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Home My WebLink About20121374.tiff { DISTRICT COURT, WELD COUNTY, OUNTY STATE OF COLORADO 1%OMMISSIONER$ Court Address: IOU MAY 2 P (2 3b RECEIVED Phone Number: COURT USE ONLY IN RE THE MATTER OF CARBON VALLEY PARK AND RECREATION DISTRICT Case Number: Attorney: Paul Rufien, P.C. 3600 S. Yosemite St. Div.: No. Ctnn.: Suite 500 Denver, CO 80237 Phone Number: 303-779-0200 Fax Number: 303-779-3662 E-mail: paulrufien@aol.com Attorney No. OATH OF OFFICE I, Brenda Hall will faithfully support the Constitution of the United 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 Carbon Valley Park and Recreation District upon which I am about to enter. Signature STATE OF COLORADO ) ) ss. COUNTY OF WELD Subscribed and sworn to before me this 16 day of ay, 20ITT, b Mollie Wright. Person aut orized to ad mister oaths (County Clerk and ecorder, Cler f the Court. Notary Public, Chairman, any other person authorized to administer o ths) " Title:` A44 h a ; Liazpi My commission expires:/ /5 C�,�mmwv bla—‘O)(15 2012-1374 e& CX7_ e is Sjhoc5 2 Colorado Q. Driver License 04-145-0649 Expires:03-15-2014 Class R Issued: 03-3,0-2009 ',cat f End: M DOB Or 5-19 0 „ t Rest PreviousT gpe:A t HL504 Wt.145 Eyes. Ha S Voter Y BRENDA JOYCE HALL - dag -- 13995 C00K STREET F _. THORNTON,CO 80602 DISTRICT COURT, WELD COUNTY, STATE OF COLORADO Court Address: Phone Number: COURT USE ONLY IN RE THE MATTER OF CARBON VALLEY PARK AND RECREATION DISTRICT Case Number: Attorney: Paul Rufien, P.C. 3600 S. Yosemite St. Div.: No. Ctrm.: Suite 500 Denver, CO 80237 Phone Number: 303-779-0200 Fax Number: 303-779-3662 E-mail: paulrufien@aol.com Attorney-No. OATH OF OFFICE I, Michael Schiers will faithfully support the Constitution of the United 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 Carbon Valley Park and Recreation District upon which I am about to enter. j Signature STATE OF COLORADO ) ) ss. COUNTY OF WELD ) Subscribed and sworn to before me this 16 day of Ma j, 20 by Mollie,Wright. Person autho ized to administ6 oaths (County Clerk and Recorder, Clerk d th Court, Notary Public, Chairman, any other person authorized to administer oaths} Title:S � 4_ L(/ ( /1-(LP My commission expires: /5 r ri_Y_ 4 7. 99-O625P'n" { ° :+ Ht sr we 260 n Eye::H� Set M :..a voter: V SSN:48446-7329 li MICHAEL RAY SCHIERS . 5451 BOBCAT ST FREDERICK CO 80530 DISTRICT COURT, WELD COUNTY, STATE OF COLORADO Court Address: Phone Number: COURT USE ONLY IN RE THE MATTER OF CARBON VALLEY PARK AND RECREATION DISTRICT Case Number: Attorney: Paul Rufien, P.C. 3600 S. Yosemite St. Div.: No. Ctrm.: Suite 500 Denver, CO 80237 Phone Number: 303-779-0200 Fax Number: 303-779-3662 E-mail: paulrufien@aol.com Attorney No. OATH OF OFFICE I, Jeff Johnson will faithfully support the Constitution of the United 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 Carbon Valley Park and Recreation District upon which I am about to enter. J /-7, .1(c_X.41-7-1-- /Signa STATE OF COLORADO ) /% ) ss. COUNTY OF WELD ) Subscribed and sworn to before me this 16 day of r, 701_, by Mollie/Wright. i a � Person auth rized to admin�i�st oaths (County Clerk and ecorder, Clerk S" e Court, Notary Public, Chairman, any other person authorized to administer o ) Title: ( _/ CI4 .-7 pidcii O_, My commission expires: , / Colorado Driver License 92-114-6528 Expires:08-24-2013 '54 s Class R - Issued 06-06-2006 rt cc End: DOB:- 0824-1941,- L. x." Rest V Previous Type::A " 44 ti Ht.6'00"Wt 240 Eyes: BLU Voter ' . . JEFFREY A JOHNSON 101 FLORA CT FREDERICK.CO80530 SPECIAL DISTRICT TRANSPARENCY NOTICE-2012 Annual Senate Bill 87-09-0807 } �t �: -4,,e;,,,,,,,-,: .. ,;4. Carbon Valley Park and Recreation District ^` • ' <. , f+a :fi: '701 5th Street, Frederick, CO 80530 303-833-3660 ' Y0.'.. J' -\ • i ♦Y ,,k rt £ • ` n, - >,i, Renee'Witty, Executive Director, 303-833-3660 S i i' 21. .Kti{: fpp fir`' tr 7' 1st and 3rd Wednesday at T00 pm, 701 5th Street, "' Frederick, Co 80530, Community Room " f ' g : Carbon Valley Recreation Center, Dacono City Hall, ` 4 kw ::4 ., ,1-44,,,./J17 t Firestone Post Office. x � u 6.657 mills, for levy in yeary 2011 '' 2,016,398.45 n;. (1) Jeff Johnson-Frederick (2) Brenda Hall-Firestone H This office will be on May 2016 ballot. This office will be on May 2016 ballot. ,Two-year term 'Four-year Term -Two-year term 'Four-year Term (3) Anthony Onorato, Jr.-Firestone (4) Mike Schiers-Frederick ./This office will be on May 2014 ballot. This office will be on May 2016 ballot. ,Two-year term 'Four-year Term Two-year term 'Four-year Term (5) Christopher RiverAT Large (6) Connie Marshall-Dacono VThis office will be on May 2014 ballot. 'This office will be on May 2014 ballot. Two-year term 'Four-year Term iTwo-year term J Four-year Term (7) Mary Collard-Dacono 'This office will be on May 2014 ballot. ,Two-year term 'Four-year Term „. 4x. <s May 2, 2014 ° ` , 7:‘;$40444007.7!: Name: Renee'Witty '' ' Contact information: 701 5th Street, Frederick, CO « ,, —‘4".''',4,4%. 80530 303-833-3660 ` Name: Renee'Witty sp € '*'Contact information: 701 5th Street, Frederick, CO 'tth1:y k � „ ...� " 80530 303-833-3660 W'"+ If s must 1e '' • ,t .. Not applicable until 2014. be onQ; Secretary of State:www.sos.state.co.us *p" <t' /r=.. 4 District or other website: www.recdistrict.com '' ''" l'At mail-in may be obtained from: Weld County Clerk and Recorder k or online from Secretary of State: ,� , ,: xwww.elections.colorado.gov i. ' "' may be returned to: Weld County Clerk and Recorder Name: Renee' Witty Notice Date: 5/12/12 °�_ Z„Title: Executive Director �e _ , E-mail: renee@recdistrict.com * / \ Carbon Valley S-t\.° A Recreation District c�P�� • l�s 701 5th Street 49)5"- Frederick, Colorado 80530 / A \ (303) 833-3660 * - CARBON VALLEY-* BOARD OF DIRECTORS DISTRICTS NAME &ADDRESS CONTACT TERM IN OFFICE District Anytime (303) 833-4249 Mary Collard 1 PO Box 313/1080 Glendale Cr, May 2010 to May 2014 E-mail: Dacono, CO 80514 Dacono marycollard97@yahoo.com District' Evening (303) 833-3646 Connie Marshall 1 913 Glen Heather Ct. May 2010 to May 2014 E-mail: Dacono Dacono, CO 80514 clmarshall99@comcast.net District Jr. Day (303) 833-9982 Anthony Onorato Jr. 2 PO Box 157/242 Monmouth E-mail: May 2010 to May 2014 Firestone Firestone, CO 80520 teonorato@msn.com District IAnytime (720) 340-4783 Brenda J. Hall \ 2 5163 Remington Ave. E-mail: May 2012 to May 2016 Firestone, CO 80504 bjhall315@aol.com Firestone District Anytime (303) 833-0958 Jeff Johnson 3 101 Flora Ct. E-mail: May 2012 to May 2016 Frederick, CO 80530 jeff@systemsaverinc.com Frederick District Anytime (720) 353-2828 Michael R. Schiers 3 5451 Bobcat St. May 2012 to May 2016 E-mail: Frederick, CO 80504 Frederick michael@schiers.com District Chris Rivera Day (303) 589-9959 4 3605 Morningside Circle May 2010 to May 2014 Frederick, Colorado 80516 E-mail: At Large rivev290@omail.com OFFICERS OF THE BOARD CONTACT PERSON ATTORNEYS President Renee' M. Witty Paul Rufien PC Vice President Executive Director 3600 South Yosemite Treasurer 701 5th Street Suite 500 Secretary Frederick, Colorado 80530 Denver, Colorado 80237 Accountant-Mollie Wright P.A. 303-651-9033 303-833-3660 303-779-0200 CERTIFICATE OF COVERAGE Certificate#: 3474 Administrator THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN Colorado Special Districts Property and Liability Pool THOSE PROVIDED IN THE COVERAGE DOCUMENT. THIS CERTIFICATE P.O. Box 1539 DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE COVERAGE DOCUMENTS LISTED HEREIN. Portland OR 97207-1539 --- --------- --------- - COMPANIES AFFORDING COVERAGE NAMED MEMBER — COMPANY A Colorado Special Districts Property and Liability Pool Carbon Valley Park and Recreation District COMPANY B General Reinsurance Corporation 701 5th Street -. . --_.. —... --_-._ - _. • Frederick, CO 80530 COMPANY C Certain Underwriters at Lloyd's, London • COMPANYD COVERAGES !This is to certify that coverage documents listed herein have been issued to the Named Member herein for the Coverage period indicated. Nothwithstanding any requirement,term or condition of any contract or other document with respect to which the certificate may be issued or may pertain,the coverage afforded by the coverage documents listed herein is subject to all the terms,conditions and exclusions of such coverage documents. CO Type of Coverage Coverage# Effective Date Expiration Date Limits ILTR General Liability 25C12651-73 1 1/1/2012 • 1/1/2013 General Aggregate Unlimited A, �� 'Except that for claims,occurrences or suits to which the Each Occurrence` $1,000,000 B X Commercial General Liability monetary limits of the Colorado Governmental Immunity Act, X Public Officials Liability C.R.S.24-10-101,et.seq.,as amended,apply,there shall be a further sublimit of(a)$150,000 for an injury to any one person in I X Employment Practices any single occurrence;and(b)$600,000 for an injury to two or . _ more persons in any single occurrence;but in the event of an X I Occurrence injury to two or more persons in any single occurrence,the sublimit shall not exceed$150,000 for each injured person. Automobile liability 2501265 -73 1/1/2012 1/1;2013 Occurrence' A _._...... �..,,,�...,1 v Each�.... _. $1,000,000 B i • Scheduled Autos "---------'-- --- _ lI X Hired Autos • X Non-Owned Autos Auto Physical Damage 25C12651-73 1/1/2012 1/1/2013 See below if applicable. A, • C ; x Scheduled Autos i X Hired Autos Excess Liability 25C1265173 1/1/2012 1/1/2013 General Aggregate Unlimited A' Each Occurrence $2,000,000 B X Other Than Umbrella Form --- 25C12651-73 1/1/2012 1/1/2013 See below if A, Property applicable. C X , 'DESCRIPTION Evidence of Coverage in force • • CERTIFICATE HOLDER CANCELLATION:SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN • li To Whom It May Concern ACCORDANCE WITH THE POLICY PROVISIONS. By Joseph E. DePaepe ( Date: 5/10/2012 Linked Automobiles VIN Description Make Value 1FBS531L71HB12668 E350 Van Ford $ 0,000.00 1GCCS1459281fi9344 S-10 Chevrolet $10,000.00 1 FTNF21LX2EC57214 F250 Ford $12,893.00 1FDKE30G4PH71041 Terra Transit Bus Ford $$8,500.00 1 N9TA16ASWLO13124 Bus NEO $8,500.00 SFWUS0818R00360 Utility Trailer DIA $5,000.00 1MDFHLJ17YA118728 Trailer Utility $5,000.00 Linked Inland Marine Items IM Code Description Serial# Value Craftsman 46"Riding Lawn Mower 0409070008759 $3,000.00 01 4x2 Gator W004X2054104 $4,977.00 02 2002 Kabota Tractor 77534 03 $25,000.00 2003 Quest 500 2x4 Red Machine w/plow 2BVCHHD1X3V000119 $4,783.00 04 Hardware,Software $162,000.00 John Deere 72'Deck Lawn Mower FX751VA01777 $4,000.00 John Deere Gator TX W04X2XD0317S2 $6,000.00 Linked Properties Property Code Location Address Value Gym 6615 Frederick Way $2,601,255.00 01-01 Recreation Facility 701 Street 5th $9,575,z74.Oti 02-01 BMX Motoshed Forest Avenue 518,891.13 03-01 Baseball Field Concession/storage 6th&Walnut $3,778.23 01-02 Garage#1 701 5th Street $22,915.77 01-03 Garage#2 701 5th Street $29,222.65 02-02 BMX Shed&concession Forest Avenue $6,297.04 03-02 Batting Cage 6th&Walnut $7,4 Storage Shed#2 701 5th Street $7,4554.4.113 3 Storage Shed#3 701 5th Street Storage Shed#4 $4,587.16 701 5th Street $4,587.16 Storage Shed#1 701 5th Street $2,866.97 CERTIFICATE OF COVERAGE Certificate#: 3474 Administrator THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN Colorado Special Districts Property and Liability Pool THOSE PROVIDED IN THE COVERAGE DOCUMENT. THIS CERTIFICATE P.O. Box 1539 DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE COVERAGE DOCUMENTS LISTED HEREIN. Portland OR 97207-1539 - --- COMPANIES AFFORDING COVERAGE NAMED MEMBER COMPANY A Colorado Special Districts Property and Liability Pool Carbon Valley Park and Recreation District !i COMPANY B General Reinsurance Corporation 701 5th Street -------- Frederick, CO 80530 �'COMPANY C Certain Underwriters at Lloyd's, London COMPANY D - COVERAGES 'I This is to certify that coverage documents listed herein have been issued to the Named Member herein for the Coverage period indicated. Nothwithstanding any requirement,term or condition of any contract or other document with respect to which the certificate may be issued or may pertain,the coverage afforded by the coverage documents listed herein is subject to all the terms,conditions and exclusions of such coverage documents, CO Type of Coverage Coverage# Effective Date Expiration Date Limits LTR • General Liability 25C12651-73 1/1/2012 l 1/1/2013 General Aggregate Unlimited A, *Except that for claims,occurrences or suits to which the Each Occurrence' 51,000,000 B X li Commercial General Liability monetary limits of the Colorado Governmental Immunity Act, X Public Officials Liability C.R.S.24-10-101,et seq.,as amended,apply,there shall be a further sublimit of(a)$150,000 for an injury to any one person in X (Employment Practices any single occurrence;and(b)$600,000 for an injury to two or more persons in any single occurrence;but in the event of an x I Occurrence injury to two or more persons in any single occurrence,the sublimit shall not exceed$150,000 for each injured person. Automobile Liability 25012551 73 111/2012 1/112013 Each Occurrence* 51,000,000 X Scheduled Autos X Hired Autos X Non-Owned Autos Auto Physical Damage 25012651-73 1/1/2012 1/1/2013 See below if applicable. -. A, _ C ' X Scheduled Autos I X Hired Autos • Excess Liability 25C12651 73 1/1/2012 1/1/2013 General Aggregate Unlimited A B X Each Occurrence• $2,000,000 Other Than Umbrella Form ------ --- II, A, Property 25C12651-73 1/1/2012 1/1/2013 See below if applicable. C X DESCRIPTION Evidence of Coverage in force ;CERTIFICATE HOLDER CANCELLATION:SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN To Whom It May Concern ACCORDANCE WITH THE POLICY PROVISIONS. I By Joseph E DePaepe f Date: 5/10/2012 Linked Automobiles YIN Description Make Value 1FBSS31L71HB12668 E350 Van Ford $20,000.00 1GCCS145928169344 5-10 Chevrolet $15,695.00 1FTNF21 LX2EC57214 F250 Ford $15,695.00 1FDKE30G4PH71041 Terra Transit Bus Ford $22,893.00 1N9TA16A5WLO13124 Bus NEO $8,500.00 5FWUS0818R00360 Utility Trailer DIA 81,800.00 1MDFHLJ17YA118728 Trailer Utility 55,000.00 Linked Inland Marine Items IM Code Description Serial# Value Craftsman 46"Riding Lawn Mower 0409070008759 $3,000.00 01 4x2 Gator W004X2054104 $4,977.00 02 2002 Kabota Tractor 77534 03 $25,000.00 2003 Quest 500 2x4 Red Machine w/plow 2BVCHHD1X3V000119 $4,783.00 04 Hardware,Software $162,000.00 John Deere 72 Deck Lawn Mower FX751VA01777 $4,000.00 John Deere Gator TX W 04X2XD0317S2 $6,000.00 Linked Properties Property Code Location Address Value Gym 6615 Frederick Way $2,601,255.00 01-01 Recreation Facility 701 5U.Shat $9,575,274.06 02-01 BMX Motoshed Forest Avenue $18,891.13 03-01 Baseball Field Concession/storage 6th&Walnut $3,778.23 01-02 Garage#1 701 5th Street $22,915.77 01-03 Garage#2 701 5th Street $29,222.65 02-02 BMX Shed&concession Forest Avenue $6,297.04 03-02 Batting Cage 6th&Walnut $7,4 Storage Shed#2 701 5th Street $7,454.13 4. 3 Storage Shed#3 701 5th Street $4,587.16 Storage Shed#4 701 5th Street $4,587.16 Storage Shed#1 701 5th Street $2,866.97 I CERTIFICATE OF COVERAGE Certificate#: 3474 Administrator I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN I Colorado Special Districts Property and Liability Pool I THOSE PROVIDED IN THE COVERAGE DOCUMENT. THIS CERTIFICATE P.O. Box 1539 i DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY I THE COVERAGE DOCUMENTS LISTED HEREIN. • Portland OR 97207-1539 I COMPANIES AFFORDING COVERAGE NAMED MEMBER COMPANY A Colorado Special Districts Property and Liability Pool Carbon Valley Park and Recreation District i COMPANY B General Reinsurance Corporation l 701 5th Street i Frederick, CO 80530 COMPANY c Certain Underwriters at Lloyd's, London 'CO I COMPANY O I COVERAGES This is to certify that coverage documents listed herein have been issued to the Named Member herein for the Coverage period indicated. Nothwithstanding any !i requirement,term or condition of any contract or other document with respect to which the certificate may be issued or may pertain,the coverage afforded by the coverage I documents listed herein is subject to all the terms,conditions and exclusions of such coverage documents. CO Type of Coverage Coverage# Effective Date Expiration Date Limits .LTR General Liability 25012651-73 1/1/2012 1/1/2013 General Aggregate Unlimited A •Except that for claims,occurrences or suits to which the Each Occurrence* $1,000,000 B X I, Commercial General Liability monetary limits of the Colorado Governmental Immunity Act, X Public Officials Liability C.R.S.24-10-101,et.seq.,as amended,apply,there shall be a further sublimit of(a)$150,000 for an injury to any one person in ' X Employment Practices any single occurrence;and(b)$600,000 for an injury to two or - - --- more persons in any single occurrence;but in the event of an X Occurrence injury to two or more persons in any single occurrence,the sublimit shall not exceed$150.000 for each injured person. Automobile Liabi!ity 25012651 73 1/1/2012 1/1/2013 Each Occurrence' A $1,cco occ B X Scheduled Autos - X Hired Autos - i X Non-Owned Autos Auto Physical Damage 25012651-73 1/1/2012 1/1/2013 See below if applicable. C ' x I Scheduled Autos ----- I I X Hired Autos Excess Liability 25012651-73 1/1/2012 1/1/2013 General Aggregate Unlimited A' -- Each Occurrence* $2,000,000 B I X Other Than Umbrella Form . ---- A, Property 25012651-73 1/1/2012 1/1/2013 See below if applicable. C I X DESCRIPTION Evidence of Coverage in force • CERTIFICATE HOLDER CANCELLATION:SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED I BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ll To Whom It May Concern ACCORDANCE WITH THE POLICY PROVISIONS. I By: Joseph E. DePaepe -----Date: 5/10/2012 Linked Automobiles VIN Description .M4ake 1FBSS31L71HB12668 E350 Van Value Ford $20,000.00 1GCCS145928169344 3-10 Chevrolet 1 FTNF21LX2EC57214 F250 $15,695.00 Ford $15,695.00 1FDKE30G4PH71041 Terra Transit Bus Ford 1N9TA16A5WLO13124 Bus NEO $ ,893.00 $8,500.00 5FWUS0818R00360 Utility Trailer DIA IMDFHLJ17YA118728 Trailer $1,800.00 Utility $5,000.00 Linked Inland Marine Items IM Code Description Serial# Value Craftsman 46"Riding Lawn Mower 0409070008759 $3,000.00 01 4x2 Gator W004X2054104 02 $4,977.00 2002 Kabota Tractor 77534 $25,000.00 03 2003 Quest 500 2x4 Red Machine w/plow 2BVCHHD1X3V000119 04 $4,783.00 Hardware,Software $162,000.00 John Deere 72'Deck Lawn Mower FX751VA01777 $4,000.00 John Deere Gator TX W04X2XD0317S2 $6,000.00 Linked Properties Property Code Location Address Value Gym 6615 Frederick Way $2,601,255.00 01-01 Recreation Facility 701 5th Street $9,575,274.06' 02-01 BMX Motoshed Forest Avenue 03-01 513,773 Baseball Field Concession/storage 6th&Walnut $3,778.23 01-02 Garage#1 701 5th Street $22,915.77 01-03 Garage#2 701 5th Street 02-02 $$6,297.04 BMX Shed&concession Forest Avenue $6,297.04 03-02 Batting Cage 6th&Walnut Storage Shed#2 $9,319.62 5th Street $7,454.13 701 Storage Shed#3 701 5th Street Storage Shed#4 $4,587.16 701 5th Street $4,587.16 Storage Shed#1 701 5th Street $2,866.97 CERTIFICATE OF COVERAGE Certificate#: 3474 Administrator THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND I:CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN Colorado Special Districts Property and Liability Pool THOSE PROVIDED IN THE COVERAGE DOCUMENT. THIS CERTIFICATE P.O. Box 1539 DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE COVERAGE DOCUMENTS LISTED HEREIN. Portland OR 97207-1539 - - - -COMPANIES AFFORDING COVERAGE NAMED MEMBER COMPANY A Colorado Special Districts Property and Liability Pool Carbon Valle Park and Recreation District ',COMPANY B General Reinsurance Corporation Valley 701 5th Street Frederick, CO 80530 'COMPANY C Certain Underwriters at Lloyd's, London I COMPANY D COVERAGES -_ - This is to certify that coverage documents listed herein have been issued to the Named Member herein for the Coverage period indicated. Nothwithstanding any requirement,term or condition of any contract or other document with respect to which the certificate may be issued or may pertain,the coverage afforded by the coverage documents listed herein is subject to all the terms,conditions and exclusions of such coverage documents. i CO Type of Coverage Coverage# Effective Date Expiration Date Limits LTR X iabil General Liability 25C12651-73 1/1/2012 I 1/1/2013 General Aggregate Unlimited A, that limits claims, laimsGovernmental Occurrence _--- General Liability *Except ,00raroGov rnmenor sto which theEach Occurrence' $1,000,000 B monetary Colorado Governmental Immunity Act, — ----- - X Public Officials Liability C.R.S.24-10-101,et.seq.,as amended,apply,there shall be a _ further sublimit of(a)$150,000 for an injury to any one person in X Employment Practices any single occurrence;and(b)$600,000 for an injury to two or - '-- __ _. more persons in any single occurrence;but in the event of an X Occurrence injury to two or more persons in any single occurrence,the sublimit shall not exceed$150,000 for each injured person. Automobile i ieurr„ 25C12551-73 111/2012 1/112013 Each Occurrence, 00^0 a , c6 A, B X Scheduled Autos -- -- - X Hired Autos X Non-Owned Autos Auto Physical Damage 25C12651-73 1/1/2012 1/1/2013 See below if applicable A, C x I Scheduled Autos X 1 Hired Autos Excess Liability 25C12651-73 1/1/2012 1/1/2013 General Aggregate Unlimited B Each Occurrence $2,000,000 X Other Than Umbrella Form -- -- -- --- -_- A Property 25C12651-73 1/1/2012 1/1/2013 See below if applicable. C X DESCRIPT ION Evidence of Coverage in force CERTIFICATE HOLDER CANCELLATION:SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN To Whom It May Concern ACCORDANCE WITH THE POLICY PROVISIONS. • By. Joseph E. DePaepe ( � __.- Date: 5/10/2012 Linked Automobiles VIN Description Make 1FBS531L71HB12668 E350 Van Value Ford $20,000.00 1GCCS145928169344 S-10 Chevrolet 1FTNF21LX2EC57214 F250 $15,695.00 Ford $15,695.00 1 FDKE30G4RH7lo41 Terra Transit Bus Ford $22,893.00 1N9TA16A5WLO13124 Bus NEO 5FWUS0818R00360 Utility Trailer $8,500.00 DIA $1,800.00 1MDFHLJ17YA118728 Trailer Utility $5,000.00 Linked Inland Marine Items IM Code Description Serial# Value Craftsman 46"Riding Lawn Mower 0409070008759 $3,000.00 01 4x2 Gator W004X2054104 02 $4,977.00 2002 Kabota Tractor 77534 $25,000.00 03 2003 Quest 500 2x4 Red Machine w/plow 2BVCHHD1X3V000119 04 $4,783.00 Hardware,Software $162,000.00 John Deere 72'Deck Lawn Mower FX751VA01777 $4,000.00 John Deere Gator TX W04X2XD0317S2 $6,000.00 Linked Properties Property Code Location Address Value Gym 6615 Frederick Way $2,601,255.00 01-01 Recreation Facility 701 St reet tree o. $9,575,274.06 02-01 BMX Motoshed Forest Avenue 518,891.13 03-01 Baseball Field Concession/storage 6th&Walnut 01-02 22,9 .77 Garage#1 701 5th Street $22,915.77 5 01-03 Garage#2 701 5th Street 02-02 $$6,297.04 BMX Shed&concession Forest Avenue $6,297.04 03-02 Batting Cage 6th&Walnut Storage Shed#2 $7,4 701 5th Street $7,454.13 4. 3 Storage Shed#3 701 5th Street Storage Shed#4 701 $4,587.16 5th Street $4,587.16 Storage Shed#1 701 5th Street $2,866.97 CERTIFICATE OF COVERAGE Certificate#: 3474 Administrator THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN ' Colorado Special Districts Property and Liability Pool THOSE PROVIDED IN THE COVERAGE DOCUMENT. THIS CERTIFICATE P.O. Box 1539 DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY • • THE COVERAGE DOCUMENTS LISTED HEREIN. Portland OR 97207-1539 -- --- - - - - COMPANIES AFFORDING COVERAGE NAMED MEMBER COMPANY A Colorado Special Districts Properly and Liability Pool Carbon Valley Park and ecreation District i COMPANY B General Reinsurance Corporation ' 701 5th Street — Frederick, CO 80530 COMPANY C Certain Underwriters at Lloyd's, London • I COMPANY D - _ - — --- • COVERAGES • This is to certify that coverage documents listed herein have been issued to the Named Member herein for the Coverage period indicated. Nothwithstanding any requirement,term or condition of any contract or other document with respect to which the certificate may be issued or may pertain,the coverage afforded by the coverage documents listed herein is subject to all the terms,conditions and exclusions of such coverage documents. CO Type of Coverage Coverage# ' Effective Date Expiration Date Limits .,LTR__. _._... General Liability 2 25012651-73 i 1/1/2012 1/1/2013 General Aggregate Unlimited A, "Except that for claims,occurrences or suits to which the Each Occurrence' $1,000,000 B X Commercial General Liability monetary limits of the Colorado Governmental Immunity Act, --- --- -- -- X Public Officials Liability C.R.S.24-10-101,e:.seq.,as amended,apply,there shall be a further sublimit of(a)$150.000 for an injury to any one person in X • Employment Practices• any single occurrence;and(b)$600,000 for an injury to two or --- - ------ ------more persons in any single occurrence;but in the event of an X Occurrence injury to two or more persons in any single occurrence,the sublimit shall not exceed$150,000 for each injured person. • Automobile Liability 25C12651.73 1/1/2012 _con O_currcncc* $1,000,000 B X Scheduled Autos —-- ---- X Hired Autos - _ ---- - _ - X Non-Owned Autos Auto Physical Damage 25012651-73 1/1/2012 1/1/2013 See below if applicable. C jxj Scheduled Autos X I Hired Autos ---' --- • L _ Excess Liability 25012651-73 1/1/2012 1/1/2013 General Aggregate Unlimited A, B Each Occurrence' $2,000,000 X Other Than Umbrella Form -- .--- • A, Property 25012651-73 1/1/2012 1/1/2013 See below if applicable. Cxl DESCRIPTION -- _ - _-- Evidence of Coverage in force CERTIFICATE HOLDER CANCELLATION:SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN To Whom It May Concern ACCORDANCE WITH THE POLICY PROVISIONS. By: Joseph E. DePaepe < / Date: 5/10/2012 Linked Automobiles VIN Description Make Value 1FB5531L71HB12668 E350 Van Ford $20,000.00 1GCCS145928169344 S-10 Chevrolet $10,000.00 1FTNF21LX2EC57214 F250 Ford $15,695.00 1FDKE30G4PH71041 Terra Transit Bus Ford $22,893.00 1 N9TA16A5WLO13124 Bus NEO $8,500.00 5FWUS0818R00360 Utility Trailer DIA 51,800.00 1MDFHLJ17YA118728 Trailer Utility $5,000.00 Linked Inland Marine Items IM Code Description Serial# Value Craftsman 46"Riding Lawn Mower 0409070008759 $3,000.00 01 4x2 Gator W004X2054104 $4,977.00 02 2002 Kabota Tractor 77534 $25,000.00 03 2003 Quest 500 2x4 Red Machine w/plow 2BVCHHDIX3V000119 $4,783.00 04 Hardware,Software $162,000.00 John Deere 72'Deck Lawn Mower FX751VA01777 $4,000.00 John Deere Gator TX W04X2XD0317S2 $6,000.00 Linked Properties Property Code Location Address Value Gym 6615 Frederick Way $2,601,255.00 01-01 Recreation Facility 701 5th Street $9,575,274.06 02-01 BMX Motoshed Forest Avenue $18,891.13 03-01 Baseball Field Concession/storage 6th&Walnut $3,778.23 01-02 Garage#1 701 5th Street $22,915.77 01-03 Garage#2 701 5th Street $29,222.65 02-02 BMX Shed&concession Forest Avenue $6,297.04 03-02 Batting Cage 6th&Walnut $9,319.62 Storage Shed#2 701 5th Street $7,454.13 Storage Shed#3 701 5th Street $4,587.16 Storage Shed#4 701 5th Street $4,587.16 Storage Shed#1 701 5th Street $2,866.97 CERTIFICATE OF COVERAGE Certificate#: 3474 • Administrator THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN Colorado Special Districts Property and Liability Pool THOSE PROVIDED IN THE COVERAGE DOCUMENT. THIS CERTIFICATE P.O. Box 1539 DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY i THE COVERAGE DOCUMENTS LISTED HEREIN. • Portland OR 97207-1539 — -- - --- -_- COMPANIES AFFORDING COVERAGE NAMED MEMBER COMPANY A Colorado Special Districts Property and Liability Pool Carbon Valley Park and Recreation District COMPANY B General Reinsurance Corporation 701 5th Street Frederick, CO 80530 COMPANY C Certain Underwriters at Lloyd's, London COMPANY D --- COVERAGES This is to certify that coverage documents listed herein have been issued to the Named Member herein for the Coverage period indicated. Nothwithstanding any I requirement,term or condition of any contract or other document with respect to which the certificate may be issued or may pertain,the coverage afforded by the coverage documents listed herein is subject to all the terms,conditions and exclusions of such coverage documents. CO Type of Coverage Coverage# ' Effective Date Expiration Date Limits • LTR General Liability 25C12651-73 1/1/2012 '� 1/1/2013 General Aggregate Unlimited A at thB T monetary limits ms, o ces or eint Io wmuhty Each Occurrence' $1,000,000 I X �Commercial General Liability the Colorado Governmental Immunity Act, -- - _ - -- -- -- - - X Public Officials Liability C.R.S.24-10-101.et.seq.,as amended,apply,there shall be a further sublimit of(a)$150,000 for an injury to any one person in X Employment Practices any single occurrence;and(b)$600,000 for an injury to two or —- - -- -- --- - more persons in any single occurrence;but in the event of an X j Occurrence injury to two or more persons in any single occurrence,the • sublimit shall not exceed$150,000 for each injured person. Automobile Liability 25012651-73 1/1/2012 1/2013 Each Occurrence' $$1,000,0000 -. A B --- X Scheduled Autos -- - -- - X I Hired Autos ---- - I X Non-Owned Autos -- - i Auto Physical Damage 25C12651-73 1/1/2012 1/1/2013 See below if applicable. A, C i x Scheduled Autos �XIl Hired Autos • - -- - -- - - - - Excess Liability 25012651-73 1/1/2012 1/1/2013 General Aggregate Unlimited A, Other Than Umbrella Form Each Occurrence' $2,000,000 B X • A, Property 25C12651-73 1/1/2012 1/1/2013 See below if applicable. C DESCRIPTION I Evidence of Coverage in force CERTIFICATE HOLDER CANCELLATION:SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 'BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN To Whom It May Concern ACCORDANCE WITH THE POLICY PROVISIONS. By: Joseph E. DePaepe � �� Date: 5/10/2012 Linked Automobiles VIN Description Make Value 1FBSS31L71H812668 E350 Van Ford 520,000.00 1 GCC5145928169344 S-10 Chevrolet $10,000.00 1FTNF21LX2EC57214 F250 Ford $15,695.00 1 FDKE30G4PH71041 Terra Transit Bus Ford $22,893.00 1 N9TA16A5WLO13124 Bus NEC $8,500.00 5FWUS0818R00360 Utility Trailer DIA $1,800.00 1MDFHLJ17YA118728 Trailer Utility 55,000.00 Linked Inland Marine Items IM Code Description Serial# Value Craftsman 46"Riding Lawn Mower 0409070008759 $3,000.00 01 4x2 Gator W004X2054104 $4,977.00 02 2002 Kabota Tractor 77534 $25,000.00 03 2003 Quest 500 2x4 Red Machine w/plow 2BVCHHD1X3V000119 54,783.00 04 Hardware,Software $162,000.00 John Deere 72'Deck Lawn Mower FX751VA01777 $4,000.00 John Deere Gator TX W04X2XD031752 $6,000.00 Linked Properties Property Code Location Address Value Gym 6615 Frederick Way $2,601,255.00 01-01 Recreation Facility te,,,,. Street 5th n 59,575,274.06 02-01 BMX Motoshed Forest Avenue S18,891.13 03-01 Baseball Field Concession/storage 6th&Walnut $3,778.23 01-02 Garage#1 701 5th Street $22,915.77 01-03 Garage#2 701 5th Street $29,222.65 02-02 BMX Shed&concession Forest Avenue $6,297.04 03-02 Batting Cage 6th&Walnut $9,319.62 Storage Shed#2 701 5th Street 57,454.13 Storage Shed#3 701 5th Street 54,587.16 Storage Shed#4 701 5th Street $4,587.16 Storage Shed#1 701 5th Street $2,866.97 CERTIFICATE OF COVERAGE Certificate#: 3474 Administrator I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN Colorado Special Districts Property and Liability Pool THOSE PROVIDED IN THE COVERAGE DOCUMENT. THIS CERTIFICATE P.O. Box 1539 DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE COVERAGE DOCUMENTS LISTED HEREIN. Portland OR 97207-1539 ---- - - - --- - -- -� COMPANIES AFFORDING COVERAGE NAMED MEMBER COMPANY A Colorado Special Districts Property and Liability Pool Carbon Valley Park and Recreation District COMPANY B General Reinsurance Corporation 701 5th Street ------ - - - I COMPANY C Certain Underwriters at Lloyd's, London Frederick, CO 80530 y COMPANY D• �! COVERAGES This is to certify that coverage documents listed herein have been issued to the Named Member herein for the Coverage period indicated. Nothwithstanding any • requirement,term or condition of any contract or other document with respect to which the certificate may be issued or may pertain,the coverage afforded by the coverage 'll documents listed herein is subject to all the terms,conditions and exclusions of such coverage documents. CO Type of Coverage Coverage# Effective Date Expiration Date Limits LTR 2 1265173 12 General General Liability -Except t that for claims,occurrences or suits to which the Each Occurrence Aggregate - -.. $1,000,0 ed A, X Commercial General Liability p $1,000,000 B monetary limits of the Colorado Governmental Act, -- --------'. X Public Officials Liability C.R.S.24-10-101,et seq.,as amended,apply,there shall be a further sublimit of(a)$150,000 for an injury to any one person in ' X I Employment Practices any single occurrence;and(b)$600,000 for an injury to two or — more persons in any single occurrence;but in the event of an X Occurrence injury to two or more persons in any single occurrence,the sublimit shall not exceed$150,000 for each injured person. Automobile Liability 25O12651-73 1/1/2012 11162013 Each Occurrence• $1,000,000 BX ',Scheduled Autos —-- ----- ---- - - rX •Hired Autos IX Non-Owned Autos Auto Physical Damage 25O12651-73 1/1/2012 1/1/2013 See below if applicable. lit A C x Scheduled Autos — - X Hired Autos Excess Liability 25O12651-73 1/1/2012 1/1/2013 General Aggregate Unlimited A' Each Occurrence $2,000,000 B X Other Than Umbrella Form --------- --------- A, Property 25O12651-73 1/1/2012 1/1/2013 See below if applicable. C x DESCRIPTION Evidence of Coverage in force CERTIFICATE HOLDER I CANCELLATION:SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN To Whom It May Concern ACCORDANCE WITH THE POLICY PROVISIONS. ill' By: Joseph E.DePaepe Ivy// Date: 5/10/2012 Linked Automobiles VIN Description Make Value 1FBS531L71HB12668 E350 Van Ford $20,000.00 1GCCS 145928169344 5-10 Chevrolet $10,000.00 1 FTNF21LX2EC57214 F250 Ford $15,695.00 1FDKE30G4PH71041 Terra Transit Bus Ford $22,893.00 1N9TA16A5WLO13124 Bus NEO $8,500.00 5FWU50818R00360 Utility Trailer DIA $1,800.00 1 MDFHLJ17YA116728 Trailer Utility $5,000.00 Linked Inland Marine Items IM Code Description Serial# Value Craftsman 46"Riding Lawn Mower 0409070008759 $3,000.00 01 4x2 Gator W004X2054104 $4,977.00 02 2002 Kabota Tractor 77534 $25,000.00 03 2003 Quest 500 2x4 Red Machine w/plow 2BVCHHD1 X3V000119 $4,783.00 04 Hardware, Software $162,000.00 John Deere 72'Deck Lawn Mower FX751VA01777 $4,000.00 John Deere Gator TX W04X2XD0317S2 $6,000.00 Linked Properties Property Code Location Address Value Gym 6615 Frederick Way $2,601,255.00 01-01 Recreation Facility 701 5th Street $9,575,274.06 02-01 BMX Motoshed Forest Avenue 818,891 13 03-01 Baseball Field Concession/storage 6th&Walnut $3,778.23 01-02 Garage#1 701 5th Street $22,915.77 01-03 Garage#2 701 5th Street $29,222.65 02-02 BMX Shed&concession Forest Avenue $6,297.04 03-02 Batting Cage 6th&Walnut $9,319.62 Storage Shed#2 701 5th Street $7,454.13 Storage Shed#3 701 5th Street $4,587.16 Storage Shed#4 701 5th Street $4,587.16 Storage Shed#1 701 5th Street $2,866.97 Hello