HomeMy WebLinkAbout20120476.tiff WELD COUNTY
COMMISSIONERS M`Geady Sisneros P.C.
400
M GEADY SISNEROSenver,17th Avenue, 203-121
C 2012 FEBfE6 10 P I� 43 Denver, Colorado 80203-1214
303.592.4380 tel 303.592.4385 fax
RECEIVED www.mcgeadysisneros.com
February 8, 2012
Weld County Clerk & Recorder
1402 17th Avenue
P.O. Box 459
Greeley, CO 80632
Re: Pioneer Metropolitan District Nos. 2, 3, 4 and 5
Dear Sir or Madam:
Enclosed per the requirements of Sections 8 and 9 of Article XII of the Colorado Constitution are
copies of Oaths of Director, Certifications of Board Appointment, and the Districts' Public
Entity Liability Certificates (which serves as Public Official Position Schedule Bonds) for the
following new directors of the Districts:
1. David Foster—Appointed December 30, 2011 to fill a vacancy on each of the Boards.
2. Jean Gold—Appointed January 27, 2012 to fill a vacancy on the Pioneer Metropolitan
District No. 5 Board.
Please contact me if you have any questions. Thank you.
Very truly yours,
MCGEADY SISNEROS,P.C.
C i{p fifer S. Henry o Je lfer S.
Paralegal
Enclosures
cc: Division of Local Government (via US Mail)
2012-0476
a sN)lau
(00223057.DOC v:1 )
•
DISTRICT COURT,COUNTY OF WELD,STATE OF
COLORADO
901 9th Avenue
Greeley, Colorado 80631
970-351-7300
PETITIONER: IN RE PIONEER METROPOLITAN
DISTRICT NO. 2
MaryAnn M. McGeady A COURT USE ONLY A
McGEADY SISNEROS, P.C. Case Number: 2006 CV232
450 E. 17th Ave., Suite 400
Denver, Colorado 80203-1214
Phone: (303) 592-4380 Div.: I Ctrm.:
Fax: (303) 592-4385
E-mail: mmcgeady@mcgeadysisneros.com
Atty. Reg. ##: 12417
OATH OF DIRECTOR
The undersigned solemnly swears (or affirms) that he will faithfully perform the duties of
this office as required by law and will support the Constitution of the United States, the
Constitution of the State of Colorado, and the laws made pursuant thereto.
Ak
David Foster
Address: 621 Seventeenth Street, 19th Floor
Denver, CO 80293
STATE OF COLORADO )
�Q
) ss.
COUNTY OF �,~e l,��ier ) �J
Subscribed and sworn to before me this ptiti day of ana , 20 l L.
WITNESS my hand and official seal.
A41
M ll�
Lop'‘‘ Notary Public
WO )0 My /2.f z0l14
• • i My commission expires:
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uAAK kxpires 09/02J2014
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CERTIFICATE OF APPOINTMENT
I, Joel II. Farkas, President of the Board of Directors of the Pioneer Metropolitan District
No. 2 of Weld County, Colorado hereby certify that a special meeting of the Board of Directors
of said District held December 30, 2011, at 9:00 a.m. at the Westin Riverfront Resort, 126
Riverfront Lane, Rapids Room, Avon, Colorado, the Board determined that due to the
resignation of Christopher Paulson, it was necessary to appoint a new Director to act until the
next regular election of the District. Nominations were open for appointment of a new Director,
and that upon unanimous vote there was appointed to the Board the following qualified elector of
the District to act until the next regular election of the District:
Name: David Foster
Address: 621 Seventeenth Street, 19th Floor
Denver, Colorado 80293
I further certify that I have caused this Certificate of Appointment to be delivered to said
new Director and to the Division of Local Government of the State of Colorado.
PIONS F, 1i ROPOLITAN DISTRICT NO. 2
By: --
Joe . Farkas, President
[SEAL]
{00220666.DOCX v:I }
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Colorado Special Districts`/ Property and Liability Pool
Public Entity Liability Certificate Holder Declarations
Master Coverage Document Number: PEL 01 01 12
Certificate Number:25C60209-3367 Coverage Period: 1/1/2012 to 1/1/2013
Named Member: Broker of Record:
Pioneer Metropolitan District No. 2
c/o McGeady Sisneros, P.C.
450 E. 17th Ave., Suite 400
Denver, CO 80203
Coverage is provided for only those coverages Indicated below for which a contribution is shown.
Per Occurrence !Annual Aggregate '
Coverage Limit Limit Deductible Contribution
Public Entity Liability Coverage $1,000,000 None None $470.00
including:
General Liability Included None None Included,
Medical Payments-Premises l $10,000 $10,000 I N/A I Included
{
Employee Benefits Admin. Liability Included None ( None I Included!
Public Officials Liability Included None t $1,000 $968.00
Employment Practices Liability Included j None 'See Below Included'
Pre Loss Legal Assistance r $2,000 $4,000 None Included!
No-Fault Water&Sewer Backup $10,000 $30,000 $500 Included{
Cyber Liability $200,000 "$1,000,000 None Included!
Fiduciary Liability $200,000 **$1,000,000 None Included'
Excess Liability I No Coverage No Coverage N/A j No Coverage
Auto Liability No Coverage ! No Coverage i None i No Coverage
i Medical Payments-Auto No Coverage No Coverage N/A No Coverage
Non-Owned/Hired Auto Liability No Coverage ! No Coverage None No Coverage
I .
Uninsured Motorist No Coverage No Coverage None No Coverage
Auto Physical Damage No Coverage No Coverage N/A No Coverage
Hired Auto Physical Damage 3 No Coverage No Coverage I N/A No Coverage;
Auto Physical Damage-Employee $2,500 N/A a N/A j Included!
Deductible Reimbursement L I _
Total Contribution:( $1,438.00 1
" Employment Practices Liability Deductible: 50% of loss,subject to a maximum deductible of$100,000
each occurrence
"Cyber Liability and Fiduciary Liablity each have a $1,000,000 All Member Annual Aggregate Limit.
Additional endorsements that may be applicable to Member:
This Certificate Holder Declaration is made and Is mutually accepted by the Pool and the Named Member
subject to all terms which are made a part of the Public Entity Liability Coverage Document. This
Certificate represents a brief summary of coverages.Please refer to the Master Coverage Document for
actual coverage,terms, conditions,and exclusions.2Countersigned by: A. ki-li Wednesday, December 21, 2011
Authorized Representative
Entity ID#: 60209
DISTRICT COURT, COUNTY OF WELD,STATE OF
COLORADO
901 9`h Avenue
Greeley,Colorado 80631
970-351-7300
PETITIONER: IN RE PIONEER METROPOLITAN
DISTRICT NO.3
MaryAnn M. McGeady A COURT USE ONLY
McGEADY SISNEROS, P.C. Case Number: 2006 CV233
450 E. 17th Ave., Suite 400
Denver, Colorado 80203-1214
Phone: (303) 592-4380 Div.: 1 Ctrm.:
Fax: (303) 592-4385
E-mail: mmcgeady@mcgeadysisneros.com
Atty. Reg. #: 12417
OATH OF DIRECTOR
The undersigned solemnly swears(or affirms)that he will faithfully perform the duties of
this office as required by law and will support the Constitution of the United States, the
Constitution of the State of Colorado, and the laws made pursuant thereto.
David Foster
Address: 621 Seventeenth Street, 19th Floor
Denver,CO 80293
STATE OF COLORADO )
Ver ) ss.
COUNTY OF
kik
Subscribed and sworn to before me this t 0 day of alri, . 20 (L.
WITNESS my hand and official seal.
pY Ldp , Notary ub is
•
;;S 11 My commission expires:
•
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��QQ((��QQris$ign Expires 09V0V12014
iUU2?�i3.1))C� f
CERTIFICATE OF APPOINTMENT
I,Joel H. Farkas, President of the Board of Directors of the Pioneer Metropolitan District
No. 3 of Weld County,Colorado hereby certify that a special meeting of the Board of Directors
of said District held December 30, 2011, at 9:00 a.m. at the Westin Riverfront Resort, 126
Riverfront Lane, Rapids Room,Avon, Colorado,the Board determined that due to the
resignation of Christopher Paulson, it was necessary to appoint a new Director to act until the
next regular election of the District. Nominations were open for appointment of a new Director,
and that upon unanimous vote there was appointed to the Board the following qualified elector of
the District to act until the next regular election of the District:
Name: David Foster
Address: 621 Seventeenth Street, 19th Floor
Denver, Colorado 80293
I further certify that I have caused this Certificate of Appointment to be delivered to said
new Director and to the Division of Local Government of the State of Colorado.
PIONEER MEN' OP LITAN DISTRICT NO. 3
By:
Joel H. F<<r as, President
[SEAL]
(00220667.DOCX v.I
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Colorado Special Districts Property and Liability Pool
Public Entity Liability Certificate Holder Declarations
Master Coverage Document Number: PEL 01 01 12
Certificate Number:25C60226-3368 Coverage Period: 1/1/2012 to 1/1/2013
Named Member: Broker of Record:
Pioneer Metropolitan District No. 3
c/o McGeady Sisneros, P.C.
450 E. 17th Ave., Suite 400
Denver, CO 80203
Coverage Is provided for only those coverages Indicated below for which a contribution is shown.
Per Occurrence Annual Aggregate
Coverage Limit Limit Deductible ! Contribution '
'Public Entity Liability Coverage $1,000.000 ! None None $470.00 I
Including:
! General Liability Included None None Included!
Medical Payments-Premises $10,000 $10,000 N/A Included
Employee Benefits Admin. Liability Included None None Included!
;
Public Officials Liability Included None $1,000 $968.00
_._ _ s I
Employment Practices Liability Included None ' See Below : Included!
I Pre Loss Legal Assistance $2,000 $4,000 None Included!
I No-Fault Water& Sewer Backup I $10,000 $30,000 i $500 Included
_._ ._
Cyber Liability I $200,000 `"$1,000,000 None Included
Fiduciary Liability $200,000 ""$1,000 000 None Included
I Excess Liability No Coverage , No Coverage { N/A No Coverage
Auto Liability No Coverage No Coverage t None No Coverage)
Medical Payments-Auto No Coverage ' No Coverage i N/A No Coverage
Non-Owned/Hired Auto Liability No Coverage No Coverage None No Coverage!
Uninsured Motorist No Coverage No Coverage None No Coverages
__
,Auto Physical Damage , No Coverage No Coverage i N/A No Coverage,
Hired Auto Physical Damage No Coverage No Coverage . N/A No Coverage'
F Auto Physical Damage-Employee $2,500 I N/A i NIA Included!
l• Deductible Reimbursement !
Total Contribution:I $1,438.00
" Employment Practices Liability Deductible: 50%of loss, subject to a maximum deductible of$100,000
each occurrence
"Cyber Liability and Fiduciary Liablity each have a$1,000,000 All Member Annual Aggregate Limit.
Additional endorsements that may be applicable to Member:
This Certificate Holder Declaration is made and Is mutually accepted by the Pool and the Named Member
subject to all terms which are made a part of the Public Entity Liability Coverage Document. This
Certificate represents a brief summary of coverages.Please refer to the Master Coverage Document for
actual coverage,terms, conditions,and exclusions.
Countersigned by Vc- Wednesday. December 21, 2011
Authorized Representative
Entity ID#: 60226
.
DISTRICT COURT,COUNTY OF WELD,STATE OF
COLORADO
901 9th Avenue
Greeley,Colorado 80631
970-351-7300
PETITIONER: IN RE PIONEER METROPOLITAN
DISTRICT NO. 4
MaryAnn M. McGeady ♦ COURT USE ONLY •
McGEADY SISNEROS, P.C. Case Number: 2006 CV234
450 E. 17`h Ave., Suite 400
Denver, Colorado 80203-1214
Phone: (303) 592-4380 Div.: 1 Ctrm.:
Fax: (303) 592-4385
E-mail: mmcgeady@mcgeadysisneros.com
Atty. Reg. 4: 12417
OATH OF DIRECTOR
The undersigned solemnly swears(or affirms)that he will faithfully perform the duties of
this office as required by law and will support the Constitution of the United States,the
Constitution of the State of Colorado,and the laws made pursuant thereto.
David Foster
Address: 621 Seventeenth Street, 19th Floor
Denver,CO 80293
STATE OF COLORADO )
'rp�� ) ss.
COUNTY OF . e�V t�1' ) rr''
Subscribed and sworn to before me this tt day of sanua i , 20 [
WITNESS my hand and official seal.
t011L-1:AL41—j-ti
‘40`l‘40`lLpp
.�A•..� Notary Public
.�.
t My commission expires: 6112-1, 1'.�
, oPPo
OF CO‘-
My Commission Expires 09/02/2014
(00220664 DOC v:1
CERTIFICATE OF APPOINTMENT
I,Joel H. Farkas, President of the Board of Directors of the Pioneer Metropolitan District
No. 4 of Weld County, Colorado hereby certify that a special meeting of the Board of Directors
of said District held December 30, 2011, at 9:00 a.m. at the Westin Riverfront Resort, 126
Riverfront Lane, Rapids Room, Avon, Colorado, the Board determined that due to the
resignation of Christopher Paulson, it was necessary to appoint a new Director to act until the
next regular election of the District. Nominations were open for appointment of a new Director,
and that upon unanimous vote there was appointed to the Board the following qualified elector of
the District to act until the next regular election of the District:
Name: David Foster
Address. 621 Seventeenth Street, 19`h Floor
Denver, Colorado 80293
I further certify that I have caused this Certificate of Appointment to be delivered to said
new Director and to the Division of Local Government of the State of Colorado.
PIONEER _1 R PULITAN DISTRICT NO. 4
•
By:
Joel H. I as, President
[SEAL]
{00220668 DOCX v I }
2` V \ Vunrslofoice
••Colorrado Special Districts Property and Liability Pool
Public Entity Liability Certificate Holder Declarations
Master Coverage Document Number: PEL 01 01 12
Certificate Number:25C60231-3369 Coverage Period; 1/1/2012 to 1/1/2013
Named Member: Broker of Record:
Pioneer Metropolitan District No. 4
c/o McGeady Sisneros, P C.
450 E. 17th Ave., Suite 400
Denver, CO 80203
Coverage is provided for only those coverages indicated below for which a contribution is shown.
j Per Occurrence 1Annual Aggregate
Coverage Limit Limit Deductible Contribution
public Entity Liability Coverage $1,000,000 i None f• None $470.00 !
including: _
General Liability Included None None Included
iMedical Payments-Premises ! $10,000 $10,000 N/A Included'
Employee Benefits Admin. Liability Included None None Included!
I Public Officials Liability Included None $1,000 $968.00
ir Employment Practices Liability Included None 'See Below Included/
I Pre Loss Legal Assistance $2,000 $4,000 None Included;
No-Fault Water&Sewer Backup No Coverage No Coverage None No Coverage!
Cyber Liability $200,000 ? "$1.000,000 None Included!
Fiduciary Liability $200,000 "$1.000,000 None Included!
Excess Liability I No Coverage - No Coverage N/A No Coverage
Auto Liability I No Coverage No Coverage - None No Coverage)
, Medical Payments-Auto No Coverage No Coverage N/A No Coverage'
Non-Owned/Hired Auto Liability No Coverage No Coverage j None No Coverage!
,-T-Uninsured Motorist No Coverage No Coverage None No Coverage;
.
Auto Physical Damage No Coverage No Coverage N/A No Coverage!
Hired Auto Physical Damage No Coverage No Coverage i N/A No Coverage]
Auto Physical Damage-Employee $2,500 N/A j N/A Included;
Deductible Reimbursement _ •
Total Contribution: $1,438 00
" Employment Practices Liability Deductible: 50%of loss,subject to a maximum deductible of$100,000
each occurrence
"Cyber Liability and Fiduciary Liablity each have a$1,000,000 All Member Annual Aggregate Limit.
Additional endorsements that may be applicable to Member:
Public Entity Liability—No-Fault Water&Sewer Back
This Certificate Holder Declaration is made and is mutually accepted by the Pool and the Named Member
subject to all terms which are made a part of the Public Entity Liability Coverage Document. This
Certificate represents a brief summary of coverages.Please refer to the Master Coverage Document for
actual coverage,terms,conditions,and exclusions.
Countersigned by'. ll Wednesday. December 21, 2011
_ 4 ��/�� _
Authorized Representative
Entity ID#: 60231
DISTRICT COURT,COUNTY OF WELD, STATE OF
COLORADO
901 9th Avenue
Greeley, Colorado 80631
970-351-7300
PETITIONER: IN RE PIONEER METROPOLITAN
DISTRICT NO. 5
MaryAnn M.McGeady ♦ COURT USE ONLY •
McGEADY S[SNEROS, P.C. Case Number: 2006 CV235
450 E. 17`h Ave., Suite 400
Denver, Colorado 80203-1214
Phone: (303) 592-4380 Div.: 1 Ctrm.:
Fax: (303)592-4385
E-mail: mmcgeady@mcgeadysisneros.com
Atty. Reg. I: 12417
OATH OF DIRECTOR
The undersigned solemnly swears (or affirms) that he will faithfully perform the duties of
this office as required by law and will support the Constitution of the United States, the
Constitution of the State of Colorado, and the laws made pursuant thereto.
0_ 4
David Foster
Address: 621 Seventeenth Street, 19th Floor
Denver, CO 80293
STATE OF COLORADO )
) ss.
COUNTY OF Dr ) Q
Subscribed and sworn to before me this I u day of -9111.O1,\ , 20 l2. .
WITNESS my hand and official seal. I ---- ---
tiN0Y Zo`"‘‘ Notary Public
`. OTAR} No 1 My commission expires: 61/Z-/1. (y-�
•
Ott P A G O
' OF CO-0r
(0022obti�Expires 0810212014
CERTIFICATE OF APPOINTMENT
I,Joel H. Farkas, President of the Board of Directors of the Pioneer Metropolitan District
No. 5 of Weld County, Colorado hereby certify that a special meeting of the Board of Directors
of said District held December 30, 2011, at 9:00 a.m. at the Westin Riverfront Resort, 126
Riverfront Lane, Rapids Room,Avon, Colorado, the Board determined that due to the
resignation of David Foster, it was necessary to appoint a new Director to act until the next
regular election of the District. Nominations were open for appointment of a new Director, and
that upon unanimous vote there was appointed to the Board the following qualified elector of the
District to act until the next regular election of the District:
Name: David Foster
Address; 621 Seventeenth Street, 19`h Floor
Denver, Colorado 80293
I further certify that I have caused this Certificate of Appointment to be delivered to said
new Director and to the Division of Local Government of the State of Colorado.
PIONEER M OP LITAN DISTRICT NO. 5
By:
Joel H. Fa 'as, President
[SEAL]
(00220669,DOCX v.1 }
��j \ Veit / ice
Colorado Special Districts Property and Liability Pool
Public Entity Liability Certificate Holder Declarations
Master Coverage Document Number: PEL 01 01 12
Certificate Number:25C60237-3370 Coverage Period: 1/1/2012 to 1/1/2013
Named Member: Broker of Record:
Pioneer Metropolitan District No. 5
c/o McGeady Sisneros, P.C.
450 E. 17th Ave., Suite 400
Denver, CO 80203
Coverage is provided for only those coverages indicated below for which a contribution is shown.
Per Occurrence ;Annual Aggregate
I Coverage Limit Limit j Deductible : Contribution
(Public Entity Liability Coverage $1,000,000 lNone + None $470.00
including: l f
General Liability Included None None Included;
Medical Payments- Premises $10,000 $10,000 N/A Included;
Employee Benefits Admin. Liability Included ! None None Included
Public Officials Liability Included None $1,000 i $968 00 ;
Employment Practices Liability Included None •See Below Included;
i
Pre Loss Legal Assistance j $2,000 I $4,000 None Included;
No-Fault Water&Sewer Backup No Coverage No Coverage +1 None No Coverage
Cyber Liability $200,000 "$1,000,000 I None Included
Fiduciary Liability $200,000 "$1,000,000 None Included
Excess Liability No Coverage No Coverage ! N/A No Coverage,
Auto Liability No Coverage No Coverage ':. None ' No Coverage
{
Medical Payments-Auto No Coverage No Coverage N/A No Coverages
Non-Owned/Hired Auto Liability No Coverage No Coverage None No Coverage!
Uninsured Motorist No Coverage No Coverage None No Coverage:
Auto Physical Damage No Coverage No Coverage N/A No Coverages
Hired Auto Physical Damage No Coverage I No Coverage N/A No Coverage'
Auto Physical Damage-Employee $2,500 i N/A N/A Included
Deductible Reimbursement .
•
•
Total Contribution: $1,438.00
'Employment Practices Liability Deductible: 50%of loss,subject to a maximum deductible of$100.000
each occurrence
'"Cyber Liability and Fiduciary Liablity each have a$1,000 000 All Member Annual Aggregate limit
Additional endorsements that may be applicable to Member:
Public Entity Liability-No-Fault Water&Sewer Back
This Certificate Holder Declaration is made and Is mutually accepted by the Pool and the Named Member
subject to all terms which are made a part of the Public Entity Liability Coverage Document. This
Certificate represents a brief summary of coverages.Please refer to the Master Coverage Document for
actual coverage,terms,conditions,and exclusions.
Countersigned by: 4, �✓J� Wednesday December 21.2011
Authorized Representative
Entity ID#: 60237
•
DISTRICT COURT,COUNTY OF WELD,STATE OF
COLORADO
901 9th Avenue
Greeley,Colorado 80631
970-351-7300
PETITIONER: IN RE PIONEER METROPOLITAN
DISTRICT NO. 5
MaryAnn M. McGeady A COURT USE ONLY •
McGEADY SISNEROS, P.C. Case Number: 2006 CV235
450 E. 17th Ave., Suite 400
Denver, Colorado 80203-1214
Phone: (303) 592-4380 Div.: 1 Ctrm.:
Fax: (303)592-4385
E-mail: mmcgeady@mcgeadysisneros.com
Ate. Reg. #: 12417
OATH OF DIRECTOR
The undersigned solemnly swears (or affirms)that she will faithfully perform the duties
of this office as required by law and will support the Constitution of the United States, the
Constitution of the State of Colorado, and the laws made pursuant thereto.
52-(;/,'
Jean ,old
Address: 7882 Sweet Water Road
Lone Tree, CO 80124
STATE OF COLORADO
) ss.
COUNTY OF be,y
Subscribed and sworn to before me this day of jli,n t,qx_ , 20 12-.
WITNESS my hand and official seal. C
Na 141alit
Public
My commission expires: Ki 1?-0/G
(00220679.DOC v:! )
CERTIFICATE OF APPOINTMENT
I, Joel H. Farkas, President of the Board of Directors of the Pioneer Metropolitan District
No. 5 of Weld County, Colorado hereby certify that a special meeting of the Board of Directors
of said District held January 27, 2012, at 2:00 p.m. at the Offices of McGeady Sisneros, P.C.,
450 E. 17th Avenue, Suite 400, Denver, Colorado, the Board determined that due to the
resignation of Jean Gold, it was necessary to appoint a new Director to act until the next regular
election of the District. Nominations were open for appointment of a new Director, and that
upon unanimous vote there was appointed to the Board the following qualified elector of the
District to act until the next regular election of the District:
Name: Jean Gold
Address: 7882 Sweet Water Road
Lone Tree, Colorado 80124
1 further certify that I have caused this Certificate of Appointment to be delivered to said
new Director and to the Division of Local Government of the State of Colorado.
PlONEF FIR )POI,ITAN DISTRICT NO. 5
By:
Joel II Parkas, President
[SEAL)
(00220674DOCx v I )
0702 \ Yon2fOnca
Colorado Special Districts Property and Liability Pool
Public Entity Liability Certificate Holder Declarations
Master Coverage Document Number: PEL 01 01 12
Certificate Number:25C60237-3370 Coverage Period: 1/1/2012 to 1/1/2013
Named Member: Broker of Record:
Pioneer Metropolitan District No. 5
Go McGeady Sisneros, P.C.
450 E. 17th Ave., Suite 400
Denver, CO 80203
Coverage is provided for only those coverages indicated below for which a contribution is shown.
I Per Occurrence Annual Aggregate
Coverage Limit Limit Deductible 'I Contribution •
[Public Entity Liability Coverage 1 $1,000,000 ' None None '.. $470.00
Including: ,
I General Liability Included None None Included
' Medical Payments- Premises $10,000 $10,000 N/A Included
• Employee Benefits Admin. Liability Included None None Included
I Public Officials Liability Included None $1.000 $968.00
Employment Practices Liability Included None 'See Below , Included
i
Pre Loss Legal Assistance $2,000 $4,000 None Included
No Fault Water&Sewer Backup I No Coverage ! No Coverage None No Coverage..
Cyber Liability $200,000 "$1,000,000 None Included
Fiduciary Liability $200,000 "'$1,000,000 None Included
I Excess Liability No Coverage No Coverage '. N/A No Coverage.
Auto Liability No Coverage No Coverage None No Coverage
Medical Payments-Auto No Coverage No Coverage N/A No Coverage
Non-Owned/Hired Auto Liability No Coverage No Coverage None No Coverage'
IUninsured Motorist No Coverage No Coverage None No Coverage.
y 9 Coverage I9
Auto Physical Damage No Coverage No N/A No Coverage
Hired Auto Physical Damage No Coverage No Coverage
• Auto Physi al Damage-Employee $2,500 NN/A No Coverage
N/A
AIncluded
Deductible Reimbursement •
Total Contribution $1,438.00
* Employment Practices Liability Deductible: 50%of loss, subject to a maximum deductible of$100,000
each occurrence
"Cyber Liability and Fiduciary Liablity each have a$1,000,000 All Member Annual Aggregate Limit.
Additional endorsements that may be applicable to Member:
Public Entity Liability— No-Fault Water& Sewer Back
This Certificate Holder Declaration is made and is mutually accepted by the Pool and the Named Member
subject to all terms which are made a part of the Public Entity Liability Coverage Document This
Certificate represents a brief summary of coverages. Please refer to the Master Coverage Document for
actual coverage,terms, conditions,and exclusions.
Countersigned by: 4 W J apt Wednesday, December 21,2011
Authorized Representative
Entity IDA: 60237
Hello