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Home My WebLink About20120299.tiff Weld County, District Court WELD COUNTY 901 COMMISSIONERS 9th Avenue P.O. Box 2038 NI? JAN 25 A Il: 39 Greeley, Colorado 80632 (970) 351-7300 RECEIV ED IN THE MATTER OF MILLIKEN FIRE PROTECTION DISTRICT Court Use Only Attorneys for District Case No. 63 CV 15512 Richard N. Lyons, II Lyons Gaddis Kahn & Hall, PC P.O. Box 978, 515 Kimbark St. Division 1 Longmont, CO 80502-0978 Telephone: (303) 776-9900 Attorney Reg. Number: 09591 CERTIFICATE OF FILING OATH OF OFFICE AND SURETY BOND Milliken Fire Protection District, by its attorneys, and pursuant to §32-1-104, C.R.S., hereby submits the Oaths of Office for Board Director Roger Ainsworth who was appointed to replace the director seat vacated by resignation of Patricia Rand. See attached Exhibit A. The individual is covered for public officials' liability crime by a special district's insurance policy (surety bond). See attached Exhibit B. Dated: January 16, 2012 LYO A DIS KAHN & HALL, PC By /s/ Richard N. Lyons, II Richard N. Lyons, II pp s b0OL,5 l O r� IVU(53.""DA A A - a 2012-0299 CERTIFICATE OF SERVICE r, This is to certify that on January 16, 2012 a true and correct copy of the foregoing was filed with the Court and mailed by U.S. Mail, postab_ r` CTpc•; Weld County Clerk and Recorder 1402 N. 17th Ave. Greeley, CO 80631 Milliken Fire Protection District Att'n Maggie Prather, DEO P.O. Box 130 Milliken, CO 80543 And was also filed electronically with the Division of Local Lo Goo✓vprpment. 7/4 e /s/ Kyna Glover 2 OATH OF OFFICE (To be administered before EITHER the Board President/Chair OR a Notary Public) STATE OF COLORADO ) ss COUNTY OF WELD Roger Ainsworth , will faithfully support the Constitution of the United (Print Name) States and of the State of Colorado, and the laws made pursuant thereto, and will faithfully perform the duties of the office of Director of the Milliken Fire Protection District upon which I am about to enter. I` r Subscribed and sworn to before me this 12th day of January, 2012. Z;e4 President and Chairman STATE OF COLORADO ss. COUNTY OF SUBSCRIBED AND SWORN TO before me this day of , 2012, by Witness my hand and seal. My commission expires: Notary Public EXHIBIT OP ID:SW 'A L' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDITrfn 01113/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. •A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 970-586-7120 CONTANAME: Sarajane R.Gomez,C1C VFIS of Colorado 970-686-7131 Ia„e,mil,970-886-7120 ,1,,No 970-886-7131 3005 Center Green Dr„Ste 120 Boulder,CO 80301 ADDREss:sgomez@vfrsco.com Jerry Ward PRODUCER MILLI-2 CUSTOMER I0S: INSURERSS)AFFORDING COVERAGE NA(C f INSURED Milliken Fire Protection INSURER A:American Alternative Insurance District INSURERS: Po Box 130 INSURER C: Milliken,CO 80543 INSURER D: INSURER E: INSURER F: _ I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL Sties POLICY NUMBER Or3Dt'�r�' i'01TCY 1•XF I LINTS LTRINSR 1WIZ. I(MMIOD/YYYYI fMNMDDIYYYY) GENERAL IJABWTY I EACH OCCURRENCE s 1,000,000 A X COMMERCIAL GENERAL !VFIS TR-2053276 05101//1 05101/12 -D'vN°G`ItiRENrE0 1,000,000' PREMISES(Ee occurtenee) S CIA -MADE I X1 OCCUR ^MED EXP(Any one person) S -10,000 • PERSONAL&ADV INJURY $ 1,000,000 . GENERAL AGGREGATE S 3,000,000 GEN'L AGGREGATE LIMY APPLIES PER PRODUCTS-COMP/OP AGG a 3,000,000 POLICY E7 JPFRG 7 LOC - S AUTOMOBILE LIABILITYCOMBINED SINGLE LPATT $ f' (Es accident) ANY AUTO •• -' BODILY INJURY(Per Penton) Y ALL OWNED AUTOS— BODILY INJURY(Per accident) B SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) NON-OWNED AUTOS a — UMBRELLA UA$ OCCUR EACH OCCURRENCE S — EXCESS UAB CLAMS-MADE AGGREGATE a DEDUCTIBLE B RETENTION E __ a WORKERS COMPENSATION OTH- AND Ia1PWYERS'LIABILnY V N -... I WC STATu-TORY LIMITS ER ANY PROPRIETORIPARTNFR/PJCECU WF E.L.EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? N I A (Mandatory In NH) EL.DISEASE-EA EMPLOYEE$ Ryes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMB I,S A Crime VFIS-CM-1052001 j 05/01/11 05/01/12 I EXHIBIT DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(Adam ACORD 101,Additional Remarks Schedule,I)mom space Ic required) Position Schedule:eChie:Director 3-with $5K, Treasurer 1 -an .President 1-$100K,Fire Chief i-$100K.with faithful performance. _FL_ CERTIFICATE HOLDER CANCELLATION DEPARO5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Department of Local Affairs THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Division of Local Government ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE gA4E' ®1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD _____.-....,1 OP ID:BW ,d►��®e CERTIFICATE OF LIABILITY INSURANCE DATE,MNDOmm) 01/13112 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. This CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: lithe certificate holoer is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the tens and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). VF)PRODUCER of redo 970-686-7120 NN�ae Sarajane R.Gomez,CIC 3006 Center Green Dr.,Ste 120 970-886-7131 PNONh•s„D.970.686-7120I M,No 970-686-7131 Boulder,CO 80301R4AIL Ane;lo eye,agomez@aefisco.com ,lorry Ward CUSTORPR ED It MILLI-2 NSURER(5)AFFORDING COVERAGE 1 NAIL!, INSURE° Milliken Fire Protection NsuRER A,American Alternative Insurance --I DietriCt INSURER B: Po Box 130 INSURER C: I Milliken,CO 80543 INSURER D: INSURER E: li INSURER F: r COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS LS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE,POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. !Ili TYPE OF INSURANCE IADOL SUER N 11'bi YEMMf-"'115CCVIfRP I - LTR SR VAm POLICY NUMBER eateriOKYYYI IMNmc/YTYr1 LAWS IF;t7ARILITY I EACH OCCURRENCE a 1,000,000 A X CMa1E�OLAL GENERAL LIABILITY VFIS-TR-2053276 , 05101N1 05101/12 D"°"AL'E ro NtNran PITEMISES(Ea ocaMReXe+ 3 1,000,000 CLAaF MACE CI OCCUR situ ExP Ow one parson) S 10.000 PERSONAL&AM/INJURY S 1,000,000 GENERAL AGGREGATE 1 3,000,000 GM.AGGREGATE Leer APPLIES PER Pax( PRODUCTS-COMPIOP AGG 1 3.000,000 - 1 I'M I I'M 7LOc i I � 3 AYTONO00.E LTAtILITY COMBINED SINGLE OUT (Ea UCUNS t) 3 ANYALITD scow(INJURY(Per;neon) 3 ALL OARED AUTOS 800ILY INJURY(Per.cadent) S SCHEDULED AUTOS HIRED AUTOS •{ PROPERTY DAMAGE I (Per emeanD NON•ONWEDAUTOS 3 .. _.. I3 IROORELLA URA OCCUR EACH OCCURRENCE I3 EXCESS DABCIAed^5.MRDE _..... AGOREOATE j3 — _OEM CABLE RETENTION S ___Lo`.__ 1E WORKERS COMPENSATION I7(1RYI W17SI IE P4, ANC EMPLOYERS"LNMLTTY TIN ) ANY PROPRIETORPARTNERIF, U'TN n E E EACH ACCIDENT 1 S OFFICERMELHR EXCLUDED, NIA I IllLa�an�dNery in NH) E.L DISEASE-EA EMPLOYEE 3 DEScWPTIONOF OPEITATIONS Won EL DISEASE-POLICY LS3TT f.1 A Crime VMS-CM•1052001 05/01/11 08101/12 r OES(7UPT10N OF OPERATORS!LOCATIONS IVEIRCLBS MINIM AMID lei,Addelooel Ramarka BHHAW.,d mem epage is...wind; Position Schedule:Director 3-$5K, Treasurer 1-S25K,President 1-$100K,Fire Chief 1-$100K.with faithful performance. CERTIFICATE HOLDER CANCELLATION DEPAROS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Department of Local Affairs THE EXPIRATION BATE THEREOF, NOTICE WILL BE DELIVERED IN Division of Local Government ACCORDANCE WRIT THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE v I El 1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD Hello