The URL can be used to link to this page

Home My WebLink About210415 INTEGRATING SUCCESSFUL PROJECTthumbnail_20200725_092930liignlands Rancn CO 80165 EXAMINATION RESULT. PASS status on the I st ren nave passed Ure business nouns your exam =taws on me ICC wedaae within 48 72 booms== noars aver your exam Please ori- _rc%trar participating jurisdiction if you wish to pursue licensing. A passing score on this examination satisfies the testing requirements tar rc� nicc guarantee that licensing will be granted The candidate must also saasry all'.ecal orcin cia eeyraa.as in earn jurisdiction where licensing is desired. It Is extremely important that you notify Pearson VUE and ICC of any changes In herne aria39R6p void the possibility of future correspondence not being received. Please contact CoN Pterryl VM al 8]]-234-6082 and ICC at 888-422-7233 ext. 5524 with changes M your name and addYHss ICG reserves the right to amend or withhold any examination scares 4,, In is sole aprrpc tee is adequate reason to question their validity. OFFICIAL RESULTS REPORT F 14 - National Standard Fooling ¢r+ Contractor/Subcontractor CONLU0a6N Name Michael Galusha -ardri C' Address P O Baa 531656 Goes liignlands Rancn CO 80165 EXAMINATION RESULT. PASS status on the I st ren nave passed Ure business nouns your exam =taws on me ICC wedaae within 48 72 booms== noars aver your exam Please ori- _rc%trar participating jurisdiction if you wish to pursue licensing. A passing score on this examination satisfies the testing requirements tar rc� nicc guarantee that licensing will be granted The candidate must also saasry all'.ecal orcin cia eeyraa.as in earn jurisdiction where licensing is desired. It Is extremely important that you notify Pearson VUE and ICC of any changes In herne aria39R6p void the possibility of future correspondence not being received. Please contact CoN Pterryl VM al 8]]-234-6082 and ICC at 888-422-7233 ext. 5524 with changes M your name and addYHss ICG reserves the right to amend or withhold any examination scares 4,, In is sole aprrpc tee is adequate reason to question their validity. ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) TYPE OF INSURANCE 4/22/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Certificate Department 4 Corners Insurance Services (A/CNNo Ext): 720-475-1933 FAX No): 10940 S Parker Rd. Suite 422 E-MAIL ADDRESS: certs@4-cis.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Atlantic Casualty Insurance Company 42846 Parker CO 80134 INSURED INSURER B INSURER C: PERSONAL & ADV INJURY ISP Roofing &Construction INSURER D: AGGREGATE LIMIT APPLIES PER: POLICY PRO JECT1:1 LOC OTHER: 5155 Weeping Willow Cir INSURER E: X PO Box 631656, Littleton, CO 80163 1 INSURER F: Littleton CO 80130-4486 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM DD YYYY) (MM/DDYYYPY) LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR Y Y L262002159 2/25/2022 2/25/2023 EACH OCCURRENCE $ 1,000,000 PREMISEUA'VIAUES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO JECT1:1 LOC OTHER: GENERAL AGGREGATE $ 2.000.000 X PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED$ HIRED AUTOS AUTOS (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Per accident) UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION- AND EMPLOYERS' LIABILITY Y / N ANY PROP RIETOR/PARTNER/EXEC UTIVEF-1N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below /A STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The certificate holder is named as Additionally Insured in regard to General Liability Insurance for ongoing operations. CERTIFICATE HOLDER CANCELLATION U 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Wheat Ridge Building and Inspection Services Division 7500 W 29th Ave AUTHORIZED REPRESENTATIVE Wheat Ridge CO 80033-8001 U 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD City Of "f Wh6atj�idge COMMUNITY DEVELOPMENT 7500 W. 29th Avenue * Wheat Ridge, CO 80033 * O: (303)235-2855 * F: (303)235-2857 Contractor Waiver for Workers' Compensation insurance I, (print your name), Michael Galusha verify that I am the sole owner or partner of (company name): Integrating Successful Projects (ISP) Roofing & Construction , which has no employees and is not required by the State of Colorado to carry workers' compensation insurance. I further state that if i hire contractors/subcontractors, they are in compliance with the State of Colorado Workers' Compensation insurance requirements, have obtained the required contractor's license from the City of Wheat Ridge and will be listed on the permit. Signature: / �' /lcr , ---A k-All,ri Date: 4/22/2022