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Home My WebLink AboutALL DOCS - 12-00006 - BYUI Annual Fire Safety CertificationRexburf-iludison Counly Emelgency Services (.llyuil ITHXNTJRG (\L. lnl {riL rl r /tllIJjfi i,.r)r?l#rJ#ilii 19 fosl Morn Sl Rexburg, tD A3440 lonel/h@rexburg.Ofg www.rexburg.arg P ho ne : 208.J59. 30I0x326 Fax:209.3595A24 ..PERMrr*, l_cl d6ooh --$l00 Fec p*id' @I 3Y:Date: "A '"''k!y gtsleat att?firzttion puutit is nrqtrircrl to inilall, nodify, noi*laiu, or Mflirt u// uey anrt exittingJi,txtit4rytislnru'Jirc 'w/tp,ssion yilem'r,"firc ahtrm ;ysterus, aad iiber lili saJity sy*ms nnthin tit city nf lkxharg,, susrN'ss ruerur:FJ tt - J;,& L" parcer: OFFICE ADDRg$S: 93s: S-"&-nl-nz- Si,{tnbr-r.'r\. w,l^t OFFICE FHONE NUMBEil.; CONTAC? PERSON:CSLL pltONE #. 7zrb_ ?c, i -,ALl7 1 THAT APPLY.ihlttfJffri?r'y sysrEMS ro sE covERED By ?Hrs ps*Mrr_ cHrcK ALL C;*ffft:,,tr1tr":nlu*t - ;\larm (ion'ractors shall havc a minirnunr r:r Nrch:r,rcvel 1 * PLH;\SI i PROVIDI:: CF]IiT.IFICTYI.IONS: +NICli'I. Crrd6cation t'. l)a ncl (.crtifi catit_rn t Prrxrf r:f l_iabilitv Insurarrcc AUT0MA?IC $pRINKLER SYSTEMS *.liirc sprinkler conftacrors shall have amrnimum of NICE.I'l,cvcl III {)errific:rtions or cquivalent..1. pltir\li [i pRov I D H i: t.ittt,tt, tc,,\?toNS :{.N l(i Ii'l' Ccrtification.1.\n1',\ dclitinnal ( jcrtifrcadons .1" Proof r:f Liabilitl, fnsurance Xrrnn ExrrNcursHERS-sMoKE coNrRoL sysrEMS --3ff$t3,1#frsYsrEMs,--SFECIAT HAZARII $YSTEMS-*HT?if#IC FIRE EXTINGUISHING SYSTEMS FOR COMMERCTAL forsrvtt-t5se^r @ logui . "*(q ***PTEA.CI; PROVIDE DOCAMENTATION OF TRAINING LEWLS,INSTALLATION CERTIF'TCATIONS, LIABILITY TNSUNANCE, ETC, FOR ALL DISIPLINES*** BUSINESS NAME: PLEASE LIST ALL COMPANIES YOUR BUSINESS IS AUTHORIZED TOREPRESHNT: COMPANYNAME: TEJ TA ^T)AKA " --- PHONE#: 4€6 . ?'CCT COMPANY NAMtr: COMPANY NAME: P}IONE #: **PLSASE LIST AI}DTT:ONAL COMPAT{Y AUTHORIZATIONS ON THF BACK OFTHIS FORM** I certi$ that I have read this npplication and declare undet penalty of pcrjnry that rhe information containetlherein ie correct and cnmplete. I agree to comply with all city ordinancee, adopted cndes, and state lawsrelating *o the installttion, moclification, service, antl maintennnce of new and existing liie oafety systems. thetcby authorize repreeentatives of this city to in*pcct any rvork for complianc" p,r.pil**. I am either theconttactot tesponsible for the work, ot I represent the ownct as signifiedabove andlm acting with the orvne/s/contrrctorts full knowledge or consent. .a ,1 Kyo q-K4 gr'"..". e S c-rl\YAul '\ct>P{u\ sl g9\- PRINT NAME OF APPLICANT ,/ ./t/zr/ / ?--I)AT5 PERMIT VALID UNTIL I)ECEMBER 3T OF THE CALENDAR YEAR AFPLIED FO3.****tl'*********{'***t'*{'***{.***rl.****{.***{({.{.****{.{.*************rlcr{.+rFrl.,l.{.r1.+,1*:1.+,1.:1.:l.,l.rl.:}rt ,F 2- Marsh http : //moi.marsn. comnvff Portal,/PortalMain?PID:AppMoiPubli'.. MEMORANDUM OF INSURANCE DATE 04-Jan-2012 This Memorandum is issued as a matter of information only to authorized viewers for their internal use only and confers no rights upon any viewer ofthis Memorandum. This Memorandum does not amend, extend or alterthe coveragedescribed below This Memorandum may only be copied' printed and distributed within an authorized viewer and may only be used and viewed by an authorized viewer for its internal use. Any other use' duplication or distribution ofthis Memorandum without the consent ofMarsh is prohibited. "Authorized viewer" shall mean an eDtity or person rvhich is authorized by the insurrd named herein to access this Memorandum via http://wrvw.marsh,com/moi?clientsD29E, The information contained herein is as of the date referred to above, Mrrsh sh.ll be under no obligation to update such information' PRODUCER Marsh USA Inc. dba Marsh USA Risk & Insurance Services ("Marsh") COMPANIES AFFORDING COVf, RAGE co.a National Union Fire Ins. Co. of PA INSURED Brigham Young University - Idaho 525 So. Center Street 1695 Rexburg, Idaho 83460-1695 United States co.B Admiral Insurance ComPanY Co.C Co.D COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TIIE POLICY PERIOD INDICATED. NOTWITHSTANDING ANy REQUIREMENI rERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MEMORANDUM MAY BE ISSUED OR MAY PERTAIN, THE INSUMNCE 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. co UTR TYPE OF INSURANCE POLICYNUMBER POLICY EFFECTIVE DATE POLICY EXPIRATION DATE LIMITS LIMITS IN USD UNLESS OTHERWISE INDICATED A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCURRENCE GL4406247 01-Apr-2011 0l-Apr-2012 GENERAL AGGREGATE usD1,000,000 PRODUCTS. COMP/OP AGG usD1,000,000 PERSONAL AND ADV INJURY usD1,000,000 EACH OCCURRENCE usD1,000,000 FIRE DAMAGE (ANY ONE FIRE) usD100,000 MED EXP (ANY ONE PERSON) AUTOMOBILE LI-ABILITY COMBINED SINGLE LIMIT BODILY INJURY (PER PERSON) BODILY INJURY (PER ACCIDENT) PROPERTY DAMAGE EXCESS LIABILITY EACH OCCURRENCE AGGREGATE GARAGE LIABILITY AUTO ONLY (PER ACCIDENT) OTHER THAN AUTO ONLY: EACH ACCIDENT ACGREGATE WORKERS COMPENSATION / EMPLOYERS LIABILITY WORKERS COMP LIMITS EL EACH ACCIDENT EL DISEASE. POLICY LIMIT EL DISEASE - EACH EMPLOYEE I of2 1141201210:31 AM Marsh Click here for a printer-friendly version of this document. htto ://moi.marsh.com/MarshPortaVPortalMain?PlD:AppMoiPubli' l5-May-2012PROFESSIONAL& COMMERCTAL GENERAL LIABILITY CLAIMS MADE co0000003s 1 08 The Memorandum of Insurance seryes solely to list insurance policies, limits and dates of coverage. Any modifications hereto MEMORAI\DUM OF INSURANCE toauthorizedviewersrortn"iiinterna|useon|yendconfersnorights\uponanyviewerofthis Memorandum, This Memorandum does not amend, extend or alter the coverage described below. This Memorandum may only be copied' printed and distributed within an authorized viewer and may only be used and viewed by an authoriztd viewer for its internal use' Any other use, duplication or distribution of tbis Memorandum without the consent of Marsh is prohibited. "Authorized viewer" sball mean an entity or p€rson which is authorized by the insured named herein to rccess this Memorandum via http://www.marsh.com/moi?client=D298. The information contained herein is as of the date referred to above. Marsh shall be under no obligation to update such information. TNSURED Brigham Young UniversitY - ldaho 525 So. Center Street 1695 Rexburg, tdaho 83460-1695 United States PRODUCER Marsh USA Inc. dba Marsh USA Risk & lnsurance Services ("Marsh") ADD ITIONAL INFORMATION This Memorandum of Insurance provides evidence of general liability insurance in regards to operations of Brigham Young University - Idaho Also evidenced is the Professional & General Liability for the various acedemic intemship activities Professional & General Liability Claims Made: Retro Date: 10/22194 for BYU-Idaho. Additional Insured must be endorsed to the policy. General Liability Provisions : Additional Insured - Where Required Under Contract or Agreement is endorsement modifies insurance provided under the Commercial General Liability Coverage Form: Section II - Who Is An Insured, 1., is amended to addl d) Any person or organization to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance for that person or organization of the type p.ouid"d by this policy, but only with respect to liabitity arising out of your operations or premises owned by or rented to you' However, the insurance provided will not exceed the lesser of: l. The coverage and,/or limits of this policy, or 2. The coverage and/or limits required by said contract or agreement Memorandum of Insurance serves solely to list insurance policies, limits and dates of coverage. Any modifications hereto are not authorized. 2 of2 l/41201210:31 AM tqF 3 rr. ul 14 co(n14g X H tr 0t f'li- rh h<>zF<tr> &a 7a>F]HZ lq f']U iu N ) \N It oz eEw rn H = 2>, = F2= El-I -{ =iz d?R#LcJEH ig:E e.,SHzEqF-{ F :l i i"\ P = Ej' c))s-g Fl \_ (_/^) a tg :;s\-/ 5 {r4A :8 7s F? re-*) FSe :EI] z ()(J FUE; ;r-j 6 === Z=:f< = os nfiilEgH #:ililHr ;tt+gt*LFtrL:il = K _L cF.r8 ;f'l t: AdN8H , 93oFI] ffi =E_u a8dX tr.E7z\-/ z tu q;' qut qrt qF qtt qF wt qF qut /aa Xpress Bill Pay - Payment Processllg Page I of I FIRE PERMIT Billing Information PC-2 BYU|Security PC-2 BYUI Security ,83460 l Transaction detail for payment to City of Rexburg. { t-9'Y {}f ITHKBURG tx&!j -"-"" - ---* ,l,,tirtiq;il.ti l;*i$, {.';letes!,j,1, Transaction Num ber: 13777 848PT Mastercard - XXXX-XXXX-XXXX-35S4 Status: Successful City of Rexburg 35 Northlst East Rexburg, lD 83440 208-359-3020 4Cr Col, Printer J i Date:0110412012 - 10:56:16 AM Transaction taken by: shellie m rlqqxl _,._.-p_lv41e-l!sqfvjgg-"f 19y j"{_gqs:!yylv.xpressbittpay.com Copyright @ Xpress Bill Pay 2012 - All Rights Reserved https ://www.xpressbillpay. com/common/paymentjrocess.php r/4/2012