HomeMy WebLinkAboutALL DOCS - 12-00003 - 3-D Fire Protection Annual Certificationoo
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CiTY OF
REXBLRG
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Atlical fu ilY C-onmu n it1
Buti,orN c SarntY DEPARTMENT
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19E. M3h st.
Rsdut!, ldaho B+{0
wl$rtffic8SOIg
Phone:2083s3&o frd h$41
Fax 2O&3$.384
*nan€corg.oB Qlna*ol-A.,
PERMIT#: 12 [6A\L
9100 Fee Pai&@/tto Petmit Ycs.fNo
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,,A saJrA ysha eftWion pa?nit is rcq*ind to Watl, tttod;fi, mdnbia, m sade all tw nd Eidit'{
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BUSINESS*3-Ita- Po'
3'SAFETY ST'STEM
CERTIrIC TTON PERIUI:r"
AIPLICATION
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PI,EASB IDENTIFY STSTEMS TO BE COVBRED BYTHIS PERMI'T- CHE|CKAIIT}IAT
APPLY.
_EIRE AI-ARM SYSTEMS - Alarto Contrecto:s sh^Il bave a nriaiouna of NICET i.evd 1
Certificatioas ot eguienledll
*PLL,LSE PROVIDE CERTIFICATIONS:
.INICET Cemificatioo
*Pa.ocl Csri.6catioa
*Proof of Liabiliqv Iosru::tcc
l_AU1.Orrrrlfrc SPRINIq-ER SY$IEMS * Fire SprinklcrCootractors cha0 f,2vg 2 airinrnn sf
NICET Lesd IIi Certificatiots oa equivrlear
+ PLEASE PROVIDE CEMTETCATIONS:
+NICET Certificatioa
j.' Acf Additio&l Ce*ifi catioas
tPloof of l&bilirt Insuraace
_FIRE EKTTNGT15HERS _X_srervoplpE sysrEMs -stvroKE coNTRoL sgsEEMs
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#ETBAEB NOVIDE fu1UMENTATTON OF ZNIININE I.EUETS INSTAI.TATION CEEETFICATTOI$$
ZIABIITTT INSUnA|NCE, gTC FORAIT DI&IPLEW
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BUSII.iESSNAME:
PLEIISE IIST ALL COMPAI{IES YOUR BUSINE9S IS ALI'THOR]ZED TO RE.PR3SENT:
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COMPANYNAME:
COMPAITI?N.{.VE:
@MPAI\TTNAMB
PHONE#:
PHONE#:
PHONE#!
IEIEIBft*PLEASE LIST ADDNIONAL COMPAIVYAUTHORUATIONS ON THE oF TI{IS FORM{er*{.
I cadtr dg I lgl|€ rcail tllb rlpli,otiou antd dlclgre rarler padq of pcriuy tbat Ac idotDsdd €octeitrd ig socteadcoqrLc- I.grcc to
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lifc r6<ty q'stol I bcleby lnrlortse retrrtseoBdver of thb ciry o incg:a eny wurl ftr coptia*c pu ao ciricr tfis coscBtror crpooitfc for
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IV
APEUCAI\SPS RE
PERMIT VAIID UITITIL DEI:pMBER 31,r@ ,0/L
tfrt'tttttn'tr
DATE
Dec 30 11 10'.45a p.1
Fax Number:
From:
PA.GE(S)
www-3dfire
359-3022
Karrie
3.D FIRE PROTECTIOII. ITTC.
P.O. Box 5O84S
ld3rho Foils, lD 83CO5.O945
Telephone: 2O8. 5.25,-a7t77
Fox: 20/8_5,25.-8391
lrorriei@3dflre.com
FAX
I)ate: 12129/ll
To: Amanda
RE: Pennit & Stickers for 20lL
THIS TRANSMITTAL CONSISTS OF b
INFORMATION:
Thanks,
Ka:rie
"lile pfocect
Amanda,
Here is the information neede.d for our permit in the City of Rexburg, please process the
credit card given to yrcu for the permit fee and the tags (aboutSb;. Thanks, and let me
know if anything further is nedded-
Rev
Gil12 5. Errrgglcrf Wcry
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CACERTIFITE OF LIABILITY INS
TH1ScERnF|GATElSlssUEDAsAMATTERoF|NFoRruATloNoNLYlu
=g['aT,i"":"':,[?I^i:tpllY::T.^"j]1jy*fLtll-,-ylryf pl-olten iriE ]ovemee AFFoRDED By THE poLrcrEsi"rL?'il!'r,iff[ffi?{;,,' l ;#:HE:;RESENTATIVE OR PRODUCER, ANO THE CERTIFICATE HOLDER.
IMPORTANT: lf the certificat
the terms and cofrditions of the policy, certaan policies may require an endorsemenL A statement on this certificate does not confer rights to thecertifrcate holder in lieu of such endorsemen(s).
The Hartwell CorporationPO Box 51019
rNsuRED 3-D Fire protection Inc
PO Box 50645
ldaho Falls, lD 83405-0845 ,Travelerrs Prop Gas of Am
REVTStONTH|SlsTocERTtFYTHArTHEPoL|c|ESortrusuRnNceusTEDBELoW
5."1H,51+Y"YJ3:ItiSSRjY^5E-?-'5F,llES.-r,:[Y-off-o,lg:-'1t^1,.: ay! qp111lqi "!-dil1.R DocuMENr wrrn nEspecr ro wHrcH rHrscERTrFlcArE MAY BE rssu-ED- 91r,rev rEiranilnrL rusuur'rce aip6"o.o g". -r1]JidiH=r"6.ic1ff.il"""#''il["if!"F#ff'"f ;ru+Jfit:ExcltlsloNs AllD coNDnoNs oF sucH poLrcrEs. LrMrrs sHowN rrtav xnvE SEEN REDuCED By pArD cLArMs-
c21APHXI1 10to1t11 I 10t01,12
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3ODltY INJURY (P* ae'rrer.t)
AI\tr' EIUPLOYERS' LTABIU'Y Y'NANV PROPRIETOR,PARY'GRiO(ECUTIVE H IoFFlCEFyuEl,lSERO(CLUDEO? | lltt/A(Mxdatoryin NHI |J i
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DCSoRIPnONOFoPERATIOiIS'LOGATIO$IS/VeltlcLES {Ai€chACORDr0t,AddltbnatRornadeSchedut!,itmcspaceisnqrlrefi
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rIIt:---J -.. GEN'L AGGREGATE UM]T APPLIES PER:
POUCY
AUIOMOBILE LIABLITY
X lnrvruro
ALL OIVNED AUTOS
SCHEOULEDAUTqS
HIRED ATJTOS
NONOITN€D AUTOS
CTTRE-1
City of Rexburg
PO Box 280
Rexburg, lD 83440
@ 1988-2003 ACORD CORPORAnON.
SHOULD ANY OF THE ABovE DESCRBED PioUcIEs aE CANCELLED BEFoRETHE EXPIRATION DATE THEREOF, NOTICE WLL BE OEUI/ERED II{ACCOROANCE WITH THE POLIC.Y PROVISTONS.
4Qil'.*,.-
ACORo 2s (200s/09)The AGORD name and logo are registered marts of ACORD
All righG reserved.
@ Y*-*cGity of Rexburg o Receipt Number: @$....XDepartment of Community Development
35 North 1st East/ Rexburg, lD. 83440
Phone (208) 359-3020 / Fax (208) 359-3022
Base Fire Fee
CREDIT CARD N/A $ 100.00
Total:$100.00
genpmtrreceipts Page 1 of 1
Xpress Bill Pay - Payment frocpin9 Page 1 ofl
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REXBURG
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City of Rexburg
35 Northtst East
Rexburg, lD 83440
208-359-3020
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4o col, Frinter J ,}
) Transaction detail for payment to City of Rexburg.Date:0110312012 - 4:07:30 PM
Transaction Number: 137 6927 IPT
Visa - XXXX-XXXX-XXXX-01 73
Status: Successful
Description Reference # lAmt per ltem # ltems Total Amt
FIRE PERMIT 12 00003 | $100.00 s100.00
Billing Information
3-D Fire Protection 3-D Fire
Protection
,83405
ro
Transaction taken by: amanda
fF""l r tEiosel
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