Loading...
HomeMy WebLinkAbout10-11100 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780 -0020 11100 BUILDING PERMIT Permit Number: 11100 Address: 7921 GALL BLVD Permit Type: TEMPORARY SALES ZEPHYRHILLS, FL. Class of Work: SPECIAL EVENT Township: Range: Book: Proposed Use: COMMERCIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 34- 25 -21- 0010 - 00100 -0010 Improv. Cost: Date Issued: 11/03/2010 Name: LOWES HOME CENTER Total Fees: 154.40 Address: 7921 GALL BLVD Amount Paid: 154.40 ZEPHYRHILLS, FL. 33542 Date Paid: 11/03/2010 Phone: Work Desc: TEMPORARY SALE- CHRISTMAS TREE- 11 -15 -10 THRU 12 -14 -10 (30 DAYS) AL -- r e rke 1-•ts 56.06 LIN R ROGERS ELECTRICAL TEMPORARY SALES 1( " Z- '0 5.00 TEMPORARY SALES 28.00 CONTRACTOR CERTIFICATE 30.00 t1 sr, I ELECTRICAL FINAL REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection trips are necessary due to any one of the following reasons: a) wrong address b) condemned work resulting from faulty construction c) repairs or corrections not made when inspections called d) work not ready for inspection when called e) permit not posted on job site f) plans not at job site g) work not accessible. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management, state agencies or federal agencies. The payment of inspection fees shall be made before any further permits will be issued to the person owning same "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your property. If you intend to obtain financing, consult with your lender or an attorney before recording your notice of commencement." r 4 1 N 111 OR SIGNATURE PERMIT OFFI 'R MIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER -/0 I I Temworay Sales Checklist �`` /� V �l 'City of Zephyrhills 5335 8 Street CA 5 2ephyrhills,'Fl. 33542 Phone: 813 -780 -0020 / Fax: 813= 780 -0021 9 - REQUIREMENTS ��Detailed Plot Plan showing setup of location. Refer to Ord 1038 -09, Sec 5 Notarized letter from property owner stating their approval. t.� flame retardant certificate is required IF a tent is involved. Inspection required once tent is erected and prior to opening for business. Approved certified fire extinguishers per NFPA 10. Cj(,�e5 No Smoking signs must be placed outside entrances. to wT--- IF there is a wire fence or chain link fencing must have at least 5 Ft setback from tent and at least 2 mss. IF tent has sides, the sides shall be in the up position unless there is inclement weather, then 2 sides must be in the up position. FIREWORK REQUIREMENTS - (In addition to the above) 4' Proof of State License. 00 ,s Ov�crc Proof of Liability insurance. Sly'' gS�/ � 4' S ! v 1Rti ' / o � 4i List of items to be sold at site. S�1 NI `LR �tl. i Copy of Drivers License and Social Security Nuroileritit all • - on ekr A g with the sale of fireworks at the tent location. -�+�" '...- FEEs $ 30.00 - City Registration (If Regulated by DBPR - Fee is Waived) $500.00 - Fireworks fee - Fire Department fee $ 5.00 - Temporary Sales Fee for l two days $ 1.00 - Temporary Sales Fee per day for each consecutive day thereafter, not to exceed duration of 7 consecutive days and no more than two occurrences S to during a 12 month period on same property Ord #1038 - 09, Sec 6 $ 50.00 - Tent Fee (40.00/BD, 15.00 * /FD) -( *$15.00 w aived for Fireworks) i a - - -_ i . ___ _ fi t ' $40.00- Elecfncal Fee cif appfica�ble) ) 6 ± - � , Property Owner: _. /5 �IY/�7 5 G /�,�jL Applicant: ,13. ( C- Url Sr S Zn C 44 fly B r' -1Jt.+., Phone Contact: 2' 3- 3'' = ( C4'1-z'/ - D,v Address Site: l.4I 1 v - ral �- , � 2 J �i Y11,r 1 sC(� 3 3sy / Date(s) of Sale: 1 // -/5- 44 rt/i /Z /J - / Ordinance No. 1038 -09 (for additional requirements) Zephyrhills Fire Rescue 6907 Dairy Road, Zephyrhills, FL 33542 Fire Marshal Bus (813) 780 -0041 Kerry Barnett Fax (813) 780 -0044 E -mail: kbarnett @fre.zephyrhills.fl.us Plan Review #: 10 -125 Project: Tent Installation Number of Pages: Packet October 25, 2010 I have received and reviewed the packet for the tent installation located at 7921 Gall Blvd and will allow the project to move forward. Please note that this review does not eliminate any further requirements as the project continues moving forward. By receiving permit, contractor acknowledges to comply with the items listed below. Should anyone have any questions, please do not hesitate to contact the Fire Marshal's office. 1. Please follow the attached tent/vendor guidelines. 2. Prior to opening the tent up to the public an inspection shall be conducted by this agency. 3. Ensure the flame retardant certification is on the tent and sidewalls. Inspections Required: 1. Site KERR `n , FIRE MARSHAL ** *Please be advised this review of plans submitted is a cursory review to assist the contractor in compliance with applicable fire safety codes. This review is not intended to be a final approval of the submitted plans. It is the contractor's sole responsibility to ensure that the plans are in complete compliance with all applicable NFPA codes and local ordinances. In the event that further examination or site inspection reveals areas of non - compliance, it shall be the contractor's sole responsibility, at their sole expense to bring those areas in compliance. The City assumes no responsibility for the contractor's failure to be in compliance with all applicable NFPA codes and local ordinances. ZEPHVRHILLS FIRE DEPARTMENT 6907 Dairy Road, Zephyrhills, FL 33542 Fire Chief Keith Williams Bus (813)780 -0041 Fax (813)780 -0044 FIRE SERVICE USER FEES Occupancy No.: Plan No.: /0—/25 Contractor: �'6 -< Business Name: i-/i5 Billing Address: "792 ,gtti__-- Business Address: 7 92/ ice/ Business Phone No.: Billing Phone No.: Business Fax No.: Billing Fax No.: Contact: Contact: PLAN REVIEW FEES _ INSPECTION FEES — PERMIT FEE _ FALSE ALARM FEE _ Site Plan N/C _ Annual N/C _ Sprinkler $50 — 1st Alarm N/C _ Multi Family /Commercial .06 sf _ 1st Re- inspection N/C Standpipes $50 _ 2nd Alarm N/C (Minimum Charge $25.00 — 2nd Re- inspection $100 _` Fire Pump $50 3rd Alarm N/C 0 Plan Revisions DBL _ 3rd Re- inspection $250 _ Hoods $50 4th Alarm $100 _ 4th Re- Inspection $500 _ Fire Alarm $50 — 5th Alarm $150 SPRINKLER SYSTEMS (Business closed until _ LP Gas $50 _ 6th Alarm $200 _ 0 - 25 Heads $50 violations corrected) — Natural Gas $50 _ NON COMPLIANCE $150 26 plus Heads $100 — SPRINKLER SYSTEMS _ Fuel Tanks - per tank 550 STANDPIPE SYSTEM _ Hydro Undergrounds $45 _ Sparklers $100 0 Per Riser $50 _ Hydrostatic Test $65 per system, _ Fire Works $500 FIRE PUMP _ Acceptance Test $45 per system _ Camp Fire $25 El Per Pump $100 _ Hydrant Flow $75 Controlled Bum $100 _ FIRE ALARM SYSTEM Hood /Duct $50 0 - 25 Devices $50 _ FIRE ALARM SYSTEM _ Place of Assembly $50 Annual 26 plus Devices $100 _ System Acceptance $50 — Fire Protection $25 SUPPRESSION SYSTEMS _ Recall Acceptance $50 _ Flammable Application $50 Annual _ Wet 550 — OTHER _ Waste Tire Storage $50 Annual _ Dry $50 — Fire Wall/Smoke Wall $15 per wall — Generator < KW $100 CO2 $50 — LP Gas $25 per tank _ Generator >30 KW 150 _ Other $50 _ Natural Gas $25 per system _ Bio-Hazard Waste $100 Annual KITCHEN EXHAUST _ Fumigation Tenting $50 Hood /Ducts $50 ent 10'x10' or greater $15 per tent Torch PotlApplied $50 OTHER Fire Pump $45 ^ Haz. Materials $100 Annual — ^ LP Installation per tank $50 Fire Suppression $30 Fuel Tank Installation $50 _ System Acceptance (Per Tank) $50 _ Exhaust Hood /Duct $30 0 Natural Gas Installation $50 _ Re- inspection DBL (Per System) (other than annual) ❑ Spray Booth $50 fl Inspection scheduled DBL and cancelled less than _ 24 hours _ Construction Insp. N/C _ Emergency Vehicle Aa $50 FALSE ALARM PLANS TOTAL r INSPECTION TOTAL J PERMIT TOTAL I I TOTAL GRAND TOTAL L Comments: Date: fOOkt Insp red l f �'r, 'rr L E ll s September 23, 2010 To Whom It May Concern: This letter authorized D/Eagle Tent Company to apply for, sign for and pick up permits for a temporary portable tent on behalf of Lowe's Companies store locations for the purpose of selling Christmas trees. The location of these tents will be determined by each store individually. The tents will be set up for the duration of longer than 45 days starting the month of November and ending in the month of December. D/Eagle Tent Company will also be authorized to install the tents on the Lowe's location, as specified by each store. In addition, all customers will have access to the restroom facilities located inside each Lowe's store location. Store Number: 1854 Store Location: Lowe's of Zephyrhills 7921 Gall Blvd Zephyrhills FL33541 -431 County: Pasco Store Manager: Teri Connolly Lowe's Companies will assume all payment charges associated with applying for, signed for, and picked up for permits for temporary tent for Christmas Trees. Sworn to and subscribed before me thisecray of . 2009 by Mike Hacker. Personally known or produce - dentification Type of identification produced t �_ • otar Si_ nature Mike Hacker Regional Sales Director Lowe's Companies, Inc. .... r..7.......,-.-.,... \ 6 b b I 0 0411 AO RIBENI SLOPE ROAD ...AI I ■ h.:, II ilk - maw- 1 0 .4 ti wirimr __._.,___:_=______ ihkx __, - '911•:1 • ,_L. - I — — — X7 R kt 4 ki 40 t't -'. *. 11111101diral N WILIk‘WiWIl a b, ** - Nib' NIL t■ Il 8 _ _ 1 _ \ giira RIONI. im....ttili • ■■■ • ■■■■■■■■■■■■■■•■■1 1 El :101t. - - - - — i I IIIII b1.111 ` - _ ■1■1111Mbalb •■■■ _ rtz 11 , Ell r i 4 q W: 14 I 4 It 8 Oc\ ! g 1 I WI I ''A"'''..--."'''''''''Ila 11111111111rwisinfl 114114441 MI I. • l■ i k C 1 14.1114 : wiltimiNIMPIII Illrill, '11111111°14111 (--- ,, _- ,-----: Ikk '''. _agimin -.....-..;...... /. .. • - , , ' I 4■ 1 . , .. . , . . Emorogni II : .im551.., , . , , i 4 ■ i i . , , - 1 ' I !I ,i 1 1 0 1 11111111111 7 L 0 rinfigv,. i ii 14 f li 1 - _i- , 4 1 . MOINIIIIIIIII 111•11ENSIO alf illp4414 t 1 4 v kihN)h, .D , r.... b I MIN" Pi I I • ‘i g k 41 It 1 AllkAC , 7 f gill ll ---, 2 II ? il l :1 b:11■14 1 ENE 111 1111? gi.,11 ) .D :--./ 0.1t$ 14 i 1 A Eir-7 I_ `II - RI RI It, g f ,1 gp 1 111 - 1 k "tiiP '‘IITTLQUIroillf:EiA002.114 = JILIN , 4:: I I I 1 1 (P IV it Mtl;;:t■L • -- 4 i1Cti 1,, .,,_L ii :*.4---=.Amiuransimgnsp woulsommu ''''' IM,' 4 a I aa 1 i 1_141 P21 Ig w - „ acs , r i °If*. -,,,, MENki v i VI - -- ' - , 6.,..alestm-leVk 41,'• 1 , , A r•-, 11!—V 1 3 ": r..4 ',Jr., J r IV-4 11,1 ; 1 1 1 _____3. -11 3 li - - t Eil _ . _ --- - - ' . -.: 7.F•1 Er I s 2,- i i ._.$141111 . I t- 4 J I': ' iii 144110 VOX*W ' 1113-..:.4 I • '7.1" :18. I T.' ■In tr. y il 1 iii II II I .._.,„, _ _ L _ • - , ik. . 141!rhicl',S411. 1 '0001 / 1 • i li 11 1 ii LIP =mil 1 IMOD _ IINIMIP OMB _ ., A 1114 . !!N:1 1 A 1. .i li i qf ' II lilt 1 ,., ttlim..144 8 ill II 11 li / At 117;:f IOW ; s 3r I t....7 . 11= 1 II I! I I Ili 14 114 Fig _ ALN141 iptii rii , 191 - !r;:i• pip : I -,.... __ _6 _....______L.---"L''' , t i lk ii IN'4 1 0 g V "_ • 1 •' i'•;* I ' - , 1 _ .... • ! iiii 14 11111111 21 s • —‘ _ 1 A. 4 1 r '8' iiiit■SigilillEgini _ 41 -4. AVIIIIININnow -x 4. k i ri ,lisealarissmrim 1 — ' illit Orr 1 _ _____ ___ ?aiiiii.... eigen armr - --f mon - 11."4 MINIM IIIMIEFTIMIgIN ,......= .---- • - - - usufaymkwykorgi BI-M) ) 11 4 ..II --, , -. • - z , I 1 , • di\ ( \ s. 1 I • 11 ,_.__ 1M _ l'opplii ] . $ A N PASCSRE PLAN I ..:' or LOWE'S ENGINEERING AND O ODUNTY , FLORIDA low vat min isuercmo, am 1....., wog avow or ow • meaeo ace. (v) . • (It, MIMM: i: a = 4 ZEPHYRHILLS CON C /: 4' "4'411' -6t4- 'I 1 ii : Ili 6 ,a 3 g .0 a '- Rs : i o °1 t. 0 g CI 2 iv i c CL C 411 a z ae w g Co) v 0 .r E 1 a E E O a) e _ � a 'a g CD CO 0 1 4 0 s E" '� . . .. d i a ci1, 4 ,0 03 a . c e O ' vA r M a * . z m V H 0 co 8 0 N M c� .i *4 i S E 116 0 111.4 i CIT$ 0 '1° 0 F. CO ,C 00 a 2 = ` O V 0 V 2 v) 0 r- a N PO 14•40-1 M 0 y" .2 v C4 2 0. i '44 o,, a w c' i vA .a c°s H a p rn , V 0 • v i .47,4 , e . .9 ° 8 ''- a N I C i o� H 0 •.... — O l id p ' 0 C , ,4 a . w (ti r o A ?b O o) g fin 6 �tA � _ • 'S�fd r 4,,,, = A tD i vr 0 ote 44 4 , . i- .. c cLo p: E a 4 1. 1 s 5 P te" . ' d. 4::: 4tt 1 • 813 -780 -0020 City of Zephyrhills Permit Application Fax- 813- 780 -0021 Building Department • ( \ • Date Received Phone Contact for Permittin � 11 1 y Owners Name L C�l ev v 1� - -L Q Owner Phone Number Owners Address 11.1w ) y E /v f UJ1 twasbev QC Iv $S Owner Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address t ddress { JOB ADDRESS 1C .1 4 1 Ia{VQ1 ZQPk C M \t5 LOT# SUBDIVISION PARCEL I13#1 (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR u ADD /ALT 1 1 SIGN 1 1 n DEMOLISH INSTALL n REPAIR PROPOSED USE 1 1 SFR 1 1 COMM 1 1 OTHER 1 TYPE OF CONSTRUCTION 1 1 BLOCK 1 1 FRAME 1 1 STEEL n 1 DESCRIPTION OF WORK - refine Pow * .r CSok.S4 nNaL3 - 4 4 ste_ 4. Q"4- BUILDING SIZE SQ FOOTAGE HEIGHT (BUILDING $ VALUATION OF TOTAL CONSTRUCTION 1 $ aLi G AMP SERVICE 1 I PROGRESS ENERGY 1 1 W.R.E.C. 1 1PLUMBING $ � � p 1 MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION GAS 1 I ROOFING n SPECIALTY 1 1 OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA []YES NO BUILDER COMPANY SIGNATURE REGISTERED 1 Y / N I FEE CURREN � Y/ Ni Address dd �j License # ELECTRICIAN ` COMPANY Lin g • EE C s YY Con tr. SIGNATURE I /� REGISTERED 1 Y/ N I EE CURREE I 1 N 1 Y/ I N N Address 2050 Marconi Dr, 3k . too, A/plaan ta. GA 3ool'S License # E C 0CCO7 PLUMBER COMPANY SIGNATURE REGISTERED 1 Y/ N 1 FEE CURREN 1 Y/ N 1 Address License # MECHANICAL COMPANY SIGNATURE REGISTERED 1 Y/ N 1 FEE CURREN 1 Y/ N 1 Address License # OTHER COMPANY SIGNATURE REGISTERED 1 Y/ N 1 FEE CURREN 1 Y/ N 1 Address License # 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R -O -W Permit for new construction, Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R -O -W Permit for new construction. Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance SIGN PERMIT Attach (2) sets of Engineered Plans. ** **PROPERTY SURVEY required for all NEW construction. • 1 1 1 • . . • 1 Directions: Fill out application completely. Owner & Contractor sign back of application, notarized If over $2500, a Notice of Commencement is required. (A/C upgrades over $7500) ** Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs if shingles Sewers Service Upgrades A/C Fences (Plot/Survey /Footage) Driveways -Not over Counter if on public roadways.. needs ROW LINRROG -01 AUCH ACORfl CERTIFICATE OF LIABILITY INSURANCE DATE ) 10 /8 2010 PRODUCER (404) 633 -4321 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Yates Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4 Executive Park East, NE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 200 Atlanta, GA 30329 INSURERS AFFORDING COVERAGE NAIC # INSURED Lin R. Rogers Electrical Contractors, Inc. INSURERA Charter Oak Fire Insurance Company 25658 Rogers Electric Service Corporation INSURER B Travelers Property Casualty Co of America 25666 2050 Marconi Dr Suite # 200 INSURER C National Union Fire Ins Co Pittsburgh PA 19445 Alpharetta, GA 30005 INSURER D INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSRD TYPE OF INSURANCE DATE IMM/DD/W MI I DATE 1MDDIYYI GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY VT22KCO5787B539 1/112010 1/1/2011 DAMAGE TO KEN IED PREMISES (Ea occurence) $ 300,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY X x I LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 B X ANY AUTO VTJCAP5787B540 1/112010 1/112011 (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY X NON -OWNED AUTOS (Per accident) X Hired Physical Damage PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 15,000,000 C X OCCUR CLAIMS MADE BE11579455 1/112010 1/112011 AGGREGATE $ 15,000,000 DEDUCTIBLE $ — X RETENTION $ 10,000 $ WORKERS COMPENSATION AND x WRYTATT- TORY LIMITS ER R B EMPLOYERS' LIABILITY VTC2HUB8571 C37310 1/1/2010 1/1/2011 ANY PROPRIETOR /PARTNER /EXECUTIVE EL. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? E. L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under SPECIAL PROVISIONS below E . DISEASE - POLICY LIMIT $ 1,000,000 OTHER B Leased /Rented Equipment QT6600104L715 1/1/2010 1/1/2011 $2,500 Ded. 300,000 B Equipment - Scheduled QT6600104L715 1/112010 1/112011 If Applicable See Below DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS General Liability policy referenced above provides per project aggregate limit as required by written contract. Workers Compensation includes State of FL In 3A. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Zephyrhills DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 5335 8th Street Zephyrh i Ils, FL 33542- NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE _ ACORD 25 (2001/08) 0 ACORD CORPORATION 1988