The URL can be used to link to this page

Browse Search

Home My WebLink About20201987.tiff 4 ��)rinck - FIRF.S1o1 FREDERICK- FIRESTONE i� J �- -- _� Administration FIRE PROTECTION Office: (303) 833-2742 DISTRICT $tiff4 1 Fax: (303) 833-3736 F. Email: dingraham@fffd.us i ,A EIRE BOARD OF TRUSTEES RECEIVED OATH OF OFFICE MAR 0 7 2020 32-1-viii, %. rt .S., arid Colorado Constitution Article 12, §9 WELD COUNTY STATE OF COLORADO COMMISSIONERS WELD COUNTY FREDERICK- FIRESTONE FIRE PROTECTION DISTRICT VOLUNTEER FIREFIGHTERS' PENSION FUND I , Duane Roller , 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 Trustee of the Frederick- Firestone Fire Protection District Volunteer Firefighters' Pension Fund , upon which I am about to enter. (signature of oath taker) Subscribed and sworn to before me this 10th day of February , 20 20 . ant- ( Persol authorized to administer oaths ) IF SWORN OR AFFIRMED BEFORE A NOTARY THE FO ED . DALE ROB I STATE OF COLORADO NOTARY PUBLIC STATE OF COLORADO ) ss . NOTARY ID 20044034067 COUNTY OF WELD My Commission Expires Sept. 23, 2020 Subscribed and sworn to before me this i0 day of dr_)r u,ctr , 20 l AIL 24;a0 SlyttlynO c9 /c2 .3 2o, C Notary Signature Notary commission expiration 8426 Kosmerl Place, Frederick, Colorado, 80504-5444, www. fffd.us GoMMun ; Cc1/4t- : o ,rt5 2020 - 1987 97 / 13 /ao SDooLI6 ---""� FREDFIR-01 LKLIESEN AkMa CERTIFICATE OF LIABILITY INSURANCE DATE {MM/DD/YYYY) �••---�'" 2/11 /2020 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 have ADDITIONAL INSURED provisions or 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 CONTACT NAME: T. Charles Wilson Insurance Service PHONE 303 368-5757 FAX 303 368-5863 384 Inverness Parkway Suite 170 (A/c, No, Ext): (303) (A/C, No): (303) Englewood, CO 80112 E-MAIL info@wilsonins .com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : RLI Insurance Company INSURED INSURER B : Frederick Firestone Fire Protection District INSURER C : PO Box 129 INSURER D : Frederick, CO 80530 INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) , (MM/DD/YYYY1 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person; $ PERSONAL & ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ PRO- POLICY JECT LOC PRODUCTS - COMP/OP AGG $ OTHER $ AUTOMOBILE COMBINED SINGLE LIMIT LIABILITY (Ea accident) $ ANY AUTO BODILY INJURY ;Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) S HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident, _ $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION S $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y I N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED'? N IA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes; descnbe under DESCRIPTION OF OPERATIONS below , E.L. DISEASE - POLICY LIMIT $ A 3 Year Bond LSM0572052 6/1 /2017 6/1 /2020 3 year bond 25,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached if more space is required) Public Official Position Schedule Bond 5 Directors @ $5,000 each CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE —17<frffe. ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION . All rights reserved . The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: !!! 1h1 .01 LKLIESEN LOC #: ACORD ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED T. Charles Wilson Insurance Service Frederick Firestone Fire Protection District PO Box 129 POLICY NUMBER ~ Frederick, CO 80530 Weld SEE PAGE 1 CARRIER NAIC CODE SEE PAGE 1 SEE P 1 EFFECTIVE DATE: SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE : Certificate of Liability Insurance Public Official Position Schedule Bond ACORD 101 (2008/01 ) © 2008 ACORD CORPORATION . All rights reserved . The ACORD name and logo are registered marks of ACORD _ 6VRICK - r�RF• •rt, FREDERICK-FIRESTONE BOARD OF DIRECTORS FIRE PROTECTION `; ` Office: (303) 833-2742 � , DISTRICT' . , r�✓; '. Fax: (303) 833-3736 Leading Together, WWW.FFFD. US By, Serving Together y' "`l` • Ilit ' • BOARD OF DIRECTORS RECEIVED OATH OF OFFICE JUN 0 2 202n STATE OF COLORADO WELD COUNTY COMMISSIONERS WELD COUNTY FREDERICK- FIRESTONE FIRE PROTECTION DISTRICT I, EDWARD G . WEIMER do affirm* that I will support the Constitution of the United States, the Constitution of the State of Colorado, and the laws of the State of Colorado, and will faithfully perform the duties of the office of Director, upon which I am about to enter, to the best of my ability. Date: 5 r SIGNED : [Insert Name] ADMINISTERED BY : _1)(1_9 f.7y 62.or Name Kick 5 �u. 1 Title DALE ROBIN INGRAHAM NOTARY PUBLIC STATE OF COLORADO NOTARY ID 20044034067 L.!Y,c9immission Expires Se t. 23, 2020 8426 Kosmerl Place, Frederick, Colorado, 80504-5444 P. O. Box 129, Frederick, Colorado, 80530-0129 r t I `�} ul� I� - `' RES•1r FREDERICK-FIRESTONE BOARD OF DIRECTORS FIRE PROTECTION „ . . , Office: (303) 833-2742 DISTRICT Fax: (303) 833-3736 re Leading Together, `; WWW.FFFD.US By Serving Together1‘\1/4\ .h TIRE: BOARD OF DIRECTORS OATH OF OFFICE STATE OF COLORADO WELD COUNTY FREDERICK-FIRESTONE FIRE PROTECTION DISTRICT I, CHRISTOPHER R. VIGIL do affirm* that I will support the Constitution of the United States, the Constitution of the State of Colorado, and the laws of the State of Colorado, and will faithfully perform the duties of the office of Director, upon which I am about to enter, to the best of my ability. Date: 0 5r- J3 - aoaO SIGNED* 0A)e-g• [Insert Name] ADMINISTERED BY: frieastcin0 listaavti Name I�c "ar ��1 IG Title DALE ROBIN INGRAHAM NOTARY PUBLIC STATE OF COLORADO NOTARY 10 20044034067 M Commission Expires Se t t. 23, 2020 8426 Kosmerl Place, Frederick, Colorado, 80504-5444 P. O. Box 129, Frederick, Colorado, 80530-0129 r _ '[fl. RICK • FIR ��s-i�(1 , FREDERICK-FIRESTONE fh "� �� BOARD OF DIRECTORS FIRE PROTECTION Office: (303) 833-2742 DISTRICT •"ts Fax: (303) 833-3736 <. 4; WWW.FFFD.US Leading Together, By Serving Together`° FIRE BOARD OF DIRECTORS OATH OF OFFICE STATE OF COLORADO WELD COUNTY FREDERICK-FIRESTONE FIRE PROTECTION DISTRICT I, TRACY A . MC ELVANEY do affirm* that I will support the Constitution of the United States, the Constitution of the State of Colorado, and the laws of the State of Colorado, and will faithfully perform the duties of the office of Director, upon which I am about to enter, to the best of my ability. Date: r//y/ 0 & SIGNED : [ Insert N e1 ADMINISTERED BY : LILO 6240 1146,011/1K) Name csac Title DALE ROBIN INGRAHAM NOTARY PUBLIC STATE OF COLORADO N 23 M CommissionOTARY ID Expires Se00440 s t. 23,4067 2020 8426 Kosmerl Place, Frederick, Colorado, 80504-5444 P. O. Box 129, Frederick, Colorado, 80530-0129 . RLI ® RLI Insurance Company COLORADO NOTARY PUBLIC P.O. Bx3967 BLANKET Peoria, IL 61612-3967 Phone: (309) 692- 1000 Fax: (309) 683- 1610 Sz.EOIR►J OMISSIONS POLICY Bond No. LSM0568049 Item 1 . RLI Insurance Company (the "Company") will pay on behalf of Name of Insured: Frederick Firestone Fire Protection District Principal Address: 8426 Kosmerl P1 Frederick, CO 80504 , all sums which the Insured shall become obligated to pay by reason of liability for breach of duty committed by any of the employees while acting as a duly commissioned and sworn Notary Public, claim for which is made against the Insured by reason of any negligent act, error or omission, committed or alleged to have been committed by its employees, arising out of the performance of notarial service for others in the Employee's capacity as a duly commissioned and sworn Notary Public. The Employer shall be considered an additional named Insured under this Policy. Item 2 . POLICY PERIOD: This policy applies only to negligent acts, errors or omissions which occur during the policy period and then only if claim, suit or other action arising therefrom is commenced during the policy period or within the applicable Statute of Limitations pertaining to the Insured. The Policy Period with respect to each Insured commences on the later of the date hereof or the date of his employment by Employer, and terminates upon the earlier of the date of termination of said employment or the date set forth below. The Policy Period is June 1 , 2020 to June 1 , 2021 LIMITS OF LIABILITY INCLUDING DEFENSE COSTS : The total liability of the Company for all loss (defined below) for all claims under this insurance including defense costs (defined below) shall not exceed the amount of Twenty-Five Thousand Dollars And No Cents Dollars ( $ 25 ,000. 00 ). (NOT VALID IF FILLED IN FOR MORE THAN $50,000) This limit shall apply in the aggregate so that the Company's total liability for all claims and/or defense costs shall in no event exceed this amount. DEFENSE SETTLEMENT : With respect to such insurance as is afforded by this Policy, the Company shall, provided the policy limit has not been exhausted, defend, in the Insured's name and behalf, any claim or suit against the Insured alleging such negligent act, error or omission and seeking damages on account thereof, even if such claim or suit is groundless, false or fraudulent. The Company, in the Insured's name and behalf, shall have the right to make such investigation, negotiation and settlement of any claim or suit as it may deem expedient. H. DEFINITIONS : Wherever used in this policy, these words shall have the following meanings: (a) "Defense costs" shall mean any and all: ( 1 ) expenses, including attorneys' or investigators' fees, paid or incurred by the Company in the investigation, settlement or defense of claims or suits; (2) costs taxed against the Insured in a suit defended by the Company; (3) premiums for bonds required in a suit defended by the Company, which bonds the Company shall have no obligation to furnish, but only for bonds up to the Company's limit of liability; (4) interest on a judgement as required by law until the Company offers the amount due under this insurance; and (5) reasonable expenses incurred by the Insured at the Company's request, other than loss of earnings. (b) Subject to all of the Exclusions of this policy (stated below), "loss" shall mean the total of: ( 1 ) sums the Insured legally must pay as direct compensatory damages because of claims covered by this insurance; (2) sums the Company agrees to pay in settlement of such claims, whether or not the Insured's legal liability has been determined; and (3) "defense costs" as defined above. III. EXCLUSIONS : Coverage under this policy does not apply to any (i) dishonest, fraudulent, criminal, libelous, slanderous or malicious act or omission of the Employees; (ii) willful or intentional disregard of the law; (iii) bodily injury to, or sickness, disease or death of any person, including but not limited to emotional or mental distress and related conditions; (iv) injury to or destruction of any tangible property, including the loss of use thereof; (v) fines or penalties imposed by law on the Employees; (vi) punitive, treble, exemplary or similarly categorized damages, including fines and penalties; or (vii) performance of notarial service for any business which the Employee owns, is a partner of, manages or controls. IV. OTHER INSURANCE : This insurance is excess over any other applicable insurance whether such insurance is primary, excess, contributory, contingent, or otherwise the whether such insurance is collectible or not, unless such other insurance is written to be specifically excess over the insurance provided by this policy. INSURED'S DUTIES IN THE EVENT OF OCCURRENCE, CLAIM OR SUIT : (a) Upon knowledge of any occurrence which may reasonably be expected to result in a claim or suit, written notice containing particulars sufficient to identify the Insured and also reasonably obtainable information with respect to the time, place and circumstances thereof, and the names and addresses of the potential claimant and of available witnesses, shall be given by or for the Insured to the Company or any of its authorized agents as soon as practicable, but in no event longer than forty-five (45) days after discovery. Page 1 of 2 NEO 0501 -CO (02/10) RLI1 N0596815- 10,45 (b) If claim is made or suit is brought against the Insured, the Insured shall immediately forward to the Company every demand, notice, summons or other process received by it or its representative. (c) The Insured shall cooperate with the Company and, upon the Company's request, assist in making settlements, in the conduct of suits and in enforcing any right of contribution or indemnity against any person or organization who may be liable to the Insured for acts, errors or omissions with respect to which insurance is afforded under this policy; and the Insured shall attend hearings and trials and assist in securing and giving evidence and obtaining the attendance of witnesses. The Insured shall not, except at his own cost, voluntarily make any payment, admit any liability, assume any obligation or incur any expense except with the prior written consent of the Company. V. SUBROGATION : In the event of any payment for any loss under this insurance, the Company shall be subrogated to all of the Insured's rights of recovery thereafter against any person or organization and the Insured shall execute and deliver instruments and papers and do whatever else is necessary to secure such rights to the Company. The Insured shall do nothing after loss to prejudice such rights. VI. ASSIGNMENT : This policy shall be void if assigned or transferred without the Company's written consent. VII. ACTION AGAINST COMPANY: No action shall lie against the Company unless, as a condition precedent thereto, there shall have been full compliance with all of the terms of this policy, nor until the amount of the Insured's obligation to pay shall have been finally determined either by judgement after actual trial or by written agreement of the Insured, the claimant, and the Company. Any person or organization or the legal representative thereof, who is signatory to such judgement or written agreement, shall thereafter be able to recover under this policy to the extent of the insurance afforded by this policy. No person or organization shall have any right under this policy to join the Company as a party to any action against the Insured to determine the Insured's liability, nor shall the Company be impleadedby the Insured or the Insured's legal representative. VIII. CANCELLATION : If this Policy has been in effect for more than sixty (60) days, or is a renewal of a policy the Company issued, the Company may cancel this Policy upon the occurrence, after the effective date of the Policy, of one or more of the following: A. Nonpayment of premium, including payment due on a prior policy the Company issued and due during the current Policy Period covering the same risks. B . Discovery of fraud or material misrepresentation by the Insured or their representative either in obtaining this insurance or in pursuing a claim under this Policy. C . A judgement by a court or an administrative tribunal that the Insured has violated an Colorado or Federal law, having as one of its necessary elements an act which materially increases any of the risks insured against. D. Discovery of willful or grossly negligent acts or omissions, or of any violations of state laws or regulations establishing safety standards, by the Insured or their representative, which materially increase any of the risks insured against. E . Failure by the Insured or their representative to implement reasonable loss control requirements, agreed to by the Insured as a condition of policy issuance, or which were conditions precedent to the Company's use of a particular rate or rating plan, if that failure materially increases any of the risks insured against. F. A determination of the Commissioner of Insurance that the: 1 . Loss of, or changes in, the Company's reinsurance covering all or part of the risk would threaten its financial integrity or solvency; or 2 . Continuation of the policy coverage would (i) place the Company in violation of Colorado law or the laws of the state where it is domiciled; or (ii) threaten the Company's solvency. G. A change by the Insured or their representative in their notarial service activities, which results in a materially added, increased or changed risk, unless the added, increased or changed risk is included in the Policy. The Company will mail or deliver advance written notice of cancellation, stating the reason for cancellation to the Insured, and to the producer of record, at least ten ( 10) days before the effective date of cancellation if the Company cancels for a reason listed in A. above; or, at least twenty (20) days before effective date of cancellation if the Company cancels for a reason listed in B . above; or, at least forty-five (45) days before the effective date of cancellation if the Company cancels for any reason listed in C. through G. above. Upon cancellation by either the Insured or the Company, earned premium shall be computed pro rata. Premium adjustment may be made either at the time cancellation is effected or as soon as practicable after cancellation becomes effective, but payment of unearned premium is not a condition of cancellation. Dated, signed and sealed this 16th day of April 2020 00111111111 li , RLI Insurance Company , ocAPORArs les Ecc • • sic B i 711 SEAL : Barton W. Davis Vice President i''''j'N"'o�� Address Claims to: RLI P.O. Box 3961 Page 2 of 2 NEO 0501 -CO (02/10) RLI1 Peoria, IL 61612-3961 N0596815- 10,45 Hello