HomeMy WebLinkAbout20170361.tiff11/01li.
DEPART IEN7 OF Pi iNNIP SERVICES ' 155 N tl'" AVENUE ' GREELEY. CO am 1
P " 9fD-3536.100 TEXT 3640 ' FAX 87(}.304-6496
DATTE RECEIVED 11/23/16
AMOU!dT $ LASE Al ASSKJP1ED USR16-0044
APPt, CATON RECEIVED BY PLANNER A5B GtwE.l. DA
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USE BY SPECIAL REVIEW (USR) APPLICATION
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Proposed Use: A trailer will be installed on this parcel as a stopover office for field personnel.
Personnel will be on site for less than two hours at a time.
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Print Name
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Para Name
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USE BY SPECIAL REVIEW (USR) QUESTIONNAIRE
Answer the following questions on a separate sheet. If a question does not pertain to your use, please respond
with "not applicable". For assistance with some of these questions see this website:
http://www.co.weld.co.us/Departments/PlanningZoning/LandUseApplicationsAssistance/ApplicationAssistance.html
Planning Questions: Planner on Call 970-353-6100 x3540
1. Explain, in detail, the proposed use of the property. A trailer will be installed on this property as a stopover
office for field personnel.
2. Explain how this proposal is consistent with the intent of the Weld County Code, Chapter 22 of the
Comprehensive Plan. Policy 7.2 reads: "Conversion of agricultural land to urban residential, commercial and
industrial uses should be accommodated when the subject site is in an area that can support such
development and should attempt to be compatible with the region." Part of this land is already in use for oil
and gas. Agricultural land in this parcel will not be sacrificed for the trailer. The trailer is on a piece of property
that is contiguous to an oil and gas tank battery, in a remote corner of the parcel, and be easily
accommodated as an alternate use.
3. Explain how this proposal is consistent with the intent of the Weld County Code, Chapter 23 (Zoning) and the
zone district in which it is located. Per Section 23.3.40 The following BUILDINGS, STRUCTURES and USES
may be constructed, occupied, operated and maintained in the A (Agricultural) Zone District upon approval of
a permit in accordance with the requirements and procedures set forth in Article II, Division 4 of this Chapter.
A. Mineral resource development facilities including: 2. OIL AND GAS SUPPORT SERVICES. The proposed
manufactured structure to be used as office space will support mineral resource development. Also Section
23.3.40 5: "Any use permitted as a Use by Right, an ACCESSORY USE, or a Use by Special Review in the
COMMERCIAL or industrial zone districts, provided that the property is not a Lot in an approved or recorded
subdivision plat or lots part of a map or plan filed prior to adoption of any regulations controlling subdivisions.
PUD development proposals shall not be permitted to use the special review permit process to develop."
Encana is engaging in a commercial, site -specific, development that will be placed in an agricultural zone and
is completing the USR in order to make it a permanent use.
4. Describe what type of land uses surround the site. Explain how the proposed use is consistent and
compatible with surrounding land uses. Surrounding land is oil and gas production and agricultural This use is
consistent as support for oil and gas operations and will not interfere with any of the current uses.
5. What are the hours and days of operation? (e.g. Monday thru Friday 8:00 a.m. to 5:00 p.m.) The trailer would
be in use seven days a week during normal work hours, one to two hours in the morning and possibly one
hour in the afternoon.
6. List the number of full time and/or part time employees proposed to work at this site. 0
7. If shift work is proposed include the number of employees per shift. na
8. List the number of people who will use this site. Include contractors, truck drivers, customers, volunteers, etc.
4
9. If this is a dairy, livestock confinement operation, kennel, etc., list the number and type of animals. na
10. Describe the type of lot surface and the square footage of each type. (e.g. asphalt, gravel, landscaping, dirt,
grass, buildings) 594 sf building and 600 sf of gravel
11. How many parking spaces are proposed? How many handicapped (ADA) parking spaces are proposed?
2 parking spaces, 0 handicapped spaces
12. Explain the existing and proposed landscaping for the site. na
13. Describe the type of fence proposed for the site (e.g. 6 foot chain link with earth tone slats). Fencing will be 6'
earth tone painted chain link.
14. Describe the proposed screening for all parking and outdoor storage areas. na
If the site is located in a floodplain outdoor storage is restricted.
15. Explain any proposed reclamation procedures when termination of the Use by Special Review activity occurs.
Site will be reclaimed to current condition.
16. Who will provide fire protection to the site? Fire protection will be provided by the Platteville-Gilcrest Fire
Protection District.
17. List all proposed on -site and off -site improvements associated with the use (e.g. landscaping, fencing,
buildings, drainage, turn lanes, etc.) and a timeline of when you will have each one of the improvements
completed. Fencing will be installed two days after the trailer is set.
Engineering questions: 970-353-6100 x3540
1. Describe how many roundtrips/day are expected for each vehicle type: Passenger Cars/Pickups, Tandem
Trucks, Semi-Truck/Trailer/RV (Roundtrip = 1 trip in and 1 trip out of site) 4 pickup trucks per day
2. Describe the expected travel routes for site traffic. Traffic will be either from the north or south on CR 31.
3. Describe the travel distribution along the routes (e.g. 50% of traffic will come from the north, 20% from the
south, 30% from the east, etc.) 50% from the north, 50% from the south
4. Describe the time of day that you expect the highest traffic volumes from above. Usage will be heaviest in the
morning hours of 6:00 am to 8:00 am.
5. Describe where the access to the site is planned. There is a current approved access off WCR 31, 2082'
south of the intersection of WCR 24 and WCR 31.
6. Drainage Design: Detention pond summarized in a drainage report is required unless the project falls under an
exception to stormwater detention requirements per code section 23-12-30 F.1.
A. Does your site qualify for an exception to stormwater detention? If so, describe in a drainage narrative the
following:
1. Which exception is being applied for and include supporting documentation. Encana is applying for
Exception #14: A parcel greater than 5 gross acres in size is allowed a onetime exception for a new
2,000 sq ft building or equivalent imperviousness. We are adding a 594 sf bldg plus 600 sf of gravel„
which does not exceed the maximum equivalent imperviousness.
2. Where the water originates if it flows onto the property from an offsite source The Fulton Extension
Ditch is about 330' to the east of the proposed structure. Any water coming from the east side of the
ditch would go into the ditch, so water coming onto the property would be rain that hits the ground
between the property and the ditch. Any rain falling to the north, south and west of the property will flow
downhill to the west.
3. Where it flows to as it leaves the property. Water will flow to the west as it leaves the property.
4. The direction of flow across the property. The direction of flow is west to east.
5. If there have been previous drainage problems with the property, There have been no previous
drainage problems with this property.
B. Does your site require a stormwater detention pond? na If so, the following applies:
1. A drainage report summarizing the detention pond design with construction drawings and maintenance
plan shall be completed by a Colorado Licensed Professional Engineer and adhere to the drainage
related sections of the Weld County Code.
2. The drainage report must include a certification of compliance stamped and signed by the PE which
can be found on the engineering website.
3. aeneral drainage report guidance checklist is available on the engineering website. More complete
X861 :klists are available upon request.
USE BY SPECIAL REVIEW (USR) QUESTIONNAIRE (PAGE 2)
Environmental Health questions: 970-304-6415 x2702
1. What is the drinking water source on the property?
If utilizing a drinking water well include either the well permit or well permit application that was submitted to
the State -Division of Water Resources. If utilizing a public water tap include a letter from the Water District, a
tap or meter number, or a copy of the water bill. Bottled water will be provided. Weld County Environmental
was unable to find a sewer permit for the home on this parcel.
2. What type of sewage disposal system is on the property?
If utilizing an existing septic system provide the septic permit number. If there is no septic permit due to the
age of the existing septic system, apply for a septic permit through the Department of Public Health and
Environment prior to submitting this application. If a new septic system will be installed, please state "a new
septic system is proposed". Only propose portable toilets if the use is consistent with the Department of Public
Health and Environment's portable toilet policy. No sewage system is proposed. Portable toilets will be on
site.
3. If storage or warehousing is proposed, what type of items will be stored? na
4. Describe where and how storage and/or stockpile of wastes, chemicals, and/or petroleum will occur on this
site. na
5. If there will be fuel storage on site indicate the gallons and the secondary containment. State the number of
tanks and gallons per tank. na
6. If there will be washing of vehicles or equipment on site indicate how the wash water will be contained. na
7. If there will be floor drains indicate how the fluids will be contained. No drains.
8. Indicate if there will be any air emissions. (e.g. painting, oil storage, etc.) na
9. Provide a design and operations plan if applicable. (e.g. composting, landfills, etc.) na
10. Provide a nuisance management plan if applicable. (e.g. dairies, feedlots, etc.) na
11. Additional information may be requested depending on type of land use requested.
Building questions: Jose Gonzalez 970-353-6100
1. List the type, size (square footage), and number of existing and proposed structures. Show and label all
existing and proposed structures on the USR drawing. Label the use of the building and the square footage.
Manufactured home. 594 sf; 0 existing structures; 1 proposed structure
2. Explain how the existing structures will be used for this USR? This building will be used as a stopover office
for field personnel.
3. List the proposed use(s) of each structure. See above.
WELD COUNTY ACCESS PERMIT
Weld County Public Works Dept.
1111 H Street
P.O. Box 758
Greeley, CO 80632
Phone: (970) 304-6496
After Hours: (970) 356-4000
Emergency Services: (970) 304-6500 x 2700
Inspection: (970) 304-6480
Permit Number: AP16-00270
Issuance of this permit binds applicant and its contractors to all requirements, provisions, and ordinances of Weld County, Colorado.
Project Name: ZPMH16-0025
Applicant Information:
Name:
Company:
Phone:
Email:
Toby Sachen
Encana Oil & Gas (USA) Inc.
720-876-5845
toby.sachen@encana.com
Location:
Access is on WCR:
Nearest Intersection WCR:
Distance From Intersection:
Number of Existing Accesses:
31
31
3120
3
Planning Process: Other ZPMH16-0025
Road Surface Type & Construction Information:
Road Surface: Gravel
Culvert Size & Type:
Start Date: Finish Date:
Materials to Construct Access:
Required Attached Documents Submitted:
Traffic Control Plan: No
15" CMP/RCP min. if req.
& WCR: 22
Expiration date:
Property Owner Information:
Name:
Company: Cannon Land
Phone: 303-722-3424
Email:
Proposed Use:
Temporary:
Single Residential:
Industrial:
Small Commercial:
Oil & Gas:
Large Commercial:
Subdivision:
Field (Agricultural
On ly)/Exem pt:
Certificate of Insurance: No Access Pictures: Yes
A copy of this permit must be on site at all times during construction hours
Daily work hours are Monday through Friday DAYLIGHT to 'A HOUR BEFORE DARK (applies to weekends if approved)
Approved MUTCD traffic control/warning devices are required before work begins and must remain until completion of work
Special Requirements or Comments
Parcel 130909000003. Utilize existing access point on CR 31 (1-O&G) located approx. 3120 ft. North of CR 22.
Approved by:
Weld County Public Works
Date: 6/23/2016
Print Date -Time: 6/23/2016 4:03:51PM Access Permit PW008
Page 1 of 1
Traffic Study Questions for lower traffic trips (well under 100 round trips per day)
1. Describe how many roundtrips/day are expected for each vehicle type: Passenger Cars/Pickups,
Tandem Trucks, Semi-Truck/Trailer/RV (Roundtrip = 1 trip in and 1 trip out of site) 4 pickup trucks
per day
2. Describe the expected travel routes for site traffic. Traffic will be either from the north or south on CR
31
3. Describe the travel distribution along the routes (e.g. 50% of traffic will come from the north, 20%
from the south, 30% from the east, etc.) 50% from the north, 50% from the south
4. Describe the time of day that you expect the highest traffic volumes from above. Usage will be
heaviest in the morning hours of 6:00 am to 8:00 am.
FOR COMMERCIAL SITES, PLEASE COMPLETE THE FOLLOWING INFORMATION
BUSINESS EMERGENCY INFORMATION:
Business P.
"-I
Name: k &= Phone:
Address:tilOtnr—a f= 4\ . \`Z < scf Ctct City, ST, Zip:
Business
Owner Phone
"{1146
-O, , 86D4--
4--
Rome Address: City, ST, Zip:
List three persons
NAME
in the order to be called in the event of an emergency:
e c .C
TITLE ADDRESS PHONE
tt- r . 6 N70,f , r7 3t Mod
Business
Hours ? 4r° 5
N
503-46E)-1613
A '' t i3 -ni 31
Days
Type of Alarm: ,r' None J Burglar Holdup Fire Silent Audible
Name and address of Alarm Company:
Location of Safe. V,14-,
..***ky*..**44*iiki ii#}iii#kir#}.tk###}i*i**ik**i**ik*kk*i₹+i**k**kkk*kk**₹k*k₹***k**k₹kik*********k**k₹*ik*₹k****k****k₹*******k*
MISCELLANEOUS INFORMATION:
Number of entry/exit doors in this building:
9
Location(s): `t`
Is alcohol stored in building? \ Location(s):
Are drugs stored in building? Location(s):
Are weapons stored in building? ti Location(s):
The following programs are offered- ,a public service of the Weld Coun
programs of interest. I I Physical Security Check _
UTILITY SHUT OFF LOCATIONS:
Main Electrical: ►x't4�,t_
Gas Shut Off:
riffs Office. Please indicate the
Crime Prevention Presentation
Exterior Water Shutoff: VI&
Interior Water Shutoff:
Execution Version
Exhibit F-1
Form of Omnibus Assignment, Bill of Sale and Conveyance
ASSIGNMENT, BILL OF SALE AND CONVEYANCE
This Assignment, Bill of Sale and Conveyance ("Assignment"), effective as of April 1,
2015, at 7:00 a.m. Mountain Time ("Effective Time"), is by and between Encana Oil & Gas
(USA) Inc., a Delaware corporation ("Assignor"), whose address is 370 l7th Street, Suite 1700,
Denver, Colorado 80202, and Crestone Resources LP, a Delaware limited partnership, whose
address is J 1 ("Assignee"). Assignor and
Assignee are, collectively, the "Parties," and, each individually, a "Party." Capitalized terms
used but not defined in this Assignment have the meanings given those terms under the Purchase
Agreement (defined in Section E below) between Assignor and Assignee.
Upon the terms and conditions of the Purchase Agreement, for Ten Dollars and other
good and valuable consideration, the receipt and sufficiency of which Assignee acknowledges,
effective as of the Effective Time, Assignor GRANTS, BARGAINS, DEEDS, SELLS,
CONVEYS, ASSIGNS, TRANSFERS, and DELIVERS unto Assignee and its successors and
assigns, ALL of Assignor's and any of its Affiliates' right, title, and interest, whether present,
contingent, or reversionary, in and to the following (collectively, the "Assets"):
I
(2) The oil, gas, water, monitoring, carbon dioxide, disposal and/or injection wells
located on, under, within or pooled, unitized, or communitized with the Leases and Lands
whether producing, operating, plugged, permanently abandoned, shut-in or temporarily
abandoned, including the wells described in Exhibit B-1 attached hereto (collectively, the
"Wells"), and the pipelines and facilities associated or used in connection with the Wells or other
Assets, including production units, flow lines and compression facilities, pipelines, gathering,
processing, and treatment systems, and all real property, tangible personal property, equipment,
fixtures, improvements, Permits, licenses, servitudes, rights -of -way, easements and other rights
to operate the Wells or facilities associated or used in connection with the Wells or the surface
(including those rights -of -way, and easements described in Exhibit B-2 attached hereto), in each
case used or held for use in connection with the exploration, development, drilling for,
production, gathering, treatment, handling, processing, storing, transporting, sale or disposal of
Hydrocarbons or water produced from the properties and interests included in the Assets,
including all equipment installed, or in the process of being installed, on the Assets as of the
Effective Time (the "Facilities and Equipment");
Exhibit F-1 — 1
3939146.14
Exhibit B-2
Easements and Surface Rights
Agreement
Number
Lessor
Lessee
Effective
Date
Expiration
Data
Recordation
Coun
Book
Page
Entry
County L- • al
.
0
-
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0
IMI
•
-
930124.000
CANNON LAND COMPANY
ENCANA OIL & GAS (USA) INC
04/09O012
1213119999
WELD
NA
NA
3921886
WELD TOO2N R066W
SEC 011 W2
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Page 11 of 17
Sachen, Toby R.
From: Todd Hodges <thodges@fortlupton.org>
Sent: Wednesday, July 20, 2016 11:05 AM
To: Sachen, Toby R.
Cc: Claud Hanes
Subject: proposed Encana field office located on CR 31 between CR 22 & 24.
Toby,
It was great to talk with you this morning concerning your proposal to place an office trailer for a field office off of CR 31 between CR 22 & 24. Given the location and type of uses proposed the City of Fort
Lupton doesn't have any concerns about your proposal. If you have any questions or wish to discuss further do not hesitate to contact me at the cell number below.
Have a great day.
Todd A. Hodges
Planning Director
City of Fort Lupton
303-994-3174
This email has been scanned by the Symantec Email Security.cloud service.
For more information please visit http://www.symanteccloud.com
1
Diana Aungst
From:
Sent:
To:
Subject:
Chris McRickard <chris.mcrickard@CRESTONEPR.COM>
Wednesday, December 28, 2016 12:00 PM
Diana Aungst
RE: USR16-0044 hours of operation
Good morning Diana — Hours of operation will be from 7am — 5pm, 7 days a week.
Chris McRickard
Regulatory Analyst
Main: 720-410-8500
Direct: 720-410-8487
Mobile: 303-877-7581
Crestone Peak Resources
370 17th Street
Suite 2500— Mail
Suite 2400 — Visitors
Denver, CO 80202
CilikainiNE MAN
TIT .nrF i4
Please note Crestone Peak Resources is closed the 1st and 3rd Friday of each month.
From: Diana Aungst [mailto:daungst@co.weld.co.us]
Sent: Tuesday, December 27, 2016 4:17 PM
To: Chris McRickard <chris.mcrickard@CRESTONEPR.COM>
Subject: USR16-0044 hours of operation
Chris:
The application states normal work hours - what are normal work hours?
Thanks,
Diana Aungst, AICP, CFM
Planner II
Weld County Department of Planning Services
1555 N. 17th Avenue - Greeley, Colorado 80631
970-400-3524
Fax: (970) 304-6498
dau ngst(a�weldgov.com
www.weldgov.com
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
1
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
Planner:
Case Number:
Applicant:
Address:
Situs Address:
Request:
Legal Description:
Parcel Size:
MOBILE/MANUFACTURED HOME ZONING PERMIT
ADMINISTRATIVE REVIEW
Wendi Inloes
ZPMH16-0025
16-0025
Cannon Land Co
3575 E Cherry Creek North Dr., Denver, CO 80209
10651 CR 31, Fort Lupton, CO 80621
A Zoning Permit for a manufactured structure to be used as a temporary office
use, located in the (A) Agricultural Zone District
N2 of Section 9, T2N, R66W of the 6th P.M., Weld County, Colorado
318.75 +/- acres Parcel Number: 1309 09 000003
THE DEPARTMENT OF PLANNING SERVICES' STAFF RECOMMENDS THAT THIS REQUEST BE
APPROVED FOR THE FOLLOWING REASONS:
1. The submitted materials are in compliance with the application requirements of Section 23-4-130
of the Weld County Code.
2. It is the opinion of the Department of Planning Services' staff that the applicant has shown
compliance with Section 23-4-190 of the Weld County Code as follows:
a. The use is compatible with surrounding area, harmony with the character of the
neighborhood and its effects upon the immediate area.
b. The proposed use is consistent with Chapter 22 and any other applicable code provisions
or ordinance in effect.
c. The use which will be permitted will be compatible with the existing surrounding land
uses.
d. The general health, safety and welfare of the inhabitants of the area and the County will
not be affected.
This recommendation is based, in part, upon a review of the application materials submitted by the
applicant, other relevant information regarding the request, and responses from referral entities.
The Department of Planning Services' staff recommendation for approval is conditional upon the following:
1. A building permit will be required, for any new construction or set up manufactured structure, per
Section 29-3-10 of the Weld County Code. A building permit application must be completed and
submitted. Buildings and structures shall conform to the requirements of the various codes
adopted at the time of permit application. Currently the following has been adopted by Weld
County: 2012 International Building Code; 2006 International Energy Code; 2014 National
Electrical Code; the ICC/ANSI A117-1-2009 Standards for Accessibility and Chapter 29 of the
Weld County Code.. A plan review shall be approved and a permit must be issued prior to the
start of construction.
RESOLUTION #35 Factory Built Nonresidential Structured CRS 24-32-3305
Every Factory -Built Nonresidential Structure manufactured after the effective date of these
regulations that is manufactured, sold, or offered for sale in this state must display an insignia
issued by the Division of Housing certifying that the unit is constructed in compliance with the
standards adopted in schedule "B" which is incorporated herein and made a part of these Rules
and Regulations by reference, and all other requirements set forth by this resolution.
2. The manufactured structure is necessary for the effective and economic operation of the principal
use.
3. The manufactured structure will not be used for residential purposes.
4. Adequate water and sewage disposal facilities can be made available to the mobile home or
manufactured structure.
5. No reasonable alternative is available to the applicant for an office use.
6. The applicant must obtain a building permit for the manufactured structure and comply with all
installation standards of Chapter 29 of the Weld County Code.
7. The six-month limitation for this temporary use may be extended in six-month increments at the
discretion of the Director of Planning Services up to two (2) times, and thereafter by the Board of
County Commissioners
8. All manufactured structures as accessory office uses are temporary. The manufactured structure
shall be removed from the property upon the cessation of the use of the manufactured structure
as an accessory office use.
9. The applicant shall submit a statement of an exit plan acknowledging that the temporary permit
shall cease to exist at any such time as the mobile home is used for other than the permitted use.
Such statement shall include detailed plan for removal of the mobile home upon expiration of the
permit, or at such time the permit is not renewed by either the Department of Planning or Board of
County Commissioners, the applicant will have 30 days to put the exit plan into place.
10. All temporary permits shall not be transferable by the applicant and/or owner to any successor;
the zoning permit shall terminate automatically upon conveyance or lease of the property. The
structure home shall be removed from the property, or a new zoning permit shall be applied for
and approved.
11. All proposed or existing structures will or do meet the minimum setback and offset requirements
for the zone district in which the property is located. Pursuant to the definition of setback in the
Weld County Code, the required setback is measured from the future right-of-way line.
12. Adequate drinking, hand washing and toilet facilities shall be provided for employees and patrons
of the facility, at all times. As this is a temporary office use, portable toilets and bottled water are
acceptable for adequate facilities. Records of maintenance and proper disposal for portable toilets
shall be retained on a quarterly basis and available for review by the Weld County Department of
Public Health and Environment. Portable toilets shall be serviced by a cleaner licensed in Weld
County and shall contain hand sanitizers.
• No building or structure as defined and limited to those occupancies listed as Groups A, B, E, F,
H, I, M and R in Section 302.1 of the 2012 International Building Code, shall be constructed within
a 200 -foot radius of any tank battery or within a 150 -foot radius of any wellhead or within a twenty-
five -foot radius of any plugged or abandoned oil and gas well. Any construction within a two -
hundred -foot radius of any tank battery or one -hundred -fifty -foot radius of any wellhead shall
require a variance from the terms of this Chapter in accordance with Subsection 23-6-10.C of this
Code.
13. Any future structures or uses on site must obtain the appropriate zoning and building permits.
14. Effective April 25, 2011, Building Permits issued on the proposed lots will be required to adhere to
the fee structure of the Weld County Road Impact Program.
15. Effective April 25, 2011, Building Permits issued on the proposed lots, will be required to adhere to
the fee structure of the County Facility Fee and Drainage Impact Fee.
16. Pursuant to Chapter 15, Articles 1 and II of the Weld County Code, if noxious weeds exist on the
property or become established as a result of the proposed development, the applicant/landowner
shall be responsible for controlling the noxious weeds. All other vegetation, other than grasses,
need to be maintained at a maximum height of 12 inches until the area is completely developed.
17. The applicant shall maintain compliance with Section 23-4-190 of the Weld County Code at all
times.
/
Wendi Inloes Planning Coordinator
Date: July 20, 2016
Document must be filed electronically.
Paper documents are not accepted.
Fees & forms are subject to change.
For more information or to print copies
of filed documents, visit www.sos.state.co.us.
Colorado Secretary of State
Date and Time: 04/29/2016 01:31 PM
ID Number: 19871141975
Document number: 20161306575
Amount Paid: $10.00
ABOVE SPACE FOR OI FICL USE ONLY
Periodic Report
filed pursuant to §7-90-301, et seq. and §7-90-501 of the Colorado Revised Statutes (C.R.S)
ID number:
Entity name:
Jurisdiction under the law of which the
entity was formed or registered: Colorado
19871141975
CANNON LAND COMPANY
1. Principal office street address:
2. Principal office mailing address:
(if different from above)
3575 Cherry Creek North Drive
(Street name (nnd nu nher)
Denver
CO 80209
(City) (State) (Po.staliZip Code)
CO United States
(Province —i/applicable) (Cotnty—if or US)
3575 Cherry Creek North Drive
(Street #name and (number or Post Office Box inJarmatiorn)
Denver
CO 80209
(City) (State) (Po.staliZip Code)
CO United States
(Province—iJapplicable) (Coaniry —Unot US)
3. Registered agent name: (if an individual) Cannon
or (if a business organization)
Brown
(Last)
(First)
(Middle) (Suffix)
4. The person identified above as registered agent has consented to being so appointed.
5. Registered agent street address:
6. Registered agent mailing address:
(if different from above)
3575 Cherry Creek North Drive
(Street name and number)
Denver
(City)
CO 80209
(State) (Postal/Zip Code)
(Street rncuxe and (number or Post Office Box inJarmatiorn)
(City) (State) (Postal/Zip Code)
(Province—iJapplicable) (Coantry —ifnal US)
REPORT
Page 1 oft Rev. 12/01/2012
Notice:
Causing this document to be delivered to the secretary of state for filing shall constitute the affirmation or
acknowledgment of each individual causing such delivery, tinder penalties of perjury, that the document is the
individual's act and deed, or that the individual in good faith believes the document is the act and deed of the
person on whose behalf the individual is causing the document to be delivered for filing, taken in conformity
with the requirements of part 3 of article 90 of title 7, C.R.S., the constituent documents, and the organic
statutes, and that the individual in good faith believes the facts stated in the document are true and the
document complies with the requirements of that Part, the constituent documents, and the organic statutes.
This perjury notice applies to each individual who causes this document to be delivered to the secretary of
state, whether or not such individual is named in the document as one who has caused it to be delivered.
7. Name(s) and address(es) of the
individual(s) causing the document
to be delivered for filing: Cannon Brown
(Lass) (First) (Middle)
3575 Cherry Creek No. Dr.
(Suffix)
(Street name and number or Post Office Box information)
Denver CO 80209
(Ciro)
(Province — if applicable)
(State)
United States
(Country —ifnot US)
(Postal/Zip Code)
(The document need plot slate the true name and address 0/ more than one individual. However, if you wish to state the name and address
of'any additional individuals causing the document to be delivered_ for_Jiling, mark this box and include an attachment stating the
name and address of such individuals.)
Disclaimer:
This form, and any related instructions, are not intended to provide legal, business or tax advice, and are
offered as a public service without representation or warranty. While this form is believed to satisfy minimum
legal requirements as of its revision date, compliance with applicable law, as the same may be amended from
time to time, remains the responsibility of the user of this form. Questions should be addressed to the user's
attorney.
REPORT
Page 2 of 2 Rev. 12/01/2012
OFFICE OF THE SECRETARY OF STATE
OF THE STATE OF COLORADO
CERTIFICATE OF FACT OF GOOD STANDING
I, Wayne W. Williams, as the Secretary of State of the State of Colorado, hereby certify that, according
to the records of this office,
CANNON LAND COMPANY
is a
Corporation
formed or registered on 04/29/1957 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 19871141975 .
This certificate reflects facts established or disclosed by documents delivered to this office on paper through
11/21/2016 that have been posted, and by documents delivered to this office electronically through
11/22/2016 ( 14:26:31 .
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 11/22/2016 @ 14:26:31 in accordance with applicable law.
This certificate is assigned Confirmation Number 9940452
Secretary <ei State <ei the State of Colorado
****x****************************************Encl of Certificate*******************************************
Notice: A certificate issued electronically from the, Colorado Secretary of State's Web site is failly and immediately valid and effective
However, as an option, the issuance and validity of a certificate obtained electronically may be established by visiting the Validate a
Certificate page of the Secretary of State's Web site, hfill;./.w w„;U,,51afi.co, u, In: C r IicClfiSCarChC rihiiac/o entering the certificate's
confirmation number displayed on the cerrificaie, and following the bisrrucrion.s displayed. Confirming the issuance of a certificate is nrereh�
optional and is nor necessary to the valid and effective issuance of a certificate. For more information, visit our Web site,
nun,sn,;,s1a!i co,u, click "Businesses, trademarks, trade names- and select "Frequently Asked Questions."
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