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Home My WebLink AboutRECEIPTS - 07-00087 - Nelson Fire Systems - Fire Safety CertificationAF -=X1 REXBURG City of Rexburg De part m e nt Of CC M M Ur to i,y Dewe lopm e nt Receipt Nurrber, 07-0116 19 E Main St.. / Rexburg, 1D. 83440 Phone (208) 359-3020 / Fax (208) 359-3022 Receipt Date: 03105/2007 Cashier:JANELLH . . . . . . . . . . . . . . . . . . . . - Payer/Payee Name: NELSON FIRE SYSTEMS 0700087 Re ce ipt # Receipt Date Paym e nt Check Method Number CHECK 8317 Base Fire Fee Total: ................... ............ .. Previous Paymenf History Total CITy QF FJEXBURG $0.00 genprTtrreceipts Page 1 of I iig f � SCOTTSDALE INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL DECLARATIONS Policy No. CLs i 2 5 1 5 s 5 Effective Date Named Insured 06I'01f2006 12-.01 A.M.; Standard Time NELSON FIRE SYSTEMS Agent No., 4.2 0 0 Item 1. Limits af Insurance Coverage Aggregate Limits of Liability Coverage A - Bodily Injury and Property Damage Liability Damage to Premises Rented to You Limit ,r - Personal and Advertising Injury Liability Coverage C - Medical Payments Item 2. DescriptiDn of Business Form of Business: Limit of Liabilfty Products/Completeci � 21000,000 Operations Aggregate General Aggregate (other than $ 2 , o 0 0 , o o 0 Products /Completed Operations) � any one occurrence subject to the Products/Completed Operations and Genera! $ 1 , o 0 a , o 0 o Aggregate Limits of Liability any one premises subject to the Coverage A occurrence and the General Aggregate Limits � 1-00 , 000 of Liability any one personDr organization subject to the general Aggregate $ 1 , 0 a 0 , 0 0 a Limits of Liability any one person subject to the Coverage ►A occurrence and $ 5.r 000 the General Aggregate Limits 0 individual Cl Partnership El Joint Venture El' Trust El Limited Liability Company L3 Organizationinclud'ing a corporation (other than Partnership., Joint Venture or Limed Liability Company) Location of ASI Premises You Own., Rent or Occupy: 1471 SOUTH MAJOR STREET, SALT LAKE CITY, TJT 84115 [tem 3. Forms and Endorsements _ E Forms} and E nd o rseme nt (s) made a part of this policy at time of issue: i See Schedule of Farms and Endorsements item 4. Premiums Coverage Part premium: 18,417 Other Premium: Total Premium: $ 18,417 i HESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD. CLS -SD -1 L (8-01) I !ateU.aidD c 1 s F i l e F � COMMON POLICY DECLARATIONS = NEW SCOTTSDALE INSURANCE COMPANY Home Office: One Nationwide Plaza • Columbus. Ohio 43275 -- - -�---- - Administrative office: 8877 North Gainey Center Drive • Scottsdale, Arizona 85258 1-800-423-7675 A STACK COMPANY ITEM 1. Named insured and Mailin NELSON FIRE SYSTEMS 1471 SOUTH MAJOR STREET SALT LAKE C I TY , UT 8 4 115 Agent Name and Address BURNS & WILCOX, LTD. Address Policy Number CLS! 251556 t Ve k14 0 T I DE T HM S P .1, L Y CC) Nto TA e �'J S A}EARHED�U'm PP.0V1E`?1iG[C READ YOUR POUCY. EAST COTTONWOOD PARKWAY SUITE SOO fit No. 4 Program No.. NONE SALT LAKE CITY f 1 1 ITEM 2- Poli PeriodFrom-F 0 1 2006: /01/2 7 Term: 365 DAYS 12:01 .Vit, Standard Time at your mailing address.. Business Description. FARE ALARM INSTALLATTdN In return for the payment of the premium, and subject to all the terms of this policy, we agree with you. to provide the insurance as stated in this policy. This policy consists of the folkowEng coverage parts for which a premium is indicated. Where no premium is shown, there is no coverage. This premium may be subject to adjustment. Coverage Part(s) Commercial General Liability Coverage Part Commercial Property Coverage Part Commercial Crime Coverage Part Commercial Inland Marine Coverage Part Commercial Auto (Business Auto or Truckers) Coverage Part Commercial Garage Coverage Part Professional Liability Coverage Part pofivy dons : * how a =n!*01VZtra ofsh6, to do UL'I f-ZL I r, h63 P -to aftd Zhu a is } !V P. V =1 b j k• rep gra oq b y die Uta: �" gi n . % n l� cwrt from any of 9 91 Premium 18,417 NOT COVERED T COVERED NOT COVERED T COVERED NOS COVERED $ NOT COVERED M Total Policy Premium: $ 1.8 1 417. OD *POLICY F8S0.00 *INSPECTION FEE $ -L-FITI FEE SURPLUS LINES TAX Forms} and Endorsement(s) made a dart of this policy at time of issue'. SEE SCHEDULE OF FORMS AND ENDORSEMENTS STAMPING TAX $ 822..25 TOTAL _ j 242. 62 T TAH SURPLUS LINES TAXES L FEES FILED BY:---'- 8URN5 a WILCOX, LTD `FULLY EARNED RK/VW 07%07I06 SALT LAKE CITY UT THIS COMMON POLICY DECLARATION AND THE SUPPLEMENTAL. DECLARATION(S), TOGETHER WITH THE COMMON POLICY CON DITlONS,.COVERAGE PART{S}, COVERAGE FORM(S) AND FARMS AND ENDORSEMENTS. IF ANY, COMPLETE THE ABOVE NUMBERED PaLIGN"- OPS-0-1 (12-00) INSURED opsd1h,fap DECLARATIONS EXCESS LIABILITY POLICY XLS0028551 SCOTTSDALE INSURANCE COMPANY ° Renewal of Number Home office: One Nationwide Piaza - Columbus, Shia 43215 Administrative Office: 8677 North Gainey Center Drive - Scottsdale, Arizona 85258 1-800-423-7675 A STOCK COMPANY [TENI I. NAMED INSURED AND MAILING ADDRESS NELSON FIRE SYS'T'EMS 1481 S4LT'IiH MAJOR ST SALT LAKE CITY UT 8-4115 Policy Number XLS0034975 AGENT NAME AND ADDRESS SUFZNS & WILCOX LTD 2855 E COTTONWOOD STS 500 SALT LAKE CITY UT 84121-7145 NOTICE:THIS POUCY COw, 0 A MINIMUM EARNED rr;-'S-41k4W2'M1UM MOV-1810fle READYOURPOUCY, Agent No. 43701 Program No. ITEM 2. POLICY PERIOD From; 46-01—D6 To: 05--01-07 12:0' A.M. Standard Time at your mailing address. ITEM 3. THE FAMED INSURED IS -1 CORPC7RATION ITEM 4. LIMIT OF INSURANCE: A. Each Occurrence or Accident......................................................o.o,....,...... $ 5_f 000 , 000 ■ ■ ■ ■ ■ ' ■ r ■ v r i • 4 ir a !� E3., Annual Aggregate where applicable ■■■.....*.■rr■■......a■■vr fEM 5. SCHEDULE OF UNDERLYING INSURANCE; See Schedule of Underlying Insurance ITEM 6. PREMIUM MPUTATJ I r Flat Premi"Um ■ a o ■ ■ ■ ■ ■ °r # i f # q ■ s ■ ■ a ■ ■ ■ ■ ■ o ■ o ■ v 8 ■ i ■ ■ r ■ ■ ■ ■ ■ ■ ■ o ■ ■ # ! F ■ ■ ■ ! ! ■ ' r i r r ■ ■ v ■ ■ a t i i f F # ii • 4 a ■ a ■ ■ ■ ■ r 7 F 0 2 8 Subject to Adjustment: Estimated Deposit PremiumR°iF :f errrnaa■iism■oo■s■■■ *�!■�■■t■■i ■■'r■ ■sr■m■■ate*#■F F+a■ao-■m■ ■ Estimated Exposure Base: Ratio: Per: 4 L Policy i I u m Premium ■ . . m s r . s s ■ ■ . ! s ■ . • . m a f W F s a ■ ■ .■ a ■ ■ u ■ o- � ■ ■ 'i i � 11 �F � • +F f ■ ■ �F ■ !■ ! r r ■ ■ ■ ■, 5 i ■ ■ ■ ■• i i i f ! � f 4 F Audit Period: ITEM 7. ENDORSEMENTS ATTACHED TO THE POLICY AT INCEPTION: �Olicy Fee: Com-pany/Markel Fee -0 $ Inspection Fee: $ Fillin.9 Fee: P :X,,"2=a Surplus Lines Tax: $ jtpanqoing fax: � .4 'Fully Earned Surplus Lines taxes filed by49: gxu.Al!-, * Nilt�. #' not & ft &gf Wit*#roptftfta by dui * Th4 p2GW rbc plo *1 1 the ABU' r.."IE L I TIOILS WITH THE COVERAGE FORM D r-1-1. Ef EFTS, IF ANY, COMPLETE THE ABOVE NUMBERED POLICY. L -D-1 (12-00) Insured Copy