HomeMy WebLinkAbout20141996.tiff DISTRICT
COLORADO ISTO URT,COUNTY OF WELD, STATE OF RECEIVED
901 9'h Avenue
Greeley. Colorado 80631 JUN 2 6 28;1i
970-351-7300
WELD PP METROPOLITAN IN
DISTRICT' E OMMI COUNTY
PIONEER REGIONAL COMMISSIONERS
T
MaryAnn M. McGeady A COURT USE ONLY A
McGeady Sisneros. P.C.
450 E. 17th Ave., Suite 400 Case Number: 2006 CV3 30
Denver, Colorado 80303-1214
Phone: (303) 592-4380 Dis.: I Ctrm.:
Fax: (303) 592-4385
I ,
E-mail mmcgeadvomceeadvsisneros.com
Atty. Reg. #: 12417
OATH OF DIRECTOR
The undersigned solemnly swears (or affirms) that he vsill faithfully perform the duties of
this office as required by law and will support the Constitution of the United States, the
Constitution of the State of Colorado. and the h sys made pursuant thereto.
Joel t. Farkas
Address: 1880 Arapahoe Road. #281 I
Denver, CO 80202
S"FATE OF COLORADO
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Subscribed and sworn to before me this day of {1
WITNESS my hand and official seal. f
\ '
TONI SERRA Lan Public
NOTARY PUBLIC
STATE OF COLORADO
NOTARY ID 20094001459
MY COMMISSION EXPIRES JANUARY 27 20 t i tiexpires:ti �fy commission cx ( -
, 2014-1996
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25 Deferral Program
/ailligfilihilk years
Colorado Special Districts Property and Liability Pool
Comprehensive Crime Certificate Holder Declaration
Master Coverage Policy Number: CCP0037259
Certificate Number: 27C60263-789 Coverage Period: 1/1/2014 Until Cancelled
Named Member: Billing Period: 1/1/2014 to 1/1/2015
Pioneer Regional Metropolitan District Broker of Record:
c/o Special District Management Services, Inc.
141 Union Blvd., Suite 150
Lakewood, CO 80228
Covered ERISA Plan:
Coverage, Limits of Insurance and Deductibles Limits:
Public Employee Dishonesty Coverage: $5,000
- Limit is Per Loss
- Faithful Performance of Duty
- Officers. Directors, and Trustees
-Welfare and Pension Plan ERISA Compliance
if Covered Plan is shown on application
-Volunteer Workers as Employees
Forgery or Alteration Coverage: $5,000
Theft, Disappearance, and Destruction Coverage:
Inside Premises $5,000
Outside Premises $5,000
Computer and Funds Transfer Fraud Coverage:
Limits are equal to Employee Dishonesty Coverage or$25,000 whichever is less
Debit, Credit or Charge Card Forgery Coverage:
Limits are equal to Employee Dishonesty Coverage or $25.000 whichever is less
Money Orders and Counterfeit Paper Currency Coverage: $5,000
Crime Deductible: $100
Contribution: $133.31
Policy Forms: CR 00260506 Government Crime Policy
CR 25070300 Include Specified Directors or Trustees on Committee as Employees
CR 25080300 Include Specified Non-Compensated Officers as Employees
CR 25090300 Include Volunteer Workers as Employees
CR 25190506 Add Faithful Performance of Duty
CR 25120300 Include Treasurers or Tax Collectors as Employees
CR 02151104 Colorado Changes
CR 25200300 Debit, Credit or Charge Card Forgery
This Certificate Holder Declaration is made and is mutually accepted by the CSD Pool and the Named Member
subject to all terms which are made a part of the Master Comprehensive Crime Policy. This Certificate
represents only a brief summary of coverages. Please refer to the Master Policy Document for actual coverage,
terms, conditions, and exclusions.
6/1
Countersigned by k/—b/ Tuesday, December 10, 2013
Authorized Representative
Entity ID#: 60263
DISTRICT COURT,COUNTY OF WELD,STATE OF
COLORADO
9t}19`h Avenue
Oree[c1, Colorado 80631
970-351-7300
PETITIONER: IN RE PIONEER REGIONAL
METROPOLITAN DISTRICT
M1aryAnn M. McGeady A COURT USE ONLY A
McCiEADY S1SNEROS. P.C.
450 L. 17'h Ave.. Suite 400
Case Number: 2006 C'V230
Denver,Colorado 80203-1214
Phone: (303) 592-4380
Div.: I Ctrtii.:
Fax: (303) 592-4385
E-mail: mmcgcadv•u:mcgead)sisncros.com
Atty. Rue.. #: 12417
OATH OF DIRECTOR
•[he undersigned solemnly swears (or affirms) that she will faithfully perform the duties
of this office as required by law and will support the Constitution of the United States. the
Constitution of the State of Colorado. and the laws made pursuant thereto.
Jean Go
Addre : 7882 Sweet Water Road
Lone Tree.CO 80124
STAM OF COLORADO
ss.
COUNTY OF ( i- e_tT_.__
Subscribed and sworn to before me this._.'?Z3 day of a.'• .__014.
WITNESS my hand and official seal.
TONI SERRA -- -....... ---� --
NOTARY PUBLIC •. No 3' Public
STATE OF COLORADO
NOTARY ID MY COMMISSION EXPIRES JAt DAIRY 294001459 7 201. ti
My commission expires: C (2.7 -a_C 1 7
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25 Deferral Program
years
Colorado Special Districts Property and Liability Pool
Comprehensive Crime Certificate Holder Declaration
Master Coverage Policy Number: CCP0037259
Certificate Number: 27C60263-789 Coverage Period: 1/1/2014 Until Cancelled
Named Member: Billing Period: 1/1/2014 to 1/1/2015
Pioneer Regional Metropolitan District Broker of Record:
c/o Special District Management Services, Inc.
141 Union Blvd., Suite 150
Lakewood, CO 80228
Covered ERISA Plan:
Coverage, Limits of Insurance and Deductibles Limits:
Public Employee Dishonesty Coverage: $5,000
- Limit is Per Loss
- Faithful Performance of Duty
-Officers. Directors, and Trustees
-Welfare and Pension Plan ERISA Compliance
if Covered Plan is shown on application
-Volunteer Workers as Employees
Forgery or Alteration Coverage: $5,000
Theft, Disappearance, and Destruction Coverage:
Inside Premises $5,000
Outside Premises $5.000
Computer and Funds Transfer Fraud Coverage:
Limits are equal to Employee Dishonesty Coverage or$25.000 whichever is less
Debit, Credit or Charge Card Forgery Coverage:
Limits are equal to Employee Dishonesty Coverage or$25,000 whichever is less
Money Orders and Counterfeit Paper Currency Coverage: $5,000
Crime Deductible: $100
Contribution: $133.31
Policy Forms: CR 00260506 Government Crime Policy
CR 25070300 Include Specified Directors or Trustees on Committee as Employees
CR 25080300 Include Specified Non-Compensated Officers as Employees
CR 25090300 Include Volunteer Workers as Employees
CR 25190506 Add Faithful Performance of Duty
CR 25120300 Include Treasurers or Tax Collectors as Employees
CR 02151104 Colorado Changes
CR 25200300 Debit,Credit or Charge Card Forgery
This Certificate Holder Declaration is made and is mutually accepted by the CSD Pool and the Named Member
subject to all terms which are made a part of the Master Comprehensive Crime Policy. This Certificate
represents only a brief summary of coverages. Please refer to the Master Policy Document for actual coverage,
terms, conditions, and exclusions. /
Countersigned by. �i, /tc�rC Tuesday. December 10, 2013
Authorized Representative
Entity ID#: 50263
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