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CITY OFASPEN AFFIDAVIT OF INSURANCE
This affidavit must be completed and on file with the City of Aspen/Pitkin County
Community Development Departments before any Contractor License will be issued.
Tom Lester of Lester Development
Company Owner/Owner's Authorized Representative Company Name
at
PO Box 11347, Aspen CO 81612
Street Address City State Zip Code
hereby swear and affirm that I will maintain workers' compensation insurance, if required by
law, and general liability insurance with a minimum limit of not less than $500,000 for one
person and $1,000.000 for any one accident, and property damage insurance with a minimum
limit of not less than $300,000 for any one accident during the time I perform any
construction activities in the City of Aspen or Pitkin County. I also agree to produce proof of
such insurance whenever the City of Aspen or Pitkin County requests.
Tom Lester 10.28.2020
PRINT NAME SIGNATURE DATE
By signing above, I understand and agree with the aforementioned statement.
We no longer require or accept Certificates of Liability Insurance as part of the application to
become a Licensed Contractor. This affidavit is all that is required. If your insurance company
automatically sends us Certificates of Liability Insurance, please contact them and ask them
to discontinue that practice.
*See page 2 for required Notary Stamp on this form*
RECEIVED
11/19/2020
ASPEN
BUILDING DEPARTMENT
STATE OF COLORADO )
S.S. SEAL
CITY OF AND COUNTY OF )
Subscribed and sworn to before me on this day of ,20
NOTARY PUBLIC: My Commission expires:
RECEIVED
2 11/19/2020
ASPEN
BUILDING DEPARTMENT