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Home My WebLink About20171702.tiffRESOLUTION RE: APPROVE RESCHEDULED TEMPORARY ASSEMBLY PERMIT - FRANK'S RIDE FOR CHILDREN, FBO MAKE -A -WISH FOUNDATION OF COLORADO, INC. 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, Frank's Ride for Children, fbo Make -A -Wish Foundation of Colorado, Inc., 2544 Jarrett Drive, Mead, CO 80542, presented to the Board of County Commissioners an application for a Permit for Temporary Assembly on land within the unincorporated portion of the County of Weld, State of Colorado, to be held from 8:00 a.m. until 9:00 p.m., on May 20, 2017, on property described as follows: Anderson Farms, 6728 County Road 3-1/4, Erie, CO 80516; being more fully described as Lot C of Recorded Exemption, RECX15-0059; being part of the NW1/4 of Section 32, Township 2 North, Range 68 West of the 6th P.M., Weld County, Colorado WHEREAS, said applicant has paid Weld County the sum of ONE -HUNDRED DOLLARS ($100.00) for said Weld County Permit for Temporary Assembly, and WHEREAS, due to inclement weather, said applicant is requesting to reschedule to event from May 20, 2017, to June 24, 2017, and WHEREAS, having examined said application, the Board deems it appropriate to grant a Weld County Permit for Temporary Assembly to Frank's Ride for Children, fbo Make -A -Wish Foundation of Colorado, Inc., rescheduled for June 24, 2017, and WHEREAS, said permit shall be issued subject to compliance with the terms and conditions as set forth in the application materials and upon the express condition and agreement that the rescheduled temporary assemblage will be conducted in strict conformity to all laws of the State of Colorado and the Weld County Code, and WHEREAS, any violation to said terms and conditions shall be cause for revocation of said permit and forfeiture of bond. Gc: CA.PPL, SO RS), Co,C GC/( H) Co/l3/I? 2017-1702 LC0022 TEMPORARY ASSEMBLY PERMIT - FRANK'S RIDE FOR CHILDREN, FBO MAKE -A -WISH FOUNDATION OF COLORADO, INC. PAGE 2 NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that said Weld County Permit for Temporary Assembly on June 24, 2017, be, and hereby is, granted to Frank's Ride for Children, fbo Make -A -Wish Foundation of Colorado, Inc., to conduct a rescheduled temporary assemblage at the hereinabove described location. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 5th day of June, A.D., 2017. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLQRI DO ATTEST: ddiaiev G:•‘,k, Weld County Clerk to the Board Date of signature: Co! L , I l 1 ount Attorney Julie A. Cozad, Chair Steve Moreno, Pro-Tem Sean P. Conway 2017-1702 LC0022 WELD COUNTY PERMIT FOR TEMPORARY ASSEMBLY By action of the Board of County Commissioners of the County of Weld, State of Colorado, taken this 5th day of June, 2017, IT IS HEREBY GRANTED a permit for a temporary assemblage on land within the unincorporated portion of the County of Weld, State of Colorado, to be held from 8:00 a.m. until 9:00 p.m., on June 24, 2017, on property described as: Anderson Farms, 6728 County Road 3-1/4, Erie, CO 80516; being more fully described as Lot C of Recorded Exemption, RECX15-0059; being part of the NW1/4 of Section 32, Township 2 North, Range 68 West of the 6th P.M., Weld County, Colorado This permit authorizes Frank's Ride for Children, fbo Make -A -Wish Foundation of Colorado, Inc., to hold such an assemblage so long as it is in accordance with Chapter 12 of the Weld County Code and all other applicable State and County statutes and regulations. This permit is subject to compliance with the terms and conditions as set forth in the application materials and to additional conditions set forth by the Board and attached hereto. PERMIT APPROVED this 5th day of June, 2017. BOARD OF COUNTY COMMISSIONERS WELD COU TY, COLORAD ATTEST:d dovC; Weld County Clerk to the Board . ' puty Clerk to the Board id County Attorney Date of signature: QCo('I 3( (7 Julie A. Cozad, Chair Steve Moreno, Pro -Tern NOTE: THIS PERMIT MAY BE REVOKED AND THE BOND FORFEITED FOR FAILING TO MEET THE CONDITIONS SET FORTH HEREIN. 2017-1702 LC0022 WELD COUNTY APPLICATION FOR TEMPORARY ASSEMBLY INSTRUCTIONS TO APPLICANT: Complete each section and mark "N/A" where not applicable. Additional sheets may be attached and maps, sketches, or drawings may be substituted for the verbal description of plans for the assembly site. Where applicable, please attach contracts, agreements, or emails. All required information must be furnished before the application will be processed. PERMIT FEE: $100.00 Submit $100.00 fee for each event where three -hundred fifty (350) or more people assemble, or can reasonably be anticipated to assemble, at any one (1) location, unless the location is properly zoned for such assembly, in which case one permit shall be required for the total number of events scheduled for that location for the remainder of the calendar year, not to exceed ten (10) events per year. As used herein, the term event means an assembly or anticipated assembly which is scheduled to last for three (3) consecutive days or less. Applicants must provide a statement by a bonding company licensed to do business in the State of Colorado indicating its intent to furnish a bond required in Section 12-1-30.6.13 of the Weld County Code, or a bond of $3,000.00, to ensure performance by the applicant of each of the terms and conditions of the temporary assemblage permit. APPLICATION CHECKLIST: Please see Weld County Code for more detailed info. Two (2) persons trained in emergency medical technology for the first three hundred fifty (350) persons and one (1) for every three hundred fifty (350) persons after that, together with one emergency ambulance. ./ Adequate communication with hospital, police, and fire services. ,/ Fire protection services (off -site). ✓' Security ✓' Plans for communication, including the source, amount, and location of communcation equipment. ✓ Adequate and safe supply of potable water. ,/ If applicaple, the plans for meeting County Health standards for food concessions. ,/- Sanitary method of disposing solid waste. ,- Separate and enclosed toilets for males and females. f Parking area at the rate of one (1) parking space for every four (4) persons. Yl I A, Camping facilities, if the assembly is to continue overnight. ,/' Illumination if assembly is to continue during the hours of darkness. ,/ Electrical systems installation and maintenance if current systems are not self-supporting. ,/' Plans to insure that trees, underbrush, large rocks, and other natural features shall be left intact. ./ Statement by the record owners of such property consenting to such assembly. ✓ Insurance in an amount that is adequate and reasonable in light of the risks and hazards relating to the event. f $3, 000.00 bond or statement by a bonding company. Z $100.00 nonrefundable fee payable to the "Weld County Clerk to the Board". 2017-1702 WELD COUNTY APPLICATION FOR TEMPORARY ASSEMBLY APPLICANT: All partners in a partnership, officers of an unincorporated association, society or group, or, if there are no officers, all members of such association, society or group. IF A CORPORATION, ATTACH A CERTIFIED COPY OF THE ARTICLES OF INCORPORATION. Business Name, dba: Fr c r\-5 R i Cl F-0 r c k I 1O1 re. n Applicant Names(s): G-r�30r%,. A R.)5�e°OrC- Cell Phone: ( j c.t) `l '15 —`i a Work Phone: (3 0 3) • 1 n5 -- 9 I I b E-mail Address: r- r^ 1 s q- a o r± 0 `A c] 10 C) . r t r� Physical Address: 3 . J Li Li J q r e_-1-- }- Or , t; --. City: in Gt CA State: C 0 Zip Code: i3 6 .5 y D, Mailing Address: P, IAN e, City: State: Zip Code: Address and legal description of all property upon which the assembly is to be held. Physical Address: (9 �1 a ,8. C O ,, El T 1 R a CA c1 sc City: L. r;.. \ State: CO Zip Code: OS I Ca Legal Description: r. . die . r 5 cr tl Fa r rn i_ s Y t. ci L1 � s -1-) o n r S v Name and address of the record owners of such property (Attach a notarized statement by the record owners of such property consenting to the assembly if application is not made by all of the record owners.) Name: .5 .- w A ± i- et C, 1 QUA Physical Address: City: State: Zip Code: Name: Physical Address: City: State: Zip Code: Page 2 of 10 M:\CTB\TEMPORARY ASSEMBLY\General Forms\Applications WELD COUNTY APPLICATION FOR TEMPORARY ASSEMBLY 1. Nature or purposes of the assembly. 5 e_ ci i +qc-hkq 2. Dates and hours during which the assembly is to be held. 5 4- + a C.- fl P `1 3. Maximum number of persons to be allowed at assembly at any one time. -� `- -+ a c e.4 4. Maximum number of tickets to be sold, if any. 6 e- Page 3 of 10 M:\CTB\TEMPORARY ASSEMBLY\General Forms\Applications WELD COUNTY APPLICATION FOR TEMPORARY ASSEMBLY 5. identify plans to limit number of ersons to the maximum identified above. Sk_ A -I- 4e L i\ v_c/ir 6. Identify plans to provide for medical facilities, including the location and construction of any structures, the names, addresses, and hours of availability of emergency medical technicians and nurses and provisions for emergency ambulance service. Attach contract, agreement, or email. A4-4-eil_ke O1 7. Identify plans for communications with hospital, police, and fire services, including the source, amount, and location of communication equipment. Sr i`4 -«c1\.. d Page 4 of 10 M:\CTB\TEMPORARY ASSEMBLY\General Forms\Applications WELD COUNTY APPLICATION FOR TEMPORARY ASSEMBLY 8. Identify plans for fire protection. Attach contract, agreement, or email. , -k-� A -I -I- Gi c._ k e -d 9. Identify plans for security, including the number of guards, their deployment, their names, addresses, credentials and hours of availability, and description of peer group control, if any. Attach contract, agreement, or email. C e_ -c .A ++ q c_- h e c 10. Identify plans for communication, including the source, amount, and location of communcation equipment. Page 5 of 10 M:\CTB\TEMPORARY ASSEMBLY\General Forms\Applications WELD COUNTY APPLICATION FOR TEMPORARY ASSEMBLY 11., Identify plans for supplying potable (drinking) water, including the source, number, and location of facilities, and type and means of disposing of waste deposited. Attach contract, agreement, or email. S c .-(/_ A --, -I t (, k t-__ 4 12. If applicable, identify plans for meeting County health standards for food, concessions, and concessionaires who will be allowed to operate on the grounds, including the names and addresses of all concessionaires and their license permit numbers. Attach contract, agreement, or email. r. ... , c____ I !1 r,\ -P. c �t 13. Identify plans for holding, collecting, and disposing of solid waste materials. Attach contract, agreement, or email. s e_ A +-1- a h -e_ c/ Page 6 of 10 M:\CTB\TEMPORARY ASSEMBLY\General Forms\Applications WELD COUNTY APPLICATION FOR TEMPORARY ASSEMBLY 14. Identify plans for providing separate toilet facilities for males and females, including the source, number, and location, type and the means of disposing of wastes deposited. Attach contract agreement or email. S -e A +- 0 c:, h l e- SI 15. Identify plans for parking vehicles, including size and location of lots, points of highway access and interior roads, including routes between highway access and parking lots. S e_ A4 -}- } a c: K of 16. Identify plans for camping facilities, if any. A 4--/ AC 61-P_Gl Page 7 of 10 M:\CTB\TEMPORARY ASSEMBLY\General Forms\Applications WELD COUNTY APPLICATION FOR TEMPORARY ASSEMBLY 17. Identify plans, if any, to illuminate the location of the assembly, including the source and amount of power, and the location of lamps. F --r A f+ a C-- N tl 18. Identify plans, if any, for an electrical system. A -f- { r_ k 19. Identify plans for sound control and sound amplification, if any, including number, location, andpower of amplifiers and speakers. Se e A" 4- h -e c7 Page 8 of 10 M:\CTB\TEMPORARY ASSEMBLY\General Forms\Applications WELD COUNTY APPLICATION FOR TEMPORARY ASSEMBLY 20. Identify plans to ensure that trees, underbrush, large rocks, and other natural features shall be left intact and undisturbed, and natural vegetative cover retained, protected and maintained so as to facilitate drainage, prevent erosion, and preserve the scenic attributes; and the plans to abate dust on the site. r_ A -1 dkc ke ci/ Attach a statement by the record owners of such property consenting to such assembly. Attach a statement by an insurance company licensed to do business in the State of Colorado stating its intent to provide liability insurance, as required by Section 12-1- 30.B.14 of the Weld County Code, to protect against injury to persons or property occurring as a result of such an assembly. Page 9 of 10 M:\CTB\TEMPORARY ASSEMBLY\General Forms\Applications WELD COUNTY APPLICATION FOR TEMPORARY ASSEMBLY BY THIS APPLICATION, APPLICANT(S) AGREES TO INDEMNIFY AND HOLD HARMLESS WELD COUNTY OR ANY OF ITS AGENTS, OFFICERS, SERVANTS, AND EMPLOYEES FROM ANY LIABILITY OR CAUSES OF ACTION WHICH MIGHT ARISE BY REASON OF GRANTING OF A TEMPORARY ASSEMBLAGE PERMIT, AND FROM ANY COSTS INCURRED IN DEFENDING AGAINST SUCH ACTIONS OR IN CLEANING UP ANY WASTE MATERIAL PRODUCED OR LEFT BY THE ASSEMBLY. The applicant, and each of them, swears, (affirms) that, to the best of his or her knowledge, the statements contained in the application are true and correct. 4/z,/,;/" /9 /2.25 2c// reserftative Authorized Rep Sin re SUBSCRIBED AND SWORN to me before this Witness my hand and official seal. My commission expires: 3 -02 s -/7 Date day of Page 10 of 10 M:\CTB\TEMPORARY ASSEMBLY\General Forms\Applications ,20 / Frank's Ride for Children Temporary Assembly Application (page 1 of 3) June 24th, 2017 Question 1: Charity Fund Raiser Event for Make -A -Wish Foundation of Colorado The mission of Frank's Ride is to help Colorado Children who are fighting life -threatening illnesses and who want to have a wish granted. The children we sponsor participate in our run by riding in our sidecars or limousine. They and their families have a great time and really enjoy seeing all the motorcycles and vehicles supporting their wishes. Question 2: Saturday June 24th, 2017 8am to 9pm Questions 3&4: The total number we expect and will allow is 1,000 to 1,500 to attend the 2017 event. No more than 1500 will be allowed in. Question 5: We have a specified registration committee/team who register every participant. Each participant is required to submit a waiver/participation application and provide a legal picture form of identification such as a drivers license, state identification, or passport. Registered participants are identified by specified wrist bands. ONLY 1,500 waivers/applications and wrist bands are available at registration. No more than 1500 will be allowed in. Question 6 thru 10: Longmont Emergency Unit located in Longmont, Colorado will be providing emergency ambulance/medical services at this year's event. The ambulance and medical technicians will be located on the property for the entire duration of the event. Safety and Emergency communication will be conducted through phones and radios between Longmont Emergency Unit Personnel, Fire Service, Police Staff, and Security Staff and will be present throughout the duration of the event. Mountain View Fire Protection will be available and are located in Erie, Colorado The entire volunteer staff of Frank's Ride will provide security for the event and will each have a radio or cell phone and phone list. The staff members are identified by wearing black "Frank's Ride Poker Run Staff' shirts. Additionally, there will be twenty staff members designated specifically as "Frank's Ride Security. Frank's Ride for Children Temporary Assembly Application (page 2 of 3) June 24th, 2017 Questions 11 13 & 14 The location has a potable water system on site throughout the location, including drinking fountains and bottled water available in coolers on ice in various shaded areas of the event premises. (Drinking fountains are located in the Kitchen Facility and Event Building/bottled water will be available in coolers placed throughout location) Waste Management of Colorado will be providing a roll off dumpster. They will be disposing of the waste the day after the event. Question 12: Question 15: Permanent public facilities are available in the event building. Portable facilities will be provided by Waste Management (including 3 Men's, 3 Women's, and 1 Handicap Stall) All food will be provided by commercial donations. Frank's Ride Staff will be preparing and serving the food. A full service kitchen is located on the facility, including a industrial dishwasher, sinks with hot/cold water, commercial refrigerators, etc. NO outside concessions will be provided. Facility is equipped with a permanent parking area. See attached map. Points of highway access are Highway 52 to Road 3 '/4 to Parking lot at facility located at 6728 County Road 3.25; Erie, Colorado 80516 being further described as part of Section 32, Township 2 North Range 68 West of 6th P.M. Weld County, Colorado Question 16: Not Applicable. This will not be an overnight/camping event. Question 17: Question 18: Question 19: The facility has permanent lighting, including interior and exterior yard lighting throughout the facility. Permanent (Panel Breaker System) electrical systems are provided throughout the permanent building on the site. All speakers will be directed away from neighboring establishments. Sound system will be provided by a professional sound company. Frank's Ride for Children Temporary Assembly Application (page 3 of 3) May 20, 2017 Question 20: Anderson Farms is an event site. No natural environment will be disturbed. Chloe Rempel From: Sent: To: Cc: Subject: Chloe Rempel Monday, May 22, 2017 9:37 AM Bethany Pascoe; Dan Joseph; Deb Adamson; Frank Haug; Janet Lundquist; Jose Gonzalez; Roy Rudisill; Sam Kaneta III Bruce Barker; Bob Choate; Karin McDougal Special Event Permit and Temporary Assembly Permit - Frank's Ride for Children fbo Make a Wish Foundation of Colorado, Inc. Hello, Because of the surprising weather we had last week, Frank's Ride for Children is having to reschedule their event for June 24, 2017. I am working with them on updating the dates on their application to meet all Weld County and State requirements. Updated referral responses are not necessary. Please let me know if you have any questions or concerns. Applicant: Event Location: Gregory and Tammy Risedorf Frank's Ride for Children fbo Make a Wish Foundation of Colorado, Inc. 2544 Jarrett Drive Mead, CO 80542 Anderson Farms 6728 County Road 3'/4 Erie, CO 80516 File Location: LC0022 Original Document Numbers - 2017: Temporary Assembly 2017-1084 Special Event 2017-1085 Thank you, Chloe A. Rempel Deputy Clerk to the Board Weld County 1150 O Street Greeley, CO 80631 tel: 970-400-4225 Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. 1 Chloe Rempel From: Sent: To: Subject: Attachments: Importance: Chloe Rempel Monday, May 22, 2017 9:17 AM 'gregrisedorf@yahoo.com' New Date for Special Event and Temporary Assembly Special Event Documents to Reproduce.pdf; Temp Assembly Documents to Reproduce.pdf; Special Event Permit (DR8439).pdf High Greg, The State is going to require you to submit a new Special Event Permit application. We will need to reproduce your Special Event and Temporary Assembly documents to reflect the new date. I have attached both orginal applications to this email so that you can see what needs to be reproduced. We are looking at a hearing date of Monday, June 5, 2017 if we can get everything completed by then. Otherwise, we can schedule for Monday, June 12, 2017, but that would be cutting it a little close. Please let me know which date you would prefer. SPECIAL EVENT PERMIT: 1 New Special Event Permit Application and Fee: the blank application form is attached above. In addition to this document, you will be required to submit an additional permit fee of $25.00 made payable to the State of Colorado. Weld County is NOT requiring you to resubmit fees, so the $25.00 fee to the State is all that will be asked for. 2. Responses to the Weld County Questionnaire: please just update the dates on these two pages. 3. The Make A Wish Foundation of Colorado Consent and Approval Form: please submit a new letter with an updated date. 4. Certificate of Liability Insurance: please have this updated to reflect the new date. 5. Letter of Consent from Jim Anderson: please have him update this letter with the new date. 6. Special Event Permit Sign: I will make a new sign this morning that you can pick up at your convenience. It will need to be posted on the premises 10 days before the hearing. TEMPORARY ASSEMBLY PERMIT: 1. Responses to the Temporary Assembly Permit Application: please just update the dates on these three pages. 2. The Make A Wish Foundation of Colorado Consent and Approval Form: please submit a new letter with an updated date. 3. Certificate of Liability Insurance: please have this updated to reflect the new date. 4. Letter of Consent from Jim Anderson: please have him update this letter with the new date. 5. Email from Longmont Emergency Unit (LEU) for ambulance services: please have them reproduce this with the new date. 6. Email from Mountain View Fire Protection District: please have them reproduce this with the new date. 1 7. Email/Letter with Waste Management: please have them reproduce this with the new date. If you have any questions, please do not hesitate to reach out to me. I am more than happy to answer any and all questions. Thank you, Chloe A. Rempel Deputy Clerk to the Board Weld County 1150 O Street Greeley, CO 80631 tel: 970-400-4225 Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. 2 TOKIO MARI N E HCC January 30, 2017 Thank you for renewing your bond. Printa copy of the continuation certificate for your records. trnhcc.com if an original continuation certificate is required by the obligee or should Contact suretyrenswa ►� you have any further questions. Bond Summary Principal Name FRANKS RIDE FOR CHILDREN 2003 Bond Number BNDPGP59913 Indemnitor Name License Number Bond Description CO LICENSE - CONTRACTORS Bond Amount $3,000.00 Premium $100.00 Term Date 2/28/2017 to 2/26/2018 Payment Summary Payment Type Amount Received $100.00 Reference ID '8931703015 Authorization Date 1/30/2017 Charged By ADRIAN LOO Agent Information TRUENORTH 275 SOUTH MAIN STREET, SUITE 100 LONGMONT, CO, 80501 (303) 776-5122 Contact your agent at the number provided for any questions. Thank you. 1X507 W010016 TO_KIO MAR1 N E H C C CONTINUATION Monday, January 30, 2017 BONO NUMBER BONO DESCRIPTION CO / LICENSE - CONTRACTORS Principal: FRANK'S RIDE FOR CHILDREN 2003 2544 JARETT DR MEAD , CO 80542 Obligee: WELD COUNTY WELD COUNTY BOARD OF COMMISSIONERS GREELEY , CO American Contractors Indemnity Company 601 S. Figueroa SL, Suite 1600 Los Angeles, CA 90017 main (310) 649 0990 facsimile (310) 645 9274 CERTIFICATE NED AND THIS BOND CONTINUES IN FORCE TO THE IN IT ABOVE ALL ENDORSEMENTS OSHALLON�R EXCEEOITHE THAT THE LOSSES OR RECOVERIES PENALTY SET FORTH IN THE BOND WITHIN ANY EXTENSION OR ENEWALTHE LOSSES OR �PER OD` PRESENT' P IST OR N THE FIRST AND/OR SUBSEQUENT O FUTURE. ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. Signed and dated this 30th day of January 2.017 Agent; TRUENORTH 275 SOUTH MAIN STREET, SUITE 100 LONGMONT , CO 80501 American Contractors Indemnity Company ousisopm a Anowmrzo+e Make -A -Wish° Colorado 7951 E. Maplewood Avenue, Suite 126 Greenwood Village, CO 801 1 1 303.750.9474 800-366-9474 fax 303.755-3108 www.colorado.wish.org CONSENT AND APPROVAL FORM MAI�E Q\?)Yi S H€ This is a letter of Consent/Approval to show that Greg Risedorf is a representative of "Frank's Ride for Children", which benefits Make -A -Wish® Colorado, and has consent to sign permits and contracts associated with Frank's Ride for Children being held June 24, 2017. If you have any questions, please contact me. And thank you for helping us share the power of a wish®! S!yely, G1e-i.zL. Patti Forsythe Director of Events and Promotions Make -A -Wish Colorado Share the Power of a Wish' OFFICE OF THE SECRETARY OF STATE OF THE STATE OF COLORADO CERTIFICATE OF FACT OF GOOD STANDING 1, Wayne W. Williams, as the Secretary of State of the State of Colorado, hereby certify that, according to the records of this office, MAKE -A -WISH FOUNDATION OF COLORADO, INC. is a Nonprofit Corporation formed or registered on 05/02/1983 under the law of Colorado, has complied with all applicable requirements of this office, and is in good standing with this office. This entity has been assigned entity identification number 19871519647 , This certificate reflects facts established or disclosed by documents delivered to this office on paper through 03/28/2017 that have been posted, and by documents delivered to this office electronically through 03/29/2017 @ 17:01:01 . I have affixed hereto the Great Seal of the State of Colorado and duly generated, executed, and issued this official certificate at Denver, Colorado on 03/29/2017 @ 17:01.01 in accordance with applicable law. This certificate is assigned Confirmation Number 10160183 Secretary of State of the Mate ofColorado .*ms,*.****.****.*r******************.***.** nd of Certificate*************•***************************** Nonce' A certificate issued electronically from the Colorado Secretary of State's Web site is fully and immediately valid and effective. However, as an option, the issuance and validity of a certificate obtained electronically may he established by visiting the ralitiate a Certificate page of the Secretary of State's Web site. hnl' urt,t sos strrtc_co us,L t err fe snSear,hC riterut_do entering the certificate's confirmation number displayed on the certificate. and following the instructions displayed. Confirming the issuance trio certificate is merely optional and is not necessary to the valid and effective issuance of a certificate. For more information, visit our Web site, http. soan,sns ,rate.co us click "Businesses. trademarks, trade names" and select "Frequently Asked Qrtesttarrs. F.. HIV -9 (Rev.wintery 2oith 0epermrs et the Treasury interne RMue 0..- 0. A Request for Taxpayer identification Number and Certification to the Give Do not send to the IRS. girded erttey acme, n different from ac ova Make-A-tiVtsh Foundation of Colorado. Inc. O Peru+eishtp ❑ 7ruct/sWte Check approvers box (ngtiredk�❑ ndl idusVeds prof t°r ) C Corporation ❑ s comoreetoa 0 Limited febltty c0rnpany. Enter tiro lax dassiRatton (c.c arpormlbn. S.S aoatorstbn. P=AanrterstrIP) P -.-- Outer (pee ins n1Cl!-' s, b _.. __ '. 9f!'eet• and apt. °t wee no.) 7951 E. Ma•%ewood Avenue, Suite 126 Cky , state, grid ZIP cods Greenwood Vq.,. _ CO 80111 List ecaovnt num .. here Patt.l Ter identification Number IN Enter your TIN In the appropriate box. The TIN provided must match the name given on the "Name line to avoid backup withholding. For individuate, this Is your social security number (SSN). However, for a resident alien, s is proprietor, or disregarded entity, see the Pert I Instructonflnumber, see age 3. For other How to get entities, It is your employer tdentiftastion number (ON). you nave 77N on page 9. the chart on page 4 for guidelines on whoseNote. It the account is In more that one name, see number to enter. Certification U paneitie, of peMry. I certify that number (orient waiting for a number to be issued to me), and on this form Is my correct taxpayer Ident'ficat1on exempt from backup r i ent r irt have not bean snuted t by t), nrterrtal Revenue 1. Tae n abut ject to (b) h dividends, the im notifiedn ma ' t am 2. ISe Service (IR5) subject backup plan ctwithholdingp became: I ass a result of a failure to report et interest or (c) subject to backup wtthhOldtng, and3. longer ( papa no on defined b.iow)the IRS that you are tunartt►r subject to backup tfu1io�^° Certification I a U.S. citizuc io other U.S. sera ( if have b� notWed b1(IRA) erxi ores You must titres out Item d e o You tax rehan. Fo reel estate transactions, Item 2 does rot apply. For ret paiacquisition as interest and securedprodividends on yourretirement r .Sits the because you have filled to report,,,.,,rA�� cartcalfetion of debt. conMbtttlorts to an Individual em d property, are �� tohner than Interest end divldertds. You are not required to sign the certification, but You mod JYou ents Instructions on .. e'4. ggnetwetk U.S. parson Sign Here 1f General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form A person who is required to fie an information return'Nfih the IRS must obtain your cernect payer identification number (IN) to report, for example, income paid �you, real estate transactions, mortgage interest you paid, acquisition or abandonment oI secured property, cancellation of debt, or contitluttons you made to an IRA. Use Form W-9 only if you are a U.S. person (Including aa resident alien), to provide your =reel TIN to the person g (the requester) and, when apptloable. to: 1. Codify that the TIN you are giving Is correct (or you are waiting for a number to be issued), wIt 101dtng. a 2. Certify that you are not subject to backup 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If epptoab1e• you are also certifying that as a U.S. person, your atooSbie Were of any partnership income from a U.S. trade or business Is not subject to the vrithhotding tax on foreign partners' share of etfeCtlVelyy connected Income. Date* Note. Ifs requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form If it is substantially similar to this Form W -e. De finition tlon of a U.S. Parson. For federal tax purposes, you are nensir Bred a U.S. person It you area resident . M Irrdlvidusl who is a U.S. oitlsen or pr (�� a eseoclatice • A posed In partnership, f �' comply, laws pl the United States. organised in the United States or under the • An estate (other than a foreign estate), or . A domestic trust (as defined In Regulations mention 301.7101-7). or businessSpooled rules In the United States are generally required to pay a erships. Partnerships that conduct a �holdt 19 tax on any share of income from such business. Further, In certain Isrequired cases presume hersaForm W-9 has not been received. that partner Inebriety:, persona anands pay the h � Therefore, e, if you era a US.�t the person a partner Ina partnership corrductlr+g a trade to osinete theour United States. provide Form W-9 to the part of e tab P {soma, atahis and avoid withholding your share 1023iX Form W-9 (Rev.1 LETTER OF CONSENT I, Jim Anderson, do hereby authorize the use of my property for the sole purpose of holding the event known as prank's Ride for Children. This event benefits Make -A -Wish Foundation of Colorado and is scheduled for Saturday June 24th, 2017. I understand there will be approximately 1,000 to 1,500 people attending, as well as staff members from Frank's Ride and Make -A -Wish Foundation of Colorado. It is also my understanding that there will be roast pork and beef (served with all the trimmings), alcoholic /non-alcoholic beverages, as well as live entertainment on the event premises, My property is completely fenced with one main gate serving as the main entrance to the event premises. Respectfully, Ji 6728 WCR 31/4 Erie, Colorado 80516 m An erson ACCPRa CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 DATE 05/24/2017' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Willis of Arizona, Inc. c/o 26 Century Blvd. P. 0. Box 305191 Nashville, TN 37230-5191 CONTACT NAME PHONEC F N 888-467-2378 (AE FXT) 877-945-7378 (A/, CU -MAIL AlRRIF r)SS certificates@willis.cora INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Philadelphia Indemnity Insurance Company 18058-001 INSURED Make -A -Wish Foundation of America Make -A -Wish Foundation of Colorado 7951 E. Maplewood Avenue Suite 126 Greenwood Village, CO 80111 I INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: CERTIFICATE NUMBER• 25489728 :See Remarks L.UVCKAUCJ ---- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE INSn ADDL SUBR WVn POLICY NUMBER POLICY EFF (MMInnIVVYY) POLICY EXP LMM/nn/VYYY) LIMITS I nit A X COMMERCIAL GENERAL LIABIUTY Y PHPK1544332 9/1/2016 9/1/2017 EACHOCCURRENCE$ 1,000,000 $ 100,000 Pfttnnl5 aFfoccurence) I CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 $ 2,000,000 $ 2,000,000 GENERAL AGGREGATE GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES JECT PRO-LOC PER: PRODUCTS-COMP/OPAGG A AUTOMOBILE X X LIABILITY ANY AUTO OWNED -SCHEDULED X _AUTOS AUTOS NON -OWNED ONLY PHPK1544332 9/1/2016 9/1/2017 (ECOaMBINEDSaccident) INGLELIMIT $ 1,000,000 BODILY INJURY(Per person) $ BODILY INJURY(Per accident) $ PROPERTY DAMAGE (Per accident) $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE PHUB554613 9/1/2016 9/1/2017 EACH OCCURRENCE $ 5,000,000 $ 5,000,000 $ AGGREGATE DED I X'RETENTIONS 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEY/N OFFICER/MEMBER EXCLUDED?E.L. (Mandatory in NH) if yes, describe under DESCRIPTION OF OPERATIONS below N/A I PEN STATUTE IL) FR E.L. EACH ACCIDENT $ DISEASE - EA EMPLOYEE $ E. L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required THIS VOIDS AND REPLACES PREVIOUSLY ISSUED CERTIFICATE DATED: 1/25/2017 WITH ID: 25175449 Office ID #: 009-000 Event Name: Frank's Ride for Children Event Date: 06/24/2017 Certificate Holder is included as an Additional Insured as respects to General Liability if by written contract. required GERTIhIL A I t HOLutt< Colorado State Patrol - Attn: Capt. Ron Prater 15055 S. Golden Road Golden, CO 80401 Special Events Unit ...-...--...._.. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE - ',non CORPORATION All rinhfc racPrvPri Co11:5080271 Tp1:2123729 Cert: tsy/ats ©1988201 ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ARDATE ® CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 (MWDD/YYYY) 05/24/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Willis of Arizona, Inc. c/o 26 Century Blvd. P. 0. Box 305191 Nashville, TN 37230-5191 CONTACT NAMF' PHONE / F A/. NO 888-467-2378 (AE NO FxT) 877-945-7378 () -r. L AnnRMAIFSS certificatee@willis, corn INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Philadelphia Indemnity Insurance Company 18058-001 INSURED Make -A -Wish Foundation of America Make -A -Wish Foundation of Colorado 7951 E. Maplewood Avenue Suite 126 Greenwood Village, CO 80111 I INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: • R e emarxs (. UVtlIAIatJ ‘..,=RI Ir•IVN i G 1\VInIVLf.. 6:,svJ,., ---- -- - - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR R TYPE OF INSURANCE ly¢n ADD) SUER 1MVn POLICY NUMBER POLICYE l � MMPOInn EXP /VYYY l 1 LIMITS i TR A X COMMERCIAL GENERALLIABILITY Y PHPK1544332 9/1/2016 9/1/2017 EACH OCCURRENCE $ 1,000,000 $ 100,000 PRETS a occErence) J CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 $ 2,000,000 $ 2,000,000 $ GENERAL AGGREGATE GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES JECT PRO-LOC PER: PRODUCTS-COMP/OPAGG A AUTOMOBILE X - X _ LIABILITY ANY AUTO OWNED _AUTOS X SCHEDULED Y AUTOS ONLY PHPK1544332 9/1/2016 9/1/2017 COMBINEDSINGLELIMIT (Ea accident) $ 1,000,000 BODILY INJURY(Per person) $ BODILY INJURY(Per accident) $ PROPERTY DAMAGE (Per accident) $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE PHU8554613 9/1/2016 9/1/2017 EACH OCCURRENCE $ 5,000,000 $ 5,000,000 $ AGGREGATE DED I X !RETENTIONS 10, 000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory If NH) fIfyes, describeunder DESCRIPTION OF OPERATIONS below Y/ N NIA TH ¶ 'EN I ITF I !0FR E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required THIS VOIDS AND REPLACES PREVIOUSLY ISSUED CERTIFICATE DATED: 1/25/2017 WITH ID: 25175453 Office ID #: 009-000 Event Name: Frank's Ride for Children Event Date: 06/24/2017 Certificate Holder is included as an Additional Insured as respects to General Liability if reauired by written contract. CERTIFICATE HOLDER McLane Company Inc., it's parent & all subdidiaries, affiliates & divisions 2100 E. Ken Pratt Blvd. Longmont, CO 80504 ACORD 25 (2016/03) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Co11:5080270 Tp1:2123729 Cert: 89727 ©1988-201 CORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AR D CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 DATE IMMIDDIYYYY) 05/24/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Willis of Arizona, Inc. c/o 26 Century Blvd. P. 0. Box 305191 P. Nashville, TN 37230-5191 CONTACT NAMF' PHONE FAX FXT) 877-945-7378 (A/C NOY 888-467-2378 E- AnoRFss• certificates@willis.com INSURER(S)AFFORDING COVERAGE NAIC # INSURER A: Philadelphia Indemnity Insurance Company 18058-001 INSURED Make -A -Wish Foundation of America Make -A -Wish Foundation of Colorado 7951 8. Maplewood Avenue Suite 126 Greenwood Village, CO 80111 I INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: CERTIFICATE NUMBER• 25489725 VISION NUMBER:See Remarks vv v I-r"ww• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TR TYPE OF INSURANCE ADDL (Nsn SUBR wvn(MMIDflIVYYY) POLICY NUMBER POLICY EFF POLICY EXP (MMRN1/YYVY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y PHPR1544332 9/1/2016 9/1/2017 EACHOCCURRENCE$ 1,000,000 $ 100,000 PREMIStS(taoccurence) CLAIMS -MADE X OCCUR MEDEXP(Anyoneperson) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 $ 2,000,000 $ 2,000,000 $ GENERAL AGGREGATE GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PRO JECT PER: LOC PRODUCTS-COMP/OPAGG AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON BONED AUTOS ONLY COMBINEDS INGLE LIMIT $ BODILY INJURY(Per person) $ BODILY I NJURY(Per accident) $ (Per accident DAMAGE $ $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED J (RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory.in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A I PER l STATI ITF I IUFR E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) THIS VOIDS AND REPLACES PREVIOUSLY ISSUED CERTIFICATE DATED: 1/25/2017 WITH ID: 25175457 Office ID #: 009-000 Event Name: Frank's Ride for Children Event Date: 06/24/2017 Certificate Holder is included as an Additional Insured as respects to General Liability if reauired by written contract. l.,tK i iri\,A I t fVLUGR Weld County Government 1762 Weld County Rd. 20 1/2 Longmont, CO 80504 -. ••-----• • • •--- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE e;_ Co11:5080268 Tp1:2123733 Cert: 89725 ©1988-201 CORD CORPORATION. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD • AR ® CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 DATE (MMIDD/YYYY) 05/24/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Willis of Arizona, Inc. c/o 26 Century Blvd. P. 0. Box 305191 Nashville, TN 37230-5191 CONTACT NAME PHONE (ggg-467-2378 ((EA/C NO FXT) 877-945-7378 ( No). AnnR-MAIFss certificates@willis.com INSURER(S)AFFORDINGCOVERAGE NAIC # INSURER A: Philadelphia Indemnity Insurance Company 18058-001 INSURED Make -A -Wish Foundation of America Make -A -Wish Foundation of Colorado 7951 E. Maplewood Avenue Suite 126 Greenwood Village, CO 80111 I INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: emarks WVttiAlit5 L.CRIIrun.AIG1\VIrtio r,z;:o,,.-a--- - ----- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE IN- ADDL SUBR POLICY. NUMBER iMMinn rYYY ) POLICYXP (mkt/no/rm.') LIMITS 1 TR A X COMMERCIAL GENERAL LIABIUTY Y PHPK1544332 9/1/2016 9/1/2017 EACH OCCURRENCE $ 1,000,000 $ 100, 000 MISES �OEVrciccTurence) I CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 $ 2,000,000 $ 2,000,000 $ GENERAL AGGREGATE GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS-COMP/OPAGG AUTOMOBILE LIABILITY ANY AUTO OWNED HONLY HIRED RED AUTOS ONLY _NNON-O SCHEDULED UTOSVVNED AUTOS COMBINED nt) INGLE LIMIT $ BODILY INJURY(Per person) $ BODILY INJURY(Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE PHUB554613 9/1/2016 9/1/2017 EACH OCCURRENCE $ 5,000,000 $ 5,000,000 $ AGGREGATE DED I X'RETENTION $ 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? IMandatorybn NH) f yes, describe under DESCRIPTION OF OPERATIONS below N /A PER UTH- S7ATI ITF Il FR E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required THIS VOIDS AND REPLACES PREVIOUSLY ISSUED CERTIFICATE DATED: 5/9/2017 WITH ID: 25469634 Office ID #009-000 Event Name: Frank's Ride for Children Event Date: June 24, 2017 Certificate Holder is included as an Additional Insured as respects to General Liability if by written contract. required CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Larimer County 200 W. Oak Street Fort Collins, CO 80521 ACORD 25 (2016/03) Coll : 5080266 Tpl: 2147813 Cert :189723 ©1988-201 CORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Chloe Rempel From: Sent: To: Subject: Gregory Risedorf <gregrisedorf@yahoo.com> Friday, June 02, 2017 1:34 PM Chloe Rempel Fw: Franks Ride Sent from Yahoo Mail on Android On Fri, Jun 2, 2017 at 12:29 PM, Daig, Cody <cody.daig@leu-rescue.org> wrote: Howdy Greg, LEU can provide medical support for the Franks Ride event at Anderson Farms on June 24th from 10-5. Let us know if you need anything else. Cody 1 Chloe Rempel From: Sent: To: Subject: Gregory Risedorf <gregrisedorf@yahoo.com> Wednesday, May 31, 2017 11:38 AM Chloe Rempel FW: Franks Ride for Children Sent from Yahoo Mail on Android On Wed, May 31, 2017 at 7:01 AM, Emma Douglas <edouglas@mvfpd.org> wrote: See below, you're all set. Thanks Greg! Emma Douglas Community Outreach Coordinator Mountain View Fire Protection District Office: 303-772-0710 x1129 Mobile: 303-434-2891 www.mvfpd.org MVFR on MVFR on Facebook Twitter Making a difference in the lives of others. From: Roger Rademacher Sent: Wednesday, May 31, 2017 7:58 AM To: Emma Douglas Subject: Re: Franks Ride for Children Yes, they are good to go. Roger Sent from my Verizon, Samsung Galaxy smartphone Original message From: Emma Douglas <edouglas@mvfpd.org> Date: 5/31/17 7:55 AM (GMT -07:00) To: Roger Rademacher <rademacher@mvfpd.org> Subject: FW: Franks Ride for Children Chief— can you just reply acknowledging we have no concerns with this event? It's the Franks Ride you had already approved, they just had to reschedule the date due to weather. Thank you! Emma Douglas Community Outreach Coordinator Mountain View Fire Protection District Office: 303-772-0710 x1129 Mobile: 303-434-2891 www.mvfpd.org M VFR on MVFR 8n Facebook Twitter 2 Making a difference in the lives of others. From: Gregory Risedorf [mailto:gregrisedorfc yahoo.com] Sent: Friday, May 26, 2017 2:29 PM To: Emma Douglas Subject: Franks Ride for Children Hi Emma, We were forced to postpone our event due to the weather and extreme wet and muddy conditions at Anderson farms. We are now scheduled for June 24th. Can you please circulate this and then follow up with an email back so that I can submit it to Weld County for my new permits. They were able to get us on the hearing docet on June 5th. Thank you for your cooperation. Greg Risedorf (303) 775-9190 3 Chloe Rempel From: Sent: To: Subject: Gregory Risedorf <gregrisedorf@yahoo.com> Monday, April 10, 2017 10:02 AM Chloe Rempel Franks Ridefor children Franks Ride for Children is having an event open to the public on Saturday May 20th, and we will be serving food on behalf of the non-profit organization Frank's Ride for Children, for the benefit of Make a Wish Foundation of Colorado, Inc. we will not have any outside vendors for food or merchandise. Potable water is on site in the house and main food building and which has a licensed kitchen. along with a pallet of bottled water which was donated by McLane Western. I will also have 40 cases of assorted pop available. Greg Risedorf 1 Chloe Rempel From: Sent: To: Cc: Subject: Frank Haug Monday, April 10, 2017 10:22 AM Chloe Rempel Esther Gesick RE: Food Requirements for Temporary Assembly Applications Okay, go ahead and just make sure you do what Dan says is appropriate. Frank N. Haug Assistant Weld County Attorney 1150 O Street Mailing Address: P.O. Box 758, Greeley, CO 80632 tel: (970) 356-4000 x4394 fax: (970) 352-0242 Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. -----Original Message From: Chloe Rempel Sent: Monday, April 10, 2017 10:20 AM To: Frank Haug <fhaug@co.weld.co.us> Cc: Esther Gesick <egesick@co.weld.co.us> Subject: Food Requirements for Temporary Assembly Applications Hello, I just spoke with Dan Joseph about food license requirements for Temporary Assembly Permit applications because Frank's Ride for Children fbo Make a Wish Foundation of Colorado, Inc. would like to serve their own food at an event held at Anderson Farms. Temporary Assemblages can operate under an existing food license if the application is being submitted by the license holder. Or, if the application is being submitted by someone other than the license holder and it is a non-profit organization, they can serve their own food if they submit a letter or email along with their application stating that they are having an event open to the public on such and such a date, and will be serving food on behalf of a non-profit organization. Chloe A. Rempel Deputy Clerk to the Board Weld County Chloe Rempel From: Sent: To: Subject: Gregory Risedorf <gregrisedorf@yahoo.com> Friday, May 26, 2017 2:45 PM Chloe Rempel Fw: Franks Ride for Children Forwarded Message From: "Weaver, Adele" <aweaver4@wm.com> To: Gregory Risedorf <gregrisedorf@yahoo.com> Sent: Friday, May 26, 2017 2:33 PM Subject: RE: Franks Ride for Children Frank, Yes, sorry I did get it and we are all good to go for June 24. Delivery will be the 23rd and removal will be the 26th Adele Weaver Sales Specialist — Construction aweaver4Cc�wm.com Tel 303 486 6009 Waste Management Four Corners Support Line 855 411 5742 Fourcornersbuildersdirect(cr�wm.com Waste Management recycles enough paper materials to save 110 million trees each year. From: Gregory Risedorf [mailto:gregrisedorf@yahoo.com] Sent: Friday, May 26, 2017 1:21 PM To: Weaver, Adele <aweaver4@wm.com> Subject: Franks Ride for Children Hi Adele, I don't know if you got my message so I am just sending a follow up . We are rescheduled for June 24th. Everything will be the same. can you please update the service proposal to reflect the new date so I can submit it to the county for the new permits. If you have any questions please call me. Thanks. Greg Risedorf (303) 775-9190 Recycling is a good thing. Please recycle any printed emails. 1 WASTE MANAGEMENT Adele Weaver Special Events Coordinator (303)486 6009 (Direct) Aweaver4®wm. corn Service Proposal Event Name: Franks Ride for the Children Contact: Gregory Risedorf Event Date: Sat 5.20.17 Location: 2544 JARETT DR MEAD CO 80542-9783 Telephone Number: 303 775 9190 Delivery Date: May 19th 2017 Removal Date: May 22nd 2017 Email: <gregrisedorf@yahoo. corn> Anderson Park Service Description Quantity Rate Delivery Total 6 yard dumpster 2 $75.00 $25.00 $200.00 Special event Portalet 4 $55.00 $15.00 $280.00 Special event handicap portalet 1 $65.00 $15.00 $80.00 Hand wash station 1 $65.00 $15.00 $80.00 Thank you for taking the time to consider Waste Management for your special event needs. We look forward to helping your event continue to be a success! This quote is confidential and property cf'FVasteManagement DATE 3)94 I I "1 PO Box 758 PO Box 758 Greeley CO 80632 Greeley CO 80632 RECEIPT DATE ---_c/ / 1 RECEIVED FROM Fra-r11 .5 t?:des car Cklitdcen ADDRESS 045(4,4 aacc64+ °rive-,(YIA 2,C FOR T PAID RECEIPT NO 89199 054D n' NO. 89200 RECEIVED FROM Fro, -(114‹.5 (�; d e s `_;r• `Ck ; I d ren ADDRESS 54 Li Tarrtr4 f�riye.r Lt ICG 80542 +me, t kor,dttd dottokrs - oottoo — s too .00 FOR C,t1 L �?Q¢CiA.t eve - f Fee. V At l 1 ©Co RECEIPT DATE 031_0(4u1?___ NO. RECEIVED FROM '5 R; d e 5 E 'r CA -1;i dccr ADDRESS 'DS -(1 Sarre -t4 Or ;ye, i d , CO 905`i 89201 (pox- t-(uridceci dot l acs °C)/(0O-- s 100.00 FOR CA) e L 0 --ralIVOCCAla Q s ,,ery 1-11 HOW PAID cash...,...... K too oo BY O .YW e-• Chloe Rempel From: Sent: To: Subject: Attachments: Janet Lundquist Monday, April 10, 2017 2:19 PM Chloe Rempel RE: TEMPORARY ASSEMBLY PERMIT - Frank's Ride for Children fbo Make a Wish Foundation of Colorado, Inc. Temp Assembly Frank's Ride 041017.doc Here you go. I just made one referral for both the Temporary Assembly & the Special Event Permit. Janet Lundquist Support Services Manager Weld County Public Works Dept. P.O. Box 758, Greeley, CO 80632 Tele-970.356.4000 ext 3726 Fax- 970.304.6497 Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Chloe Rempel Sent: Monday, April 10, 2017 1:10 PM To: Bethany Pascoe <bpascoe@co.weld.co.us>; Dan Joseph <djoseph@co.weld.co.us>; Deb Adamson <dadamson@co.weld.co.us>; Frank Haug <fhaug@co.weld.co.us>; Janet Lundquist <jlundquist@co.weld.co.us>; Jose Gonzalez <jgonzalez@co.weld.co.us>; Roy Rudisill <rrudisill@co.weld.co.us>; Sam Kaneta III <skaneta@co.weld.co.us> Subject: TEMPORARY ASSEMBLY PERMIT - Frank's Ride for Children fbo Make a Wish Foundation of Colorado, Inc. Hello, In accordance with the procedure for processing Temporary Assembly Permit Applications, please review all records on the following document/establishment for any associated reports/incidents and return your report to the Weld County Clerk to the Board's Office. Your report will be used by the Board of County Commissioners in considering the Applicant's Temporary Assembly Permit. Please note that the applicant has been in contact with the fire district and they have approved the event, but the applicant is still awaiting the letter from the fire district stating such. PLEASE RESPOND NO LATER THAN: Monday, April 17, 2O17 by 5:00 PM Applicant: Frank's Ride for Children for the benefit of Make a Wish Foundation of Colorado, Inc. Gregory and Tammy Risedorf 2544 Jarrett Drive 1 ., ,- s 'x•:°' a3fi a 4 `s n'�r# s-, „='2"r�'* " 3 S'.�-n.,t �x �a� �<. :: " � AiVgr tUtal,'iek Mead, CO 80542 Event Address: Anderson Farms 6728 County Road 3 Y4 Erie, CO 80516 File Location: LC0022 Thank you, Chloe A. Rempel Deputy Clerk to the Board Weld County 1150 O Street Greeley, CO 80631 tel: 970-400-4225 Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. 2 MEMORANDUM TO: Esther Gesick, Clerk to the Board DATE: April 10, 2017 Y FROM: Janet Lundquist, Public Works SUBJECT: Temporary Assembly & Special Event Permit- Frank's Ride The Weld County Public Works Department has reviewed this proposal. Our requirements are as follows: REQUIREMENTS; 1. No parking will be allowed on Weld County Roadways. 2. Approximately 1,500 vehicles will require parking on the property 3. This area is not in a Special Flood Hazard Area (SFHA) as determined by the Federal Emergency Management Agency (FEMA). 4. Please utilize the Traffic Control Plan (TCP) used at last year's event. 5. Please submit an Incident Action Plan for the Office of Emergency Management. Page - 1 - of 1 April 10, 2017 C. Users\crempellAppDatalLocal\Microsoft \ Windows\ Temporary Internet Files \Content.Outlook \PI OEIC(REllernp Assembly Frank's Ride 0410I'Nine Chloe Rempel From: Sent: To: Subject: No Concerns from building Thanks Jose Gonzalez Asst Building Official Planning Services 1555 Nit' Ave 970-400-3533 Jose Gonzalez Tuesday, April 11, 2017 8:22 AM Chloe Rempel; Bethany Pascoe; Dan Joseph; Deb Adamson; Frank Haug; Janet Lundquist; Roy Rudisill; Sam Kaneta III RE: SPECIAL EVENT PERMIT - Frank's Ride for Children fbo Make a Wish Foundation of Colorado, Inc, Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Chloe Rempel Sent: Monday, April 10, 2017 1:11 PM To: Bethany Pascoe <bpascoe@co.weld.co.us>; Dan Joseph <djoseph@co.weld.co.us>; Deb Adamson <dadamson@co.weld.co.us>; Frank Haug <fhaug@co.weld.co.us>; Janet Lundquist <jlundquist@co.weld.co.us>; Jose Gonzalez <jonzalez@co.weld.co.us>; Roy Rudisill <rrudisill@co.weld.co.us>; Sam Kaneta III <skaneta@co.weld.co.us> Subject: SPECIAL EVENT PERMIT - Frank's Ride for Children fbo Make a Wish Foundation of Colorado, Inc. Hello, In accordance with the procedure for processing Special Event Permit Applications, please review all records on the following document/establishment for any associated reports/incidents and return your report to the Weld County Clerk to the Board's Office. Your report will be used by the Board of County Commissioners in considering the Applicant's Special Event Permit. PLEASE RESPOND NO LATER THAN: Monday, April 17, 2017 by 5:00 PM Applicant: Frank's Ride for Children for the benefit of Make a Wish Foundation of Colorado, Inc. Gregory and Tammy Risedorf 2544 Jarrett Drive Chloe Rempel From: Sent: To: Subject: Sam Kaneta III Tuesday, April 11, 2017 8:55 AM Chloe Rempel RE: SPECIAL EVENT PERMIT - Frank's Ride for Children fbo Make a Wish Foundation of Colorado, Inc. Same as for the Temporary permit, no concerns. Sam Kaneta III Weld County Sheriff's Office 1950 O Street Greeley, CO 80631 970-356-4015 ext 2877 skaneta@co.weld.co.us From: Chloe Rempel Sent: Monday, April 10, 2017 1:11 PM To: Bethany Pascoe <bpascoe@co.weld.co.us>; Dan Joseph <djoseph@co.weld.co.us>; Deb Adamson <dadamson@co.weld.co.us>; Frank Haug <fhaug@co.weld.co.us>; Janet Lundquist <jlundquist@co.weld.co.us>; Jose Gonzalez <jonzalez@co.weld.co.us>; Roy Rudisill <rrudisill@co.weld.co.us>; Sam Kaneta III <skaneta@co.weld.co.us> Subject: SPECIAL EVENT PERMIT - Frank's Ride for Children fbo Make a Wish Foundation of Colorado, Inc. Hello, In accordance with the procedure for processing Special Event Permit Applications, please review all records on the following document/establishment for any associated reports/incidents and return your report to the Weld County Clerk to the Board's Office. Your report will be used by the Board of County Commissioners in considering the Applicant's Special Event Permit. PLEASE RESPOND NO LATER THAN: Monday, April 17, 2017 by 3:00 PM Applicant: Frank's Ride for Children for the benefit of Make a Wish Foundation of Colorado, Inc. Gregory and Tammy Risedorf 2544 Jarrett Drive Mead, CO 80542 Event Address: Anderson Farms 6728 County Road 3 1/4 Erie, CO 80516 File Location: LC0022 Thank you, Chloe A. Rempel Deputy Clerk to the Board Weld County 1150 O Street 1 Chloe Rempel From: Sent: To: Subject: Attachments: Bethany Pascoe Friday, April 14, 2017 8:14 AM Chloe Rempel RE: SPECIAL EVENT PERMIT - Frank's Ride for Children fbo Make a Wish Foundation of Colorado, Inc. LC0022.2017.doc Please see staff's attached referral response for both the SE and the TA applications. From: Chloe Rempel Sent: Monday, April 10, 2017 1:11 PM To: Bethany Pascoe <bpascoe@co.weld.co.us>; Dan Joseph <djoseph@co.weld.co.us>; Deb Adamson <dadamson@co.weld.co.us>; Frank Haug <fhaug@co.weld.co.us>; Janet Lundquist <jlundquist@co.weld.co.us>; Jose Gonzalez <jgonzalez@co.weld.co.us>; Roy Rudisill <rrudisill@co.weld.co.us>; Sam Kaneta III <skaneta@co.weld.co.us> Subject: SPECIAL EVENT PERMIT - Frank's Ride for Children fbo Make a Wish Foundation of Colorado, Inc. Hello, In accordance with the procedure for processing Special Event Permit Applications, please review all records on the following document/establishment for any associated reports/incidents and return your report to the Weld County Clerk to the Board's Office. Your report will be used by the Board of County Commissioners in considering the Applicant's Special Event Permit. PLEASE RESPOND NO LATER THAN: Monday, April 17, 2017 by 5:00 PM Applicant: Frank's Ride for Children for the benefit of Make a Wish Foundation of Colorado, Inc. Gregory and Tammy Risedorf 2544 Jarrett Drive Mead, CO 80542 Event Address: Anderson Farms 6728 County Road 31/< Erie, CO 80516 File Location: LC0022 Thank you, Chloe A. Rempel Deputy Clerk to the Board Weld County 1150 0 Street Greeley, CO 80631 tel: 970-400-4225 MEMORANDUM To: Chloe Rempel, Deputy Clerk to the Board April 14, 2017 From: Bethany Pascoe, Zoning Compliance Officer, Dept. of Planning Services Subject: LC0022 Review of the following Temporary Assembly Permit and Special Events Permit by the Department of Planning Services shows the following: Applicant: Frank's Ride for Children c/o Greg Risedorf 2544 Jarett Dr PO Box 327 Mead, CO 80542 Location of Event: Anderson Farms 6728 CR 3.25 Erie, CO 80516 Zone District: A (Agricultural) Event Date and Times: May 20, 2017 8:00 AM - 9:00 PM Attendance: 1000 to 1500, No more than 1500 people This property is currently permitted through AmUSR-1232 as a "Guest Farm". No existing violations were noted. SERVICE, TE:M.1, AX, INTEGRITY, QUALITY Chloe Rempel From: Sent: To: Subject: Roy Rudisill Monday, April 17, 2017 11:40 AM Chloe Rempel RE: SPECIAL EVENT AND TEMP ASSEMBLY PERMITS - Frank's Ride for Children fbo Make a Wish Foundation of Colorado, Inc. No concerns from our Office. I haven't heard from the Fire Department but this is an event that historically has not been an issue. Roy Rudisill Director Office of Emergency Management 1150 O Street 970-304-6540 Office 970-381-0417 Cell Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Chloe Rempel Sent: Monday, April 17, 2017 11:29 AM To: Roy Rudisill <rudisill@co.weld.co,us> Subject: FW: SPECIAL EVENT AND TEMP ASSEMBLY PERMITS - Frank's Ride for Children fbo Make a Wish Foundation of Colorado, Inc. Good Morning Roy, Can you please send a referral response for the attached applications? Thank you! Chloe A. Rempel Deputy Clerk to the Board Weld County 1150 0 Street Greeley, CO 80631 tel: 970-400-4225 Hello