HomeMy WebLinkAbout7 Brew - 5002 Kipling Street - PIA - January 20252025003176 1 /21 /202510:31 AM
PGS 18 $98.00 DF $0.00
Electronically Recorded Jefferson County, CO
Amanda M Gonzalez, Clerk and Recorder TD1000 N
PUBLIC IMPROVEMENT AGREEMENT
THIS AGREEMENT made this of : - , : (the
"Effective Date"), by and between the CITY OF WHEAT RIDGE, COLORADO, a home
rule municipal corporation (the "City"), and WBK KIPLING RE, LLC (the "Developer"),
together referred to as the "Parties."
RECITALS
A. The Developer is the owner of certain real property located in the City of
Wheat Ridge, Colorado, which is more particularly described in Exhibit A and made a
part hereof (the 'Property"), commonly known as 5002 Kipling Street.
B. On'don L,ar , � the City, after the required review process,
approved a Site Plan for the Property, titled 7 Brew 5002 Kipling Street.
C. The approvals cited above are contingent upon the express condition that
all duties created by this Agreement be faithfully performed by the Developer.
AGREEMENT
NOW, THEREFORE, for and in consideration of the mutual promises and
covenants contained herein, the sufficiency of which are mutually acknowledged, the
Parties hereto agree as follows:
1. Purpose. The purpose of this Agreement is to set forth the terms,
conditions, and fees to be paid by the Developer upon development of the Property. All
conditions contained herein are in addition to any and all requirements of the City of
Wheat Ridge Subdivision Ordinance and Zoning Ordinance, the City of Wheat Ridge
Charter, any and all state statutes, and any other sections of the City of Wheat Ridge
Municipal Code and are not intended to supersede any requirements contained therein.
2. Related City Agreements and Approvals. The Property will be subject to
future review and the approval of site plan(s), civil construction documents, right-of-way
permit application(s), site work permit application(s), and building permit application(s).
Through such approvals, the City will review and approve the final design any
development of the Property and the Public Improvements related thereto. This
Agreement is based on information available at the time of approval of the subdivision
plat and shall not constitute approval of the Public Improvement designs.
3. Fees. The Developer hereby agrees to pay City Development Review
fees to the City for engineering, hydrological, surveying, legal, and other services
rendered in connection with the review of the development of the Property.
4. Reserved.
5. Title Policy. Prior to recording of this Agreement, a title commitment for all
those portions of the Property, as well as any other interests in real property
(easements, etc.) to be reserved for public purposes or dedicated to the City shall be
provided to the City. The title commitment shall show that all such property is or shall
be, subsequent to the execution and recording of this Agreement, free and clear of all
liens and encumbrances (other than real estate taxes which are not yet due and
payable) which would make the dedication or reservation unacceptable as the City
determines in its reasonable discretion. The City, in its sole discretion, may accept any
dedication regardless of encumbrances. The title policy evidenced by the title
commitment shall be provided within thirty (30) days after the recording of this
Agreement, in an amount equal to the fair market value of the property so dedicated or
reserved.
6. Breach by the Developer; the City's Remedies. In the event of a breach of
any of the terms and conditions of this Agreement by the Developer, the City may take
such action as permitted and/or authorized by law, this Agreement, or the ordinances
and Charter of the City as the City deems necessary to protect the public health, safety
and welfare; to protect lot buyers and builders; and to protect the citizens of the City
from hardship and undue risk. These remedies include, but are not limited to:
(a) The refusal to issue any building permit or certificate of occupancy;
(b) The revocation of any building permit previously issued under which
construction directly related to such building permit has not commenced,
except a building permit previously issued to a third party;
(c) A demand that the security given for the completion of the Public
Improvements be paid or honored; or
(d) Any other remedy available at law or in equity.
Unless necessary to protect the immediate health, safety and welfare of the City or to
protect the City's interest with regard to security given for the completion of the Public
Improvements, the City shall provide the Developer thirty (30) days prior written notice
of its intent to take any action under this paragraph during which thirty (30) day period
the Developer may cure the breach described in the notice.
7. Installation of Public Improvements.
(a) All storm sewer lines, drainage structures, paved streets, curb, gutter,
sidewalk, amenity zones, street and pedestrian lighting, shared access drives, the
undergrounding of all overhead utilities, and necessary appurtenances as shown on the
approved development plan and the associated construction documents (the "Public
Improvements" or "Improvements") as approved by the City's Community Development
Director or designee ("Director"), shall be installed and completed at the expense of the
Developer within the timeframes set forth in Section 11 of this Agreement and as outlined
in Exhibit B. The Public Improvements shall be substantially complete, with only such
exceptions as shall be approved in advance by the Director in the exercise of his or her
sole discretion, prior to the issuance of the first Building Permit.
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(b) The itemized costs of the Public Improvements required by this
Agreement and shown on the construction documents approved by the Director are set
forth on Exhibit C. All Public Improvements covered by this Agreement shall be made
in accordance with the construction documents drawn according to regulations and
construction standards for such improvement and approved by the Director. It is
understood by the Parties that the description of the Public Improvements may be
general in nature, and that reasonable modifications of the scope, nature, costs, and
similar aspects of the Public Improvements may be necessary to secure final approval
of the Public Improvements. The quantities and locations for the Public Improvements
are based on information that was available at the time of approval of this Agreement.
Additional Public Improvements may be required, and the Developer shall be
responsible for submitting construction documents for review of all Public
Improvements and/or revisions to the construction documents approved by the City.
8. Warranty of Public Improvements. The Developer shall warrant any and
all Public Improvements which are conveyed to the City pursuant to this Agreement for
a period of two (2) years from the date the Director certifies that the same conforms to
the specifications approved by the City (the "Warranty Period"). Specifically, but not by
way of limitation, the Developer shall warrant the following:
(a) That the title conveyed shall be marketable and its transfer rightful;
(b) Any and all Public Improvements conveyed shall be free from any security
interest or other lien or encumbrance; and
(c) Any and all Public Improvements so conveyed shall be free of defects in
materials or workmanship for a period of two (2) years as stated above;
and
(d) To the degree the Developer is required to install and maintain
landscaping on public or private property, it is the obligation of Developer
and its successors and assigns, to maintain the required landscaping in
perpetuity.
The City will finally accept for maintenance all Public Improvements, exclusive of
landscaping materials, after the two-year Warranty Period has expired provided all
warranty work has been completed. The City shall accept for snow removal purposes
only, all dedicated public streets after the City issues the first certificate of occupancy.
9. Reserved.
10. Observation, Inspection and Testin.
(a) The City shall have the right to require reasonable engineering observations
and testing at the Developer's expense. Observation and testing, acquiescence in, or
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approval by any engineering inspector of the construction of physical facilities at any
particular time shall not constitute the approval by the City of any portion of the
construction of such Public Improvements. Such approval shall be made by the City,
only after completion of construction and in the manner hereinafter set forth.
(b) The Director is designated by the City to exercise authority on its behalf under
this Agreement and to see that this Agreement is performed according to its terms.
Work under this Agreement may, without cost or claim against the City, be suspended
by the Director for substantial cause.
(c) The Director shall, within a reasonable time after presentation, make
decisions in writing on all claims of the Developer and on all other matters relating to the
execution and progress of the work or the interpretation of this Agreement, the master
plan and specifications. All such decisions of the Director shall be final.
(d) The Director shall make all determinations of amounts and quantities of work
performed hereunder. To assist them in this work Developer shall make available for
inspection any records kept by Developer.
(e) The Director and his or her authorized representatives shall have free access
to the work at all times, and the Developer shall furnish them with facilities for
ascertaining whether the work being performed, or the work which has been completed,
is in accordance with the requirements of the Agreement.
(f) The Director will make periodic observations of construction (sometimes
commonly referred to as "supervision"). The purpose of these observations and
construction checking is to determine the progress of the work and to see if the work is
being performed in accordance with the plans and specifications. The Director will in no
way be responsible for how the work is performed, safety in, on, or about the job site,
methods of performance, or timeliness in the performance of the work.
(g) Inspectors may be appointed to inspect materials used and work done.
Inspections may extend to all or any part of the work and to the preparation or
manufacture of the materials to be used. The inspectors will not be authorized to alter
the provisions of this Agreement or any specifications or to act as foreman for the
Developer. The Inspector will have authority to reject defective materials and to
suspend any work that is being done improperly, subject to the final decision of the
Director.
11. Completion of Public Improvements. The obligations of the Developer
provided for in Section 7 of this Agreement and Exhibits C and D, including the
inspections hereof, shall be performed on or before February 31 2027, and proper
application for acceptance of the Public Improvements shall be made on or before such
date. Upon completion of construction by the Developer of such Improvements, the
Director, shall inspect the Improvements and certify with specificity its conformity or lack
thereof to the City's specifications. The Developer shall make all corrections necessary
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to bring the Improvements into conformity with the City's specifications. Once approved
by the Director, the City shall accept said Improvements upon conveyance; provided,
however, the City shall not be obligated to accept the Public Improvements until the
actual costs described in this Agreement are paid in full by the Developer.
12. Deferred Installation of Landscaping and Financial Guarantee. If a
Certificate of Occupancy is requested prior to completion of landscaping and irrigation,
an escrow account shall be accepted for the completion of necessary landscaping and
irrigation. Said financial guarantee shall be in the amount of one hundred and twenty
five percent (125%) of the cost of installation. Escrows shall not be released until all
planting and finish materials shown on the approved landscape plan are installed and
accepted and the irrigation is installed and functional. The amount of the escrow shall
be based on an itemized cost estimate for required landscaping and irrigation. The
itemized cost for required landscaping and irrigation shall be accepted at the discretion
of the Community Development Director prior to acceptance of the escrow account.
Should the required landscaping not be properly installed upon the expiration of the
escrow account, the City reserves the right to draw upon the landscaping escrow to
have the required landscaping placed upon the subject premises. Any costs reasonably
incurred by the City in excess of the funds provided by the escrow shall be recovered by
the City through normal lien proceedings.
13. Protection.
(a) Except as expressly set forth herein, the Developer, at its expense, shall
continuously maintain adequate protection of all Improvements from damage prior to
acceptance by the City and shall protect the City's property from injury and loss arising
in connection with this Agreement. The Developer shall repair any such damage, and
indemnify the City against any injury or loss except such as may be caused directly by
authorized agents or employees of the City. The Developer shall adequately protect
adjacent property and shall provide and maintain all passageways, guard fences, lights
and other facilities for protection required by public authority or local conditions.
(b) The Developer shall be responsible for damage to any public and private
property on and adjacent to the site of Developer's Improvements caused by negligent
or willful acts of the Developer, its agents or contractors. The Developer shall take all
reasonable effort necessary to prevent damage to pipes, conduits, and other
underground structures and to overhead wires, and to water quality. The Developer
shall protect carefully from disturbance or damage all land monuments and property
marks until an authorized agent of the City has witnessed or otherwise referenced their
location, and shall not remove them until directed. When any direct or indirect damage
or injury is done to public or private property by or on account of any act, omission,
neglect or misconduct in the construction of Improvements, or in consequence of the
non -execution thereof on the part of any such parties, such damaged property shall be
restored by the Developer at its own expense to a condition similar or equal to that
existing before such damage or injury.
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(c) The Developer shall at all times, whether or not so specifically directed by the
Director, take necessary precautions to insure the protection of the public. The
Developer shall furnish, erect and maintain, at its own expense, all necessary
barricades, suitable and sufficient red lights, construction signs, provide a sufficient
number of watchmen, and take all necessary precautions for the protection of the work
and safety of the public through or around the Property's construction operations as the
Developer and the Director shall deem reasonably necessary.
14. Related Costs - Public Improvements. The Developer shall provide all
necessary engineering designs, surveys, field surveys, testing and incidental services
related to the construction of the Public Improvements at its sole cost and expense,
including final drainage study letter certified accurate by a professional engineer
registered in the State of Colorado.
15. Improvements to be the Property of the City. All Public Improvements for
roads, concrete curb and gutters, public storm sewers and public drainage
improvements accepted by the City shall be dedicated to the City and warranted for a
period of twenty-four (24) months following acceptance by the City, as provided above.
16. Performance Guarantee for Public Im rovements.
(a) In order to secure the construction and installation of the Public
Improvements the Developer shall, within ninety (90) days after the execution of this
Agreement, furnish the City, at the Developer's expense, with the Performance
Guarantee described herein.
(b) The Performance Guarantee provided by the Developer shall be in the form
of an irrevocable letter of credit in which the City is designated as beneficiary, for one
hundred twenty-five percent (125%) of the estimated costs of the Public Improvements
to be constructed and installed as set forth in Section 1.0 of Exhibit C, if applicable to
secure the performance and completion of the Public Improvements as required by
Sections 26-110 (public dedications and improvements; security) and 26-418
(agreement and financial security for required improvements), of the Wheat Ridge Code
of Laws.
(c) The Developer agrees that approval of this Agreement by the City is
contingent upon the Developer's provision of an irrevocable letter of credit to the City
within ninety (90) days of the execution of this Agreement in the amount and form
provided herein. Failure of the Developer to provide an irrevocable letter of credit to the
City in the manner provided herein shall negate the City's approval of this Agreement.
Letters of credit shall be substantially in the form and content set forth in Exhibit D, if
applicable, and shall be subject to the review and approval of the City Attorney. The
Developer shall not start any construction of any public or private improvement on the
Property including, but not limited to, staking, earthwork, overlot grading or the erection
of any structure, temporary or otherwise, until the City has received and approved the
irrevocable letter of credit. Notwithstanding the foregoing, the Developer may obtain the
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(d) The estimated costs of the Public Improvements shall be a figure mutually
agreed upon by the Developer and the Director, as set forth in Exhibit C if applicable. If,
however, they are unable to agree, the Director's estimate shall govern after giving
consideration to information provided by the Developer including, but not limited to,
construction contracts and engineering estimates. The purpose of the cost estimate is
solely to determine the amount of security. No representations are made as to the
accuracy of these estimates, and the Developer agrees to pay the actual costs of all
such Public Improvements.
(e) The estimated costs of the Public Improvements may increase in the future.
Accordingly, the City reserves the right to review and adjust the cost estimate on an
annual basis. If the City adjusts the cost estimate for the Public Improvements, the City
shall give written notice to the Developer. The Developer shall, within thirty (30) days
after receipt of said written notice, provide the City with a new or amended letter of
credit in the amount of the adjusted cost estimates. If the Developer refuses or fails to
so provide the City with a new or amended letter of credit, the City may exercise the
amount of additional security required, the City shall give credit to the Developer for all
required Public Improvements which have actually been completed so that the amount
*f security required at all time shall relate to the cost of required Public Improvements
not yet constructed.
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or spend such funds to finish Public Improvements or correct problems with the Public
Improvements as the City deems appropriate.
(g) Upon completion of performance of such improvements, conditions and
requirements within the required time, the Developer shall issue an irrevocable letter of
credit to the City in the amount of twenty-five percent (25%) of the total cost of
construction and installation of the Public Improvements (including the cost of
landscaping), to be held by the City during the Warranty Period. If the Public
Improvements are not completed within the required time, the monies may be used to
complete the improvements. If the Public Improvements require repair or replacement
during the Warranty Period and the Developer fails to complete said repairs or
replacement prior to the end of the Warranty Period, the City may draw on the letter of
credit to make required repairs or replacements to the Improvements.
17. Indemnification.
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(a) The Developer shall indemnify and hold harmless the City and its officers,
employees, agents or servants from any and all suits, actions, and claims of every
nature and description caused by, arising from or on account of this Agreement any act
or omission of the Developer, or of any other person or entity for whose act or omission
the Developer is liable, with respect to the Public Improvements; and the Developer
shall pay any and all judgments rendered against the City as a result of any suit, action,
or claim, together with all reasonable expenses and attorney's fees and costs incurred
by the City in defending any such suit, action or claim.
(b) The Developer shall pay all property taxes due on any portion of the Property
dedicated to the City and shall indemnify and hold harmless the City for any property tax
liability in connection therewith.
18. Waiver of Defects. In executing this Agreement, the Developer waives all
*bjections it may have concerning defects, if any, in the formalities whereby it is
executed, or concerning the power of the City to impose conditions on the Developer as
set forth herein, and concerning the procedure, substance, and form of the ordinances
itr resolutions adopting this Agreement.
19. Third Party Beneficiaries. There are and shall be no third party
beneficiaries to this Agreement.
20. Modifications. This instrument embodies the whole agreement of the
Parties. There are no promises, terms, conditions, or obligations other than those
contained herein; and this Agreement shall supersede all previous communication
representations, or agreements, either verbal or written, between the Parties. The
shall be no modification of this Agreement except in writing, executed with the saml-
formalities as this instrument. Subject to the conditions precedent herein, this
Agreement may be enforced in any court of competent jurisdiction.
21. Release of Liability. It is expressly understood that the City cannot b
legally bound by the representations of any of its agents or their designees except
accordance with the City of Wheat Ridge Code of Laws and the laws of the State o
Colorado.
22. Captions. The captions to this Agreement are inserted only for the
,vurpose of convenient reference and in no way define, limit, or prescribe the scope or
mtent of this Agreement or any part thereof.
23. Binding Effect. This Agreement shall be binding upon and inure to the
benefit of the Parties hereto and their respective heirs, successors, and assigns as the
case may be.
LIOLZM . - 0 - IYANUEZ300111 I -
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constitute a continuing waiver unless otherwise expressly provided, nor shall the waiver
of any default hereunder be deemed a waiver of any subsequent default hereunder.
25. Invalid Provision. If any provision of this Agreement shall be determined
to be void by any court of competent jurisdiction, then such determination shall not
affect any other provision hereof, all of the other provisions shall remain in full force and
effect. It is the intention of the Parties that if any provision of this Agreement is capable
of two constructions, one of which would render the provision void, and the other which
would render the provision valid, then the provision shall have the meaning which
renders it valid.
26. Governing Law. The laws of the State of Colorado shall govern the
validity, performance and enforcement of this Agreement. Should either party institute
legal suit or action for enforcement of any obligation contained herein, venue of such
suit or action shall be in Jefferson County, Colorado.
27. Attorneys Fees. Should this Agreement become the subject of litigation to
resolve a claim of default of performance or payment by the Developer and a court of
competent jurisdiction finds in favor of the City, the Developer shall pay the City's
attorney's fees and court costs.
28. Notice. All notices required under this Agreement shall be in writing and
shall be hand delivered or sent by registered or certified mail, return receipt requested,
postage prepaid, to the addresses of the Parties herein set forth. All notices so given
shall be considered effective seventy-two (72) hours after deposit in the United States
mail with the proper address as set forth below. Either Party by notice so given may
change the address to which future notices shall be sent.
Notice to Developer: WBK KIPLING RE, LLC
1130 Madison Street
Denver, CO 80206
Notice to City: Community Development Director
7500 West 29th Avenue
Wheat Ridge, CO 80033
City Attorney
7500 West 29th Avenue
Wheat Ridge, CO 80033
29. Force Majeure. Whenever the Developer is required to complete the
construction, repair, or replacement of Public Improvements by an agreed deadline, the
Developer shall be entitled to an extension of time equal to a delay in completing the
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foregoing due to unforeseeable causes beyond the control and without the fault or
negligence of the Developer including, but not restricted to, acts of God, weather, fires
and strikes.
30. Assignment or Assignments. There shall be no transfer or assignment of
any of the rights or obligations of the Developer under this Agreement without the prior
written approval of the City.
31. Recording of Agreement. This Agreement shall be recorded in the real
estate records of Jefferson County and shall be a covenant running with the Property in
order to put prospective purchases or other interested parties on notice as to the terms
and provisions hereof.
32. Title and Authority. The Developer expressly warrants and represents to
the City that it is the record owner of the property constituting the Property and further
represents and warrants, together with the undersigned individual(s) that the
undersigned individual(s) has or have full power and authority to enter into this Public
Improvement Agreement. The Developer and the undersigned individual(s) understand
that the City is relying on such representations and warranties in entering into this
Agreement.
[Remainder of Page Intentionally Left Blank]
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WHEREFORE, the Parties hereto have executed this Agreement on the day and
year first above written.
ATTEST:
4`
to tEitfi, City Clerk
APP OI,G -AS TO FORM:
G
CITY OF WHEAT RIDGE, COLORADO
By: �(J YA
Bud Starker, Mayor
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DEVELOPER
WBK KIPLING RE, LLC
d f�l
d
Name: Fred C6uzens
Title:��
STATE OF COLORADO )
SS.
COUNTY OF 1 S'ej"D )
The foregoing instrument was acknowledged before me this `�day of
Witness my hand and official seal.
My commission expires: Aja
LPUBLIC
401501
:,STATE OF DO
ES P IL
(SEAL)
12
Notary Public
EXHIBIT A
Legal Description of Developer Property
LOT 1, KIPLING 5000 PLAZA SUBDIVISION, COUTY OF JEFFERSON, STATE OF
COLORADO
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EXHIBIT B
Phasing Plan for Public Improvements
The public and on -site improvements for the property shall be installed in one phase as
outlined below:
All improvements to the Kipling Street frontage and corner connecting to W. 50tn
Avenue shall be completed prior to Certificate of Occupancy for this property, in
accordance with the approved plan set for the right-of-way improvements. This includes
the completion of the sidewalk, ramp modifications, street/pedestrian lighting, necessary
relocation of existing improvements, and landscaping restoration and new plantings.
Installation of landscaping, street trees, and irrigation is not required prior to Certificate
of Occupancy of issuance if C.O. occurs outside of the planting season, generally
October to June. Refer to Section 12 of this Agreement.
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EXHIBIT C
Cost Estimate for Public Improvements
(see attached)
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ENGINEERING DIVISION
APPROVED FOR:
0 DRAINAGE ❑ SIDEWALK
'.. 0 CURB d GUTTER ❑ STREET.
Project Name
Date
''. NMISCELLANEOUS CI PLAT
7 Brew - 5002 Kipling St
12/9/2024
COMMENT
Demolition
Iwona Dumin 12(10i24
Estimate Item
Item Quantity
Quantity Unit
Unit Cos CIVIL ENGINEER DATE
Sidewalk
60
SY
$30
SUBJECT TO FIELD INSPECTIONS `.
Curb and Gutter
65
LF
$20
$1,300
Asphalt
15
ITONS
$13
$195
Trucking and Dump Fees
2
LOADS
$500
$1,000
TOTAL
$4,295
Site Features
Estimate Item Item Quantity Quantity Unit Unit Cost Total Cost
Sidewalk
210
SY
87
$18,270
Curb and Gutter
94
LF
52
$4,888
Asphalt
15
TONS
400
$6,000
Pedestrian Lights
5
EA
4550
$22,750
Pull Boxes
5
EA
2500
$12,500
Electrical Conduit
300
LF
30
$9,000
Electric Meter
1
EA
8500
$8,500
ADA Ramps
2
EA
2500
$5,000
18" RCP
23
LF
282
$6,486
5tormceptor Device (Inlcudes concrete structure)
1
EA
12000
$12,000
4' Manhole
1
EA
17100
$17,100
Modify Manhole
1
EA
2000
$2,000
Traffic Control 3 DAYS 1000
$3,000
TOTAL
$127,494
EXHIBIT D
Letter of Credit Template
(see attached)
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LETTER OF CREDIT # (L.O.C. #)
BENEFICIARY: The City of Wheat Ridge
ADDRESS: 7500 West 29"' Avenue, Wheat Ridge, CO 80033
DATE: (Date of Issue)
EXPIRY DATE: (Exp. Date)
For: (Developer's Name)
(Developer's Address)
Gentlemen:
Ma I I I
. . . . . . . . . .
by your drafts at sight accompanied by your signed statement that the above is: 1) drawn in payment
of street improvements including, but not limited to, curb, gutter, sidewalk, asphalt patching, street
paving, and other street improvements shown on the final plat and associated construction document
for The (Project Name) (the "Project"), and/or 2) drawn in payment of storm drainage improvements
including, but not limited to, detention pond grading, detention pond outlet structure(s), storm sewer
the Project.
Drafts must be accomy,�xX a sig , ht draft:_2�. a signed statement b1i an authorize r
of the Beneficiary stating as follows: �'We hereby certify that the amount of our draft represents fundl
owed to the City of Wheat Ridge for payment obligations pursuant to the conditions stated above,
between (Developer's Name) and the City of Wheat Ridge." 3) This original Letter of C,,redit.
iix,oh draft must bear uyon its face a clause "Drawn under Letter of Credit No. ',L.0
of Issue).
Vkis IRREVOCABLE STANDBY LETTER OF CREDIT is not transferable.
We hereby agree with you that drafts drawn under and in compliance with the terms of the Letter of
Credit will be duly honored if presented to the above mentioned drawee Bank on or before (Exp.
Date).
Except as otherwise expressly stated herein, this Letter of Credit and all negotiations
hereunder are subject to all applicable provisions of Uniform Customs and Practices for
Documentary Credits, 2007 Revision, International Chamber of Commerce Publication No.
600.
Sincerely,
(BANK NAME)
By:
(Name and Title of Bank Officer)
DFN-132644-2