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Home My WebLink About20032526.tiff RESOLUTION RE: APPROVAL OF SPECIAL EVENTS PERMIT ISSUED TO RONALD MCDONALD HOUSE CHARITIES OF DENVER, INC., AND AUTHORIZE CHAIR TO SIGN 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, Ronald McDonald House Charities of Denver, Inc., presented to the Board of County Commissioners of Weld County, Colorado, an application for a Special Events Permit for the sale of 3.2%fermented malt beverages for consumption by the drink on the premises only,and WHEREAS,said applicant has paid the sum of TWENTY-FIVE DOLLARS($25.00)to Weld County, Colorado, pursuant to the laws providing therefore in payment for a County Retail Permit for the sale of malt, vinous and spirituous liquors for consumption by the drink on the premises only, for an event scheduled for 11:00 a.m. until 8:00 p.m. on September 13, 2003, outside the corporate limits of any town or city in the County of Weld at the location described as follows: W1/2 of the NW1/4 of Section 7, Township 3 North, Range 68 West of the 6th P.M., Weld County, Colorado WHEREAS, said applicant has also paid the sum of TWENTY-FIVE DOLLARS ($25.00) to the Colorado Department of Revenue and has exhibited a State Special Events Permit for the sale of malt, vinous and spirituous liquors for consumption by the drink on the premises only. NOW,THEREFORE, BE IT RESOLVED that the Board of County Commissioners of Weld County, Colorado, having examined said application and the other qualifications of the applicant, does hereby grant Special Events Permit Number 2003-13 to said applicant to sell malt,vinous and spirituous liquors for consumption by the drink on the premises only, only at retail at said location; and the Board does hereby authorize and direct the issuance of said permit by the Chair of the Board of County Commissioners, attested to by the Clerk to the Board of Weld County, Colorado, which permit shall be effective from 11:00 a.m. until 8:00 p.m. on September 13, 2003, providing that said place where the permitee is authorized to sell malt, vinous and spirituous liquors for consumption by the drink on the premises only, shall be conducted in strict conformity to all of the laws of the State of Colorado and the rules and regulations relating thereto, heretofore passed by the Board of County Commissioners of Weld County, Colorado,and any violations thereof shall be cause for revocation of the permit. 2003-2526 _,, LC0022 . /!pick_ , So SPECIAL EVENTS PERMIT - RONALD MCDONALD HOUSE CHARITIES OF DENVER, INC. PAGE 2 BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said application. The above and foregoing Resolution was,on motion duly made and seconded, adopted by the following vote on the 27th day of August, A.D., 2003. BOARD OF COUNTY COMMISSIONERS �� WELD COUNTY, COLORADO a�ATTEST: /� EXCUSED David E. Long, Chair Weld County Clerk to the Bo rd (AYE) Rob as ro- em BY: Ll- / _ Deputy Clerk to the Board (AYE) M. J. Geile RO D AS • 4fi (NAY) William Jerke�/// unty A torn y (/ (AYE) Glenn Vaad Date of signature: 9 A9-©3 2003-2526 LC0022 DR 8428(01/03) COLORADO DEPARTMENT OF REVENUE LIQUOR ENFORCEMENT DIVISION DENVER CO 80261 STATE OF COLORADO DEPARTMENT OF REVENUE VALID ONLY FOR THIS ORGANIZATION AT THIS LOCATION RONALD MCDONALD HOUSE CHARITIES OF DENVER INC DESIGNATED AREA WELD COLUNTY CO License Number GE 21-51742-0000 SPECIAL EVENTS PERMIT MALT, VINOUS AND SPIRITUOUS LIQUOR VALID ONLY FOR THE FOLLOWING PERIODS Date Hour Date Hour • FROM SEP 13, 2003 11:00 AM TO SEP 13, 2003 8:00 PM Date Hour Date Hour FROM XXXX)CXX)CX XXXXX TO XXXXXXXXX XXXXX This permit is issued subject to the laws of the State of Colorado and especially under the provisions of Title 12, Article 48, Colorado Revised Statutes. This permit is non-transferable. It is issued only for the specific location described above, and must be conspicuously posted at that location. In testimony whereof, I have hereunto set my hand and seal SEP 0 8 2003 sy LIQUOR ENFORCEMENT DIRE OR EXECUTIVE DIRECTOR THIS LICENSE EXPIRES 8:00 p.m. September 131 4003 gym, LICENSE FEE STATE OF `� �� _� COLORADO COUNTY OF WELD BY AUTHORITY OF THE BOARD OF COUNTY COMMISSIONERS RETAIL LIQUOR LICENSE FOR Special Events Permit SPECIFY: Retail Liquor Store,Liquor Licensed Drug Store,Hotel and Restaurant,Club,Tavern etc. TO SELL AT RETAIL Malt,_ Vinous„ and Spirituous LIQUOR SPECIFY KINDS OF LIQUORS I$ t0 Ce1�, That Ronald McDonald House Charities of Denver, Inc of the State of Colorado,having applied for a License to sell Malt, Vinous, and Spirituous Liquors,and having paid to the County Treasurer the sum of Twenty—five and 00/100 25.00($ j Dollars therefor,the above applicant is hereby licensed to sell Malt, Vinous and Spirituous Liquors containing more than 3.2%Alcohol by weight by the drink for consumption on the premises only (Insert"by the drink for consumption on the premises"or"in sealed containers NOT for consumption at place where sold.") Township 3 North n e 68 asa Special Event atW1/2 of the NW1/4 of Section 7, in the Countyot' west of 6th P.M. Weld,for a period beginning on the 13thday of Septembers 2QQ1,i<_U,.Q0.4.2:t._,and ending on the 13th_ day of September, 2003, at 8:00,p,m___,unless this License is revoked sooner as provided by law. This License is issued subject to the Laws of the State of Colorado and especially under the provisions of Article 47 of Title 12, Colorado Revised Statutes,as amended. IN TESTIMONY WHEREOF,The Board of County Commissioners has hereunto subscribed its name by its officers duly this__2 th y of August 20 03 _. 1 l` 1 �t • ‘ a Board of County Commissioners AT,ST: / t- By GAJ\ CC.). c4 C rk to the Board --- 13, -�+t� i I Bawd C SAM G�=1r�r t) _ 1►, fw;.ma� of County \ f' , ' if :, ; DR 8439(06/97) 21 , LIQUOR OR EN DEPARTMENT APPLICATION-FOR A UOUOR ENFORCEMENT DIVISION 1375 SHERMAN STREET DENVER CO 60261 SPECIAL EVENTS PERMIT (303)205-2300 - IN ORDER TO QUALIFY FOR A SPECIAL EVENTS PERMIT,YOU MUST BE NONPROFIT AND ONE OF THE FOLLOWING (See back fordehirs.) _ V CHECK ONE: 0 SOCIAL 0 CHARTERED BRANCH,LODGE OR CHAPTER OF A NATIONAL ORGANIZATION OR SOCIETY 0 FRATERNAL ❑RELIGIOUS INSTITUTION ❑PATRIOTIC 0 PHILANTHROPIC INSTITUTION ❑POLITICAL ❑POLITICAL CANDIDATE ❑ATHLETIC ❑MUMCIPALITY OWNING ARTS FACILITIES DO NOT WRITE IN THIS SPACE UAB TYPE OF SPECIAL EVENT APPLICANT IS APPLYING FOR: '� ,�'T''.":DO NOT•WRITE,IN-THISzSPACE 2110 NMALT,VINOUS AND SPIRITUOUS LIQUOR $25.00 PER DAY LIQUOR PERMIT NUMBER 2170 Q FERMENTED MALT BEVERAGE(3.2 Beer) $10.00 PER DAY 1. NAME OF APPUCANT ORGANIZATION OR POLITICAL CANDIDATE State Sales Tax Number(Required) Ronald McDonald House Charities of Denver, Inc 98-01212-0000 2. MAILING ADDRESS OF ORGANIZATION OR POLITICAL CANDIDATE 3. ADDRESS OF PLACE TO HAVE SPECIAL EVENT (include street,city/town and ZIP) (include street,city/town and ZIP) 1300 East 21st Avenue Attached is a legal description Denver, CO 80205 of the property 4NAM ., a-ekw.n ':• P`t:.. DATE OF BIRTH`' HOME ADDRESS(Suet'ar7,Sta1e,ZIP)ra '..,.ic , , r(?FKTNE NUIBER',. t 4. PRESJSEC'YOFORG.orPOLmCALCANDIDATE Kori Orsinger RMHC 1300 East Ave. Denver, CO 80205 (303)832-6641 5. EVENT MANAGER (303) Ismael E. Aldana 40 Anrhnra e Cr T.nnpPJmnnnr rn Rncni 210-4427 6. HAS APPUCANT ORGANIZATION OR POLITICAL CANDIDATE BEEN 7. IS PREMISES NOW UCENSEDTJNDER STATE LIQUOR OR BEER CODE? ISSUED A SPECIAL EVENT PERMIT THIS CALENDAR YEAR? ® NO 0 YES HOW MANY DAYS? '-tii NO O YES TO WHOM? 8. DOES THE APPLICANT HAVE POSSESSION OR WRITTEN PERMISSION FOR THE USE OF THE PREMISES TO BE LICENSED? ❑Yes 0 No `+14 , r,•,i, ,x_ '.*^r•,. `uSTEELOW THeEXACT DATE(S)FOR W WCHAPPUCAMON IS BENG MADEFOR PERMIT ,•_ Datesept 13, 2003 Date Date Date Date Hours From 11:00am. Hours From .m. - Hours From .m. Hours From .m. Hours From .m. To g.onp.m. To .m. To .m. To .m. To .m. -,-",/,,,,:!2.:-:„;;.-.,,,Z; - - ,:{4',z,'„„;y,,, , --�'AL.,,.C/' "OATH CIF APPLICANTItirn lw f1,t. I " •"2.W''''• ''' r.. . I declare under penalty of per/wy in the second degree that I have read the foregoing application and all attachments thereto,and ie that all information therein is true,,correct,and complete to the best of my knowledge. .-, ' SIGNATU /L� TITLE ¢y�,or S. Q C.L �l ciz Irr Events Manager 6/12/2003 .7;,:,,t,',. REPORT AND APPROVAL OF LOCAL LICENSING AUTHORITY(CITY OR COUNTY) . , The foregoing pplication has been examined and'the premises,business conducted and character of the applicant is satisfactory,.. and we do report that such perMit:it granted,will comply with the provons of The 12,Article 48,CAS.,as amended - THIS TELEPHONE a",a...c, ,: = ' ,�. , � � -144";:-;«THEREFORE, APPLICATION IS APPROVED LOCAL UCENSING AUTHORITY (CITY OR COUNTY) ❑ CITY NUMBER OF CITY/COUNTY CLERK Coun , Color do COUNTY (97n) 35F-6000 X/�2n6 SIGNATU 3 E' ) David E. Long, Weld County of / Board of Commisgloners R/77/9On4 DO NOT WRITE I THIS SPACE-FOR DEPARTMENT OF REVENUE USE ONLY . `-� ,, r 1 �- LIABIUTYINFORMATION" .r ° I'.''^ • License Account Humbert- ,,` Liability Date n , ' State TOTAL • �> ,r` _750 ) (Instructions on Reverse Size) • SPECIAL EVENT PERMIT QUESTIONNAIRE AND AFFIDAVIT 1. What type of an event is planned (e.g., annual, quarterly, benefit, etc.)? 2. Explain in detail the nature of your organization, its function, and who or what benefits from its operations (attach separate sheet if necessary). 3. Who or what organization will be the recipient of funds derived from this event? 4. How many attendees are expected at this event? 5. Describe the premises at which this event will take place. 6. What type of security will be provided at this event? 7. How many security personnel will be on hand? 8. How will security personnel be identified? 9. If this event is being held outdoors, how will the exterior boundaries of the premises be marked (e.g., roped, fenced, etc.)? 10. What type of entertainment will be provided, if any, for this event? 11. What method will be used in checking identification for proper age of attendees(e.g.,at the door, at the bar, etc.) and how will underage patrons be identified so as not to be served alcoholic beverages (e.g., stamp or mark on the hand, etc.) M:1CTBMTBFORMSTOSPECEV 2003-2526 12. How will the conduct and level of intoxication of attendees be monitored and by whom? 13. Have volunteers or members of your organization been trained in the sale/service of alcoholic beverages: If yes, what training have they received and by whom? 14. What types of alternate beverages and food/snacks will be available? 15. Has a State Sales Tax Number been initiated by you or a member of your organization? If so, write that number in the space provided. 16. Explain how this event will be marketed describing what kinds of advertising material will be distributed and the targeted recipients of such material. I hereby certify, under penalty of perjury, that the information provided to the Board of County Commissioners of Weld County contained in this affidavit is true and accurate to the best of my snow QIa �/ .te J A licant's Signature Date /� STATE OF COLORADO ) )SS. COUNTY OF WELD Subscribed and sworn to before me this day of ,20 Witness my hand and official seal. My commission expires: Notary Public M:\CTB\CTBFORMS\FOSPECEV • Special Event Permit Questionnaire And Affidavit 1. An annual benefit event is being planned. 2. The event is to benefit the Ronald McDonald House of Charity by donating proceeds from the event. The event is celebrating Mexican independence with La Ley 1170 AM. The event gives listeners to celebrate their heritage and help raise money for a good cause. The festival will include live music by famous Mexican Regional artist, clowns and a one-man circus act for the children. This gives families who do not take part in nighttime leisure activities the opportunity to listen and be entertained by there favorite Mexican regional artist. Artists include local, national and international musical groups. Simultaneously KJJD will like to help out the Ronald McDonald House of Charities for their hard work and contributions to the community. 3. Ronald McDonald House of Charities 4. 2500 people are expected for September 13 2003. 5. Attach is a sketch with dimensions of the assembly and location of dumpsters, restrooms and water locations on the premises. An orange barricade fence will fence of the premises. 6. Orozcos Security Agency will provide security services for the event. A team large enough to handle this kind of event will be assembled. 7. 12 Security officers will be on sight. 3 will monitor the beer garden and check Ids. S. Security officers will be identified because they will be using their security uniforms. 9. An orange safety barricade felice will outline the premises and exterior boundaries. The work will be performed by R&M Drain and Waterproofing. Attached is a copy of the type of fence and a letter for work to be performed. 10. Mexican Regional Artist will provide live performances. 11.Wristband will identify anyone over the age of 21. People over the age of 21 will be allowed to consume alcohol only in the beer garden area, which can be identified in the drawing that is attached. Tampering with wristbands or the use of fake identification will result in ejection of event.Any fake identification will be handed over to proper authorities. 12. Conduct and intoxication monitoring, will be done by security officers and bartenders serving the beer.A local bar TEXMEX will be assisting us with the serving of alcohol. Any guest who is suspected of misbehavior because of intoxication will be escorted from the premises reported to police. 13. Volunteers from local businesses with liquor license have committed to help serve alcohol. 14.Water, soda and juices will be available on the premises. 15. The Ronald McDonald House of Charities has issued us a copy of their 501c3 Tax Form. 16. This event will receive publicity on the Radio, TV, posters visual in local businesses and flyers. The targeted audience is the local Mexican Regional listening audience, KJJD committed listeners. Also we will be inviting or targeting any other people interested in enjoying this event. • .1'IEX-TAN INbEPalDANCE: FESTLVArL 1 3 1 -sow I x fi PA ICING ,3cc' .ErF ravt[e. x•4' M , �__.__._..�.�.�.-.....�..��.�_._..��...._,... ■■ ■�■ *= u)cL 'c f toad , •_ Wcokt. Ao( "‘j fiwei tf IAA ■■■■■■ Erneic� fci r20'• • fno C-asden Ol FS1313e.1 Rodriguez Gallegos Broadcasting Corp. - 9217 Eastman q'arkcDr. Suite-124B Windsor, CO 80550 970-686-0814 Office 970-686-7700 Tat Legal description of property were event is to take place: The west one-half of the northwest one-quarter of section 7, township 3 north Range 68 west of the 6th principal median, County Of Weld, state of Colorado, less the county road right-of-way according to the document recorded at book 86, page 273. • PIONEER GENERAL INSURANCE COMPANY • Denver, Colorado P 63560 POWER OF ATTORNEY ORIGINAL IS MULTICOLORED KNOW ALL MEN BY THESE PRESENTS: That the PIONEER GENERAL INSURANCE COMPANY,a corporation of the State of-Colorado has Its principal office in the City of Denver,Colorado pursuant to the following By-law,which was adopted by the Board of Directors of the said Company In 1990,to wit: 'Article VI-Section 2-RESIDENT OFFICERS AND ATTORNEYS-IN-FACT.The President or any Vice-President,acting with any Secretary or Assistant Secretary,shall have the authority to appoint Resident Vice-Presidents and Attorneys-In-Fact,with the power and authority to sign,execute,acknowledge and deliver on its behalf,as Surety: Any and all undertakings of suretyship and to affix thereto the corporate seal of the corporation.The President or any Vice-President,acting with any Secretary or Assistant Secretary,shall also have the authority to remove and revoke the authority of any such appointee at any time,does hereby make,constitute and appoint *** MICHAEL D. PIERCE, RAE L. CAMPBELL, JOAN DELAUDER *** *** LAWRENCE E. LUTGEN, SHARON K. POND *** OF FORT COLLINS, COLORADO Its true and lawful Attorney(s)-In-Fad,to make,execute,seal and deliver for and on its behalf,as Surety: ' And any and all undertakings of suretyship And the execution of such bonds or undertakings in pursuance of these presents,shall be as binding upon said Company,as fully and amply,to all intents and purposes, as If they had been duly executed and acknowledged by the regularly elected officers of the Company at Its offices In Denver,Colorado,in their own persons. The following Resolution was adopted at the Regular Meeting of the Board of Directors of the Pioneer General Insurance Company,held on June 1,1990. 'RESOLVED,That the signatures of officers of the Company and the seal of the Company may be affixed by facsimile to any Power of Attorney executed in accordance with Artide VI-'Section 2 of the Company By-laws;and that any such Power of Attorney bearing such facsimile signatures,including the facsimile signature of a certifying Assistant Secretary and facsimile seal shall be valid and binding upon the Company with respect to any bond,undertaking or contract of suretyship to which it Is attached' All authority hereby conferred shall remain In full force and effect until terminated by the Company. IN WITNESS WHEREOF,PIONEER GENERAL INSURANCE COMPANY has caused these presents to be signed by its President and its corporate seal to be hereunto affixed this 1st day of May 2003 PIONEER GENERAL INSURANCE COMPANY Secretary '` s State of Colorado ) 1 A 1 1f: County of Arapahoe ) s9. By PRESIDENT ._ V�m0AA0Q__ On this 1st day of May 2003 before mepersonalycame Bruce H. Lowdermilk to me known,Who being by me duly sworn,did depose end say that(s)he resides in the County of Adams,State of Colorado;that(s)he is the President of the PIONEER GENERAL INSURANCE COMPANY,the corporation described in which executed the above instrument;that(s)he knows the seal of the said corporation;that the seal affixed to the said instrument is such corporate seal;that it was so affixed by order of the Board of Directors of said corporation;that(s)he signed(his)(her)name by like order;and that By-law,Artide VI-Section 2,adopted by the Board of Directors of said County,referred to in the preceding Instrument,Is now in force. PEE M`e��`h 1O.�OTgq� �l, My Commission Expires 1/18/2007 5,m:A G;'o' • • ,,,9r•.�e�,,: o Notrky Public YV1AA..�a� F�1. M.S. Frick Secret foregoing is a true and correct Secretary of PIONEER GENERAL INSURANCE COMPANY,do hereby certify that the above and copy of a Power of Attorney executed by said PIONEER GENERAL INSURANCE COMPANY,which is still in full force and effect. Signed and sealed at the City of Denver,Colorado this 12th day of August 2003 . P133 Secretary 9 ❑ PIONEER GENERAL INSURANCE COMPANY LICENSE AND/OR PERMIT BOND BOND NUMBER P63560 KNOW ALL MEN BY THESE PRESENTS: That we, Jackess LLC ,as Principal, and PIONEER GENERAL INSURANCE COMPANY,incorporated and under the laws of the State of Colorado,with principal offices at Denver,Colorado,as Surety are held and firmly bound unto BOARD OF WELD COUNTY COMMISSIONERS in penal stun of THRFF THOUSAND AND NO/100 Dollars,( $3,000.00 ) lawful money of the United States for which payment, well and truly to be made, we bind ourselves, our heirs, executors, administrators,successors and assigns,jointly and severally,firmly by these presents. WHEREAS,the said Principal has applied to said Obligee for a license to ASSEMBLY PERMIT FOR 9/13/03 NOW,THEREFORE,THE CONDITIONS OF THIS OBLIGATION IS SUCH, That if the said Principal shall indemnify said Obligee against all loss to it caused by said Principal's breach of any ordinance,rule or regulation relating thereto,then the above obligation shall be void,otherwise to be and remain in full force and effect until the 20TH day of SEPTEMBER 20 03 ,unless renewed by continuation certificate. THIS BOND MAY BE TERMINATED at any time by the Surety upon sending notice in writing,by certified mail,to the Clerk of the Political Subdivision with whom this bond is filed,and at the expiration of thirty(30)days from the receipt of said notice, this bond shall ipso facto terminate and the Surety shall thereupon be released from any liability for any acts or omissions of the Principal subsequent to said date. Signed,sealed and dated the 12TH day of AUGUST 20 03 . Jackes LLCM— ;LLB cr r/� �j(//�/� Principal By < _� N/ PIONEE GENERAL DVSURANC COM ANY c• Resident Agent SHARON K. POND Attorney-In-Fact P-1219/90 O O e s 0§rarment of the Treasury Internal Revenue Service , P . a . `Box 9941 In reply refer to : 2916820108 • Ogden UT 84409 Dec . 19 ,• 1997 LTR 1224C 84-0728926 000000 00 000 03317 • RONALD MCDONALD HOUSE CHARITIES OF - DENVER INC • 1000 E 16TH AVE DENVER CO 80218 • Taxpayer Identification Number : 84- 0728926 • Dear Taxpayer : Thank you for your correspondence dated Nov . 17, 1997 . • Our records show your organization is exempt from income tax under Section 501 ( c ) ( 3 ) of the Internal Revenue Coda . • you have any questions about this letter , please writ _ to 'us at the address shown at the top of the first page cf this letter . If you orefer , you may call the IRS telephone number listed in your local directory _ An employee there may be able. to help you , bu: the office at the address shown on this letter is mast familiar with your case . Whenever you write , please include this letter and , in the spaces • below , give us your telephone number with the hours we can reach you . Keep a copy of this letter for your records . ? c:,, Telephone Number (='3 ) (576/-77S-S4(576/-77S-S4Hours c-1.,4--12-:=c-1.,4--12-:==- O'21n - C,O,1,1 t s • • • Internal Revenue Service Department of the Treasury P. O. Box 2508 Cincinnati, OH 45201 Date:-February 5, 2001 Person to Contact: Paul Perry 31-07423 • Customer Service Representative Ronald McDonald House Charities of Denver Inc Toll Free Telephone Number: 1:00 a.m.to S:10 pm EST 1300. E. 21st Avenue 877-829.5500 Denver, CO 80205 Fax Number: 513-263-3756 Federal Identification Number 84-0726926 Dear Sir or Madam: • This letter is in response to your request for a copy cf your organization's determination letter. This letter will take the place of the copy you requested. n Our records indicate that a determination letter issued in May of 1977 granted your organization exemption from federal income tax under section 501(c)(3) of the Internal Revenue Code. That letter is still in effect. Eased on information subsequently submitted, we classified your organization as ore that is not a private foundation within the meaning of section 509(a) of the Code because it is an organization described in sections 509(a)(1) and 170(b)(1)(A)(vi). , This classification was based on the assumption that your organization's operations would continue as stated in the application. If your organization's sources of support, or its character; method of operations, or purposes have changed, please let us know so we can consider the effect of the change on the exempt status and foundation status of your organization. Your organization is required to file Form 990, Return of Organization Exempt from Income Tax, only if its gross receipts each year are normally more than $25,000. If a return is required, it must be filed by the 15th day of the fifth month after the end of the organization's annual accounting period. The law imposes a penalty of S20 a day, up to a maximum of 510,000, when a return is filed late, unless there is reasonable cause for the delay. All exempt organizations (unless specifically excluded) are liable for taxes under the Federal Insurance c a Contributions Act (social security taxes) on remuneration of 5100 or more paid to each employee during calendar year. Your organization is not liable for the tax impgsed under the Federal Unemployment Tax Act (FUTA). Organizations that are not private foundations are not subject to the excise taxes under Chapter 42 of the Code. However, these organizations.are not automatically exempt from other federal excise taxes. Donors may deduct contributions to your organization as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to your organization or for its use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. R C0"d 1Fi101 . . . . . -2- Ronald McDonald House Charities of Denver Inc - 84-0728926 Your organization is not required to file federal income tax returns unless it is subject to the tax on unrelated business income under section 511 of the Code. If your organization is subject to this tax, it must file an income tax return on the Form 990-T, Exempt Organization Business Income Tax Return. In this letter, we are not determining whether any of your organization's present or proposed activities are unrelated trade or business as defined in section 513 of the Code. • The law requires you to make your organization's annual return available far public inspection without charge for three years after the due date of the return. If your organization had a copy of its application f of or recognition of exemption on July 15, 1987, it is also required to make a cop available for public inspection y the exemption application, any supporting documents and the exemption letter to any individual who requests such documents in person or in writing. You can charge only a reasonable fee for reproduction and actual postage costs for the copied materklls. The law does not require you to provide copies of public inspection documents that are widely available, such as by posting them cn the Internet (World'Mae Web). You may be liable for a penalty of 520 a day for each day you do not make these documents available for public inspection (up to a maximum of 510,000 in the case of an annual return). Because this letter could help resolve any questions about your organization's exempt status and foundation status, you should keep it with the organization's permanent records. If you have any questions, please call us at the telephone number shown in the heading of this letter. This letter affirms your organization's exempt status. Sincerely, cy John E. Ricketts, Director, TE/GE Customer Account Services t t Jackes LLC. Jesse Rodriguez Gallegos 1078 S. Coffman Longmont, Co 80501 August 13,2003 Weld County Office of Clerk To The Board 91510'"Street P.O. Box 758 Greeley, CO 80631 To Whom It May Concern: I Jesse Rodriguez Gallegos give The Ronald McDonald House of Charities and La Ley 1170 AM permission to host" La Ley 1170AM Mexican Independence Celebration and The Ronald McDonald House of Charities Fundraiser on my property.Attached is a certificate of good corporate standing with the state of Colorado for Jackes LLC. If there are any questions please call me at(970)566-8674. Legal description of property were event is to take place: The west one-half of the northwest one-quarter of section 7, township 3 north Range 68 west of the 6th principal median, County Of Weld, state of Colorado, less the county road right-of-way according to the document recorded at book 86, page 273. Sincerely, /i7,90,ceiatd . J riguez Gallegos P t/Owner rage i of 1 • • E Food DONETTA DAVIDSON 2004 Periodic Report Colorado secretary of State File Number:2003!1185650 Filing Fee: 1766-4110 Filed: Jtirie 9,MOS 1014 AM MOT Entity ID Number: 2001103025 Entity Name' * JACKES,LIZ * to Jurisdiction of Formation: CO Person responsible for accuracy JESSE RODRIGUEZ GALLEGOS of report data: 1078 S. COFFMAN LONGMONT CO 80501 Name of Entity's Registered Agent: GALLEGOS JESSE RODRIGUEZ Street Address of Registered Office: 1078 S COFFMAN LONGMONT CO 80501 TO Box Addr of Registered Office: Address of Entity's Principal Office: 1078 S COFFMAN LONGMONT CO 80501, United States 'Entity's Additional Mailing Address: 'Denotes optional Automation trans not requimd by law if no intormeton is d:played ra mts irsrn.none was reparred by The reporting entity. Al wonnaaran satiable to lbe Secretary of Slate is(Splayed above- NOTICE: This°knage"is merely a display of intormation Prat was sled Scher ells. It is not an image that was created by optically scanning a paver document No such paper document was Nded. Consequeniy,no copyof a paper document is avaeabte regarding Misfiling Questions? Contact The Business Division. For contact information please visit the Secretary of State's web Se. http://www.sos.state.co.us/forte/tmpdocs/C2001032725 2003185650_00002_H.gif 6/9/2003 • Page 1 of 1 E-Filed 2003 Periodic Report DColorado oSecretary ofs DAVIDSONte File Number 20031185850 Filing Fee: $3000) Vii; _ Filed: June 9,2003 1024 AM MDT >1.0 j Entity ID Number: 20011032725 Entity Name: ,r JACKES,LLC * K Jurisdiction of Formation: CO Person responsible for accuracy JESSE RODRIGUEZ GALLEGOS of report data: 1078 S. COFFMAN LONGMONT CO 80501 Name of Entity's Registered Agent: GALLEGOS JESSE RODRIGUEZ Street Address of Registered Office: 1078 S COFFMAN LONGMONT CO 80501 'PO Box Addr of Registered Office: Address of Entity's Principal Office: 1078 S COFFMAN LONGMONT CO 80501, United States 'Entity's Additional Mailing Address: 'Denotes optional information that is not required by law. if no information is displayed for INS Hem none was reported by the reporting entity. Alf informafl'on avahblo b the Secretary of State Is displayed above. NOTICE: This Image is merely a hwlay of information that was tiled electrorucad'y. 1t is not an image that was created by optically scanning a paper document No such paper document was filed. Consequently,no copy of a paper document is available regarding this fling Questions? Contact the Business Division. For contact information,please visit the Secretary of State's web site. °' • • http://www.sos.state.co.us/forte/tmpdocs/C2001032725_2003185650_00002_H.gif 6/952003 I arrrr ��.ia1 IMPORTANT DOCUMENT • Certificate of I"fame 3.etitto. .ae aREGISTERED ,011-4-1, ISSUED BY r c L A -; Dam of MaxdacOre3f APPLICATION �'.ii :.::›4 �. 4 NUMBER \ »arsrrnffsuc SW01 z; tat-3 /--} .4,-;)if EVANSVILLE� INDIANA 47711 Order Number IF?.•. F140.1 4t4,. r1,iii'{ 334419 �f.13 MANUFACTURERS OF 171E FlW SHED E1, -t '.₹. TENT PRODUCTS DESCRIBED HEREIN 3 This is to certify that the materials described have been flame-retardant treated for ape inherently noninflammable) and were supplied to: $$$ 692330 w RENTAL CITY ti III 8330 GUNPARK DR c BOULDER CO 80301 Certification is hereby made that t The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire 1 . Marshal Code, equal to exceeds NFPA 701, CPAs 84, ULC 109. � . The method of the FR chemical application is: Serial t lip 8151310(1) S `) � Description of item certified: CENT END 60WX2OLO SNY IO'SPAC. ax _ Flame Retardant Process Used Will Not Be Removed By a Washing And Is Effective For The Life Of'r�/ The�1_ Fabric L- sNY11F3t MFG NEW PHILADEIPHIA.CH ' signed: J) N""_c_c - — �, Name of Applicator of Name Resistant finish TENT DEPARTMENT--ANCHOR INDUSTRIES INC. J -t - p c z2 AlffiJiareera mieratarosom rdat ayraont intivrossm ingroamiLa aranr onus dino aoarararan . r zr< Y a. s. �1 c c c ClJ X S Jun 19 03 12: 07p Maria 303 p. 3 A,•! .• Ipe q .. wtinty. once • n ,....-r• -.....„ „4„:„.... .:.,,,, ., tit ywt .w 'arl. .. Barricade Fence ZyYw ^es yy "s A ry MlekRa • mtors Orange Safety a►ay..�r �eMh�'ee�qIjpj : ' 19 Highly visible orange safety fence clea, • °44retie� UV Stabilized. 4 X 100 ft. rolls y '�� p�Wifa6�� Conwed VISIO Fence :404:0vi MR�lateeenligea ►ac, X05229-004 Utility Fence 4yfiti*yeieeieelwee►®ee�ecte tY '`'sgltV'a 0,4%*'�p#.060�wra � Tenax Beacon Plus ' t `3;:q �:�asses 89903004 Utility Fence �Y � � Fence Poles & Ties er ,:z �� , - „ d Tenax Holes and Poles SystemTM consist � 1 w EI kF . , , , . Black plastic ties for utility fence applic boundaries 30113609 60 in. Holes and Poles 30010201 7 in. black plastic Ties 1000/pk T-ll4x • --rkIs -Crenet. iS _ . borace a S n 0n jra�`1 . • • • CITY OF GREELEY LICENSE 013073 • • • OWNER 13073 BW3RENEWAL 0560-00014 OROZCQ SECURITY GUARD AGENCY ' i 3.10 a7 3601 MAGNOLIA ST EVANS, CO 80620-0000 6 41�' ift CERTIFICATION SITE 4' ' 3601 MAGNOLIA ST A 0 2/07/200 3 EVANS. CO 80 62 0-0000 P RATM DATE : 12/3012003 C'r '11e V et 111'4 E 25.00 25.00 DUE lrt 3003 .00 • CODE TYPE OF CERTIFICATION ,I' BLSECURB SECURITY PATROL BUSINESS r 2003 BUSINESS LICENSE RENEWAL This license is issued subject to all the terms and provisions of ail of the ordinances of the City of Greeley in force and effect retallne hereto and is subject to revocation and upon these terms is so accepted by the licensee herein, named. Director of Finance POST IN CONSPICUOUS PLACE . , �y�,' OLD REPUBLIC SURETY COMPANY •s,n ` P 0 BOX 1976 DES MOINES, IA 50306 CONTINUATION CERTIFICATE WMWMER eora WACM,TaR ESFECTrve wTE EXPNUTION 0ATe RLI- 312224 SECURITY GUARD 12/31/2002 12/31/2003 OROZCO, YOLANDA OROZCO SECURITY GUARD AGENCY 3601 MAGNOLIA STREET EVANS, CO 80620 CITY OF GREELEY CITY HALL 701 10TH AVENUE GREELEY, CO 80631 • THIS BOND CONTINUES IN FORCE TO THE ABOVE EXPIRATION DATE CONDITIONED AND PROVIDED THAT THE LOSSES OR RECOVERIES ON xy:j:. IT AND ANY AND ALL ENDORSEMENTS SHALL NEVER EXCEED THE PENALTY SET FORTH IN THE BOND AND WHETHER THE LOSSES OR >a�< RECOVERIES ARE WITHIN THE FIRST SUBSEQUENT OR WITHIN ANY EXTENSION OR RENEWAL PERIOD,PRESENT,PAST OR FUTURE ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. SIGNED AND DATED THIS ELEVENTH DAY OF AUGUST, 2002 I % 7 40-4216 LINDEN/BARTELS & NOE . P O BOX 336640 OLD REPUBLIC SURETY COMPANY GREELEY, CO 80633 suR pUttur \ \s, S U R f J •,, O`rORgt°Co By��= y tt s Its u ,°i,;3:F' .1; '^ ,vF „4, H x OV.t.va' t',.i tS , 0 • I. :2 S •�� • S • OF ' COlO • • STATE RADO 187 . DEPARTMENT OF STATE CERTIFICATE I, DONETTA DAVIDSON, SECRETARY OF STATE OF THE STATE OF COLORADO HEREBY CERTIFY THAT . ACCORDING TO THE RECORDS OF THIS OFFICE RODRIGUEZ GALLEGOS BROADCASTING CORPORATION .� (COLORADO CORPORATION) FILE # 19981092645 WAS FILED IN THIS OFFICE ON May 19, 1998 AND HAS COMPLIED WITH THE APPLICABLE PROVISIONS OF THE LAWS OF THE STATE OF COLORADO AND ON THIS DATE IS IN GOOD STANDING AND AUTHORIZED AND COMPETENT TO TRANSACT BUSINESS OR TO CONDUCT ITS AFFAIRS WITHIN THIS STATE. , Dated: April 22, 2003 • ;(0a A L� 4 l� SECRETARY OF STATE eammiamos lalammeas Page 1 of 1 • j•• • Q1 Cyr\ _ If I r* STATE '� K :'ORADO DEPARTMENT OF STATE CERTIFICATE I,DONE TTA DAVIDSON.Secretary of State of the State of Colorado, herchy certify that.according to the records of this office, JACKES.LLC (Colorado LIMITED LIABILITY COMPANY File ff 20011032725 was filed in this office on February 13.2001 and has complied with the applicable provisions of the laws of the State of Colorado and on this date is in good standing and authorized and competent to transact business or to conduct its affairs within this state. Dated:June 2.2003 For Validation: Certificate ID: 671938 To validate this certlteals,visit the following web slit,enter this certificate 10,then follow the inaltud'ons dupteyed. W ww.$o$.state,co.utu Vui idateCertlff cats SECRETARY OF STATE • • http://www.sos.state.co.us/forte/corporation/images/docstmp/GS_20011032725.gif 6/9/2003 , FRCI1 : SUPER HOWL PORTABLE RESTROOMS FAX NO. : 3033416822 Aug. :1 2003 03:34PM P2 -v.4 Super Bowl Portable Restrooms,Inc. 3263 Oakland St Aurora,CO 80010 (303)341-6800, (303)341.6828 Fax Special Event Proposal Date:- August 11,2003 customer Name: La lay 1170 Contact: Ismael Phone#: 303-2104427 Fax#: 970-686.7700 Event'Narne: EventAddress: _ City: Longmont Event Date& Time.: September 13, 2003 PibklUp. Detively Date: September 13, 2003 Dicta: September 14,2003 Regilar Units ti .:. 13 t se0.00 7'ates. sva0.00 Deluxe Units ..10#00:',: • Total: 40.00 area IOW; „$O.Otl . Deluxe Units With Lights . .., Rl 'E Total: -$0.00 Super Deluxe Units Super Deluxe Units With Lights QM.:. MEW' Totet ..$0.00 Sink units :44,:c., 2 A -::$60.00 total; 5120.00 Disabled Accessible Units ( 2 Pjc Ess : 588.00 TOta1; $1T0A0 Just Like flume Units t11Jl =: '.=':'I., Tota1 , $0.00 Boxes ';'"-,,iii"...s Pdt�EB 1otd .i00o .'.: .�Liners . ilie 'eara . .. :Total:.'--$0.00 *dal cleans pates Weekday Services 28-27DAYS -,940.:::- �a , T6tak5 40.00 weekend Services 28-12DAYS OilkiL pfkie...g 'i:.. 'tat $0.00 Trash SErvio&S, -06991.•'. W Y �: ,. +! ROLL-OFF DELIVERY ¶utze x94, �_ __ ;FMloetio :T.otat $0.00 Roll-Offs za: ::: rifer ''. 'lntal• ••4o.00 t GRAND TOTAL: 51,070.00 Thank you for allowing ua to submit tithe repeaal.. We look forward to doing-business with youl Super Bowl Representative: ._.. QJowe og:;e4 ere Wig torso airy*. e Hello