Liability Limited Partnership ❑Corporation ❑"S"Corporation ❑Association El Estate O Govemment ❑Joint Venture O Trust ❑Non-profit 501(c)(3)(please enclose copy of IRS letter of exemption) ❑Other Non-profit Certificate/License to be issued in the name(s)of(full legal name of corporation;individual owner or name of first partner) (names of second and additional partners or corporation officers) Trade Name FEIN Number/Social Security Number Business Located at(street or rural route,city,state,and ZIP code) County in which business is actually located Phone Number -098-098 Mailing Address(if different from location above;include street,city,state,and ZIP code) Date you started business ❑If seasonal,mark each ❑JAN O MAR ❑MAY ❑JULY O SEPT O NOV business month. ❑FEB ❑APR ❑JUNE ❑AUG ❑OCT ❑DEC Seasonal Dates of operation:Begin Date /_ End Date Month Day Month Day Are you liable for reporting state sales tax? O Yes ❑ No Liquor? El Yes ❑ No Gaming?❑ Yes ❑ No If yes,do you have a Dept.of Revenue Sales Tax Account Number?❑ Yes ❑ No If YES Account# If no,give the name and address(account number,if possible)of the individual or firm responsible for payment of state sales tax Colorado Sales Tax Account Number Name and address of previous owner In consideration thereof,I do hereby certify that I have complied with all items of sanitation as listed in the Colorado Retail Food Establishment Code,and that I have complied with all orders given me by authorized inspectors of the Colorado Department of Public Health and Environment or local board of health. I do hereby agree that in the event that the items of sanitation are not complied with,I will discontinue serving food until such time as requirements are met. Signature Title Date Health Department Use Only ❑No fee License(School,Charitable,Penal ❑Grocery Store 20,001-40,000 Sq Ft (3280 750) $138.00 Institution,Church,Other) (3273 750) $0 ❑Grocery Store 40,001-70,000 Sq Ft (3281 750) $175.00 ❑Restaurant 0-100 Seats (3274 750) ..$154.00 ❑Grocery Store Over 70,000 Sq Ft (3282 750) $250.00 ❑Mobile Unit (3289 750) $154.00 ❑Grocery w/Deli 0-3,000 Sq Ft (3283 750) $138.00 ❑Temporary/Special Event Establishment (3291 750) $154.00 ❑Grocery w/Deli 3,001-10,000 Sq Ft (3284 750) $225.00 ❑Restaurant 101-200 Seats (3275 750) $175.00 ❑Grocery w/Deli 10,001 -20,000 Sq Ft Restaurant Over 200 Seats (3285 750) $240.00 ❑ (3276 750) $189.00 ❑Grocery w/Deli 20,001 -40,000 Sq Ft (3286 750) $263.00 ❑Grocery Store 0-3,000 Sq Ft (3277 750) $55.00 ❑Grocery w/Deli 40,001 -70,000 Sq Ft (3287 750) $300.00 ❑Mobile Unit(Prepackaged Foods) (3292 750) $55.00 ❑Grocery w/Deli over 70,000 Sq Ft (3288 750) $383.00 ❑Temporary/Special Event Establishment (Prepackaged Foods) (3293 750) $55.00 ❑Grocery Store 3,001 -10,000 Sq Ft (3278 750) $100.00 (999) O Grocery Store 10,001 -20,000 Sq Ft (3279 750).. $115.00 HANDWASH STATION TICERLIAL CONTAINER SINGLE USE TOWELS 5 GALLOWS OF CLEAR WARN WATER 00000 r 01000 ; SPOUT RAT STAYS ON 5 GALLON WASTE WATER WICKET tnpid/99 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,91510th 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#: 2007-39 DATE: May 21, 2007 TIME: 9:00 a.m. APPLICANT: Enrique Guerrero Lujan 3883 Weld County Road 6 Erie, Colorado 80516 REQUEST: Application for a temporary assembly of more than 350 persons on June 3, July 8, August 12, September 2, and October 7, 2007 LEGAL DESCRIPTION: Part of the SE1/4, Section 22,Township 1 North, Range 68 West of the 6th P.M., Weld County, Colorado LOCATION: 3883 Weld County Road 6, Erie,Colorado 80516;being north of and adjacent to Weld County Road 6, and east of the 1-25 Frontage Road (See Legal Description for precise location.) BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO DATED: May 4, 2007 PUBLISHED: May 9, 2007, in the Fort Lupton Press NOTICE P OF APP APPLICATION CATEI OFFMB PROOF OF PUBLICATION FOR TEM Pursuant to the Weld County FORT LUPTON Code,a public the will be held in the Chambers of the BoardW lof d STATE OF COLORADO County Commissioners of unty !'aunty, Colorado, Weld County lennial Center, 915 10th COUNTY OF WELD SS. 'et, First Floor, Greeley, orado 80631, at the time specified. If a court reporter is desired, please advise the at Clerk a the I, Karen Lambert, do solemnly swear that I Board,in writing, least days prior of the hearing. The cost of engaging a court reporter shall be am the Publisher of the Fort Lupton Press; borne by the requesting party. In accordance with the Americans that the same is a weekly newspaper printed Dwith modatties Act,e if special and published in the County of Weld, State accommodations are required in order for you to participate in this hearing, please contact the Clerk of Colorado, and has a general circulation to the Board's Office at(970)33h- therein; that said newspaper has been 7215,Extension 4226,prior to the day of the hearing. The complete case file may be published continuously and uninterruptedly examined in the office of the Clerk to the Board of County in said county of Weld for a period of more Commissioners, Weld County Centennial Center, 915 10th than fifty-two consecutive weeks prior to the Street,oa Third Floor, Grmessages first publication of the annexed legal notice Colorado 80631.E-Mail messages sent to an individual or advertisement; that said newspaper has Commissioner may not be included in the case filee To ensure Inclusion of your E-Mall been admitted to the United States mails as correspondence Into the case file,a please send a copy to second-class matter under the provisions of DOCKS us the act of March 3, 1879, or any TME:900am2007 amendments thereof, and that said APPLICANT: Enrique Guerrero Lujan newspaper is a weekly newspaper duly 3883 Weld County Road 6 Erie,Colorado 80516 qualified for publishing legal notices and REQUEST: Application for a temporary assembly of more than advertisements within the meaning of the 350 August ers12ons 5 September on June 3, 2uly 8,and laws of the State of Colorado. That the October 7,2007 LEGAL DESCRIPTION: Part of annexed legal notice or advertisement was the SE1/4, ion 22,Township 1 r'h, Range 168 West of the 6th published in the regular and entire issue of I.,Weld County,Colorado CATION: 3883 Weld County every number of said weekly newspaper for being 6north EdColoradoet,to the period of 1 consecutive insertion(s)•being , Erie,of and adjacent 6; , and Weld County Road 6,and east of that the first publication of said notice w as the I-25 Frontage Road (See egalati Description for precise in the issue of newspaper, dated 9th day of BOARD OF COUNTY May, 2007, and the last on the 9th day of COMISSIONERS WELD 1 COUNTY,COLORADO May, 2007. DATED:May 4,2007 PUBLISHED:May 9, 2007,in the Fort Lupton Press Publisher. S bscribed and sworn bef 9th day of May, 2007. 0 NOTARY A Pr 411 LrkQic. SFp s1rk Si, ,p co..SsioN ExP"Pt CASE NO.401951 key 41153 Hello