Loading...
HomeMy WebLinkAbout210472 LGCY INSTALLATION SERVICES LLC21-22 and 22-23 GL EXCESS AL WC - City of Wheat Ridge_Page_1LGCYINS-01 AANDERSON T ACOR"' CERTIFICATE OF LIABILITY INSURANCE .--�' DATE (MMIDDIYYYY) 6/10/2022 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 Chris Brimhall NAME: PHONE FAX (A/C, No, Ext): (801 ) 325-5033 (A/C, No): Diversified Insurance Group 136 E. South Temple, Suite 2300 Salt Lake City, UT 84111 E-MAIL SS: cbrimhall@diversifiedinsurance.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Admiral Insurance Company 24856 INSURED INSURER B: Hartford Ins Co Of The Midwest 37478 INSURER c: Key Risk Insurance Co. 10885 LGCY Installation Services, LLC INSURER D: 8/21/2021 3333 Digital Drive, Suite 600 Lehi, UT 84043 INSURER E DAMAGE TO RENTED PREMISES Ea occurrence INSURER F: MED EXP (Any oneperson) 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 INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR FEI-ECC-35006-00 8/21/2021 8/21/2022 DAMAGE TO RENTED PREMISES Ea occurrence 100 000 $ MED EXP (Any oneperson) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 GEN'L X POLICY JECT 1:1LOC PRODUCTS - COMP/OP AGG $ 2,000,000 Deductible $ 10,000 OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 $ BODILY INJURY Perperson) $ ANY AUTO 34UENAA1401 6/1/2022 6/1/2023 OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ PeOPERT nt AMAGE $ X HIREDX NON -OWNED AUTOS ONLY AUTOS ONLY A UMBRELLA LIAB CCUR EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 X EXCESS LIAB n CLAIMS -MADE FEI-EXS-45008-00 8/21/2021 8/21/2022 DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED?Y (Mandatory in NH) NIA BNUWC0155297 10/21/2021 10/21/2022 X PER OTH- STATUTE ER E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE- EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ B Auto Physical Damage 34UENAA1401 6/1/2022 6/1/2023 Comp /Collision Ded 1,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Excess policy applies in excess to the General Liability only Workers Compensation Excludes Officers: Doug Robinson and Luke Toone CERTIFICATE HOLDER CANCELLATION ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cit of Wheat Rid City Ridge THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7500 W 29th Avenue Wheat Ridge, CO 80033 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LGCYINS-01 LOC #: ADDITIONAL REMARKS SCHEDULE AANDERSON Page 1 of 1 AGENCY NAMED INSURED Diversified Insurance Group p LGCY Installation Services LLC 3333 Digital Drive, Suite 600 Lehi, UT 84043 POLICY NUMBER EE PAGE 1 CARRIER NAIC CODE EE PAGE 1 SEE P 1 EFFECTIVE DATE: SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Additional Locations 1616 Central Park Drive Hurst, TX 76063 10910 Sam Houston Parkway N., Suite 900-A Houston, TX 70064 9246 S. Farmer Ave., Suite 104 Tempe, AZ 86284 6901 TPC Drive, Suite 600 Orlando, FL 32822 10420 Harris Oaks Blvd., Suite F Charlotte, NC 28269 ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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 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. Division of Professions and Electrical Board LGCY Installation Services, LLC Electrical Contractor EC.0102298 01/13/2022 Number Issue Date Active 09/30/2023 Credential Status Expire Date Verify this credential at: dpo.colorado.gov Division of Professions and Electrical Board LGCY Installation Services, LLC Electrical Contractor EC.0102298 01/13/2022 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 ®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 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 Lee Ryan Halley Master Electrician ME.0601133 10/01/2020 Number Issue Date Active 09/30/2023 Credential Status Expire Date Verify this credential at: dpo.colorado.gov Division of Professions and Electrical Board Lee Ryan Halley Master Electrician ME.0601133 10/01/2020 Number Issue Date Active 09/30/2023 Credential Status Expire Date Verify this credential at: dpo.colorado.gov 1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800 F 303.894.7693 dpo.colorado.gov