Loading...
HomeMy WebLinkAboutTotal Mechanical Inc 26-17 CONTRACTOR LICENSE APPLICATION City of Oak Park Heights 14168 Oak Park Blvd. N. Oak Park Heights, MN 55082 TELEPHONE: DIRECT:(651)351.1661 GENERAL:(651)439-4439-FAX: (651)439-0574 Email:jhultman@cityofoakparkheights.com Business Name: Total Mechanical Services,Inc. Address: 420 Broadway Avenue St.Paul Park,MN 55071 Telephone: ( 651 ) 768-9367 Fax: ( E-mail accountinoetotalmech.com LICENSE REQUIREMENTS • Fee based on trade. State license is required for residential general contracting, roofing, plumbing and fire protection. Mechanical Contractors require MN State Surety Bond. •Certificate of Insurance, minimum coverage, $100,000 per person, Public Liability; $250,000 per accident, Bodily Injury; and $100,000 Property Damage. CITY OF OAK PARK HEIGHTS MUST BE NAMED AS AN ADDITIONAL INSURED on this policy. •Agreement to hold CITY OF OAK PARK HEIGHTS harmless for ALL claims of damage liability that may come against the license/permit holder. • Proof of WORKERS COMPENSATION INSURANCE if required, by law, to be carried. • State and Federal Tax Identification numbers pursuant to MN STATE STATUTE 270.72. •The CONTRACTOR further agrees to adhere to all OSHA STANDARDS, UNIFORM TRAFFIC CODES and any CITY CODES AND STANDARDS that may apply to this license. • License period: January 1 to December 31 of each year. Cancellation will occur upon failure to provided continued proof of insurance coverage. LICENSE CLASSIFICATIONS: Commercial General Contractor- $50 Blacktopping - $50 x Heating, Ventilation &A/C - $50 Building Moving -$50 **Attach copy of MN Mechanical Bond Concrete and Masonry- $50 Outside Sewer&Water-$50 Excavating/Grading - $50 Siding - $50 Pool Installation - $50 Signs & Billboards - $50 Irrigation System Installation - $50 COMPLETION OF THE WORKERS COMPENSATION INSURANCE ANDTAX I.D. FORMS IS REQUIRED BEFORE A LICENSE CAN BE ISSUED. THESE FORMS ARE ATTACHED AND MADE PART OF THIS APPLICATION. Office Use Only: Liability Insurance Expiration: 2/0 - Worker's Comp. Insurance Expiration: U -L G Mechanical Surety Bond ID: 01 e CO ) ? Mechanical Surety Bond Expiration: 8 19 2., LEAD ID & Expiration: -- Date License Issued: -J 1 -21#0 No. 2,(O � I l LICENSE APPLICANT: Pursuant to Minnesota Statute 270.072 Tax Clearance; Issuance of Licenses, the licensing authority is required to provide the Minnesota Commissioner of Revenue your Minnesota business tax identification number and the social security number of each license applicant. Under the Minnesota Government Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the following regarding the use of this information: 1. This information may be used to deny the issuance, renewal or transfer of your license in the event you owe the Minnesota Department of Revenue delinquent taxes, penalties or interest; 2. Upon receiving this information, the licensing authority will supply it only to the Minnesota Department of Revenue. However, under the Federal Exchange of Information Agreement the Department of Revenue may supply this information to the Internal Revenue Service. 3. Failure to supply this information may jeopardize or delay the processing of your licensing issuance or renewal application. Please provide the following information and return along with your application to the agency issuing the license. Do not return to the Department of Revenue. Licensing Authority: City of Oak Park Heights License Period: Annual: January 1 through December 31 Personal Information: (Complete only if applicable) Applicant's Name: Applicant's Address: City State Zip Code Social Security No.: Business Information: (Complete only if applicable) Business Name: Total Mechanical Services,Inc. Business Address: 420 Broadway Avenue St.Paul Park MN 55071 City State Zip Code Minnesota Tax Identification No.: 240339 Federal Tax Identification No.: 41-1616216 If a Minnesota Tax Identification number is not required, please explain: Date: 12/30/2025 Signature: �- Title: Accounting Manager PROOF OF WORKERS' COMPENSATION INSURANCE COVERAGE Minnesota Statue, Section 176.182, requires every state and local licensing agency to withhold the issuance or renewal of a license or permit to operate a business in Minnesota until the applicant presents acceptable evidence of compliance with the workers' compensation insurance coverage requirement of Chapter 176. The information required is: the name of the insurance company, the policy number, and dates of coverage or the permit to self-insure. This information will be collected by the licensing agency and retained within their files. This information is required by law. Licenses and permits to operate a business may not be issued or renewed if it is not provided and/or is falsely reported. Furthermore, failure to provide or falsely reporting this information may result in a $2,000 penalty assessed against the applicant by the Commissioner of the Department of Labor and Industry. Provide the information specified above, in the spaces provided, or certify the precise reason your business is excluded from compliance with the insurance coverage requirement for workers' compensation. Insurance Company(not the Insurance Agent): Citizens Insurance Company of America Policy Number WBXJ72596502 Dates of Coverage: 10/1/2025 to 10/1/2026 - OR - I am not required to have Workers' Compensation Insurance because: (check one) ( ) I have no employees covered by law; ( ) I am self-insured (include permit to self-insure); or ( ) Other(specify) I have read and understand my rights and obligations with regards to business licenses, permits and Workers' Compensation coverage and hereby certify by my signature below that to the b of my knowledge, the information provided is true and correct. Signature G Date: 12/30/2025 Amy Crouzer Printed Name of Signature Accounting Manager Title/Position of Person Signing INDEMNIFICATION AGREEMENT To: City of Oak Park Heights 14168 Oak Park Boulevard, N. Oak Park Heights, MN 55082 NOTE:The following must be signed by an Officer of the Corporation or by the Owner and notarized. In consideration for the granting of this license, the license applicant agrees to hold the City harmless from all damages and claims of damage which may arise by reason of any negligence on the part of the Contractor or the Contractor's agents or employees engaged in the performance of this Contract/Permit, and will indemnify the City for the amount of all claims, liens, expenses and claims for liens of work, tool, machinery, materials or insurance premiums and for the amount of all loss by reason of the failure of the Contractor to fully perform its obligation under this Contract/Permit, including but not limited to attorney fees and costs incurred relative to such claims and losses. 12/30/2025 By: Date Corpora fficer or Individual Proprietorship Owner Subscribed and sworn to before me this 1 day of n-u j-,- , . n 04"`' r,. Brandon Joseph Winter 1 °xi NotaryPublic 6-6 i Notary Public. /1 , . t,.1,froz,A_' �,-u` County. I � = ; Minnesota My Commission Expires 01/31/2030 My commission expires: Ol/v� /./ 3�, Updated:01-01-2018 1 Minnesota Department of Labor and Industry Construction Codes and Licensing Division Licensing and Certification Ilk DEPARTMENT OF PO Box64217 r LABOR AND INDUSTRY St. Paul, MN 55164-0217 Email: dli.licenseestate.mn.us Website: www.dli.mn.qov Mechanical Bond Phone: (651)284-5034 BOND NO. AMOUNT EFFECTIVE DATE EXPIRATION DATE PRINT IN INK or TYPE 16122858 $25,000.00 8/19/2024 8/19/2026 KNOW ALL PERSONS BY THESE PRESENTS: THAT Total Mechanical Services, Inc. (Business name as registered with the Office of the Minnesota Secretary of State;or if individual proprietor,individual's name.) (DBA or"doing business as"name if applicable) With business office at 420 Broadway Avenue Saint Paul Park MI 55071 (651)768-9367 (Business Address) (City) (State) (Zip Code) (Telephone number) as PRINCIPAL,and The Guarantee Company Of North America USA (Surety Company Name) 605 Highway 169,Suite 800 Plymouth MN 55441 (952)852-2431 (Surety Company Address) (City) (State) (Zip Code) (Telephone number) a corporation duly organized in the state of MI and authorized to do business in the state of Minnesota,as Surety,are hereby held and firmly bound to the state of Minnesota and any person injured or suffering financial loss by reason of the Principal's failure to faithfully perform the duties,and in all things comply with all laws,ordinances,and rules related to the Principal's license or any permit applied for and all contracts entered into,in the penal sum of TWENTY-FIVE THOUSAND DOLLARS($25,000.00). For payment of this sum,Principal and Surety bind themselves,their heirs,representatives,successors and assigns,jointly and firmly by these presents. NOW THEREFORE,the condition of this obligation is such that WHEREAS the said Principal has contracted to do gas,heating,ventilation,cooling, air conditioning,fuel burning,or refrigeration work within the state of Minnesota,then the Principal shall faithfully and lawfully comply with the Minnesota State Mechanical Code(Minnesota Rules,Chapter 1346)as provided in Minnesota Statute 326B.197 when performing work in the state of Minnesota and indemnify any person dealing or transacting business with the Principal from any financial loss or damage occasioned by the failure of the Principal to comply with any requirements of Minnesota Rules,Chapter 1346,then no obligation under this bond shall accrue;otherwise this bond shall remain in full force and effect. During the term of this obligation the Principal and Surety will pay unto the persons injured or sUfferltig'finane'ral Ibss''the amot➢nt"needed to correct non-complying work.The aggregate liability of the Surety hereunder pertains to all claims,regardless of the number of claims,made against the bond or the number of years the bond remains in force,shall in no event exceed the total sum of TWENTY-FIVE THOUSAND DOLLARS($25,000). The bond may be cancelled by the Surety,as to future liability,by giving written notice by Certified Mail,addressed to the Principal at the address as stated in the bond,and to the Department of Labor and Industry,Construction Codes and Licensing Division,443 Lafayette Road No.,'St.Paul,MN 55155.Thirty(30)days after the mailing of that notice,this bond shall be null and void as to any liability thereafter arising,the Surety remaining liable, however,subject to all the terms,conditions,and provisions of this bond,for any and all acts covered by this bond up to the date of the cancellation. The Surety shall notify the Principal and the Department of Labor and Industry if it has made any payments on the bond which result in the value of the bond falling below the minimum amount required by law. Signed and sealed this 21st day of June 2024 (SURETY SEAL) Total Mechanical Services,Inc. Print Name of Principal(s) N OF RIN AL(S) Print Name of Principal(s) SIGNATURE OF PRINCIPAL(S) Acknowledge(notarize)signatures on reverse side and attach The Guarantee Company Of North America USA power of attorney form. NAME OF SURETY File with: Minnesota Department of Labor and Industry SIGNATATTORNEY IN FACT CCLD Licensing and Certification (SURETY COMPANY) Troy Staples,Attorney-in-fact 443 Lafayette Road N. St. Paul,Minnesota 55155 Mechanical Bond 3.21.2023 A��8 DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 9/22/2025 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: Amanda Kaehler Holmes Murphy&Associates, LLC PHONE FAX - 2727 Grand Prairie Parkway (A/C,Lo,Extl:612-349 2486 IAIC,No): Waukee IA 50263 ADDRESS: AKaehleriholmesmurphy.com INSURER(8)AFFORDING COVERAGE NAIC INSURER A:Citizens Insurance Company of America 31534 INSURED TOTMECPC INSURER B:Hanover Insurance Company 22292 Total Mechanical Services, Inc. INSURER C:Great American E&S Insurance Company 37532 420 Broadway Avenue St. Paul Park, MN 55071 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1839374906 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 TYPE OF INSURANCE ADDL SUBR POUCY EFF POUCY EXP UMITS LTR INSD wVD POLICY NUMBER IMMIDDIYYYYI IMM/DOIYYYY) A X COMMERCIAL GENERAL LIABILITY Y ZBXJ55580202 10/1/2025 10/1/2026 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) S 1,000,000 X Contr Uab Per MED EXP(Any one person) $10,000 X Policy Fonn/XCU PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X FjE a X LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER. $ B AUTOMOBILE LIABILITY ADXJ55584202 10/1/2025 10/1/2026 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE _ AUTOS ONLY _ AUTOS ONLY (Per accident) X Comp:$1,000 X Coil:$1,000 Hired Car Phys Dmge $$50,000 B X UMBRELLA LIAB X OCCUR UHXJ55580302 10/1/2025 10/1/2026 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED I X RETENTION$n $ A WORKERS COMPENSATION WMXJ51191703 10/1/2025 10/1/2026 X AND EMPLOYERS'LIABILITY STATUTE OTH- ER Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? N NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Pollution/Errors&Omissions Liab PCMF40529900 10/1/2025 10/1/2026 Ea Poll Cond/Ea Claim $2MM/$2MM A Installation Floater/Spedal Form ZBXJ55580202 10/1/2025 10/1/2026 Ded:$1,000/Repl Cost $500,000/Jobsite Leased-Rented Equip/Special Form Ded:$1,000/ACV $375,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) License/Permit Requirements Additional Insured only if required by written contract with respect to General Liability:City of Oak Park Heights. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Oak Park Heights 14168 Oak Park Blvd. N. Oak Park Heights MN 55082 AUT REED REPRESENTATIVE ter--..."0/:^4\ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD