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Home My WebLink About20190617.tiffBOARD OF COUNTY COMMISSIONERS PASS -AROUND REVIEW/Regular or Consent Hearing Agenda REQUEST RE: BOCC Agenda Item - Approve Road Maintenance Agreement for: Rocky Mountain Midstream, LLC — USR18-0053 DEPARTMENT: Public Works DATE: January 16, 2019 PERSON REQUESTING: Tisa Juanicorena Brief description of the issue: The Department of Public Works received a request from qhe applicant, Rocky Mountain Midstream, LLC, requesting that the Board of County Commissioners consider approving the Road Maintenance Agreement during the Construction Period for (USR18-0053). No collateral is required with this agreement. Weld County Public Works, Planning Services and the County Attorney's Office have reviewed the above -mentioned signed original document and observed the following: • All Public Works related items, of the "Road Maintenance Agreement According To Policy", are found to be acceptable. • This Agreement complies with the terms of the Use by Special Review Permit Resolution, as signed by the Board of County Commissioners. What options exist for the Board? 1. Have this BOCC Hearing item be placed on the next available agenda as part of the Consent Agenda. 2. Have this BOCC Hearing item be placed on the next available agenda as part of the Regular Agenda. Recommendation: Option 1. The Departments of Public Works, Planning Services and the County Attorney's Office are recommending approval of the Road Maintenance Agreement According To Policy for USR 18-0053, and that this item be placed on the next regularly scheduled BOCC Hearing, as part of the Consent Agenda. v Sean P. Conway Scott K. James Steve Moreno Mike Freeman, Pro-Tem Barbara Kirlaneyer, Chair 02- - 9 Approve Recommendation mC Schedule as Regular BOCC Hearing Item Other/Comments: cc RA;(-r1'lEP),PLCKo) Ooh/ &51(9 a-0210 goi-P 2019-0617 /4L G257, 964 =Mama Tal,PNIM, ROAD MAINTENANCE AGREEMENT ACCORDING TO REQUIREMENTS DURING THE CONSTRUCTION PERIOD Rocky Mountain Midstream, LLC — USR18-0053 THIS AGREEMENT is made this 11th day of January, 2019, by and between Rocky Mountain Midstream, LLC, a corporation organized under the laws of the State of Colorado, whose address is 7859 Walnut Hill Lane, Suite 335, Dallas, Texas 75230, hereinafter referred to as "Property Owner," authorized to do business in the State of Colorado, and the County of Weld, a body corporate and politic of the State of Colorado, by and through its Board of County Commissioners, whose address is 1150 "O" Street, Greeley, Colorado 80631 hereinafter referred to as "County." WITNESSETH: WHEREAS, Property Owner is the owner of the following described property in the County of Weld, Colorado: Lot A of Recorded Exemption, RECX18-0083; being part of the E1/2 SE1/4 of Section 28, Township 1 North, Range 67 West of the 6th P.M., Weld County, Colorado hereinafter referred to as "the Property," and WHEREAS, Property Owner has received Board of County Commissioner approval of USR18-0053, and WHEREAS, the Property Owner facility will generate additional vehicles and heavy traffic directly associated with USR18-0053, for an extended period of time; and WHEREAS, the County, and Property Owner are desirous of agreeing to terms involving regulation of haul routes, traffic control, and road wear arising from such additional traffic. NOW, THEREFORE, IN CONSIDERATION OF the foregoing and of the promises and covenants contained herein, the parties hereto promise, covenant and agree as follows: Part I: SITE SPECIFIC PROVISIONS A. Reserved B. HauUTravel Routes: The Property Owner shall be financially responsible for its proportional share of the associated costs for maintaining and/or improving designated haul/travel routes. 1.0 Haul Routes. The following roads are designated as haul/travel routes for the Property: 1) North and south along CR 19. 2.0 Haul trucks shall enter and exit the site at the approved access(es) on CR 19 and travel north -south for further dispersal. Any County roads used by traffic associated with USR18-0053 may become part of the established haul/travel routes. 3.0 Weight Limits. No travel vehicles may exceed CDOT required specifications for pounds -per -axle and axle configurations unless overweight permits have been applied for and granted. 4466978 Pages: 1 of 6 02/14/2019 11:33 AM R Fee:$0.00 Carly Kcppes Clerk and Recorder. Weld County. CO - USRI8-0053 RMCA 6 020/9-b67 4.0 Temporary Deviations. In unusual or rare occasions, if projects mandate deviation from the above -mentioned haul/travel route for a limited period (six months or less), Weld County Public Works may authorize, in writing, the deviation. In that circumstance, haul/travel vehicles will utilize paved county roads whenever possible. A deviation from the established haul/travel route lasting more than six (6) months or requests for one (1) or more deviations within a 12 -month period shall authorize the County to change the haul/travel routes designated herein, and provide notice to the Property Owner. 5.0 Haul Route Signage. Property Owner shall install travel route signs, if applicable, as per Manual of Uniform Traffic Control Devices standards, at all exit points of the Property which can be clearly seen by drivers leaving the facility and which clearly depict County approved travel routes. 6.0 No Deviation from Permitted Haul Routes. Except as authorized by the Board pursuant to this Agreement, no use of any roads other than those specifically authorized for use in this Agreement is permitted without the prior written amendment of this Agreement. C. Maintenance Requirements: 1.0 Off -Site Dust ControUAbatement: The Property Owner is required to provide dust abatement along affected haul route roads, as determined by the County. County will determine the proportionate share of dust control to be paid by Property Owner. The amount and extent of dust control measures will be determined by site -specific conditions at the time, as determined exclusively by County personnel. The County reserves the right to install traffic counters on the driveway(s) of the Property Owner's facility. The County will have sole responsibility for determination of the percentage of haul route traffic on all affected roads. 2.0 Obligation to Maintain Current and Future Haul Routes: Property Owner will be financially responsible for the excavation, repair, and patching of any damage on current or future haul route roads, which in the sole opinion of County has been created by vehicle traffic to and from the Property. Should Property Owner's site activities or vehicle circulation patterns change in the future so that County approves an alternate haul route, and all or a significant portion of Property Owner's sourced traffic no longer utilizes the above -described haul route and instead utilizes other portions of County roads, Property Owner shall cooperate with County in maintenance of said roads which are included within the new haul route. The type and method of repair will be determined by the County Engineer or his representative. Repairs shall commence within 48 hours of notification by the County for any roadway damage that exposes the driving public to adverse or unsafe driving conditions. All other repairs shall commence within thirty (30) days of receipt of Weld County's written notice. 2.1 Need for Immediate Repairs: In the event of damage to an Approved Haul Route by Project traffic that causes an immediate threat to public health and safety or renders the road impassible ("Significant Damage"), County shall, after inspection, notify Property Owner of such Significant Damage. Property Owner shall identify the repair required and shall consult with County on the extent, type, timing, materials and quality of repair (i.e. temporary versus permanent) within twenty-four (24) hours after receipt of such notice and shall commence such repair within forty-eight (48) hours after receipt of such notice. If Property Owner identifies Significant Damage prior to receiving notice thereof from County, Property Owner may commence repair of such Significant Damage and shall concurrently notify County of the extent, type, timing, materials and quality of repair (i.e. temporary versus permanent). 2.2 Repair of Road: On or before December 31 of the calendar year in which County staff has determined through site analysis and/or pavement testing that a particular haul route road portion will require paving measures in order to protect the public health, safety, and welfare, and has budgeted sufficient funds for the following calendar year to pay its share of the Off -Site Improvement/Repair Costs, County shall notify Property Owner in writing that the Off -Site Improvements/Repairs shall be undertaken. Within ninety (90) days of its receipt of County's 4466978 Pages: 2 of 6 02/14/2019 11:33 AM R Fee:$0.00 Carly Kopues, Clerk and Recorder, Weld County CO ®Ill tigdrillNi rli:IC!! LLC - USR18-0053 - RMCA '.of6 notice of the need to undertake the road maintenance repairs and/or improvements, Property Owner shall submit Off -Site Construction Plans and Cost Estimates to County for review. Property Owner shall have sole responsibility for the completion of the repairs and/or improvements on or before December 15 of the year following County's notice of the need for repairs. 2.3 In County's sole discretion, County may undertake the repairs and/or improvements. Property Owner's payment for its Proportionate Share of the road repairs/improvements will be calculated as described in this Agreement. 3.0 Annual Road Inspection: County may conduct a road inspection annually with the cooperation of Property Owner and all other Property Owner and/or Lessees who are required by County to participate in road improvement/maintenance agreements. As a result of the annual inspection, County, in its sole discretion, shall determine actual conditions and shall further determine what road repair/improvement/maintenance work is to be performed during that construction season. Notification to the Property Owner of the required roadway repairs will be given as soon as the data becomes available. 4.0 Proportionate Share of Road Maintenance Responsibilities: 4.1 Property Owner shall pay its Proportionate Share of costs of dust control/abatement, paving, repairs, maintenance, improvements, or future road replacement of any particular Haul Route Road. Property Owner's Proportionate Share shall be based upon the percentage of traffic on the road that is attributable to Property Owner's facility. County personnel will determine the percentage based on then current Equivalent Single Axle Load (ESAL) Counts. Property Owner shall not be responsible for traffic that is not sourced from the Property Owner's facility. 4.2 The County shall notify Property Owner of County's preliminary determination and assessment of Property Owner's proportionate share of costs. Prior to County's final determination and assessment, County shall provide Property Owner with a reasonable opportunity to review, comment upon and supplement County's data, collection methodology, and determinations. The County shall review and consider Property Owner's input prior to making a final determination and assessment. The County shall have sole responsibility for determination of Property Owner's proportionate share of costs. Part H: GENERAL PROVISIONS A. General Requirements: 1.0 Permits. Property Owner must still apply for and abide by the terms of any necessary right-of-way permits, grading permits, and building permits. No work may occur in the County's right-of-way without a County -issued right-of-way permit and access permit. 2.0 Release of Liability: Property Owner 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 the site specific Use associated with USR18-0053, 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 the 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. 3.0 Liability for Damage to Road. Property Owner shall be financially responsible for any and all damage caused to any Weld County Road as a result of the design and construction of the site specific Use associated 4466978 Pages: 3 of 6 02/14/2019 11:33 AM R Fee:$0,00 Carly Koppes, Clerk and Recorder, Weld County: CO - USRI8-0053 - RMCA 6 with USR18-0053, without regard to the negligence, or lack thereof, of Property Owner or its agents. This provision shall survive Termination of this Agreement pursuant to section B.2.0, below, and shall be of no further force and effect ten years after mutual execution of this Agreement. B. Violations of Agreement and Remedies 1.0 Violation of Terms of Agreement: If in County's reasonable opinion, Property Owner has violated any of the terms of this Agreement, County shall so notify Property Owner and shall state with specificity the facts and circumstances which County believes constitute the violation. Property Owner shall have thirty (30) days within which to either cure the violation or demonstrate compliance. Thereafter, County may seek any remedy described in this Agreement or otherwise provided by law. 2.0 Termination of Agreement: Termination Event: This Agreement shall terminate upon the earliest of the following events: 2.1 Cessation of all Permit Related Activities: Termination of this Agreement shall occur upon Property Owner's complete cessation of all activities permitted by the USR. A partial cessation of activities shall not constitute a Termination of this Agreement, nor shall County's issuance of a partial release constitute a Termination. Unless informed in writing by the Property Owner of cessation of activities, and verified by the County, cessation shall be presumed if the County determines that the USR has been inactive for three (3) years. 2.2 Execution of Replacement Agreement: This Agreement shall terminate following County's execution of a new Improvements Agreement with a new Property Owner or Operator who has purchased the Property or has assumed the operation of the business permitted by the USR, and intends to make use of the rights and privileges available to it through the then existing USR. 2.3 Revocation of USR: This Agreement shall terminate following County's revocation of Property Owner's USR, except that the Property Owner shall only be released from this Agreement after the successful completion of all improvements required under this Agreement. 2.4 Completion of Construction: This Agreement shall terminate following Property Owner's completion of construction of the facilities authorized by the underlying USR. Property Owner shall notify the County of completion. 3.0 Revocation of USR: Property Owner acknowledges that failure to comply with the material terms of this Agreement constitutes cause to revoke the USR, and County may exercise this option in its sole reasonable discretion by proceeding with revocation under the then current provisions of the Weld County Code. 4.0 Court action: Upon notice of violation and failure to cure within the time permitted by this Agreement, County may seek relief in law or equity by filing an action in the Weld District Court. C. Miscellaneous Provisions. 1.0 Definitions: 1.1 All references in this Agreement to "County Engineer" shall refer to the any individual or individuals appointed by the County Engineer to act on his/her behalf. 1.2 All references to "Haul Routes" include identified travel routes for subdivisions; references to "haul vehicles" include subdivision vehicular traffic, as applicable. 4466978 Pages: 4 of 6 02/14/2019 11:33 AM R Fee:$0.00 Carly Koppes. Clerk and Recorder, Weld County, CO kir atiMI4IWI IlDilif'tt! i G GRtION! ,�' , ! III ,C - USR18-0053 - RMCA f 6 1.3 All references to "Property Owner" shall include any individual or entity, including an "Operator", who is acts on behalf of the Property Owner regarding this Agreement. 2.0 Successors and Assigns: This Agreement may not be delegated, transferred or assigned in whole or in part by Property Owner without the express written consent of County and the written agreement of the party to whom the obligations under this Agreement are assigned. Property Owner's release of its obligations shall be accomplished by County's execution of a new Improvements Agreement with the successor owner of the property. Consent to a delegation or an assignment will not be unreasonably withheld or delayed by County. County's rights and obligations under this Agreement shall automatically be delegated, transferred or assigned to any municipality which, by and through annexation proceedings, has assumed jurisdiction and maintenance responsibility over the roads affected by this Agreement. All of the terms and conditions set forth in this Agreement shall be binding upon the heirs, executors, personal representatives, successors and assigns of Property Owner, and upon recording by the County, shall be deemed a covenant running with the land herein described. 3.0 Governmental Immunity: No term or condition of this agreement shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 4.0 No Third Party Beneficiary Enforcement: It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person or entity not included in this Agreement. It is the express intention of the undersigned parties that any person or entity, other than the undersigned parties, receiving services or benefits under this Agreement shall be an incidental beneficiary only. 5.0 Entire Agreement/Modifications: This Agreement including the Exhibits attached hereto and incorporated herein, contains the entire agreement between the parties with respect to the subject matter contained in this Agreement. This instrument supersedes all prior negotiations, representations, and understandings or agreements with respect to the subject matter contained in this Agreement. This Agreement may be changed or supplemented only by a written instrument signed by both parties. 6.0 Board of County Commissioners of Weld County Approval: This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld County, Colorado or its designee. 7.0 Choice of Law/Jurisdiction: Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute between the parties, Property Owner agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 8.0 Severability: If any term or condition of this Agreement shall be held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, this Agreement shall be construed and enforced without such provision, to the extent that this Agreement is then capable of execution within the original intent of the parties. 9.0 Attorneys Fees/Legal Costs: In the event of a dispute between County and Contract Professional, concerning this Agreement, the parties agree that each party shall be responsible for the payment of attorney fees and/or legal costs incurred by or on its own behalf. 10.0 Binding Arbitration Prohibited: Weld County does not agree to binding arbitration by any extra- judicial body or person. Any provision to the contrary in this Agreement or incorporated herein by reference shall be null and void. 4466978 Pages: 5 of 6 02/14/2019 11:33 AM R Fee:$0.00 Carly Koppes Clerk and Recorder Weld County CO ■III �!��r ' ��Y I�h ah'� F:r Rocky Mountain Midstrear Pag 11.0 Authority to Sign: Each person signing this Agreement, and associated Exhibits, represents and warrants that he or she is duly authorized and has legal capacity to execute and deliver this Agreement. Each party represents and warrants to the other that the execution and delivery of the Agreement and the performance of such party's obligations hereunder have been duly authorized and that the Agreement is a valid and legal agreement binding on such party and enforceable in accordance with its terms. If requested by the County, Property Owner shall provide the County with proof of Property Owner's authority to enter into this Agreement within five (5) days of receiving such request. PROPERTY OWNER: Rocky Mountain Midstream, LLC By: Date: January 11, 2019 Name: Blaine Pritchett Title: Projects Manager, Rocky Mountain Midstream, LLC STATE OF COLORADO SS. COUNTY OF WELD The foregoing instrument was acknowledged before me this 11th day of January, 2019, by Blaine Pritchett, Projects Manager, Rocky Mountain Midstream, LLC. WITNESS my hand and official seal. STACIE L REIBER NOTARY PUBLIC STATE OF COLORADO NOTARY ID 20134060847 Ct4MISSION EXPIRES SEPTEMBER 25, 2021 Notary Public WELD COUNTY: �G� ATTES . �,�a/1J W. ;ti BOARD OF COUNTY COMMISSIONERS Weld o nt, Clerk to the Bo rd WELD COUNTY, COLORADO BY: Deputy Cl:'k to the Boar 4466978 Pages 6 of 6 02/14/2019 11:33 AM R Fee:$0.00 Carly Koppel, Clerk and Recorder, Weld County. CO dill PiiilakJ�IioJ, IVY.I 'Iri' krldi PJfilV:l'47 K,V. ike Freeman, Pro-Tem FEB 06 2019 Rocky Mountain Midstream, LLC - USR18-0053 - RMCA Page 6 of 6 a0/9 -0e,./7 4458875 01/09/2019 03:03 PM Total Pages: 1 Rec Fee: $13.00 Doc Fee: $20.00 Carly Koppes - Clerk and Recorder, Weld County, CO re Stale Documentary Fee Date: December 21, 2010 $20.00 Special Warranty Deed (Pursuant to 38-30-115 C.RS.) THIS DEED, made on December 21st, 2016 by CRESTONE PEAK RESOURCES HOLDINGS, LLC, A DELAWARE LIMITED LIABILITY COMPANY Grantor(s), of the City and County of Denver and State of Colorado for the consideration of ($200,000.00) Two Hundred Thousand and 00/100"` dollars in hand paid, hereby sells and conveys to ROCKY MOUNTAIN MIDSTREAM, LLC, A TEXAS LIMITED LIABILITY COMPANY Grantee(s), whose street address is ONE WILLIAMS CENTER, Tulsa, OK 74192, County of Tulsa, and State of Oklahoma, the following real property in the County of Weld, and State of Colorado, to wit: LOT A, RECORDED EXEMPTION NO. 1469.28-4-RECX75-008$, RECORDED OCTOBER 10, 2016 AT RECEPTION NO. 4437690. LOCATED IN THE SE 114 OF SECTION 2% TOWNSHIP 1 NORTH, RANGE 67 WEST OF THE 6TH P.M., COUNTY OF WELD, STATE OF COLORADO RESERVING TO SELLER OWNERSHIP OF ALL MINERALS, OIL, GAS, AND OTHER HYDROCARBON SUBSTANCES AND GEOTHERMAL RESOURCES AND MINERAL RIGHTS IN CONNECTION WITH THE PROPERTY also known by street and number as: VACANT LAND, FT LUPTON, CO 80603 with all its appurtenances and warrants the title against all persons claiming under the Grantor(s), subject to general taxes for the year 2018 and those specific Exceptions described by reference to recorded documents as reflected In the Title Documents accepted by Grantee(s) in accordance with Record Title Matter (Section 8.2) of the Contract to Buy and Self Real Estate relating to the above described real property; distribution utility easements, (including cable T1/}; those specifically described rights of third parties not shown by the public records of which Grantee(s) has actual knowledge and which were accepted by Grantee(s) in accordance with Off -Record Title Matters (Section 8.9) and Current Survey Review (Section 9) of the Contract to Buy and Sell Real Estate relating to the above described real property; inclusion of the Property within any special tax district; arty special assessment if the improvements were not installed as of the date of Buyer's signature on the Contract to Buy and Sell Real Estate, whether assessed prior to or after Closing; and other CRESTONE PEAK RESOURCES HOLDINGS, LLC, A DELAWARE LIMITED LIABILITY COMPANY By: CRESTONE PEAK RESOURCES LLC, A DELAWARE LIMITED LIABILITY COMPANY, ITS MEMBER By: TONY BU SIDENT AND CEO State of Colorado County of 'b.o } )ss. } The foregoing Instrument was acknowledged before me on this day of December 21st, 2018 by TONY BUCHANON AS PRESIDENT AND CEO OF CRESTONE PEAK RESOURCES LLC, A DELAWARE LIMITED LIABILITY COMPANY, AS MEMBER OF CRESTONE PEAK RESOURCES HOLDINGS LLC, A DELAWARE LIMITED LIABILITY COMPANY Witness my hand and official seal My Commission expires: 3.15• aoz Z. wfro Notary Public rt a _ S Sea is ROBERT J.BRESNAHAN NOTARY PUBLIC STATE OF COLORADO NOTARY ID* 20104009995 MY COMMISSION EXPIRES Qom' /1511022 When recorded return to: ROCKY MOUNTAIN MIDSTREAM, LLC, A TEXAS LIMITED LIABILITY COMPANY ONE WILLIAMS CENTER, Tulsa, OK 74192 Form 34 closing/deeds/wd.html 25162150 (431973) III 11111111111 Ill I I I III II III 4458874 01/09/2019 03:03 PM Total Pages: 1 Rec Fee: $13.00 Carly Koppes - Clerk and Recorder, Weld County, CO WHEN RECORDED ROCKY MOUNTAIN MIDSTREAM LLC RETURN TO: ONE WILUAMS CENTER TULSA, OK 74192 STATEMENT OR AUTHORITY (§98-80-172. C.R.S.) 1. This Statement of Authoriy relates to an entity' named ROCKY MOUNTAIN MIDSTREAM. LLC, A TEXAS UNITED UABILTfY COMPANY 2. The type of entity is a: ❑ Corporation 0 Registered Limited Liability Partnership ❑ Nonprofit Carporetion 0 Registered Limited Liability Limited Partnership ▪ Limited Liability Company 0 Limited Partnership Association ❑ General Partnership 0 Government or Governmental Subdvteion err Agency DLimited Partnership 0 Trust O 3. The entity is formed under the laws of Texas 4. The mailing address for the entity is ONE WILLIAMS CENTER, Tulsa, OK 74192 5. The © name ® position of each person authorized to execute instruments conveying. encumbering or otherwise affecting title to reel property on behalf of the entity is MATTHEW R HASTINGS, ERECTOR OF OPERATIONS AND ENGINEERED A1MI/OR LARRY C. LARSEN, GENERAL MANAGER 8. The authority of the foregoing persons) to bind the entity: X❑ is2 not limited D is limited as fold s: 7. Other matters concerning the manner in which the entity deals with interests in real property: NONE 8. This Statement of Authority Is executed on behalf of the entity pursuant to the provisions of §30.90-172, C.R.S.e 9. This Statement of Authority amends and supersedes in all respects any and all prior dated Statements of Authority executed on behalf of the entity. Executed this this day of Away 4th, 2019 ROCKY MOUNTAIN MIDSTREAM, LLC, A TEXAS LIMITED LABILITY COMPANY 9,. MATTHEW R. IRECTOR OF OPERATIONS AID ENGINEERING State of at �+ c County al • ck..16 - The foregoing Instrument was acknowledged before me on this day of Jemmy 4th, 2019 by MATTHEW R. HASTINGS, ERECTOR OF OPERATIONS AND ENGINEERING FOR ROCKY MOUNTAIN MIDSTREAM, LLC, A TEXAS UMITED LIABILITY COMPANY Witness my hand end official seal My Commission expires: j% / IS 292-1 1/2 Notary PiAIlc 'This form should not be used unless the early b capebb of hotline He to real property. aTtw absenos of my 9readon shall be pine tote salience that no such ■dludon Wilde. *The statement of authority must ba minded io obtain the bmalb of the statute. Form 884 olosing/recardings/soa.html 25162150 (17273205) THOMAS R MAY NOM NEW MEMO:UAW /y.., NOTARY IDMI7404734i /. r{ OMMENON ER E ICVE MER 1 2021 III I IIIIIIII IIIII I®n 11 REAL PROPERTY TRANSFER DECLARATION - (TD -1000) GENERAL INFORMATION Purpose: The Real Property Transfer Declaration provides essential information to the county assessor to help ensure fair and uniform assessments for all property for property tax purposes. Refer to 39-14-102(4), Colorado Revised Statutes (C.R.S.). Requirements: All conveyance documents (deeds) subject to the documentary fee submitted to the county clerk and recorder for recordation must be accompanied by a Real Property Transfer Declaration. This declaration must be completed and signed by the grantor (seller) or grantee (buyer). Refer to 39.14-102(1)(a), C.R.S. Penalty for Noncompliance: Whenever a Real Property Transfer Declaration does not accompany the deed, the clerk and recorder notifies the county assessor who will send a notice to the buyer requesting that the declaration be returned within thirty days after the notice is mailed. If the completed Real Property Transfer Declaration is not returned to the county assessor within the 30 days of notice, the assessor may impose a penalty of $25.00 or .025% (.00025) of the sale price, whichever is greater. This penalty may be imposed for any subsequent year that the buyer fails to submit the declaration until the property is sold. Refer to 39-14-102(1)(b), C.R.S. Confidentiality: The assessor is required to make the Real Property Transfer Declaration available for inspection to the buyer. However, it is only available to the seller if the seller filed the declaration. Information derived from the Real Property Transfer Declaration is available to any taxpayer or any agent of such taxpayer subject to confidentiality requirements as provided by law. Refer to 39-5-121.5, C.R.S. and 39- 13-102(5)(c), C.R.S. 1. Address and/or legal description of the real property sold: Please do not use P.O. Box numbers VACANT LAND, FT LUPTON, CO 80603 2. Type of P rchased: Single Famil�Residential ❑ o home O Condominium ElMulti-UnitRes El Commercial LI Industrial Agricultural Mixed Use X Vacant Land Ej Other 3. Date of Closing: January 04, 2019 Date of Contract if different than date of closing: May 30, 2018 4. Total sale price: Including all real and personal property. $200,000.00 5. Was any personal property included in the transaction? Personal property would include, but not limited to, carpeting, draperies, free standing appliances, equipment, inventory, furniture. If the personal property is not listed, the entire purchase price will be assumed to be for the real property as per 39-13-102, C.R.S. ❑ Yes ❑X No If yes, approximate value $ Describe: 6. Did the total sales price include a trade or exchange of additional real or personal property? If yes, give the approximate value of the hBeds or services as of the date of closing. Yes ONoIfyes, value $ If yes, does this transaction Involve a trade under IRS Code Section 1031? ❑ Yes QX No 7. Was 100% interest in the real property purchased? Mark 'no" if only a partial interest is being purchased. Yes ❑ No If no, interest purchased: 8. Is this a transaction among related parties? Indicate whether the buyer or seller are related. Related parties include persons within the same family, business affiliates, or affiliated corporations. ❑ Yes ❑X No 9. Check any of the following that I to the condition of the Improvements at the time of purchase: El New ❑ Excellent Good ❑ Average ❑ Fair O Poor ❑ Salvage If the property is financed, please complete the following: 10. Total amount financed: 11. Lew financing: (Check all that y) LNew ❑ Assumed ❑ Seller U Third Party ❑ Combination; Explain 12. Terms: ❑ Variable Starting Interest rate % O Fixed Interest rate 96 Length of time years Balloon Payment ❑ Yes ❑ No If yes, amount $0.00 Due Date Form 76 closing/recordings/rpt.html 25162150 (431973) III 1 1111111111 111111 11111 III 13. Mark any that apply: ❑Seller assisted down payment Seller concessions Special terms of financing. If marked, please specify: For properties other than residential (Residential is defined as: single family detached, townhomes, apartments, and condominiums) please complete questions 14-16 if applicable. Otherwise, skip to #17 to complete. 14. Did the purchase price Include a franchise or license fee? O Yes ❑ No If yes, franchise or license fee value? 15. Did the purchase price involve an installment lend contract? ❑ Yes ❑ No If yes, date of contract: 16. If this was a vacant land sale, was an on -site inspection of the property conducted by the buyer prior to the closing? Yes ❑ No Remarks: Please include any additional information concerning the sale you may feel is important. 17. Signed on this day of January 04.2019 Have at least one of the parties to the transaction sign the document, and include an address and a daytime phone number. Signature of n Grantee(Buyer) n or Grantor(Seller) ROCKY MOUNTAIN MIDSTREAM, LLC, A TEXAS LIMITED LIABILITY COMPANY BY: MATTHEW R. HASI7NGS, DIRECl'OR OF OPERATIONS AND ENGINEERING 18. All future correspondence (tax bills, property valuations, etc.) regarding this property should be maked to: ROCKY MOUNTAIN MIDSTREAM, LLC, A TEXAS LIMITED LIABILITY COMPANY ONE WILLIAMS CENTER, Tulsa, OK 74192 Phone: (816) 500.4796 xChrls Email: Form 76 closing/recordings/rpt.html 25162150 (431973) Hello