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Certificates & Signature Blocks Revised 05-05-08 May 5, 2008 SAMPLE OF CERTFICATES/SIGNATURE BLOCKS REQUIRED ON FINAL PLATS, FINAL PUDS, MINOR SUBDIVISIONS AND ANNEXATION MAPS 1. Planning Commission Certificates 2. City Council Certificate 3. Planning Director Certificate 4. Review Certificates (City Engineer, Public Service Company of Colorado, Qwest Communications) 5. City Administrator’s Certificate 6. Attorney’s Certificate 7. Title Company’s Certificate 8. Surveyor’s Certificate 9. Clerk and Recorder’s Certificate 10. Certificate of Dedication and Ownership 11. Lender’s Approval & Subordination 12. Plat and/or PUD Notes (may or may not be applicable). 13. Annexation Petition Acknowledgment (annexation map) 14. Vesting Statement 1. Planning Commission Certificates Planning Commission Certificate (final plat) The Preliminary Plat for NAME OF DEVELOPMENT was approved by the City of Lafayette Planning Commission on EXACT DATE OF PRELIMINARY PLAN APPROVAL A.D. Chairperson Attest: Secretary Planning Commission Certificate (final PUD) The Preliminary Planned Unit Development for NAME OF DEVELOPMENT was approved by the City of Lafayette Planning Commission on EXACT DATE OF PRELIMINARY PLAN APPROVAL A.D. Chairperson Attest: Secretary ---PAGE BREAK--- Certificates & Signature Blocks Revised 05-05-08 Planning Commission Certificate (minor subdivision approved by PC) Pursuant to Section 26-16-6 of the Lafayette Code of Ordinances, this Minor Subdivision plat for NAME OF DEVELOPMENT was approved by the Planning Commission of the City of Lafayette, Colorado on EXACT DATE OF MINOR SUBDIVISION APPROVAL A.D. Chairperson Attest: Secretary 2. City Council Certificates City Council Certificate (final plat or minor subdivision) This final plat (minor subdivision) is approved by the City Council of the City of Lafayette, Colorado, this day of , 20__, A.D. for filing with the Clerk and Recorder of Boulder County and for conveyance to the City of the public dedications shown hereon; subject to the provision that approval in no way obligates the City of Lafayette for the financing or constructing of improvements on land or easements dedicated to the public except as specifically agreed to by the City Council. Mayor Witness my hand and official seal of the City of Lafayette. Attest: City Clerk City Council Certificate (final PUD) This final PUD is approved by the City Council of the City of Lafayette, Colorado, this day of , 20__, A.D. for filing with the Clerk and Recorder of Boulder County and subject to the provision that approval in no way obligates the City of Lafayette for the financing or constructing of improvements on land or easements dedicated to the public except as specifically agreed to by the City Council. Mayor Witness my hand and official seal of the City of Lafayette. Attest: City Clerk ---PAGE BREAK--- Certificates & Signature Blocks Revised 05-05-08 3. Planning Director Certificate for minor subdivisions approved by staff. Planning Director Certificate Pursuant to Section 26-16-6 of the Lafayette Code of Ordinances, this Minor Subdivision plat for NAME OF DEVELOPMENT was approved by the Planning Director of the City of Lafayette, Colorado on A.D. Planning Director Attest: City Clerk 4. Review Certificate Review Certificates City of Lafayette Engineer Public Service Company of Colorado Qwest Communications, Inc. 5. City Administrator Certificate City Administrator's Certificate (final plat, final PUD or minor subdivision) I, Gary Klaphake, City Administrator of the City of Lafayette, Colorado, hereby certify that I have examined the final plat (final PUD or minor subdivision) and it appears to be in compliance with all applicable ordinances of the city and that a development agreement has been executed by the developer and accepted by the City. City Administrator Attest: City Clerk ---PAGE BREAK--- Certificates & Signature Blocks Revised 05-05-08 6. Attorney’s Certificates (Use either Attorney or Title Company certificate, not both). Attorney's Certificate I, being an attorney licensed to practice law in the State of Colorado, certify that I have examined title to the above described land dedication to the City of Lafayette, Colorado, and that the party executing the dedication is the owner thereof in fee simple, and the dedicated land is free and clear of liens and encumbrances. Attorney at Law Date Attorney's Certificate (in the case of no land dedication) I, being an attorney licensed to practice law in the State of Colorado, certify that I have examined title to the above described land within the City of Lafayette, Colorado, and that the party executing the plat is the owner thereof in fee simple. Attorney at Law Date ---PAGE BREAK--- Certificates & Signature Blocks Revised 05-05-08 7. Title Company Certificates If Title Company certificate is used and there is land dedication the city will require a title insurance policy). Title Company's Certificate I, a ________________representing Land Title Guaranty Company certify that I have examined title to the described land dedication to the City of Lafayette, Colorado, and that the parties executing the dedication are the owners thereof in fee simple, and the dedicated land is free and clear of all liens and encumbrances. Name Title Executed this day of 20__ A.D. Title Company's Certificate (in the case of no land dedication I, representing Land Title Guarantee Company certify that I have examined title to the described land within the City of Lafayette, Colorado, and that the parties executing the plat are the owners thereof in fee simple. Name Title Executed this day of 20__ A.D. ---PAGE BREAK--- Certificates & Signature Blocks Revised 05-05-08 8. Surveyor’s Certificate Surveyor's Certificate I, do hereby certify that I am a duly registered professional land surveyor licensed under the laws of the State of Colorado, that this plat is a true, correct and complete plat of “(name of subdivision)” as laid out, platted, dedicated and shown hereon, that such plat was made from an accurate survey of said property by me and under my direct responsibility, supervision and checking and correctly shows the location and dimensions of the tracts staked upon the ground in compliance with Articles 50-53 of Tile 38, Colorado Revised Statutes governing the subdivision of land. In witness whereof, I have set my hand and seal this day of 20__ A.D. (Surveyor’s name) COLORADO REGISTERED PROFESSIONAL LAND SURVEYOR NO. (address) (phone number) 9. Clerk and Recorder’s Certificate Clerk and Recorder's Certificate I hereby certify that this instrument was filed in my office at o'clock this day of , 20__, and is recorded in Plan File # Reception # Fees: Deputy Clerk and Recorder ---PAGE BREAK--- Certificates & Signature Blocks Revised 05-05-08 10. Certificates of Dediciation and Ownership Certificate of Dedication and Ownership (plat) Know all men by these presents, that being the owners of all that real property situated in Boulder County, Colorado, and lying within the exterior boundary of "(name of subdivision)", a subdivision of a portion the City of Lafayette, County of Boulder, State of Colorado, described as follows: A tract of land located in the … Have by these presents laid out, platted and subdivided the same into (tracts, lots, outlots) as shown hereon and designate the same as “(name of subdivision),” in the City of Lafayette, County of Boulder, State of Colorado, and do hereby dedicate and convey to the City of Lafayette, Colorado, for public use the streets and Rights-of-Way the pedestrian access easements shown hereon for pedestrian access purposes only, the access easements shown hereon for access purposes only, the emergency access easements for emergency access purposes only, the utility easements shown hereon for utility purposes only and the drainage easements shown hereon for drainage purposes only. Executed this day of , 20__ A.D. Owner Acknowledgment State of Colorado ) County of Boulder ) ss The foregoing instrument was acknowledged before me this day of , 20__, A.D. by of as owner of the property described hereon. Witness my hand and official seal. My commission expires . Notary Public ---PAGE BREAK--- Certificates & Signature Blocks Revised 05-05-08 Certificate of Ownership (PUD) Know all men by these presents, that hereby certifies that he/she is the owner of fee title to all that real property situated in Boulder County, Colorado, and lying within the exterior boundary of "(name of subdivision)", a subdivision of a portion the City of Lafayette, County of Boulder, State of Colorado, described as follows: A tract of land located in the … Executed this day of , 20__ A.D. Owner Acknowledgment State of Colorado ) County of Boulder ) ss The foregoing instrument was acknowledged before me this day of , 20__, A.D. by of as owner of the property described hereon. Witness my hand and official seal. My commission expires . Notary Public ---PAGE BREAK--- Certificates & Signature Blocks Revised 05-05-08 11. Lender’s Approval and Subordination Certificate Lender’s Approval and Subordination The undersigned consents to the dedication of the streets, right-of-way and easements as indicated on the Subdivision Plat and hereby subordinates any interest it may have to such dedication. Mortgage Company Name By: State of ) )ss County of ) The foregoing Lender’s Approval and Subordination was acknowledged before me this day of 20__A.D. Notary Public My Commission Mortgagees’ Consent (condominium map or minor subdivision) Company Name), hereby consent to the recording of the condominium map (minor subdivision) of (name of map) and join in the dedication made hereon to the extent of their interest therein. (Mortgage Company Name) By: State of ) )ss County of ) The foregoing Mortgage Company was acknowledged before me this day of 20__A.D. Notary Public My Commission ---PAGE BREAK--- Certificates & Signature Blocks Revised 05-05-08 12. Plat and/or PUD Notes (may or may not be applicable). Notes For purposes of information only, certain portions of the plan described hereon may be subject to the Development Agreement recorded at reception number_______ on 20__, in the office of the Clerk and Recorder of Boulder County, Colorado, and the declaration of covenants, conditions, and restrictions recorded at on 20__ in the office of the Clerk and Recorder of Boulder County, Colorado. 13. Annexation Petition Annexation Petition Acknowledgment Know all men by these presents that being owner(s) of that parcel of land shown and described hereon, has (have) petitioned the City of Lafayette in the County of Boulder, State of Colorado, for annexation of said parcel to said City of Lafayette, and do (does) hereby acknowledge said petition for annexation this day of 20__ A.D. 14. Vesting Statement Vesting (include only if vesting is requested and approved) Approval of this plan may create a vested property right pursuant to Article 68 of Title 24, C.R.S. as amended. Such vested right shall be valid for a period of (insert number) years, pursuant to approval by the Lafayette City Council on (effective date).