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HomeMy WebLinkAbout210441 ELEVATED ELECTRICAL CONTRACTORCERTIFICATE OF INSURANCE (1)_Page_1THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251 City of Wheat Ridge 7500 W 29TH AVE WHEAT RIDGE CO 80033 Account Information: I Policy Holder Details : I Elevated Electrical Contractor I March 23, 2022 Contact Us Need Help? Start a live chat online or call us at (866) 467-8730. We're here weekdays from 8:00 AM to 8:00 PM ET. Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any questions or concerns. Sincerely, Your Hartford Service Team WLTRO05 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 DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 03/23/2022 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 be endorsed. If SUBROGATIONIS 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: STANTON INSURANCE LLC PHONE (720) 388-1906 (A1C, No, Ext): FAX (720) 302-2515 (A1C, No): 34340016 8000 S LINCOLN ST STE 205 EACH OCCURRENCE $1,000,000 LITTLETON CO 80122 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: Hartford Underwriters Insurance Company 30104 INSURED INSURER B: Nutmeg Insurance Company 39608 ELEVATED ELECTRICAL CONTRACTOR INSURER C : 14310 E 102ND AVE INSURER D: COMMERCE CITY CO 80022-8911 INSURER E: 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 TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIY YYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS -MADE -1 OCCUR DAMAGE TO RENTED $1,000,000 PREMISES Ea occurrence MED EXP (Any one person) $10,000 X General Liability A X X 34 SBA AK4ER4 03/15/2022 03/15/2023 PERSONAL &ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 JECT POLICY � PRO- FLOC PRODUCTS -COMP/OP AGG $2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 Ea accident BODILY INJURY (Per person) X ANY AUTO B ALL OWNED SCHEDULED AUTOS AUTOS X X 34 UEC AA0637 03/15/2022 03/15/2023 BODILY INJURY (Per accident) HIRED NON -OWNED X AUTOS X AUTOS PROPERTY DAMAGE (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $1,000,000 A EXCESS LIAB CLAIMS- MADE 34 SBA AK4ER4 03/15/2022 03/15/2023 AGGREGATE $1,000,000 DED RETENTION $ 10,000 WORKERS COMPENSATION PEROTH- I I AND EMPLOYERS' LIABILITY STATUTE ER E.L. EACH ACCIDENT ANY YIN PRO PRI ETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA E.L. DISEASE -EA EMPLOYEE (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS below A Employment Practices Liability Insurance 34 SBA AK4ER4 03/15/2022 03/15/2023 Each Claim Limit $25,000 Annual Aggregate Limit $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION City of Wheat Ridge SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 7500 W 29TH AVE BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED WHEAT RIDGE CO 80033 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 ADDITIONAL REMARKS SCHEDULE AGE Grer NAMED INSURED STANTON INSURANCE LLC ELEVATED ELECTRICAL CONTRACTOR ARAB NUMBER 10.310 E 102ND AVE SEE SCORE 25 COMMERCE CITY CO 80022 8 91 1 NiCARRIER SEE ACORD25 EIMEACTIVEDIRTE SEE ACORD 25 FORMNUMER. AITUTI TOM TIME . Certfiate holder is an additional insured Fords Business Liability Coverage Form SL3032 attached to this policy. CeNi(iate holder Is an additional insured per the Commeroal Auio Broad Form Endorsement HA 9916, attached to this policy. Waiver o1 Subrogation applies In favor oithe Cehi(iate Holder Fords Business Liability Coverage Form SL0000, attached to this poliry. Waiver of Subrogation applies In favor of the Cehifiate Holder Fords Commercial Auto Broad Form Endorsement HA9916, attached to this poliry. Notice of Cancellation will be provided In accordance with Form 519013, attached to this policy. Notice of Cancellation will be provided In accordance with Form IH0313, attached to this policy. AcoaN 101 (2014,01) BE 2014ACORD CARINUCTRAINION. AN nem:reaom. E CAUSESWHOM CERTIFICATE OF LIABILITY INSURANCAn adAM oAWWWWWOMI A FULL TURNS OUNI THEREOF WHOLE WILL BE ISHERAERN IN LOS LL A�AEAFRAHMMCATE MANUEL lmtp�y�MIM* WAR AM, OF ANN awl CONOW, LABEL MU CAN A INS Al AINAAA,D h AM IF WILD a AN C DF MAN I CAREAV MANOR MANAMBLIA MEN FULL CLASS THARDEREEND, AM OUNI THEREOF WHOLE WILL BE ISHERAERN IN A�AEAFRAHMMCATE MANUEL lmtp�y�MIM* WAR AM, OF ANN awl CONOW, LABEL CERTIFICATE HOLDER COPY City Of Wheat Ridge 7500 W 29th Ave Wheat Ridge, CO 80033-8001 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) COLORADO �/ Department of co �T�Y Regulatory Agencies Division of Professions and Occupations Below are your electronic wallet cards to use as proof of your license. You can also print your license at any time by visiting www.colorado.gov/dora/DPO_Print_ License and following the instructions listed. If you would like a more durable wallet card option, you can order one for a fee by visiting wvw.nasbastore.org and selecting the "Colorado License Cards" link on the left hand side of the page. If you prefer, you can also contact NASBA by phone at 1-888-925-5237 or by email at nasbastoregnasba.org. Should you have questions about your credential, or need other information please contact our Customer Service Team at 303-894-7800 or dora_dpo_licensinggstate.co.us. Division of Professions and Electrical Board Elevated Electrical Contractors LLC Electrical Contractor EC.0102029 04/27/2021 Number Issue Date Active 09/30/2023 Credential Status Expire Date Verify this credential at: dpo.colorado.gov Division of Professions and Electrical Board Elevated Electrical Contractors LLC Electrical Contractor EC.0102029 04/27/2021 Number Issue Date Active 09/30/2023 Credential Status Expire Date VeSify this credential at: dpo.colorado.gov 1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800 F 303.894.7693 dpo.colorado.gov Do RA COLORADO Department of Regulatory Agencies Division of Professions and Occupations Below are your electronic wallet cards to use as proof of your license. You can also print your license at any time by visiting www.colorado.gov/dora/DPO_Print_License and following the instructions listed. If you would like a more durable wallet card option, you can order one for a fee by visiting www.nasbastore.org and selecting the "Colorado License Cards" link on the left hand side of the page. If you prefer, you can also contact NASBA by phone at 1-888-925-5237 or by email at nasbastoreCnasba.org. Should you have questions about your credential, or need other information please contact our Customer Service Team at 303-894-7800 or dora_dpo_licensing@state.co.us. Colorado Department of Regulatory Agencies Division of Professions and Occupations � �}X. Electrical Board "( Patrick Wayne Day Master Electrician 0 M E.3000683 04/27/2021 Number * Issue Date Active ``off' 09/30/2023 Credential Status A'� *Expire Date fy this credential at: dpo.colorado.gov Veri 4 Pah," P4LAj Division Director: Ronne Hines Credential Holder Signature Colorado Department of Regulatory Agencies Division of Professions and Occupations Electrical Board _ [ Patrick Wayne Day C1 Master Electrician M E.30006 , 04/27/2021 Number Issue Date Active \ 09/30/2023 Credential Status ` Rt^� "° Expire Date Verify this credential at: dpo.colorado.gov Division Director i -Ronne Hines Credential Holder 5ignature 1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800 F 303.894.7693 dpo.colorado.gov