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Home My WebLink About210500 TOP ELECTRIC certificate of liability insuranceCERTIFICATE OF LIABILITY INSURANCE ITS WEE NM AFFlRMATNELY " NEOAYWELY AMEND, E%TENO OR ALTER THE COV — rr AFFOROEO ET THE THIS DERIIFICATE OF INSURANCE ODES NOT CONETIIU]E A CONTRAOT EETIYEEN THE ISMIWO IMSIMaatm err M E nOMMa AS rade arrarR A NpERn1 On SCOTT BROWN STATE FANMAGENCV INC te0 MMINION WAY GTE S COLCRAOO WI NGS. M "Ia To DEMI Ina. 3132 N Hermck An Cdptla SMkM;C08090] A 98C3509B-2 6VOfl/N1B Y$NMOD]3 1: verewrm E o.vH F { t.OL0.0a0 mR4GGEa]E _ WIf prec ra0aY❑ j ®rm _ _ _ i 3. 01) _. w s 2.W.0o0 M ER u xp Owv AUTCAUul INCBw1LV uuasaamtas parotrmte Darotrml3 umness PMRany a I.M _ o { 1.0110.00 tcmp r LPMff _ INJURY Iarw mI s uPIAVAE mwp s rr_EggJ._ { w�•y{{ =} R 6V1&W➢E OCCucgwcE E - { RED It Kal NpRA9COYEMEIPoM gO!/WY6V WELnY IMwYYp FXXI E�RWEM WE �N Prp ff-GexsiXMiew's MI.M EL E1Gri9awlf e ELgagE-E1NpgE { eYwEAE-wunurM or OrEMMM16rrD1'A1pX0rvExCw prippler.MN6nygesynarhtY.igrmiynMu��aMMrMMI OMer AUYO COvxgles; Metlkal prymmlCj25.00 CgnpeMmiue EMumbleS230 COEiNanaeducnelM�so11 Tar GOIINaIa Hddm kIiatad E an a iOnN inminE an 0e Inik BMgMDANYOFTEN ME MEOPoWEE BE CMICELLEO LEPoRE EJie1"a Sar"Ar NN MM TNFAEOF, MI WEC ME OEV/EREO N 7WUnio LLC ACLOppAXCEMINTXEFIXICY PMOYNpIM ]O BI MW Fl_ Jum BEM,FL 3300 EOrmw°prT AC0111023(2016103) The ACORO name and lope am rNp{breM mNM{ OI AGOgp _^�••�� ry �wer�se. rWrua RAMra.r2 oaro-mre Colorado: lorado Department of Regulatory Agenci Division of Professions and Occupations Electrical Board Leota M Everson Master Electrician ME.0027462 Number 10/01/2020 Issue Date Active 09/30/2023 Credential Status Expire Date Veynffyt�hiis credential at: dpo.colorado.gov �/ Division Directorf Ronne Hines Credential Holder Signature DC number on the douglas cc Permit is E170123 Top Electric address 3132 N. Hancock Ave, Colorado Springs, CO 80907, United States Snip of Top Electric Stamp TV PINN111 7501 E. Lowry Blvd. ASSURANCE Denver, CO 80230-7006 303.361.40001800.873.7242 — — — PinnecoLcorn October 1, 2021 Policy #:4074279 ITEM 1. INSURED Top Electric Inc. Womem Group, Inc. dbe Pikes Peek P.O. Box 7306 P. O. Box 4880 Cdora to Springs. CO 80933 Woodland Park, CO 80866 (719) 687J500 ITEM 2. POLICY PERIOD: FROM: 10/01/2021 TO 10101/2022 Alliancel10.00 12:01 A.M. MOUNTAIN STANDARD TIME ITEM 3. A. WorkersCompensation Insurance. Part One of the policy applies to the workerscompensation law of the states listed here: COLORADO B. Employers Liability Insurance: Pan Two of the policy applies to work In each state listed in Item 3 A. The limits of out liability under pan two are: BODILY INJURY BY ACCIDENT $1,000.000 EACH ACCIDENT BODILY INJURY BY DISEASE $1,000.000 EACH EMPLOYEE BODILY INJURY BY DISEASE $1,000,000 POLICY LIMIT C. Other Slates Insurance: Par Three of the policy applies to the states, if any, listed here: NONE (Please contact Pinnaml Assurance for information on coverage outside the state of Colorado) D. This Policy Includes the allched endorsements and schedules 359-8 Blanket Waiver of Subrogation 414 Notification of Change in Ownership Endorsement 511 Other State Endorsement CAT09 Catastrophe (Other than Certified Aces of Terrorism) TRPRA Termism Risk Insurance Program Reauthcrzation Ac of 2015 ITEM 4. We will determine the premium for this policy by our manuals of rules, classifications, rates and rating plans. All Infomatlon required below is subject to verigcation and change by such. The statements of estimated advanced premium are also a par of this policy. Poge3ofi P UBgpp- rail E LOW"hdC ,CO W230 -7M6 1umaiml 1&N25 4074279 56553930 MALL Coverage hHmmagon tor4074279 ESTIMATED PREMIUM Location: Top Electric Inc. 3132 N Hancock Ave Colorado Springs, CO 80907 Period: 101012021 -101012022 Class RT Description Emp Payroll Rale Prem Charge 519005 EM Electricalwiring-including 3.00 $68,340 2.891700 $1,976 fiMuree/eppliencea 4 drivers Total for Top Electric Inc. $68,340 $1,976 Description Period Adjustment Amour Ratable Manual Premium 10101/2021-10101/2022 $1.976 Increased Limits(1,000,000/1,000.000/1,000,000) 101012021-101012022 1.011 $22 Increased Limits Minimum Premium 10/012021 -10/012022 $98 Designated Provider Discount 10/012021 -10/012022 .975 $52- PinnacolPerformanceCredit 10/0112021-10MI2022 .90/ $102. Annual Policy Fee 10101/2021 -10/012022 $160 Terrorism Insurance Coverage 10101/2021-101012022 $3 Catastrophe Insurance Coverage 101012021 -1 WOM022 $7 Net Estimated Annual Premium 10/012021-10/012022 $2,112 Policyholder Disclosure Notice of Terrorism and Catastrophe Insurance Coverage Coverage for acts of terrorism is included in your policy. Under your existing coverage, any losses resulting from certified ads of terrorism would be partially reimbursed by the United States Government. Beginning January 1, 2016' • The current 85% Federal share of compansa0on under the TRIPRA decreases by one percentage point per calendar year until it is equal to 80%. • The current program trigger for aggregate Industry insured losses W exceed $100 million Increases by $20 million per calendar year until It is equal to $200 million. • Notwithstanding above, the United States Goverment will not make any payment under the Ad for any gonion of Insured Losses that exceed $100 billion. Premium for tcmonam is calculated on the basis of said unIMIL The total Colorado payroll is divided by 3100 and multiplied by the approved terrorism rate. $0.005 per $100 of payroll. The calculation is expressed as (Colorado Paymb'$i 00 X Approved Terrorism Rete = Premium). This premium Is not subject to any other modification including. but not turned to, premium discount, experience rating, schedule rating, or retrospective wing. Additionally, all workers' compensation canters are required to charge premium to cover large losses. Premium for Catastrophe (other than Carideo Acts of Tenrcdsm) is calculated on the basis of total payroll. The total Colorado payroll Is divided by $100 and multiplied by the approved Catastrophe (other than Certified Acts of Terrorism) rate. $0.01 per $100 of payroll. The calculation is expressed as (Colorado paymill $100 X Catastrophe (other than Cenffied Acts of Tenodsm) Value = Premium). This premium Is not subject to any other modifications including, but not limited to. premium discount, experience rating, schedule rating, or retrospective rating. This Policy Information Page reflects coverage, Premium andpayrell information as of the date of issuance 75e1 E. Lwry MW Curvy. CO ae230-7006 Pgp3ar7 P UBues- 1M1=2118:2425 bT4a7856553930 P41LL PINMAA COL 7501 E. Lowry Blvd. ASSURANCE Denver, 00 80230-7008 303.361.4000 / 800.873.7242 parrecol.corn October 1, 2021 Policy #:4074279 Top Electric Inc Western Group. Inc. dbe Pikes Peek P.O. Box 7306 P. O. Box 4880 Colorado Springs. CO 80933 Woodland Park, CO 8086E (719) 6873500 Your Pinnacol Team Policy 4074279 Period Period Effective Date 10101/2021 Policyholder Top Electric Inc. Team Construction and Natural Resources C Local Phone 303.361.4200 Local Fax 303.361.5200 Toll Free Phone 866.820.6129 Toll Free Fax 888.329.2216 Position Team Member Email Phone Team Leader Judy Fania jutly.fenia@pinnacol.com 303.381.4551 Underwriter Ashley Phommahaxay ashley.phommahaxay@pinnacol.00m 303.361.4371 Safety Consultant Joel Nobles loel.nobles@pinnacol.mm 303.381.4579 Claim Representative Jessica Floras jessica.8ores@pinnacol.com 303.3614503 For questions about your policy, pbaea... beet your agent or your Plnnacpl ASSUranca Team As your team, we would like to sincerely (hank you for your business. We!ook forwaM to serving you! ]5m E. Lowry R" Cerny. co B W-70ac veeee.f7 v Ilaam- 10N1r202118:2433 QU4279 5iesc930 pM