HomeMy WebLinkAbout210433 ADVANCED CONSTRUCTION MGMTA`osro CERTIFICATE OF LIABILITY INSURANCE DP.EpuAmwmNdma
ACORD 25120DBM31 ®AC D ORFORATN IM8
xEMmaTuleo.vremgiaiwnRcanNPvuwlio Bv..FYCO1falueu lFwn m�simmxPreaaNun[IxFlxd xmlawmBdAosllwwT'mTwa
Me msuxo PInxlBaslunxl®PIFNRsoRASNe
aN ENoou6m Ilm,r umEud xof nEa
rnnAwx.Nle.e.�..l..
W&pf Wuyy: gguel
NM11ReInm RteE
IK.wF ImNmall [u lK.wiuNie'x�[e
EITm�,xNf�Ejb �����' "��
mNldlp!
i
C BCBx$
(303
mN�I
HBItl®
INBORERSAFFOROWO COVEMOE _ _
EveoNmlvuv�Cao�Y
W5
3585
f:wWnC1y N®R'�.f
Wm
7
66]Q¢98
AevW, CO BIADI
lx�Pd
Kf1EPE
ES
CFAIiFIGTE N NmMk
M816 TOCERllYTIMTiHE Po11CRp 0i1N611RP110E lIB1EDBElONINVE BFEN bBUEDMTX RMMED RANPo GOR IIXKYFiAA)D
WM IWIWIIXBTAV AXTREO N5,TERNOREMFORDEOPANYCOMR..CTD OWER DDCLMEM WITXRTTO NF XTNI$
CFR lT fiEI66U O IMYYE CIiXE IXWPANC
NN,
EAFMYM BVTIF PoI DERCRbEDREREIHIS9IAECTTOaLME ]FAM6.
MMNSa $
Fl6fI6tlN6Mp COMD11gN8C:&IdI FVNCI[d NMrt66Xg4N MY MW 6EENREgICED BY YID BWNB.
M
W MN .w➢ 1NR6[MIIW!
xuu6. 'ER6TM WT!
' IIUL9'[1'1
A
X
®
ENluxn
®o.YGa' 498AtIWIT'
O°Q.wa N.tll4 ®wnJP
°_�
svwxfaa mi=l
COI=
eAdfaaawRvt
Yt.6Il0AED
�TlOIFMED
YID].NJ
1®FAWNwMeN
$5.m
[MNM.a.wwPm
el,%6,dtl
6R@aA.OEMR
uaa0000
[BRIF➢aRENx.NFIEYIu
�
'
^�'B-'�xYPw
sz68gme
❑lax.®vPa6c,°I.m
°
AVTOIDlI��Y
❑YRrwm
IOMIDH[IbFIM
Be�DsuntA
5
❑.I. VA.®AIINE
.q.q.
°YIP1YOi®IANPiR/
°CCOF °WW XKE
FM1DC191MOPP
5
IYGIrtW.,E
i
°
!
° N���DN WN[R14,RNaddPplq'
° ,IO YYWR ° 0
NIYMCRIEMWMiME1FYMM
YNFlXfLldDi
ELE.g1ACFaPRT
!
ELmYAee-ueswFx
s
r..awrwr
![Ecw�Bawldave. rm
ELIa[pE-Youcrulr
!
° P
[[sw[MNa MGA1Nwf ILOCAtaW.LllIL®Iemtl�WlFtll..tllbulP bWylinms[wNUWIi[al
GnExLi CwMcw XdN/bhtlRmN lrwM
Cly of YVIwPI RIO)!
]6W Wsf 2B'Ave
RNpe,CO 611Ip]
Axro PIFNlms N�cNwouoelFBa Tfn PKaTxx
� sLelrvwox
eNl�xbavNc+AlSrBN]AB
ACORD 25120DBM31 ®AC D ORFORATN IM8
�„41 City of
Wheat�idge
COMMUNITY DEVELOPMENT
7500 W. 2a'^ Avenue' Wheat Ridge, CO 80033' O: (303)235-2855 ` F: (303)2352857
Contractor Waiver for
Workers' Compensation Insurance
1, (print your name), CUT^ �16 A We I"
verify that I am the sole owner or partner of (company name):
�i/aVire� nsfivUr, �914
which has no employees and is not required Wthe 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 R/epn/-lY!w<� stWId,qMmit
Signature:
Date: �—z.l
City and County of Denver akwa.52.gbfsaeon Notable. LIC238363
Community Planning and Development EaplmNen Date: m151=2
xvw.dmvergov.ofgrconeanMr oeenaing Lkanse Tjpe: 6ucfin9Comnchr-ClaasB
issue! To: By Authomy ofab Essons" f
4
ADVANCED CONSTRUCTION
MANAGEMENT
87U INDEPENDENCE WAY
Ali CO 110005
Omoml WnWOrryRannm CNe Plomnt Dab Trnsa shrus
F]SOPo 72-851000.--0fOtadU131p O7n4CWU 5TeHG7 Pont
RENEWALINFOWSADON Ranenal notices wit be e-mailed to e-mail address on
R5nesam Information is aveable at YeNWdQMVQMoe.oglCor%mCUx Licensing.
INSPECTION wCosea TON Impeetion requests called in by 12'00 a.m. wiA musty Ce
scnedukM for are solica 1p woMbt dry.
Please maids Ma ddlowing infonlwtlon vdien
you call for an impaction:
J Pemitnurnber
J tYPe of lnsmcbon eM nsPec6on tads
Auditioned lnepadbn Request System: 720-886-2601
ImpeCbna an laMrmed MOMa"wouBb Friday.
Wallet Connector 10 Cald: MUST BE KEPT IN YOUR POSSESSION AT ALL TN2E3.
ungnowM.dama�.�mamnNr
City and County 0Denver
Community Planning and Development
IDERTLFICATION CARD piWCOLFA%AVEDEPT205
DENVER. COWRADO al
Lk ns ntsbaoon LIC2303B3
P _
No.:
No.
DENVER
%ria dNfy@NADVANCED CONSTRUCTION IMNAOEMENT.
.,u,e
bmbeenl uWa BuiW MCm"a-Cwmeu«meinme Cllr
and County d Denver. bo0nnmi an 26 July 2019 antl endng on 31
Li ms S CBWtmes:
720.0052770
.Ju120N. unless license is waked.
Permit OauMer
720.6652105
_
ImMectm Adnlnbbatbn:
720.8652505
By AUNodty M WS ExepuWa Direnbr of
Automated Inspection Request:
720.065.2501
Comenunin Planning and Dmloomnm
LIC, 16 `CffiO`8WPOA