HomeMy WebLinkAbout2020 CCMD David Barton 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-0002705 Coverage Period: 1/1/2020 to EOD 12/31/2020
Named Member:Broker of Record:
Chatfield Corners Metropolitan District
c/o Marchetti & Weaver, LLC
28 Second Street, Suite 213
Edwards, CO 81632
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