HomeMy WebLinkAboutALL DOCS - 13-00013 - 3-D Fire & Life Safety Annual CertificationoI
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3O Firr & Lif* Saf*ty $ystems, LLC
P.O. Box 5O{t4S
ldaho falls, lD 83405.0845
fehphone: 2O8. 525.83??
Far: 208.525.838f
karici@Sdflrs.com
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City of Rexburg
PO Box 280
Rexburg, ID 83440
omondos@rexburo.oro
Amondo,
This is o new business ond f need to get o permit/license ond stickers to do fire
sprinkler system inspections in Rexburg" I think f have enclosed oll the necessory
documents. As per our conversotion. you stoted thot no permit fee would be
chorged for this business ond thot new stickers ond a permit would be printed
showing the new business nome. I will need obout 300 stickers, plecse mqil them to
the following oddress"
3D Fire &Lite Sofety Systems, LLC
Attn: Korrie
PO Box 50845
fdoho Folls, ID 83405
Thonk you for your help and pleose let me know if onything further is needed.
Thonks,
Korrie
clTy oF
REXB1IRG , Burrpruc $ernrv DErARTMENT
Antr i a* F am i ly Corxmu n i t?19 E tlain $.
Rerbuq, ldaho 83440
wnl#,rexfuS,a$
Phone 20S3583m0#6Fex e0&35$.@4
ian6ilh@m$urg.oB
..SAFETY$YSTEM
CETTIFI C{TION PER}TIT"
AFPLICAIION
PERMIT#:
BY: Darsi_
"_A t"fuY gy* r*tifrdion pemit it nqtind to iwtall no&fi, nrintain, or tmtice all nw axd uisting
fn exti*gatsbcrs,fn snppnsrin Estuns,fn alarw s1tftms, and othn life safery Esms wi$b, * Agiy
RNb*rg"
BUSIhIESS NAI\dE:3! Fire- ,1" L,la
St00 Fec Paid. Ys/No pennit Approvcd: yes/No
OFFICE.IDDRES$r
oFFrcE PHor{E NUMFEn 5Zt&A::
coirracr pERrloN: Hurri* - qng.q - cEr.L pHoNE #, 5 35 *g3l -1
PI.EASE IDENTIFY SYSTE.MS TO BE COVERED BY THIS PENMIT. CHECK ALL TI{ATAPPLY.
-FrRE aLARM sYsTEMs - Alaru coneectors shall have a r'iaimuoo of NICET l.*eel l
Cenifications or equivelmt.
+PLL{SE PROWDE CERITFICATIONS:
+NICET Cemfication
.$Pancl Ce$ificsrios
fProof of Liebilir,v Insurance
{*urou*rrc SPRINXLER SY$TEMS * Ffie Sprio}ler Conractors shall have a mioimum of
NICET l-Er'ei UJ Ceti6cations or eouivalenr.
+PLE,ASE PROVIDE CERTIFICATIO]{S:
.t hifCET Cenifrcation
{r A-ay Additional Certifi cations
*Ihoof of Liabrlitv Insurance
_ -FIRE S(TINGUISHERS v" STANDPIPE SYSTEMS _SMOre CONTROL S$IIEMS
!{SPECIAL }TAZARD $YsTEM$ .[*NIRE PUMPS
-*AT-T'TOMATIC FIRE ET(TINGUISHINS SYSTEMS FOR COMMERCIAL COOKING
T*PLAASE PROWDE DOCATWET{TATIAIV OF T7.AINA\TG LEVEI^X IN*TAT,IANON ffiRTMUNONS,IIASIIXIT INSURANCE, ETC FO R AI.T, DISIPIJIWS*X
BUSINES$ NA}{E:
PLEASE IIST ALL COMPA}IIES YOUR BUSINE$S IS AUTHORIZAD TO REFR3SENT:
@MPANYNAME: _ PHONE #:
CO}TPSJ\IYN.AME:PHONE#:
PHONE#:COMPATIYNAMB
{*FI'*PLBISE ilST.{DDTflONAT COMPANY ALNHORP,ATIONS ON T}IE OFTHIS FORII'rc€i*
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APPI.JCA,NT'5 $IGN
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3D Flre & Life SatewSystems, LLCPO 8ox 50845
ldaho Fatls, tD gg405-0948
tilsuneR($l AFFORUNG COVEnAcE
TNSUR€fi A : phoontr Inrurunco CompNny
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_clRJlF!cATE HOLpER
City of Rexburg
PO Box 280
Rexburg, lD 83440
AU IHORIIED R€PRE3€IIIATru€
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ACORD 25 (20{0/051 @ 1988.2010 ACORD CORPORATTON.The ACORD name and logo are regielered marks of ACORD
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3.D FIRE PITOTECTIOII. IJIC.
P.O- Bor 50845
ldqho Folls, lD a3co5-@45
felephone: 2Og . S,zg.9rfl
Fox: 2Oa-5,25'8381
lrorriei @ 3dfire-com
Amanda"
Here is the information needed for our permit in the City of Rexburg, please process the
credit card given to you for ttie permit fee and the tags (about jp;' Thanks' and let me
knorr if anything further is needed.
FAX
Date: tt, n'l*
To: Amanda
RE: Perrnit & Stickers for J0t3
Fax Number: 3594A22
Frorn:Karrie
wurw.3dfire
THrS TRAI\SMrrrAL coNslsTs oF 6 PAGE(S)
INFORMATION:
Thanks.
Karrie
"we Pnotect
+ p\o-,a-\-.ru arr.y, -r-L l--C.l-+t
+o Karri<\@ 3dri{<-' cc; rYr-
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Dec 19 12 03'.24p p.2
CITY OF
REXB{IRG
Arrrmi q\ fsnirl C-onntu nity
Butrr>lNe SernrY DEPARTMENT
19 E. Main 51.
Rerdurg, ldaho 83440
W.@$S.$C
Phono: zfl^jsssoco gf +a9 |
Fm 20&.95&3@ajedH@ruotryrrg Lma*oLa.-
CASAEHTY SYSTEM
CEKMF'ICATION PERMIT"
APPLICAfiON
PERMIT#:
51{10 Fee Paid: YcsA'[o Peilit Yerfl'{o
BY: - Datei-
"A toJ"U Esten e*fu:napn"rritit nqxind x irtstaL rrTn&b, mainbia, msntict a!/nwand uiding
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OFFIC1SADDRESS:
orFrcEPHoNBNUMB"o 5ZS ^82-t1
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PLEASB IDENTIFY SYS:TEMS TO BE COYERED BY THIS PERMIT. CHECK ALL T}IAT
APPLY.
_FIRE ALARM SYSIRfS - Alaro Contractos sh"ll l3ag a Eis;anln of NICET Lerd 1
Cefiificatiots or equivaieat.
+PI.BAS.E PROVIDE CE RTIFICATI ONS:
*NICET Certiica.tioo
aPa!.L Ccrci6cation
*hoof of Liebilitv Insuraace
-X-eUfOuEfrC SPRINKIER SySTEl,tS *Firc Spdqklcr Cootracor slall have 3 '''i-i'urrn sf
NICET I-evel UI Cestifcetio$ or equivaleot-
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*NICET Cettificatioa
l.' Agt Additiooai Cer-tifi cations
Ahoof of Liabilrtv Iosutaoce
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X srecrel I{AzARD sysrEMs i-nnn PUMPs
-AUTOMAIIC FIRE EilINGI.'ISHING SYS,TEMS FOR COMMERCIAL @OKNG
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BU$INESS'I.IAIUTE:
PLEASE LIST ALL COMPSIYIES YOUR BUSINESS ISAUTHORIZED TO REPRESENT:
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PERMITVAIID UNTTL DECEMBER g1,N? J43
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,ACORD
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INSURED
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3DFIR-T OP lD: TC
3-D Fire Protection Inc
PO Box 50845ldaho Falls, lD 83405-{1845
CERTIF,?n,= oF LIABILITY,",fioNcE oATE (WlMrODaYYYn
49t28t12
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY.AND CONFERS NO RIGHTS UPON THE CERTTFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMANVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW- THIS CERTIFICATE OF INSURANCE DOES NOT CONSnTUTE A CONTRACT BETWEEN THE |SSU|NG INSURER(S), AUTHORTZEDREPRESENTATIVE OR PROOUCER, AND THE CERTIF]CATE HOLOER,
IMPORTANT: lf the certificate holder is an ADDITIONAL INSURED, the poticy(ies) must be endorsed. lf SUBROGATTON rS WltVEO, suOject t6the terms and conditions of the poticy, certain policies may reguie an endorsement A statement on this certificate does not confer rights to thecertaticate holder in lieu of such
iI!?.'iil",' corporarion 121--??'po eJx ai-oie 208_524-5721
ldaho Falls. lD 83405-1019
DeRay Perry
rNsuRER A r Phoenix lnsurance com
tNsuRERB:Travelers Proo Cas of Am
,Tower Insurance Com
RAGES TIFICATE REVISION NUMBE
THIS IS TO CERNFY THATTHE POLICIES OF INSUMNCE LISTED BELow HAVE BEEN ISSUED To TFIE INSUREo NAMED ABoVE FoR THE Poucv PERodINDICATED, NOTII/ITHSTANOING ANY REOUIREfiIENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUI,IENT WITH RESPECT TO WHTCH THISEERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSUFiANCE AFFORDEO BY THE POL]CIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS ANO CONDITIONS OF SUCH FOLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CTAIMS.
A I X I corrMERcrAL cEmnar LrAB,r rw
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GEN'L AGGREGATE LIMIT APPUES PER:
AUTOMOAILE LTABILIIY
AiiY AUTO
Au-ollrEo f--.lscHeou-eoAUTOS L_l AUTqS
I I NO\€WNEDHIREDAUToS l_ l Aurix
DT810-s393C2tATIL12 1U01t12, 10/01113BOOILY INJURY (Per pers6)
BOOILY INJURY (Per ac.ideni) ; $
WORKERS COMPENSANON
ANO EMPIOYERS' L]ABf ITY
ANY PROPRIETO RIPARINERJEXEC UTIV€
OFF]CERN,IEMEER A\CLUDEO?
(Mandatory in NH)E.L. DISEASE. EA EMPLOYE
DESCRPf|ON OF OPERATIONS J LOCAIIOI{S / VEHICLES lAtlrch ACORO 101, Addltlonc RmrAs Schedute, it eru 39*e ir rguired)
City of Rexburg
PO Box 28O
Rexburg, lD 83440
SHOULD ANY OF THE ABOVE DESCRISED POLICIES BE CANCELLED BEFORE
THE EXPIRATION OATE THEREOF, NOTICE WILL BE OELIVERED tN
ACCORDANCE WITH THE POLICY PROVISTONS-
AUT}iORIZED REPRESEIi TATIV E
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@ tgBS-2010 ACORD CORPORATIO}I. All rights reserved.
The ACORD name and logo are registered marks of ACORDACORD ?,slz010m$l
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City of Rexburg
35 Northlst EastRexburg, lD 83440208-359-3020
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Transaction Number: f S4S3SSSPiVisa - XXXX-XXXX-XXXX-01 73
Status: Successful
FIRE PERMIT
Billing Information
3-D Fire Protection 3-D FireProtection
, 8340s
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