HomeMy WebLinkAboutALL DOCS - 12-00081 - Simplex Grinnell LP Annual Certificationa)
4
H
Fl
a
a
E
H
o
H
N
Fl
H
4
Ho
F]
Hcz
T9(n \I
FDO
lrrJ
cF I\9 A
lJo
r.t u) H?
FD v FF{F\/H-l^l t-t
o *o-X
3Ho
.-tOl.t
vOP
F{
,P=€s-'r (p t_.
@3rr
rF' H
Hv
H+h(o o)
O
tr
Hn
H
T9E
O :fh
H Hts 19
Av
Atv
Av
m
H
)- i-i;r:.H3 i-^-i c
FX:
{ ,f i-{g.{ W 4
n (--{c
*;="'; /\'t:;n'S. t{ J
a
z
*l-
H
t!
-
rt
r
-
F
ofn
tn
FV
Flwi.'i
t9
N9
\
N
$ry
35N l.tE
Rexburg, lD 83440 www.rexburg.org
Emergency Services
Phone: 208.372.2326
Fox: 208.359.3022
CITY OF
REXBURG
Am e ri ca\ Family Co tnfl uni tl
BUSINESS NAME: SIMPLEXGRINNELL LP
"A tnftu y$em certfication perwit is rcquired to install, nodtfi, maintain, or seruice all new and existingfre
extinguishers,fre suppression s1$emqfre alarzt sltstems, and otber lfe safery ysnns within the Ci4t of Rexburg"
OFFICEADDRESS. 2702 Sourh 1030 West, #60, Salt, Lake Ctty, UT 84119
OFFICE PHONE NUMBER: 801-262-9406 888-962-4242
CONTACT pERSON: Jean Courr CELL PHONE #: 80I-262-9406
24 tlrs
PLEASE IDENTIFY SYSTEMS TO BE COVERED BY THIS PERMIT. CHECKALL
THAT APPLY.
X FIRE AI-ARM SYSTEMS - Alarm Contactots shall have a, minimum of NICET Level 1
Cetifications ot equivalent.
{. PLEASE PROVIDE, CE,RTIFICATIONS:
.:. NICET Certifrcation
.!.Panel Certification
*Proof of Liability Insurance
*NICET Level II tequited for design wotk
X AUTOMATIC SPRINKLER SYSTEMS * Ffue SpdnKler Conftactors shall have a
minimum of NICET Level I Certifrcations or equivalent.
{. PLEASE PROVIDE, CE,RTIFICATIONS:
{.NICET Certification
{.Any Additional Certifi cations
.i.Proof of Liability Insurance
* NICET Level II required for design work
X FIRE EXTINGUISHERS
€.Proof of Certification & Training
X AUTOMATIC FIRE EXTINGUISHING SYSTEMS FOR COMMERCIAL
COOKING
..?.Proof of training for commercial cooking heads
x
X
STANDPIPE SYSTEMS
SMOKE CONTROL SYSTEMS
X SPECIAL HAZARD SYSTEMS
X FIRE PUMP
l-
'?*{.PLEASE PROVIDE DOCUMENTATION OF TRAINING LEVELS,
II{STAI.I-4TION CERTIFICATIONS, LIABILITY INSURANCE, ETC. FOR ALL
DISIPLINES***
I cettiS that I have tead this application and declare undet penalty of periury that the information contained
herein is comect and complete. I agtee to comply with all city otdinances, adopted codes, and state laws
telating to the installation, modification, service, and maintenance of new and existing life safety systems. I
heteby authorize representatives of this city to inspect any work fot compliance purposes. I am eithet the
contractor tesponsible fot the work, ot f teptesent the ownet as signified and am acting with the ownefs
/contractot's full knowledge ot consent.
Davld Smothers/Total Service Manager
PRINT NAME OF APPLICANT
02/ r4l 2012
APPLICANT'S SI
DATE
PERMIT VALID UNTIL DECEMBER 31 OF THE CALENDAR YEAR APPLIED FOR.
{.x**{.{.*****{.**{.*{.{.**{.{.***{**********{**{(,t:t **{(********************{.******{.*{.{({.*{<
-4oRif tfi*
COVERAGES CERTIFICATE NUMBER:889178 . A REVISION NUMBER:
.{cO.F CERTI ATE OF LIABILITY IN CE DATE (ilreDO/YYYY-)
9t16t2011
THIS CERTIFICATE IS ISSUED AS A MATTER OF THFORMAAOil ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTTTUTE A CONTRACT BETWEEN THE |SSUING INSURER(S), AUTHORTZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
|MPoRTANT:lfthecertificateholderisanADD|T|oNAL|NsuRED,ttrepotic
the terms and conditions of the policy, certain polieies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
PRODUCER
Marsh USA lnc.
1 166 Avenue of the Americas
New York, NY 10036
ilAilE:
tsHqE I FAxlA/C,Io.Exo: \zlz ) 3+5-5uuu l lArC-Not:
EffiLADDRESS:
HSUNER(SI AFFOROII{G COVERAGE NAIC *
INSURER A: AGCS Marine lnsurance Company (Allianz)
INSURER B: CHARTIS CASUALry COMPANY
INSURER C: Commerce & Industry tns Co.
INSURER D: lllinois National Insurance Co.
INSURER E: Natl Union Fire Ins Co" of Pittsburgh, PA
INSURER F: New Harnpshire lns. Co.
22837
40258
19410
23817
19445
23W1
INSURED
SimplexGrinnell, LP
2702 South 1030 West. #60
SALT LAKE CITY, UT M119
United States
TI-IIS IS TO CERTIFY THAT THE POLIC1ES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED fo TTIE INsuneD NAMED ABoVE FoR THE PoLIcY PERbdINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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 SHO\A/T{ MAY HAVE BEEN REDUCED tsY PAID CLAIMS.
ftsRITP TYPE OF INSURAI{CE ruut POLICY NUITBER POUCY EXP{IiM'DDTYYYYI LIM']
F GENERAL L!ABILITY
X I coMMERcTAL GENERAL LrABtLtw- l---l T--r
I I CLATMS-MADE lX I occuR
_J.*-rc's a co-t*cto*
GL2449607 (Primary GL)10t1t2411 10t1t2012 EACH OCCURRENCE $ $2,000,000.00
DAMAGE TO RENTED
PREMISES {Ea @renet s $1,000,000.0c
MED EXP (Any one psson)s $10.000.00
PERSONAL & ADV INJURY s $2,000.000.00
*l GENERAL AGGREGATE $ $4,000,000.00
GEN'L AGGREGATE LIMIT APPLIES PER
X lpoucvl l',5""; I lroc
PRODUCTS - COMP/OP AGG s $4,000.000.0c
E
E
E
F
AU'
X
X
3MOBILE L'ABIUTY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
f--l SCHEDULED
L-__] AUTOS
lv I NoN-owNED
l^ | Auros
l{
cA3506468 (VA)
c43506464 (AOS)
cA 350646s (MA)
CA 3506466 (NH) (Primary AL)
10nno11
10t1t201'l
10t1D411
10t1t2011
10t1t2012
10t1t2012
14ht2012
10nt2412
UUMtsINhU ljIN(,LE LIMI I(Ea eeidentl $7,500,000.0c
BODILY INJURY (Per peBon)
BODILY INJURY (Pef accidsnt)
PX9PhF(TY DAMAGEaPer accidenll
NEW HAMPSHIRE ICSLI $ $rsnnmon
F
F
UI{BRELLA LIAB
EXCESS LIAB
X I occun-l
"*,r.-roo=
CA 3506467 (NH) (Excess AL)
GL 2449608 (Excess GL)
10t1t201'l
10t1t2011
1U1t2412
10t1t2012
EACFI OCCURRENCE $ s5.500.000-00XAGGREGATE PROOUCTS.$ $11,000.000.00
oro I I nereNrrons NEW HAMPSHIRE (CSL)$ $7.250.000.00
B
c
D
E
F
WORKERS COMPEIISATION
ANDETTPLOYERS'LIABTUTY YrlANY PROPRIETOR/PARTNER:/EXECUTIVE T:-:.-oFFICERyMEMBEREXCLUDED? IN I(M.ndatory In ilH)
lf ves. desibe underDEscRlPTtoN oF oPERATtoNS betow
N1A
wc 015884005 (CT,GA,PA,SC)
wc 015884006 (FL)
wc 015e84008 (Mt)
11yg 615354@r (CA)
wc 015884007 (MA, ND, OH, WA,
10t
101
101
1At
101
t2011
t2411
t2011
t2011
t2011
10t1t2012
10t'U2012
1U1t2412
10t1t2012'tot1t2012
y lwvDlAlU-l l()lH." LinovrlrrrTcl I ED
E,L, EACH ACCIDENT $ $2,000,000.00
E,L. DISEASE - EA EMPLOYEI $ $2,000,000.00
E.L. OISEASE - POLICY LIMIT $2.000.000.0(
A
A
A
Builder's RisMnstallation/Contract Works
Rental Eguipmenucontraclo/s Equipment
Btanket Transit
oc & ocw 91128600
oc & ocw s1128600
oc & ocw 91128600
10t1t201'l
fin2a11
10t1t2011
10t112012'tot1t2012
10t1t2012
USD $1,000,000.00 per jobsite
USD $1,000,000.00 per jobsite
USD $1,000,000.00 per conveyance
OESCRIPIION OF OFERATIONS t LOCATIOI{S, VEHICLES {Atlach ACORD lol, Addltlsat n€marks schcdute, tf moc apac" ls requtred}
Project: Fire Protection rnstallation, Maintenance, Testing, rnspection, Etc.
Pl-ease refer to attached ACORD 101 for further remarks.
City of Rexburg
19 E Main St.
Rexburg, lD 83440
United States
SHOULD AT'IY OF THE ABOVE DESCRIBED PoLIGIES BE GANGELLED BEFoRETHE EXPIRATION DATE THEREOF, NOTICE WILL AE DELIVERED INACCORDANCE W|TH THE FOLICY PROVISIONS,
AUTHORIZEO REPRESEXTATIV€
;,*1.," !r- , /lr*t*k&,%L
*qRSH USA lt{C, 8Y: F€nktin Hanod, ctobal Marine
@ 1988-2010 ACORD CORPORATTON.
The ACORD name and logo ae registered marks of ACORDACORD 25 (2010105)
All righb r€seryed.
AGEilCY CUSTO'IIER ID:
LOC g:
oc.?'-ADDITIONAL REMARKS SCHEDULE Paqe 2 of 2
AGEI{CY
Marsh USA lnc.
NAIIEO IIiISURED
SimplexGrinnell, LP
2702 South 1030 West, #60
SALT LAKE CITY, UT 84119
United States
POLICY IiIUMBER
CARRIER ilAtc
EFFECTruE DATE:
THIS ADDITIO}.IAL REMARKS FORM IS A SCHEDULE TO ACORD FORM.
FoRtrl NUMBERT 2s FoRM TTTLE: CERTIEICATE OF LlABlLlry INSURANCE
ING POLICIES OF INSURANCE:
rnsurer Policy Number(s) Effective Dat.e(s) Expiration DaLe{s)F wc 01s884009 (MN) J.a/t/zarr Lo/L/2orzF wc 01ss84003 (Aos) !o/1/2a:.j- to/1,/zor2
ING NO?ICE OF CANCELIJATION TO CERTIFICATE HOTDERS:
is endorsement modifies the notice of cancellation of insurance provided hereunder:
li_::y :l_:h:_i!::e described policies be cancelred, gller rhan for non-pa)nnenr of premium, before rhexpilation date thereof. 30 days advice of cancellaLion will be delivered to certificat.e holders inccordance with the policy endorsements.
All other t.erms and conditions of t.his policy remain unchanged
FOR QUESTIONS REGARDING THIS CERTIFICATE OF INSURANCE CONTACT:,.fean court (Email: jcourt@simplexgrinnell.com phone: aoL-262-9406)
This c€rtif€te of Insurane was geretated byExlcls RlsKyotks@ m.certiftcates@.To leam mre about EXtGts certiti€le Managerent solutions vsrt www.6xtgis.comny6.
ADDITIONAL
@ 2OO8 ACORD CORPORATION.
The ACORD name and logo are registered marks ol ACORD
ACORD 101 (2008/01)All rights reserved.
I o
zh4
lr{ }r{zo
F-rZ2Ecrir-2Zrn q,fr=2n t-lL{r [T1
Fl f-{|-l r'J
l.^l
A\/LJ'tr
lJ..izo-F]Fn,l-l
\./ fr.i
O FIJ
E5(t)
@tl
l-{oz
L'(|1l
sl 2u0g
A\^/vJ
lrl '\
Eo
F]F.H
IIFTl'L)J
9U
lrt-rFlv !T1trE
a4-)
^<Fl> HH ,-,. IEU q't'inz jz !*>4 q' H F: U P. ,-t lt). (t)= ;, ,.-r ljj ,_,, y # ( q= sEfifi >A Fr-,
= SqAQ >H :->.) LE)\l^ 4,>9z lEr', U eQ <2E ASBS ;E g
E yf;a2 c4:j FlF €-UAF =- IEg s_338 2z I
R E ttl €- (Att) qr
--rf, -z- -
LtutH C3986 2 U
3hl- rn trl
. 'ri -^: C) Fft.-1ff F VcPIE- z<aE
EsX :J-- - Gj-62 o
44.zv ^ r:a'4 9, Z>7-4' -
Ei i-li " =Fl> !cq l,-c|n'
.)
P'
z
oEFl
rI
-
z
Izo
|l
*]
m
z
H
z>t-
U)
o
F-
.i
-lO
(-rt
cc+s.
b\i
F$
HSr.. Sa
=frzxrtV=z
#PE=zu!o=-
{;m-n;iI
qTl=o
F7Efim{
"3=toz
t
o
a-
f(a
no
Ff.
na,
Fl
o
3
t
o(o
a)
3
h
tzr
f,r)o
(o
ol
;i N=f f;E ?= EF KEne s-==nE i= iE ie;f;$'sii ad ?; P=
Fg \= ilE 1; F liE3$--H3E -7 i F
;=a \ ifi E ildx' 3E 6 dO f^= Lr =r, 66 I =u n7 B I6 ie E -
3- gE or =E 5zg ts em {mfr *=
E3= ttr5H
Flll
I A
r-fl
()
Ft
F\
b\t
l$ F.g*.
?<rs8$a
\{
rfiZ, it
*F
;ft _EZ
f;$
r-l-lFfrHr$Eftm{%q
$oX
'11
*la
a-
:I{a
r"}
f$
\
iflql
f".l
o
:3
-t)
o
t{}
qt
*
vt
t/r
il
11
$
tr)
gl
*{r
3FRH $EE FF g$ 7iI!$! lI* tE iIic
ffiE V gqs \HEsfi gi 5 iiPs si E8$ H3 q H',t
HE{v'r H gE "7 3 g
:# \ ifi F qnil 7 t=' nt$a Hi H ;r/! {O ,r
0 q.tt Ef
i 9* 6
il il€ il6 Tg ez.
m=rrtm fira =3s3EB
Ft Fl
rage r ur rGeneration2l C ertifrc ate
oo
\Ft\\r
=Toq)
r+o
o\t
oo3b\ro
FT\ro5
s)6
6so
BUil, oFF\=q
OFf,g
*=FEt\)a. C-
SEos
AE$o
--5q)sto5
d\
d!S
cns'!
\,rox
N
{oomu,
I!t
=
!,s
;lo55\ro\raf5a
Q
{
{!,-CLoo,
o3
!t
=.
N
No
I
http ://lms.tyco-training. com/knav/nav?cmd:c ert&idx:4l
rage I oI Iueneratlonz I uertlllcate
tO1,,(D
;\fruS.Ed+Fsa.-\ a5 q)
;TFs;oBtqRi osEgoSSqa€
$3o=$Fhst Jrsq
6"€\
Ee
co
=.{UE
ox
\
{
Nad
=
=oFt
{o
*
;ro55\roil'5
(^)
{!,
CLoCL
o
E=.
I
No
I
5/r6t20tIhttp ://lms.tyco-training.com/knav/nav?cmd:cert&idx: 1 07
II
i:l
.tj.,I'i
'I
z
{6z
l-
rz,(n-l
-{
C
{m
'T1on
nmn
{
=nD-6.z
=
mzq
zm
FNnz,o
-.1
mn:E
7oroq
mr/l
@
b\o
a-
f,
Q
nrD-.r
11
-h
n
AJ
r$
o
-D
\o(a
\
-oJ'\-
q
t4
f,nrD
(o
o)
x * Hfi HZ E = .t rE g ,ru
EIHFTEFEb2"
Z F >z EB H P 6- =A g 3E;H E F 1H E {A #E d sn Sn € FH EE q s -
F F fr= EG E Hj- +u"e H= 6 + m-t2 e !E6; E g
a= a rq2 HTo o-n -i.i |-rO;n qnme€ Fwr^ o<= a
1 rri=nt/\ z_ ,.\cz
=F/- tfIO
l-r|IN
xEN
#\\z\s$9aN
;{
3\gf
gf
U
v,
oz
o-Tl
-{
Im
z
6z
t-
atron
mJ
o'Tl
-E
vo-71
mtn!noz
t-
mzozmmvvr
Generation2 I Certificate
This is to certifi thut
Nuthunuel Johnson
has saccessfully completed the
(TSPI-FAI 82) simplex 4 I 00ES spotright session
course.
CEU_ID:
Credits: 0.0
Completion Date: April lZ,Z0ll
Page 1 ofl
&erttffcafr of ffrbirhm$snf
http ://lms.tyco-training. comlknav/nav?cmd=ce rt&idx:120
Generation2 1 Certificate
6ertfffrnte nt S$
tqcaf*M$
teheffieilt
Page 1 of 1
This is to cerffi that
Jumes Bugge
has successfully completed the
Simplex 4100U Sewice FA074 End-of-Course Test
QSPI)
course,
CEU ID:
Credits: 0.0
Completion Date: February 21'r2017
htto ://ims.tvco-trainins. com/knav/nav?cmd:cert&idx:0
Lren€ratlonz r uertulcale rage 1 oI I
This is to certify that
Jumes Bugge
has successfally completed the
simplex 4 I 00u Progrumming FA07s End-af-Course
Test (TSPI)
course.
CEU_ID:
Credits: 0.0
Completion Date: February 23,Z0ll
fiertffiffife of Hcbieberueilf
tttp : / llms.tyco-training. com/knav/nav?cmd:cert&idx: 1 3t8t2011
=z;Eqt-=o=zz>mF
mr
4,262
.-|E5+m-rtz..o
tsvon^ rrr-v,m-lqf,
(?, rn5oz
t
\o
\.
O-\.
\
Q
n
rv
\r+
\!
at
-!o
0J
r+\.o
f,
t'\
ota
-t
AJ
\5
t/l
(/|
-t
.f,
nrD
. {
(o
O)
\\
EEN.ESxE 4Z E=59== N\E $ Hu EE # * E 42'4 N F 3 n= Fg i P F 6
e= \ z 3 >z ea e 1 F=+ = \ a r =? EE#i N = ^E \Jx ;g fr F I,' ,\ E ? 6',fi ','oa E o6a \ = g =q ez ; -f I $ E s ;F FZ Z F'HE N :gE X2 F -8
En $ =e LH = tr
9 6i 62 z
! TL <o Lv Bd E= -'
I
m wt Z F-l Lrl
u Ea RB67 gft E9; r€ z>z wG 5Ao <= t<= -r rri F}jlrlm -x 'C
v tttz (Au1 =Q62 cr)-r- -4H H]- rn -,_,
.\ k2
-J
a a
(-rl
c(_fs.
b-
1.. (t!os
?Q.,lSr$
\
=frz=
22"mF
mr-Z
zu!6l+
t-l-Fm-eil2xPxEffm{%=nToz
\
o
a_
f,
Q
no
n
OJ
o
f,
\
o
Q
oJ
3
t4
h
fno
(o
ol
E gF\88*B E2 H5 FH== N= i E$ ?= = t D? .;=.N! tfE EE iSEA
i 6 \y = - zq --r = 5 zI! V = e sc qB F E-{iE \EFFfi E= e ='$
9E \r\s;- ^F 2> g =t
FEd-==H! "e fi F3-\ ia fr il*I Fq A 6u P= 2o 66'Tlm vrZ Etlrm(-)-lttt {O FF
O 11al E= 9* 6; re 5i == ?z +tm+m*_v 6A'r'
i2-t-=inEB
tfi Iil
oD
oxl-
Io
@
{
{rfl
cz
mTa
=
l-o@
@o
E=i.., { 8P5= j -:
xg o q,P
P q"a
d 58 3 o 6qq Ee 3 qesry
_r E{+ 83 I Ho re
i +.= = E{ g.de 6'3 n Tr= \.5 Qq
H 1q ,E r.\ F'g :s ;,E6 == q g sS $i*SPe 3'e R il E: $ i="-t+=- ='::i =Sf,EEFF dfi a' - oq p.e q aE.dg;oSx oE a aB Eaog +.s 8 da =#q ai= 61 r (o 5d gq g B' ato3 o =d-g: 5 =(O
- 9<cte(6€
-g,
I
=
oltrl
5DFT
oo.r =.bo
i, !lo=t:til'6s6'3
@
o
o
P
o
Taoa
o
F+
o
o=.
0)
.Tl
-
-o
a(,
6'=of
N
o
tlN
omca
o
o
o
o
oo
6150)c.p
r0)ad5tq)
0)
g
a
o
Jo
htla-{
OP(noi
C=
o€fn=>=Jg
n(,
\-Jy
='
mo--
$-*o
o
b
.Q
vhs6'ia =.aI\:s.5wt
GS(\l
R
Xrl'
€
=o
o
Jg
o
o
cr
oo
3p.
o
(D
A'
P.
(q()o
ao
(D-l
x{Ed'
do\<oo:_osq,g
s6'O;.>:CXar<aR sufi F\\-*5x q
3r* i
E=3 *
d+ !
FF $
ri Ql 6'rh\
#R A3: *s ;..
o \dFd
v.
'\
r
E
d'
q)
gJ
Y. i-
oi \'
6:Qf,u
t\ a)
$o
o IIIdlurt='i l$sLr
3ls
"18III
h
\)('
c
N
1\N,6\sN\'
III
CD'i- O;3s
o.-b;9sxoil
l- .+.ad--l =.=- _=.
o)(QIo
^i-o. o
xi
g.
o
J
-{
o)t.=.
$.
o
ln(D
5-q)a
N)
(o
zrhq >i'
t *i'
mx.
9Utri o)
3q
"l=lTB lo'
4leFIEeF-lr
I l-+rr
8 ltr:i, lO$tiI{lFIdltl5lJI
U
w
x:
€
so)
U)Fra€(\
\
arf(\
(\
GFarr
*€=o
o3g
o
o
tt
oo
o
oo
o
9t
(o
ooc
oo
.(D -.1
'tf u)
oo\<o
o:to=q8
S:doA.
!^Sd==QK.3N'd' 33.R F
\<<5x €
8*5'\-(t)
E=3 $s+ Ir+da5 *
QO H.*$ 6'L.b =qo ='i,ti < v)
do F=gQ)eordmxro.
S.
o-r
E
6
o)
:loi
S.
D
o
Il"'ls
l$lil*
luIII
rnx'o
oi
.O
ho
$'
N)
A.
f\trC''i
NN
(-\
d.s$\tr
\I
a.3!
xo:1.-
E
ToAO
J€
ntsYF
C) o:
{=.
6' :'
IoIO='coa
To
v:
6'
'Tl
ott-
.o)
--
N)
.o
mX
\'dt
6'
za
r
I
Y
m
_{
?
3
2nl-{Jtr
=
q,
o
rfto
{
IL{lot9l{t5t:
o)
.o\
--l
AJ
5:
?
m-
o
T
3
9.
l
o
oX
tr.,=.
:
cD'i- c\x=a
)qF
oil
a\'
6'='o)Q
Io'to
or--oo
=\.
=io
::t
:oi
-'
f-r
(D
,t-
lo'l(tt5la
ls
l--lN)
t(o
IIIIII
'11
or
I-
:
J
-
N
A
zo
r
I,mt
c)I
7
3
2
. 11!'1
$'
=
N
{
{t
o{t
rFo
\
s
ts
Fw
Fih
t\ns:
|,+iF\
;Q
*\F.s\h)
€
o
6-
oo.
oo
5
E
o
o
q)
(cI
oo
aho
O-{
t6'
do
R+
=lq8
sdOX.>;r$*
\r-<5^< €3S5\.-ah
E=3 FG+ !rdR:r +qo H.*Q) d'I h \
t40 i.R< 6d.o sil3c)idmx
La-
a-r
O\'
;
o)
*l
oi\'\.
o
-n
d
-\
:{
N
o(o
rn><'>i
di
o)
o
TIo
-{
\)
\_s
t\tr
{r\
N
\\
(\c
\N
\
\
\I
6.ffi
R".f1.
\ X4hK.*'
q)
o
--l
oi\.
(r'i- o(<ro
c/)ot
o -'o
;9R-xorT
3\'A' =.
$Q
lp^i=ui-oo
:\.-:i-i
6'
n
ni=.
r
o)(D
l-nlo
t-
tal<l:lrt-lN)
IO
EF
-='ldi
mx.
OFi
da)3Q^
"l= l-n5lo
zt=ili
ki<-la
$F-B lx:sl(>slt
I{l
il@l3l
rlq
(\
SF
q =|'
5rsFE
F'sGgs
GF(i
€
=oo
6'
o
q
oo
6-
o
q,
0,
o,o
do
O-{
td'oo
o:[o=
9"8
Sdod.
cX=r<aF sN'd' spx c\_2- X e\--<Ss €3*5--.6I-|o s
>-,5\(" .=- ;'d+ s
Rd\5 +ao I-Q) d't*\\.vLto ='ds cq'u I-RR
o 3;mx
a
dr
E
6
.o)
soi
U
q
Il;'
rnx
si
d'
D
o
Tl(D
;+
l\)
N
$('
N
\\Nfi\
\\N\t
\
\I
a)
aoo
_.rr
-t:o)
5
=xo
m-
F
9.
6-x
=.
f,ao-
(/)i c)bdg6-€fnF;*YX X
\,o)
J. -'=.hi ,x=-\
Tl 8;S
:oo
=\.Yr:o
6'
-l
=.
Q
o)
o
l-nf(Dl-a
.?
-_
l\)o
(o
tnxb\'
lr
t_I lllo
a
lo)F
lrlrIlN)
lrIA
zo
ra
m
{.m--{
?g
z'm-l
In€
oit6
n
{
bo
x
€
\t\rj
lrt(\
Uu
\oaF.V)
€=
o
o
g
o
o
q
oo
5E.o
o
AT
aol
GIoo
ao
O-{
E6'do\oR+
q8
SdcD ;'>;r$*
5i€3S5._._6
t-|o S.
5=r $$+ lc=rdQ^d' sr-E A\.vftS 4-: Eo gB
Fd.<.
\'g
<.r
E
6'
OJ
SJ\. s'
d.Q-u
l\ a)
$$
or"l II$luctFet6
-i fsN lx>xtF
IIIII
$
Nn\t\
d'
\N\l
\I
il Ft 8s3s=.(,,=-S=51=.q:R;srrX P z:S.b, o I
E 5E Rd6i
ry(,=.O^qqlq qR rH='rE; 5.'< d
o;.^l(,nf'Yvg -ng Pts 8€;{* 5= (D
6 0lH s.-; t3
N corT =g ;oot I=0 EE; *0)rxJYge,
mt
il
o5oo)B
@ott
o3go5
-@
No
5
P.lgS S
Efi 6E* d
$$. io5' d
Po @=o cSS o E9R.S g
U$* frq;{* 5'Eg cn O6qEF;frrE = SW
e€3g$Eg Ba iigil5dFqE=;$d
*$s 3g g ifix3 l=Y.\C)-
E{ q -9,
Td *
$=. =iox oor* 3
lF d
[] $ss €
90
sil
=. Iqt =.E:c5E
F$
o
ssgg
qq
.90 po
HHA{
L
E-
+
ai
o)E
0r
I
ta)=
\
\
il
Ft-
!x-Tr
oqqo
a_o
I
q
do6-\
Q)otd'ov,I
oHa)(/,
=f onQa99{ n-r3g='8=: ,EsE=E_i
E-1 PF*RSlJ=!9q(DqJFt EEsses
@ = =6o--l!o-
F dd E S1 s? EE ,HE =
-or 6d
8 *8.
I <9 oI='a €qE .g
EE 3d? eo
o0)t
@o€
oauo-
-O)
l\)o
s
I
E= S
EH F^
E+ PqB' E
Sil -t
[R #
SS cn
f;$ € s,$3 -fr*es3=g-F* 5i ixxgFrt[* gE iE bs F s
$iuF+=;EFilEE s.E d'
*n q
${ 3
5=. F
=F v[] sSS Eo
eo
\
\
il
s
*
lTl-Tl
oqo
B
Iu=.(dgo.:\ao
6'o?
loBq)q
L
!
s
o
0)
o
a)
c)o
ts\
$i:=.sqt =.scso
B$B
ssgg
qq
.9sD
HHS{
:f 9> Q@3n@d o'.9q) ='o=: €sE=ER
d; -r ? )9'itr o FE ;-q 8.F'68
B g= o cr =. iu* *g $.8 = t
a 96 'Eg 'n9 ELat o'ro \ {= C)E C4a qd s-.; E3
N !or= =U)d; g
=0' EE; ^€lDixfooo\
ooa
aoEo3qo-
_@
NO
s
P$s eg$ s
$$ !o ;;. <lt
Po a\o tr5= o Eoqro?r5X.f =
tit s:-
$$$riglge$s
$ilu $
$ =. Eli5= Oo\+ 55[ ;FS 8
P.; ilss €
9o
sr=.soi i.E:CIU
F$B
B€qq
.90 -go
H\
A{
b
!
+
o
q)
a)
c)
'b
A)
\
\
\
il
s
*
lTl'Tl
oqqo
fo_(D
I
D
oo6".\
(t)
o
d'o(t,
IaoBq)
(rt
Xpress Bill Pay - Payment frysine Page 1 of I
City of Rexburg
35 Northlst East
Rexburg, lD 83440
208-359-3020
4o col, Printer ld I
tilll ()1,
REXBURG
{ lt*
l [i ir..J:t ltltirtitr' { r'rt'rfrlrqJl}
I Transaction detail for payment to City of Rexburg.Date:0212412012 - 2:05:54 PM
Transaction Number: 14391540PT
Visa - XXXX-XXXX-XXXX-0893
Status: Successful
Description Reference #Amt per ltem # ltems Iotal Amt
FIRE PERMIT 12 00081 $100.00 1 5100.00
Billing Information
Jean Court
.84119
Total Paid:l StO0.OO
Transaction taken by: amanda
@
Provided
| [ cro6e I
Payment Service By www.x p ress b i I I p ay. co m
Copyright @ Xpress Bill Pay 2012 - All Rights Reserved
htps : //www.xpressbillpay. com/common/paymentlrocess.php 2/24/2012