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Home My WebLink About210456 COLORADO HOME IMPROVEMENTS LLC - COIGARCIADAng VARCHULFTA ,a►co�zo CERTIFICATEOF LIABILITY INSURANCE DATE(MMIDDIYYYY) 5/3112022 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 have ADDITIONAL INSURED provisions or 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 CONTACT NAME: PHONE FAX (A/C, No, Ext):(303) 420-4774 (A/C, No): (303) 420-2882 Mountain Insurance Brokers 3705 Kipling St # 106 Wheat Ridge, CO 80033 A oR�Ess: service@mountaininsurance.com INSURERS AFFORDING COVERAGE NAIC # EACH OCCURRENCE $ 130003000 INSURER A: Mesa UnderwritersSpeci alty Ins C.O. INSURER B MED EXP (Any oneperson) $ 5,000 INSURED GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC JECT OTHER: INSURER C PRODUCTS -COMP/OP AGG $ 2,000,000 Colorado Home Improvements LLC INSURER D AUTOMOBILE 7121 Samuel Drive Unit 206 Denver, CO 80221 INSURER E INSURER F 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 CONTRACT OR 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD(MM/DD/YYYY) POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR MP000500610000200 5/25/2022 5/25/2023 EACH OCCURRENCE $ 130003000 DAMAGE TO RENTED 1003000 PREMISES Ea occurrence $ MED EXP (Any oneperson) $ 5,000 PERSONAL &ADV INJURY $ 130003000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC JECT OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 1 1 COMBINED SINGLE LIMIT (Ea accident $ BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION ACORD 25 (2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Wheat Ridge BuildingDIVISIOII THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7500 W. 29th Ave. Wheat Ridge, CO 80033 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Company: COLORADO HOME IMPROVEMENTS Address: 7121 SAMUEL DR #206 City, State ZipCode: DENVER, CO 80221 Type: GENERAL CONTRACTOR Subtype: Website: Email: DGARCIA0505@GMAIL.COM Phone 1:(720)595-9700 Phone 2: Phone 3: Fax: Status: Active Issued: 3/11/2010 Expires: 5/31/2023 Trust Account No. Business Agency: Business No. Bus Lic Issued: Bus Lic Expires: Notes: Mw"- FINANCIAL INFORMATIOIV CONTACTS QUANTITY PAID DATE AMOUNT PAID BY PAY METHOD ACCOUNT NAMETYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL CONTACT DAVID GARCIA 7121 SAMUEL DR #206 DENVER CO 80221 (720)595-9700 DGARCIA0505@GMAIL .COM CONTACT 2 JASMINE GARCIA 7121 SAMUEL DR #206 DENVER CO 80221 (720)595-9700 JASGARCIA05@GMAIL. COM Mw"- FINANCIAL INFORMATIOIV DESCRIPTION QUANTITY PAID DATE AMOUNT PAID BY PAY METHOD ACCOUNT CONTRACTOR 0 5/27/2022 110 100331024 CREDIT 9999.99999.0001 REGISTRATION FEE Printed: Tuesday, 31 May, 2022 1 of 1 I TRAKiT City of "�qW heat idge COMMUNiTy DEVELOPMENT 7500 W. 291" Avenue' Wheat Ridge, CO 80033' O: (303)235-2855' F: (303)235-2857 Contractor Waiver for Workers' Compensation Insurance I, (print your name), verify that I am the sole owner or partner of (company name): 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 Rid a and will be listed on the permit. Signature: —R� =L " _ Date: J) 311 ;4 oa -;�-