The URL can be used to link to this page

Home My WebLink AboutALL DOCS - 13-00366 - Mountain Alarm Safety Certification35N I'tE Rexburg, lD 83440 Rexburg -Mqdison Cou nly Emergency Services Phone: 208.372.2341 Fox: 208.359.3022www.rexburg.org c |l'Y o I; fuXBURG Ar rcr i c als F amily Co fi mu hitv PERMIT#: $100 Fee Paid: Yes/No Permit Approved: Yes/No BY: Da;te;- "A toftry gtsten nftfrcation pernit is required to install, nodijt, maintain, or seruice a// new and existingfre exlingaishers,fre sappression slstems,fre alarm ystems, and other lfe safe4t slstems within the Ciry of Rexburg" BUSINESS NAME: Fire Protection Service Cotp dba Mountain Alarm Patcel: OFFICE ADDRESS:3293 Hamison Blvd Ogden UT 84414 OFFICE PHONE NUMBER: 801-395-8738 CONTACT PERSON: Eric Garner CELL PHONE #z 80L-710-3477 PLEASE IDENTIFY SYSTEMS TO BE COVERED BY THIS PERMIT- CHECKALL THAT APPLY. _X_FIRE ALARM SYSTEMS - Alarm Contractors shall have a minimum of NICET Level 1 Cetifications or equivalent. .I. PLEASE PROVIDE CE,RTIFICATIONS : .f.NICET Certification {.Panel Certification {.Proof of Liability Insurance AUTOMATIC SPRINKLER SYSTEMS * Fire Sprinkler Conftactors shall have a minimum of NICET Level III Certifications ot equivalent. i. PLEASE PROVIDE, CE,RTIFICATIONS : *NICET Certificarion ..'. Any Additional C ertifi cations {.Proof of Liability Insutance -FIRE EXTINGUISHERS -STANDPIPE SYSTEMS -SMOKE CONTROL SYSTEMS -SPECIAL HAZARD SYSTEMS FIRE PUMPS -AUTOMATIC FIRE EXTINGUISHING SYSTEMS FOR COMMERCIAL -l COOKING ***PLEASE PROWDE DOCUMENTATION OF TRAINING LEWLS,INSTALI-4TION CERTIFICATIONS, LIABILITY INSURANCE, ETC. FOR ALL DISTPLII\TES*** BUSINESS NAME: PLEASE LIST ALL COMPANIES YOUR BUSINESS IS AUTHORIZED TO REPRESENT: COMPANY NAME: COMPANY NAME: COMPANY NAME: PHONE #: PHONE #: PHONE #:**PLEASE LIST ADDITIONAL COMPANYAUTHORIZATIONS ON THE BACK OF THIS FORMX* I certi$' that I have tead this application and declare undet penalty of perjury that the infotmation containedhetein is cotrect and complete. I agree to comply with all city otdinances, 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 fot complian"" pn"po.... I am either the Eric R Gamer PRINT NAME OF APPLICANT conttactot tesponsible fot the wotk, ot I teptesent the owner as sigtrifiej_above and am acting with the ownetrs/conttactor'sfullknowredgeorconsen, qD) # 09/04/2013 DATE PERMIT VALID UNTIL DECEMBER 31 OF THE CALENDAR YEAR APPLIED FOR.:F{.***&|*:|.*,|.'.:I.:Io&*{.:I(:|o|.***,r:k***:tol.{.:|.:t.:lo|.*:|.,I.:t<'IC:|.:t.,|.:I.:I({.***:|.,|.**{.:l<'******* Eric R. Garner APPLICANT'S SIGNATURE Page 1 oflNICET: Certification Directory T" Certification Directory Entry Cary Q. Coles West Valley, UTTechnologist ID: Technician ID: 115645 Awarded ExpiresFire Protection Engineering Technology Fire Alarm Systems, Levet: III 1O/23/2OOB 02/07/2075 Search Results https://candidate.nicet.orglCertification/CertificationDirectoryEntry.aspx?eid:f8 eckxl3oo/o2... g/4lZ0I3 NICET: Certification Directory T" Page I of 1 Certification Directory Entry Nate S. Johnson Salt Lake City, UT Technologist ID: Technician ID; 115373 Awarded Expires Fire Protection Engineering Technology Fire Alarm Systems, Level: III 05/77/2072 Ot/0t/2O15 Search Results https://candidate.nicet.org/Certification/CertificationDirectoryEntry.aspx?eid:OQ4r57O9L... 91412013 NICET: Certification Directory Tt Page 1 ofl Certification Directory Entry Brad E. Mugleston Salt Lake City, UT Technologist ID: Technician IDr 130686 Awarded Expires Fire Protection Engineering Technology Fire Alarm Systems, Level: 1 1O/07/20t0 7I/07/2013 Search Results https://candidate.nicet.org/Certification/CertificationDirectoryEntry.aspx?eid:gSK5JK1Yu... 9/4/2013 RESA.ACOR\--'CERTIFIC OF LIABILITY INSUR E DATE (Mir/ODTYYYY) 4t4t2019 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: lf the certilicate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. lf SUBROGATION lS WAIVED, subiect to the terms and conditions of the pollcy, certain policies may requiro an endorsement. A statement on this certiticate does not confer dghts to the ceilificato holder in lieu of such endorsement(s).PRoDUcER (801) 937-6700 The Buckner Company 6550 South Millrock Dr. Suite #300 salt Lake city, UT 84121 l?"' Sandy Reed HLrss, sreed@buckner.com :ilxl;;F[,n *, MoUNALA-01 INSURER(S) AFFORDING COVERAGE NAIC f lNsuRED Fire Protection Service Gorp. dba Mountain Alarm CopperState Fire Protection, Link Home Security 3293 Harrison Blvd. Ogden, UT 84403- rNsuRER A: Philadelphia Indemnity lnsur. tNsuRER B ' workers compensation Fund wsunen c, Advantaqe Workers Compensation Insuranc INSUREB D: INSURER E : INSUFEF F : t=f,c COVERAGES NUMBER:REVISION NUMBER: 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 REOUIREMENT, 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. INSFLTR TYPE OF INSURANCE POLICY NUMBER LIMITSI A GEI x IERAL LIABILITY COMMERCIAL GENERAL LIABILITY I cr-nrus-t',tnoe I X i occun rHPK999413 4t1t2013 4t1t2014 EACH OCCURRENCE s 1,000,00( DAMAGE IUHENIEUPREMISES lEa occurrence)$100,00( MED EXP (Any one person)$5,00( PERSONAL & ADV INJURY s 1,000,00( GENERAL AGGREGATE $2,000,00( IL AGGREGATE LIMIT APPLIES PER: ,o.,"" lT-l ?F.o+ f 'l ,-o" PRODUCTS. COMP/OP AGG e 2,000,001 $ A AU]'oMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS rHPK999413 4t1t2013 4t1t2014 COMBINED SINGLE LIMIT {Ea accidenl)$ 1,000,001 x BODILY INJURY (Per pergn)a BoDILY INJURY (Per accident)$ PROPERTY DAMAGE (Per accident)$ $ $ A x UMBRELLA LIAB EXCESS LIAB X I occun_-l "*,r.-"oo.rHU8416051 4t1t2015 4t1t2014 EACH OCCURRENCE $5,000,001 AGGREGATE $5,000,001 DEDUCTIBLE RETENToN s 10.000 $ x $ B WORKERS COMPENSANON AND EMPLOYERS'LIABIL]TY Y/NANY PROPRIETOFYPARTNER/EXECUTIVE I-i;-'I oFF|CER/MEMBER EXCLUDED? LNI(Mandetory In NH) lf ves. describe undernFsiRrPTtoN oF oPFRATtoNS berow N/A r193323 4t1t20'tg 4t1t2014 v I wcSlA E.L. EACH ACCIDENT s 1.000.001 E.L. DISEASE. EA EMPLOYEI s 1,000,001 E.L. DISEASE. POLICY LIMIT s 1.000.001 c florkels Compensation 2224949 4t1t2013 4t112014 $1,000,/$1,000,/$1,000 DESCRTPTTON OF OPERATTONS / LOCAnONS / VEHICLES (Attach ACORD 101, Addirlonal Roma.k schedule, lf moro 3pace b lequlrcd) CERTIFICATE HOLDER CANCELLATION For Inlormatlon Only SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 8E CANCELLED BEFORE THE EXPIRANON DATE THEREOF, NONCE WILL BE DELIVEREO IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZ ED REPRESENTATIVE @ 198&2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2009/09) o) .Ec.E FrFo L €E EEr E$r EEi EFEf5E EEE EF{ Esg EEi Egg[€E E€3 €t Gl{= EEr() bFTB ]\ Elo-e bE ) .tr E g€ g !q +'filR ts = xs;{$ H fi ; ElgE iEIE ? I:Ed3 6E-g E P'$o'= ='=EF +E.n fig*H tc .E fif tB €fio H fi#zs $e? fi Frd= S€i fiEilH -Eo tr.\:TR E1i -e*E S?,i g() t&I _tE ZF EeE o_xut ET'g !!trs3 artl-l- bothr(, fsILq-o o#IEul-q!- Eoo r', .Etr'E F- os-o(Jg gE E*.a!: cfl ETF EEE EEE EEE#ET cEI ,r5{Etg aEi Egg,iFg gEE. i€? ; g ui{: EH' bFz.e (c) Eb3Abs * .c E g€ q C ee,{E H = c'EC\ld ?i *9U)F ^'F 3 'ii5$ FE g pEs$ ?E E *gils {E ffi=(/)e. E!).9 eEtLi' qsH &#zE fr. e"X s.E -E EEg E'deg oEI E,F$i E.= >*-r x gr! € (/}: EX tr-S f=, z? #gqX r.u ao o(J L (E(J E'e+rtF - F l-o' tf-l TJ fitIL {ro o{.r$:(J fIt{_EL.{lu a) 4 E E U) a) f-l E C,^) oIe T H]>J-t _g E; , FD e't. tsFDC ,- r-r' , - l-rt 5 -a?; Lx-. FDFEd'.*Hr-,H F 9. tr E N H re Fl C :th H Hg? q? o r-tv ge o) o) ri F( Fll l-i'F FJX ETq l-{'r+Jo ttat t-, tl H q -*.:--:4 I City of Rexburg ReceiPt#:466 Date:9/202013 trtification ffi1 --..-+*--- t- I Snb Tcrh l Totel Armntllre: TotdPelaen* Co&: REXBURG-R€Cp'456-20-9-201 3 aa&s 100.00 100.00 Peger I of I