HomeMy WebLinkAboutALL DOCS - 14-00001 - Delta Fire Systems Annual Certificationoo
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35N ldE
Rexburg, lD 83440
Rexburg -Modison Counly
www.rexburg,org
Emergency Services
Phone: 208.372.2341
Fox: 208.359.3022
CITY OT
REXBURG
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Ant tict's I'ami \ Lu t]tt | | ili ry
PERMIT#i ,t
$100 Fee Paid: fl Yes ! No Permit Approved: Z[y.r ! No
BY:Date:
"A toftA rystum certfication perrnit is required to install, nodfii, maintain, or service all new and exi$ingfre
extingaishtrc, fre suppresion gtilemL fre alarzn slstems, and other ltrt tortU slstens within the Ciry of fuxburg"
BUSINESS NAME: DELTA FIRE SYSTEMS, tNC. - DBA: 3-D F|RE pRorEcTtoN pur".1, N/A
oFFrcE ADDRESS. PO BOX 26587, SALT LAKE CITY, UT 84126-0587
oFFrcE pHoNE NUMBER: (801) 972-4500
CONTACT pERSON: LADAUN M|TCHELL, TREASURER CELL pHONE #. (801) 972-4500
PLEASE IDENTIFY SYSTEMS TO BE COVERED BY THIS PERMIT- CHECK ALL
THAT APPLY.
n ftng AI-ARM SYSTEMS - Alarm Conrractors shall have a minimum of NICET Level 1
Certifications or equivalent.
*PLEASE, PROVIDE, CERTIFICATIONS :
*NICET Certification
*Panel Certification
.i.Proof of Liability Insurance
E AUTOUATIC SPRINKLER SYSTEMS - Fire Sprinkler Contracrors shall have a
minimum of NICET Level III Cerufications or equivalent.
*PLEASE PROVIDE CE,RTIFICATIONS:
*NICET Certification
{. Any Additional Certifi cations
*Proof of Liability Insurance
I r'rnB EXTTNGUTsHERS
.l.Proof of Certification & Training
E eutouATrc FIRE EXTTNGUISHING sysrEMS FoR coMMERcTAL
COOKING
*Proof of training for commercial cooking heads
an STANDPIPE SYSTEMS
SMOKE CONTROL SYSTEMS
El spncnr HAZARD SYSTEMS
E prnp PUMPs
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--^'ORD.GERTIFICATE OF LIABILITY INSURANCE DATE (XilIDO/VYYY)
12122f2013 t
THIS CERTIFTCATE lS ISSUED AS A IIATTER OF titFORilATtOt{ Oi{LY AND CONFERS t{O RtcHTS UPOil THE CERnFTCATE HOLOER. TH|S
CERNFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTENO OR ALTER THE COVERAGE AFFORDED BY THE POLIC]ES
BELOW. lHlS CERTIFTCATE OF TNSURANCE DOES NOT COiTSTTTUTE A CONTRACT BETWEEN THE lSSUrilc |i{SURER(S}, AUTHORTZED
REPRESENTATIVE OR PRODUCER, AI{D THE CERTIFICATE HOLDER.
ItPORtAt{T: It tho catlltlcale holder ls an ADDltlOl{AL INSURED, the pollcy(les) mult be endorlod. lf SUBROGAIION lS WAIVED, lulgject to
the terms and conditlons of tho pollcy, certaln pollcior may nrqulre an endor3emenl. A statemont on thlE certlflcato does not Gonfer rlghtr to the
certlflcate holder ln llou of such endoBomonl(sl.
PROOUCER
Marsh USA hc.
333 Sd,h 7lh Stset Suite 1400
Minneaodis, MN 55402-2400
02203&UPLOA-CAWX-13.14 DELTA OELTA
agntA9 |
llAflE: -
?HOI{E I FAIaAJC. Io. Eril: I lArC. llol:E.I||AILAOORESS:
, __ J!9!EFE(!I 4EloeD_I!c. qglyE8^c-E
. ACE Am€.ican In$rance Company[SlteEP
NAIC I
t2661
II{3UREDoelta Fire Systems, Inc.
1 507 Solth Pioneer Roed
Sall Lake Cily, UT 8410,1
ACE Property And Casualty lm Co 20699
lfsgR_ER E_:
Iil!|UNER F :
NUMBER:cHt-004292935-06
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE
|NDICATED. NOTWITHSTANDTNG ANY REQUTREMENT. TERM OR COND|TTON OF ANY CONTRACT OR OTHER DOCUMENT wtTH RESPECT TO wHlqH rHtS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIEED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSTONS ANO CONOITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
GENERAL LIAALITY
CLA|MS-MADE Fl o""r*
CONTRACTUAL LIA8.
GENL AGGREGATE UMITAPPLIES PER
ANY AUTO
ALLowNEo l -'lscxeouleo
AUTOS L_J AUTOS
I Y I NON-OWNEDHIREoAUToS | ^-l nUrOs
:omp$r000 i X lco[$t000
EODILV INJURY (Per percm)
AIDEf,PLOYERS.LIAS|LITY Y'ilANV PROPRIETOR/PARTNER/EXECUTIVE T::--IoFFTCERMEMBEREXCLUoED? | N I(ltrnd.lory ln ilHl
lf ves- dastu xndet
OESGR|PnOil OF OPEnATIONS, LOCATIOI{S ,VGHICLES (Altrch ACOnO loi, AddltloNl R.m.rlc &hrdul., It mc .pre lr Equlnd)
Veritioation ol insuranoe
SHOULD AI{Y OF THE ABOVE DESCRIEED PiOLIC|ES AE CAI{CELLED bEFORE
THE EXPIRATOI'I DATE IHEREOF, NOTICE wlLL 8E DELfVERED IN
ACCORDANCE WITH IHE POLICY PROVISIOIiIS,
of t nh USA lnc,
Manashi Mukherjee -.lr(alr.aor* -Ste 'al. i-or-
@ tgEE-20t0 ACORD CORPORAION. All rights n$orvod.
The ACORD name and logo are roglltered mark ot ACORDACORD 2s (2010/05)
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Date: 0110212014
ReceiPt #: 676r fiF:[ iifFT fl[i FiftiiiT
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Project:
Address:
Delta Fire Systems Annual
Certification
1732320
14-00001
FIRESAFETY
ertification
Please contact the Building Department at
(208)37 2-234 1 for fu rthe r q u estions a bout th is
receipt
$100.00
clrY oF RFxaungi
24Hour Notice for inspections
Gall inspection hotline at
(2081372-2344
***Credit card payments are accepted, but are subject to a 3o/o convenience fee on payment amounts over $500'**
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