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HomeMy WebLinkAbout210505 LEVELLO CONSTRUCTIONF13_Passing_ResultW" OFFICIAL RESULTS REPORT ilk Mail r F13 - National Standard Residential' INTERNATIONAL CODE COUNCIL Building Contractor (C) f Name: Lee Lipniskis Candidate ID: ICNON177680 Address: 4711 S Himes Ave. Date: 4/22/2022 Apt. #2011 Tampa FL 33611 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. PearsonVU E.com/authenticate Digital embossing eliminates the possibility of unauthorized embossing of counterfeit score reports. Registration Number: 416936907 Validation Number: 657344077 LEVECON-03 MCKENZIE1RRA AC'OR"' CERTIFICATE OF LIABILITY INSURANCE �..-■-' DATE(MMIDDIYYYY) 6/20/2022 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 SU BROGATION 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 FAX (A/C, No, Ext): (720 ) 733-2598 (A/C, No): J Sequeira Agency Inc. Dba Bravura Brokerage 7200 E. Dry Creek Rd. STE E204 Centennial, CO 80112 E-MAIL SS:julie@bravurabrokerage.com INSURERS AFFORDING COVERAGE NAIC # 6/6/2023 INSURER A: Kinsale Insurance Company 38920 INSURED INSURER B: GENT X INSURER C: $ Excluded Levello Construction LLC INSURER D: $ 1,000,000 6145 Broadway Ste 43 Denver, CO 80216 INSURER E $ 2,000,000 INSURER F: $ 2,000,000 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 CLAIMS -MADE [X]OCCUR0100193697-0 6/6/2022 6/6/2023 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence 100 000 $ GENT X MED EXP (Any oneperson) $ Excluded PERSONAL &ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY E] PEO- E] LOC OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED r SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident $ BODILYINJURY Perperson) $ BODILY INJURY Per accident $ PeOaccident DAMAGE $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED FFRETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVELlE.L. OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA PEROTH- STATUTE ER EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYEE $ E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 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 Ave. 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 41 City of �A 6 1 1 Wh. COMMUNITY DEVELOPMENT 7500 W. 29"' Avenue * Wheat Ridge, CO 80033 * O: (303)235-2855 * F: (303)235-2857 Contractor Waiver for Workers' Compensation Insurance 1, (print your name), Lee Lipniskis verify that l am the sole owner or partner of (company name): Levello Construction LLC which has no employees and is not required by the State of Colorado to carry workers' compensation insurance. I further state that if t 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 Ridgejand wip be listed on the permit. Date: 08/04/2022