HomeMy WebLinkAboutALL DOCS - 13-00329 - 4130 Airport Rd, Nampa - Phoenix Fire Protection Annual Certificationa)
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35N l,rE
Rexburg, lD 83440
Rexburg -Modison Counfy
Emergency Services
Phone: 208.372.2326
Fox: 208.359.3022www.rexburg.org
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REXBURG
\'-----
Americas t^amily C(t nunun itl
"A toftu sltstem ceftfrcation perwit is required to nodtfi, maintain, or seruice a// new and existingfreextinguislters,fre suppression gtstems, jire alarm s-ystems, and itber lfe safe4t slstems witbin the Citl oltRexburg,,
BUSINESS NAME:
OFFICE ADDRESS:
oFFrcE pHoNE NUMBER, F 07, 4bS- 4 t I 6
coNTAcT pERSo N, ,J(, , o, l-jUn+ cELL pHoNE #:
PLEASE IDENTIFY SYSTEMS TO BE COVERED BY THIS PERMIT- CHECK ALLTHAT APPLY.
-FIRE ALARM SYSTEMS - Alatm Conmactors shall have aminimum of NICET Level 1Cetifications or equivalent.
' PLEASE PROVIDE CERTIFICATIONS:
*NICET Certification
*Panel CertiFrcation
{.Proof of Uability Insurance
{.NICET Level II required for design work
f
+Lj'UTO-I'IATIC SPRINKLER SYSTEMS * Fire Sprinkler Contractors shall have aminimum of NICET Level I Certifications or equivalent.
i. PLEASE PROVIDE CERTIFICATIONS:
{.NICET Certificaticn
{.Any Additional Certifications
{.Proof of Liability Insurance
* NICET Level II required for design work
-FIRE EXTINGUISHERS
.i.Proof of Certification & TrainingAUTOMATIC FIRE EXTINGUISHING SYSTET4S FOR COMMERCIALCOOKING
i.Proof of training for commercial cooking heads
-STANDPIPE SYSTEMS -SPE6IAL HA2ARD SYSTEMS-SMOKE CONTROL SYSTEMS -FIRE PUMP
'.**PLEASE PROUIDE DOCUMENTATION OF TRAINII{G LEVELS,TNSTALLATION CERTIFICATIONS, LIABILITY INSURANCE, ETC. FOR AILDISIPLINES*r.*
I ceti$ that I have tead this application and declate under penalty of pe{ury that the information containedhetein is cottect and complet.. i .gt". to comply with all city otainances, adopted codes, and state lawstelating to the installation, modifi""tior,, serice, and maintenance of new and existing life safety systems. Iheteby authorize teptesentatives of this city to inspect any work fot compliance putposes. I am eithet thecontractor tesponsible for-the wotkr or I teptesenithe owner as signified above and am acting with the ownefs/ conttactot's full knowledge ot consent.
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PERMIT VALID UNTIL DECEMBER 31 OF THE CALENDARYEAR APPLIED FOR.**************************t'*{'*{'***********************{.,|.******:t{.*:*l.***,r.x*******
PRINT NAME OF APPLICANT CANT'S SIGNATURE
CITY OF
REXBURG
Americab Family Community
February 26,2013
Phoenix Fire Protection
1388 N. 39th Street
Nampa,Id 83687
Dear Trent Bice;
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 exiinguishers, fire suppression systems, firealarm systems, and other life safety systems within the city of Rexburg.
Please complete the application and return it with your $100 renewal fee to:City of Rexburg
Attn: Amanda Saurey
Building Department
35 North I't East
Rexburg, Idaho 83440
Please provide a copy of all the certifications that apply to your specific discipline asoutlined in the application as well as proof of liability "ou"iug". Without adequatecertifications and proof of liability, your application will be dinied. the permit will bevalid until December 3I,2013. once appioved, the permit will allow yo., to work withinthe city limits.
In addition to annr:a-l cefification. a construction permit is required for installation ormodification to any item listed on the enclosed application. Separate fees will be chargedfor construction and operation permits.
If you have any questions, please contact me.
Sincerg[y, n/l ,' I'
4 tL4 rz4-t r& -1)aa.t
Amanda Saurey
Building Safety Coordinator
,nrf
Amanda saurey Building safety coordinator 35 N. ]i E. Rexburg, ID g3440 p. o. Box 2g0 amandas@rexburg.org
Phone (208) 359.3020 ext.234t Fax (20& 359.3022
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PHOFOOl OP lD: CT
t\r,"/'-CERTIFICATE OF LIABILITY INSURANCE oATE l[rfltDDrYYYY]
03/19/13
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORIIIIATION ONLY AND CONFERS NO R,IGHTS UFON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRTIATIVELY OR NESATIVELY AiNEND, EXTEND OR AI.THR THE COVERAGE AFFQRDED BY T}If POLIGIESqELOW- THIS CERTIFICATE OF TNSURANCE DOES NOT CONSTITUTE A COilTRACT BETWEEN THE lSSUtNc TNSURER(SI, AUTHOnTZEDREPRESENTATIVE OR PRODUCER, AND T+{E CERTIFICATE I-IOLDf;R,
lllll"uK rAN | : lr tne certll.cate nclde. is an ADEITIONAL INSURED, the policy{ies} mu$t be endorsed. lf SUBROGATIONIS WAIVED, stbjdmthe terms and eonditions _of the policy, certain pollcies may require an endorsement A statement on this certificate does not corlfer righte to thecertificate holder in lieu olqueh endorsement(s). _PR0DUCHR 209-466-266iHenry Insurance Agency
904 ftth Ave. So. " ' 208466-184C
Nampa, lD 83651Robert L. Henry
NAUE:
PHoNE -TFtr _
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E.MAIL
ILDDRESS: ,*
* ,.. rNsu-fiERlslAFFoRotNG covERAGE I usrc I
TN$URERA:The Charter Oak Fire Ins ColilsunED Phoenix Fire Frotection, LLC
4130 Airport Rd.
Nampa, In 83687
rnsuRER E : Ulvelere Indernnity Co of C_T _
rNsuR€Rc lTravelere Ffopefy & CasualtV
tNsuRER D 1 co of America
INSURER E :
IN$URER f
ES CERTIFICATE RFVtSInNTH|3|STocERT|FYTHATTHEPoLtc|EsoF1NSURANcEL|sT€oBELoWF|AVE8EEil|ssUEDTorHEtnzunrnNAMEDAm
lNDlcArED' NOrWlTl"{sTANDlNg|ryI REoulREMENr, rERM oR coNDlTloN oF ANi cb-ru-r-nnci oii-o'iir'rCiocuggNr wryH REspFCr ro w1tcg rHlsCERTITICATE MAY BE ISSUEN OR MAY FERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJFCT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCFO BY PAID CLAIMS.
N5n
t-?R TYFE OF IN$USANCE luSl
WN POLICY NII',IBER tsOUgY EFF
.MM'DD'YYYYI
POLICY EXPI!'IMlDD'YYYYt UMITS
A
X
GENERAL LlABIUTY
T'l *o**r*",o, GFNERAL LrABrLrry-T-] .*'".-,*oou Ix I o..u*
lxcu included
x tT co 5292M755 88{07t12 08ltt7/13
EACH OCCURRENCE s 1,000,00(
OAMAGE TO RENTS.OPftEMISES lEa oigrrc 300.00t
MED EXP {Any one persn}5.001
FERSONAL A ADV INJUF,Y s I,000,001
-J GENERAL AGGRGGATE s 2,000,001
GEN'I AAGREGATE LIMIT APPLIES PFR*|or,." lTl rn+ f-],o.FRODUCTS - COMP/OP AGG e 2,000,00{
B X
IOMOBILE LIASIIITY
ANY AUTO
ALL OWNEDAUTOS
HIREO AUTOS
$CHEOULFgAUTOSN0N.ora/NEoAUTOS
3A 5292M755 o8l07t'12 QBt07t13
COMBINEO SINGLE LIMITlEs ssidenll $ ,|,000,00(
SOOII-Y INJURY (Per pe6cn)
BODILY INJURY {Peramident)
PR(}PLRtY DAMAGE{Pddsidtrtl
c
UMBRELLA LIAB
EXCE$S LIAS
OCCUR
CLAI'IIS.MAPE ]uP 5292M755 o8to7t12 08/07/13
EACI{ OCCURRENCE s 1,O00,001XAGGREGATE
oso I X lnrrrrurror* 10.00C
WORKFRS COMPENSATION
AI,IOEI'PLOYERS'LNAILITY Y/NANY PROPRIETOR/PARTNER/EXECWIVE T---'-]OFFICER/MEMBEREXCLUD€D? L|{ Mand€lofy In l'l H)
lf yar, dEtrrib€ utrder
DE$CRIFTION OF OPERATlOlrlS below
ttllA
I WCSTATU- I IOTHJTOPYIIMITqI IFP
E,t. €AEH ACCIDENT
r.L. OI$EASE - EA EMPLOYEI
E.L. OfSEASE . POLICY LIMIl $
DESCRIPTIONOFOFERATIONSILOCATIONS/VEHICLES (AfiachI'CORDl0l,AddlllonetRqmt*sschndderttnorcspac*lcrsquir6dl
CITYORI
City of Rexburg
35N{stt
Rexburg, lD S3440
SllOUl-D Al.lY OF THE AaOyE DESCRTBED POL|C|ES EE CANC€LLED BEFORETHE EXptRATtON DATE THEREOF, NOTtCg W|LL BE DELTVERED tNACCORDANCE WITH THE POLICY PROVISIONS.
AUT}IORIZED REPAESENTATIVERobertL'Henry j!,1- n / i{rn-r q*-y{ A . /{:J-u*ivr,n} n
@ 1S88"2010 ACORD CORPORATION. A[ rishtsAcoRD 25 (2010/05)The ACORD and lcgo are registered marks of ACORD
City of Rexburg Receipt#: 394
Date:8/20O013
Total Anouut Ilue;
Tofal Fayment:
Cods REXBURG-Recpt394-20_8 ?Str3-mmdas
100.00
t00.ss
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