1985 - 03-18-85 Regular Meeting - Laserfiche WebLink

Home Browse Search

LA • • aooK 11 PAGE 712 INITIAL CERTIFICATION of FIRE DEPARTMENT 7 WHEREAS, G.S. 118-38 requires certification to the Commissioner of Insurance as to the firemen and fire departments who serve the citizens of North Carolina within the various cities and counties of our State as a requirement for eligibility for benefits under the "North Carolina Firemen's and Rescue Squad Workers Pension Fund Act" and also the "Law-Enforcement Officers, Firemen's, Rescue Squad Workers' and Civil Air Patrol Members' Death Benefits Act" (143-166.2, (d)), the undersigned certifies to the North Carolina Commissioner of Insurance that: (1) The Northwest Pocket Fire Department serves the citizens of Northwest Pock r KrbVXxXFire District) and perform such functions as protection of life and property through firefighting within Lee ((6t ")v County). (2) The North Carolina Commissioner of insurance has determined that Northwest Pocket ("NK/Fire District) which is served by the above named Fire Department, is classified as not less than Class 9 in accordance with rating methods or insurance classification rules now in effect, or by such other reasonable methods as determined by the Commissioner. (3) The above named Fire Department operates fire apparatus and equipment of a value of Five Thousand Dollars or more and has the following members. (Attach roster) (4) The above named Fire Department has been approved to serve within Lee (")~%/County) by resolution adopted by the Lee 00(1§X QgQ"Xik/County Board of Commissioners) of Lee (XCounty) at a meeting held on the day of 19 , and the undersigned was directed to execute and orward a copy of same to the North Carolina Commissioner of Insurance. Witness my hand and seal, this the SEAL Signature tie Date day of . 19 Notary Public Signature my commission expires Return to: NC Dept. of Insurance, Fire E Rescue Division, PO Box 26387, Raleigh, North Carolina 27611