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COMMUNITY DEVELOPMENT: BUILDING DEPARTMENT One Descombes Dr • Broomfield, CO 80020 • Office [PHONE REDACTED] • Fax [PHONE REDACTED] • [EMAIL REDACTED] SLAB-ON-GRADE ACKNOWLEDGMENT This statement relates to Broomfield, Colorado. (Street Address) Lot Block Subdivision Filing The buyer(s) is/are: The general contractor is: I have read the soils report and/or summary soils report for the aforementioned property. I understand there are certain risks associated with slab movement due to the presence of expansive soils. I choose to accept those risks. The disclosure requirements set forth in Article 6-6.5-101 Colorado Revised Statutes have also been explained to me regarding expansive soils. Buyer: Date: (Signature) (Signature) Buyer: Date: Contractor’s Agent: (Print Name) Title: Signature: NOTE: If Buyer is not known at this time, Contractor assumes obligations of both Buyer and Contractor as set forth above. This statement shall be recorded by the builder in the office of the county clerk and recorder. The builder shall pay the $43.00 recording fee. Building Division, Revised July 2025 SIGN