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HomeMy WebLinkAbout210423 FLOWERS ELECTRIC LLCDrivers License - Barrows with Master License as of 04-13-222:38 Done 10 of 10 .ill 5G O' C O L O RA ,�� d L DRIVER LICENSE 1 BARROWS -- 2 ANDREW KENNETH 8 9637 TIMBER HAWK CIR APT 25 HIGHLANDS RANCH, CO 80126 3 DOB 4a Iss 9a Endorsements 06/02/1965 10/30/2018 4d Customer Identifier 4b Exp 12 Restrictions 08-289-0613 06/02/2023 C 5 DD Previous Type 9 Vehicle Classifications 2339813 A R 15 Sex 16 Hgt 1 M 18 Eyes 17 Wgt VETERAN BLU 2101b �. a" +x - - 19 Hair . RED Q K. By ��— RROWS 0610\ Colorado Department of Regulatory Agenc, Division of Professions and Occupations Electrical Board Andrew Kenneth Barrows Master Electrician M E.0030067 Number Active Credential Status Verify this credential at: dpo.colo �I -44 . 10/01/2020 Issue Date 09/30/2023 Expire Date Division Director: Ronne Hines redential Holder Signature Q. U ACo�z v° CERTIFICATE O LIABILITY INSURANCE DATE (MM/DD/YYYY) OF INSURANCE 04/29/2022 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(les) 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: PHOFAX (A/C. No. Ext): (888) 202-3007 AIC No Hiscox Inc. 5 Concourse Parkway ADDRESS: contact@hiscox.com Suite 2150 MED EXP (Any one person) $ 5,000 Atlanta GA, 30328 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Hiscox Insurance Company Inc 10200 $ INSURED INSURER B FLOWERS ELECTRIC, LLC 1973 Bahama st INSURER C INSURER D: AURORA, CO 80011 INSURER E: BODILY INJURY (Per accident) $ 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 OF INSURANCE ADDLSUBRPOLICTYPE IVSD WVD POLICY NUMBER YEFF MM/ D/YYYY POLICY EXP MM/ D/YYYY LIMITS A- X I COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: X POLICYF-] PRO- F LOC JECT OTHER: Y UDC -4857463 -CGL -21 06/02/2021 06/02/2022 EACH OCCURRENCE $ 1,000,000 DAMAGE TO PREMISES Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 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 COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A PER H 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 City of Wheat Ridge 7500 W 29th Ave Wheat Ridge, CO 80033 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD a� d CERTIFICATE OF LIABILITY INSURANCE Darz9/2022 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: N the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. N SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this cart8ieete dose not Bonier rights to the certificate holder in lieu of such endorsement(s). PRODUCER Plnnacol Assurance 7501 E. Lowry Blvd Denver, CO 80230 CONTACT NAME: PHONE FAC No: EMAILAX ADDRESS : MgpoltMvinnad.can INSURE AFFpedNGCOVERAGE NNC0 II VURERA:Pinmand Auurenm 41IN INSURED Flowers Electric LLC INSURER a: $ 1973 Bahama St msuRER c: INSURER D: Aumre. Colorado 800115215 INSURER E: INSURER F: TO RENTED PREMISES Ear—r u 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. m3N Lm LTR WPEOFINKIMNCE ADOL UBR POUCYNUMBER POLICY EFF MT E%P MMU LILYTS EACHCCCURRENCE $ tCOMMEBCNA.GENERALLMBILOY CWMSW,➢E OCCUR TO RENTED PREMISES Ear—r u $ MEDIXPMam $ PERSONALBP➢VINJURY $ GENLpGGREG4TELIMn APPLIES PER GENERALAGGREGNTE $ POLICY�J�ECT LOC PRODUCTS AGO $ $ OTHER: AMTOMOMLEIIAMMTY COMBINED SINGLE UNIT ¢Ne $ BODILYINIURY(Perpm—) $ PNYAUTO OWNED SCHEDULED AUTOS ONLY ALROS BODILY IWURY IPx exNaiQ $ PPR-OPE�RDTY'OAMGE $ AUTOS ONLY AUTOSONLHIREDD UMBRELLA DAB pCCUR EACHOCCURRENCE. $ AGGREGATE $ EXCESS UAB numn- DE DEC RETENTIONS $ WdIREN3CONPEXSATIOX ANOEMPLOYERS'LIABILRY YIN A PNYPROPRHTORIPARTNEPo CUTNE OFFICERIMEMBEREXCLUDEW O ,(Nntlebryln NH) N/A N 4'CI1 e5a DB0Y1N1 sanion] % gEpTUTE EN EL EACH ACCIDENT $ 100,Boo EL. DISEASE-FAEMPLOYEE $ 100000 ESdRIPT10N OF OPEMTIONS Below �brc YYeezz R1P`FOe O1 O E.L 013EASE-POLICY LIMn $ 500,000 D MY IOXOFOPEMMMILOCATIONSIVEHICLES(ACOROIM,MditlwlMme SO,Mub,auyb n the ITn mau MmulM) Unless olherev a statetl in the Polity provisions. ooNwaea in Colorado only. Electrical Work CERTIFICATE HOLDER CANCELLATION City of Wheat Ridge 7500 W 2991 Avenue Wheal Ridge, CO 80033 9 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZEDREPRESENTARNE Plnnacol Assurance ®1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER COPY City of Wheat Ridge 7500 W 29th Avenue Wheat Ridge, CO 80033 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend, or alter the coverage afforded by the policies listed thereon. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT (CONT) 4231058 AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page a. of a AGENCY NAMED INSURED Flowers Electric LLC POUCYNUMBER 1973 Bahama St 4231059 Aurora, Colorado 80011-5215 CARRIER NAIL CODE Pinnacol Assurance 41190 EFFECWEDATE: 04/29/2022 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: Am 0 (M0 ) FORM TITLE: Certificate of Liability Insurance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO PROVIDE 10 DAYS WRITTEN NOTICE TO THE NAMED CERTIFICATE HOLDER, BUT FAILURE TO PROVIDE SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Lookup Detail View umneea IrMermebsn mb ones asafemryeasme rrmmmn•asw scene.. 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