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HomeMy WebLinkAbout210461 POWUR PBC, INC584819331081451C20220603180429044659AC oR" CERTIFICATE OF LIABILITY INSURANCE 06/0 /YYYY) 06/03//202202 2 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 NAME: AUTOMATIC DATA PROCESSING INSURANCE AGCY INC 1 ADP BLVD MS 325 ROSELAND, NJ 07068 PHONE FAX AIC, No, Ext : 877 677-0428 AIC, No): 877 677-0430 E-MAIL ADDRESS: spcbicadp@travelers.com INSURER(S) AFFORDING COVERAGE NAIC # (877) 677-0428 INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA MM/DD/YYYY INSURED POWUR PBC INC INSURER B: INSURER C: DBA POWUR PBC, DBA POWUR HOME CONSTRUCTION INSURER D: 2683 VIA DE LA VALLE STE 321 G INSURER E: DEL MAR, CA 92014 INSURER F: COVERAGES CERTIFICATE NUMBER: 584819331081451 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS -MADE F] OCCUR PREMISES Ea occurrence $ MED EXP (Any oneperson) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ ANY AUTO OWNEDSCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED PROPERTY DAMAGE accident) $ AUTOS ONLY AUTOS ONLY H(Per $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N NIA UB-OT676222-22 01/01/2022 01/01/2023 X PER EOR H E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION CITY OF WHEAT RIDGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7500 W. 29TH AVE. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN WHEAT RIDGE, CO 80033 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE d © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: 4A613E10-AA8A-4D45-AB82-8F1194646D3F ® COLORADO � Department of Regulatory Agencies Div ion 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 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. Colorado Department of Regulatory Agencies Colorado Department of Regulatory Agencies Division of Professions and Occupations Division of Professions and Occupations Electrical Board Electrical Board Stanley John Pena 1R Stanley John Pena 1R Master Electrician Master Electrician ME.0601456 10/01/2020 ME.0601456 10/01/2020 Number Issue Date Number Issue Date Active 09/30/2023 Active 09/30/2023 Credential Status Expire Date Credential Status Expire Date Verify this credential at: dpo.c 9d€LtRY d by: Verify this credential at: d p6Ad"jW. 1r. A� nAt i I I Sf&k" 9oltu, Pw a��9 Division Director Ronne Hines Cr 'gl,d4p4 q§jwature Division Director. Ronne Hines gip �y�_Signature 1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800 F 303.894.7693 dpo.colorado.gov 0 AIih��-'°'RL' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/03/2022 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 Aon Risk Insurance Services West, Inc. Denver Co office CONTACT NAME: PHONE (303) 758-7688 FAX(303) 758-9458 (A/C. No. Ext): A/C. No.: E-MAIL 1900 16th Street, Suite 1000 Denver Co 80202 USA ADDRESS: POLICYNUMBER MM/DD/YYYY MM/DD/YYYY INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA: Guldeone National Insurance Company 14167 Powur PBC, INC. 2683 via de la Valle INSURER B: 01/20/2023 INSURER C: $1,000,000 Suite 321G Del Mar CA 92014 USA INSURER D: INSURER E: INSURER F: $100,000 COVERAGES CERTIFICATE NUMBER: 570093459313 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. Limits shown are as requested INSR IN ACCORDANCE WITH THE ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERALLIABILITYENV56200407401 01/20/2022 01/20/2023 EACH OCCURRENCE $1,000,000 CLAIMS -MADE I X (OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $100,000 L� MED EXP (Any one person) $5,000 PERSONAL &ADV INJURY $1,000,000 GENT AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $3,000,000 X POLICYPEO ❑ LOC PRODUCTS - COMP/OP AGG $3,000,000 II --II Deductible $25,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY ( Per person) ANYAUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED AUTOS NON -OWNED Per accident ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE AGGREGATE EXCESS LAB CLAIMS -MADE DED I RETENTION WORKERS COMPENSATION AND PER STATUTE 0TH EMPLOYERS' LIABILITY Y / N E.L. EACH ACCIDENT ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L. DISEASE -EA EMPLOYEE (Mandatory in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS below A E&o-PL-Primary ENV56200407401 01/20/2022 01/20/2023 Aggregate Limit $3,000,000 Each occurrence Lim $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD L 0 OWN 0 ff-A SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. city of wheat Ridge 7500 W. 29th Ave. AUTHORIZED REPRESENTATIVE wheat Ridge Co 80033 USA �r„ 9L ?ddI[lrt� G#rtktxd 9tG« ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD L 0 OWN 0 ff-A AGENCY CUSTOMER ID: 570000087114 LOC #: ARS ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Insurance Services West, Inc. NAMED INSURED Powur PBC, INC. POLICY NUMBER See Certificate Number: 570093459313 CARRIER See Certificate Number: 570093459313 NAIC CODE [EFFECTIVE DATE ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER SUBR WVD INSURER POLICY EFFECTIVE DATE (MM/DD/YYYY) INSURER LIMITS INSURER OTHER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS OTHER A Env contr Poll ENV56200407401 01/20/2022 01/20/2023 Aggregate Limit $3,000,000 Each Occurrence $1,000,000 ACORD 101 (2008101) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. DoonSign Envelope I D'. 02BF93BAAECO41 F69CA3DC9MFE77535 isleCOLORADO DeaRmrentof Regulatory Agencies Imss:on of Protestants and occopeflo ca Below are your electronic wallet cards to use as proof of your license. You can also print your license at anytime by visiting wwwcolorado govidolel BPO Print—License and following the Instructions listed. If you would like e more durable wallet card option, you can order one for e fee by visiting www.n38638tore org and selecting the "Colorado License Cards" link on the left hand Bide of the page. If you prefer, you can also contact NASBA by phone at 1688-925523] or by email at nasbastoreCnasba otg. Should you have questions about your credential, O need other Information please contact our Customer Service Team at 3D3Betsor dola_dpullcensingCetate. ce us. Colorado Department of Regulatory Agencies Colorado Department of Regulatory Agencies Division of Pretensions and occupations Division of Professions and Occupations El and leaI eoaru El and leaI eoaru covert PBC covert PBC Electrical contractor Electrical contractor ECO101896 18/13/2828 EC 0101896 18/13/2828 Number Issue Date Number Issue Date Active 89/38/2823 Active 89/38/2823 credential status F Aire Date credential status F Aire Date venly lhlsoreden112 at dpo.color ®9Y.siyned Mc ve Nylhls credential q did comr mlWsia.m byha P,�dpdyallud Wage, reemr. Bonne dines aeden k l reemr. Bonne tunes cede ", jn 1560 Broad way, 3IDe 1350, Lon wr CO 80202 P 303 894 7800 F 303 894 7693 dpo.ccIEnd do. gov lie