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HomeMy WebLinkAboutGardner Builders Minneapolis LLC 26-19 rP 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: Gardner Builders Minneapolis,LLC Address:730 2nd Ave S,Ste 1233,Minneapolis,MN 55402 Telephone: (612 ) 326-6377 Fax: ( ) E-mail licensing@gardner-builders.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: X 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 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. (� r ,, Office Use Only: Liability Insurance Expiration: C _J -Z�w Worker's Comp. Insurance Expiration: 7 Mechanical Surety Bond ID: Mechanical Surety Bond Expiration: LEAD ID & Expiration: ( , Date License Issued: j -23-2(p. No. 2,lU - 19 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: Gardner Builders Minneapolis,LLC Business Address: 730 2nd Ave S,Ste 1233 Minneapolis MN 55402 City State Zip Code Minnesota Tax Identification No.: 1715033 Federal Tax Identification No.: 27-3263896 If a Minnesota Tax Identification number is not required, please explain: 12/15/2025 {'� Date: Signature: ziZ„ Title: Cheif Strategy Officer 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): New Hampshire Insurance Company Policy Number WC25893656 Dates of Coverage: 9/1/2024-9/1/2025 - 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, the information provided is true and correct. -'t �%✓� Date: 12/15/2025 Signature '- " Barry Stoffel Printed Name of Signature Chief Strategy Officer 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. 1a - IS-d,oa5 By: ---3.:,:kta"--- Date Corporate Officer or Individual Proprietorship Owner Subscribed and sworn to before me this I F,*\ day of ().e 0,evnlae r , aao a s . CCU. G\eCSAO C' , Notary Public. V-veuwve vn County. My commission expires: .�av\ 211 a ash "` RICA ANN GIERSOORF Notary Public-Minnesota ..'t.- My Commission Expires Jan 31.2026 Updated:01-01-2018 DATE(MMIDD/YYW) AR o® CERTIFICATE OF LIABILITY INSURANCE E(MMID IY 25 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: Anna Simons Holmes Murphy&Associates, LLC PHONE FAX 2727 Grand Prairie Parkway (A/C.No.Extl:612-349-2470 (A/C,No): Waukee IA 50263 ADDARESS: asimons@holmesmurphy.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER :Berkley Assurance Company 39462 INSURED GARBUIPC INSURER B:Allmerica Financial Benefit Insurance 41840 Gardner Builders Minneapolis,LLC 730 Second Ave S,Ste 1233 INSURER C:National Union Fire Ins.Co..Pittsburgh 19445 Minnepolis,MN 55402-1302 INSURERD:New Hampshire Insurance Company 23841 INSURER E:Travelers Property Casualty Co.America 25674 INSURERF:Arch Insurance Company 11150 COVERAGES CERTIFICATE NUMBER:533966939 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 INSDADDL I SUBR POLICY NUMBER POLICY EFF POLICY EXP (MMIDD/YYYY) (MMIDD/YYYY) LIMITS C X COMMERCIAL GENERAL LIABILITY 3292213 9/1/2025 9/1/2026 EACH OCCURRENCE $2,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $300,000 X Contr Liab Per MED EXP(Any one person) $10,000 X Policy FomUXCU PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: • GENERAL AGGREGATE $4,000,000 POLICY X �E0. 1 LOC PRODUCTS-COMP/OP AGG I $4,000,000 OTHER: I $ B AUTOMOBILE LIABILITY AWXD.qS6-598 9/1/2025 9/1/2026 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 $ I AUTOS ONLY AUTOS ONLY (Per accident) X I Comp:$500 X Coll:$500 $ B X UMBRELLA LIAB X OCCUR CUP1X279956 9/1/2025 9/1/2026 EACH OCCURRENCE $25,000,000 EXCESS LIAB UXP300030202 9/1/2025 9/1/2026 CLAIMS-MADE AGGREGATE $25,000,000 DED X RETENTION$in(Inn $ D WORKERS COMPENSATION IWC48407261 9/1/2025 9/1/2026 X SPER TATUTE ERH AND EMPLOYERS'LIABILITY Y I N - ANYPROPRIETOR/PARTNER/EXECUTIVE N NIA E.L.EACH ACCIDENT $2,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $2,000,000 A Profession)Liab-Claims Made PCADB50289270925 9/1/2025 9/1/2026 Each Claim/Condition: $5,000,000 Pollution Liability General Aggregate: $5,000,000 Retention: $50,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City Contractor License Additional Insured only if required by written contract.with respect to General Liability,Automobile Liability and Umbrella/Excess Liability applies on a primary, basis and the insurance.of the additional'insured shall be non-contributory:City of Oak Park Heights,Project Owner and Others as required by written contract, per policy terms and conditions. . Waiver of Subrogation only if required by written contract with respect to General Liability,Automobile Liability,Workers Compensation and Umbrella/Excess Liability applies in favor of:City of Oak Park Heights,Project Owner and.Others as required by written contract,per policy terms and conditions. . See Attached... 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. 14186 Oak Park Blvd Nortd;„,-,,--e\ Oak Park Heights MN 55802 Au�RES I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: GARBUIPC LOC#: ACCORD ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Holmes Murphy&Associates,LLC Gardner Builders Minneapolis,LLC 730 Second Ave S,Ste 1233 POLICY NUMBER Minnepolis,MN 55402-1302 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE The General Liability,Automobile Liability,Workers Compensation and Umbrella/Excess.Liability includes an endorsement providing 30 days'notice of cancellation will be furnished to the certificate holder. ACORD 101(2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD