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HomeMy WebLinkAbout210448 KOZAR CONSTRUCTION LLC - COI and WCCERTIFICATE OF LIABILITY INSURANCE F DATE (MM/DDIYYYY) 05/19/2022 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 CONTACT Sally S Schey NAME: The Ahbe Group/Sally S Schey A/CONNo, Ext): (303) 232-0553 A/c, No): (303) 232-9442 7167 S Alton Way E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # POLICY NUMBER Centennial CO 80112 INSURERA: Evanston Insurance Company 41190 INSURED INSURER B: Plnnacol 41190 INSURER C: Kozar Construction LLC 33992 Meadow Moutain Road INSURER D: INSURER E: Evergreen CO 80439 INSURER F: COVERAGES CERTIFICATE NUMBER: CL21112335465 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 ACCORDANCE WITH THE POLICY PROVISIONS. 7500 W 29th Ave AUTHORIZED REPRESENTATIVE POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE 7 OCCUR PREM SES Ea occurrDence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV I NJU RY $ 1,000,000 A 3AA523053 11/23/2021 11/23/2022 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2'000'000 X POLICY ❑X JECT F—]LOC PRODUCTS-COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILELIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION PER OTH- B AND EMPLOYERS' LIABILITYY / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A 4234063 11/23/2021 11/23/2022 STATUTE ER 500, 000 E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Blanket additional insured, blanket waiver of subrogation, blanket primary and noncontributory, blanket per project included. CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Wheatridge ACCORDANCE WITH THE POLICY PROVISIONS. 7500 W 29th Ave AUTHORIZED REPRESENTATIVE Wheatridge CO 80033 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD OFFICIAL RESULTS REPORT rm_��Wfl G13 - National Residential Building CODE COUNCIL Contractor (C) Name: Kory Kozar Address: 33992 Meadow Mtn Rd Evergreen CO 80439 Candidate ID: Date EXAMINATION RESULT: PASS Congratulations! You have passed the above-named examination. You will be able status on the ICC website within 48-72 business hours after your exam. Please cor participating jurisdiction if you wish to pursue licensing. A passing score on this examination satisfies the testing requirements for licensure guarantee that licensing will be granted. The candidate must also satisfy all local on in each jurisdiction where licensing is desired. It is extremely important that you notify Pearson VUE and ICC of any changes in na avoid the possibility of future correspondence not being received. Please contact be 877-234-6082 and ICC at 888-422-7233 ext. 5524 with changes to your name and ICC reserves the right to amend or withhold any examination scores if, in its sole or adequate reason to question their validity. The authenticity of this score report can be validated by using Pearson VUE's Online Score Report AuthE www.PearsonVUE.com/authenticate Digital embossing eliminate$ the possibility of unauthorized embossing of counterfeit score i Registration Number.' 420621077 Validation Number. 9173