HomeMy WebLinkAboutALL DOCS - 14-00583 - Viking Automatic Sprinkler Coot
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fexburg" ln 83410
Rexburg -Modison Counfy
www^rex*ursf.org
fnergency Servlc*r
Fhone: ?$8"313.134 I
F<:x; ?08.359.302?
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PERMIT#:
S100 Fee P*id: flYesff F,Io Fermit;{pproved: flYes fl wo
BYr D*.te:
-',,{ .r'4li'$r .y$tw ttd:ifi*ztiotx p*rTtlit is wqwircd ta ixtall, wodi$, rx*itzlain, or *rvire all pew *adarxlirgfrr
rr"vs*gvisleryf.r* nglstzssim gr.rlc;ra4fiy a/*nx gr&ru4 and *t|:er li/t srg*g gshm witbin tbr Cig' af llexbxrg"
FUsrNEss NAtrrEr V&ing Automatic $prinklql Co, . .rur**1,
oFFrcE Annpss$, t2 E. Bower St. - M*ridian, *D 83S42
SFFICE pHor\{E NU1*,raER. (208) B&S-37S2
66NTACT FER$6N: Larren Bailey, GM CELL pHONg gr {20E} 89&9a03
PLEASE INENTTFY SYSTSMS TO SE CO\IERNI} BY THIS FERMIT. CHECKALL
THAT APPLY.
fJ FIRA AI-ARM SYSTAMS - Alarm Conuacr*r* shall h*r-e a mhrntelu oll-IICST Level 1
(lcrri fi cations or cttuiyalcnr
"t'pLSASLi PROVIDH CHRTIFICATION$:
T NICF:T Ccrtificauon
*Par:el Csrtific*tion
$Proof of l.iability Insurance
E *utom*xlc $FKINr{T.Ir.R $Ir$TpMs - Fire sprinkler con*actnrs sh*ll have arninirnurn .,' **$mi # ffiiffi ffixff#fffi Ln r,
*l,iICST Certification
*I. An;* &rldi tjonal fl ertifi catir:n s
*Prn*f *f Liabilitv l*surance
f] rrRn EXTrNcursHERs
.i'Proor of (lcrrifrcadon & l"raining
fl euronmtlc FIRE Ex?rNGUrsHrNc $y$raM$ Fon c$MMaRcrAL
COOKING
.:'Pr..f .f training fi.,r commcrcial cooking heads
mtl
STANNFIFE SY$TE}f$
SMOKE CCINTROL SYSTEMS
El spscrAl HAzARD sYsrxus
EI plne PUMps
*irilry{.trA{tr Y&.CIYID& -OOC0rrU&JVfA flf$jf CIf' ?:nrUhlnfc LETI&I*S,
]hTSfldTIiT M ON CBA TIFI CATION S, IJABILTTY INSU&.AT{ CE, ETC. FAR'g"T
l?f$prj?ue',f***
Br,]$n{sss $Ar}rsr Mking Autpmatis $prinkter Qr,
FLF-ISN LIST .*LL COIdFA}{IES Y$UR BU$INFSS IS AUT}TO*IEEN TO
REPRESENT:
FHONE #r
FI,IONE #:
FHONE #:
FHONF #:
PHT}NE #;
PHONF #:
FHONH #r
FHSNE #:
FHONF #:
CCIMPANY NAJbIET
COMPAFTY NAJ}IE:
COMPAI{YNAIf{Sr
COMPANYHAME:
COMPANYNAME:
COMPA}IY I"{AME:
COMPAI"{Y I{AI}IS:
COMPAIIIYNAME:
COIi{PAT{YNAME:
I certi&' dr*r I hEte read tbi* appliradon tnd deel*rE rmdatpen*trty of geriury tbat tht infor*adon corlaiued
h*tein ie co*rest and complrte. I agree to uunpty witb dl ctty ordin*ncc*, *d*rpted *ede*, *nd *tatt l*v.*
reloting ro *re lnstsllation, rnodification, rervice, a*rd m*inrceran*e of ngw cnd cxC*ting life safety ry*terns" I
hereby authodxe tepresentativc* bf tr';e qit to iaqrc€r any wor& fot norapll*n* parpoeea. I xm sither the
,y'contractnt'r futt lmowltdgs tr corracrt"
Larren Bailey, GM
PRINT NAME OF APPLICS}{T
December g, 2014
DATEpERe[rT vALrI] {}NTIL nACEMSSX,31 CIF ?HE CALSNDARTCEAS Appugn FSR.
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Cllentf:',3t35S
CERTIFICATE OF
VIKIAUTOT
LI.ABILITY INSURI\NCE
rnre csnrrnd*rE l$ ls$uEo As * mArrEn sF tNForu$ATtoN {tf'aly AXo cOilFsR$ tilo RlctlTs iJPt}t{ Tt{E CERTIr'ICATE HoLtER. ll{ls
CSRTIFICATE DO6S NOT AFFIR$ATIV€LY SR NSGATIVELY AII€ND, gXTEilN OR ALTER THE COVcRAGE AFFORP€D BY TT}E POLICIES
EELOW. TH|S CEftTIF|CATE Or ${SURAHCE OOE$ HOT CONgTnUIfiA SONTnACT EETWEEN T}lg 'S8U|H0lNgURrR{S}, AUTHORIZES
R€PRF$SilTATIVE OR PROOUCSN, AiID THE E€RTIFIOATE HgLOgR.
iilipdiitAiiiY;'K*rii"i*Xiriiiiri"6idA;&$ #AiifriTAilAr igsu-nHiliiGpoi$yiffii must.ffi-#rHXil;F3ilEnoeaiioli is Wxvrn.suu,*it to
the terme snd $ondilions of the policy, Gsrtsin pslicl€a may tGqulrp sn endorsemant A strtam6nt cr lhie carlificato do.s not confor rights to tht
certilicate holder in lieu of such andorsement{s).
pRooucen
Propel Insurance
Portland Commercial Insurance
SSS $W $th AvenuG. $uite ll70
Portlandn OR 97104-?025
Viking Automatic Sprinkler Co
3?45 NW Frnnt Ave
Portland, OR S72t8
*w*rge:.W$*rl:s
CT}VERAGES CERTIFTCATE H1'!'8SRI
?rrisisrr:ceRTlFYn*rrltnvgere[issuentorne|NsUREDNAMEoABovEFoRT|.|EP0L|cYFER|oD
INPICATES, NOTWiTHSTANDIN$ ANY RE&|JIRSMEI*1. TERM OR CONDITION OF ANY fOilTRACT 6R OTHER DOCUMF}IT WITH RFSPECT TO WI{IC*i TFII$
SEftTIFICATc MAY tsE ISSUSO OR MAY FSRTAIN, TH€ ILISURANCE AFFOROEN BY THfi FOUCIE$ OSSCNBE|} II*REIN I$ SUSJCCT T& ALL THE T€NMS.
EXcLUstoNS ANO C0Nnfflotlt$ OF $UCH FSLISIEE. LIMIT$ $HA!ilX MAY i{AVE &EEht REOUCE! EY FAID CLAI[d$'
rlp€ ss tlr*uRANcE ADoiisuBiii"-"""'..",t**niwvnj..** PcllcYr$rn'BEt
'3lnol4lol,3ln0'l
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r***n,.r.r-.-..*...""""..,".........".'"^^'*
i *1.000.000
8&OlrY lHJl,tRY tpsrcddslt) i S
A aEhERAL LIASILIfi
s*N"t AGGRSGATE lr[{'r AFPLIdS pfril
.. . "*u* i xl:f"q i---l'o"
Au?QuoEltc uAalilTY
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i FFX:$g{$3482
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: trloRl{EES CoSP€f{SATlOfi
ANDS*IPLOYERS',LIAEILITY Y/NANV OROPRIETOfu PARTNER/EXECUTlVE .-
tsFFrsEaJM0MlegExfl,uFnp? l(i andstory in hH)
lf ws, d*ssibe iJsdcr
_*-. : siqsgRlprrot'r of p-tiS4IQNg|-$"19.w .-......*
A iPollution
A :Professional Liab
r1
itrAl
-. .."""-.i - "**-*-,j-e&"*:s{$5::gJPL!lHI-i3-/3014i 0{t3ltr0{q $1,S$0,S$0 $5,000 Oed
nu4iartet,itgr E t{,000,01}0 s5,s00 oed
MED g)(P {Arv orP
J PERSOFIAL & ACld '}IJURY
S€HERAL AGGflESATF
ts.rlr0r,{ I 01rslrlot q3fc$Rsrgf$Etysg.'..*.,
o€ScRtpTtoN ot oPE&.t.TtSl{S t tOCATtOilg ' VEil|eLE$ {Anect! A$CRo 101, adddord Rrm#l{n 6rlrs&rh,lf mffi }pffi13 f*q{htd}
B6: Operations of the N*r*ed In*ured.
Bfvt$loftl NUMBERI
SHOULP IT,IY QF THE ASOVE OEEGtrAgD POI.ICIES EE C*NCELLED SEFORE
Tl{E EXPIRAT}AH OATS Tt{g*gOF, ttlSTIC€ ttlLL Af, ggUVrRgD lN
AccgRoAXcE lf{lrH THe FoucY pno\naloi{s.
City of Rexburg Bulldlng Oept"
35 North 'lst East
Rexburg, lD 83448
e {9S8-2010 ACORD CORPOFATIOfi' All rights rossrved"
ACORD ?5 {301010s} { of I
#$1314S83/Ml 3',t4S43
The ACORO name and logo ars r€*i$tered madcr of A€ORD cxc0$
.\
.T
Ity
Date: 1213012014
Receipt #: 3616.: ' ;:i: :..', .:.i,.. ...'.
i-.j;.- i.ri li:':.lili,t :
r:i initirrr::
',..'i,:.- i :l .:i;::-,:..'::.'i:
..: ..:,. .-.
f.i! ! -i'.i , '.i| i: - i: :
P,_rojectl
eOar.si
Please contact the Building Department at
(208)372-2341 for further questions about this
receipt
Viking Automatic Sprinkler Co.Perry.qi! # :, ri-oosp,!.
Pgrmit Typ.e :: FIEE.9AFETy
100.00
trAI D
DEC3ol'' i
-.: : -*-- -clw oF RqxfiuLG i
24 Hour Notice for inspections
Call 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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