HomeMy WebLinkAbout2018 Gabrielle Keown OathEO
DISTRICT COURT, EAGLE COUNTY, COLORADO
Court Address: 885 Chambers Avenue
Eagle, CO 81631
Telephone: (970) 328-6373
Petitioner:
SMITH CREEK METROPOLITAN DISTRICT
Attorney for Petitioner:
Name:
William P. Ankele
Address:
WHITE BEAR ANKELE
TANAKA & WALDRON
Professional Corporation
2154 E. Commons Ave., Suite 2000
Centennial, CO 80122
Phone Number:
(303) 858-1800
Fax Number:
(303) 858-1801
Email:
wpankele@wbapc.com
Atty. Reg. ti:
12142
♦ COURT USE ONLY
Case No: 94 CV 4237
Ctrm:
Div: H
OATIl( OF OFFICE PURSUANT TO § 32-1-901, C.R.S.
GABRIELLE KEOWN
SMITH CREEK METROPOLITAN DISTRICT
STATE OF COLORADO
ss.
COUNTY OF EAGLE
I, Gabrielle Keown, 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 Smith Creek Metropolitan District upon which I am about to enter
for an elected term ending May 2022.
Sig watt & Recorder
�a91e t;ounty Cterk D
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J"U 4 201k
9993.001 I: 589860-1 Ipm
Subscribed and sworn to before me this __ _day of , 2018.
By:_
Person authorized to administer oaths (County
Clerk and Recorder, Clerk of the Court, and any
Other person authorized to administer oaths or
Chairman of the Board of Directors)
IF SWORN OR AFFIRMED BEFORE A NOTARY TIM, FOLLOWING SHOULD BE
COMPLETED.
STATE OF COLORADO )
) SS.
COUNTY OF BIrDOyYI64,U )
Subscribed and sworn to before me this _ Z1
ALLISON SCOTT
NOTARY PUBLIC
STATE OF COLORADO
(S E A L) NOTARY ID N 20104019069
My Commisslen Expires 06-18-2020
1VIy commission expires:_ UN ��Z020
day of _, 2018 by
0(j I � g1mg L%k��
Notary Public
To be filed with the Clerk of the Court and with the Division of Local Government within thirty
(30) days after the election (or being appointed).
9993.0011:589860-1
�j►
Colorado Special Districts Property and Liability Pool
Comprehensive Crime Certificate Holder Declaration
Master Coverage Policy Number: CCP0037259
Certificate Number: 31 C60730-1463
Named Member:
Smith Creek Metropolitan District
c/o Marchetti & Weaver, LLC
28 Second Street, Suite 213
Edwards, CO 81632-
Covered ERISA Plan:
Covered Desicinated Agent(s)
Coverage Period: 1/1/2018 Until Cancelled
Billing Period: 1/1/2018 to 1/1/2019
Broker of Record:
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:
$5,000
Debit, Credit or Charge Card Forgery Coverage:
$5,000
Money Orders and Counterfeit Paper Currency Coverage:
$5,000
Fraudulent Impersonation Coverage:
$5,000
Crime Deductible: $100
Fraudulent Impersonation Deductible: 20% of Fraudulent Impersonation Limit
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 Duly
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.
r, )
Countersigned by
4 4.4
Friday, September 08, 2017
Entity ID#: 60730
