HomeMy WebLinkAboutALL DOCS - 12-00079 - Viking Automatic Sprinkler Annual CertificationlJ.
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35N l,tE
Rexburg, lD 83440
Rexburg -Mqdison Cou nly
Emergency Services
Phone: 208.372.2326
Fox: 208.359.3022
c|l'Y or
NEXBURG
C\, *-
Am er i ca! Fami lv Comntun i tvwww.rexourg.org
*A toftu ysten nrtfication pennit is required to install, modtfi, maintain, or seruice all new and existingfre
extinguisbers,fre suppression ystemtfire alarrz gtstems, and other lfe safery s-ystens uitbin the CiE of Rixburg"
BUSINESS NAME: Vikinq Autqnatic Sprinkler Co. patcel:
OFFICEADDRESS: 32 E. Bower St. - Meridian, ID 83742
OFFICE PHONE NUMBER:208-888-2762
CONTACT PERSON: Ron A. rarson, VP CELL PHONE #: 208-890-9401
PLEASE IDENTIFY SYSTEMS TO BE COVERED BY THIS PERMIT. CHECK ALLTHAT APPLY.
-FIRE ALARM SYSTEMS - Alarm Conttactors shall have aminimum of NICET Level 1
Cetifications ot equivalent.
€. PLEASE PROVIDE CERTIFICATIONS:
TNICET Certification
*Panel Certification
*Proof of Liability Insurance
TNICET Level II required for design work
X AUTOMATIC SPRINKLER SYSTEMS * Fire Sprinkler Contractors shall have a
minimum of NICET Level I Cettifications or equivalent.
* PLEASE PROVIDE CERTIFICATIONS:
{.NICET Cerification
i.Any Additional Certifications
{'Proof of Liabilitylnsurance - Insurance certificate to follow (nail)
t NICET Level II required for design wotk
-FIRE EXTINGUISHERS
€.Proof of Certification & Training
AUTOMATIC FIRE EXTINGUISHING SYSTEMS FOR COMMERCIAL
COOKING
{.Proof of training for commercial cooking heads
STANDPIPE SYSTEMS X SPECIAL I{AZARD SYSTEMSX
SMOKE CONTROL SYSTEMS X FIRE PUMP
-l -
*X*PLEASE PROVIDE DOCUMENTATION OF TRAINING LEWLS,
IAISTALLATION CERTIFICATIONS, LIABILITY INSURINCE, ETC. FOR ALL
DISIPLINES***
I certiS that I have read this application and declate under penalty of petiury that the information contained
herein is cotrect and complete. I agree to comply with all city otdinances, adopted codes, and state laws
relating to the installation, modification, service, and maintenance of new and existing life safety systems. I
heteby authodze teptesentatives of this city to inspect any wotk fot compliance either the
contractor tesponsible for the wotk, ot I reptesent the ownet as signified above and the ownetts
/conttactofs full knowledge ot consent.
Ron A. I-arson, VP
PRINT NAME OF APPLICANT
2/20/2012
SIGNATURE
DATE
PERMIT VALID UNTIL DECEMBER 31 OF THE CALENDAR YEAR APPLIED FOR.
*****{ats****,l.rl.:l.rl.rl.:l.rfrl.rF*:l**{.:1.**{.***:1.*{.{.:N.:1.*****rl.***{.*{.****:1.
2-
COVERAGES
EEI|ER^L IIAIIUTY
GEN'L AGGREGAT= LIMIT APOLIES PER-
POLICYIa|]ii'Ir | |Loc
CERTIFFATE HOLDER
ctrv ot aErBmo
forth lrt Errt
P.O, Box 280
nExsnRG, rD 83{40
i?l .*ur.",* .ENEML LrAsrLrrY
t-T_l cL tMeruAoE [Tlo..r^
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TE NUMBER: 25re7022
I'SA
The ACoRD nams and logo are registerea moelli
REVISION NUTIBER:
Xrtlrd
ACORD 25 (2009/09)25t97022
,^C,o&if CERTIFICATE OF LIABILITY INSURANCE DATE (IIT'DDTYTYYI
0L/3r/20r2
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATTON ONLY AND CONFERS No RTGHTS UPON THE CERTIFICATE xoloEn. ixisCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVEFAGE AFFORDED BY THE POLICIESELOW. THIS CERTIFIGATE OF INSURANCE DOES NOT CONSTTTUTE A CoNTRACT BETWEEN Tl{E TSSU|NG TNSURER(S), AUTHORTZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
||uPoRTAilT:ffth€cgrtl'icateholderlsanADD|TloNAL|NsURED'thepo||cy(ics)mu'tb3inoorego.ttsUeRoG@
the trrms and condlsona of the pollcy, certeln pollcles may rsquire rn endorssmsnl A stit€ment on thls certlflcate docs not conirr rlghtsto the
cortiticlts holdor In licu of luch endorsemont(r).
PRoDUCER 801384 1-503-27,1-GS11
Full.rtm & esllruy tDauraBca
PO B* 29018
Portlud, OR 97296-001E
IlD xl.l!.D
!Xii:i"' rarbrla Dickl.aron
503-271-65Lr I iff ".,. so3-274-6521
E.TIAILADORESS;PRODUCEcIstilEl
kdl chlaronOf u1 lcrt,onco. co
-. vrKrN-l
NAUiER(S} AFFORDIG COVERAOE NArc t
IIISURED
Vlklng Autdrtlc gprinklcr Co.
la ldrbo Corporrglm
32{5 Nl{ lroDt .lv.ruc
lortlard, On 97210
FISURERA: IIAIIIILUS IlfS CO t7370
t{sUtER B: TR.I ITEnS IUD CO 25558
usuRERc: elffl.mR OI.r PIRE IXS C.O 25615
trtSuiER D:
T|SUNER E :
IX3UIEP
T|{|s|STocERT|FYTHATTHEPoL,c|EsoF|NsUMNcEL|sTEDBELowHAvEBEENtssue5rorrleo
INDICATEO. NOTWTTHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF A^IY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY fiE POLTCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AiID CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE EEEN REDUCED BY PAID CLA]T,1S.
0L/3r/L1 oL/31-/Lt
I
I
s 1,000,000
PERSOIIII&AovtNJURy | 9 1,000,000
2,000,000
ANY AUTO
ALL o{A/IIIED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NOr'l-owrED AUTOS
$ 1.,000,000
EODILY INJURY (Per pcm)
oL/ 3t/L3l EACH occuRRENcE
s {'000,000
/liD EFI.oYEiS. UIAl|-rfY Y r xilY PROPRFTOR/PARTNER/EXECUTIVE |-oFF|CER/UEMAER EXCLUDED? I I(fird.lory h t{Hl
Th. c€rtltlcltr boldor ia nurd u addltlmrl iBsur.d sith logard to op.ntioDr of tb. nrm.d iorurrd ln
rccoldloca rltb tbc pollcy Eatlt, codditionr eod cxclurionr p.r thr rttrchod .Ddorr@.ac. covorrga
aflord.d tbal1 b. Pllarry a$d DoD-coatrlbutory vbcn rcqulred by rrlttca contrrct per lhe rttachad cDdorteoas!.
Italv.r of SubrogrtioB rpplira to Oenrrrl !,iability rhan rcqui.rcd by rrit!.|l coDtraet pcr th. rttrchad cndorr@6D!.
It r.tp.ctst Ch. Auto tlrbtlltf, addltr,oorl lnrurrd rad ralvcr o! tubrogrtlon rgpllct yhaD rcquir.d by vlltlaD contnc!
tbr etttchrd aDdort€aant,
SHOULD ANY OF TT{E ABOVE DESCRISEO POIJCIES BE Cff{CELLED BEFORETHE EXPIRATK'N DATE THEREOF. }IOTICE WILL BE DELIVERED Ii{ACCORDA'{CE WTH THE POLICY PROYIITK''{S.
CORPORATION. All rlght. regerved.
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Receipt Number:1&9994..,..- *
rvelopment
. 83440
)8) 359-3022
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$100.00
Total:
$100.00
$100.00
$ 100.00
FEB ? 4 z01Z
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