HomeMy WebLinkAbout992034.tiff RESOLUTION
RE: APPROVE IMPROVEMENTS AGREEMENT ACCORDING TO POLICY REGARDING
COLLATERAL FOR IMPROVEMENTS (PRIVATE ROAD MAINTENANCE),
AUTHORIZE CHAIR TO SIGN, AND ACCEPT COLLATERAL FOR USE BY SPECIAL
REVIEW PERMIT#1214 -TONY DILLER
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,. by Resolution dated April 7, 1999, the Board approved a Site Specific
Development Plan and Special Review Permit#1214 for I-1 (Industrial) uses (manufacturing of
machined metal parts) in the C-3 (Commercial) Zone District, for Tony Diller, Bruce Victor, and
Jeff Giacomino, % Tony Diller, P.O. Box 88, Commerce City, Colorado 80037, on the following
described real estate, to-wit:
Part of the N1/2 NW'/ of Section 32, Township 2
North, Range 66 West of the 6th P.M., Weld
County, Colorado
WHEREAS„ pursuant to certain Conditions of Approval in said Resolution, the Board
has been presented with an Improvements Agreement According to Policy Regarding Collateral
for Improvements (Privately Road Maintenance) between the County of Weld, State of
Colorado, by and through the Board of County Commissioners of Weld County, and Tony Diller,
with terms and conditions being as stated in said agreement, and
WHEREAS, the Board has been presented with a letter stating Escrow Account
#4043011872 has been opened in the name of Anthony Diller at Norwest Bank Colorado, N.A.
Brighton Branch, 15 South Main Street, Brighton, Colorado 80601-1609, with a hold on it stating
"No withdrawals without a request from Weld County Board of Commissioners," and
WHEREAS., after review, the Board deems it advisable to approve said agreement and
accept collateral as stated above, copies of which are attached hereto and incorporated herein
by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Improvements Agreement According to Policy Regarding
Collateral for Improvements (Private Road Maintenance) between the County of Weld, State of
Colorado, by and through the Board of County Commissioners of Weld County, and Tony Diller,
be, and hereby is, approved.
BE IT FURTHER RESOLVED that Escrow Account#4043011872, which has been
opened in the name of Anthony Diller at Norwest Bank Colorado, N.A. Brighton Branch,
15 South Main Street, Brighton, Colorado 80601-1609, with a hold on it stating "No withdrawals
without a request from Weld County Board of Commissioners," be, and hereby is, accepted.
•
Pc —D a I I e a. 992034
PL1297
IMPROVEMENTS AGREEMENT - TONY DILLER
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 11th day of August, A.D., 1999.
:OARD OF COUNTY COMMISSIONERS
D COUNTY CO ORADO
ATTEST:,, //pp�,_�/� / �e4 i≥c'
1 Dale K. Hall, Chair
It
Weld County Clerk tot -'o �'
r86. .✓'
Barbara Kirkmeyer, o-Tem
BY: �A�o, �;C�t1.:.:
Deputy Clerk to the : t!1 N \ �, i �C e) .
♦ I /George' xter
_-7
APPROVED AS TO FORM•
C 'Cary Attorney -,
Gle n Vaad '
992034
PL1297
IMPROVEMENTS AGREEMENT ACCORDING
POLICY REGARDING COLLATERAL FOR IMPROVEMENTS
(PRIVATE ROAD MAINTENANCE)
3 2) THIS AGREEMENT,made and entered into this 30th day of June, 1999 ,by and between
the County of Weld.State of Colorado,acting through its Board of County Commissioners,hereinafter called
"County", and Tony ni l l ar (DVG. LLC) hereinafter called "Applicant".
WITNESSETH:
WHEREAS, Applicant is the owner of or has a controlling interest in the following described
property in the County of Weld, Colorado:
Part of the N1/2 NW1/4 of Section 32, Township 2
North, Range 66 West of the 6th P.14. , Weld County,Colorado
WHEREAS, a final subdivision/PUD plat of said property, to be known as
1712 Denver Ave. Fort Lupton, CO 80621 has been submitted to the County for
approval; and
WHEREAS, of the Weld County Subdivision Ordinance provides that no final plat
shall be approved by the County until the Applicant has submitted a Subdivision Improvement Agreement
guaranteeing the construction of the public improvements shown on plans,plats and supporting documents
of the subdivision, which improvements, along with a time schedule for completion, are listed in Exhibits
"A" and "B" of this Agreement.
NOW,THEREFORE,IN CONSIDERATION OF the foregoing and of the acceptance and approval
of said final plat,the parties hereto promise, covenant and agree as follows:
1.0 Engineering Services: Applicant shall furnish,at its own expense,all engineering services
in connection with the design and construction of the subdivision improvements listed on
Exhibit"A" which is attached hereto and made a part of this reference.
1.1 The required engineering services shall be performed by a Professional Engineer
and Land Surveyor registered in the State of Colorado, and shall conform to the
standards and criteria established by the County for public improvements.
1.2 The required engineering services shall consist of, but not be limited to, surveys,
designs,plans and profiles,estimates,construction supervision,and the submission
of necessary documents to the County.
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1.3 Applicant shall furnish drawings and cost estimates for roads within the subdivision
to the County for approval prior to the letting of any construction contract.
Applicant shall furnish one set of reproducible "as-built" drawings and a final
statement of construction cost to the County.
2.0 Rights-of-Wavand Easements: Before commencing the construction of any improvements
herein agreed upon,Applicant shall acquire,at its own expense,good and sufficient rights-
of-way and easements on all lands and facilities traversed by the proposed improvements.
3.0 Construction; Applicant shall furnish and install, at its own expense, the subdivision
improvements'isted on Exhibit"A:which is attached hereto and made a part hereof by this
reference,according to the construction schedule set out in Exhibit"B"also attached hereto
and made a part hereof by this reference.
3.I Said construction shall be in strict conformance to the plans and drawings approved
by the County and the specifications adopted by the County for such public
improvements. Whenever a subdivision is proposed within three miles of an
incorporated community located in Weld County or located in any adjacent county,
the Applicant shall be required to install improvements in accordance with the
requirements and standards that would exist if the plat were developed within the
corporate limits of that community. If the incorporated community has not adopted
such requirements and standards at the time the subdivision is proposed, the
requirements and standards of the County shall be adhered to. If both the
incorporated community an the County have requirements and standards, those
requirements and standards that are more restrictive shall apply.
3.2 Applicant shall employ,at its own expense,a qualified testing company previously
approved by the County to perform all testing of materials or construction that is
required by the County; and shall furnish copies of test results to the County.
3.3 At all times during said construction, the County shall have the right to test and
inspect or to require testing and inspection of material and work at Applicant's
expense. Any material or work not conforming to the approved plans and
specifications shall be removed and replaced to the satisfaction of the County at
Applicant's expense.
3.4 The Applicant shall furnish proof that proper arrangements have been made for the
installation of sanitary sewer or septic systems,water, gas, electric and telephone
services.
3.5 Said subdivision improvements shall be completed, according to the terms of this
Agreement,within the construction schedule appearing in Exhibit"B". The Board
of County Commissioners, at its option, may grant an extension of the time of
completion shown on Exhibit"B"upon application by the Applicant subject to the
terms of Section 6 herein.
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4.0 Release of Liability: Applicant shall indemnify and hold harmless the County from any
and all liability loss and damage county may suffer as a result of all suits, actions or claims
of every nature and description caused by, arising from, or on account of said design and
construction of improvements,and pay any and all judgments rendered against the County
on account of any such suit, action or claim, together with all reasonable expenses and
attorney fees incurred by County in defending such suit, action or claim whether the
liability,loss or damage is caused by,or arises out of the negligence of county or its officers,
agents, employees, or otherwise except for the liability, loss, or damage arising from the
intentional torts or the gross negligence of the county or its employees while acting within
the scope of their employment. All contractors and other employees engaged in construction
of the improvements shall maintain adequate workman's compensation insurance and public
liability insurance coverage, and shall operate in strict accordance with the laws and
regulations of the State of Colorado governing occupational safety and health.
(THERE IS NO SECTION 5)
6.0 Approval of Streets by the County: Upon compliance with the following procedures by the
Applicant,streets within a subdivision may be approved by the County as public roads and
will be maintained and repaired by a homeowners association or,in its absence,the owners
of lots within the subdivision.
6.1 If desired by the County, portions of street improvements may be placed in service when
completed according to the schedule shown on Exhibit"B",but such use and operation shall
not constitute an approval of said portions.
6.2 County may, at its option, issue building permits for construction on lots for which street
improvements detailed herein have been started but not completed as shown on Exhibit"B",
and may continue to issue building permits so long as the progress of work on the
subdivision improvements in that phase of the development is satisfactory to the County;
and all terms of this Agreement have been faithfully kept by Applicant.
6.3 Upon completion of the construction of streets within a subdivision and the filing of a
Statement of Substantial Compliance, the applicant(s) may request in writing that the
County Engineer inspect its streets and recommend that the Board of County Commissioners
partially approve them. Not sooner than nine months after partial approval, the County
Engineer shall, upon request by the applicant, inspect the subject streets, and notify the
applicant(s) of any deficiencies. The County Engineer shall reinspect the streets after
notification from the applicant(s)that any deficiencies have been corrected. If the County
Engineer finds that the streets are constructed according to County standards, he shall
recommend full approval. Upon a receipt of a positive unqualified recommendation from
the County Engineer for approval of streets within the development, the Board of County
Commissioners shall fully approve said streets as public but with private pay.
7.0 General Requirements for Collateral:
7.1 The value of all collateral submitted to Weld County must be equivalent to 100%
of the value of the improvements as shown in this Agreement. Prior to Final Plat
approval,the applicant shall indicated which of the five types of collateral prefered
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to
to be utilized to secure the improvements subject to final approval by the Board of
County Commissioners and the execution of this Agreement. Acceptable collateral
shall be submitted and the plat recorded within six (6) months of the Final Plat
approval. If acceptable collateral has not been submitted within six(6)months then
the Final Plat approval and all preliminary approvals shall automatically expire. An
applicant may request that the County extend the Final Plat approval provided the
cost estimates are updated and the development plans are revised to comply with all
current County standards, policies and regulations. The improvements shall be
completed within one (1) year after the Final Plat approval (not one year after
acceptable collateral is submitted) unless the applicant(s) requests that this
Agreement be renewed at least thirty (30) days prior to its expiration and further
provides that cost estimates for the remaining improvements are updated and
collateral is provided in the amount of 100% of the value of the improvements
remaining to be completed. If improvements are not completed and the agreement
not renewed within these time frames, the County, at its discretion, may make
demand on all or a portion of the collateral and take steps to see that the
improvements are made.
7.2 The applicant may choose to provide for a phased development by means of
designating filings of a Planned Unit Development Plan or Final Plat Subdivision.
The applicant would need only to provide collateral for the improvements in each
filing as approved. The County will place restrictions on those portions of the
property that are not covered by collateral which will prohibit the conveyance of the
property or the issuance of building permits until collateral is provided or until
improvements are in place and approved pursuant to the requirements for a Request
for Release of Collateral.
7.3 The applicant intends to develop in accordance with Exhibits "A" and "B".
8.0 Improvements Guarantee: The five types of collateral listed below are acceptable to Weld
County subject to final approval by the Board of County Commissioners.
8.1 An irrevocable Letter of Credit from a Federal or State licensed financial institution
on a form approved by Weld County. The letter of credit shall state at least the
following:
8.1.1 The Letter of Credit shall be in an amount equivalent of 100%of the total
value of the improvements as set forth in Section 6.0 and exhibits "A" and
"B„
8.1.2 The Letter of Credit shall provide for payment upon demand to Weld
County if the developer has not performed the obligations specified in the
Improvements Agreement and the issuer has been notified of such default.
8.1.3 The applicant may draw from the Letter of Credit in accordance with the
provisions of this policy.
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8.1.4 The issuer of the Letter of Credit shall guarantee that at all times the
unreleased portion of the Letter of Credit shall be equal to a minimum of
100%of the estimated costs of completing the uncompleted portions of the
required improvements, based on inspections of the development by the
issuer. In no case shall disbursement for a general improvement item
exceed the cost estimate in the Improvements Agreement (i.e., streets,
sewers, water mains and landscaping, etc.). The issuer of the Letter of
Credit will sign the Improvements Agreement acknowledging the
agreement and its cost estimates.
8.1.5 The Letter of Credit shall specify that 15% of the total Letter of Credit
. amount cannot be drawn upon and will remain available to Weld County
until released by Weld County.
8.1.6 The Letter of Credit shall specify that the date of proposed expiration of the
Letter of Credit shall be either the date of release by Weld county of the
final 15%, or one year from the date of Final Plat approval, whichever
occurs first. Said letter shall stipulate that, in any event, the Letter of
Credit shall remain in full force and effect until after the Board has
received sixty (60) days written notice from the issuer of the Letter of
Credit of the pending expiration. Said notice shall be sent by certified mail
to the Clerk to the Board of County Commissioners.
8.2 Trust Deed upon all or some of the proposed development or other property acceptable to
the Board of County Commissioners provided that the following are submitted:
8.2.1 In the event property within the proposed development is used as collateral, an
appraisal is required of the property in the proposed development by a disinterested
M.A.I. member of the American Institute of Real Estate Appraisers indicating that
the value of the property encumbered in its current degree of development is
sufficient to cover 100% of the cost of the improvements as set forth in the
Improvements Agreement plus all costs of sale of the property.
8.2.2 In the event property other than the property to be developed has been accepted as
collateral by Weld County,then an appraisal is required of the property by a M.A.I.
member of the Institute of Real Estate Appraisers indicating that the value of the
property encumbered in its current state of development is sufficient to cover 100%
of the cost of the improvements as set forth in the Improvements Agreement plus
all costs of sale of the property.
8.2.3 A title insurance policy insuring that the Trust Deed creates a valid encumbrance
which is senior to all other liens and encumbrances.
8.2.4 A building permit hold shall be placed on the encumbered property.
8.3 Escrow Agreement that provides at least the following:
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8.3.1 The cash in escrow is at least equal to 100% of the amount specified in the
Improvements Agreement.
8.3.2 The escrow agent guarantees that the escrowed funds will be used for improvements
as specified in the agreement and for no other purpose and will not release any
portion of such funds without prior approval of the Board.
8.3.3 The escrow agent will be a Federal or State licensed bank or financial institution.
8.3.4 If the County of Weld County determines there is a default of the Improvements
Agreement, the escrow agent, upon request by the County, shall release any
remaining escrowed funds to the County.
8.4 A surety bond given by a corporate surety authorized to do business in the State of Colorado
in an amount equivalent to 100% of the value of the improvements as specified in the
Improvements Agreement.
8.5 A rash deposit made with the County equivalent to 100%of the value of the improvements.
9.0 Request for Release of Collateral: Prior to release of collateral for the entire project or for
a portion of the project by Weld County, the Applicant must present a Statement of
Substantial Compliance from an Engineer registered in Colorado that the project or a portion
of the project has been completed in substantial compliance with approved plans and
specifications documenting the following:
9.1 The Engineer or his representative has made regular on-site inspections during the
course of construction and the construction plans utilized are the same as those
approved by Weld County.
9.2 Test results must be submitted for all phases of this project as per Colorado
Department of Transportation Schedule for minimum materials sampling, testing
and inspections found in CDOT Materials Manual.
9.3 "As built" plans shall be submitted at the time the letter requesting release of
collateral is submitted. The Engineer shall certify that the project "as built" is in
substantial compliance with the plans and specifications as approved or that any
material deviations have received prior approval from the County Engineer.
9.4 The Statements of Substantial Compliance must be accompanied,if appropriate,by
a letter of acceptance of maintenance and responsibility by the appropriate utility
company, special district or town for any utilities.
9.5 A letter must be submitted from the appropriate Fire Authority indicating the fire
hydrants are in place in accordance with the approved plans. The letter shall
indicate if the fire hydrants are operational and state the results of fire flow tests.
9.6 The requirements in 9.0 thru 9.5 shall be noted on the final construction plans.
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9.7 Following the submittal of the Statement of Substantial Compliance and
recommendation of approval of the streets by the County, the applicant(s) may
request release of the collateral for the project or portion of the project by the
Board. This action will be taken at a regularly scheduled public meeting of the
Board.
9.8 The request for release of collateral shall be accompanied by"Warranty Collateral"
in the amount of 15%of the value of the improvements as shown in this Agreement
excluding improvements fully accepted for maintenance by the responsible
governmental entity, special district or utility company.
9.9 The warranty collateral shall be released to the applicant upon final approval by the
Board of County Commissioners.
10.0 Public Sites and Open Spaces: When the Board of County Commissioners, pursuant to a
rezoning, subdivision or planned unit development, requires the dedication, development
and/or reservation of areas or sites other than subdivision streets and utility easements of a
character, extent and location suitable for public use for parks, greenbelts or schools, said
actions shall be secured in accordance with one of the following alternatives,or as specified
in the PUD plan, if any:
10.1 The required acreage as may be determined according to the Weld County
Subdivision Regulations shall be dedicated to the County or the appropriate school
district, for one of the above purposes. Any area so dedicated shall be maintained
by the County or school district.
10.2 The required acreage as determined according to the Weld County Subdivision
Regulations, may be reserved through deed restrictions as open area, the
maintenance of which shall be a specific obligation in the deed of each lot within
the subdivision.
10.3 In lieu of land,the County may require a payment to the County in an amount equal
to the market value at the time of final plat submission of the required acreage as
determined according to the Subdivision Ordinance. Such value shall be
determined by a competent land appraiser chosen jointly by the Board and the
Applicant. The cash collected shall be deposited in an escrow account to be
expended for parks at a later date.
11.0 Successors and Assigns: This Agreement shall be binding upon the heirs, executors,
personal representatives,successors and assigns of the Applicant,and upon recording by the
County, shall be deemed a covenant running with the land herein described, and shall be
binding upon the successors in ownership of said land.
IN WITNESS WHEREOF,the parties hereto have caused this Agreement to be executed on
the day and year first above written.
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BOARD OF COUNTY COMMISSIONERS
LD COUNTY,COLORADO
D: e K. I, �P.ir, (08/11/99)La ,ar..ra J. Ki- eyer„ hai Protem
ATTEST: 4 S� r {� /�l a,f,� �� r
no ti '1k9 G _e ,Baxter
Weld County Clerk to the B i: d
BY:_,"4„1 _:,_/
Deputy Clerk to the Board `,�� enn Vaa:
APPROVED AS TO FORM:
ounty Attorney
APPLICANT
r / ->"2 fie
BY: /,- .��%i �Yfi 1%ry/
(title)
Subscribed and sworn to before me this day of I)P 1,794 ..)J , 19 L/17
My Co mission expires: J4 �l- , /( =///(C//
'a -,`7--,//// Notary' Public
i[
SHERYL L. LOCKMAN
NOTARY PUBLIC
STATE OF COLORADO 2
M:FORM\UPRNATE.DB
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EXHIBIT"A"
thlomookladidtpmx i1SR# 1714
Filing:
Location: 1717 Tlanver Ave Fort T.upton, (`n Rnfi71
Intending to be legally bound, the undersigned Applicant hereby agrees to provide throughout this
subdivision and as shown on the subdivision final plat County dated , 19
recorded on , 19 , in Book , Page No. , Reception No.
, the following improvements.
(Leave spaces blank where they do not apply)
Estimated
Improvements Unit Cost Construction Cost
EXdF1eK&Il�d(nX ( rivate Parkin Tot1 77 Snn nn
Street base
Street paving
Curbs, gutters,& culverts
Sidewalk
Storm sewer facilities
Retention ponds
Ditch improvements
Subsurface drainage
Sanitary sewers
Sanitary sewers
Trunk & forced lines
Mains
Laterals(house connected)
On-site sewage facilities
On-site water supply& storage
Water mains-Includes Bore
Fire hydrants
Survey & street monuments & boxes
Street lighting
Street name signs
Fencing requirements
Landscaping 4.875.00
Park improvements
Road Culvert
Grass Lined Swale
Telephone
Gas
Electric
Water Transfer
SUB-TOTAL $77,476 nn
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Engineering and Supervision Costs
(testing, inspection,as-built plans and work in addition to preliminary and final plat;supervision of actual
construction by contractors)
TOTAL ESTIMATED COST OF IMPROVEMENTS AND SUPERVISION $27,325.00
The above improvements shall be constructed in accordance with all County requirements and specifications,
and conf ce with this provision shall be determined solely by Weld County,or its duly authorized agent.
S ov ments shall be completed according-ti; the construction schedule set out in Exhibit"B".
(In corporation,to be signed by President and attested to by Secretary,together with corporate seal.)
Date: August 3rd , 19 99
Corporate Seal
DVG LLC
i
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EXHIBIT "B"
ITIMMNSI'CaNticX715)MXX IO.SR# 1714
Filing:
Location: 1712 Denver Ave Fort T.npton, CO R0621
Intending to be legally bound,the undersigned Applicant hereby agrees to construct the
improvementsshown on the final subdivision plat of Subdivision,
dated , 19 ,Recorded on 19 , in Book
,Page No._ , Reception No. ,the following schedule.
All improvements shaH be completed within years from the date of approval of the
final plat.
Construction of the improvements listed in Exhibit"A" shall be completed as follows:
(Leave spaces blank where they do not apply.)
Improvements Time for Completion
Sitettad g (Private Parking Lot) December 31. 1999
Street base
Street paving
Curbs, gutters, and culverts
Sidewalk
Storm sewer facilities
Retention ponds
Ditch improvements
Subsurface drainage
Sanitary sewers
Trunk and forced Lines
Mains
Laterals(house connected)
On-site sewage facilities
On-site water supply and storage
Water mains
Fire hydrants
Survey & street monuments& boxes
Street lighting
Street name signs
Fencing requirements
Landscaping December 31, 1999
Park improvements
Telephone
Gas
Electric
Water Transfer
Sub-Total
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The Coun at its option, and upon the request by the Applicant, may grant an extension of time for
completi n s r any particular improvements shown above, upon a showing by the Applicant that the
ab.v ed le-cannot be met. /0"41144
(If corporation,t e signed by Presi t and attested to by Secretary,together with corporate seal.)
Corporate Seal Date: June, 30 , 19 99 .
DVG,LLC
mMomn\aprivue.db
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T
From: LEE MORRISON
To: slockman
Date: 7/23/99 5:08pm
Reply requested when convenient
Diller
The improvements agreement is satisfactory
the collateral is also satisfactory as an escrow.
The items can be placed on the agenda as approve improvements agreement and
approve form of collateral.
Lee D. Morrison
Assistant Weld County Attorney
frirskiNit ' MEMORANLIJM
TO: Sheri Lockman, Planner DATE: July 7, 1999
WI D FROM: Donald Carroll, Engineering Administrator t
SUBJECT: USR-1214; Tony Diller, Bruce Victor, and Jeff Giacomino
COLORADO
At the request of Planning Services, I reviewed the Improvements Agreement According Policies Regarding
Collateral for Improvements (Private Road Maintenance) for Tony Diller(DVG, LLC). Exhibit A has been changed
to a private parking lot estimate for asphalt and base. This number appears to be adequate to complete the work
and this Weld County Public Works Department has no conflict with this proposal.
cc: USR-1214
plan37
We!d County Planning Dept.
JUL 12 1999
RECEIVED
‘1)(frariMEMORANDUM
ViseTO: Board of County Commissioners July 28, 1999
COLORADO FROM: Sheri Lockman, Planner
SUBJECT: USR-1214
Planning Staff has reviewed the landscaping section of the improvements agreement and find it
satisfactory.
Account Application/information
• ' BANKS
Bank name
NORWEST BANK COLORADO, N.A. BRIGHTON
Account(s)I Want to Open Bank Use Only
•
CLASSPLUS SAVINGS 01017 K5342 05/14/1999 13:52 1630
Customer Information SOLE OWNER _ Customer lnforn
Full name Full name
ANTHONY DILLER •
Street addresT How long at rhioaddress Street address it) ` How long at this address
Yr Yr Mo
13615 WELD CNTY ROAD 2 5 5
City State—Zip code Cntry City State code Cntry
4
BRIGHTON CO 80601
Taxpayer identification number(TIN) Home phone Taxpayer Identification number(TIN) Home phone .
521-15-0267 303/659-6827
Previous street address How long at this address Previous street address How long at this address
Yr Yr Mu
City State Zip code City State Zip code
Current employer _ ... Business telephone number Current employer Business telephone number
TD MACHINING 303/289-2325
Current employer's address How long with employer Current employer's address How long with employer
Yr Mo Yr Mo
13 6
City State Zip code City State Zip code
Driver's license or other identification number Date of birth Driver's license or other identification number Date of birth
DL 02/28/1961
My Previous Account (most recent)
Name of financial institution and city � - Checking account number
NBBR ._ BRIGHTON 404301
Verification
EXISTING NORWEST CUSTOMER
Complete the section below which applies to you, either Substitute Form W-9 or W-8
Request for Taxpayer Identification Number and Certification (Substitute Form W-9)
Certification: Under penalties of perjury, 1 certify that:
I) The number shown on this form is my correct Taxpayer Identification Number, and
2) UNLESS I HAVE CHECKED ONE OF THE BOXES BELOW, I am not subject to backup withholding either because I have not been notified by the
internal Revenue Service(IRS) that i am subject to backup withholding as a result of a failure to report all interest or dividends, or the IRS has notified
me that/am no longer subject to backup withholding (does not apply to real estate transactions, mortgage interest paid, the acquisition or
abandonment of secured property, ,:ontributions to an Individual Retirement Arrangement(IRA), and payments other than interest and dividends).
ElI am subject to backup withholding. Li l am exempt from backup withholding. Signature
X
Foreign Status Certificate of Foreign Status (Substitute Form W-8)
Certification. Under the penalties of perjury, I certify that, I am not a U.S. citizen or resident, or I am an exempt foreign person.
Signature ------
X
•
Signatures # SIG REQ: 1
Everything 1 have stated in this application is correct to the best of my knowledge. I understand that you-will retain this application. You are authorized
to check my credit and employment history and to answer questions about your credit experience with me. I have received a copy of your Deposit
Account Agreement and Use of Information brochure and i agree to be bound by them. If indicated above, i have requested a debit card.
For accountnumber(s) 4043011872 Types) S TIN 521-15-0267 Y
_
Authorized signature Dare _._
X _ ANTHONY DILLER
Authorized signature - Date ESCROW ACCOUNT
X PO BOX 88
Authorized signature - Dale - COMMERCE CITY CO 80037
X
Authorized signature _--_—_— Date- -
-- --
X
NC 74089 MUi 16.98-222903-J) Pli
�K Norwest Bank Cokradc N.A.
NCRWE4 BANKS Brighton
NMI 15 South Main Street
NN IM Brighton, Colorado 80E0'-1609
303/659-0350
June 30, 1999
Wi;ld County Board of Commissioners
To Whom It May Concern:
A Money Market Savings Account has been opened in the name of Anthony Diller, Escrow
Account at Norwest Bank Colorado, NA Brighton branch. The account number is 4043011872
and the account has a hold on it stating that "No withdraws with out a request from Weld County
Board of Commissioners".
Please call me if you have any questions, 303 655-3130.
Thank you,
Joey-Smith
Hello