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Home My WebLink About20163227.tiffRESOLUTION RE: APPROVE TEMPORARY ASSEMBLY PERMIT - ROCKY MOUNTAIN CIDER COMPANY, DBA WILD CIDER 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, Rocky Mountain Cider Company, dba Wild Cider, 11455 County Road 17, Firestone, CO 80504, has 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 10:00 AM until 4:00 PM, on October 22, 2016, on property described as follows: Rocky Mountain Cider Company, dba Wild Cider, 11455 County Road 17, Firestone, CO 80504; being further described as Lot B of Recorded Exemption, RE -41, being located in the E1/2 SE1/4 of the Section 5, Township 2 North, Range 67 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, having examined said application, the Board deems it appropriate to grant a Weld County Permit for Temporary Assembly to Rocky Mountain Cider Company, dba Wild Cider, 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 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. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that said Weld County Permit for Temporary Assembly on October 22, 2016, be, and hereby is, granted to Rocky Mountain Cider Company, dba Wild Cider, to conduct a temporary assemblage at the hereinabove described location. CCSoCRS) 1O1 acil / Co 2016-3227 cc: a,PI°L LC0022 TEMPORARY ASSEMBLY PERMIT — ROCKY MOUNTAIN CIDER COMPANY, DBA WILD CIDER PAGE 2 The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 17th day of October, A.D., 2016. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: dit/144) G 'c.C Weld County Clerk to the Board / Attorney Date of signature: tWWi1(( Mike Freeman, Chair Sean P. Conway, Pro -Tern Steve Moreno 2016-3227 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 17th day of October, 2016, 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 10:00 AM until 4:00 PM, on October 22, 2016, on property described as: Rocky Mountain Cider Company, dba Wild Cider, 11455 County Road 17, Firestone, CO 80504; being further described as Lot B of Recorded Exemption, RE -41, being located in the E1/2 SE1/4 of the Section 5, Township 2 North, Range 67 West of the 6th P.M., Weld County, Colorado This permit authorizes Rocky Mountain Cider Company, dba Wild Cider, 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 17th day of October, 2016. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: dtt4401) v•;� Mike Freeman, Chair Weld County Clerk to the Board 'N)Sean P. Conway, Pro -Tern +►�► �� -E''t ��.1 lam( L Gil my Attorney Steve Moreno Date of signature: tat( -7/1C0 NOTE: THIS PERMIT MAY BE REVOKED AND THE BOND FORFEITED FOR FAILING TO MEET THE CONDITIONS SET FORTH HEREIN. 2016-3227 LC0022 APPLICATION FOR TEMPORARY. ,ASSEPAELY INSTRUCTIONS TO APPLICANT: Complete each section and mark "NIA" 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. All required information must be furnished before the application will be processed. NAME:Adam Adam Gorove RE IDENCE:11455 CR 17 Firestone, CO 80504 MAILING ADDRESS: AGE:54 NAME:Michelle Heath AGE:45 REST DE i C E :4500 19th St Boulder, Co 80304 MAILING ADDRESS: lAl" E: Melinda Caldas RESIDENCE:36624 innisbrook oEr PurcellMile, VA 20132 MAILING ADDRESS: NAME: Syliva Birkin AGE: 47 RESIDENCE:2007 Cape Bend ave Tampa, FL 33613 AGE:73 MAILING ADDRESS: (This must list all partners in a partnership, officers of an unincorporated association, society or group, or, if there are no officers, by all members of such association, society or group. IF A CORPORATION, ATTACH A CERTIFIED COPY OF THE ARTICLES OF INCORPORATION.) 1. Address and legal description of all property upon which the assembly is to be held :11455 CR 17 Firestone, Co Lot B of recorded exemption 1311 4.5-4.*RE41 located in the e2se4 of section 5 T2N, R67W of the 6th P.M. Weld County Colorado A. Name, residence and mailing 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 Mark Birkin R E I DEN E : 11455 CR 17 Firestone, Co 80504 MAILING ADDRESS: Same NAME: RESIDENCE: MAILING ADDRESS: 2016-3227 a:NJUU'U0000UUUMJvlooUGU.aoU UU 2. Nature or purposes of the assem b!y: wine Festival and special event within festival to benifit Wild Animal Sanctuary. Dates and hours during which the assembly is to be held:10/22/16 10AM to 4PM 4. Maximum number of persons to be allowed at assembly at any one time:1000 1000 5 The maximum number of tickets to be sold, if any:1000 6. Identify plans to limit number of persons to the maximum identified above: All Persons required to purchase ticket to enter festival. Perimeter fencing will be in place to prevent unauthorized entrance into festival. Required amount of security gards as per sec 12-1-20-10 will patrol festival grounds during event to prevent unauthorized entry. Identify plans for supplying potable (drinking) water, including the source, number, and location of facilities, and type and means of disposing of waste deposited: Potable water will be supplied by Eldorado Springs Water. There will be 4 locations throughout festival with coolers and cups supplied at each locations Each location will have trash receptical to deposit waste cups. Should additional water be required there is CWCWD avallible on site to fill water coolers. 8. identify the plans for holding, collecting, and disposing of solid waste materials: Trash recepticels located throughout festival and emptied as necessary by staff to central dumpster provided by American Disposal. At completion of festival dumpster will be emptied. 9. Identify the 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: Portable toilet facilities will be located on site at a rate of l per 100 persons. Service provided by United site rentals. Location shown on map included with submisson. L1 000 LDIJ0DD00 ODLIflDOIJO.00000xa 10. Identify the 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: Mountain Veiw fire has been notified of dates and times of festival and has supplied a letter. There are no medical facilities planned on site due to the proximity of festival location in relation to medical facilities, Firestone F.D. 1.5 miles from festival, UC health emergency room 2.5 mi from festival, Mt Veiw fire 5 ml. All emergency serviced will be notified of event prior. 11. Identify the plans, if any, to illuminate the location of the assembly, including the source and amount of power, and the location of lamps: Daylight hours only 12. Identify the 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: Majority of traffic expected to travel on hwy 119 east from 125 to CR 17. North on 17 to event. Parking will take place on 40 acres N and adjacent to festival site. We will have 5 persons directing traffic to parking locations, 13. Identify the plans for communications with hospital, police, and fire services, including the source, amount, and location of communication equipment: Volunteers and staff will be instructed to call 911 in the event of an emergency. Festival location less than 3 miles from emergency services. All emergency services will be notified of festival. If necessary Mountain veiw fire will comunicate directly with hospital. Al staff will have radios to comunicate within the event. 14. Identify the plans for camping facilities, if any: None a 0 :t]0D`l00fl000 00'000 000.00g0do 15. Identify the plans for fire protection: See letter from Mountain View fire attached This is an _ open air event with no structures. There are fire extinguishers on site within the event should they be needed. Staff will be instructed to call 911 should there be any type of fire. 16. Identify the 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: See security plan attached 17. Identify the plans for sound control and sound amplification, if any, including number, location, and power of amplifiers and speakers: Acoustic music only. Stage facing N to parking area. Nearest house aproxamatly 1/2 mile to the North. 18. 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: See event coordinator application detailing all food vendors. 19. Identify the plans, if any, for an electrical system: None :tiaa`0flaoaao ow000 oaa.00 anon 20. Identify the 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: Festival grounds are field grass no anticipated wear expected but if necessary will be reseeded as needed. Parking is in alfalfa and grass, if necessary will be replanted. All areas have adequate ground cover so no dust is expected from festival. 21. Attach 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.B.13 of the Weld County Code to ensure performance by the applicant of each of the terms and conditions of the temporary assemblage permit. 22. 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 12-1-303.14 of the Weld County Code, to protect against injury to persons or property occurring as a result of such an assembly. 23. Submit $100.00 fee for each event where three -hundred fifty (350) or more people assemble or can reasonably by 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 reminder 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. 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. :b onto° DO DD Il a COO OQU.QC' UUQQ The applicant and each of them, swears, (affirms) that, to the best of his knowledge, the statements contained in the application are true and correct. -• A.a. ilea trs signature areri CoPS iier/r1—' Applicants printed name ePt5f4c1/44.÷ Applicant's position _i_.3SCRIBED ED AND SWORN to before me this cl fCla day of Witness my hand and official seal. My commission expires f ISM; go/I Kota. Public CATHERINE PRIEST NOTARY PUBLIC STATE OF COLORADO NOTARY ID 20154015166 MY COMMISSION EXPIRES APRIL 15 2019 r ! ACTB\CTBFORMS F0ASM8LY.D0Cdoc DR 8506 (8199) COLORADO DEPARTMENT OF REVENUE LIQUOR ENFORCEMENT DIVISION DENVER CO 80261 303-205-2300 COLORADO LIMITED WINERY WINE FESTIVAL PERMIT 21 APPLICATION Initial Festival Application - $25.00 Annual Fee r i Subsequent Festival Application DO NOT WRITE IN THIS SPACE Name of Applicant exactly as it appears on your current Limited Winery License: ete-L Jar'L J a L. C Cell C Trade Name of Applicant: wadi clef otem. State Sales Tax No: Applicant License No: It7 1 897 3. Business Address of Applicant: 1I'-#rr 1 _ City vise r 4, Mailing Address (Number and Street) t 5. Festival Location: Lig'in e_ R i 7 rely- 54° tre. Rights wises Granted By: Lt'ttatha copy of Premises Use Authorization Letter or Lease County cial City or Town rkrec ct Business Telephone: le', - 5-'32 ma- (II 4 cr State State o Festival Dates (Limit 3 days) f I / CD Z 2./1 (ao 7. Notification to Local Licensing Authority Local Licensing Authority Name: ILA -1 e--/ d tires tit( ZIP Code goro ZIP Code Ss Date Application Copy provided to Local Licensing Authority: /VD/ egoiG2 NOTICE TO LOCAL LICENSING AUTHORITY THIS APPLICATION FOR A WINE FESTIVAL PERMIT WILL BE GRANTED TO THE ABOVE NAMED APPLICANT UNLESS ANY OF THE BELOW LISTED CONDITIONS APPLY. IF ANY OF THESE CONDITIONS APPLY PLEASE CONTACT THE STATE LICENSING AUTHORITY IMMEDIATELY. w THE APPLICANT HAS NOT PROVIDED YOU WITH AT LEAST 10 BUSINESS DAYS NOTICE OF THE PROPOSED FESTIVAL ❑ PAST WINE FESTIVALS HAVE HAD A HISTORY OF VIOLATION OF THE COLORADO LIQUOR CODE II] IF GRANTED THIS PERMIT WOULD RESULT IN VIOLATIONS OF THE COLORADO LIQUOR CODE OR THE LAWS OF THE LOCAL GOVERNMENT - DR 8506 (08/99) ISO COLORADO LIMITED WINERY WINE FESTIVAL PERMIT APPLICATION DO NOT WRITE IN THIS SPACE - FOR DEPARTMENT OF REVENUE USE ONLY DATE LICENSE ISSUED ,LICENSE ACCOUNT NUMBER FROM PERIOD To X365-110 (999) TOTAL to Sheets! Person Winery Name License # responsible Phone# What we love the winery 4703139 Ryan Moore 609.731.8684 tyan.moore@decadentsaint.com Kingman Estates 4700340 Doug Kingman 720.56047270 dougekingtnanAkingmanwine.com { Mountain Spirit 3 - 4701869 Andrew Ritchie 7 t 9.22 t .15 �� . �l�t��- � iTl�i,�,n�aril�� , �ritinery . cotn Aspen Peak Cellars 4702296 Marcel Flul er infoRaspenpealccellars.com _,303.816.5504 Ten Bears 26773470001. Bill Conkling 97'0.5 66.404.3 tenbearswinery@botmail,com Garfield Estates 40771660005 Allison Barratt 970.464.0941 alison®garfieldestates,eom Vino Passarelli 28739590002, Mark P'assarelli. 301483 .52 79 vitiopassareili@gin'Acor Wild Cider 4701837'Adam Gorove ;303.994.77- events@itidcider.com Avanti Winery 4702253 James Griffin 303.904.7650 igr7fggranan icloud,com Stem Ciders 4701843 Eric Foster 970A2 0.89 54 tric@stemciders.com Black Arts Cellars 4703622 John Cowperthwaite 303, 722,0669 johttc@bacellars.com River Garden Winery 4705955 Robert Stahl 30.3.3 4.4164 :rgwinery@gvnai1.corm Mallon_ on_ la velle vie 4702903 John Barbier 970.464,4959 mtbv24 ,gmai1.com - Restone Meadery 3904420001 Jess Simon 720.4106,1 15 ; Jess redstouereaderyicom _ Spero Winery June Spero 720.519.1506 sperowinery®ao1.com BookCltff Winery 24956510001 lUlla MM'Ierz .30:3.499.7301 butla4bookclit corn Red Fox Cellars 4701277 Kyle Hamilton 303.918.5716 k .redfoxeellars.enm Forgotten Roots 4705067 Ryan Carroll into@forgo #enrl tswinery.cor Blue Skies 4701624 i970,686.5301 Tat= Cochran 970-407-9463 BSWevents@outiook.com Page I To Whom it may concern From Mark . Birkin 11455 CR 17 Firestone, CO 80504 I hereby give permission for Wild Cider to hold the 2016 Carbon Valley Wine festival on my Property on October 22" 2016. The applicant swears, (affirms) that, the statements contained above are true and correct. Owner Mark Birkin 11455 CR 17 Firestone, CO 14454 rtg cSe> 5°0 ioece _ IX; e Plrea ecc Printed Name Mark Birkin Owner Signature of owner SUBSCRIBED AND SWORN TO BEFORE ME THIS72 R _ DAY OF Illi)\itrive$16X' 2016. WITNESS A D AND OFFICIAL SEAL. My commission expires Viture f3'�` et i ll` _ Ltar C-Nistsul N rARY PUBLIC DIANA M CREASQN Notary PubHHc State of Colorado Nctvy 10 2013 40243 9 My Commission Empires SeP 9, 20 17 To whom it may concern, 10/5/16 I am the property owner directly north and adjacent to the property where the Carbon Valley Wine Festival is proposed. Legal description is, PT NE4 5-2-6T DESO AS BEG NE COR SEC 80025W 5154231 600251211.oa' TO TPOB TH 60O25W 18$1.24' TO E4 COR SEC NBOD2I'W 1330.08' NOD4YE 1399.71' S75D5O1`E 1381.62' TO TPOB PT LOT B RE -4884 I give consent to park vehicles on the above mentioned property far the wine festival on 10/22/16 r Toni Scott COR i CERTIFICATE OF LIABILITY INSURANCE DATE uumw m 9/13/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FOLDER. 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 INSUR Si, AUTHORIZED t3EP ESENntritiE Oft PROCNICER, AMC THE CERTIFICATE IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the p►aliey(les) must 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(a). PRODUCER The Wright Group Services 1873 S Bye St Sts B0Q Denver CO 80222 INSURED Rocky Mountain Cider Company 11455 Ccun Road 17 Firestone CO 80504 ROCK 2I I A Brien Kelly rJ2?(Lca: 303-8617788 _.AD_DRESS; bk&liyc twgservJ . I INSURER'S) AFFORDING COVERAGE INSURER A .:GREAT AMERICAN_ INSURER B tia 3133-861-7502 NAIC # COVERAGES - - CERTIFICATE 'NUMBER: 112035 583 INSURER C _ INSURER 0 : INSURER E : 1 N9URElt F S. REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS . TWIC ELE ISSUED OR WAY PERtisitst, rt-AE. INSA.A4INC.E. OFFORCIEla WI. WE c .. AEs OCSC WEQ I ha ,tE V' No ALL WE T WISE iii:IL EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITSHOWN M MAY HAVE BEEN REDUCED I BY PAID CLAIMS. . Mt TYPE OPINSURANCE I-POLCY r POLICY a xP lN5 POLICY Y NUMBER ' �'lMbM DDIYYYYJ ' flIWIDDIYYYY) LIMITS PAC1090715 IA A A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE x OCCUR GE 'L AGGREGATE LIMIDAPPUES PER: POLICY OTHER: AUTOMOBILE ABILITY Y ITl ALLVAINED AUTOS HIRED AUTOS i _ PRO- JECT r S _ LOC SCHEDULE] AUTOS NON -OWNED AUTOS 13117/2015 3117/2017 z EACH OCCUR .ENCE Si.CCD,'QUO DAMAGE striataLTEO PREMI4E$ 1E ► -, ce) SaPPQCICP MED EXP ere perm° $5.00 0 PERSONA. S NW INJURY 51.000.000 GeNewa. AGGREGATE PRODUCTS-GOMPIOP AEG 52,000,000 S2,000 000 I I CAP1090718 6 3/17/2018 UMBRELLA t.IAH X OCCUR EXCESS UAB CL _ I S-LIAD non j RETENTIONS WORKERS COUPENSATION AND EMPLOYERS' LABILITY ANY PROPRCETORIPARTNEFIEXECUTIVE OfFICERMIEMBEFit ExcLUDEVLUDE 07 (Ml en o,r9 rin NH) if es. deacdbe wider DESCRIPTION OF OPERATIONS below YIN UMB1090717 f O9OTI7 NIA 3117/2017 CO IME L, SOMA MIRY tax. cnsnn1, BODILY INJURY (Per accident) i P .oisarnma fats _ t VI 1311712017 EACH REECE I $1.000,000 AGOREGATE IPER STATUTE I ER ;,E.L. EACH ACCIDENT' E.C. DISEASE • EA EMPLOYE F.L. T 19 :E -POLICY LIMIT S DESCRIPTION IPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached If mere space Is required) CERTIFICATE HOLDER Weld County Colorado PO Box 758 Greeley CO NM CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN ACCORDANCEACCORDANCE VVErfl THE POLICY PROVISIONS. I AUTHORIZED REPRESENTATIVE ACORD 2S (201 1) © 1988 014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A i r f rr P •w as S 3 ''s, 2: Lill _ Ti n e �k-y4 iee < 1 't ri.. U, .. • #5. 1 abut. I 93 C ° a 9 L' O V, 6 3 ler> 1' • • . • Sai err B • r Y Fill "AIM 1 •' ; . Liu L Gw. y J g O g. tirt '+Ltpl. -As 5 •r. o rs. IRRIGATJON DCTCH --/ 0.- cfi IP et P a ‘st ? 7: ty 3 Vl ibie to 3 0 is co 6) It) to, Ul ‘ iv ted sbfr, co j (i Eli I~ 0 WELD COUNTY COLORADO LAND RECORDS AFFIDAVIT OF INTERESTED LAND OWNERS SURFACE ESTATE 9/27/2016 9:05:41 AM THE UNDERSIGNED, States that to the best of his or her knowledge the attached list is a true and accurate list of the names, addresses, and the corresponding Parcel Identification Number assigned by the Weld County Assessor of the owners of the property (the surface estate) within 500 feet of the property being considered. This list was compiled utilizing the records of the Weld County Assessor available on the Weld County Internet Mapping site, http://www.co.weld.co.us, and has not been modified from the original. The list compiled for the records of the Weld County Assessor was assembled within thirty days of the applications submission date. Property Owners Within 500 ft of Parcel ## 131105009941 Signature Date Account Parcel Owner Mailing Address m i 109006 R0933601 ear ZADEL CF-iRl i 80933601 131104000006 ZADEL L JENNIFER L 11298 LONGMONT, COUNTY CO ROAD 805049582 17 R3774905 Arlie _ _ BABCOCK LAND CORP 212 N WAHSATCH AV PRINGS, CO 809033476 R3775005 131104201003 BABCOCK LAND CORP 212 COLORADO N WAHSATCH SPRINGS, AVE STE CO 301 809033476 131105000041 BIRKIN RIB I N MARK 11455 LONGMONT, COUNTY CO ROAD 805049562 17 R5369086 88749300. 31105000057 FAYE MICHELLE J 131105000057 FAYE DAREN T 7813 LONGMONT, COUNTY CO ROAD 805049549 24 88749300 VA N N O R SD E L DAVID R 11335 LONGMONT, COUNTY ROAD CO 805049562 17 R8763300 131105000058 R8763400 131105000059 ALLEN JENN1E L 11371 COUNTY ROAD 17 WELD COUNTY COLORADO LAND RECORDS AFFIDAVIT OF INTERESTED LAND OWNERS SURFACE ESTATE 0/27/2016 9:05:42 AM THE UNDERSIGNED, States that to the best of his or her knowledge the attached list is a true and accurate list of the names, addresses, and the corresponding Parcel Identification Number assigned by the Weld County Assessor of the owners of the property (the surface estate) within 500 feet of the property being considered. This list was compiled utilizing the records of the Weld County Assessor available on the Weld County Internet Mapping site, http://www.co.weld.co.us, and has not been modified from the original. The list compiled for the records of the Weld County Assessor was assembled within thirty days of the applications submission date. Property Owners Within 500 ft of Parcel # 131105000041 Signature Date Mailing Address Account Parcel Owner LONGMONT, M O NT, CO 805049562 R6776677 131105100004 CACHE BANK & TRUST CIO PO GREELEY, BOX LOAN 337060 OPERATIONS CO_806330618 DEPT R6784757 13 X0012 SCOTT LARRY . 1 R6784757 131105100012 SCOTT TONI J 3312 GREELEY, 66TH AVE CO 806349628 MOUNTAIN VIEW FIRE RESCUE 3561 N. Stagecoach Road, Unit 200 * Longmont, CO 80504 (303) 772-0710 • FAX (303) 651-7702 To Whom It May Concern; In regards to the Carbon Valley Wine Festival at Wild Cider, to be held on October 22, 2016 at 11455 WCR 17, Firestone CO 80504, Mountain View Fire Rescue has been advised of this event and at this time does not require medical personnel to be dedicated to this location during the Festival. The event organizers have been advised of pricing options for medical staff, should they wish to provide dedicated medical coverage. Respectfully, Keith Long Assistant Chief of Operations vsr .mvfpd.org Club° WI Veslival Presented by At Security Plan 10.22.16 Wild Cider is excited to be hosting the First Annual Carbon Valley Wine Festival (CVWF) on our property! We are committed to insuring a safe and fun event for our patrons and vendors! Festival Information: Name: Carbon Valley Wine Festival presented by Wild Cider ■ Address: 11455 WCR 11, Firestone, Co 80504 Date: October 22, 2016 • Festival Time: 11:00 am to 4:00 pm (alcohol served) • Gates Open: o VIP 10►:00 am o General Admission 10:30 am • Anticipated Patrons: 1000 • Vendors: Cider, Mead, Wine, Beer, Food, Other products, Live music • Festival Grounds Delineation: +a Wine Festival: • Orange Perimeter Fencing and Barbed Wire, staked ■ Two (2) gates manned at all times Security One (1} c� Identification Crowd Control Security • Volunteers —Two (2) Ticketing Wrist Bands Crowd Control Beer Garden: ■ Orange Perimeter Fencing, staked Gate manned at all times • Security — One (1) o Crowd Control o Security * Volunteers —Two (2) o One (1) on each side of entrance Law Enforcement Jurisdiction: Weld County Sheriffs Department • Email to: kcogswell@co.weld.co.us 92016 • 911 Carbon Valley Wine Festival presented by 'i ld Cider 11455 WCR 17 Firestone, CO 80504 Contracted Security Services: • Big Al's Security Team Address: 2649 E Mulberry St A-11, Fort Collins, CO 80524 Phone: 97O 825.5991 Email: adrniti@biftalsecuacom Contact: Michael Vermillion/ Project Manager • Contracted Services: Six (6) unarmed security guards or 2/350 patrons estimated 1000 patrons 9;30 am to 5:0o pm Bonded and insured Easily identified by SECURITY on clothing htto:/Jbigalsecuri _corn/ • Deployment of Six (6) Security Guards: c� Two (2) at CVWF entrance gates - Identification, Crowd Control, Security • VIP Gate • General Admission Gate ■ One (11 in beer garden Crowd Control, Security o Three (3) patrol wine festival grounds — Crowd Control, Security • Credentials and Additional Training of Security Team: Military, security and law enforcement background TIPS (Training for Intervention Procedures) Certification Concealed Weapons Training Identification Fraud Training First Aid Certification CPR Certification PPCT training Multiple non -lethal trainings as well as other weapons trainings o Ri-annual refresher training in all areas • Threat Assessment Visit: o Perform a threat -based security analysis of event prior to event ■ Based upon this analysis, a security plan is formulated addressing the client's security needs and any additions will be put into place Wild Cider Volunteer and Staff: Alcohol Service: ALL alcohol vendors participating in the festival must utilize TIPS (Training for Intervention Procedures) Certified staff — no exception Patron must be wearing a festival wrist band to be served — no exception • Age and Identification at gate by Security Team • Wrist band is then issued • All vendors will be issued wrist bands o Wild Cider Staff will be monitoring ail patrons for intoxication will not allow service of alcohol Will offer additional non-alcoholic beverage in lieu of alcohol a Will call UBER or ZIP Car if intoxicated person does not have a ride • Communication Within Festival Perimeter: o Four (4) Wild Cider Staff members will have radios to communicate as needed o Cell Reception is available on property to contact Emergency Personnel if needed Carbon Valley Wine Festival presented by Wild Cider 11455 WCR 17 Firestone, CO 80504 o ALL Volunteers and Wild Cider Staff will have a designated hat to insure easy recognition to guests a Patrons and Vendors can easily identify and contact as needed • Emergency Needs • Security Needs • Other If you have any questions or need further clarification please contact one of the following individuals: Lynn Yarger/Evert Coordinator ev►entswild+ider.corn 303.517.2428 Cheers! Adrat #3/4149a Wedding and Special Event Coordinator The Cider Mill at Wild Cider 303.517.2428 Adam Gorove/Owner Adam@wilricider.com 303 994.7723 Mark Birkin/Owner mj@wildcider.com. 480.818.2331 Carbon Valley Wine Festival presented by Wild Cider 11455 WCR 17 Firestone, CO 80504 DR 0161 (02/16/11) COLORADO DEPARTMENT OF REVENUE DENVER CO 00261.0009 THIS LICENSE IS NOT TRANSFERABLE WAGE WITHHOLDING LICENSE USE ACCOUNT NUMBER - for all references 29811999 LIABILITY INFORMATION ISSUE DATE L 010116 Feb 18 2016 PRECISION OPERATIONS GROUP SHS 2649 E MULBERRY ST # ;►-I'f FORT COLLINS CO 80524 Executive Director Department of Revenue f .:Fort Collins License Number 00129607 Business Start Date 01/0/1201 U Valid until revoked or canceled Sales/Use Tax License BIG AL'S SECURITY TEAM 323 LINCOLN CT FORT COLLINS CO 80524-2790 Business Location 323 LINCOLN CT FORT COLLINS, CO 80524-2790 NOTICE: THIS LICENSE MUST BE CONSPICUOSLY DISPLAYED AT THE ADDRESS SHOWN AND IS NOT TRANSFERABLE. MI5 CERTIFIES THATTHE LICENSEE SHOWN HEREON IS AUTHORIZED To COLLECT SALES TAX FOR THE CITY OF FORT COLLmS, COLORADO AT THE ADDRESS INDICATED IN ACCORDANCE tiTH CHAPTER 24 OF' HE CITY CODE. ANY ALTEFiAT1ON MADE ON THIS LICENSE WILL AUTOMATICALLY MAKE IT NULL AND VOID. FINANCIAL OFFICER CITY OF FORT COLLINS OFFICE OF TIE SECRETARY OF STATE OF THE STATE OF COLORADO CERTIFICATE OF FACT OF GOOD S'T'ANDING I, Wayne W. Williams, as the Secretary of State of the State of Colorado, hereby certify that, according to the records of this office, Big Ails Security Team, LLC is a Limited Liability Company formed or registered on 10/29/2009 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 20091572736 _ This certificate reflects facts established or disclosed by documents delivered to this office on paper through 09/14/2016 that have been posted, and by documents delivered to this office electronically through 09/17/2016 @ 01:20:54 a 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 09/17/2016 @ 07.20:54 in accordance with applicable law. This certificate is assigned Confirmation Number 9840357 . Secretary of State of the State of Colorado *********************************************End of certiicatc******************************************* Noire.: A cwrafiese ken/ e / e!ecl ►;dc&y. _tironi the C••? r aili 4 ec j f 'rat ° /mawedia e/ rth/d aid e k tire. However, as an option, the issuance and valid( r of a certificate obtained electronically may be established by visiting the Validate a Certificate page of the Secretary. of State's Web site, http://www.sos.stateacausibiz/CertificateSearchCriteria.clo co.us izJCerti aeateSearchCriter+ia.d'o entering the certificate's confirmation number- displayed on the certificate, arid following the instructions displayed. Qaa to r ,rg t�'ct issi ancc soft: certificate is rrer'eiv optional and is ow rJCCesszn . to .tine valid and cifivitte issuance of a centikeist For more information, visit our Web site, hap:// w.'{,w.sas.state.co.usJ click "Businesses, trademarks, trade names" and select "Frequentlyent& Asked Questions." I Sheriff Steve Reams 1950 0 Street Greeley, CO 80631 Re: Carbon Valley Wine Festival Please accept this as formal notification and information for your file for The Carbon Valley Wine Festival presented by Wild Cider Festival Information: Name: Carbon Valley Wine Festival presented by Wild Cider Address: 11455 WCR 17, Firestone, CO 80504 Date: October 22, 2016 Festival Time: 11:00 am to 4:00 pm (alcohol served) Gates Open: O VIP 10:00 a m o General Admission 10:30 am Anticipated Patrons: 1000 ■ Vendors: Cider, Mead, Wine, Beer, Food, Other products, Live music Contracted Security Services: • Big Al's Security Team Address: 2649 E Mulberry St A-11, Fort Collins, CO 80524 aPhone: 970.825.5991 Email: ackrnin@bigalsecuribi.com Contact: Michael Vermillion/ Project Manager If you have any questions or need further clarification please contact one of the following individuals: Lynn Yarger/Event Coordinator eventsrildcdierecom 303.517.2428 Cheers! Lynn Yarger Wedding and Speciat Event Coordinator The Cider Mill at Wild Cider 303.527.2428 Adam Gorove/Owner adarya@wlldcider.com 303.994.2723 Mark Birkin/Owner irnj@wilcicider.com 480.818.2337 Carbon Valley Wine Festival presented by Wild Cider 11455 WCR 17 Firestone, CO 80504 United Site Services of Colorado, Inc. 6015 E 58TH AVE Commerce City, Co 80022 Toll Free: 888-232-0001 Local: 303-985-0164 Fax: 303-985-1428 United SITE SERVICES Site Service Quotation Quote No.: 414-722417 Quote Date: 06/23/15 Sell To: WILD CIDER LYNN VARCER 11455CR 17 FIRESTONE, CO 80504 Casty #: USS-234503 Phone: 303-517-2428 :Item Deluxe Restroom Delivery, Setup, Removal Environment/Energy/Compliance Deluxe Restroom Subtotal:..... Unit EA EA Salesperson Contact Ronald P. Kelley Mollie: Office: 303-222-7023 x27023 Fax: 408-578-9294 Bonald.Keil ey@unitedsitesen4ces4com Quote Expires: 09/22/16 Ship To; WILD CIDER 11455 CR 17 FIRESTONE, CO 80504 Attn: LYNN VARGER Phone; 303-517-2428 Terns; Dim Upon Receipt Quantity From Thru 20 10/22/16 101221/5 1 10/22/16 10/22/16 2 Station Sink EA Delivery, Setup, RemovalllN L EA Environment/Energy/Compliance 2 Station Sink ubtotal:. - • . - • • • ... Unit Price 60.00 0.00 4 10/21/16 10124/16 1 10/21/16 10/24/16 • ■ ■ • i• m u m r .Y. Accepted: - Date: Rath, To: United Site Services, PO Box 53257, Phoenix, AZ 85072-3267 NOTE: Total paces have been calculated for 1 billing period only. Damage Waiver Is optional. Please read the terms and candlli nns on the task page of this clocanerP1 for more information, SIM 80.00 0.00 Total: Total Price 1,200400 one time 0.00 one tine 154.50 one time 1,354 80 320.00 one time 0.00 one time 41.28 one time 361.28 1,715.05 Vendor Information List .Menu Items at booth r7 ui } `s I I I I 1 Contact number (a) Yij"� ,r'y1T� 7 1 He Contact Person Name de d, ir 7`L Qom• Y ` ■i I.( ti cr,I k i V '.. Vendor! Bootie Name ei VY i1 •1 r� c 4'1 9r! e- i Hours of Operation `it d to i 4 Booth # I , DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 North 17th Avenue Greeley, CO 80631 Web: womawetdhealth.arg Environmental Health Services (970)-304-6415 Fax (970)-304-6411 VENDOR APPLICATION FOR TEMPORARY FOOD EVENTS Al l vendors must complete and submit to Event Coordinator for each event. i• ix Weld County. If no menu and no equipment change is occurring from one event t- to another the completed e to cl of i o iii al be copied.. Please attach a copy 1 .C' �`,3 7 may of your current into iormi_E� event or mobile unit Colorado Retail � ofpLJ Establishment License, if already licensed. :aLiz,' 'Event Nameloo � ,r 1 I 'i f ec . Va Date(s):O + Z2 a Oil I 7a.. Tr Tempera r� lets the following information: Ilium! of Eve ir Hours of Event: cc fraucositi,of co 8ic Retail Food F1sta eoof? lislimerit ame: r (?�' I Iii! Which county issued your license: 1 LD � s- et Name; Oro e `l" lkplbcinc umber (Prior to Event): .771 e :'C_''` nom.' Main w Address: Email; ,ad.04n Cell Numb (l: ur'irtriven!): ell 7&23 - Start z 00 S.73 *Ail vendors shall have the original Colorado Retail Food Establishment license on premise at all time? All vendors must provide documentation of Reinsure or nuu-prulit status Type of �'''en�o�r+ yp'Check appropriate box ar I have attached copy of documentation Licensed Temporary Event Vendor f Kt Licensed Mobile Unit Nonarro•tit (provide documentation) If you don't hold a Tem erg. r• fi Event or Mobile Retail Food Establishmeat License please contact the Health Department at 970-304-6411 Please list any additional events and dates that you plan on participating in Weld County Event name Date Location FOR HEALTH DEPARTMENT USE Licensed Needs a license Non-profit EH Specialist Signature APPROVED Yes No Dare IMENU "lease attach additional sheet, as necessary,' Please list all food products and the specific source of all food items (name of grocery chain, wholesaler, etc.) Be sure to include items such as topping and condiments. Food and Drink Items _ - Location where obtained 1 Grocery Store A Example: Hamburgers _ Exam le; onions i Chain Store B 1 fdpo tisr- 6 FiginvpLa. a_eLL I Gni i4 y tivi (F) COS -1 C D eesTALucieit tchm T Di EsPers 2. itiir 43 , _ 4 I Q pree_rt2. oh) 1 reetcociAtD ritherce r1/41 it ii 5. uice WI typeritt, Lahr1rf?fill arts- ps A ,t ib. 0 L 1 vile to it ../- b 6 its 4a 7r S. 9. ti 10. 11. 12. 13. 14. H. HANDWASHING AND FOOD HANDLING A hand -washing station WITHIN each booth or unit is REQUIRED unless only prepackaged foods requiring no preparation and / or cooking are to be served. Please check the space below that applies to your booth it unit. �J I will be serving only prepackaged foods that require no preparation, handling, and/or cooking. I will be serving foods that require preparation, handling, and/or cooking and will provide the following for hand -washing: l.) a minimum of 2 gallons of warm potable water that must be refilled as needed in a container with a `hates -free' spigot 2.) soap 3,) paper towels 4.) 5 gallon bucket (minimum) to catch and contain wastewater until it is properly disposed NOTE: Hand 'sanitizers ' are NOT an acceptable substitute required hand washing set-up. How will you prevent bare band contact with ready to eat foods (at both the commissary and in the booth)? A Tongs . I Food -grade disposable gloves (Note: if gloves are changed hands must be washed) 0 Deli tissues Other (list) Ill. FOOD PREPARATION AT COMMISSARY Preparation at Approved Facility or Commissary Before Event Check which preparation procedureeach menu item requires. Food Thaw Cut/ Wash Assemble Cook/ Rake Cool Reheat Cold Holding Hot Holding Example: Hamburgers Ern le: Onions �.� 1, Ugly - ! i if ( tea b I €12 -112_ CAN Pe 2 (Mary" 46 0 Oil sZ,rife k fi• OD Vt: a. 7-billi nap P.*7-.. 6. i I 7. S. 9, 1'0. .. What is the name and location of your commissary? (Complete Commissary Agreement on page Name of Commissary: ft:utJiirJ �.'� `.zsz-Pr Address of Commissary;se, l I! City/State/Zip of Commissary: Produce How will produce be prepared prior to use? (mark all that apply) fitt a C! Wash produce in food preparation sink ❑ Not Applicable . , Buy product pre -washed and cut at commissary .P1( Buy product pre -washed and pre-cut o Other (specify) Thawing- Will foods need to be thawed at the commissary? Y / N if yes, answer question below. How will frozen foods be thawed? (mark all that apply) Under refrigeration D Under cool running water o As part of the cooking process o Other (specify) O Not Applicable Cold. Holding — Will foods be cold held at the commissary? Y i` i If yes, answer question below. How will foods be held at 41°F or below? (mark all that apply) o Walk-in cooler or freezer fl Reach -in cooler or freezer o In cooler with ice immediately be transport to site o Other (specify) IV, Food Handling -at t1Booth/Event List all menu items, including beverages, to be served from the temporary food booth. Check which food handling procedure each menu item requires at the booth. Reheat Cook' Grill Hot Holding Assemble Food Cold Holding Example: Hamburger .X X Exa..m le: Onion . l• 'PUMA C.. ycnr_ 2. V 3, Pt ital if cocapcitir e ki- cte.erio Cain 7. 9, Coc►kinaand 11vtflaldinu of Food items 1. How will these foods be cooked and/or reheated at the site? (mark all that apply) ❑ H t plate ❑ Not Applicable v+en o Microwave ❑ gill ❑ Deep fryer ❑ Other (specify) 2, How will hot foods be held at 135°F or above at the event? (mark all that apply) (Stern° burners are prohibited) ❑ Hot holding unit. O Steam table O Not Applicable ❑ Held under heat lamps c carved immediately after cooking 'rock -pot ❑ Held on grill until served a Other (specify) 3. What utensils will you use to dispense or serve the hot items? a Tongs L Ladle ;❑ Not r .ppikable ❑ Spatula. ]ether (specify) ,,, Cold Food Items L How w cold foods be helot at 41.°F or below at the event? (mark all that apply) Refrigerator / freezer O Not .Applicable ❑ Ice chest - must be divinable and foods may not be kept in contact with the ice unless they are packaged and sealed. ❑ Other (specify) 2. What utensils will you use to dispense or serve the cold items? ❑ Tongs a Ladle ❑' Spatula ❑ Other (specify) Ele‘Applicable 3. What ki of loud thermometer (0-2210°T) do you have? letil sietmm probe Q Thermocouple O Digital '‘I) it 44 tiA 1 fl i ) • 4- F Cr 5 Si 4 cr S �y STATE OF COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT LICENSE TO OPERATE A RETAIL FOOD ESTABLISHMENT ACCOUNT NUMBER use for all references LIAB1LIIY 1NFOFtMATION ISSUE DATE (AY 6t tt f ty lel a month] day (rat 300365690000 62 3289 8123/20 t6 8/212016 THIS LICENSE MUST BE POSTED AT THE FOLLOWING LOCATION: HOT TIN ROOF PJZZA MOBILE UNIT WELD COUNTY, co 8063) LICE NS E VALID TO DE xi ER 31 20[6 This certifies that licensee shown hereon Is akil red and flcuasad to engage in business In accordance with the prowls.0ns of the taw and regulations of the Colorado Department of Public. Health Owner ter ROCKY MOUNTAIN WILD CIDERand l=n+ nrxt t Any alterations made on this license wilt autornatikatty mel+te it t; UCFhJSJNQ AQENCY: WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT null and void. fiEVOR JIRJCEK, M A £S , DIRECTOR ENVIRONMENTAL HEALTH SERVICES POST IN A CONSPICUOUS PLACE Lit DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 North 170 Avenue Greeley, CO 80631 Web: v Apos-w,uieIdhealthsorq Environmental Health Services (97fl-304-6415 Fax 19700-304-6411 VENDOR APPLICATION FOR TEMPORARY FOOD EVENTS Alt vendors must complete and submit to Event Coordinator for each event in Weld County, if no menu and no equipment change is occurring from one event to another, the completed original may be copied. Please attach a copy of your current temporary event or mobile unit Colorado Retail Food Establishment License, if already licensed_ Event Name: CARBON VALLEY WINE FESTIVAL Date(s): OCT. 22, 2016 Minot cu mplety the fallowing inform:Atirin. WieAA'ridaVolitig6sgt17 Firestone, CO 80504 Views of Event; 410AM - 4PM Temporary MILE HIGH Retail Food F stabl LOBSTER SHACK ishruc n.r Name: Which LARIMER county issued your lico st: Contact NANCY Name: VAN REETH I Email: firtflehighlobstershack@gmaitcorn Teleplione (207 Number ) 72-5-6373 (Prior to Event): Cell ( Number ) (During Event): SAME Mailing 532 SR/CRAM Addrebss; DRIVE City: FT COLLINS Mate: CO Zip: 80525 *All vendors shall have the original Colorado Retail Food Establishment license on premise at all times* All vendors must provide documentation of liceasure or iron -profit status Check appropriate box Type of Vendor: Licensed Temporary Event Vendor Licensed divlobitc Unit Non -Profit (provide documentation) I have attached ca of documentation El you don't hold a Lentr rrary Event or Mobile RRct-ail Food Esiablkhnnent License please contact the Health Department at 970.3044415_ Please list any additional events and dates that you plan on participating in Weld County Event name Date Location r FOR HEALTH DEPARTMENT USE Licensed APPROVED Needs a license Yes Non-profit No wEH Specialist Signature Date I; MENU (Please attach additional sheet, as necessary) Please list all food products and the specific source of all food. items (name of grocery chain, wholesaler, etc.) Be sure to include items such as topitings and condiments. Food and Drink Items Location where obtained Example: Hamburgers Grocery Store A Example: Onions Chain Store B 1. 2. PLEASE SEE ATTACHED 3. 4« 5. 6_ 7. S. 9. 10. 12. 13 14. II, HANi)WASHING AND FOOD HANDLING A hand -washing station WITHIN each booth or unit is REQUIRED unless only prepackaged foods requiring no preparation =d i' or cooking are to be served. Please check the space below that applies to your booth / unit. C,l I will be serving only prepackaged foods that require no preparation, handling, and/or cooking. CS 1 will be serving foods that require preparation, handling, and/or cooking and will provide the following for hand -washing: 1.) a minimum of 2 gallons of warm potable water that must he refilled as needed in a container with a `hands -free' spigot 2.) soap 3.) paper towels 4.) 5 gallon bucket (minimum) to catch and contain wastewater until it is properly disposed NOTE: Hand 'sanit ers' are NOT an acceptable substitute for required hand -washing set-up. How will you prevent bare band contact with ready to eat foods (at both the commissary and in the booth)? a Tongs rXFood-grade disposable gloves (Note: if gloves are changed hands must be washed) Deli tissues o Other (list) III. FOOD PREPARATION AT COMMISSARY Preparation at Approved Facility or Commissary Before Event Check which preparation procedure each menu item requires. Thaw Cut/ Wash I Assemble Cook/ I Cool Bake Reheat Cold Holding Hot .Molding Food Example: Hamburgers X X Example: Onions 1. 2, LOBSTER IMIEAT 3. LEMONS x x 4. T. 6. ` r 7. a 8. 9. 10. What is the name and location of your commissary? (Complete Commissary Agreement on page 7) Name of Commissary: SACKMTS HOT SHOT CATERING Address of Commissary: 2642 E. MULBERRY City/State/Zip of Commissary: FT COLLINS_ CO 80524 Produce How will produce be prepared prior to use? (mark all that apply) a Wash produce in food preparation sink ❑ Buy product pre -washed and cut at commissary a Buy product pre -washed and pre-cut Other (specify) 0 Not Applicable Thawing- Will foods need to be thawed at the commissary? Y l N If yes, answer question below. How will frozen foods be thawed? (mark all that apply) ❑ Under refrigeration LX Under cool running water ❑ As part of the cooking process O Other (specify) ❑ Not Applicable Cold Holding — Will foods be cold b eld at the commissary? Y / N If yes, answer question below. How will foods be held at 41°F or below? (mark all that apply) [ Walk-in cooler or freezer ❑ Reach -in cooler or freezer r' In cooler with ice immediately he innsport to site ❑ Other (specify) Hot Holding Will foods be hot held at the commissary? V I N If yes, answer question below. How will foods be held at 135 degrees or above? (mark all that apply) D Steam table D Reach -in hot box D Oven In Other (specify) O Grill Cooling - Will foods be cooled at the commissary? Y / N If yes, answer question below. How will foods be rapidly cooled to 41°.F or below? (mark all that apply) ❑ Shallow pans (less than 4") in refrigerator or cooler Di Using an ice -bath to cool the food product Ci Ice paddle or wand p Other (specify) Reheating— Will foods be reheated at the commissary? Y / N If yes, answer question below. How will foods be re -heated to at least 165 degrees F? (mark all that apply) In Microwave D Hot Plate Q Grill Oven Other (specify) Transport Please provide the distance that you will be transporting food to the event? 29 MILES What equipment will you use to control temperatures during transport? a Coolers with ice C1 Cambros for cold foods D Cambros for hot foods p Other (specify) W. Food Handyin I lit the Booth/Event List all menu items, including beverages, to be served from the temporary food booth. Check which food handling procedure each menu item requires at the booth. Food 1 Cold Holding Reheat - fi Cook/ Grill Assemble X Hot Holding Example: Example: X - Hamburger X X Onion X X 1. LOBSTER X 2, HOT DOGS AND BRATS (PRE-CCOKE t) _ X X N X 3. CONDIMENTS 4. SODAS, WATERS, MO IE X 5. CHOPPED ONIONS, PICKLES 6. SAURKRAUT x 7. CHIPS (SINGLE SERVE) 8. CUT LEMONS X - SI. BUTTER _ 1d,. SPLIT TOP ROLLS X SHOESTRING POTATO STICKS (PREPACKAGES) Cooking, and Hot Holding of Food Item 1. How will these foods be cooked and/or reheated at the site? (mark all that apply) rig Grill p Hot plate 0 Not Applicable t77 Deep fryer co Oven ❑ Microwave ❑ Other (specify) 2. How will hot foods be held at 135°F or above at the event? (mark all that apply) (Sterne burners are prohibited) D Hot holding unit a Steam table p Not Applicable D Held under heat lamps p Sewed immediately after cooking O Crock -pot O Held on gill until served ❑ Other (specify) 3. What utensils will you use to dispense or serve the hot items? a Tongs 0 Ladle ❑ Not Applicable ❑ Spatula ❑ Other (specify) Cold Food Itep 1. How will cold foods be held at 41°F or below at the event? (mark all that apply) ❑ Refrigerator ' freezer Q Not Applicable I:21c Ice chest - must be drainable andloods may not be kept in contact with the lee unless they are packaged and sealed. 0 Other (specify) 2. What utensils will you use to dispense or serve the cold items? a Tongs ❑ Ladle ❑ Not Applicable 0 Spatula D Other (specify) 3. What kind of food thermometer (0-220°F) do you have? aMetal stem probe O Thermocouple EXDigital V. ilcanwne and Related What type of Sanitizer will you use at the booth? 2 Bleach at 50-200 ppm ❑ Quaternary Ammonia at 200-400 ppm ❑ Other: Note: Test strips for sanitizer in use must be provided and be on -site Where will utensil washing take place? a Commissary 3 compartment sink rif Commissary dish machine 0 Commercial 3 -compartment sink unit (part of mobile unit) What type of Sanitizer will you use in the 3 compartment sink? ❑ Bleach 0 Quaternary Ammonia (a Other ❑ Not Applicable- using dish machine Where will wastewater from hand washing and cleaning be disposed of? fl Commissary ❑ Approved on -site receptacle at event 0 Other Waste water CA.14NOT be dumped on the ground or into storm drains. Water must be placed in approved receptacle or sanitary sewer. Please find out from event coordinator where this is located for each event. What is your booth plan for flying insects and dust control, if applicable? CANOPY WITH WALLS. NO FOOD IS LEFT EXPOSED TO THE OPEN AIR BOOTH LAY OUT N1, MAP Provide a drawing of the Temporary Food Establishment. Identify and describe all equipment The map shall include the following: in Cooking equipment u Hot and Cold Holding equipment Cl Hand Washing facilities ❑Work surfaces ❑ Food and Single Service storage (i Garbage containers ❑ Customer Service area a Summary Paragraph: 'rit -.n pamgruph or two about how .your operation works. WE HAVE A ' X 7' PROFESSIONAL, S/S FOOD CART THAT IS HAULED VIA OUR TRUCK it HAS COW STORAGE AND STEAM TABLES WJTH A LARGE GRILL THAT IS POWERED BY PROPANE AS IS THE HANDWASNING HOT WATER HEATEF . MILE HIGH LOBSTER SHACK 532 Strachan Drive 4 Ft. Collins, CO 80525 Nancy K. Van Reeth Doug E, Van Reeth (207) 725-6373 (707) 240-8375 FOOD & DRINK ITEMS Lobster Meat LOCATION WHERE OBTAINED Hebrew National Dogs Guineas Beer Brats Mayo, Heinz Yellow Mustard, Ketchup, Relish, Gulden's Mustard, Celery Sal L Sodas, Water Butter, lemons Single serve Chips Ivtoxie New England style Split -top Buns Whoopie Pies Dill Pickels Shoestring Potato Sticks Gluten -free Buns Northeast Seafood, Denver Restaurant Depot, Denver Sugarland, Colorado Springs Pepperridge Farms Wicked Good Whoopies from Gardiner, ME Sam's Walrn rt King Soopers SA CIKITS Mot Shot Catering 2649 E Mulberry Unit 31, Ft Collins CO 80524 -' _ ', Alt (970) 493-1643, Fax (970) 224-5054 Emall i; { saeh ts. em, Website wttw.sackits.com Kitchen Rental A s-eement All renters must provide proof of a current Colorado Food Service License and a certificate of insurance listing Sackits LLC as also insured. An immaculately clean. kitchenis wha surfaces, including doors that :you use are left spotless w know when you arrive if there any sanitation problem. returned to their oriuMai places when you leave. are that ail . Please let us fishes and equipment must be All boxes muer be ,kenbeoken clown fiat and placed in the recycle box. Please recycle all appropriate plastic: aiurrinarn and cars Please let us know mediately includes kitchen eeuipmert, per electrical, etc, in a problem t: any aspect of the facility. This freezers. sinks, stoves, pl robing, bathrooms. -ou happen to damage any equipment you will be responsible for replacing it. cidents do happen, se please have the integrity to let us know immediately. Once you have booked kitchen time. you are responsible for paying for those hours. You are required to clock in and out on our time clock, While we understand that things come up. we have committed those kitchen hours to you and expect you to follow through with your financial commitment to Sackits LLC. Violations of Health Department Cndes may result in revocation of your kitchen usage. Our agreement with Mile High Lobster Shack is at the food truck special rate of S195.00 Der month On the ''` day of each month an invoice will be issued for that mont'h's rent. Sackits Rap esentaiiv'e. t 1tis agreernen s LC,'f;- Date' time itvlil he r dewed for renewal) 10x10 CANOPY COLD HOLDING COOLERS CONDIMENT TRAY FOOD PICK UP DRY STORAGE TABLE STORAGE UNDERNEATH FOR NON-PERISR ARIZ DRY GOODS wane r, oil the &r id COW HOLDING COOLERS STEAM.TABLES GRIDDLE 5 VII AC1 COLD HOLDING SINK CAJ:MCE 110111/4 DRY STORAGE AND HOT WATER. NW UNDERNE TH* mar PROPANE TAN is AND WATER CONTAINFAS DRY STORAGE STAINLESS STEEL 4X7 FOOT CART CHIPS & WHOOPIE PI5 STORAGE UNDERNE,AThTAM FOR COLD HOLDING & NoH4PERISHARLE Mar woos - rat off the ;per FOOD ORDERING WAWA STATE OF COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT LICENSE TO OPERATE A RETAIL FOOD ESTABLISHMENT t`eilairaRR. kite Pat SI t1 t41t intali t IABliMA Y IliirtrAl!taR TFOM [Mud* t,taw Ili IN tit. cc -k Nnit I3auk DACE DICE ilSE VALID TO] DECEMBER 91 238s6g9t -I t} 003 Lentien4i4 RES ftssoo i?t!+>»►Z Is ZQf D NILE HIGH 1.O6$TER 3HAC*C LLC !SALE MOH LOBSTER SHACK -PUSH CART STRACI4AN DRIVE PORT COLLINS CO BMMT6 Thrs v'arDlies that licensee shown hereon is $u at and licit -ma! to coiling fn tarseress in acvardtufue wtth the pmeist ns of the law and 1ag=1kn of the Coiarado Department of Pubitc Waits and Envrtanrrnrd. My atarafrena mede on tat kola 4ond autornatl4'rtly trlgkb •t nuf2 and void TM IS UCROE MUST BE POSTED AT THE FOLUNG LOCATION: 2642 E MULBERRY Pal (C► MIIIMSSAKY) •• •• a "Tit , • POST IN A co$SFIcL+Qus PLACE Q omaiaalM'iil GE,PAR1 ERT OF REVENUE OEM ER CO Pat2e1430 MGR, mitt taAaa for: SALES TAX rilai fultlyrr STATE JNJYbPJ! is al nleptexam COUNTY LARI EFe Lutekt@iVDJ4i jS'l•1 } • _. �� to,. • • LICENSE 9$12091.55r 11U3 usage MAT la POOFHP0 PPOIrcuc na tto lusdarr% btn PLAcir*flE r Wi Wiliam static" tclItickCsAit bitrapt tl tuKai J)t 4 MILE HIGH LOBSTER SHACK LLC 532 STRACHAN OR PORT COLLINS CO 8O'5-2153 tUt ttT1f It tut In LCFME "MiD 10 nceEMeen 31 �+a►a THIS LICENSE IS NOT TRANSFCRAaL�E tomitiplout& Eatct&irn Oinks Pepanirinal Q 1hr„te.t Ac J CERTIFICATE OF LIABILITY INSURANCE DATE (NMIODPI'YYY) 0'90)212016 THIS CERTIFICATE IS ?SSUEO AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTiFICAT€ HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND CIR ALTER THE COVERAGE AFFORDED BY ThE POUCtEB BELOW. THIS CERTIFICA.TE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR1WD REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certiTwca$e holder is an ADDITIONAL INSURED, the pallcy(les) must be endorsed: II SUSROGAT10N IS WAIVED. subject to the terms and conditions of the policy, certain policies may require an endorsement. A staternerrt on this certificate dues not confer rights to the certificate holder in lieu of such eindarsement(s). PRODUCER Veracity insurance Solutions, LW. 260 South 2500 West, Suite WS Pleasant Grove UT 84062 INSURED Mile High Lobster Shack, DBA Mile High Lobster Shack 532 STRACHAN DRIVE FORT COLLINS OO 80525 art' FLIP Program SI11ipport Piaaif ci .Cina..� ' &I 6.66.-054 cis w} n a tm, . I r i,lla'a ll t pl a g rn c1:,ptrt INSURER : INS4JRER E : s� c IlaMatt'[+t INSURER E r ltsl (et hRi- IHBUR ERJBI AFrO INO COVERAGE HANG a GraafAmerican Alliance Insurance Co 26032 COVERAGES CERTIFICATE HUMBER; REVISION NUMBER THIS IS 10 c ktify mai 1Ht IVLICIE , CIF IH,&W1A1tCE LISTED BELOW HAVE BEEN ISSUED TO THE INrAMED ti4AVED MOVE F THE POLICY PERIOD INDICATED NOTWITHSTANDING Mit FEQtJIP:ftMetft. TERM OR CONIDI TON OF ANY CONTRACT OR OTHER DOCUMENT WITH !INSPECT TO'b1ttilic i THE CERTIFICATE MAY Be ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED I-REIIEIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND COND?TiDNS Cc SUCH POLICIES LIMITS SHOWN MAY J4A.VF REI=N REDUCED BY RAID CLAIMS iN w MPS W Orly t{stieu✓1 r i�yq �.� Min w'i7ldfif!I!Iti&wrQll 'Eli 4 [Y tDtYYP5�^r9`Irat '; LSul GENERAL LI,IIAI1TI Y Mal 7I'+L1. a 10000,10') B k " TPf afhe"6 [� :; an.0 C0MhiFRCAu. GENET We x i1fl rat 4cw' :, A Cllsl MPI. X O BUR I _ _ ML EXP (env Olt perda,) S 5.000 PBail aiss-FoiSBiai 07121/2016 DM-I/2017r LACK. 014.81■ iM 1,000,000 C,fNERAL AGGREGATE .a 2,000,900 (girl Armin GAITLIfAIT s PUE.E PER PROD:1cts- co$a o ACC t 2.000,000 It PC-.:t:Y ea+t AN £3?JLEE 2 TT fallt'i w:GR.ELIABI1,STY FE t ,_ -." t .l II• ANY AUTO ALL Ali TOG AUT S.LE Co BOOJLY INJURY JEW m on) S BODILY INJURY 4Perac-c.+den11 S NiotI.OwNEO PFEIFEr�/ MIRgio Auros Actros PoQak=pde R; DAMAGE 4 S JSEI. J411AH wain ExCES8 UM - EAI14Ei,1'AULI fl I EACH C-CCO RENCE 3 ACCaL.41.G7: s tillg I Mk "r?1h9,I#r _ it 111 ls+i�Ii1'f�i�l'1 msee AND nart,O" AEJW Lustre YINAN P# OPRIETORIPARTNEb1InXECullNE -- ( ut tE_wR,tCta�� ,11�, A ri tE r— et.1 kILAC .. �. 4 NM I.utari I G isNRO t l UIQitA . r-.AEMwtoYEE S IF Mit nines ;beam Ygi I.jii r�� CrP C�{h(dt1C77�.1l n - E CV !S -'cLL 'r i;Lit s i I1 I — 1 nuseternen of OP'ERAMO$U r LOCA11CIMS I VENtcLEs (,Wad, WORD lot, ASIft emal Renews ticket:Wisp Wawa spy. Is req,iled) certEfrcate holder had been added as additional insured regarding The above mentioned policy perattached Additional Insured - Designated Person or 0rganl2atian (CO20 26, ED 04 13) tT'1 FATE HOLD CleteELLAT PUN WILD C1DER 11455 WCR 17 FIRESTONE CO 80504 SHOULD AMY OF THE ABOVE DESCRIPEO POLICIES BE CANCELLED BEFORE ma EXPIRATION DATE THEREOF? NOTICE WILL DE DELIVERED IN ACeORDANCE WITH TIE POLICY PI% 3VJSIONS AUTH DIUZED REPRESStTAThh E ;Di1900-2014 ACORU OORPO RATION. All rights rdaervtall. ACORt1 25 (2014/61I The ACORD mend am:iogn are registered marks el ACORO INSfZ6 (2014011 DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 North 171h Avenue Greeley CO 80631 Web: wwvit v1pnt .- ICI *.rlq, Fire Ituflhn► real ilea I th Strvicr4 ( )7tOO- 04-6415 Fax (97[1)-304-6411 VENDOR APPLICATION FOR TEMPORARY FOOD k�,.. 1/4' 6�'•ii•.�� ;�. E=I �, (161 S.1. r% tc:. X11! � 1, ��il� 'lil;ti'i)5 i1.11l0t 4' "1 I I 1 Jed' I illI Goi .4 nsgusi . N. , Ah^ i I I, `L! I Event Name: le h Date(s) e(s) _ Please complete the ra;lluwin, information: I_uc:144m of liven! (address): f 'curs cit` I: •ct3t: -i ompornry Retai roo-d Establishment Narnc: r„ i'1 .'t4 kat.szkilhe a Which count)► it tawd your license Contact Name: 4 !\1‘0L 1 cieephone Number (Prior to :techtE { — 4 ! 17 loci `; 7 Mai liiii• 1,_ 'Ali vendors shall have the c rig n{ai C:elorado Cell Number tl)urit.lp litez fit) : Stale: il�: Fond Establish f to l'cen9e p' e riisa at at1 times All 1 cudurs must inn ide documentation O1 lieensure or non-profit status Type of Vendor: Check apprcpriatc hux I have attached imp) DI documentation 1 icy it cd I+`rnporary Hoenig Vendor I licensed Nekibiiiic Unit INon-I'roi i t f prcwide documentation} If you don't (hold a Temporary Event or Mobile Retail Food Establishment License please eosstaet the Health Deportment at 970-30.1-6415. Please list any additional events and dates that you plan nu participating in Weld Count) Event rime Date Location FOR HEALTH OE Ptik RTl r cNT USE Licensed Needs a license Non-profit Elf .S'peciuulist �'�f{ it store v.-- AI'('R(PrkI) Yes No bow MENU. (Please attach additional sill r, as awcessary) Please list all !bad products and the specific source of all food items (name or grocery chain. wholesaler. etc.) Be sure to include items such as toppijj and co diment . Food and Drink Items Example: Hamburgers Example: Onions I Zaocio, r-- 4 5. 7, S. 9. i0. c 11. irtiL ifii'lit 1M htr'c' o$itniust'd Grocer/ Story: A Chain Shire It \SL41" tit� 1 -rf 112. 13. I4. 11. HANLAWAsHlNc. c1l.' l]�_ h.OOI) I IANltl:IS A hind -washing sitillinn 'i l 111% cinch booth or unit is Rl:QL IRE() unless only prepackaged foods requiring no preparation and / or cooking are to be served. Please check the space beltm that applies to your booth / unit. 0 I will be serving only prcpac kaged foods that require no preparation. handling. and/or cricking. I will he serving foods dun require preparifion, handling, and/ur cooking and will provide dw Mowing for hand -washing: I.) a minimum or2 gallons of warm potable water that must he refilled led as needed in a container tAith a 'hands -tree" spigot la soap 1.) paper towels 4.) 5 gallon bucket (minimum) to catch and contain wastewater until it is properly disposed NOTE' Hand 'can ti ers ' are N Tan actsepfable cubstitute fin. required hard -washing .�•c-cf{�_ How will you prevent bare hand contact with ready to eat foods (at both the commissary and in the booth)? ai'ongs 'g 1 ood-grade disposable „gloves (Note: if glove -N arc changed hands must be a ash ed ) S Deli tissues la -Other (list) • `,� ill. FOOD PREPARATION AT COMM (NSA RN' Preparation at Approved Facility or Commissary !MON Event Cheek which preparation proecdurc each Fitcrnti item requires. Food Example: Hamburgers Example: Onions 1-: 2. 3. C Ver"tr?c. • t a 5 6. s..'1 41g11.1- 7_ a - rThaw X Cut/ Wash sseiTible Cook/ (Cool Reheat Rold Bake Htaliwn�y?±Tth. Hot 'Holding v $_ 9. it 4 What is the name and location of your commissary? (Complete Commissary Agreement on pup 7) Name of Cora rn i ssary: Address oi' Commissary: City/State/Zip of Commissary: Produce i-low will produce be prepared prior to use? (mark all that apply) ▪ Wash produce in rood preparation sink In Buy product pre-titiashed and cut at commissar) & Buy product pre -washed and pre-cut o Other (specify) , O Not Applicable Thawing- Will foods need to be thawed at the commissary? V LIN1 if yes, answer question hckm . How will frozen foods be thawed? (mark all that apply) In Under refrigeration L Under cool running water ❑ As part ot'the cooking process p Other (specify) 0 Not Applicable Cold Holding — Will foods be cold held at the commissary? Y efei Flow will foods be held at 4 P°F or below? (mark all that apply) [a Walk-in cooler or freezer • Reach -in cooler or freezer • in cooler with ice immediately he transport to site p Other (s ecify ) _.1 If yep, answer question n below. • Hot Holding — Will foods be hot held at the connniiksar '? V 4'N Flom will foods be held ai 135 dcgrcc& or i1lloce? (mark all thataryl") p Steam table ❑ Reach -in hot box D Oven D Other (s facc i tl ) _ y------- O (kill dos ...wregmeAmnignai If yes, answer question below. Cooling — Will roods be tooled at the cammiss:inr? 1' AN; If yes, answer question below, f law will roods be rapidly cooled to 419-2 or below? (mark all that appl N ) D Shaflow pans (fess than 4") in refrigerator or cuolcr O Using an ice -bath to cool the food product ❑ Ice p addte or wand ❑ Other (specify) Reheating-- Will foods lie reheated at the commissary? V .fic N_ If yes, answer question hel n , How %%ill foods be re -heated En at feast 165 ilcureeN I-? ;mark Atli that apply) CI Microwave 0 lint Plate p Grill ❑ Oven D Other (specify) Transport ["least provide the distance that you IA ill he transporting food to the event? What equipment will you use to control temperatures during Ilan:Tort? ❑ Coolers with ice D ('amhros for cold roods ❑ Caambras for hot roods lc Other (specify) � t� t !L\ 4 sooti \ C yol NiNzas ti slk \A\ ‘Y,'.‘,1 1/4 \ (1% cifikeickAt k1/4 UV. rood H ndline At the Booth/Event List all menu items. including beverages, to be served from the temporary food booth. Cheek * h icl r food handling procedure each menu item requires at the booth, Food Cold Holding Reheat- ` Cook/ Grill Example_ Ha mb►u r2c►r Exam le; Onion X (lot Ilok1iii x Assemble 2. 3. sa S. 6. 7. _ S. L. 10, X V J r cooking ortil apt I1clltli'UZ U[F'IHMd Items I. I-Iow will these foods he cooked imd/ur reheated at thw site' (mark all that apply; j ` �raIl O I lot plate O Not ;'ipplicuble Deep fryer O (hen O Sri' ie rov1.tt'e ❑ Other (specify ) 2. I low will hot foods ds be held at 1.35°F or above il the event? (murk all that apply) (aSterno burners- are prohibited) ❑ Imc i ht ldinj unit O Strain table O Not Applicable O Held folder heat lamps Irciived i medIiatelb Mkt enrikititt CI Crock -pot a Held on grill until sets;AI ❑ Other (specify) _ 3. What utensils Will ytiu use to dispense or serve the but item;'! O > ongs ❑ Ladle Ie ❑ Spatula Other (sptacil l �'��`.•' Li \i.1 Applicable 5 Coltl1'opi 1h90s 1.�HOW will cold foods he held at 41°F or helot+. at the event? (mark all that appl) ) ,ji" Refrigerator f tree/er O Noi Applicable ❑ Ice chest - must be Ifreniu hk tare/foocts way not he kepi in contract er with the see rmitcs rho arc packaged and ceded o Other (specify) taros 2. What utensils will you use to dispense or sent the cod items? ❑ Tongs ❑ 1 odic Q Not Applicable Spatula itit Other (spccit) j \ • -- L -n en\ . �' r=��-t . 1t�:c s 3. What kind or rood thermometer 0-22011 do )oft hat e'? ctal stem probe O Thermocouple ❑ I )iitai V. Cleaning and Re 1t 'd What type of Sanitizer will you use at the booth? t3lcach at 50-20{0 ppm ❑ Quaternary Ammonia at 200-44)() ppm o Mier: Notes 'rest strips for sanitizer in use must be provided and be on -site Where wilt utensil washing take placer Q Ccomrissary 3 compartment sink O Commissary dish machine 0 Commercial mercial 3 -compartment sink unit (pant ni mobile unit) What type of Sanitizer will you use in the 3 compartment sink? r"itleach p Quaternary Ammonia ❑ Other O Not Applicable- lasing disk machine Where Is ill wastewater from hand washing; and cleaning be dispo: rcl or: ❑ Commie.ssay O Apl'rov d s it-srly reecptacie at event D Othei Waste, !voter (ANNO7 he dumper ` on the! ground or into worm drains Ii iatei tnuSr he placed in approved teceptcreic r ,vanitary sewer Please find our from e rent craor c/jnaem' where INS is hisc'C!(1('for etr '() event What is your booth plan for flying insects and dust control, if applicable? S BOOTH WO! 7, N D MAP Provide a drawing of the Temporary Food 'Establishment. Identify and describe all equipment. The mapshall include the following: o Cooking equipment Hand Washing facilities C1 Food and Single Service storage Q Customer Service area p hot and Cold !folding equipment ❑ %Vork car faee c t] Garbage containers O Summary Paragraph:ti f . . Write a paragraph or two about how �� our r operalion works, What is your booth plan for flying insects and dust control, if applicable? t n� i 1"ic 1 _ 1A) ) le, r it 2,_..,4 ,.J BOOTH LAYOUT AND _ MAP I Provide a drawing of the Temporary Food Establishment, Identify and describe all equipment. The map !hall include the following: �,et zfCooking equipment allot and Cold Holding equipment illaud Washing facilities 0 Work surfaces Or Fond and Singly.' Service storage l ''rt;nrhage containers ;Customer Service area O / ,49 1, 4r (1ti) r ) j ore- • ` 0t Coilackt C.(x')\U4 r-- 1 At; r „ r pa"- ca. -0)45\X creAkor tr‘ik arta Ulm JAI' tie r; (11;00 r // 12.1 AJ j?I ~ c4 rf , 1 (Th et.; isi C, % kiJ i4 4. : k ; Cr—, ;;—/A }IS tvdia:ct t \I jut . ,..EL 11i ' ‘nos er.1 •= k.14 tip.0 7. f r) 1/4. -}rig t.t — ( I; tel let -....-> erk* :.:;11 vt '1/4 L t fi%-- 1'3 r t rot\ i+) ) it, irk Yd' r f" 1� tferis * 1:712 . All licenses. certifications. and regivtrations issued too inrfiPirlool erwue•r..t or vote j' ipriruers "'< +e 1l ctd { mutt. Uet„\1nmeat ttf Pnhlk ttealtk anti 1 nt.irt.nn cnt nurst fs a I:0410ynt l h , critii.ni<na ,+? citizenship, fhl8 regnire`tni ll dp,e, nor apph :ion i;,i l are aril an intliVatitJ „« net of soli i`n,t<riath>t Ver€tieuiim irteludes completing the .tllisat ii and pro. idnic a notarized eotn of an approc.ati identifcation..'tppruted identitiration ine}udks: • A talid i'ntornk+ Brit et is heen.e in .1 t'rti,.rads. identuii a nor, i.+rt - • A I't led States mil tars card oranilitaz. dependent'. :don itirat ion earl. • A tntitec€ States ttr:rst Guard ylerehanl \ lit rincr earn, • A Native American 1'rihal Document. In addition to the above listed firm. ,il tdentttiertion. the Ii I.'n t ie will i'e alit sned'. • A certificate t erifs ittg nniusaliz d stain- issued in m1 uutln irked a <:at<t of the (.t tc.t !stale, hearing applicant`'+iltiaet photograph impressed it iii tile rio'.e,l 'niiu,'..n! ta, oft'=e uttn_• aeenet: • .A certiticate te'riti int; f rated Statest'iti;rntthip i»ue.t'.t at a=jilt, rued ,terns .tt t. t nited States Rearing applicant's intact flhistngraph impressed st tilt t€t+.' ; Sias',' etnhirssed seal • s;' the ISSni1t} atteth<. tn. • (Mier of +rani'l State', driter's license or tclentifteanun card A,il alt awes s:rib Ltt' Int presence prior to isntng license theretitre..•nl' those States ;s -.test helm.] are de.•' acrepialtll.' ' .'lfahania \ritiniu. \r{,attw,s_ I abiti,rnia. 4 .,nttetitiau. Defusinc. I tt.trict ,e I t,tundnta. V is.rt i t t VJ -.he. Indiana fltsa. F.un.aw kentock.. I .tukiana. tit tie. \tln,h .•{:t. }!, -..Ian{tl. {f. •.0 .. t$' tiniu. \et ;,,tt `<•s. t`tampchire. \et. hrne). \en \",+rl.. \ ath Dakota; t Su,. t H,kthn na. i•esrr, Is anise Kit, =,ia lalnrwi. "..'uth t .,n 6n., SOU* Ualttta. Virginia. t.'.-a'.',viola.. and tL..ttntnt,: AFFIDAVIT - RESTRICTIONS ON PUBLIC BENEFITS Isi4 rN\ . sitc•:,r .,r :ttisrrt Stet ier it n..Rt ,d periers a:adc`r 'I Ittws of the State ;.t(.•h,ri,du that +cheek ,nact • I am a t sited State, ruiner. ur © t am a Permanent Resident of dw l tuned Sate:,. or • I ant foul -nil?. present in the l:ailed Staten purstiatit to 1 etter:tt List . understand that this stunt statement is rettitirell IK fats hccciu.e I has,: applied for a puhlic benefit_ I understand that state fait requires -me to pros ide pond -dun I ant Lit' buII present in the tlnitcd `its+t=•4 prior to receipt of this ptth€ic henelit. I fw'ther aekrntwtgslge that tnahin, a lal,r. l eiiI 'us, ur iratnlui:'ii statement or representation in thin sworn affidavit is punirhahle under the triniinal tans nt t-+,i,ur as-, .<. perjure in the Second degree under t alotado Itet } sd Statute IS;f;.;lt+ stn,€ it ',hall i,tltctttutc a sip: cl c criminal offense eacij timer ptrishi.• hen<tit is fratui lentlt rett•;t c,t. S,irnam-e Finn's Legal \iatm. J'.,'. 1,..IL _I‘ it k:S rt_. {.! t t_t l i Finn's Site Address: )"5—f ', < =!'i: c.'.•�- Street 1 nit i sf1 Print Name $.TriMCounty Health Department COMMISSARY AGREEMENT Mobile Food Facility DBA ti i ttilitlk Food Facility Owner e r� e r ! ,tRr`� rimes+ a .1,Ki a' i cs L L _ a City Commissary DR A i ='t Lrt,N1 1 eF9►c Commissary ()eviler'_ Name ZAte---t ' r: ItZere Address L zoNea- 2c ,s - City Phone P r.iMrs.fls. .-•-r- ,.� . - -- . -- --_ _ states that hefshe has your permission to use your commissary/food facility/base of operations for the purpose of storing food. and supplies used for the mobile food facility, necessary preparation of food, filling unit with potable water, cleaning of the unit, and clumping of wastewater from storage tams. This is in accordance with the laws governing mobile retail food establishments or pushcarts as stated in the olio srdu Brian Fond Es•mbli%Jtmeni Rues and fte2nlitiolts Section 9-1071. To qualify as an approved commissary, you must: 1. Provide approved, food grade hoses for potable water supply to mobile units. Provide an approved area for the storage and preparation of food products and supplies, with approved, properly installed equipment. 3. Provide an approved area with an approved 3 -compartment sink/dishwasher for the washing, rinsing, and sanitizing of utensils and equipment 4. Provide an approved area with floor drains for cleaning and maintenance of the mobile food Facility. .5. Provide direct access to an approved floor sink for proper wastewater disposal from holding tanks, 6. Maintain a valid Retail Food Establishment License ( for commissary/food facility). 7. Post and. maintain a daily log (check-in/out) sheet, the mobile food facility owner must sign daily that they are using your commissary, and you must sign daily verifying that the mobile food facility uses your commissary. ►d. Maintain your commissary in satisfactory condition as determined by the Local Health Department. Once the mobile food facility has been approved for licensing, you must also agree to nofif r the Tri-County Health Department if the above mentioned mobile food facility has not utilized your}acift, as required, for three f'3J r on.ceentirre days. Fuse must also certify snider petra ty ofperjruy that you are the legal owner andir operator of •rfai, fours fnei1ily and will abide &y the contents of this fetter,,. Date TIllS AcRIMiF:Nr LETTER R MLIST RE UPDATED ANT) RESUB tITTED ANNUALLY TCIJD s-.cio (kctt3is/u!l STATE OF COLORADO DEPARTMENT OF PUBLIC HEAL ill AND ENVIRONMENT Est 25:5 Oa rr16r:�o �wwcarrf 11 um! "lotJI rt!aiter► t 1 12 I. $7M-0901$ LICENSE TO OPERATE A RETAIL FOOD ESTABLISHMENT iOMNI Ir`' P40 iftriekin.okt I t 11111"* 114 THIS LICENSE MIST BE POSTED AT THE FOLLOWING LOCATION: MATER S CATERING MOBII.E FI AM I Nei SPr fl ILA INC ' 3515 CAROUSEL I,N COLORADO SPRINGS. O W917 I!" P. 1 i 'v.1i['}.%,tr I wiz 1Rj!SI .J,Likr t3 DECI: 1[31+: i •/p a. R (!`1?2ll 1 1O T r i$ ct*'tiff S !Prim Itcensee 511: DV" t rent. cs. .3tifttcanzed and IIcen :ed U ktrvige r Uos.nesi rr r at .ordan c %t r 7Me 4.ruVr,*ir,tcl SI the law and recta nick is n' !h i Colo/44k- nf ltrtiJ L: I-Inalt % wad Environment Any allatalrcrlr I`1ac11r •)r" In s laren,n tad( aurQmatu ila II" are is r hull 3OO '../Ckl() ►4116 POST IN A CONS P MUCUS PLACE CERTIFICATE OF INSURANCE ISSUE DATE 8/25/2016, THIS CERTIFICATE IS ISSUED AS A MAilER OF INFOfMAT1ON ONLY AND CONFER -S NO PULPITS UPON THE CERTIFICATE HOWER_ 114I CERi1'F1C ATE 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 INSURERS'S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT. IF THE CERTIFICATE HOMER Is AN A.nuUTJON*L INSURED, THE POLICY(IFS) MUST SE ENOORSEa Er SUBROGATION ISWAIVED, .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 NOLDCR IN LIEU OF SUCH ENDORSEMENT(S). PRODUCER INSURER(S) AFFORDING COVERAGE I Northeast Agencies, Inc 846 Main Strut - Suite 10� INSURER 0S: Scottsdale Insurance Company - - Williamsville, NY 14221 1INSURER 6: N/A INSURED INSURER C: Matthew Spain , dfhra Mateo's Catering 3515 Carousel Lane INSURER D: i Colorado Springs, CO 80917 -- — INSURER E: N/A COVERAGES - - TMIS POLICY RESPECT HEREIN PAID IS TO C ERTIFY THAT PERIOD INDICATED. TO WHICH THIS IS SUBJECT TO CLAIMS_ THE POLICIES OF INSURANCE LISTED BELOW HAW BEEN ISSUED TO THE INSURED NAMED ABOVE PrOR ThE NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH CERTIFICATE MAY SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED AY THE POLICIES DESCRf;REQ ALL THE TERMS, EXCLUSIONS AND GOMDmDNS OF SUCH POLICIES- LIMITS SHOWN MAY HAVE BEEN REfDUCeb BY - INSR TYPE OF __"I POLICY POUCY POLICY LIMITS }UM INSURANCE I NUMBER EFFECTIVE DATE EXPIRATION. D&TE .-AENERAL _ UABILJTY CPS243114D0 5/1/201a 5/1/2D17 GENERAL AGGREGATE 2,OQ0,t]tifl PRODUCTS-COMIOPAGG- 1,000,000 PERsantAL & ADV. eNJtlf4Y' 1.41a0,00O EACH OCCURRENCE 1,000,OID1) DAMAGE PREM RENTrD To YOU 100,4co MED EXPENSE (Any one pew) 5,4136 PERSONAL LIABILITY CONFINED SINGLE LIMIT MEDICAL PAYMENTS TO OTHERS EXCESS LAB' EACH OCCURRENCE AGGREGATE - - ERY BUILDING CONTENTS BUSINESS INCOME DESCRJPTION OF OPMAT1ONS / SPECt,4LTY ITfl4s Slow Push Cart — WI$d Cider and The carbon Valley Wine Fn ICI are named as additional insure swith respect to general Jiabilaly, CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE fESCRIIMEDPOLICIES' SE CANCELLED Wild Cider and The Carbon Valley Wine Festival BEFORE THE ExP1rI*TION DATE THEREOF, Notice WILL BE DELIVERED IN 11455 WCR 17 ACCORDANCE WITH THE POUCY PROVISIONS. Firestone, CO 84)504 ufHoRv}rU SIGNATURE Date: Department of Public Health & Environment 1555 N, 17th Ave.,, Greeley CO 80631 Phone: (970) 304-6415 rviobiie Unit Inspection Form Length of !inspection: Estabitsivs tent Page 1 of Type of Inspection! Reguiqr / Follow-up items circled below Identify violations to be corrected Ctterected emits Lined Immedtateftir I c Found raw animal food; stored above ready to eat roods All raw anima) fors shah be stored below ready ra eat foods I.: 3 c Observed employee changing gloves without washing hands in-between donning new gloves. Food employees shall clean their hands and exposed portions of their arms imm iiatety before dortntng single -use gloves icr working with fund, and between removingsailed gloves and putting on dean gloves Now: — 2e Fvund employee drinkf s on An employee may drink tram a clean, closed 1 ._ __ beverage container it it is stored to prevent contamination of food, food rants t surfaces,. equipment and single tervice 3r&les. Observed employee touching ready to enticed with bare hands flare hand contact with ready to at food is prohibited U How: _L 2g 3c Found `_` at F. The temperature of potentially7 How: L' hazardous foods shall be held at 135 degrees F or above Fo€td was riot off ii off temperature for more than 4 hours. ii Haw: ." Found -- - - at F The temperature of potentially ae hazardous foods shall be held at 41 degrees F or below Food was not off' off temperature for more than 4 hours. 3f Found no food probe thermometer on site A calibrated food thermometer with a numerical kale of 0-220 F shalt te pc©viided and accecsibie at an times / found no thin mass probe thermometer on site A than mass Probe thermometer shall be provided if cooking thin mass toads ;_ Ll 3g Facility found operating with inadequate equipment to maintain temperature_ Adequate equipment shall be provided to maintain food temperatures / facility does not have adequate equipment to protect road from contaminations Food preparation shah occur at comm iSsary and not onsite II ti+aw: 56 round no hot water j 010 WAter at hand sink at true of inspection Hot and cc$d water shall be provided at all Now: times to ensure proper hand washing can take place . :. 6c Fauna no maw wi Cpnrrtst spate at hand sink hand sinks shall be supplied with an adequate supply of soap and oaaer towels at all times Sc Found sanititer greater than 7t',Kf ppm of chlorine_ Sanitizer shall be between 54.1-21Xt ppm. Found sanitizer greater than 4t}0 ppm ai quaternary ammonia Sanitizer shall be between 154]-0J pprn ] tic Found no test strips for sanitizer. Test siiias for sanither shall to available for use at all times. ❑ El be between 5O-ida , 124 Found sanitiaer bucket with less than 50 ppm of chlorine Sanititershalt ppm Found sanitizer bucket- with legs than 150 pqm of •uatetna ammonia. Sanitizes shall be between 150-400 ppm. 13b Single use utensils found with toad contact surface racing customers Single use utensils snail be stored in a manntr when! the hanrile facci the customer I C la Plumping found IeakinR at tIrrie of inspection Plumbing shall be maintained in good repair r Addttlonal inspection remarks: • Environmental Health Specialist Received By Rased On an inspechon this day, the items circled rdentafyr the vtotition in operation or facilities that must S corrected by the next routine inspection or such shorter pentad of time as rna' he specified in wr,tingb.y the regtllatoryarrthority Failure to comply with any hone litnirs (or corrections mealier(' u the naticq may rEsuto in cessation or vow food serrice aperatron . DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 New 1 th Avenue Greeley, CO 80631 Web: www.weldhealth_o c BtwironmeiitalHealth Services (970)-304-6415 flaxx (970)--04-641 t VENDOR APPLICATION FOR TEMPORARY FOOD EVENTS Ali vendors must corptete and submit to Event Coordinator for each event in Weld County. If no menu and no equipment change is occurring from one event to another, the completed original may be copied. Plcaae attach a copy of your current temporary event or mobile unit Colorado Retail Food Establisbnient License, itTalready licensed. Yr 222120110 Event Name: carn �1.01\eVag,. vr.a Date(s): Elam eonitilete the t'oltcryIng,lail'ormaticm: _m_ Location of Event (address): 1 Hours of Event: Temporary Retail Food Establishment Name: ir 1,00JC0 Fp° d Cutk. Lip co O perFerit, Lite Bch county issued your license:: Tn-county' Email: poloido Coo ciAto e Era t I, corn Contact Name: --t-0. °freely all s Cell Cat Number (During )11k1r-7 9.C. Event) g_ Telephone (31(4 Number (Prior to Event): ) site 1--Ta 1 Mailing Address: i - aC 1 � taconi�` r�'� cie City: Therifi 4-on Mate. f'.-+, �"" Zip:Sozq/__r,_et.1� *Ail vendors shall have the original Colorado Retail Food Establishment license on premise at all times* All vendors must nrovtde documentation of llccnctire ur n + n- refit Mahn Type of Vendor: Check a o :late box I have attached co of documentation i Licensed Temporary Event Vendor O i !Licensed MobileUnit� Non -Profit (provide documentation If you don't hold a Tcznuure.ry Event or Mobile Retail Food Establishment License please contact the Health Department at 970-3044415. Please list any additional events and dates that you plan con participating in Weld County Event name Date Location FOR HEALTH DEPARTMENT USE Licensed APPROVED Needs a lice Yes Non-profit __ No EH Specialist Signature Date I. MENU (Please attach additional sheet, as necessary) Please list all food products and the specific source of all food items (name of grocery chain, wholesaler, etc.) Be sure to include items such as yippi_pm and ondimeints. Food and Drink Items 13, 14. Location where obtained Grace Store A Chain Store B S H. 1ANDWAS1INC AND FOOD HA IfJNG A handrwasking station WITHIN each booth or unit is REQUIRED unless wil r prepackaged foods requiring no preparation and / or cooking are to be served. Please check the space below that writs to your booth / unit. O I will be serving only prepackaged foods that require no preparation, handling, and/or cooking - 1 will be serving foods that require preparation, handling, and/or cooking and will provide the following for hand -washing: 1.) a minimum of 2 gallons of Warm potable water that must be refilled as needed a container with a 'hands -free' spigot 2J soap 3) paper towels 4.) 5 gallon bucket (minimum) to catch and contain wastewater until it is properly disposed NOTE: Hand rsanitizersare NOT an acceptable substitute jar required hand -washing set-up How will you prevent bare hand contact with ready to eat foods (at both the commissary and in the booth) ? on.gs Food -trade disposable gloves (Note: if gloves are changed hands must be washed) 1t tissues Other (list) Thaw Cut/ Wash Assemble HI. FOOD PREPARATION AT COMMISSARY Preparation at Approved Facility or Commissary Before Event Check which preparation procedure each menu item requires. Food 1. S t, 2. St. Lg,� 0 r 1 3. r me r,1/ 4. What is the name and location of your commissary? (Complete Commissary Agreement on page 7) S. i d Verik ,�_ _ 6, Name of Commissary: _ \c k iLta.hallasedar--- Address of Commissary: OsE _ City/State/Zip of Commissary: Produce How will produce be prepared prior to use? (mark all that apply) )(Wash produce in find preparatioa sink ® Buy pr ut pt pre -washed and curt at LQQLtrrnissary Buy product pre -washed and ptut p Other (specify) ) Thawing- Will foods need to be thawed at the commissary? VF How vial frozen foods be towed? (mark all that apply) Cook/ Bake Linder refrigeration . Under cool running w°:atc As part of the cooking wocnt. 0 Othcr (specify) Cool O Not Applicable p Not Applicable Cold Holding — Will foods be cold held at the commissary? Y How OH foods be held at CT or below? (mark all that apply) Walk-in cooler or freezer Reach -in cooler or freezer [1 In cooler with ice 'trim diutely be t Other (specify) sport to site If yes, answer question below. If yes, answer question below. Page 3 of K Hat Holding — Wil foods be hot held at the commissary? V Row wilt foods be kid at 135 do :s or above? (mark all That apply) p Steam table CI Reach -in hot box p Oven p Other (specify) _ p +frrill If yes, answer question below. Cooling — {i!1 floods be cooled at the commissary? V' i If yes, answer question below. Flow will foods be rapidly cooled to 41°F or below? (mark all that apply) p Shallow pans (less than 4") in refrigerator or miler p Using an icc bath to cool the food product O !cc paddle or wand CI Other (specify) Rcheatiar Will f r a ds he reheated at the commissary? V if yes, answer question below. How will foods be re -heated to at least 165 degrees F? (mark all that apply) p Microwave El Het Plate p Grill O Oven p Other (specify) Transport Please provide the distance that you will be transporting food to the event? What equipment will you use to control temperatures during transport? kiCorolers with ice p C an pros for cold foods p Cobras for bot. food. Other (specify) Page: 4 of g eer Food Handlintatthtie Ro List all menu. items, inetudinig beverages, to be served from the temporary food boo& Check which food handling procedure each menu item requires at the booth. Cold Holding Rebeat Cook! Grill Ce.ktti .and Hot !-folding of Food ltruic I. How will these rocas he cooked and/oar reheated at the site? (ma& all that apply) Grill 0 Hot plate 0 Not Applicable p fryer 0 Oven 0 Microwave Other (specify) 1 ii.SCSsip 2. How will hot foods be held at 135°F or above at the event? (mark all that apply) (Sterna burners are prohibited) of holding unit 0 Steam table 0 Not Applicable a Held under heat lamps 0 Served immediately after cooking 0 C ck-pat t$ Held on grill until served ,Other (specify) 3. What utensils will you use to dispense or serve the hot items? "1 Tongs 0 Not Applicable lEi(Spatula CI Other (specify) Cold Food Items I_ How will cold foods be held at 41°F or below at the event? (mark all that apply) Refrigerator ' freezer 0 Not ApplicableIce chest - must he draxnabie and foods may not be kept in contact with the ice cwless they are packaged and sealed. Other (specify) 2. What utensils wilt you use to dispense or serve the cold items? are dla Not Applicable patina a Other (specify) 3. h tt :"ndof fond thermometer (0-220°F) do you have? )(Mctai stern probe enmoeouple 0 Digital Page 5 of 8 V. Cleaning and Related What t e of 8aniher will you use at the booth? Bleach at 50-200 ppm Cl Quaticrnary ArrtmoaiR at 200-400 ppm O Other; Note: Test strips for sanitizer in use must be provided and he on -site where will utensil washing take place? 9 Commissary 3 compartment sink a Commissary dish machine Wha Commercial 3 -compartment sink unit (part of mobile unit) e of San titer will you use in the 3 compartment sink? Bleach El Quaternary Ammonia 0 Other Not Applicable- using dish machine Where will wastewater from hand washing and cleaning be disposed of? Commissary u Approved on -site receptacle at event 0 Other Waste water CABOT be eyed on the ground or into storm drains Water must be placed in approved ved receptacle or sanitary sewer. Please find out, from event coordinator where this is located for each event. What is your broth plan for Dying insects and dust control, if applicable? BQf TH LAYOUT AND MAP Provide a drawing of the Temporary Food Establishments Identify and describe all equipment c r The nap shall include the following: O Cooking equipment O Hot and Cold Holding equipment 3' O Hand Washing facilities Q Work surfaces '` + ahi Q Food and Single Service storage l] Garbage containers 5C O Customer Service area 0 'icoicA-cm NIS Summary Paragraph: Write a paragraph or two about how your operation works. Li kiwi " smite Fa fir. '� �.�s2vt� ,�1/4�,1 �. mn\t krn �W�Std rc�, skoned, in. orzkrideRoE°mss iana itzrart-Qrs On bonrct MR ITY1017.44 Se 0A6' 0004 esco'rsci fa&ern#1e4 On rd -�e mobs t�: Qn i�r aerin O � ereCIL MI \tletekt.ddeath ait is rr1Cul 4oid ud alt. 4Thenwt4rMiladAA r e.. Weti-A'5 Cl'14. PitOkr- hold i rig to()5 an. COMMcorvonSSARY AGREEMENT Date 1, Faa. etatik (Owner/Operator) located at OH Mart Ilan CI ai tigehreithis kr CD (Address s of lctabi¢ cut) do hereby give tny permission to Lowco good Trod. Name of NJohilc Utt �"empoBooth) to use my kitchen facilities to perform the following,' if Preparation of ktokts such as vegetables or fruits, cutting meats, cooking, cooling. r ti Storage of foods, single items, and cling amts i Serwtcc and cleaning of the e ent rano I 04., (Establishment Name) Com mi5 Watts Supply'? Noltmicipal Commissary i Sewer Service? Municipal / V' Ware washing idlos,c:Filling water tanks /Dumping way water Otte' (list below) Well Septic Indicate the equipment le at the COMMittrY for the proposed uses: Hand sink drPrep Sink Mop sink IL/ Dish .machine Refrigeration Le Cooling equipment_ the- _ ....� -. I am a self contained mobile unit do not require use of a cedar Three bay sink tat" Thy St Page 7 of 3n-8t`fg— 3gz3 rhoneNumbW PfR000B2I 0 STATE OF COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT LICENSE TO OPERATE A RETAIL FOOD ESTABLtSHMENT LIABILITYINFORt411Ol h i LICENSE D TO could t r+�aua � N Obi meth dirf r DECEMBER 31L_ ACCOUNT FIUMBFR. use to, all raletinces 255.00 S UCSNBB war BE POSTILD AT THE FOLLOWING LOCATION: Loa entry LW 12875 Clarkson Cit Thornton, CO 80241 .0140 (0211811) DEPARTMENTOf REVENUE DENVER CO 80201,00-13 Must toned taxes for. SALES TAX LICENSE This L IGEN85 must DE POSTED A T THE FOLLOWING LOCATION IN A COM&PIGUOUS Platt 12875 CLARK SIR THORNTQN CO 8O241-3988 Lowcountry - Mobile Mobile Thornton. CO 80241 T#h1B LUCENSE IS NOT TRANSFERABLE K. IOW STATE COLORADO USE ACCOUNT NUMBER for all references 2117 7014.1000 COUNTY ADAMS LIA tL.YTY INFORMATION laird dr? kk Llatli din 12-J110 4.011 L x'115 ��IIr�11�'1{11111"i11in l �t11'11�1Er11� �� tr11l$lut i!1 LOINCOUNTRY, LLC ATTN: STACEY YATES 12675 CLARK ON GIR ti-SORUTON CO -80241-3986 RT D C D �I�� 16 _ — - 3CMR Thin earth >1 i M C 11Iae shown kraut ka aub:nixed ancii Mosneed to emir buainets In accordance • with Whi provision; of the Law and tectulatIont of Cho CaIousdo pepartnepeig of Pubic Math and Etwiror mtnl. My earwions mare on. thin &ante wit autornatkally make Ft nut and void', POST 1N A CONSPICUOUS PLACE ISSUE DATE mast ! dig Nom' Jan- oc 10 malt LICENSE VALID 1'O DECEMBER 3 2t}1? THIS UGENSE 1S NOT TRANSFERABLE Executive Meow Det of Revenue DATE IMMIODWYYY] ORK3 CERTIFICATE OF LIABILITY INSURANCE 9/B12016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFOIR.MATlON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE IIOLOER THIS CERTIFICATE DOES NOT AO PIRMATT 'EL.Y ON NEOATIVELY AMEND" EXTEND OR ALTER THE (X VEIACE r1fFORDED BY THE k OIJCIE5 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT 'CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS „ AUTHORIZED REPRESENTATIVE OR PRODUCER. AND THE C1 RTIFIOATE HOLDER_ IMPORTANT: it Ito certificate holder Is all ADDITIONAL INSURED, the pionGAIN) mina S undamped. II SUBROGATION 15 WAIVED, subject to the tan= sled conditions at Its Pn , certain policies moy require al% erfdarsemet A statement o n #tile certificate des not confer rights to the certificate Skier Ira lieu 0 such entiersernentiel, nOuuCER. Mobile rood Vendors Insurance 11200 dollyTville Rd Austin TX 78759 ItUea' l STACEY YATES DR1 LOCO FOOD TRUCK 12875 CLARKSON CIRCLE I iH ISSUED CO 00241 _ COVERAGES eal.5fli090'64 RE IIOM NUMBER: THORNTON TO CER7I1-Y THAT THE POLICIES+�IiUFI CERTIFICATE NUMB P:. OF �SUNiC� _iS8BELOWHAVEHAVEQCBEEISSUED ToToE'INSURED►1=ti MOVE FOR POLICY RI THIS IS tWOICAITED. NOTMTHSTANOING MY REOUIREMEN1, TOM on CONoITCEON OF AI41 CoNt1RACT OR OTHER pocumEter v'viTWm RAT TO VIMIC}i THIS CERTIFICATE MAY OE ISSN OR MAY PERTAIN, THE iM$URJ*JCE ,APF0IFI0E0 EY THE PotiCIFS fl SCRIBED HEREIN IS. SUBJECT TO ALL NE TERM, EXCLUSIONS ARO CONDITIONS O1 SUCH POLICIES.. LIMrrs MOWN MAY HAVE BEEN REbUC'ED ire PAID CAMS: - 434AndOn COlaialsxturth (00120 678-63841 rav I e ;1Cr MPQ' AorsfistarentionCiwhortioningtaChth II�I;I � ►NO Minn GE I MCI niSURERAASADVOC AMer .CSrr I36Ofi'4 Ir�' - esE1 Financial Deceit t Ins 1840 k I PV5t RER C INBIUKR IlOINIT l E rn- r- g- t Y ' ■ 1 4 TYPE 7r.ri' 'UIN411 'i. 1 • 4. Cif Pf NP . p •, se r-, Lk A G81i a PAL LIAMnr X I crmaaWErgcrl4 +W:*; ►. umutmy CI tS-Mea [30 00G oun„AcomEttAI E LIMIT APPLIES Pet B z AI3TOW3th .JE IU,'8I LiTY PNY AUTO ALL OSVPWU AUTOS Hew Amos SC H DLR EI) r-- zi,g,j1491.4NriEe, AUTOS Dad SO X3O suad501317 al G7 f 2015 umeREaa +tea 1 EX4# EIS La M1:14 _FPS ItoccU F! CL MS W i€€ % Rait ma casetnrAtIOIN sit° oour tiJ1:81t r Y l hi Air p{paDRiP.Tt7M1Uff'ARl fU-yAC CUiI'�"` �" i hi N �q Ir f71201 The i t.+ gal Liability and Auto Liability poi ciala include a blanket arruetiI rumerep3tun o> S,JLOCls� icro.NMIr (AMP n141 ALiditia R awl 00 bnquf tia additional insured endcraa-nt that prrsndos adetttlt.,ana L Ina s -ea status to tta ..art.iEir.ato holder only whan there is s written contract hatwesn the named innared and the certificate bolder that requires such status „GOO , 000 300, 000 f11 :tom ,_ melloworl� a A yourRY I, oral `rs . .FAIR A so l y INJURY (Per BODILY t prittruket 5 ,000 1,000 ,,000 s 2.O O 2,000,000 CERTIFICATE. HiOLOEIR -, Wild Cider and Carbon Valley Wine Festival ACORD 25 ( IWOE) I WHIM r,nicnki hi CA►NOELL&TIO3N *Mao etc or THE EVE DESCRIBED POLICIES BE CANCEL.LE BEFCIst� THE Expimrroli LATE THEREOF. Wince ALL BE DELIVERED Iw :ltlitt WITH ille POLICY PROMISIO 4SS Jim Wharton /BRANCO 1511348400 ACORD CORPORATION. All .r chits reserved. Thai a r Mtn mamas m n ri I r a n s.,Q rciairkttenri rrtrink ni a rem n Rocky Mountain Cider Company will provide a cash bond as required by section 12-1-30.6.13 of the Weld County Code, Adam Gorove President -0 Co RECEIPT DATE oq!aaiiG 0 -ci ( 2 m co ADDRESS 1 1 Li S - O 0 .2 8 t C) tv 20 2 c_ RECEIVED FROM Roci< NO. 88899 iin 0 O rt 4frok rite C;der Coe trinpobn c, 1Rretone1Co°OM I 0 `to FOR W •ares aissemb peirnnit HOW PAID CASH CHECK t Cif (0 i i 00 MONEY ORDER BY Cog RECEIPT DATE Oct (aaii NO88900 P. co RECEIVED FROM R0 o u n+api n r Co nepretaint 0 23) 8 m lc° ADDRESS UN SS OR L iir 17 r S3 01 C I CO WO 5 C zecNu 0 0) c cu0 2 HOW PAID CASH CHM( i ci 630 oar MONEY ORDER _AC t GO 8Y __ CeeR NOTICE OF APPLICATION FOR TEMPORARY ASSEMBLY Pursuant to the Weld County Code, a public hearing will be held in the Chambers of the Board of County Commissioners of Weld County, Colorado, Weld County Administration Building, 1150 0 Street, Assembly Room, Greeley, Colorado 80631, at the time specified. If a court reporter is desired, please advise the Clerk to the Board, in writing, at least five days prior of the hearing. The cost of engaging a court reporter shall be borne by the requesting party. in accordance with the Americans with Disabilities Act, if special accommodations are required in order for you to participate in this hearing, please contact the Clerk to the Board's Office at (970) 400-4225, prior to the day of the hearing. The complete case file may be examined in the office of the Clerk to the Board of County Commissioners, Weld County Administration Building, 1150 0 Street, Greeley, Colorado 80631. E -Mail messages sent to an individual Commissioner may not be included in the case file. To ensure inclusion of your E -Mail correspondence into the case file, please send a copy to crempel@co.weld.co.us DOCKET ##: 2016-89 DATE: October 17, 2016 TIME: 9:00 a.m. APPLICANT: Rocky Mountain Cider Company dba Wild Cider 11455 County Road 17 Firestone, CO 80504 REQUEST: Application for a temporary assembly of more than 350 persons on October 22, 2016 LEGAL DESCRIPTION: Lot B of Recorded Exemption, RE -41, being located in the E1/2 EI M4 of Section 5, Township 2 North, Range 67 West of the 6th P.M., Weld County, Colorado. LOCATION: Adjacent to County Road 17; approximately 2,300 feet north of County Road 24 BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO DATED: September 21, 2016 PUBLISHED: October 7, 2016, in the Greeley Tribune Affidavit of Publication NOTICE OF APPLICATION FOR TEMPORARY ASSEMBLY Pursuant le the Weld County Cam, a public hearing Will be held in the Chambers of the Board t Cau � 5 i o vrtis 6OrBm l Weld O County,Colorado, Weld County Administration 80631, �� the limbStreet. Astern,* Room, areele , specificspecific& a court reporter isd K BEL $pl opriotl tthee o thel Cler k e Board, rd, In Writing, in lees l cost cJi engaging. a court reporter shall bre Americans by the request- �rhll�t9 ��, Its pew., In accordance with the yy It special accornmoslatloa$ ate required in Moor for you par, licipate in this heating, please :conta Office at (97 O) 400.4225,, prior to the day of the hearing, The complete case The may be examined In the office el' the Clerk to the �ear�l of County Commissioners, �o��1� 00631. 4E��Ia�4 Marti Build i n.g, 1150 0 Street, messages sent to an individual inclusionoei>f et may o I ce � t be in- elucletD�rt the case tile. To eneutplease send a copy to epande��rly,IC��. Into ff ��e �. eea,e flies crew el©c*rweld.co, 13 DOCKET It 20116.89 DATE October 17, 2016 TIME; 9;00 r • APPLICANT; Rocky Mountain Cider pan y- DBA Wild Cider 11455 County Road. 17 Firestone, CD 80504esaernbl mere thanREQUEST;; Application for a temporary 350 persons on October ,2016 LEGAL l]!ESen1'P1'YoW: Lot B of Sectionecorded 5, Township 2 North. Range 'mated In the E1 �g SE W4 Of S� Colorado. 67 West of the 6th IPM., Well County, ra clm tl+��y± 2,300 Adlecent to RoadWi11�( Road 17;'(,3 ts,et north o � BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO DATED: October d, 2016 The Tribune October 7, 2016 e STATE OF COLORADO County of Weld, I Kelly Ash of said County of Weld, being duly sworn, say that I am an advertising clerk of THE GREELEY TRIBUNE, ss, that the same is a daily newspaper of general circulation and printed and published in the City of Greeley, in said county and state; that the notice or advertisement, of which the annexed is a true copy, has been published in said daily newspaper for consecutive (days) : that the notice was published in the regular and entire issue of every number of said newspaper during the period and time of publication of said notice, and in the newspaper proper and not in a supplement thereof; that the first publication of said notice was contained in the Seventh day of October A.D. 2016 and the last publication thereof: in the issue of said newspaper bearing the date of the Seventh day of October AM. 2016 that said The Greeley Tribune has been published continuously and uninterruptedly during the period of at least six months next prior to the first issue thereof contained said notice or advertisement above referred to; that said newspaper has been admitted to the United States mails as second-class matter under the provisions of the Act of March 3,1879, or any amendments thereof; and that said newspaper is a daily newspaper duly qualified for publishing legal notices and advertisements within the meaning of the laws of the State of Colorado. October 7, 2016 Total Charges: 13.90 tr.) 7th day of October 2016, My Commission Expires 2/14/2019 otary Public JER y eer�.�� ILt r:�T� JER1l, YIN L MART) r'4 �" NOTr$�, `" P U-� '�., Y 'tea SWE or CC, LOR.A00 NOTARY' 200'740(4708 MY 'OOMM saj r P p 4 FE ty, y 14 201q r^ I Chloe Rem el From: Sent: To: Cc: Subject: Attachments: Frank, Chloe Rempel Thursday, August 18, 2016 11:43 AM Frank Haug Bruce Barker Wine Festival Permit Limited WineryFestival Permit (DRSS06),pdf I am working on a Temporary Assembly Application in conjunction with a Wine Festival Permit. This is the first Wine Festival Permit that Weld County is involved with (to Esther's and my knowledge). It looks like WC just needs to be supplied with a copy of the completed application. Would you mind looking it over just in case? I attached the actual application form and listed the relevant State liquor code below. Also, we were thinking that we should request a copy of the finalized Wine Festival Permit from the State to add to the Temporary Assembly Permit. Thoughts? 12-47-4033. Wine festival permit (1) A wine festival permit application may be filed with the state licensing authority by any limited winery licensee or by any, manufacturer licensee that is licensed to manufacture vinous liquors. The applicant shall specify the licensed premises for the first of the wine festivals to be held, which application shall be fl led at least ten business days before such festival is to be held, The applicant shall include a twenty-five dollar annual processing lee with the application filed with the state licensing authority. Such fee shall entitle the perrnittee to use the wine festival permit for twelve months after the date of issuance, so long as such 1 ermitte.e notifies the state licensing authority and the appropriate local licensing, authority of the location of all other wine festivals under this permit at least ten business days before any such festival is to be held, A wine festival permit shall entitle the permittee to hold no more than nine wine festivals during the twelve-month period, (2) The applicant shall be the licensee filing the application, hut any wine festival permit that is issued as a result of such application shall be considered to be jointly held by the permn ittee and the participating limited winery licensees or manufacturer licensees that arc licensed to manufacture vinous liquors, (3) Notification of all subsequent festivals shall be by supplemental application, as approved by the state licensing authority. (4) The state licensing authority may deny a .wine festival permit or supplemental application for any of the following reasons: (a) A documented history of violations of this article or rules issued under this article by any participating licensee., (h) The filing of an incomplete. or late application; or (c) A finding that the application, if granted, would result in violations of this article or rules issued under this article or violations of the laws of local government. (5) After the issuance of an initial wine festival permit, all supplemental applications that are complete and filed in a timely manner shall be deemed approved unless the state licensing authority provides the permittee with a notice of denial at least seventy-two hours prior to the date of the eevent, (6) The penuittee and participating licensees are authorized to use the licensed premises jointly to conduct wine tastings and sell any vinous liquors manufactured by a Colorado limited winery or manufacturer licensed to manufacture vinous liquors. No wine festival permit shall authorize the perrnittce to use the licensed premises for more than seventy-two hours for any one wine festival. (7) If a violation of this article occurs during a wine festival and the licensee responsible for the violation can he identified, such licensee may be charged and the appropriate penalties shall apply. l l` the responsible party cannot be identified, the state licensing authority may send a written notice to every licensee identified on the permit application and may fine each the same dollar amount, which amount shalt not exceed twenty- five dollars per licensee or two hundred dollars in the aggregate, No joint fine levied pursuant to this subsection (7) shall apply to the revocation of the licensee's license under section [2-47-601. 1 (8) A joint fine levied pursuant to subsection (7) of this section shall not create or increase civil liability under section 12- 47-801(3) for a participating licensee or create joint liability for such a licensee, Thank you, Chloe A. Rempe! Deputy Clerk to the Board of Commissioners 1150 0 Street Greeley, CO 80631 / PO Box 758 teal 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 To: Subject: Attachments: Adam, Adam Go rove Temporary Assembly Application and Wine Festival Permit Limited WineryFestival Permit (DR8506) pdf; Temporary Assembly Application Packet.pdf After speaking with the State, you will need to apply for a State of Colorado Wine Festival Permit. Once you have the application completed, you will have to rescind your liquor license for the day; the State has a fee to delicense, once the event is over, you can turn your license back on. All of the other wineries that will be present must be listed on the application. You can collectively decide who you want to donate the proceeds to. As far as Weld County is concerned, we require you to submit a copy of the completed State application. We will then request a copy of the enacted permit from the State to add to your Temporary Assembly Application. You are required to complete the Temporary Assembly Application and submit it to Weld County. There are several requirements: 1. $100,00 fee. 2. Temporary Assembly Application completed, signed, and notarized. 3. Copy of your Certificate of Liability Insurance. 4. Statement by a Bonding Company or check for $3,000 that will only be cashed in the event that significant damage/ is done. 5. Map of property identifying roads, toilets, hand washing stations, turn around location, and paramedic location. 6. Potable water plan. 7. Waste disposal plan. 8. Toilet facilities contract (1 per 100 males and 1 per 100 females). 9. Ambulance agreement. 10. Security agreement. 11, Food services licenses. Once we have received the completed Temporary Assembly Application and all supporting documentation/ we will send referrals to all relevant Weld County departments and set a Commissioner hearing date. We will also send notice to all surrounding property owners. I have included the State's Wine Festival Code below for your reference. It can be found on their website. 12-47-403.5. Wine festival permit. (1) A wine festival permit application may be filed with the state licensing authority by any limited winery licensee or by any manufacturer licensee that is licensed to manufacture vinous liquors. The applicant shall specify the licensed premises for tile first of the wine festivals to he held, which application shall be filed at least ten business days before such festival is to be held. The applicant shall include a twenty-five dollar annual processing fee with the application filed with the state licensing authority. Such tee shall entitle the permittee to use the wine festival permit for twelve months after the date of issuance, so long as such permittee notifies the state licensing authority and the appropriate local licensing authority of the location o, f all other wine festivals under this permit at least ten business days before any such festival is to he hell. A wine festival permit shall entitle the permittee to hold no more than nine wine festivals during the twelve-month period, (2) The applicant shall be the licensee filing the application, but any wine festival permit i hat is issued as a result of such application shall be considered to be jointly held by the permittee and the participating limited winery licensees or manufacturer licensees that are licensed to manufacture vinous liquors. (3) Notification of all subsequent festivals shall be by supplemental application, as approved by the state licensing authority. r 1 (4) The state licensing authority may deny a wine festival permit or supplemental application for any of the following reasons, (a) A documented history of violations of this article or rules issued under this article by any participating licensee; (b) The filing of an incomplete or late application; or (c-) A finding that the application, if granted, would result in violations of this article or rules issued wider this article or violations of the laws of a local government, (5) After the issuance of an initial wine festival permit, all supplemental applications that are complete and filed in a timely manner shall be deemed approved unless the state licensing authority provides the permittee with a notice ofdenial at least seventy-two hours prior to the date of the event. (6) The permittee and participating licensees are authorized to use the licensed premises jointly to conduct wine tastings and sell any vinous liquors manufactured by a Colorado limited winery or manufacturer licensed to manufacture vinous liquors, No wine festival permit shall authorize the permittee to use the licensed premises for more than seventy-two hours for any ore wine festival, T (7) If a violation of this article occurs during a wine festival and the licensee responsible for the violation can be identil iect such licensee may be charged and the appropriate penalties shall apply, if the responsible party cannot be identified, the state licensing authority may send a written notice to every licensee identified on the permit application and may fine each the saute dollar amount. which amount shall not exceed twenty- five dollars per licensee or two hundred dollars in the aggregate. No joint tine levied pursuant to this subsection (7) shall apply to the revocation of the licensee's license under section 12-47-601. (8) A joint fine levied pursuant to subsection (7) of this section shall not create or increase civil liability under section 12- 47-801(3) for a participating licensee or create joint liability for such a licensee. If you have any questions or concerns, please do not hesitate to contact me. Sincere regards, Chloe A. Rer y&l Deputy Clerk to the Board of Commissioners 1150 0 Street Greeley, CO 80631 PO Box 758 to l: 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 Chloe Rempel From: Sent* To: Cc: Subject: Frank Haug Thursday, August 18, 2016 3:07 PM Chloe Rempel Bruce Barker RE: Wine Festival Permit That sounds right to me. It looks like it is through the state. However, we need to make sure that they otherwise meet our rules. So the temporary assembly permit. Frank N. Haug Assistant Weld County Attorney 1150 0 Street Mailing Address; P.0, 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: Thursday, August 18, 2016 11:43 AM To: Frank Haug cfhaug@co.weld.co,us> Cc; Bruce Barker <bbarker@co.wveld.co,us> Subject: Wine Festival Permit Frank, I am working on a Temporary Assembly Application in conjunction with a Wine Festival Permit. This is the first Wine Festival Permit that Weld County is involved with (to Esther's and my knowledge). It looks like WC just needs to be supplied with a copy of the completed application. Would you mind looking it over just in case? I attached the actual application form and listed the relevant State liquor code below. Also, we were thinking that we should request a copy of the finalized Wine Festival Permit from the State to add to the Temporary Assembly Permit, Thoughts? 1 Chloe Rem el From: Sent: To: Subject: Jose Gonzalez Tuesday, September 27, 2016 10:57 AM t Chloe Rernpel; Dan Joseph; Deb Adamson; Bethany Pascoe; Paul Wood; Janet Lundquist; Roy Rudisill; Frank Haug RE: TEMPORARY ASSEMBLY - Rocky Mountain Cider Company DBA Wild Cider No concerns form building division Thanks Jose Gonzalez Asst Building Official Building Department 1555 N 17th Ave tee: 970-400-3533 jgonzaiez@weidgov.core 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 Rern pel Sent: Monday, September 26, 2016 4:02 PM To: Dan Joseph <djosephc.o.weld.co.us>; Deb Adamson <dadannson@co.weld.co,us>; Bethany Pascoe <bpascoe@co,weld.co.us>; Jose Gonzalez <jgonzalez@co.weld,co.us>; Paul Wood cpwood@co.weld.co,us>; Janet Lundquist <jlundquistco.weld.co.us>; Roy Rudisill <rrudisill@co.weld.co.us>; Frank Haug <fhaugco.weld.co.us> Subject: TEMPORARY ASSEMBLY - Rocky Mountain Cider Company DBA Wild Cider Hello, In accordance with the procedure for processing Temporary Assembly 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 within two weeks. Your report will be used by the Board of County Commissioners in considering the Applicant's Temporary Assembly Permit, PLEASE NOTE: The applicant has applied for a wine festival permit, which is an application that is processed solely by the State, The festival is a charity event, in which all proceeds will go to the Wild Animal Sanctuary. Additionally, the Wild Animal Sanctuary is currently working on a Special Events Permit because they will have breweries at the event, which are not covered under the wine festival. Please let me know if you have any questions, 1 Chloe Rempel From: Sent: To: Cc: Subject: Chloe and All, Paul Wood Tuesday, September 27, 2016 1:15 PM Chloe Rempel; Dan Joseph; Deb Adamson; Bethany Pascoe; Jose Gonzalez; Janet Lundquist; Roy Rudisill; Frank Haug Paul Wood; Sam Kaneta III RE: TEMPORARY ASSEMBLY - Rocky Mountain Cider Company DBA Wild Cider The Weld County Sheriff's Office sees no issues with this Temporary Assembly and their security plan appears to be satisfactory. If you have any questions or concerns, please feel free to contact me. Thanks! Sergeant Paul Wood Animal Control/Municipal Policing/School Resource Units Weld County Sheriffs Office 1950 "O" Street, Greeley, CO 80631 pwood(co.weld,co.us Ofc: ( o) 356-4015 Ext, 2838 Direct (970) 400-2838 Fax: (97°) 304-6468 {,4 rein{ a t ii-OirlaC: R Set itica ■ "be 5trong anJ Courageous." From: Chloe Rem pel Sent: Monday, September 26, 2016 4:02 PM To: Dan Joseph; Deb Adamson; Bethany Pascoe; Jose Gonzalez; Paul Wood; Janet Lundquist; Roy Rudisill; Frank Haug Subject: TEMPORARY ASSEMBLY - Rocky Mountain Cider Company DBA Wild Cider Hello, In accordance with the procedure for processing Temporary Assembly 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 within two weeks. Your report will be used by the Board of County Commissioners in considering the Applicant's Temporary Assembly Permit. PLEASE NOTE: The applicant has applied for a wine festival permit, which is an application that is processed solely by the State. The festival is a charity event, in which all proceeds will go to the Wild Animal Sanctuary. Additionally, the Wild Animal Sanctuary is currently working on a Special Events Permit because they will have breweries at the event, which are not covered under the wine festival. Please let me know if you have any questions. PLEASE RESPOND NO LATER THAN: Tuesday, October 4, 2016 Applicant: t Chloe Rempel From: Sent: To: Cc: Subject: Hi Adam, Chloe Rempel Thursday, October 06, 2016 9:30 AM 'Adam Gorove' Frank Haug Wine Festival Event I am still awaiting the documents that our County Attorney requested on Tuesday regarding the additional parking on an adjacent lot. Just as a reminder, we need a copy of a signed letter from the property owner that states you are allowed to use their property for parking. We also need a map that shows how/ where cars will be parked, and the access point between the two properties for people to walk back and forth from (people cannot walk back and forth on the county road). Let me know if you have any questions. Thank you, Chloe A. Rempel Deputy Clerk to the Board of Commissioners 1150 O Street Greeley, CO 80631 /PO Box 758 tel: 970-400-4225 I 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: Works for me. Michelle Martin Planning Manager 1555 N 17th Ave Greeley, CO 80631 mmartin@co.weld.co.us PHONE: (970) 400-3571 FAX: (970) 304-6498 Michelle Martin Friday, October 14, 2016 12:25 PM Chloe Rempel RE: Temp Assembly - Wild Cider AND Special Event - Wild Animal Sanctuary -- Wine Festival and Beer Garden 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: Friday, October 14, 2016 10:55 AM To: Dan Joseph <djoseph@co.weld.co.us>; Deb Adamson <dadamson@co.weld.co.us>; Bethany Pascoe <bpascoe@co.weld.co.us>; Janet Lundquist <jlundquist@co.weld.co.us>; Michelle Martin <mmartin@co.weld.co.us> Cc: Frank Haug <fhaug@co.weld.co.us> Subject: Temp Assembly - Wild Cider AND Special Event - Wild Animal Sanctuary -- Wine Festival and Beer Garden Hello All, Please see the attached updated application packets. I believe the most notable additions are in relation to overflow parking. The applicants have secured the neighbor's property for extra parking. They have provided a letter from the adjacent property owner providing permission to use their property, a photo of the gate between the two properties, and a map showing the parking plan. This is up for review on Monday's agenda. Can you all please send me your recommendations asap? Thank you, Chloe A. Rempel Deputy Clerk to the Board Weld County i 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. From: Chloe Rempel Sent: Monday, September 26, 2016 4:02 PM To: Dan Joseph <djoseph@co.weld.co.us>; Deb Adamson <dadamson@co.weld.co.us>; Bethany Pascoe <bpascoe@co.weld.co.us>; Jose Gonzalez <jgonzalez@co.weld.co.us>; Paul Wood <pwood@co.weld.co.us>; Janet Lundquist <ilundquist@co.weld.co.us>; Roy Rudisill <rrudisill@co.weld.co.us>; Frank Haug <fhaug@co.weld.co.us> Subject: TEMPORARY ASSEMBLY - Rocky Mountain Cider Company DBA Wild Cider Hello, In accordance with the procedure for processing Temporary Assembly 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 within two weeks. Your report will be used by the Board of County Commissioners in considering the Applicant's Temporary Assembly Permit. PLEASE NOTE: The applicant has applied for a wine festival permit, which is an application that is processed solely by the State. The festival is a charity event, in which all proceeds will go to the Wild Animal Sanctuary. Additionally, the Wild Animal Sanctuary is currently working on a Special Events Permit because they will have breweries at the event, which are not covered under the wine festival. Please let me know if you have any questions. PLEASE RESPOND NO LATER THAN: Tuesday, October 4, 2016 Applicant: NAME AND ADDRESS: EVENT: File Location: Sincere regards, Rocky Mountain Cider Company DBA Wild Cider 11455 County Road 17 Firestone, CO 80504 Wild Animal Sanctuary Wine Festival LC0022 2 Chloe A. Rempel Deputy Clerk to the Board of Commissioners 1150 O Street Greeley, CO 80631 / PO Box 758 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. From: Chloe Rempel Sent: Monday, September 26, 2016 5:05 PM To: Dan Joseph <djoseph@co.weld.co.us>; Deb Adamson <dadamson@co.weld.co.us>; Bethany Pascoe <bpascoe@co.weld.co.us>; Jose Gonzalez <jonzalez@co.weld.co.us>; Paul Wood <pwood@co.weld.co.us>; Janet Lundquist <iundquist@co.weld.co.us>; Roy Rudisill <rrudisill@co.weld.co.us>; Frank Haug <fhaug@co.weld.co.us> Subject: Special Events Permit - The Wild Animal Sanctuary 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 see in conjunction with Rocky Mountain Cider Company, DBA Wild Cider's Temporary Assembly Application. PLEASE RESPOND NO LATER THAN: Tuesday, October 4, 2016 Applicant: The Wild Animal Sanctuary 1946 County Road 53, Keenesburg, CO 80643 Event Address: 11455 County Road 17, Firestone, CO 80504 File Location: LC0022 Thank you, Chloe A. Rempel Deputy Clerk to the Board of Commissioners 1150 O Street Greeley, CO 80631 /PO Box 758 tel: 970-400-4225 3 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. 4 Chloe Rempel From: Sent: To: Cc: Subject: Janet Lundquist Friday, October 14, 2016 12:22 PM Chloe Rempel Frank Haug RE: Temp Assembly - Wild Cider AND Special Event - Wild Animal Sanctuary -- Wine Festival and Beer Garden Public Works doesn't have any concerns with the changes or this event. 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: Friday, October 14, 2016 10:55 AM To: Dan Joseph; Deb Adamson; Bethany Pascoe; Janet Lundquist; Michelle Martin Cc: Frank Haug Subject: Temp Assembly - Wild Cider AND Special Event - Wild Animal Sanctuary -- Wine Festival and Beer Garden Hello All, Please see the attached updated application packets. I believe the most notable additions are in relation to overflow parking. The applicants have secured the neighbor's property for extra parking. They have provided a letter from the adjacent property owner providing permission to use their property, a photo of the gate between the two properties, and a map showing the parking plan. This is up for review on Monday's agenda. Can you all please send me your recommendations asap? Thank you, Chloe A. Rempel Deputy Clerk to the Board Weld County 1 Chloe Rempel From: Sent: To: Cc: Subject: Attachments: Bethany Pascoe Friday, October 14, 2016 3:19 PM Chloe Rempel Frank Haug RE: Temp Assembly - Wild Cider AND Special Event - Wild Animal Sanctuary -- Wine Festival and Beer Garden LC0022.2016.doc Please see staffs attached Referral Response. Thank -you Bethany Pascoe Zoning Compliance Officer II Department of Planning Services 1555 N 17th Ave, Greeley, Co 80631 970-400-3555 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: Friday, October 14, 2016 10:55 AM To: Dan Joseph <djoseph@co.weld.co.us>; Deb Adamson <dadamson@co.weld.co.us>; Bethany Pascoe <bpascoe@co.weld.co.us>; Janet Lundquist <jlundquist@co.weld.co.us>; Michelle Martin <mmartin@co.weld.co.us> Cc: Frank Haug <fhaug@co.weld.co.us> Subject: Temp Assembly - Wild Cider AND Special Event - Wild Animal Sanctuary -- Wine Festival and Beer Garden Hello All, Please see the attached updated application packets. I believe the most notable additions are in relation to overflow parking. The applicants have secured the neighbor's property for extra parking. They have provided a letter from the adjacent property owner providing permission to use their property, a photo of the gate between the two properties, and a map showing the parking plan. This is up for review on Monday's agenda. Can you all please send me your recommendations asap? Thank you, Chloe A. Rempel Deputy Clerk to the Board Weld County 1150 0 Street 1 MEMORANDUM To: Chloe Rempel, Deputy Clerk to the Board October 14, 2106 From: Bethany Pascoe, Zoning Compliance Officer, Dept. of Planning Services Subject: LC0022 Upon review of the Special Events Permit and Temporary Assembly Permit by the Department of Planning Services shows the following: TEMPORARY ASSEMBLY PERMIT INFORMATION: Owner: Mark Birkin 11455CR17 Firestone, Co 80504 Rocky Mountain Cider Co Dba Wild Cider 11455 CR 17 Firestone, Co 80504 SPECIAL EVENTS PERMIT INFORMATION: The Wild Animal Sanctuary 1946 County Road 53 Keenesburg, Co 80643 Dates: October 22, 2016 10 AM — 4 PM Maximum number of people: 1000 (Temporary Assembly) 1000 estimated (Special Events) PROPERTY INFORMATION: Zone District: Agriculture Upon review of my case files and computer, no active violations were noted. There is an existing Use by Special Review (USR13-00119) for a Winery (Cidery and Tasting Room) and Breakfast Facility. This USR also referred to Special Events occurring on -site. SERVICE, TEAMWORK, INTEGRITY, QUALITY Chloe Rempel From: Sent: To: Subject: I just spoke to him. Frank Haug Monday, October 17, 2016 8:39 AM Chloe Rempel rays okay with it 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. 1 Chloe Rempel From: Sent: To: Subject: Roy Rudisill Monday, October 17, 2016 8:52 AM Chloe Rempel RE: Temp Assembly - Wild Cider AND Special Event - Wild Animal Sanctuary --Wine Festival HI Chloe, I just talked to Frank and let him know that I have talked with the First Responder agencies that have jurisdiction and they have no issues with the event. Mt View Fire will take the lead on an incident action plan if it meets their requirements but at this time it looks like they will just monitor the event. No concerns from OEM. 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: Friday, October 14, 2016 10:49 AM To: Roy Rudisill <rrudisill@co.weld.co.us> Subject: Temp Assembly - Wild Cider AND Special Event - Wild Animal Sanctuary --Wine Festival Hi Roy, Please see the attached updated application packets. Also, now that you've had a chance to speak with Frank, would you mind sending me an email with your recommendation to the board? Thank you! Chloe A. Rempel Deputy Clerk to the Board Weld County 1 Chloe Rempel From: Sent: To: Subject: Here you go. Frank Haug Monday, October 17, 2016 8:50 AM Chloe Rempel FW: wild cider wine festival 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: Dan Joseph Sent: Monday, October 17, 2016 8:49 AM To: Frank Haug <fhaug@co.weld.co.us>; Deb Adamson <dadamson@co.weld.co.us> Subject: RE: wild cider wine festival Nope. They are good to go. Dan Joseph CP-FS Food Program Coordinator Weld County Department of Public Health and Environment 1555 North 17th Avenue Greeley, CO 80631 phone: 970.304.6415 x 2206 fax: 970.304.6411 1 Hello