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HomeMy WebLinkAbout210419 SUREPODS LLCInsurancePage 1 of 1 AC7:"R" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 04/07/2022 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 Willis Towers Watson Insurance Services West, Inc. c/o 26 Century Blvd P.O. Box 305191 CONTACT Willis Towers Watson Certificate Center NAME: PHONE 1-877-945-7378 FAX A/C No Ext): No : 1-888-467-2378 E-MAIL certificates@willis.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Nashville, TN 372305191 USA INSURER A. Liberty Insurance Corporation 42404 INSURED SurePods, LLC INSURER B: EACH OCCURRENCE $ 2 , 000 , 000 2300 Principal Row INSURER C: INSURER D: Orlando, FL 32837 INSURER E: INSURER F: DAMAGE TO RENTED PREMISES Ea occurrence $ 1, 000 , 000 COVERAGES CERTIFICATE NUMBER: W24520742 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 EACH OCCURRENCE $ 2 , 000 , 000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 1, 000 , 000 MED EXP (Any one person) $ 10 , 000 A PERSONAL & ADV INJURY $ 2 , 000 , 000 TB7-661-066943-021 09/01/2021 09/01/2022 GENERAL AGGREGATE $ 4 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- LOC JECT PRODUCTS - COMP/OP AGG $ 4 , 000 , 000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ a 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 $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NO (Mandatory in NH) N /A WA7-66D-066943-031 09/01/2021 09/01/2022 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1, 000 , 000 If yes, describe under DESCRIPTION OF OPERATIONS below _ 1, 0 0 0, 0 0 0 E.L. DISEASE POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Contractor License CERTIFICATE HOLDER CANCELLATION ACORD 25 (2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 22452306 BATCH: 2480374 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 7500 W 29th Avenue Wheat Ridge, CO 80033L AUTHORIZED REPRESENTATIVE l f� ACORD 25 (2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 22452306 BATCH: 2480374 lk��� OFFICIAL RESULTS REPORT a ma F11 - National Standard General Building CODE COUNCIL Contractor (A) Name: Matthew Gaskin Candidate ID: ICNON178725 Address: 424 N 44th Ave Date: 4/22/2022 Phoenix AZ 85043 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 WE 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: Licki Digital embossing eliminates the possibility of unauthorized embossing of counterfeit score reports. Registration Number: 418882511 Validation Number: 362725407