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HomeMy WebLinkAbout210484 APEX CLEAN AIR LLCCert of Ins - The City of Wheat RidgeACORO® CERTIFICATE OF LIABILITY INSURANCE `.� DATE (MM/DD/YYYY) 06/28/2022 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 NAME: Heather Little Garner D Jensen Insurance Group 750 East 9000 South Ste B Sandy, UT 84094 a/c °"N Ext: (801)352-7100 A/C No: (801)352-7414 E-MAIL ADDRESS: heatherpegarnjenseninsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: American Fire and Casualty Company 24066 05/09/2022 INSURED INSURER B: Ohio Security Insurance Company 24082 Apex Clean Air Llc INSURERC: 3855 S 500 W Ste C INSURER D: Salt Lake City, UT 84115 INSURER E : DAMAGE TO RENTED PREM SES (Ea occurrence) INSURER F: MED EXP (Any one person) COVERAGES CERTIFICATE NUMBER: 00010473-1717393 REVISION NUMBER: 8 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 MM/DD POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY BKA58331701 05/09/2022 05/09/2023 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE [XI OCCUR DAMAGE TO RENTED PREM SES (Ea occurrence) $ 300,000 MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ECT [::] LOC X PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY BAS58331701 05/09/2022 05/09/2023 EOa acc denINED SINGLE LIMIT $ 300 000 BODILY INJURY (Per person) $ ANY AUTO OWNEDSCHEDULED AUTOS ONLY X AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y /" OFFICER/MEMBER EXCLUDED? F_N (Mandatory in NH) /A XWS58331701 01/26/2022 01/26/2023 PER X STATUTE ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 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) CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by HLL on 06/28/2022 at 02:21 PM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Wheat Ridge City Hall THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN of ACCORDANCE WITH THE POLICY PROVISIONS. 7500 W. 29th Ave. Wheat Ridge, CO 80033 AUTHORIZED REPRESENTATIVE IF A AO' A10P ;Ia� (HLL) © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by HLL on 06/28/2022 at 02:21 PM OFFICIAL RESULTS REPORT 9_M9W_�W_-1 F29 - National Standard Master INTERNATIONAL Mechanical CODE COUNCIL Name: Michael Brazile Candidate ID: ICNON173077 Address: 4372 S Billings Cir Date: 2/17/2022 Aurora CO 80015 EXAMINATION RESULT: PASS Congratulations! You have passed the above-named examination. You will be able to verify your pass status on the ICC website within 48-72 business hours after your exam. Please contact your participating jurisdiction if you wish to pursue licensing. A passing score on this examination satisfies the testing requirements for licensure only, and does not guarantee that licensing will be granted. The candidate must also satisfy all local ordinance requirements in each jurisdiction where licensing is desired. It is extremely important that you notify Pearson VUE and ICC of any changes in name and/or address to avoid the possibility of future correspondence not being received. Please contact both Pearson VUE at 877-234-6082 and ICC at 888-422-7233 ext. 5524 with changes to your name and address. ICC reserves the right to amend or withhold any examination scores if, in its sole opinion, there is adequate reason to question their validity. The authenticity of this score report can be validated by using Pearson VUE's Online Score Report Authentication found at: www. PearsonVUE.com/authenticate Digital embossing eliminates the possibility of unauthorized embossing of counterfeit score reports. Registration Number: 415388840 Validation Number: 61102333