HomeMy WebLinkAbout210501 ARCO CONSTRUCTION coiACOR I @DATE
CERTIFICATE O F LIABILITY INSURANCE
(MM/DD/YYYY)
07/22/2022
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 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 (855) 222-5919 FAX
A/C No Ext): A/C No):
Next First Insurance Agency, Inc.
PO Box 60787
Palo Alto, CA 94306
E-MAIL support@nextinsurance.com
ADDRESS: pp
INSURER(S) AFFORDING COVERAGE
NAIC #
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INSURERA: Next Insurance US Company
16285
EACH OCCURRENCE
INSURED
INSURER B:
_7RENTECLAIMS-MADE � OCCUR
Arco Construction
1816 Kohinoor PI
INSURER C:
DAMAGE TO
PREM SES (Ea occur ence)
INSURER D:
MED EXP (Any one person)
Golden, CO 80401
INSURER E :
INSURER F:
COVERAGES CERTIFICATE NUMBER: 775995092 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
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
X COMMERCIAL GENERAL LIABILITY
AUTHORIZED REPRESENTATIVE
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EACH OCCURRENCE
$1,000,000.00
_7RENTECLAIMS-MADE � OCCUR
DAMAGE TO
PREM SES (Ea occur ence)
$100,000.00
MED EXP (Any one person)
$15,000.00
PERSONAL & ADV INJURY
$1,000,000.00
A
X
NXTWYPC943-00-GL
07/22/2022
07/22/2023
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000.00
X PRO- ❑ LOC
POLICY F]JECT
PRODUCTS - COMP/OP AGG
$2,000,000.00
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/N
PER OTH-
STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$
OFFICER/MEMBER EXCLUDED? ❑
N/A
E.L. DISEASE - EA EMPLOYEE
$
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
Each Occurrence:
$25,000.00
A
Contractors Errors and Omissions
X
NXTWYPC943-00-GL
07/22/2022
07/22/2023
Aggregate:
$50,000.00
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
The Certificate Holder is City of Wheatridge. This Certificate Holder is an Additional Insured on the General Liability policy per the Additional Insured Automatic Status
Endorsement. All Certificate Holder privileges apply only if required by written agreement between the Certificate Holder and the insured, and are subject to policy terms and
conditions.
CERTIFICATE HOLDER CANCELLATION
City of Wheatridge LIVE CERTIFICATE
7500 W 29th Ave
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Wheat Ridge, CO 80033
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
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@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
* OFFICIAL RESULTS REPORT
INTERNATIONAL G11 - National Standard General
CODE COUNCIL Building Contractor (A)
Name: CHAD MORGAN Candidate ID: ICNON105618
Address: 541 Somerset Dr Date: 12/10/2021
Golden CO 80401
EXAMINATION RESULT: PASS
Congratulations! You have passed the above-named examination. You will be able to verify your pass
status on the ICC website within 48-72 business hours after your exam. Please contact your
participating jurisdiction if you wish to pursue licensing.
A passing score on this examination satisfies the testing requirements for licensure only, and does not
guarantee that licensing will be granted. The candidate must also satisfy all local ordinance requirements
in each jurisdiction where licensing is desired.
It is extremely important that you notify Pearson VUE and ICC of any changes in name and/or address to
avoid the possibility of future correspondence not being received. Please contact both Pearson VUE at
877-234-6082 and ICC at 888-422-7233 ext. 5524 with changes to your name and address.
ICC reserves the right to amend or withhold any examination scores if, in its sole opinion, there is
adequate reason to question their validity.
The authenticity of this score report can be validated by using Pearson VUE's Online Score Report Authentication found at:
www.PearsonVUE.com/authenticate
Digital embossing eliminates the possibility of unauthorized embossing of counterfeit score reports.
Registration Number: 410915902 Validation Number: 998923774
♦SAI
City of
"� WheatRjdge
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), ( iV`--14 R22�,
verify that I am the sole owner or partner of (company name):
2 D C-al�,�--f-f u �4 "off ,
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 a will be listed on the permit.
Signature: �- l�