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Certificates & Signature Blocks Revised 03/23 December 2015 SAMPLE OF CERTIFICATES/SIGNATURE BLOCKS REQUIRED ON FINAL PLATS and PUD (Non-Minor) 1. Planning Commission Certificates 2. City Council Certificate 3. Review Certificates (City Engineer) 4. City Administrator Certificate 5. Attorney’s Certificate/Title Company’s Certificate 6. Surveyor’s Certificate 7. Clerk and Recorder’s Certificate 8. Certificate of Dedication and Ownership 9. Lender’s Approval & Subordination 10. Plat and/or PUD Notes (may or may not be applicable). 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 03/23 2. City Council Certificates City Council Certificate (final plat with dedication) This final plat is approved by the City Council of the City of Lafayette, Colorado, this day of , 20 , A.D. and may be filed with the Clerk and Recorder of Boulder County. All dedications to the City of Lafayette, Colorado as shown hereon are accepted by the City, provided that neither approval nor acceptance obligates the City of Lafayette for the financing, construction or maintenance of public improvements on property interests dedicated to the City. Mayor Witness my hand and official seal of the City of Lafayette. Attest: City Clerk City Council Certificate (final PUD or plat without dedication) This final PUD (plat) 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, provided that approval in no way obligates the City of Lafayette for the financing, construction or maintenance of public improvements on property interest owned or dedicated to the public. Mayor Witness my hand and official seal of the City of Lafayette. Attest: City Clerk 3. Review Certificate Review Certificates City Engineer ---PAGE BREAK--- Certificates & Signature Blocks Revised 03/23 4. City Administrator Certificate I, Fritz Sprague, City Administrator of the City of Lafayette, Colorado, hereby certify that I have examined this final plat (or final PUD) 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 5. Attorney’s Certificates/Title Company Certificate (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 property interests being dedicated to the City of Lafayette, Colorado; that the party executing the Dedication is the owner thereof in fee simple; and such property interests are dedicated free and clear of liens and encumbrances. Attorney at Law Reg. No. Date ---PAGE BREAK--- Certificates & Signature Blocks Revised 03/23 Title Company Certificate I, , a representing (insert name of title company) certify that we have examined title to the above described property interests being dedicated to the City of Lafayette, Colorado; and that the party executing the Dedication is the owner thereof in fee simple; and such property interests are free and clear of all liens and encumbrances. Name Title Executed this day of , 20 A.D. 6. 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 or under my direct responsibility and supervision and correctly shows the location and dimensions of the tracts, lots and outlots as shown hereon; and is otherwise in compliance with Articles 50-53 of Title 38, Colorado Revised Statutes pertaining to 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) 7. 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 under reception # . , Fees Paid $ Clerk and Recorder Deputy ---PAGE BREAK--- Certificates & Signature Blocks Revised 03/23 8. Certificates of Dedication and Ownership Certificate of Dedication and Ownership (plat with dedication) Know all men by these presents, that , being the fee owner of all that real property situated in 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 (insert property interests exactly as shown on the plat, such as “the streets and rights-of-way, the pedestrian access easements, the emergency access easements, the utility easements, the drainage easements, etc. for such public purposes as indicated on the plat. 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 as of , Owner of the property described hereon. Witness my hand and official seal. My commission expires . Notary Public ---PAGE BREAK--- Certificates & Signature Blocks Revised 03/23 Certificate of Dedication and Ownership (plat without dedication) Know all men by these presents, that , being the fee owner of all that real property situated in 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. 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 as of , Owner of the property described hereon. Witness my hand and official seal. My commission expires . Notary Public ---PAGE BREAK--- Certificates & Signature Blocks Revised 03/23 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 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 ) County of ) ss The foregoing instrument was acknowledged before me this day of , 20 , A.D. by as property described hereon. Witness my hand and official seal. My commission expires . of , Owner of the Notary Public ---PAGE BREAK--- Certificates & Signature Blocks Revised 03/23 9. Lender’s Approval and Subordination Certificates Lender’s Approval and Subordination (plat with dedication) The undersigned hereby consents to the subdivision or the property herein described; to the dedication of the property interests as indicated on the subdivision plat; and hereby subordinates any interest it have in the property to such dedications. (Mortgage Company Name) By: Capacity State of ) )ss County of ) The foregoing Lender’s Approval and Subordination was acknowledged before me this day of _ 20 A.D. by as of (Mortgage Company Name). Notary Public My Commission expires: ---PAGE BREAK--- Certificates & Signature Blocks Revised 03/23 Lenders Approval (subdivision plat with no dedication) (Mortgage Company Name), hereby consent to the subdivision of the property herein described and to the recording of the condominium map of this plat. (Mortgage Company Name) By: Capacity State of ) )ss County of ) The foregoing Lender’s Approval was acknowledged before me this day of 20 A.D. by as of (Mortgage Company Name.) Notary Public My Commission expires: 10. Plat and/or PUD Notes (may or may not be applicable). Notes All or portions of the property described hereon may be subject to the Development Agreement and/or Declaration of Covenants, Conditions, and Restrictions recorded contemporaneously with this plat/plan in the office of the Clerk and Recorder of Boulder County, Colorado. ---PAGE BREAK--- Certificates & Signature Blocks Revised 03/23 December 2015 SAMPLE OF CERTIFICATES/SIGNATURE BLOCKS REQUIRED ON MINOR SUBDIVISIONS WITH DEDICATION 1. City Council Certificate 2. Planning & Building Director (or Planning Commission if referred) Certificate 3. Review Certificates (City Engineer) 4. City Administrator’s Certificate 5. Attorney’s Certificate/ Title Company’s Certificate 6. Surveyor’s Certificate 7. Clerk and Recorder’s Certificate 8. Certificate of Dedication and Ownership 9. Lender’s Approval & Subordination (if applicable) 10. Plat and/or PUD Notes (may or may not be applicable). 1. City Council Certificate (minor subdivision) This final plat is approved by the City Council of the City of Lafayette, Colorado, this day of , 20 , A.D. and may be filed with the Clerk and Recorder of Boulder County. All dedications to the City of Lafayette, Colorado shown hereon are accepted by the City, provided that neither approval nor acceptance obligates the City of Lafayette for the financing, construction or maintenance of public improvements on property interests dedicated to the City. Mayor Attest: City Clerk 2. Planning & Building Director Certificate (modify as appropriate if referred to Planning Commission.) Pursuant to Section 26-16-6 of the Lafayette Code of Ordinances, this Minor Subdivision plat for NAME OF DEVELOPMENT was recommended for approval by the Planning & Building Director of the City of Lafayette, Colorado on A.D. Planning & Building Director Attest: City Clerk 3. Review Certificates City Engineer ---PAGE BREAK--- Certificates & Signature Blocks Revised 03/23 4. City Administrator Certificate I, Fritz Sprague, City Administrator of the City of Lafayette, Colorado, hereby certify that I have examined the within subdivision plat 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 03/23 5. Attorney’s Certificates/Title Company Certificate (Use either Attorney or Title Company certificate, not both). Attorney’s Certificates I, , being an attorney licensed to practice law in the State of Colorado, certify that I have examined title to the above described property interests being dedicated to the City of Lafayette, Colorado; that the party executing the Dedication is the owner thereof in fee simple; and such property interests are dedicated free and clear of liens and encumbrances. Attorney at Law Reg. No. Date Title Company Certificate I, , a representing (insert name of title company) certify that we have examined title to the above described property interests being dedicated to the City of Lafayette, Colorado; that the party executing the Dedication is the owner thereof in fee simple; and that such property interests are dedicated free and clear of all liens and encumbrances. Name Title Executed this day of , 20 A.D. 6. 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 or under my direct responsibility and supervision and correctly shows the location and dimensions of the tracts, lots and outlots shown hereon; and is otherwise in compliance with Articles 50-53 of Title 38, Colorado Revised Statutes pertaining to 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) ---PAGE BREAK--- Certificates & Signature Blocks Revised 03/23 7. 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 under reception # . , Fees Paid $ Clerk and Recorder Deputy 8. Certificates of Dedication and Ownership Know all men by these presents, that , being the fee owner of all that real property situated in 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, (insert property interests exactly as shown on the plat, such as “the streets and rights- of-way, the pedestrian access easements, the emergency access easements, the utility easements, the drainage easements, etc. for such public purposes as indicated on the plat. 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 as property described hereon. Witness my hand and official seal. My commission expires . of , Owner of the Notary Public ---PAGE BREAK--- Certificates & Signature Blocks Revised 03/23 9. Lender’s Approval and Subordination The undersigned hereby consents to the subdivision of the property herein described; to the dedication of the property interests to the City of Lafayette, Colorado as indicated on this subdivision plat; and hereby subordinates any interest it may have in the property to such dedication(s). (Mortgage Company Name) By: Capacity State of ) )ss County of ) The foregoing Lender’s Approval and Subordination was acknowledged before me this day of _ 20 A.D. by , as of (Mortgage Company Name). Notary Public 10. Plat Notes (may or may not be applicable, and may include additional notes, as the circumstances require). Notes All or portions of the property described hereon may be subject to a Development Agreement and/or Declarations of Covenants, Conditions and Restrictions recorded contemporaneously with this plat in the office of the Clerk and Recorder of Boulder County, Colorado. ---PAGE BREAK--- Certificates & Signature Blocks Revised 03/23 December 2015 SAMPLE OF CERTIFICATES/SIGNATURE BLOCKS REQUIRED ON MINOR SUBDIVISIONS/PUD NO LAND DEDICATION 1. Planning & Building Director (or Planning Commission if referred) Certificate 2. Review Certificates (City Engineer) 3. City Administrator’s Certificate 4. Surveyor’s Certificate 5. Clerk and Recorder’s Certificate 6. Certificate of Ownership 7. Lender’s Approval 8. Plat and/or PUD Notes (may or may not be applicable). 1. Planning & Building Director Certificate (modify as appropriate if referred to Planning Commission). Pursuant to Section 26-16-6 of the Lafayette Code of Ordinances, this Minor Subdivision (/PUD if applicable) for NAME OF DEVELOPMENT was approved by the Planning & Building Director of the City of Lafayette, Colorado on A.D. Planning & Building Director Attest: City Clerk 2. Review Certificates City Engineer 3. City Administrator's Certificate I, Fritz Sprague, City Administrator of the City of Lafayette, Colorado, hereby certify that I have examined the within final subdivision plat (or PUD) 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 03/23 4. 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, and shown hereon; that such plat was made from an accurate survey of said property by me or under my direct responsibility and supervision and correctly shows the location and dimensions of the tracts, lots and outlots shown hereon; and otherwise is in compliance with Articles 50-53 of Title 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) 5. 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 under reception # . , Fees Paid $ Clerk and Recorder Deputy 6. Certificates Ownership (plat) Know all men by these presents, that , being the fee owner(s) of all that real property situated in 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. Executed this day of , 20 A.D. Owner ---PAGE BREAK--- Certificates & Signature Blocks Revised 03/23 Acknowledgment State of Colorado ) County of Boulder ) ss The foregoing instrument was acknowledged before me this day of , 20 , A.D. by as of , Owner of the property described hereon. Witness my hand and official seal. My commission expires . Notary Public ---PAGE BREAK--- Certificates & Signature Blocks Revised 03/23 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 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 ) County of ) ss The foregoing instrument was acknowledged before me this day of , 20 , A.D. by as of , Owner of the property described hereon. Witness my hand and official seal. My commission expires . Notary Public ---PAGE BREAK--- Certificates & Signature Blocks Revised 03/23 7. Lender’s Consent (Mortgage Company Name), hereby consents to the subdivision of the property as herein described and to the recording of the this subdivision plat (Mortgage Company Name) By: Capacity State of ) )ss County of ) The foregoing Lender’s Consent was acknowledged before me this day of 20 A.D. by (Mortgage Company Name.) as of Notary Public My Commission expires: 8. Plat and/or PUD Notes (may or may not be applicable, and may include additional notes as the circumstances require). Notes All or portions of the property described hereon may be subject to the Development Agreement and/or Declaration of Covenants, Conditions, and Restrictions recorded contemporaneously with this plat/PUD in the office of the Clerk and Recorder of Boulder County, Colorado.