2011-03
.'
J!I
--=ilr Policy Number
VFIS- TR-2062288-03/ 001
AAIC THIS ENDORSEMENT CHANGES THE POLICY.
American Alternative Insurance Corporation PLEASE READ IT CAREFULLY.
COMMON POLICY CHANGE ENDORSEMENT
Named Insured HUGHSONVILLE FIRE DISTRICT Effective Date: 03-31-11
12:01 A.M., Standard Time
Agency Name VFIS
This endorsement will not be used to decrease coverages, increase rates or deductibles or alter any terms or conditions
of coveraqe unless at the sole reauest of the insured.
COVERAGE PART INFORMATION - Coverage parts affected by this change as indicated by [)lelow.
D Property
~ Crime $ 255.00
D Portable Equipment [R1~CC~~\w~[Q)
D Auto APR 1 8 2011
D General Liability
D Management Liability TOWN OF \lVAPPINGER
D TOWN CLERK
The following item(s):
D Insured's Name D Insured's Mailing Address
D Policy Number D Company
D Effective/ Expiration ~ate D Insured's Legal Status/Business of Insured
D Payment Plan D Premium Determination
D Additional Interested Parties D Coverage Forms and Endorsements
D Limits/Exposures D Deductibles
D Covered Property/Location Description D Classification/Class Codes
D Rates D Underlying Exposure/ Insurance
is (are) changed to read {See Additional Page(s)}
SEE NEXT PAGE
The above amendments result in a change in the premium as follows:
This premium does not include taxes and surcharges.
ONo Changes 10 To be Adjusted at Audit I Additional $ 255.00 Retu rn
Tax and Surcharge Changes
Additional Retu rn
Countersigned By: ~ ~ fJ.L II
AUTHORIZED AGENT
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~*
AAIC
A Ie Alt t. I C ti COMMON POLICY CHANGE ENDORSEMENT
mer an erna Ive nsurance orpora on
Policy Number
VFIS- TR-2062288-03/ 001
Named Insured HUGHSONVILLE FIRE DISTRICT
Agency Name
VFIS
POLICY CHANGES ENDORSEMENT DESCRIPTION (CONT'D)
Effective Date: 03 - 31-11
12:01 A.M., Standard Time
ADDED SPECIFIC EXCESS COVERAGE FOR THE DISTRICT TREASURER OF THE
HUGHSONVILLE FIRE DISTRICT IN THE AMOUNT OF $1,000,000 WITH FAITHFUL
PERFORMANCE.
ADDED SPECIFIC EXCESS COVERAGE FOR THE DEPUTY TREASURER OF THE
· HUGHSONVILLE FIRE DISTRICT IN THE AMOUNT OF $1,000,000 WITH FAITHFUL
PERFORMANCE.
ALL OTHER TERMS AND CONDITIONS REMAIN THE SAME
REMOVAL PERMIT
If this policy includes the Commercial Property Coverage Part, the following applies with respect to the Coverage Part:
If Covered Property is removed to a new location that is described on this Policy Change, you may extend this
insurance to include that Covered Property at each location during the removal. Coverage at each location will apply in
the proportion that the value at each location bears to the value of all Covered Property being removed. This permit
applies up to 10 days after the effective date of this Policy Change; after that, this insurance does not apply at the
previous location.
INSURED COPY
.E'*
AAIC
Policy Number
VFIS- TR-2062288-03/ 001
SCHEDULE OF ADDITIONAL INTEREST(S)
American Alternative Insurance Corporation
Named Insured HUGHSONVILLE FIRE DISTRICT
Effective Date:
03-31-11
Agency Name VF I S
Loss Payee
HEWLETT PACKARD FINANCIAL SERVICES COMPANY
420 MOUNTAIN AVENUE
MURRAY HILL, NJ 079740006
DESCRIPTION LEASED EQUIPMENT VALUE $7800 - PREM 1-1
12:01 AM., Standard Time
Loss Payee
COMMUNITY FIRST NATIONAL BANK AND/OR IT'S ASSIGNS
215 S SETH CHILD RD
MANHATTAN, KS 66502
DESCRIPTION APPLIES TO 12 SCOTT SCBA'S VALUED AT $68,944
INSURED COPY
~.
AAIC
American Alternative Insurance Corporation
Policy Number
VFIS- TR-2062288-03/ 001
SCHEDULE OF NAMED INSURED(S)
Named Insured HUGHSONVILLE FIRE DISTRICT
Effective Date:
03-31-11
Agency Name VFIS
HUGHSONVILLE FIRE COMPANY, INC
12:01 AM., Standard Time
HUGHSONVILLE FIRE DEPARTMENT VOLUNTEE AND EXEMPT FIREMAN'S BENEVOLENT
ASSOCIATION
HUGHSONVILLE FIRE CO LADIES AUXILIARY
INSURED COPY
Named Insured:
HUGHSONVILLE FIRE DISTRICT
Policy Number: VFIS-TR-2062288-03/001
Policy Period: From: 03-01-2011
To: 03-01-2012
I
Public Employee Blanket Bond - Form P
I
Covered Entity:
HUGHSONVILLE FIRE DISTRICT
Limit of Insurance
$
250,000
Deductible
None
Faithful Performance
Yes
SPECIFIC EXCESS LIMIT OF INSURANCE -NAME SCHEDULE
Names of Covered "Employees"
Excess Limit of
Insurance Each
"Employee"
Faithful
Performance
SPECIFIC EXCESS LIMIT OF INSURANCE - POSITION SCHEDULE
Titles of Positions
DISTRICT TREASURER
DEPUTY TREASURER
Number of
"Employees" in
Each Position
1
1
Excess Limit of
Insurance
Each "Employee"
$ 1,000,000
$ 1,000,000
Faithful
Performance
Yes
Yes
VCR100 (11/06)
04-0~2011
INSURED COPY'
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
SPECIFIC EXCESS LIMIT OF INSURANCE -
POSITION SCHEDULE
This endorsement applies only to:
EMPLOYEE DISHONESTY COVERAGE FORM A - BLANKET
PUBLIC EMPLOYEE DISHONESTY COVERAGE FORM 0 - BLANKET PER LOSS
PUBLIC EMPLOYEE DISHONESTY COVERAGE FORM P - BLANKET PER EMPLOYEE
Titles of Positions
Number of "Employees" in
Each Position
Excess Limit of
Insurance Each
"Employee"
[If no entry appears above, the information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.]
1. The excess Limit of Insurance shown in the schedule above applies to each "employee" who holds
a position shown in the schedule opposite that limit.
2. The excess Limit of Insurance applies only to that part of any covered loss that is excess of an
amount equal to the Limit of Insurance shown in the Declarations for COVERAGE FORM A, 0 or
P plus any applicable deductible amount.
3. The excess Limit of Insurance applies only to loss caused by an identified "employee".
4. The most we will pay for an "employee" holding more than one position in the largest excess Limit
of Insurance in effect and applicable to anyone of those positions at the time of loss.
VCR304 (03/03)
CRIME
Copyright 2002 American Alternative Insurance
Corporation. All rights reserved. Includes copyrighted
material of the Insurance Services Office, Inc. with its
permission.
Page 1 of 1
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