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HomeMy WebLinkAbout210473 HARDIN SIGNS INC.Wheat R_Page_1lllk O CERTIFICATE OF LIABILITY INSURANCE �� DATE (13/2022 VY) 6 13/2022 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(les) 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 hofder in lieu of such endorsement(s). PRODUCER CUNIAUI NAME: Cindy Norris Madison Insurance Group A/c No Ext): (303) 322-0800 A/C, No : (303) 322-0874 7600 E Eastman Ave Ste 500 ADDRESS: cnorrisCmadisoninswance.net INSURER(S) AFFORDING COVERAGE NAIG # EACH OCCURRENCE $ 1,000,000 INSURERA: OHIO SECURITY INS CO 24082 Denver CO 80231 INSURED INSURER B: OHIO CAS INS CO 24074 Hardin Signs Inc INSURER C: 700 Wagonwheel Dr INSURER D: INSURER E: AUTOMOBILE Fort Collins CO 80526 INSURERF: COVERAGES CFRTIFICATF NIIMRFR• ISFVIsenM MllruaEo• 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. INSIR LTR TYPE OF INSURANCE INSD UtIK1 WVD POLICY NUMBER POLICY ti'F (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7xOCCUR BKS55863071 11/27/2021 11/27/2022 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence) $ 300,000 MED EXP (Any one Person) $ 15,000 PERSONAL a ADV INJURY $ 1,000,000 GsE�N'L AGGREGATE LIMIT APPLIES PER: �s POLICY FIJECT 7 LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY$ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON-OWNEDAMAQlz AUTOS ONLY J AUTOS ONLY (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ Per accident) $ $ X UMBRELLA LIASx EXCESS LIAB OCCUR CLAIMS -MADE US055863071 11/27/2021 11/27/2022 EACH OCCURRENCE $ 1.000,000R AGGREGATE $ 1,000,000 DED X RETENTION $ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABI JTY Y I N NY PROPRIETOR/PARTNER/EXECUTIVE ❑ FFICER/MEMBER EXCLUDED? Mandatory In NH) If yes, describe under ESCRIPTION OF OPERATIONS below N 1 A STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMB $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space Is required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Wheat Ridge ACCORDANCE WITH THE POLICY PROVISIONS. 7500 W. 29th Ave AUTHORIZED REPRESENTATIVE C1.0' N NWriy Wheat Ridge CO 80033 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) INSR TYPE OF INSURANCE LTR 02/10/2022 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 terns 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 BAILEY BAUER NAME: State,Rafm BARRY B BAILEY INSURANCE AGENCY INC PNGNE 970 493-2323 IFa c. Na: 970-493-7301 838 W DRAKE UNIT 109 ADDRESS: BAILEY@BARRYBAILEYINSURANCE.COM INSURERS) AFFORDING COVERAGE NAIC N FORT COLLINS CO 80526 INSURER A : State Farm Fire and Casualty Company 25143 INSURED INSURER B: HARDIN SIGNS INC. INSURER C: MICHAEL & BETH HARDIN INSURER D: 700 WAGONWHEEL DR INSURER E: FORT COLLINS CO 80526 INSURER F: CUVtKAUtaS CERTIFICATE NUMBER' oPVICInki rdrliunco• 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 TYPE OF INSURANCE LTR ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP MM/DD MM/DD LIMBS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Ll OCCUR I EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ ._. PERSONAL &_ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY JECT E LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGO $ $ OTHER: AUTOMOBILE LIABILITY Y Y 424 1311-817-06D 02/17/2022 08/17/2022 COMBINED SINGLE LIMA $ Ea accident __ A AWNEDNY OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per person) $ 1,000,000 _ BODILY INJURY (Per accident) E 1,000,000 HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Par accident $ 1,000,000 MEDICAL PAYMENT $ 25,000 _ UMBRELLA LIAB __ OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS -MADE AGGREGATE $ DED .RETENTION _ E WORKERS COMPENSATION ANDEMPLOYERS'LUIBILITY YtN ANY PROPRIETOR/PARTNER/EXECUTIVE 7 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS below NIA li PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached U more space Is required) COVERAGE IS PRIMARY TION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN AMC LLC C/O REGISTRY MONITORING ACCORDANCE WITH THE POLICY PROVISIONS. INSURANCE SERVICES INC. 5388 STERLING CENTER DR AUTHORIZED REPRESENTATIVE WESTLAKE VILLAGE CA 91361 4�F @ 1988-2015 ACOCORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1001486 132849.12 03-16-2016 OF License or Registration Number: SG -1503 Certificate Number: 1616 -SG THIS CERTIFIES THAT Michael J. Hardin Hardin Signs, Inc. HOLDS A LICENSE, REGISTRATION AND/OR SUPERVISORS CERTIFICATE WITH THE CITY OF FORT COLLINS, COLORADO AS A Specialized Contractor - Signs VALID FROM May 7 2021 Contractor Signature THRU May 7 2023 C ,, M Contractor Licensing Administrator It is the responsibility of the holder of this license and/or certificate to be familiar with the City of Fort Collins Municipal Code Chapter 15, Article V, Contractors for contractor and supervisor responsibilities. Renewals: A courtesy renewal notice is typically sent 1-2 months prior to the scheduled expiration of any license or supervisor certificate, together with related forms. However, if the notice is not sent and/or received, it is the responsibility of the contractor to assure that the license is renewed and kept current. The license and/or supervisor certificate may be renewed provided that the biennial fee is paid and renewal occurs within sixty (60) days following the anniversary date. Once the sixty (60) days has passed, a new application must be submitted subject to the current licensing processes and procedures as outlined under the Expiration section below. If the adopted building code or other applicable code over which an examination was administered is no longer in effect or has been changed substantially, a renewing supervisor will be required to either pass a renewal examination for which no fee will be required, or provide proof of having successfully completed training covering the current adopted applicable code or the equivalent thereof as approved by the Building Official. It is imperative to keep address and other pertinent information current with the Building Services Department so that renewal notices and other information that may be sent throughout the year are received. Renewal notices are sent as a courtesy only. It is the responsibility of the license holder and/or supervisor certificate holder to track the date of expiration of his/her license or certificate. Any licenses or certificates not renewed within the 60 day grace period will be expired and subject to the requirements listed below, whether or not a renewal notice was received. �"rte�otUns CONTRACTOR'S CARD Business Name: Hardin Signs, Inc. Card Holder Name: Michael J. Hardin License or Registration: SG -1503 Certificate: 1616 -SG Expiration: May 7 , 2023 .%'iar %%T,emre Contredor Licensing Administrator oftyf fns DEVELOPMENT REVIEW CENTER 281 N. College Ave., Fort Collins, CO 80522 Inspection Scheduling 970-221-6769 Inspection Scheduling — text 888-406-6394 Contractor Licensing 970-224-6165 Permitting 970-016-2740 - City of `7`Iheat e COMMUNITY DEVELOPMENT 7500 W. 291h Avenue * Wheat Ridge, CO 80033 * O: (303)235-2855 * F: (303)235-2857 Contractor Waiver for Workers' Compensation Insurance I, (print your name),-11140/ICIV / 17. verify that II am the sole owner or partner of (company name): /7 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 contractors/subcontractors, they are in compliance with the State of Colorado Workers' Compensation insurance requirements, have obtained the required contractor's license from the City of Wheat Ridge and will be listed o e permit. Signature: ze4��& Date: C/470 01