HomeMy WebLinkAbout2023 LCMD Oath of Office - Donald WelchCrime Certificate Holder Declaration
Master Coverage Document Number: J05931794 Insurer: Federal Insurance Company (Chubb)
Certificate Number: 23PL-60059-3125 Coverage Period: 1/1/2023 to EOD 12/31/2023
Named Member:Broker of Record:
Lake Creek Metropolitan District NO BROKER
c/o Marchetti & Weaver
28 Second St, Ste 213
Edwards, CO 81632
Covered Designated Agent(s):
Coverages and Limits:
Employee Theft:$25,000
· Limit is maximum for each loss
· Employee includes executives, full-time, part-time, seasonal, leased and
temporary employee(s), interns or non-compensated volunteer.
· Includes funds from a sponsored benefit plan.
Public Official Faithful Performance of Duty:$25,000
Client Theft:$25,000
Forgery or Alteration:$25,000
On Premises:$25,000
In Transit:$25,000
Computer System Fraud:$25,000
Funds Transfer Fraud:$25,000
Debit, Credit or Charge Card Fraud:$25,000
Money Orders and Counterfeit Paper Currency Fraud:$25,000
Social Engineering Fraud:$25,000
Deductible(s):
All Crime except Social Engineer Fraud:$250
Social Engineering Fraud: 20% of Social Engineering Fraud Limit
Contribution: $282
Policy Forms:
PF-52815 (04/20) The Chubb Primary℠ Commercial Crime Insurance
PF-52853 (04/20) Governmental Entity (Colorado Special Districts Pool) Endorsement
PF-53127 (04/20) Colorado Amendatory Endorsement
PF-52851 (04/20) Add Corporate Credit Card Coverage
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 Crime Policy. This Certificate represents only a brief summary of coverages. Please
refer to the Master Policy Documents for actual coverage, terms, conditions, and exclusions.
Countersigned by:
Authorized Representative
