CONTRACTOR LICENSING APPLICATION. Complete Separate Application for each License

Size: px

Start display at page:

Download "CONTRACTOR LICENSING APPLICATION. Complete Separate Application for each License"

Debra Wheeler
6 years ago
Views:

1 City of Lawrence PLANNING & DEVELOPMENT SERVICES Building Safety Division 1 Riverfront Plaza, Suite 11 0 Lawrence, Kansas p (785) f (785) buildinginspections@lawrenceks.org CONTRACTOR LICENSING APPLICATION Complete Separate Application for each License (CLASS A, B, C, D, E AND L) LICENSE APPLYING FOR: 0Ciass A General Contractor (Requires 10 years experience). Shall entitle the holder to construct, remodel, repair, demolish any structure and perform work described as Class D, Building Specialties. 0Ciass B Building Contractor (Requires 6 years experience). Shall entitle the holder to construct, remodel, repair, demolish all structures not exceeding three stories in height, perform work described as Class D, Building Specialties and perform non-structural remodeling, tenant-finish, and repairs of all structures. 0Ciass C Residential Contractor (Requires 4 years experience). Shall entitle the holder to construct, remodel, repair, and demolish single family or duplex residences, buildings accessory thereto and perform work described as Class D, Building Specialties. 0Ciass D Framing Contractor (Requires 2 years experience). Shall entitle the holder to construct. remodel, and repair framing work of a structure. 0Ciass D Concrete Contractor (Requires 2 years experience). Shall entitle the holder to do general concrete work. 0Ciass E Electrical Contractor (Requires 4 years experience). Shall entitle the holder to construct. remodel, and repair electrical work of a structure. 0Ciass E Fireplace Contractor (Requires 4 years experience). Shall entitle the holder to construct, remodel, and repair fireplace work of a structure. 0Ciass E Mechanical Contractor (Requires 4 years experience). Shall entitle the holder to construct, remodel, and repair mechanical work of a structure. 0Ciass E Plumbing Contractor (Requires 4 years experience). Shall entitle the holder to construct, remodel, and repair plumbing work of a structure. ~lass L Limited Contractor- Shall entitle the holder to perform work limited in scope as approved by the Contractor Licensing Board. Fees 1:8] Application Fee (Non-refundable) AND f2l(65.00 License Fee D Change of Qualifying Party (application fee only) D Additional Qualifying Party (application fee only) Company Name: Mailing Address: City: L A. w r-e.. t'\ (L_ State: h2 Zip Code: b bdt-t 1 Phone No: Owner or Authorized Individual: Address: G. KYt J: (br:;,...v) St ~ vttayyj a 1

4 , City of Lawrence PLANNING & DEVELOPMENT SERVICES Building Safety Division 1 Riverfront Plaza, Suite 110 Lawrence, Kansas p (785) f (785) org/pds buildinqinspections@lawrenceks.org CONTRACTOR LICENSING APPLICATION INSURANCE VERIFICATION REQUIREMENTS The contractor shall be required to maintain and carry in force for the duration of the contract, insurance coverage of the types and minimum liability as set forth below. All Class A, B, C, D or E contractors shall submit an original certificate of insurance. The certificate holder on the Certificate of Insurance shall be as follows: City of Lawrence, Kansas Planning and Development Services Department 1 Riverfront Plaza, Level 1, Suite 110 Lawrence, Kansas A. General Liability Class A, B, and C contractors shall maintain general liability coverage in the amount of not less than 1,000,000 per occurrence single limit for bodily injury and property damage. Class D and E contractors shall maintain general liability coverage in an amount not less than 500,000 per occurrence single limit for bodily injury and property damage. Class L Limited contractors shall maintain general liability coverage as required for Class A, B, and C contractors, or for Class D and E contractors, as deemed appropriate by the Contractor Licensing Board. B. Worker's Compensation and Employer's Liability 1. Worker's Compensation as required by State Statutes. If the contractor is exempt from the Worker's Compensation requirement, the contractor must submit a letter stating the exemption. 2. Employer's Liability 100,000 each occurrence. (Include all states endorsements) Before a license will be issued, the contractor shall furnish to the City of Lawrence, Planning and Development Services Department with a Certificate of Insurance verifying such coverage. Name of Insurance Carrier (Liability): Agent's Name: Co fl_ n ev 5+v A) c :{:A)~ Grtvt' Agent's Telephone No. q J3-3 78'- /OS() Name of Insurance Carrier (Workmen's Amp.): Agent's Name: AI ' Agent's Telephone No. (

5 City of Lawrence PLANNING & DEVELOPMENT SERVICES Building Safety Division 1 Riverfront Plaza, Suite 110 Lawrence, Kansas p (785) f (785) buildinqinspections@lawrenceks.org CONTRACTOR LICENSING APPLICATION WORKER'S COMPENSATION WAIVER If the company has no employees, the following statement must be signed by the owner/operator of the Company and witnessed by a Notary. I ~ 0/id h.&. Yr"\, as sole owner/operator of.mvdy\c.d dt..j~s o:p: 1\J E U. do not have any employees, and therefore requesting to be exempted from carrying worker's compensation. I understand that at any time in the future I employ another individual I must provide Worker's Compensation Insurance Coverage as required by the State of Kansas and furnish City of Lawrence, Planning and Development Services Department with a Certificate of Insurance. Signature: ~= STATE OF KANSAS COUNTY OF DOUGLAS SS. BE IT REMEMBERED, that on this //1, day of ~U&f, 20 ILJ. the undersigned, a NotarY Public in and for the ounty and State aforesaid came rr d flctf'yl ' who is personally known to me to be the same person who executed the within instrument of writing, and such person duly acknowledged the execution of the same. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my seal the day and year first above written. Notary Public:~ 5

6 GARRY DEAN STIDHAM OWNER AND FOUNDER OF ADVANCED SYSTEMS OF NORTH-EAST KANSAS INC EDUCATION: BACHELORS OF SCIENCE DEGREE EARNED FROM FRIENDS UNIVERSITY WICHITA KANSAS 1989 BUSINESS AND MARKETING WORK HISTORY STARTED MY REPAIR JOURNEY WITH ADVANCED SYSTEMS OF KANSAS IN WICHITA KS 33 YEARS AGO AS A LABORER. WORKED MY WAY UP TO SUPERVISOR AND LATER A MANAGER OVERSEEING MANY OPERATIONS. OPENED ADVANCED SYSTEMS OF NE KANSAS IN NOVEMBER OF 20011N LAWRENCE KANSAS SINCE WE HAVE REPAIRED THOUSANDS OF RESIDENTS IN THE IMMEDIATE AREA OF LAWRENCE AND SURROUNDING TOWNSHIPS. IN 2007 WE OPENED ADVANCED SYSTEMS OF MISSOURI IN LEES SUMMITI MO. AND DEVELOPED AND PATENTED THE PRODUCT THE 11 PERFECT PIER" AS SEEN IN THE BROUCHURE. ADVANCED SYSTEMS HAS SEVERAL DIFFERENT APPROACHES TO STABILIZING WALL MOVEMENTS SUCH AS FOR INWARD MOVEMENT OF AN BASEMENT BOWING WALL 1) H-BEAM APPLICATION 2) TIE-BACK APPLICATION DOWNWARD MOVEMENT OR SETILEING 1) WE HAVE OUR 11 PERFECT PIER" -THIS APPLICATION IS OUR FLAGSHIP AND MANY TIMES WE OFFER A LIFETIME TRANSFERRABLE WARRANTY. OUR PIERS HAVE A POUND RATING AND A POUND SAFETY RATING ADVANCED SYSTEMS TWO MAIN APPROACHES TO WATERPROOFING BASEMENTS. 1) HIGH PRESSURE INJECTIONS WITH ACTIVE WALL CRACK LEAKS POLYURETHANE RESINS 2) APPLYING RUBBER MEMBRANE OVER THE PROBLEM AREA AND HEAT SETIING THE MEMBRANE TO THE EXTERIOR WALLS SINCE 2001 OUR BUSINESS HAS INCREASED AN AVERAGE OF 24% PER YEAR AND SERVING OVER 200 CUSTOMERS PER YEAR.

7 CONT. AND HAS OPENED 2 DIFFERENT LOCATIONS THRU OUT THE MID-WEST AND LOOKING TO OPEN ONE IN ROGERS ARKANSAS- SO WE ARE NOT LOOKING TO SLOW DOWN ANY TIME SOON. ANY FURTER QUESTIONS FEEL FREE TO CALL THANK YOU FOR THIS OPPURTUNITY. DEAN STIDHAM PRESIDENT,CEO ADVANCED SYSTEMS NE KS INC. 8/14

8 COMMERCIAL GENERAL LIABILITY CLAIMS-MADE GEN'L AGGREGATE LIMIT APPLIES PER: PRO- X POLICY JECT LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS UMBRELLA LIAB EXCESS LIAB CERTIFICATE OF LIABILITY INSURANCE OCCUR SCHEDULED AUTOS NON-OWNED AUTOS OCCUR CLAIMS-MADE EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) EACH OCCURRENCE AGGREGATE WC STATU- TORY LIMITS E.L. EACH ACCIDENT OTH- ER E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT DATE (MM/DD/YYYY) 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 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 Cornerstone Kansas City LLC 4400 College Blvd. Ste. 150 Overland Park KS INSURED Advanced Systems of Northeast Kansas 809 Branchwood Dr. Lawrence KS COVERAGES CERTIFICATE NUMBER: CL REVISIONNUMBER: 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 ADDL SUBR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS GENERAL LIABILITY A X DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below X CONTACT NAME: PHONE FAX (A/C, No, Ext): (913) (A/C, No): (913) ADDRESS: lhervey@ckcins.com INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : Lynn Hervey /30/ /30/2014 INSURER(S) AFFORDING COVERAGE 8/14/2014 NAIC # Auto Owners Insurance Company ,000, ,000 10,000 1,000,000 2,000,000 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION City of Lawrence, KS Building Safety Division 1 Riverfront Plaza Suite 110 Lawrence, KS ACORD 25 (2010/05) INS025 (201005).01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE David Parkhurst/LS ACORD CORPORATION. All rights reserved. The ACORD name and logo are registeredmarks of ACORD

STRENGTHS: 3" Steel Diameter Deep Installation <Q::;.:.:_:.Q FLAWS: ~.

fill SoiL r.:: ~ ~.:::. :.c?:: ~..;.; ~ :.:.. <:.o...:: : ~ STRENGTHS: Installed under load Concrete.

alignment STRENGTHS: Simple installation Installed direc~y under load Steel pier encasing

9 STRENGTHS: 3" Steel Diameter Deep Installation <Q::;.:.:_:.Q FLAWS: ~... : : :: ~ Offset load Support capability is least of all systems Higher cost Hollow piers fill SoiL r.:: ~ ~.:::. :.c?:: ~..;.; ~ :.:.. <:.o...:: : ~ STRENGTHS: Installed under load Concrete.sections FLAWS: 6" diameter sections prevent deep installations Unable to control straight alignment STRENGTHS: Simple installation Installed direc~y under load Steel pier encasing Unique high strength concrete Positive lock between segments - stays connected Deepest driven pier in the market FLAWS: ELIMINATED

10 Advanced Systems of N.E. Kansas Dean Stidham Estimator

CERTIFICATE OF LIABILITY INSURANCE

CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/8/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY