HomeMy WebLinkAbout210444 COLORADO FINEST PLUMBING LLC - liabilityCERTIFICATE OF LIABILITY INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AHD CONFERS NO RIGHTS UPON THE MR11IWTE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY qt NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE MLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AIRMORI
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CERTIRCATE HOLDER CANCELLATION
For IGIGGMGGnal Purpoems Only
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City of
" 9 Wheat�idge
COMMUNITY DEVELOPMENT
7500 W. 28" Avenue' Wheat Ridge, CO 80033" O: (303)2352855' F: (303)235-2857
Contractor Waiver for
Workers' Compensation Insurance
(,(print your name), I]zrc/ Pa,V+(.
verify that I am the sole owner or partner of (company name):
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 actors/subcontractors, they are in
compliance with the State o of do Workers' Compensation Insurance
requirements, have obtain equlred contractor's license from the City
of Wheat Ridge wil a permit.
Signature:'"'`---�--
Date: