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HomeMy WebLinkAbout210508 ATLAS CONTRACTING Atlas CDPHE GAC License (1)Coloradofp Public Health�1.. General Abatement Contractor) his certifies that;)/ Has Contracting & Environmental Solutions' ),,` GAC No.. 26365,1 as the certificatton requiremenfs of 25-7-507, C.R.S. and Air Quality Control Commission Regulation No. 8 Part B, and is hereby authorized to perfonn asbestos abatement activities in the state of( [ssued, July 16, 202T� � Expires . August 07, 2022 Awhori7ed APC Rcjireentative SEAL. ,acoR" C E RT I F I CAT E O F LIABILITY INSURANCE DATE (MM/DD/YYYY) �� 07/13/22022 THIS CERTIFICATE IS ISSUED ASA 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 Bill Vaughan NAME: Blue Sky Ins PHONE (303) 647-5477 FAX A/C No Ext): A/C, No): E-MAIL billy@bskyins.com ADDRESS: 88 Inverness Circle East INSURER(S) AFFORDING COVERAGE NAIC # Suite A-103 INSURERA: Underwriters at Lloyd's of London 15792 Englewood CO 80112 INSURED INSURER B: AutoOwners Insurance Co 18988 Atlas Contracting, Inc INSURER C : 4833 Front St Unit B #126 INSURER D : INSURER E: Castle Rock CO 80104 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2271314970 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 ADDLSUBR INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED 50,000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 A X Professional Y ENC0006096-02. 07/08/2022 07/08/2023 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: X POLICY ❑ PRO- ❑ LOC JECT PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident BODILY INJURY (Per person) $ X ANYAUTO B OWNED SCHEDULED AUTOS ONLY AUTOS 5386720300 05/18/2022 05/18/2023 BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident X HIRED X NON -OWNED AUTOS ONLY /� AUTOS ONLY CAPP $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N/A E.L. EACH ACCIDENT $ (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Contractors Pollution Liability ENC0006096-02. 07/08/2022 07/08/2023 Each Occurence 1,000,000 General Aggregate 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Colorado Premier Restoration, Inc is named as additional insured. CERTIFICATE HOLDER CANCELLATION ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Colorado Premier Restoration, Inc ACCORDANCE WITH THE POLICY PROVISIONS. 2750 W Mansfield Ave AUTHORIZED REPRESENTATIVE Englewood CO 80112"g. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ♦x`41 City of Wh6at'g "*iC COMMUNITY DEVELOP ENT 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), verify that I am the sole owner or partner of (company name): which has no employees and is not required by the State of Colorado to carry workers' compensation insurance. I further state that if 1 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 Ridgy -arc Sign Date: ill be listed on the permit. c--% C�,2 ZO22