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HomeMy WebLinkAboutArchetype Signmakers Inc 26-34 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 **2026 license** Business Name: Archetype Signmakers. Inc. Address: 9611 James Ave S. Bloomington. MN 55431 Telephone: (952 ) 641-9600 Fax: (952 ) 641-0023 E-mail kathya©archetypesign corn 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 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 x 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: /b `/-2 Worker's Comp. Insurance Expiration: JO - 1 -Z( Mechanical Surety Bond ID: Mechanical Surety Bond Expiration: -- LEAD ID & Expiration: Date License Issued: J— Z0 -ZC4 No. 26'34- 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: Archetype Signmakers, Inc. Business Address: 9611 James Ave S Bloomington MN 55431 City State Zip Code Minnesota Tax Identification No.: 4242225 Federal Tax Identification No.: 41-1937341 If a Minnesota Tax Identification number is not required, please explain: Date: 12/15/2025 Signature:` 1 c011)020) Title: CFO 4 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): EMC Property&Casualty Comp Policy Number 6H74362 Dates of Coverage: 10/01/2025-10/01/2026 - 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 best of my knowledge,th ' formation provided is true and correct. Date: 12/15/2025 Signature Kathleen Alexander Printed Name of Signature CFO Title/Position of Person Signing 410 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. 12/15/2025 By: ca611)42)Date Corporate Officer or Individual Proprietorship Owner Subscribed and sworn to before me✓ / this }y day of PeLe filb °24 ` , Notary Public. C /1 n Q/i n County. My comrhission expires: 191/3/7 Zoz 7 yc,. KEEFER 7)OERR Stat6 of Nl !nc .,\ MyCOmnUSsi: i:�.::. ' Janua 31 202/ Updated:01-01-2018 Construction Codes and Licensing Division DEPARTMENT OF Licensing and Certification Services rim LABOR AND I N D U S T R Y 443 Lafayette Road North St. Paul, MN 5155 Phone: (651)284-5034 Sign Contractor Bond E-mail: DLI.License@state.mn.us Website: www.dli.mn.gov BOND NO. AMOUNT EFFECTIVE DATE ENDING DATE PRINT IN INK or TYPE 108385537 $8,000.00 12/18/2025 12/18/2027 KNOW ALL PERSONS BY THESE PRESENTS: Archetype Signmakers, Inc. THAT (Business name as Registered with the Office of the Minnesota Secretary of State;or if individual sole proprietor, individual's name.) (DBA,doing business as name if applicable) With business office at 9611 James Avenue South Bloomington MN 55431 952-641-9600 (Business Address City State Zip Code Telephone number) as PRINCIPAL,and Travelers Casualty and Surety Company of America (Surety Company Name) One Tower Square Hartford CT 06183 860-277-0111 (Surety Company Address City State Zip Code Telephone number) A corporation duly organized in the state of CT and authorized to do business in the state of Minnesota, as Surety, are jointly and severally held and firmly bound to the state of Minnesota as obligee, in the sum of EIGHT THOUSAND DOLLARS ($8,000.00) for the benefit of persons injured or suffering financial loss by reason of failure of such performance as herein specified for the payment of which, we bind ourselves, our heirs, executors, administrators, successors and ass firmly by these presents.The bond shall be filed with the Minnesota Department of Labor and Industry and shall be in lieu of all other license bonds to any other political subdivision. NOW THEREFORE, the condition of this obligation is such that WHEREAS the said Principal has contracted to perform installation of signs within the state of Minnesota, then the Principal shall faithfully and lawfully comply with the requirements provided in Minnesota Statute 326B.865 and all applicable local or state code requirements 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 the state or local codes relating to sign installation, 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 suffering financial loss the amount 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 EIGHT THOUSAND DOLLARS ($8,000.00). The bond must be renewed biennially and maintained for so long as determined by the commissioner. The aggregate liability of the surety on the bond to any and all persons, regardless of the number of claims made against the bond, may not exceed the annual amount of the bond. The bond may be cancelled as to future liability by the surety upon 30 days written notice mailed to the commissioner 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 1st day of December, 2025 (SURETY SEAL) Archetype Signmakers, Inc. Print Name of Principal(s) SIGNATURE OF PRINCIPAL(S) Print Name of Principal(s) SIGNATURE OF PRINCIPAL(S) Acknowledge(notarize)signatures on reverse side and attach Travelers Casualty and Surety Company of America power of attorney form. NAME r1F SURFTY File with: Minnesota Department of Labor and Industry CCLD—Licensing and Certification SIGNATURE OF ATTORNEY IN FACT(SURETY COMPANY) 443 Lafayette Road N. Hillary D. Shepard St. Paul, Minnesota 55155 A OR B AND C MUST BE COMPLETED A FOR ACKNOWLEDGEMENT OF Individual,Partnership,Limited Liability Companyor Limited Liability Partnership (Note: If partnership all signatures required to be notarized. Please copy the page if necessary.) STATE OF ) )ss COUNTY OF ) On this day of personally came to me well known to be the identical person(s)described in and who executed the foregoing bond and he/she/they acknowledged the same to be his/her/their own free act and deed. (SEAL) Notary Public, County, My Commission Expires B. FOR ACKNOWLEDGEMENT of Corporate Contractor STATE OF ) )ss COUNTY OF ) On this day of personally came who being by me duly sworn,did say thathe/she is of ,a corporation;and that said instrument was executed in behalf of the corporation by authority of its Board of Directors;that he/she acknowledged said instrument to be the free act and deed of the corporation. (SEAL) Notary Public, County, My Commission Expires PART C MUST BE COMPLETED BY THE SURETY COMPANY G FOR ACKNOWLEDGEMENT of Corporate Surety STATE OF Kansas ) )ss COUNTY OF Johnson ) On this 1st day of December, 2025 personally came Hillary D Shepard and to me personally known,who being by me duly sworn, did say that he/she is the attomey in fact, of Travelers Casualty and Surety Company of America ,the corporation whose name is affixed to the foregoing instrument;that the seal affixed to the foregoing instrument is the corporate seal of the said corporation; and that said instrument was executed in behalf of said corporation by authority of its board of directors and said Hillary D Shepard acknowledged that he/she executed said instrument as attorney in fact as the free act and deed of said corporation. t '`-'' Erin C. Lavin ERN C.LAVIN (SEAL) Notary Public-State of Kansas Notary Public, Johnson County, Kansas MYAPPt Expires My Commission Expires November 22, 2027 This material can be made available in different forms,such as large print,Braille or on audio. DATE(MM/DO/YYYY) ACORO� CERTIFICATE OF LIABILITY INSURANCE 12/31/2025 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 Marsh & McLennan Agency LLC PHONE Ally Werng FAX 6160 Golden Hills Drive (A/C.No.Extt: (A/C,No): Minneapolis MN 55416 E-MAIL ADDRESS: AIIy.Wenig©marshmma.com INSURERS)AFFORDING COVERAGE MAC 0 INSURER A:EMC Property and Casualty Comp 25186 INSURED ARCHESIGNM1 INSURERS:Lloyd's Archetype Signmakers, Inc. dba Archetype Signs 9611 James Ave S INSURER C: Minneapolis MN 55431 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:764763074 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 I POLICY EFF POLICY EXP LIMITS LTR DASD MD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERALUABILITY 6D74362 10/1/2025 10/1/2026 EACH OCCURRENCE $1,000,000 DAMAGE TO CLAIMS-MADE X OCCUR PREMISES(EaENTED occurrence) $500,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY 6E74362 10/1/2025 10/1/2026 COa acMBcidINEDent)SINGLE LIMIT $1,000,000 (E 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) $ A X UMBRELLA LIAB X OCCUR 6J74362 10/1/2025 10/1/2026 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X I RETENTION$n $ A WORKERS COMPENSATION 6H74362 10/1/2025 10/1/2026 X ;MUTE X EH - AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE N NIA E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (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 B Professional Liability ANE1556 12/25/2025 10/1/2026 Each Claim/Agg 1,000,000 A Contractors Equipment 6M74362 10/1/2025 10/1/2026 Leased/Rented Equip 200,000 Installation Coverage Any One Jobsite 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD