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Home My WebLink AboutALL DOCS - 13-00536 - Viking Auto Sprinkler Annual Certificationoo lJ. Pq' l-a . H"lJ C^l gq T9 tr e'f' o l-{5 FD c'r- lJ. c) (n ti5 E lJ. F ti - o E C) : taJ FD(n C:{. w o { o E n(no)il Ao 19o cl. r- o H l-r . A. lJ. FD : H g u E H It a U E H o H fr f: H E Ho Fl Hoz tr H N K H T9E O :fh H IJttr gt Av c c,Jt C^? oD ). i-l*,PT. f' L^l n$xl * r1 i-i.Fg \/\{ i f4 r'la * f:{ "t: X ^,t = € LIJ a z Fl a{ H t! r* F-l H - H ott H tt PcDE' H LJ T9 A w\ t\['\F.\r*.t!t ttt. \li t\1i.\\tt 35N l.tE Rexburg, lD 83440 Rexburg -Modison Cou nty Emergency Services Phone: 208.372.2341 Fox: 208.359.3022www.rexburg.org SAFETY SYSTEM CERTIFICATI ON PERMIT APPLICATION PERMIT#: g100 Fee Paid: E Yes fl No Permit Approved: I Y." n No BY: Date: *A toftu slsten nrtifcation perruil is required to install, nodfii, maintain, or service all new and existingfre extinguithers,fre supprusion gtstemqfre alarn sjtstems, and other lfe safery ystens within the Ciry of Rexburg" BUSTNESS NAME: Viking Automatic Sprinkler Co. oFFrcE ADDRESS. 32 E. Bower St. - Meridian, lD 83642 oFFrcE pHoNE NUMBER. (208) 888'2762 coNTAcT pERSoN: Larren Bailey, GM CELL pHONE g. (208) 8e0-e403 PLEASE IDENTIFY SYSTEMS TO BE COVERED BY THIS PERMIT- CHECK ALL THAT APPLY. E ffnn ALARM SYSTEMS - Alarm Contracrors shall have a minimum of NICET Level 1 Cenifications or eouivalent. 'PTNASN PRO\TDE CERTIFICATIONS: {.NlCET Certification {.Panel Certification .E Ptoof of Liabiliw Insutance E eUfOUeTIC SPRINKLER SYSTEMS - Fire Sprinkler Contractors shall have a minimum of NICET Level III Certifications or equivalent. I?.PLE,ASE PROVIDE CERTIFICATIONS: {.NICET Cettification {.Any Additional Certifications {.Proof of Uabiliw Insurance E rrnn EXTTNGUTsHERS {.Proof of Certification & Training E euroueuc FIRE EXTTNGUISHING sysrEMS FoR coMMERcTAL COOKING {.Proof of taining for commercial cooking heads ctit'Y 0ir REXBURGcs'-"---------- Am triil's t" * milv C<t mmwi tv zn STANDPIPE SYSTEMS SMOKE CONTROL SYSTEMS EI spBcrer HAZARD SYSTEMS EI rmn PUMPs louro,Glient#: f Sf :RTIFICAACORD^CERTIFI TEOF LIABILITY INSURANCE DATE (HiI/DD/YYYY) 01/30/2013 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 TNSURANCE DOES NOT CONSTTTUTE A CONTRACT BETWEEN THE |SSUING TNSURER(S), AUTHORTZED REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER, IMPORTANT: lf the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Propel Insurance Portland Commercial lnsurance 888 SW 5th Avenue, Suite 1170 Portf and, OR 97204-2025 fiXilil"' CrystalGummins '\'^ .*'. 503 467-7540 | lff n^'. 866 577-1326 iilSl!==, c-c@propel insurance.co INSURER'SI AFFORDING COVERAGE NAIC # tNsuRERA : Nautilus Insurance Gompany INSURED Viking Automatic Sprinkler Co 3245 NW Front Ave Portland, OR 97210 tNsuRER B: Gontinental Insurance Gompany INSIJRER C: INSTJRER D: INSURER E : COVERAGES CERTIFICATE NUMBER:REV]SION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVEBEENISSUED TOTHE INSURED NAMEDABOVE FORTHE POLICYPERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITIONOF ANY CONTRACTOR 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. TYPE OF INSURANCE NSR tvD POLICY NUMBER POLICY EFF IiIiI'DD/YYY\A POLICY EXP.IIII'DD/YYYN LIMITS A GEI x x {ERAL LIABILITY COMMERCIAL GENERAL LIABILITY lcrerrus-rr,noe I X occun BI/PD Ded:5,000 ECP200453301 013112012011311201tEACH OCCURRENCE s1.000.000 DAMAGE TO RENTEDPRFMISFS /Fa 6c."mn.a\s100.000 MED EXP (Anv one Derson)s5.000 PERSONAL & ADV INJURY s1.000.000 x WA Stop Gap ,GENERAL AGGREGATE s2,000,000 GEII'L AGGREGATE LIMIT APPLIES PER: ror'"' filiffi fl,-o" PRODUCTS - COMP/OP AGG s2.000.000 B AU'.OMOBILE LIABILITY ANY AUTO ALL OWNEDAUTOS HIRED AUTOS f_l scHeouleo i I AUTOS I v I NON-OWNED l 4 ] Auros tl 5090740364 )1t31t2013011311201t,MtsINEU SINGLE LIMI I I eccident)e1.000.000 x BODILY INJURY (Per pe6on) BODILY INJURY (Per accident) x PROPERTY DAMAGE $ A UMBRELLA LIAB EXCESS LIAB X I occun_l "*,"r-"oo, FFX200453401 0t31t2012011311201/EACH OCCURRENCE $6.000.000xAGGREGATE$6.000-000 DED I RETENTION$$ WORKERS COMPENSATION AND EMPLOYERS' LtABtLtTY Y ' NANY PROPRIETORyPARTNEFyEXECUTIVE r-OFFICEFUMEMBER EXCLUDED? (Mandatory In NH) lfyes, desdibe under DESCRIPTION oF OPEMTIONS below N/A IWCSTATU- I IOTH.I fhDw r rirrTc I IED E.L. EACH ACCIDENT $ E.L, OISEASE - EA EMPLOYEI$ E.L. DISEASE - POLICY LIMIT $ A A Pollution Professional Liab ECP200453301 EGP200453301 10t31t2012 10t31t2012 01131/,2011 01t31t20u $1,000,000 $5,000 Ded. $1,000,000 $5,000 Ded. DESCRIPTION OF OPERATIONS I LOCATIONS , VEHICLES (Attach ACORD '101, Additional Remarks Schedule, if morc sp6ce is rcquircd) RE: Operations of the Named Insured. CERT!FICATE HOLDER CANCELLATION City of Rexburg Building Dept. 35 North 1st East Rexburg, lD 83440 SHOULD ANY OF THE ABOVE DESCRTBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ltu @ 1988-2010 ACORD CORPORATION. All rights reserved. AGORD 25 (2010/0s) 1 of 1#s1 077008/M1 077001 The ACORD name and logo are registered marks of ACORD cxc00 oI (-rl o(-fs, b\i lr F?!oS 9i Ft.TJIsE$a H> =8,ziioY=F mrZzzulct= .-l-lF il= =?t=o :i7 IEffm-{ul f,Br n =oz \ o o- Q no n AJ o f, \ o(o AJ = t/) (/) no (o o) t* F- E $ *E fz E = E EFt S= $ f;g ei = E d=i=A!irs s.E =: gE =4\l =-3e 6= = s= EF\FE=n;= = == = = (\. oo g- 9n ge H - tF: |s5+i= ?e x F 8ES EEg ?6 E ." re a E=a aZ =Eda '\ 24 =E !+TIx =i ?= 0 *oil ne Eil ;!3 { O O};O 11 Tl ,nfr=_ Ea E6ry =e 256 =q na= lt E<fnHm-r Jn 62 y,r, i2 3 =H 'l sH = t?t Fr 3IiEI-t Client#:@'/3 5':3q 1313s8 VIKIAUTO2 ACORD,"CERTIFICATE OF LIABILITY INSURANGE DATE (MM/DD/YYYY) 1t28t2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGAT]VELY 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 CERTIF]CATE HOLDER. IMPORTANT: lf the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. lf SUBROGATION lS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Propel Insurance Portland Commercial lnsurance 888 SW Sth Avenue, Suite 1170 Portland. OR 97 204-2025 ixffii"' GrystalCummins lll8.Nr,rEo. e,o, 503 467-7563 | 1fi6. ro,, 866 577-1326 . c-c@propelinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # rNsuRER A . Nautilus Insurance Company INSURED Viking Automatic Sprinkler Co 3245 NW Front Ave Portland, OR 97210 TNSURER B . Gontinental Insurance Company INSURER C : INSURER D r INSURER E : INSTJRER F : COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVEBEENISSUED TOTHE INSURED NAMEDABOVE FORTHE POLICYPERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITIONOF ANY CONTRACTOR 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. LIM]TS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSF-TR TYPE OF INSURANCE NSR n rVD POLICY NUMBER LIMITS A GENERAL LIABILITY Tl "o""a*",o. GENE*oL LrABlLrrY-----f----l | | cr-rrrvrs-r,,raoe I Xl occun xl BUPD Ded:5,ooo ECP200453302 ,113',U201401t31t201tEACH OCCURRENCE s1.000.000 IENTEDI occurre s100,000 MED EXP (Any one p€rson)s5,000 PERSONAL & ADV INJURY s1.000.000 xl wa Stop Gap GENERAL AGGREGATE s2.000.000 GEN'L AGGREGATE LIMIT APPLIES PER:-l ro,-,." lllfg [-1.o" PRODUCTS - COMP/OP AGG s2.000.000 B AU'] T T .OMOBILE LIABILITY ANY AUTO ALL owNED f--l SGHEDULED AUTOS [--J AUTOSI v I NON-OWNEDHTRED Auros lll_l nuros tl 5090740364 t1t31t20140'U311201t(.;OMtsINED SINGLI LIMI fEe accident)1,000,000 BODILY INJURY (Per person) BODILY I NJURY (Per accident) PROPERTY DAMAGE $ A UMBRELLA LIAB EXCESS LIAB x OCCUR CLAIMS-MADE FFX2004s3402 tlt31t20140113'U201tEACH OCCURRENCE s6.000.000 x AGGREGATE $6.000.000 oeo I I Rerertror.r$$ WORKERS COMPENSATION AND EMPLOYERS'LrABrLrTY Y/ NANY PROPRIETO FVPARTNER/EXEC UTIVE T------.IOFFICERII.,IEI"4BSR =X'LUDED? I i (Mandatory in NH) lf yes, describe under DESCRIPTION OF OPEMTIONS bebw N ,r _a- lwc STATU- I loTr-fITORY LIMITS I IER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE E-L- DISEASE - POLICY LIMIT A A Pollution Professional Liab ECP200453302 ECP200453302 t113112014 t1t31t2014 01t31t201 01t31t201 $1,000,000 $5,000 Ded $1,000,000 $5,000 Ded DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, AdditionalRemrks Schedule, if more space is required) RE: Operations of the Named Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOREcity of Rexburg Building Dept. | ;;i;-;lilRAnoN DArE THEREoF, NoncE wrLL BE DELTvERED rN 35 North lst East I ACCORDANCE WITH THE POLTCY PROVTSTONS. Rexburg, lD 83440 AUTHORIZED REPRESENTATIVE ,l*. @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 #s13 1 of 1 The ACORD name and logo are registered marks of ACORD IITY CF RT:TIIUF:$ Frliir Bi': tJitill{fi *UTilHfif i[ 5F'F;ii'l]iLft: iiAT[:13,ji4,ili t'1[ ,i1'J:4/[liTR 'iiHi:1trriflrl? RiiEiPT i'it; i.l.S?i? EEF Nfi: 54?41 44 fiRt 'n[t''i FIF:E t'[F:HlT ll]["Lrx .G uttity Date: 1212412013 ReceiPt #: 670 lH[*i Ali[ui;T r'*iiitllT Ltil-lttriL FrRiilT |t13 [013i Tfiftllli Tilii Aiilr |lAut A i{I[r iiAY ifiil . sr lffi "[[U "UU Viking Automatic Sprinkler Annual Certification Permit #: 13-00536 Permit Type: rtnesAFEw Address: tification Please contact the Building Department at (208137 2-2341 f or fu rther q uestio n s about th is receipt 1732320 DEC 2 4 2013 ctTY oF-REXqUBG 24 Hour Notice for insPections Gall inspection hotline at (2081372-2344 ***Cred1 card payments are accepted, but are subject lo a 3o/o convenience fee on payment amounts over $500***