The URL can be used to link to this page

Browse Search

Home My WebLink About20191045BOARD OF DIRECTORS OATH OF OFFICE STATE OF COLORADO WELD COUNTY RECEIVED MAR t 8 2J19 WELD COUNTY COMMISSIONE'R'S FREDERICK FIRESTONE FIRE PROTECTION DISTRICT I, TRACY 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: March 11, 2019 SIGNED: Tracy McE aney ADMINISTERED BY: By: Board of Directors, Vice President/Chairperson INSTRUCTIONS: *The individual may choose to "affirm", "swear", or "swear by the everliving God", and must take the Oath with an upraised hand. The Oath may be administered by any Officer of the Board, or any individual designated by the Board to administer the Oath. A copy of the executed oath must be filed with the District Court in which the District was formed, the County Clerk and Recorder for any County in which the District has territory, and the Department of Local Affairs. COMA•, ; VkO1S 3/2511 a 2otc - jo l-15 SOooyCo FREDFIR-01 LKLIESEN CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 3/25/2019 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 T. Charles Wilson Insurance Service 384 Inverness Parkway Suite 170 Englewood, CO 80112 INSURED Frederick Firestone Fire Protection District PO BOK 129 Frederick, CO 80530 CONTACT NAME: PHONE (A/C, No, Ext): (303) 368-5757 E-MAIL info,�@w,•'ilsonins.com ADDRESS: vv^• (A/C, No):(303) 368-5863 INSURER(S) AFFORDING COVERAGE INSURER A : R. L. I. INSURER B : INSURER C : NAIC # 0028 INSURER D : 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 LTR TYPE OF INSURANCE ADDL INSD UBR SWVD POLICY NUMBER POLICY EFF (IA MIDDIYYYYI POLICY EXP lM M/DD/YYYM LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GE 'L AGGREGATE POLICY OTHER: LIMIT APPLIES PER: LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABLITY ANY AUTO OWNED AUTOS ONLY AUTOS ONLY SCHEDULED AUTOS AUUTOS ONLYY COMBINED SINGLE LIMIT Ea accident) $ BODILY INJURY (Perperson) $ BODILY INJURY (Per accident) $ (Pe accident) (DAMAGE $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N NIA PER STATUTE H ER E.L. EACH ACCIDENT - - -- E.L. DISEASE - EA EMPLOYEE $ - $ E.L. DISEASE - POLICY LIMIT $ A 1 Year Bond LSM0568049 6/1/2018 6/1/2019 1 Year Bond 25,000 DESCRIPTION OF OPERATIONS / LOCATIONS I 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED X3.2 J_. Zeta-- ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: FREDFIR-01 LKLIESEN LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY T. Charles Wilson Insurance Service NAMED INSURED Frederick Firestone Fire Protection District PO Box 129 Frederick, CO 80530 Weld POLICY NUMBER SEE PAGE 1 CARRIER SEE PAGE 1 NAIC CODE SEE P 1 EFFECTIVE DATE: SEE PAGE 1 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 Hello