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HomeMy WebLinkAbout2020 Courtney Holm Oath of OfficeDISTRICT COURT OF EAGLE COUNTY,
STA TE OF COLORADO
Court Address: Eagle County Justice Center
885 Chambers Avenue
PO Box 597
Eagle, Colorado 81631
IN RE THE MATTER OF BERRY CREEK A COURT USE ONLY A
METROPOLITAN DISTRICT
Attorneys for the District:
Collins Cockrel & Cole, P.C.
James P. Collins Case No. 79 CV 41
390 Union Boulevard, Suite 400
Denver, Colorado 80228-1556
(303) 986-] 551 Div.: Ctrm.:
(303) 986-1755 -Facsimile
E-mail: jcollins@.cccfirm.com
Atty . Reg. #: 7958
OATH OF OFFICE
I , Courtney Holm , 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 faithfull y
perform the duties of the office of Director of Berry reek Metropolitan District upon which I am
about to enter to the best of my ability .
I
I c__
Title of Pers n Administering Oath *
*Pe rs ons authorized to adm inister oaths: Chairman o f the Board of Directors,
Notary Public, County Clerk and Recorder or Clerk of the Court
IF SWORN OR AFFIRMED BEFORE A NOTARY THE FOLLOWING MUST BE COMPLETED:
ST A TE OF COLORADO )
) ss .
COUNTY OF EAGLE )
tJ/1 t-r--
Subscribed and sworn to before me this -'-~ ____ day of May, 2020 .
Mycommissionex pires: :(1,_\y !'1,7,.0~(!lf:-'i ~
CHERI L CURTIS
Notary Public
State of Colorado
Notary ID# 20074027333
My Commission Expires 07-17-2023
Comprehensive Crime Certificate Holder Declaration
Master Coverage Document Number: CR 00 26 11 15 Insurer: Fidelity and Deposit Company of Maryland
Certificate Number: POL-0002394 Coverage Period: 1/1/2020 to EOD 12/31/2020
Named Member:Broker of Record:
Berry Creek Metropolitan District T. Charles Wilson Insurance Service
PO Box 1058 384 Inverness Parkway
Edwards, CO 81632-1058 Suite 170
Englewood, CO 80112
Covered ERISA Plan: Covered Designated Agent(s):
Coverage Limits:
Public Employee Dishonesty Coverage:$15,000
Limit is Per Loss
Faithful Performance of Duty
Officers, Directors, and Trustees
Welfare and Pension Plan ERISA Compliance if Covered Plan is shown
Volunteer Workers as Employees
Forgery or Alteration Coverage:$15,000
Theft, Disappearance, and Destruction Coverage:$15,000
Inside Premises
Outside Premises
Computer and Funds Transfer Fraud Coverage:$15,000
Debit, Credit or Charge Card Forgery Coverage:$15,000
Money Orders and Counterfeit Paper Currency Coverage:$15,000
Fraudulent Impersonation Coverage:$15,000
Crime Deductible:$250
Fraudulent Impersonation Deductible: 20% of Fraudulent Impersonation Limit
Contribution: $211
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
CR 25020506 Include Designated Agents as Employees, when listed
CR 04171115 Fraudulent Impersonation
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:
Authorized Representative