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Home My WebLink About20161836.tiffBOARD OF DIRECTOR OATH OF OFFICE STATE OF COLORADO COUNT,/ §32.1,901, C.R.S.. and Colorado Constitution Artide I2, §9 rlts1_RID r faithfully support the Constitution of the Cited States and of the State of Colorado. and the laws made pursuant theretoand mil faithfully perform the dunes of the office of Director of District upon which I am about to enter (name of special dustnctl Subscribed and sworn to before me tnis day of ≥ 20 (signature of oath taker) Person authorized to administer oaths, :.e. County Clerk and Recorder Clerk of the Court, Chairman of the Bowl Directors or any other person authorized to administer oaths) IF SWORN OR AFFIRMED BEFORE A NOTARY THE FOLLOWING SHOULD BE COMPLETED STATE OF COLORADO SS. COUNTY OF Subscnbed and sworn 'c before me this cay of 20 (notary signature; SEAL PROCEDURAL INSTRUCTIONS: The oath must be taken within 30 days after the election date or appointment to fill a vacancy! Oaths taken prior to the election date are invalid. A copy of the executed oath and an individual, schedule, or blanket surety bond must be filed with the Clerk of the Court, the Clerk and Recorder in every county in which the district extends and with the Division of Local Government If this is the oath of an appointed director, also provide the notice of appointment to the Division in addition to the oath and bond documents: note who is being replaced, if applicable. Diws,on of Local Govemmen! - Hev5ed 10/17,,5 Ccromwai ca `ow) to -15 -lip Local Affarrc So -1 2016-1836 SDcOLI Page 1 of 3 rHE OBLIGAPCN CONDITION OP THE OBLIGA TICN WHEN CGV=RAGE EFFEC OVE EXTENT OF SURETY'S' LIABILITY 71 Old Republic Surety Company 8 Old Republic Insurance Company O CHECK APPLICAS'_E COMPANY HEREINAFTER REFERRED TO AS THE SURETY; PUBLIC OFFICIAL SCHEDULE BOND (Position Form) Bond No. RPO 624862 1. KNOW ALL MEN BY THESE PRESENTS, that __OLD REPUBLIC INSURANCE PENNSYLVANIA corporation, COMPANY , a authorized to transact business as Surety, in the State of COLORADO as Surety, is held and firmly bound unto BRIGGSDALE FIRE PROTECTION DISTRICT as Obligee in the respecti+re sums set opposite the positiors listed in the appropriate schedule, or in an endorsement, for the payment of which well and truly to be made the Surety does hereby bind tself, its successors, and assigns, firmly by these presents, SIGNED, SEALED AND DATED the 28T1 -I day of .AUGUST , 2008 2, The condition of this obligation is such that if each employee occupying any such position shall faithfully discharge the duties thereof while such position is covered hereunder and shall promptly account for and pay over, according to law, all money or property received by them by virtue of such position or, 'n default thereof, shall pay all damages, costs, and expenses resulting from such default or defaults, then this obligation shall be void, otherwise to remain in full force and effect, subject, how- ever, to the terms and conditions hereinafter set forth, 3. This bend shall be effective as of \L (i[ �S"I' 26 , 2008 . Positions named in the attached schedule are covered on and after the effective date; positions added by being included in a new schedule identified by the signature of the Surety by an Officer or .Aitcrney-in-Fact and attached as of any premium anniversary date, shall be covered cn and after that anniversary date; positions added by endorsement shall be covered on and after the date specified therein. 4. The coverage on eacn position is continuous from the inception of coverage to termination thereof, and the coverage for separate periods shall not be cumulative, The liability of the Surety for the failure of any employee to account for and pay over shall be limited to the failure to account for and pay over funds actually in such employee's possession during the period within which he is covered. if the coverage on any position for separate periods be for different amounts, the maximum liability of the Surety for all defaults of any employee who may occupy that position shall not exceed the largest amount of coverage in force Curing any period within which defaults shall have occurred, nor shall the coverage for one period ha available for defaults occurring within any other period. A failure to account in one period shall .not be considered a default occurring during that period unless the funds were actually in the possession of the employee during such period, If an employee occupy, at one time or at different times, two dr more covered positions, the maximum liability of the Surety for all defaults of that employee she l not exceed in the aggregate the largest amount of coverage on any position in which defaults of that employee shall have occurred, nor shall the coverage for one posi- tion be available for defaults L1 any other position. ADDITION OF POSITIONS -- CHANGE CF AMOUNTS TEMPORARY AUTOMATIC COVERAGE DISCOVERING AND REPORTING LOSS, CR FACTS INDICATING LOSS TERMINATION CHANGES IN PRINTED PROVISIONS - HOW MADE Page 2 of 3 5. Positions may be added to the schedule, or the amount of coverage on a position may be changed, upon the written application of the Obligee; such addition or change shall not be effective until the Surety has executed and mailed to the Obligee an endorsement accepting such addition or change, nor until the effective date specified therein. 6. Any newly created position shall be covered automatically for the first sixty days for the smallest amount for which any position of that class is then covered, but in no event for more than Five Thou- sand Dollars ($5000), or if there be no other position of that class, for the largest amount for which any position is then covered, but in no event for more than Five Thousand Dollars ($5000). Recovery under this clause for defaults of any occupant of any such position may not be made unless claim be filed with the Surety within ten days after the expiration of such sixty day period, nor if during such sixty day period such position be covered by schedule or addition thereto as hereinbefore provided, 7. Upon discovery by the Obligee of any loss, or of facts indicating loss, the Obligee shall promptly, and in any event within ten days thereafter, notify the Surety thereof by registered mail addressed to the Surety. 8. The coverage on any position shall terminate if such position is omitted from the schedule attached as of any anniversary date The coverage on any employee shall terminate when the employ- ment terminates or the Obligee discovers or becomes aware of any default committed by such employee. The coverage on any employee, or on any position, or the bond in its entirety, may be terminated by written notice from either of the parties to the other, Such notice from the Surety shall become effective thirty days after receipt thereof by the Obligee; such notice from the Obligee shall become effective immedi- ately upon receipt thereof by the Surety 9. The liability of the Surety shall not be affected by any attempt by anyone representing or pur- porting to represent the Surety to construe or interpret this bond, nor by any change in the printed provi- sions of the bond made otherwise than by written instrument duly executed by a Vice -President of the Surety or by a printed endorsement duly executed by an Attorney -in -Fact, By OLD REPUBLIC INSURANCE COMPANY Attorney -in -Fact SCHEDULE OF POSITIONS COVERED HtREUNDER Page 3 of 3 ACCEPTANCE NUMBER POSITION CITY BRIGGSDALE BRIGGSDALE Rate $ per hi.ndred, Annual Minimum Premium per position, Annual Minimum Earned Premium per position, STATE AMOUNT COLORADO OLORADO 31,000 00 $5,000,00 �nuitd ,, CS A. OLD REPUBLIC INSURANCE COMPANY WEST :E2 MOINES, IA 32263 RPC062433 Principal Agency s?IGGS:A:: 23 MILTON s223GSDALE, ISIBBETT AGENCYC 1752 25TH 2§74 Obligee e223Gs2A2z y< PROTECTION DI 96 MILTON ST, BENGGS AIE, C mate Billing Address ION 223222 al Standard Remarks » NOTICE: Please Respond to any request printed below to avoid her ha & THIS 5 N2 IS ONCINU .P222 - II P«:2 T2 2«222&2:. PONRx22 PREMIUM WILL PE .z=, .=a. >__= ca z:=zxs AT ANNIVERSARY CYPESS 23222»2 d:12 1. 222222. BOARD OF DIRECTOR and the laws made pursuant theretoan; sdi faithfully Distrut upon which I em about enter t j" (name of special drsfPct) Subscribed anti sworn to oefnre nae this OATH OF OFFICE STATE OF COLORADO COUNTY gaz-?-eol C a s and a Constuurion pride I2 §9 RLSTRIC T mdLtatthfnliY suppor' the Constitution s the ((ruled States and al the State of Colorado the duties of the office of Director of ,, t, y F, r4 Y 13? ^' ,7/74, authorized to administer oaths Courty Clerk and Recorder. Clerk of the Court, Chairman of the Board cf Drectors or any other person authorized to administer oaths) IF SWORN OR AFFIRMED BEFORE A NOTARY THE FOLLOWING SHOULD BE COMPLETED STATE OF COLORADO ss COUNTY OF S bscrbed and sworn to before me (his day of SEAL PROCEDURAL INSTRUCTIONS The oath must be taken within 30 days after the election date or appointment to fill a vacancy Oaths taken prior to the election date are invalid, A copy of the executed oath and an individual, scheduleor blanket surety bond must be filed with the Clerk of the Court, the Clerk and Recorder in every county in which the district extends and with the Division of Local Government. If this is the oath of an appointed director also provide the notice of appointment to the Division in addition to the oath and bond documents, note who is being replaced, if applicable. urvisrov ofLoca, Gci.er^menf eta^.me^r arfLhaus iii-? aevrsea 'r',I ;/'5 Page 1 of 3 THE OBLIGATON CONDi riON OF THE OBLIGATION WHEN COVERAGE EFFECTIVE EXTENT OF SURETY'S LIABILITY Id _l Old Republic Surety Company 0 Old Republic Insurance Company -.CHECKAP?!;CAd'E CCMPANY'.HEREINAFTER REFERRED TO A.3 THE tuFsr ; PUBLIC OFFICIAL SCHEDULE BOND (Position Form) Bond No, RPO 624862 1. KNOW ALL MEN BY THESE PRESENTS, that OLD ?EPUBL;C INSURANCE COMPANY , a PENNSYLVANIA corporation, authorized to transact business as Surety, in the State of COLORADO as Surety, is held and firmly bound unto BRIGGSDALE FIRE PROTECTION DISTRICT as Obligee, in the respective sums set opposite the positions listed in the appropriate schedule, or in an endorsement, for the payment of which well and truly to be made the Surety does hereby bind itself, its successors, and assigns, firmly by these presents, SIGNED, SEALED AND DATED the 2STF[ day of AUGUS t _..__ , 2O08 2. The condition of this obligation is such that if each employee occupying any such position shall faithfully discharge the duties thereof while such position Is covered hereunder and shall promptly account for and pay over, according to law, all money or property received by them by virtue of such position or, 'n default thereof shad pay all damages, costs, and expenses resulting from such default or defaults, then this obligation shall be void, otherwise to remain in full force and effect, subject, how- ever, to the terms and conditions hereinafter set forth, 3, This bond shall be effective as of AU-iUST 26 , 2009 Positions named in the attached schedule are covered on and after the effective date; positions added by being included in a new schedule identified by the signature of the Surety by an Officer er .Attorney -in -Fact and attached as of any premium anniversary date, shall be covered on and after that anniversary date; positions added by endorsement shah be covered on and after the 'late specified therein. 4, The coverage on each position is continuous from the inception of coverage to termination thereof, and the coverage for separate periods shall not be cumulative, The liability of the Surety for the failure of any employee to account for and pay over shall be limited to the failure to account for and pay over funds actually in iin.ich employee's possession during the period within which he is covered, If the coverage on any positinn for separate periods be for different amounts, the maximum liability of the Surety for all defaults of -any employee who may occupy that position shall not exceed the largest amount of coverage in force goring any period within which defaults shall have occurred, nor shall the coverage for one period available for defaults occurring within any other period, A failure to account in one period shall :not be considered a default occurring during that period unless the funds were actually in the possession of the employee during such period. If an employee occupy, at one time or at different times, two or more covered positions, the maximum liability of the Surety for all defaults of that employee she not exceed in the aggregate the largest amount of coverage cn any position in which defaults of that employee shall have occurred, nor shall the coverage for one posi- tion be available for defaults n any other position, A.DCITION CF POSITIONS -- CHANGE OF AMOUNTS TEMPORARY AUTOMATIC COVERAGE DISCOVERING AND REPORTING LOSS, OR FACTS INDICATING LOSS T ERM INA'rON CHANGES IN PRINTED PROVISIONS - HOW MADE Page 2 of 3 5. Positions may be added to the schedule, or the amount of coverage cn a position may be changed, upon the written application of the Obligee; such addition cr change shall not be effective until the Surety has executed and mailed to the Obligee an endorsement accepting such addition or change, nor until the effective date specified therein, 6, Any newly created position shall be covered automatically for the first sixty days for the smallest amount for which any position of that class is then covered, but in no event for more than Five Thou- sand Dollars ($5000), or if there be no other position of that class, for the largest amount for which any position is then covered, but in no event for more than Five Thousand Dollars ($5000). Recovery under this clause for defaults of any occupant of any such position may not be made unless claim be filed with the Surety within ten days after the expiration of such sixty day period, nor if during such sixty day period such position be covered by schedule or addition thereto as hereinbefore provided. 7. Upon discovery by the Obligee of any loss, or of facts indicating loss, the Obligee shall promptly, and in any event within ten days thereafter, notify the Surety thereof by registered mail addressed to the Surety. 8, The coverage on any position shall terminate if such position is omitted from the schedule attached as of any anniversary date, The coverage on any employee shall terminate when the employ- ment terminates or the Obligee discovers or becomes aware of any default committed by such employee. The coverage on any employee, or on any position, or the bond in its entirety, may be terminated by written notice from either of the parties to the other. Such notice from the Surety shall become effective thirty days after receipt thereof by the Obligee: such notice from the Obligee shall become effective immedi- ately upon receipt thereof by the Surety. 9. The liability of the Surety shall not be affected by any attempt by anyone representing or pur- porting to represent the Surety to construe or interpret this bond, nor by any change in the printed provi- sions of the bond made otherwise than by written instrument duly executed by a Vice -President of the Surety or by a printed endorsement duly executed by an Attorney -in -Fact, By OLD REPUBLIC INSURANCE COMPANY ley -in -Fact SCHEDULE OF POSITIONS COVERED HtREUNDER ACCEPTANCE NUMBER POSITION 4 DIRECTORS 1 TREASURER BRIGGSDALE RR.tGGSDALE CITY STATE Page 3 of 3 AMOUNT COLORADO COLORADO $1,000.00 $5,000,00 per I•-�nr rred, Annual m Premium per position, S Annual Minimum Earned Premium per position, .3 P tined ui :.?_S A. Ti REPT3222 2232 ±22 WEST DiPE YOINES »2 S22c3 222224:32 Principal Agency Obligee S?: STATE 21 2: 1«53 23TE BRIGGSCALE 2< PROT 93 NT ETON ST. 30311 Alternate Billing Address PD 3232 Renn ar • ya 7mms 2x23 3222 NOTICE: Please Respond to any request @ntedbelow * avoid furtkk&dR@&expense u» Y wCm CONY T, S :: «. P Page 1 of 3 rliE o©uGAT'CN 'NHEN COVERAGE EFFECTIVE EXTENT OF SURETY'S LiAaiLITY 7, Old Republic Surety Company Old Republic Insurance Company •CHECK APP'_iCAii'_E COMPANY HEREINAFTER REFERRED TO A3 THE SURETY) PUBLIC OFFICIAL SCHEDULE BOND (Position Form) Bond No, RPO 624862 1, KNOW ALL MEN BY THESE PRESENTS, that OLD REPUBLIC INSURANCE COMPANY a PENNSYLVANIA corporation, authorized to transact business as Surety, in the State of COLORADO as Surety, is held and firmly bound unto BRIGGSDALE FIRE PROTECTION DISTRICT as Obligee, in the respective sums set opposite the positions listed in the appropriate schedule, or in an endorsement, for the payment of which well and truly to he made the Surety does hereby bind itself, its successors, and assigns, firmly by these presents, SIGN=D, SEALED AND DATED the 28TH day of AUGUST , 2008 OF THE CONDITION 2. The condition of this obligation is such that if each employee occupying any such position OBLIGATIONshall faithfully discharge the duties thereof while such position Is covered hereunder and shall promptly account for and pay over, according to law, all money or property received by them by virtue of such position or, 'n default thereof, shall pay all damages, costs, and expenses resulting from such default or defaults, then this obligation shall be void, otherwise to remain in full force and effect, subject, how- ever, to the terms and conditions hereinafter set forth, 3. This band shall be effective as of AUGUST 26 , 2008 _, Positions named in the attached schedule are covered on and after the effective date; positions added by being included in a new schedule identified by the signature of the Surety by an Officer or Attorney -in -Fact and attached as of any premium anniversary date, shall be covered on and after that anniversary date, positions added by endorsement shall be covered on and after the date specified therein. 4, The coverage on each position is continuous from the inception of coverage to termination thereof, and the coverage for separate periods shall not be cumulative. The liability of the Surety for the failure of any employee to account for and pay over shall be limited to the failure to account for and pay over funds actually in such employee's possession during the period within which he is covered, If the coverage on any position for separate periods be for different amounts, the maximum liability of the Surety for all defaults of any employee who may occupy that position shall not exceed the largest amount of coverage in force during any period within which defaults shall have occurred, nor shall the coverage for one period be available for defaults occurring within any other period. A failure to account in one period shall not be considered a default occurring during that period unless the funds were actually in the possession of the employee during such period.. If an employee occupy, at one time or at different times, two or mere covered positions, the maximum liability of the Surety for all defaults of that employee shed not exceed in the aggregate the largest amount of coverage on any position in which defaults of that employee shall have occurred, nor shall the coverage for one posi- tion be available for defaults n any other position, ADCITION CF POSITIONS -- CHANGE OF AMOUNTS TEMPORARY AUTOMATIC COVERAGE DISCOVERING AND REPORTING LOSS, OR PACTS INDICATING LOSS TERMINATION CHANGES IN PRINTED PROVISIONS - HOW MADE Page 2 of 3 5. Positions may be added to the schedule, or the amount of coverage cn a position may be charged, upon the written application of the Obligee, such addition or change shall not be effective until the Surety has executed and mailed to the Obligee an endorsement accepting such addition or change, nor until the effective date specified therein. 6 Ary newly created position shall be covered automatically for the first sixty days for the smallest amount for which any position of that class is then covered, but in no event for more than Five Thou- sand Dollars ($5C DO), or if there be no other position of that class, for the largest amount for which any position is then covered, but in no event for more than Five Thousand Dollars (65000). Recovery under this clause for defaults of any occupant of any such position may not be made unless claim be filed with the Surety within ten days after the expiration of such sixty day period, nor If during such sixty day period such position be covered by schedule or addition thereto as here1nbefore provided, 7. Upon discovery by the Obligee of any loss, or of facts indicating loss, the Obligee shall promptly, and in any event within ten days thereafter, notify the Surety thereof by registered mail addressed to the Surety, 8. The coverage on any position shall terminate if such position is omitted from the schedule attached as of any anniversary date. The coverage on any empioyee shall terminate when the employ- ment terminates or the Obligee discovers or becomes aware of any default committed by such employee. The coverage on any employee, or on any position, or the bond in its entirety, may be terminated by written notice from either of the parties to the other, Such notice from the Surety shall become effective thirty days after receipt thereof by the Obligee; such notice from the Obligee shall become effective immedi- ately upon receipt thereof by the Surety 9. The liability of the Surety shall not be affected by any attempt by anyone representing or pur- porting to represent the Surety to construe or interpret this bond, nor by ary change in the printed provi- sions of the bond made otherwise than by written instrument duly executed by a Vice -President of the Surety or by a printed endorsement duly executed by an Attorney -in -Fact. By OLD REPUBLIC INSURANCE COMPANY Attorney -in -Fact SCHEDULE OF POSITIONS COVERED HEREUNDER Page 3of3 ACCEPTANCE NUMBER POSITION 4 DIRECTORS I TREASURER CITY STATE AMOUNT BRIGGSDALE RRIGGSDALE COLORADO COLORADO 31,000 CO Rate $ per hundred, Annual 4Minirrum Premium per position, Annual Minimum Earned Premium per position, $ =Si IA 5`.0266 yc^d tiuroCar 5PO0624362 Principal Agency Obligee IRS M PTO ST. CO �.viry J 25TH AVE., GREEL- PRO. T. ON D I S ROJ C. 9 "Yi S Bt- I'J\.. SJA.:_, r CO6 Alternate Billing Address PO SCH7CUL Rep Tara; -3Fy Special Remarks 2J15 Cant Type coo p D Ren By Standard Remarks NOTICE: Please Respond to any request printed below to avoid further handling & expense TR_7 ?,,,DND IS CONTLUOTO„;',PP7Y- Tr.:1r I AiD TO A. 1 :V ,T vAR . PT_ M _'vr'',1 WILL _v -$ .:.- ED AT ANNI7ERSA1R.7 WE RECEI7E CrePP. r+le BOARD OF DIRECTOR OATH OF OFFICE STATE OF COLORADO CnuNTY §32-1-90t C R S .and Colorado Constitution Artide 12. §9 wcid rn STRICT I. t�%��._JC,fli tLl will taithrl'lly su0000 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 District, upon which I am about to enter 11 Ar�_,y 1 r btt� ©i11�Gt. (name of special district) `� r 1� Subscribed and sworn to before me this f f day of 20 /l By • ;Person authorized to administer oaths. Le. County Clerk and Recorder, Clerk of the Court, Chairman of the Board of Directors, or any other person authorized to administer oaths) IF SWORN OR AFFIRMED BEFORE A NOTARY THE FOLLOWING SHOULD BE COMPLETED STATE OF COLORADO I CS COUNTY OF Subscribed and sworn to before me this day of 20 notary signature) SEAL PROCEDURAL INSTRUCTIONS: The oath must be taken within 30 days after the election date or appointment to fill a vacancy: Oaths taken prior to the election date are invalid. A copy of the executed oath and an individual, schedule, or blanket surety bond must be tiled with the Clerk of the Court, the Clerk and Recorder in every county in which the district extends and with the Division of Local Government, If this is the oath of an appointed director, also provide the notice of appointment to the Division in addition to the oath and bond documents; note who is being replaced, if applicable. Civisron of Local Government - Department of Local rtrra,rs SC -1 Rev,sed 'o,r7,15 Page 1 of 3 THE OBLIGATCN CONDITION OF THE OBLIGATION WHEN COVERAGE EFFECT'VE EXTENT OF ,URETY's LIABILITY Old Republic Surety Company iX Old Republic Insurance Company CHECK APP'_ CA a.E CCMPaNY'-iERE;NAFTER REFERRED TO AS THE SURETY) PUBLIC OFFICIAL SCHEDULE BOND (Position Form) Bond No. RPO 624862 1, KNOW ALL MEN BY THESE PRESENTS, that _OLD REPUBLIC INSURANCE COMPANY , a PENNSYLVANIA corporation, authorized to transact business as Surety, in the State of COLORADO as Surety, is held and firmly bound unto _BRIGGSDALE FIRE PROTECTION DISTRICT as Obligee, in the respective sums set opposite the positions listed in the appropriate schedule, or in an endorsement, for the payment of which well and truly to be made the Surety does hereby bind itself, its successors, and assigns, firmly by these presents, SIGNED, SEALED AND DATED the 28TFI day of AUGUST , 2008 2. The condition of this obligation is such that if each employee occupying any such position shall faithfully discharge the duties thereof while such position is covered hereunder and shall promptly account for and pay over, according to law, all money or property received by them by virtue of such position or, in default thereof shall pay all damages, costs, and expenses resulting from such default or defaults, then this obligation shall be void, otherwise to remain in full force and effect, subject, how- ever, to the terms and conditions hereinafter set forth, 3, This bond shall be effective as of AUGf.,;ST _26 , 2008 Positions named in the attached schedule are covered on and after the effective date; positions added by being included in a new schedule identified by the signature of the Surety by an Officer or Attorney -in -Fact and attached as of any premium anniversary date, shall he covered on and after that anniversary date; positions added by endorsement shah he covered on and after the date specified therein. 4 The coverage on eau' position is continuous from the inception of coverage to termination thereof, and the coverage for separate periods shall not be cumulative. The liability of the Surety for the failure of any employee t account for and pay over shall be limited to the failure to account for and pay over funds actually in such employee's possession during the period within which he is covered. If the coverage on any position for separate periods be for different amounts, the maximum liability of the Surety for all defaults of any employee who may occupy that position shall not exceed the largest amount of coverage in force during any period within which defaults shall have occurred, nor shall the coverage for one period Le available for defaults occurring within any other period. A failure to account in one period shail net be considered a default occurring during that period unless the funds were actually in the possession of the employee during such period. If an employee occupy, at one time or at different times, two iDI more covered positions, the maximum liability of the Surety for all defaults of that employee she'i not exceed in the aggregate the largest amount of coverage on any position in which defaults of tl' at employee shall have occurred, nor shad the coverage for one posi- tion be available for defaults u any other positiron. ADDITION CF POSITIONS -- CHANGE OF AMOUNTS TEMPORARY AUTOMATIC COVERAGE DISCOVERING AND REPORTING LOSS, CR FACTS INDICATING LOSS TERMINA r'ON CHANGES IN PRINTED PROVISIONS - HOW MADE Page 2 of 3 5. Positions may be added to the schedule, or the amount of coverage on a position may be changed, upon the written application of the Obligee, such addition or change shall not be effective until the Surety has executed and mailed to the Obligee an endorsement accepting such addition or charge, nor until the effective date specified therein. 6. Any newly created position. shall be covered automatically for the first sixty days for the smallest amount for which any position of that class is then covered, but in no event for more than Five Thou- sand Dollars ($5C00), or if there be no other position of that class, for the largest amount for which any position is then covered; but in no event for more than Five Thousand Dollars ($5000). Recovery under this clause for defaults of any occupant of any such position may not be made unless claim be filed with the Surety within ten days after the expiration of such sixty day period, nor if during such sixty day period such position be covered by schedule or addition thereto as .hereinbefore provided, 7. Upon discovery by the Obligee of any loss, or of facts indicating loss, the Obligee shall promptly, and in any event within ten days thereafter, notify the Surety thereof by registered mail addressed to the Surety. 8. The coverage on any position shall terminate if such position is omitted from the schedule attached as of any anniversary date. The coverage on any employee shall terminate when the employ- ment terminates or the Obligee discovers or becomes aware of any default committed by such employee, The coverage on any employee, or on any position, or the bond in its entirety, may be terminated by written notice from either of the parties to the other. Such notice from the Surety shall become effective thirty days after receipt thereof by the Obligee; such notice from the Obligee shall become effective immedi- ately upon receipt thereof by the Surety 9. The liability of the Surety shall not be affected by any attempt by anyone representing or pur- porting to represent the Surety to construe or interpret this bond, nor by any change in the printed provi- sions of the bond made otherwise than by written instrument duly executed by a Vice -President of the Surety or by a printed endorsement duly executed by an Attorney -in -Fact, OLD REPUBLIC INSURANCE COMPANY Attorney -in -Fact SCHEDULE OF POSITIONS COVERED HtREUNDER Page 3of3 ACCEPTANCE NUMBER POSITION 4 DIRECTORS 1 I'RPASTIR.ER BRIGGSDALE BRIGGSDALE CITY STATE AMOUNT COLORADO $1,000.00 COLORADO $5,00O.00 Rata $ per ft.;ndred, Annual Minirnum Premium per position, $ Annual Minimum Earned Premium nor position, a Prmed TRIGGSDALE 17 IRE 22. Agency 1750 25Th Obligee mate Billing Address 205 526:4 ETTE 2:32+22? 3 *Remr Standard Remarks TH:3 BOND :UM 22 2« Doesploar $70.: c [ m TypeL m FaV B \ _ By mw, : a Cep eAmopM • NOT$EP,a+mmpendb4v request.printed. mowbwoidt her handling & expense: ©e7 P `Z«y- c ===uwe,a.m .., m«?7??»2Y. 22 73»»22? m CrepaE, Numberr E s BOARD OF DIRECTOR OATH OF OFFICE STATE OF COLORADO O'UNTY `COL' "t " `N, ratfnfully suoocrt the Ccnsrtatson C and the laws made pursuant thereto a?d '.vitl faithfully perform the Juries of the office 01 Director r District 000n which I am about to enter Q / (came of special district; Subscribed and sworn to before r're thi tl day Jr 20 I4 532-t )C1 C..R.S-and �rrioradc ';an stqutlnr� article 12 f5 J„, e United Stales and of the State of Colorado Ey._ ath taker; ;Person authorized to administer oaths. Ccunty Clerk and Recorder Clerk of the Court- Chairman of the Board of Director or any ether person authorized '0 administer oaths) IF SWORN OR AFFIRMED BEFORE A NOTARY THE FOLLOWING SHOULD BE COMPLETED STATE OF COLORADO ss COUNTY OF Subscribed and sworn to before me this lay of 2r} (notary sigra`,rei SEAL PROCEDURAL INSTRUCTIONS, The oath must be taken within 30 days after the election date or appointment to fill a vacancy Oaths taken prior to the election date are in.alid, A copy of the executed oath and an individual; schedule, or blanket surety bond must be filed with the Clerk of the Court, the Clerk and Recorder in every county in which the district extends and with the Division of Local Government. If this is the oath of an appointed director, also provide the noticeof appointment to the Division in addition to the oath and bond documents; note who is being replaced, if applicable. Ouesmon of Local Govern.^,ent - Depammcnt -,r Lac -3, s SD' Pev,sed 70/r N'f 5 THE OBLIGATION Page 1 of 3 :7 Old Republic Surety Company X Old Republic Insurance Company r.] CHECK AP PLO? ; _E Ci:MPaNY HERE: NAFTER REFERRED TO AS THE SURETY) PUBLIC OFFICIAL SCHEDULE BOND (Position Forrn) Bond No, RPO 624862 1, KNOW ALL MEN BY THESE PRESENTS, that OLD REPUBLIC INSURANCE COMPANY a PENNSYLVANIA corporation_ authorized to transact business as Surety, in the State of _ COLORADO as Surety, is held and firmly bound unto ___BRIGGSDALE FIRE PROTECTION DISTRICT as Obligee, in the respective sums set opposite the positions listed in the appropriate schedule, or in an endorsement, for the payment of which well and truly to be made the Surety does hereby bind itself, its successors, and assigns, firmly by these presents, SIGNED, SEALED AND DATED the 28TH day of AUGUST , 2008 OF THE CONDITION 2. The condition of this obligation is such that if each employee occupying any such position OBLIGATION shall faithfully discharge the duties thereof while such position is covered hereunder and shall promptly account for and pay over, according to law, all money or property received by them by virtue of such position or, 'n default thereof, shall pay all damages, costs, and expenses resulting from such default or defaults, then this obligation shall be void, other,+rise to remain in full force and effect, subject, how- ever, to the terms and conditions hereinafter set forth, 3. This bond shall be effective as of AUGUST 26 , 2008 Positions named in the attached schedule are covered on and after the effective date; positions added by being included in a new schedule identified by the signature of the Surety by an Officer or Attcrney-in-Fact and attached as of any premium anniversary date, shall be covered on and after that anniversary date, positions added by endorsement shah he covered on and after the date specified therein. SUPS O 5 E(TENTOF 4. The coverage on eecc position is continuous from the inception of coverage to termination uaBlurr thereof, and the coverage for separate periods shall not be cumulative. The liability of the Surety for the failure of any employee to account for and pay over shall he limited to the failure to account for and pay over funds actually in such employee's possession during the period within which he is covered, If the coverage on any positien for separate periods be for different amounts, the maximum liability of the Surety for all defaults of :any employee who may occupy that position shall not exceed the largest amount of coverage in force iTiuring any period within which defaults shall have occurred, nor shall the coverage for one period L's available for defaults occurring within any other period, A failure to account in one period shall not be considered a default occurring during that period unless the funds were actually in the possession of the employee during such period, If an employee occupy, at one time or at different times, two or more covered positions, the maximum liability of the Surety for alt defaults of that employee she!I not exceed in the aggregate the largest amount of coverage on any position in which defaults of tt'<tt employee snail have occurred, nor shad the coverage `or one posi- tion be available for defaults iI any other position, 'NHEN COVERAGE EFFECTIVE ri aDCITION OF POSITIONS — CHANGEOF AMOUNTS TEMPORAR' AUTOMATIC COVERAGE DISCOVERING AND REPORTING LOSS, OR FACTS INDICATING LOSS TERMINA ION CHANGES IN PRINTED PROVISIONS - HOW MADE Page 2 of 3 5. Positions may be added to the schedule, or the amount of coverage on a position may be changed, upon the written application of the Obligee; such addition or change shall not be effective until the Surety has executed and mailed to the Obligee an endorsement accepting such addition or change, nor until the effective date specified therein. 6. Any newly created position shall be covered automatically for the first sixty days for the smallest amount for which any position of that class is then covered, but in no event for more than Five Thou- sand Dollars (55000), or if there be no other position of that class, for the largest amount for which any position is then covered, but in no event for more than Five Thousand Dollars ($5000). Recovery under this clause for defaults of any occupant of any such position may not be made unless claim be filed with the Surety within ten days after the expiration of such sixty day period, nor If during such sixty day period such position be covered by schedule or addition thereto as hereinbefore provided. 7. Upon discovery by the Obligee of any loss. or of facts indicating loss, the Obligee shall promptly, and in any event within ten days thereafter, notify the Surety thereof by registered mail addressed to the Surety. 8. The coverage on any position shall terminate if such position is omitted from the schedule attached as of any anniversary date. The coverage on any employee shall terminate when the employ- ment terminates or the Obligee discovers or becomes aware of any default committed by such employee. The coverage on any employee, or on any position, or the bond in its entirety, may be terminated by written notice from either of the parties to the other. Such notice from the Surety shall become effective thirty days after receipt thereof by the Obligee; such notice from the Obligee shall become effective immedi- ately upon receipt thereof by the Surety. 9. The liability of the Surety shall not be affected by any attempt by anyone representing or pur- porting to represent the Surety to construe or interpret this bond, nor by any change in the printed provi- sions of the bond made otherwise than by written instrument duly executed by a Vice -President of the Surety or by a printed endorsement duly executed by an Attorney -in -Fact, By OLD REPUBLIC INSURANCE COMPANY Attorney -in -Fact SCHEDULE OF POSITIONS COVERED HtREUNDER Page 3 of 3 ACCEPTANCE NUMBER POSITION 4 DIRECTORS ITRFASUR.ER BRIGGSDALE BRIGGSDALE CITY STATE COLORADO COLORADO Rate S per hundred, Annual Minimum Premium per position, $ Annual Minimum Earned Premium per position, 5 AMOUNT 31,000,00 S5,000,00 U3 A. OLD REPUBLIC 2N32Z22c2 2?22a%v :°:3 2316 . ..,: �,_� ,_�_ m:232?. m e «� „ RENEWAL a.z +x§=322 22:223. 1A 32263 5264 RP0 624562 Principal » < Agency Obligee 15 2213 52T2G3DALT 2223 22 §3 MILTON 2T. 32TSGS'n 2? +2 222a3ETT Al 1752 222E A Gx33232. CO BRIGG22«22 2223 LEO T6T2«?2 9316 93 222222 32. BRIGG32»23, 22 3 ma@B. Address TR aowiDescriool 20 323221 al Remar.cs ndard Remarks t. NOTICE: Please Respond to any request printed below # avoid further handlig&awn» 2223 3222 :3 222»«2§ IUM :3 PATS ??ANNIVE22ARY, BOARD OF DIRECTOR OATH OF OFFICE STATE OF COLORADO COUNTY §32-I-901,,';RS arc r—oiorado 1 Cnnsiltutlon Article 12. §S fliSTRIC; T �ti i`r � � `� writ f3thfuUy support the Constitutor of the United States and of the State of Colorado and the laws made pursuant thereto, and will faith oily perform the duties of me office of Director of District, upon which I fm about to enter (name of special 3istnct, Subscribed and sworn to betorc me tins / (signature of oath take/) Person authorized to administer oathsle County Clerk and Recorder Clerk of the Court, Chairman of the Board of Directors or any other person authorized to administer oaths; IF SWORN OR AFFIRMED BEFORE A NOTARY THE FOLLOWING SHOULD BE COMPLETED STATE OF COLORADO sS COUNTY OF Subscribed and sworn to before me this day of 20 tnotaf / signature, SEAL PROCEDURAL INSTRUCTIONS. The oath must be taken within 30 days after the election date or appointment to fill a vacancy Oaths taken prior to the election date are invalid. A copy of the executed oath and an individual, schedule, or blanket surety bond must be tiled with the Clerk of the Court, the Clerk and Recorder in every county in which the district extends and with the Division or Local Government. If this is the oath of an appointed director, also provide the notice of appointment to the Division in addition to the oath and bond documents; note who is being replaced, if applicable. Division of Local ucvemmenr - De ntmenr or L0ca! Affairs Sri -1 Revised 10/1701,5 THE OBLIGATION WHEN COVERAGE EFFECTIVE EXTENT OF SURETY'S LIABILITY Page 1 of 3 71 Old Republic Surety Company X Old Republic Insurance Company Ei tCHECK APPS CA;rp� COMPANY HEREINAFTER REFERRED TO AS THE SURE -FYI PUBLIC OFFICIAL SCHEDULE BOND (Position Form) Bond No. RPO 624862 1, KNOW ALL MEN BY THESE PRESENTS, that __OLD REPUBLIC INSURANCE COMPANY , a PENNSYLVANIA corporation, authorized to transact business as Surety, in the State of COLORADO as Surety, is held and firmly bound unto BRIGGSDALE FIRE PROTECTION DISTRICT as Obligee, in the respective sums set opposite the positions listed in the appropriate schedule, or in an endorsement, for the payment of which well and truly to be made the Surety does hereby bind itself, its successors, and assigns, firmly by these presents, SIGNED, SEALED AND DATED the 28TFI day of AUGUST 2008 OF THE CONDITION 2. The condition of this obligation is such that if each employee occupying any such position OBLIGATION shall faithfully discharge the duties thereof while such position s covered hereunder and shalt promptly account for and pay over, according to law, all money or property received by them by virtue of such position er, n default thereof shad pay all damages, costs, and expenses resulting from such default or defaults, then this obligation shall be void, otherwise to remain in full force and effect, subject, how- ever, to the terms and cond'tiuns hereinafter set forth. 3. This bond shall be effective as of ALTGI S'I` 26 , 2008 , Positions named in the attached schedule are covered on and after the effective date, positions added by being included in a new schedule identified by the signature of the Surety by an Officer or ,Attorney -in -Fact and attached as of any premium anniversary date, shall be covered on and after that anniversary date; positions added by endorsement shah he covered on and after the date specified therein. 4. The coverage on eace position is continuous from the inception of coverage to termination thereof, and the coverage for separate periods shall not be cumulative, The liability of the Surety for the failure of any employee to account for and pay over shall be limited to the failure to account for and pay over funds actually in such employee's possession during the period within which he is covered. If the coverage on any position for separate periods be for different amounts, the maximum liability of the Surety for all defaults of any employee who may occupy that position shall not exceed the largest amount of coverage in force During any periodwithin which defaults shall have occurred, nor shall the coverage for one period be available for defaults occurring within any other period, A failure to account in one period shall not be considered a default occurring during that period unless the funds were actually in the possession of the employee during .such period. If an employee occupy, at one time or at different times, two ar more covered positions, the maximum liability of the Surety for all defaults of that employee ;hail not exceed in the aggregate the largest amount of coverage on any position in which defaults of that employee shall lave occurred, nor shall the coverage for one posi- tion be available for defaults 1 any other position. ADCITICN CF POST-ICNS --- CHANGE CF AMOUNTS TEMPORARY AUTOMATIC COVERAGE DISCOVERING AND REPORTING LOSS, OR =ACTS INDICATING LOSS TERMINATION CHANGES IN PRINTED PROVISIONS - HOW MADE Page 2 of 3 5. Positions may be added to the schedule, or the amount of coverage an a position may be changed, upon the written application of the Obligee; such addition or change shall not be effective until the Surety has executed and mailed to the Obligee an endorsement accepting such addition or change, nor until the effective date specified therein, 6. Any newly created position shall be covered automatically for the first sixty days for the smallest amount for which any position of that class is then covered, but in no event for more than Five Thou- sand Dollars (650C0), or if there be no other position of that class, for the largest amount for which any position is then covered, but in no event for more than Five Thousand Collars ($5000). Recovery under this clause for defaults of any occupant of any such position may not he made unless claim be filed with the Surety within ten days after the expiration of such sixty day period, nor if during such sixty day period such position be covered by schedule or addition thereto as nereinbefore provided. 7. Upon discovery by the Obligee of any loss, or of facts indicating loss, the Obligee shall promptly, and in any event within ten days thereafter, notify the Surety thereof by registered mail addressed to the Surety. 8. The coverage on any position shall terminate if such position is omitted from the schedule attached as of any anniversary date. The coverage on any employee shall terminate when the employ- ment terminates or the Obligee discovers or becomes aware of any default committed by such employee. The coverage on any employee, or on any pcsition, or the bond in its entirety, may be terminated by written notice from either of the parties to the other. Such notice from the Surety shall become effective thirty days after receipt thereof by the Obligee; such notice from the Obligee shall become effective immedi- ately upon receipt thereof by the Surety 9. The liability of the Surety shall not be affected by any attempt by anyone representing or pur- porting to represent the Surety to construe or interpret this bond, nor by any change in the printed provi- sions of the bond made otherwise than by written instrument duly executed by a Vice -President of the Surety or by a printed endorsement duly executed by an Attorney -in -Fact, By OLD REPUBLIC INSURANCE COMPANY Attorney -in -Fact SCHEDULE OF POSITIONS COVERED HtREUNDER 4 DIRECTORS I TREASURER BRIGGSDALE BRIGGSDALE Page 3 of 3 COLORADO $1,000.00 COLORADO $5,000,00 Pate 3 per hundred, annual Ainimru n Premium per position, $ Annual Minimum Earned Premium per position, $ EE1 SDALE 95 22» s 322303 Cz Agency TRIBBETT AGENCY, 2L= 1750 25TH AVE., IT 205 GREECE Y, 22 32§34 Obligee BRIGGSDALE FIRE PROTECTION DISTFT 95 MILTON ST. BRIGGSDALE, C, Billing ss Cleo. g : � Bond Last wr : t Sc « Rem m:: Pate Moo a?gardRmarks NOTICE: Plea # Respond to any request printed @low to avoid further hang & expense THIS SON: IS CDNTI ?3.pEY : ! i» PAID TO IVEISARY. I z »<>= a2 'ILLE »*c>:«< &==z zz a:==z? AE 12223&2« °m° ©E . , .� . w::zs» <c +22x2»2 Ratable amm. Hello