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Home My WebLink About20161611.tiff FREDERICK-FIRESTONE • -IRE Board of Directors FIRE PROTECTION DISTRICT �� ;? Office: (303) 833-2742 ''/ c. ( ) ) Fax: (303) 833-3736 z8Esc u ()I I It:lliM,VI'.NI:ALA 1 1(>,PII:I'AS BOARD OF DIRECTOR RECEIVED OATH OF OFFICE MAY 1 3 2016 §32-1-901,C.R.S.,and Colorado Constitution Article 12, §9 WELD COUNTY STATE OF COLORADO COMMISSIONERS WELD COUNTY FREDERIC =FIRESTONE FIRE PROTECTION DISTRICT I, JEFFREY JURGENA 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 Frederick-Firestone Fire Protection District, upon which I am about fo enter. (name of special district) (signature of oath taker) Subscribed and sworn to before me this 9th day of Ma 20 16 By: (P s authorized to administer oaths,i.e. 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 Weld ) Subscribed and sworn to before me this 94.11 day of tAcl ,20 I /�� i (� 2016-1611 Agci4 (.T�4 JFrc ' (notary signature) - ° C A;r. H-067 ' NCTil ni SEAL 8426 Kosmerl Place,Frederick,CO 80504;www.fffd.us cu A 3 J -gyp i �0n ICaLW Lo S-l2-au r b 5D00410 FREDERICK-FIRESTONE Board of Directors FIRE PROTECTION DISTRICT S; F/RE-->',. ( ) 1 Office: 303 833-2742 42 �4 ( Fax: (303) 833-3736 __� 1ESCU4 , (11Ff.ICI M.V I:NI:ItA 1'In,PII�1'AS BOARD OF DIRECTOR OATH OF OFFICE §32-1-901,C.R.S.,and Colorado Constitution Article 12, §9 STATE OF COLORADO WELD COUNTY FREDERICt-FIRESTONE FIRE PROTECTION DISTRICT I, CHRISTOPHER R. VIGIL 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 Frederick-Firestone Fire Protection District, upon which I am about to enter. (name of special district) A.% /0 (signature of oath taker) Subscribed and sworn to before me this 9th day of Mav ,20 16 . ': By: -� autho(A ' edtoadnister oaths,i.e. 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 Weld ) -a- Subscribed and sworn to before me this C h day of Mal ,20 i(„ . ��k � t L'H6 ��+17t% Lei-i';re�EC� �1.4p`-t�5 -i-r °: (notary signature) �J 1 # it . , 4. SEAL 8426 Kosmerl Place,Frederick,CO 80504;www.fffd.us FREDERICK-FIRESTONE \Fria'? Board of Directors FIRE PROTECTION DISTRICT ;4 Office: (303) 833-2742 4 . ) Fax: (303) 833-3736 (ll i l(:I l'NI.V ESIE:IIA 1'10,PIE'INS BOARD OF DIRECTOR OATH OF OFFICE §32-1-901,C.R.S.,and Colorado Constitution Article 12, §9 STATE OF COLORADO WELD COUNTY FREDERICt-FIRESTONE FIRE PROTECTION DISTRICT I, EDWARD G. WEIMER 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 Frederick-Firestone Fire Protection District, upon which I am about to enter. (name of special district) (signature of oath taker) Subscribed and sworn to before me this 9th day of May ,20 16 . t` J By: rs authorized to administer oaths,i.e. 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 Weld ) Subscribed and sworn to before me this C1412 day of Nt c, ,20 I(a aLi i Lert,D1,1 t:e doo44c3 hob ►w. (notary signature) DALE P,_o' _ IN GRAHAM 9AH✓114y Nui.4R_' PUBLIC - A �. v...l_9 a STATE OF-COLORADO SEAL My Commission Expires d tai 8426 Kosmerl Place,Frederick,CO 80504;www.fffd.us __''+ 41 FREDFIR-01 KIMT01 .a►ORL7 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 5/3/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT T.Charles Wilson Insurance Service PHONE FAX 384 Inverness Parkway Suite 170 (A/C,No.Ext):(303)368-5757 (A/C,No): (303)368-5863 Englewood,CO 80112 ADDRESS:info@wilsonins.com 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY )(MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED I PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION 1 PER OTH- AND EMPLOYERS'LIABILITY Y I N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under -DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A 3 Year Bond LSM0572052 06/01/2014 06/01/2017 Bond Amount 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 Colorado Department of Local Affairs THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Division of Local Government-Special Districts 1313 Sherman St.,Rm 521 Denver,CO 80203 AUTHORIZED RERE�� REPRESENTATIVE I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Hello