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Home My WebLink About210499 MOUNTAIN VIEW REMODELING City of Wheat Ridge Workers Comp Waiver (1)♦SAI City of "� WheatRjdge COMMUNITY DEVELOPMENT 7500 W. 29th Avenue * Wheat Ridge, CO 80033 * O: (303)235-2855 * F: (303)235-2857 Contractor Waiver for Workers' Compensation Insurance I, (print your name), Steven Trampe verify that I am the sole owner or partner of (company name): Mountain View Remodeling LLC 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 Ridgee and will be listed on the permit. Signature: Date: 7/26/22 r�� OFFICIAL RESULTS REPORT 1 rarer: G11 - National Standard General INTERNATIONAL Building Contractor (A) CODE COUNCIL Name: Steven Trampe Candidate ID: ICNON160845 Address: 6169 Balsam St. Date: 6/1/2021 Arvada CO 80004 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 398027111 Validation Number: 688261425 ACOR I @DATE CERTIFICATE O F LIABILITY INSURANCE (MM/DD/YYYY) 07/26/2022 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: PHONE (855) 222-5919 FAX A/C No Ext): A/C No): Next First Insurance Agency, Inc. PO Box 60787 Palo Alto, CA 94306 E-MAIL support@nextinsurance.com ADDRESS: pp INSURER(S) AFFORDING COVERAGE NAIC # 0 Click or scan to view INSURERA: Next Insurance US Company 16285 EACH OCCURRENCE INSURED INSURER B: _7RENTECLAIMS-MADE � OCCUR Mountain View Remodeling LLC 6169 Balsam St INSURER C INSURER D: Arvada, CO 80004 INSURER E : MED EXP (Any one person) $10,000.00 INSURER F: COVERAGES CERTIFICATE NUMBER: 493164942 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 MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY AUTHORIZED REPRESENTATIVE 0 Click or scan to view EACH OCCURRENCE $1,000,000.00 _7RENTECLAIMS-MADE � OCCUR DAMAGE TO PREM SES (Ea occur ence) $100,000.00 MED EXP (Any one person) $10,000.00 PERSONAL &ADV INJURY $1,000,000.00 A X NXTJHJHL47-00-GL 07/24/2022 07/24/2023 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $1,000,000.00 X PRO- ❑ LOC POLICY F]JECT PRODUCTS - COMP/OP AGG $1,000,000.00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N PER OTH- STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Each Occurrence: $10,000.00 A Contractors Errors and Omissions X NXTJHJHL47-00-GL 07/24/2022 07/24/2023 Aggregate: $20,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Certificate Holder is City Of Wheat Ridge. This Certificate Holder is an Additional Insured on the General Liability policy per the Additional Insured Automatic Status Endorsement. All Certificate Holder privileges apply only if required by written agreement between the Certificate Holder and the insured, and are subject to policy terms and conditions. CERTIFICATE HOLDER CANCELLATION City Of Wheat Ridge LIVE CERTIFICATE 7500 W 29th Ave SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Wheat Ridge, CO 80033 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 0 Click or scan to view @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD /° ACOROCERTIFICATE OF PROPERTY INSURANCE DATE (MM/DD/YYYY) 07/26/2022 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. PRODUCERNext First Insurance Agency, Inc. enc PO BOX 60787 g y Palo Alto, CA 94306 CONTACT NAME: (A/C, No Ext), PHONE (855) 222-5919 FAX No): E-MAIL ADDRESS: su ort nextinsurance.com PP @ CAUSES PRODUCER DEDUCTIBLES CUSTOMER ID: INSURER(S) AFFORDING COVERAGE NAIC # BUILDING PERSONAL PROPERTY BUSINESS INCOME EXTRA EXPENSE RENTAL VALUE BLANKET BUILDING BLANKET PERS PROP BLANKET BLDG & PP INSURED Mountain View Remodeling LLC 6169 Balsam St INSURERA : State National Insurance Company, Inc. 12831 INSURER B: BASIC Arvada, CO 80004 INSURER C : $ INSURER D: $ INSURER E: SPECIAL INSURER F: $ COVERAGES CERTIFICATE NUMBER: 493164942 REVISION NUMBER: LOCATION OF PREMISES / DESCRIPTION OF PROPERTY (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 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 POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) COVERED PROPERTY LIMITS CAUSES PROPERTY OF LOSS DEDUCTIBLES BUILDING PERSONAL PROPERTY BUSINESS INCOME EXTRA EXPENSE RENTAL VALUE BLANKET BUILDING BLANKET PERS PROP BLANKET BLDG & PP $ $ BASIC BUILDING $ BROAD $ CONTENTS SPECIAL $ EARTHQUAKE $ WIND $ FLOOD $ $ A CAUSES X INLAND MARINE OF LOSS NAMED PERILS OPEN PERILS TYPE OF POLICY Contractors Equipment 07/24/2022 07/24/2023 X EQUIPMENT MISC TOOLS BORROWED TOOLS $ 3,000.00 X $ 600.00 POLICY NUMBER NXTVDWRRTJ-00-IM X $ 3,000.00 CRIME TYPE OF POLICY $ BOILER& MACHINERY/ EQUIPMENT BREAKDOWN $ L $ SPECIAL CONDITIONS / OTHER COVERAGES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Proof of Insurance. CERTIFICATE HOLDER CANCELLATION City Of Wheat Ridge LIVE CERTIFICATE 7500 W 29th Ave SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Wheat Ridge, CO 80033 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Click or scan to view ©1995-2015 ACORD CORPORATION. All rights reserved. ACORD 24 (2016/03) The ACORD name and logo are registered marks of ACORD