HomeMy WebLinkAboutSALUD FAMILY HEALTH CENTER LOT 4 - FDP200011 - SUBMITTAL DOCUMENTS - ROUND 5 - Supporting Documentation (4)2012 Page 1 of 3
CITY OF FORT COLLINS
INFORMATION FOR DEVELOPMENT AGREEMENTS
The following information is needed by the City in order to prepare a Development Agreement.
Please fill in the blanks with names and titles exactly as they should appear and return this form.
Hard copy or email to your development review engineer is fine. This form is for
informational purposes only and is not your development agreement. It requires no
signatures. If you should have any questions please call your development review engineer. This
information should match that shown on a plat (if applicable).
Development Name: Salud Wellness Center
Contact Person: John Santistevan
Email/ phone number: jsantistevan@saludclinic.org 303-818-4410
DEVELOPER INFORMATION:
Provide complete name(s) of the Entity(s) who is the Developer and include the type of
organization:
(Examples are as follows: Development Innovations, Inc. a Delaware corporation; or ABC Partners, a Nebraska
general partnership; or John Z. Doe, an individual)
Salud Health Center, LLC, A Colorado Non-Profit
Provide complete name(s) and title(s) of the individual(s) who will sign the Development
Agreement for the Developer. The individuals must be officers for the development Entity or the
individual(s). Also include the name and title of the person who will sign as an Attest for
corporations.
Name: Title:
John Santistevan President & CEO
2012 Page 2 of 3
LENDER INFORMATION:
If with the development a lender has either already provided a construction loan or will be
providing a construction loan and will want or need an acknowledgement from the City
regarding the development this information is needed so the information can be provided within
the development agreement. The City will not enter into a separate acknowledgement agreement.
Lender Name:
(example: Wells Fargo Bank, National Association)
Check the appropriate statement or provide additional information
o A loan exists. This lending institution has extended a loan to the Developer.
o This lending institution intends to extend a loan to the Developer.
A lender acknowledgement for this development will not be needed.
o
CONTACT INFORMATION:
The Development Agreement specifies addresses for each of the parties (City, Developer,
Owner, and Lender) so as to provide any notice regarding the Agreement. Provide the addresses
for notice to be sent:
(Examples:)
Development Innovations, Inc. Moe, Larry, & Curly Attorneys in Law
c/o John Z. Doe c/o Mr. Moe
1000 Developer Lane 101 Litigation Lane
Denver, CO 80241 Beverly Hills, CA 90210
Developer: With a copy to:
Alan McGuire
Facilities Director
203 N. Rollie Avenue
Fort Lupton, CO 80621
Michael Johnson
Attorney
203 N. Rollie Avenue
Fort Lupton, CO 80621
Lender (if applicable): With a copy to:
Owner: With a copy to:
John Santistevan
President & CEO
203 N. Rollie Avenue
Fort Lupton, CO 80621
Michael Johnson
Attorney
203 N. Rollie Avenue
Fort Lupton, CO 80621
o
2012 Page 3 of 3
OWNER INFORMATION:
For developments where the current Owner is not the Developer and the Owner will continue to
own the property until after the development plans are signed, completed and filed with the City
the Owner also needs to be a party to the development agreement. If this is the case the
following information is needed.
Relationship: Explain the relationships between the Developer and the Owner for this
development. In addition, explain any transfers of property ownership that will take place before
the development construction begins. This information is needed to clarify responsibilities for
the development.
Owner is the Developer
Provide complete name(s) of the Entity(s) who is the Owner. Include type of organization:
(Examples are as follows: Development Innovations, Inc. a Delaware corporation; or ABC
Partners, a Nebraska general partnership; or John Z. Doe, an individual), if different from the
Developer
Salud Health Center, LLC, A Colorado Non-Profit
Provide complete name(s) and title(s) of the individual(s) who will sign the Development
Agreement for the Owner. The individuals must be officers for the development Entity or the
individual(s). Also include the name and title of the person who will sign as an Attest for
corporations.
Name: Title:
John Santistevan President & CEO
Attest:
President/CEO