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2020 Blair Hayes Oath of OfficeComprehensive Crime Certificate Holder Declaration Master Coverage Document Number: CR 00 26 11 15 Insurer: Fidelity and Deposit Company of Maryland Certificate Number: POL-0002383 Coverage Period: 1/1/2020 to EOD 12/31/2020 Named Member:Broker of Record: Bachelor Gulch Metropolitan District T. Charles Wilson Insurance Service c/o Marchetti & Weaver, LLC 384 Inverness Parkway 28 Second Street, Suite 213 Edwards, CO 81632 Suite 170 Englewood, CO 80112 Covered ERISA Plan: Covered Designated Agent(s): Coverage 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 Volunteer Workers as Employees Forgery or Alteration Coverage:$5,000 Theft, Disappearance, and Destruction Coverage:$5,000 Inside Premises Outside Premises 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: $135 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