HomeMy WebLinkAboutALL DOCS - 13-00085 - 525 S Center St - BYUI Annual Life Safety Certificationa
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M8morandum of Insurance (MOI)
Msmorandum of Ingurailce
MEMORAHDUM OF I}ISURA!{CE
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C0MPANTES ATFOXDII'{C COVAnACS
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: MF$O*.ANfrUM MAy BE ts$t:m OR MAY PERT ttl, TIm INSURAilCE AF9O*DED BY 'IIIE POLICISS DIISCtBED HBREIN lS SttsrECT rI) ALr llG
: TNRIVK HXCLI'SIONS AND C(}NDIfION$ OT $TKfi FOLICIES, UMNS SHOWN MAY HNVE BSFN R[N,!CEO 8Y PAID CI,AIMS
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COMF;.NSATION/
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;l--'ANy orrrl: OCcr,rRREmE USD 1,000,000lilr por.Ky AccFsOAr€ i USD3,000"000:.1.
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IT{ETTIORANDUMOF INSURANCE
; Tbk Mtoona*rn b |M 'r I nrri'r of hernrrfou only io rutterled vir{f,cr for ridr fulcrur! sro erry ed *onfsrt [o *;rn or* *y ffilffi]IMlmorssdlc rtbMtnormdudsQ rof m€o4crlcod ordrer ah. covffilcdscriba.l ldtr Tur Mcnorradneury@ Lc eofed, pri*d ud lj drr$ibqd tlrf,tn rtr 'otLar&Gd vft*rt rod any ooly bt ued rnd viarcd bt u [rhoriaql vics for lt htarrrrl sr. Ary o&," xc, dup&rrdm r i' diNttib{doo of llh lt{c*qnndurr *ft$dt ltt ffMt of lfbnh fu },t&tbtted, "Auibdrod vlcvan rhr0 mcrl m at'ty c pcrrao wli.b h ruilortcd !g iI ttc inruEd HEld h'qdt ro &cst &b Mcaonndun vh bcpa:r.fi8a.'|nll|h'coudmrrrhffiHcrF&sf/xrrt|,uprb8dlDdrc$claEu& Tbc tuerudm ]
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DATE :
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: INSUNED
lnsurance Services, Brighur young tJniversity.
.52i So. Center Sheer 1695
Rexburg
td{h{, 83460-t69J
Unired $tetss
puvides evidenrx of general liability in*urance in regards to oporffions of Brigharn yo'ngr
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tProfes$ionat & Gcaerct Lisbiltry Cl&ims Made:
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l.Sdditional tosured must be cndorsed to tfie policy.
: Genmal Liabitity hovisions:
]Additional lnsured . Where R*quircd Urder Contract or Agreement
i This endorse'rnetrl moditi€s inruraoce pmvided rmder tle commcrcial oencral Liability coverage Fonn:
lSection n - Who ls An lrrured, 1., is am€nded to add:
d) Any penon or orgrnir*tion to whonn you become obligated to inetude as an additionol insured under rhis policy, es a resuhI of any conFsct or sgreemsnt you cnEr into which rcquircs you to ftimi$h insurance fin that person or orgenization of thc type
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providcd by this policy' but only lvith r.spect to lirbitiry ari*ing out of your cpcotions or premims owned by or r€n&d to yo..I"lowevcr, ths insrmnee pmvided will not exceed tie les$or of:
l. 'Ilte coverage aad/or timits of this policy, or
2. Tlre coverage rsd/or linnirs rcquircd by gaid contra* or agrc.smetrt
1TheMernorandurnofInsuranceservessorcrvioirs|;dffioiLiiii"**s*
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3n6n0l3 4:2t pM
CITY OF
REXBURG
Americals Family Community
February 26,2013
BYU Idaho
Mr. Ryan Rasmussen
525 S. Center St.
Rexburg,Id 83460
Dear Ryan;
Enclosed is the Safety System Certification Permit renewal application as required by theCity of Rexburg. A safety system certification permit is requlied to install, modify,
-
maintain, or service all new and existing fire extinguishers, fire suppression systems, firealarm systems, and other life safety systems within the city of Rexburg
Please complete the application and return it with your $100 renewal fee to:City of Rexburg
Attn: Amanda Saurey
Building Department
35 North l't East
Rexburg, Idaho 83440
Please provide a copy of all the certifications that apply to your specific discipline asoutlined in the application as well as proof of liability.ou.iug". Without adequate
certifications and proof of liability, your application will be denied. The permit will bevalid until December 3I,2013. once approved, the permit will allow yo., to work withinthe city limits.
In addition to annual certification, a separate permit is required for installation ormodification to any item listed on the enclosed application. Separate fees will be chargedfor construction and operation permits.
If you have any questions, please contact me.
SincerSAy,
--.--/ruftt({an-t,
Anianda Saurey
(lL{,I[f
Building Safety Coordinator
Amanda Saurey Building safety coordinator 35 N. Ii E. Rexburg ID 83140 p. o. Box 2g0
Phone (208) 359.3020 ext.234t Fax (20& 359.3022
amandas@rexburg. org
Rexbulg -Modison Counly
www.rexburg.org
"A tnfttJ slstem certfication perntit is required to install, modtfi, maintain, or seruice a// new and existingfreextinguishers,fire suppression gtstems,fre alarm sltstems, and iher ffi safe4t sltstens within tbe Cltl o1{oOnrg"
BUSINESS NAME:
OFFICEADDRESS: fa< s. a_zrt* g/. f .% f_/,
OFFICE PHONE NUMBER:
coNTAcT PERSot{, 4.n ?asr. .,'ns.o,n CELL pHoNE #: ?a7- aabg271
PLEASE IDENTIFY SYSTEMS TO BE COVERED BY THIS PERMIT. CHECK ALLTHAT APPLY.
-FIRE ALARM SYSTEMS - Alarm Contractors shall have aminimum of NICET Level 1Certifications or equivalent.
' PLEASE, PROVIDE CERTIFICATIONS:
{.NICET Certification
{.Panel CertiFrcation
{.Proof of Liability Insurance
{.NICET Level II required for design work
-LeuroMATIC SPRINKLER SYSTEMS * Ffue Sprinkler contractots shall hLe aminimum of NICET Level I Certifications or equivalent.
* PLEASE PROVIDE, CE,RTIFICATIONS:
{.NICET Certification
{. Any Additional Certifi cations
{.Proof of Liability fnsurance
{. NICET Level II required for design work
X FIRE EXTINGUISHERS
{.Proof of Certification & Training
AUTOMATIC FIRE EXTINGUISHING SYSTEil4S FOR COMMERCIALCOOKING
c|lY or
REXBURG
ctsJ '--'.._--'-----
Ant e r i ca\ Fa m i I y Co nuilu n i tv
Emergency Services
Phone: 208.372.2326
Fqx: 208.359.3022
t?.Proof of training for
-STANDPIPE SYSTEMS
-SMOKE CONTROL SYSTEMS
commercial cooking heads
-SPECIAL HAZARD SYSTEMS
,I< FIRE PUMP
***PLEASE PROUIDE DOCUMENTATION OF TRAINING IEVELS,TNSTAI.I}ITION CERTIFICATIONS, LIABILITY INSURAATCE, ETC. FOR ALL
DISIPLJNES***
I certi$ that I have tead this application and declare under penalty of pe{ury that the information containedhetein is corect and complete. I agtee to comply with all city ordinan.es, adopted codes, and state lawstelating to the installation, modification, service, and maintenance of new and existing life safety systems. Iheteby authorize representatives of this city to inspect any wotk for comptiance putposes. I am eithet theconftactot tesponsible fot-the wotk, ot I teptesent the ownet as signified above and am acting with the owneds/conttactorts full knowledge or consent.
g APPLICANT'S SIGNATURE
(von (asr*tngg^-
PRINT NAME OF APPLICANT
t/3(z( r3
DATE
PERMIT VALID UNTIL DECEMBER 31 OF THE CALENDAR YEAR APPLIED FOR.**{'x***:{'***********x***********************************************:************
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Receipt Number:a
y Development
1, lD. 83440
x (208) 359-3022
$100.00
$100.00
MAR I 2 2013
CITY OF REXBURG
$100.00
$ 100.00
genpmtrreceipts Page 1 of 1