HomeMy WebLinkAbout11-11869 CITY OF ZEPHYRHILLS
5335 - STH STREET �`�
, , (sis)�so-oozo 11869
FIRE ALARM SYSTEM PERMIT
Permit Number: 1 1 869/1 1 739 Address: 7952 7954 GALL BLVD
Permit Type: FIRE ALARM SYSTEM ZEPHYRHILLS, FL.
Class of Work: FIRE ALARM SYSTEM Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: ZEPHYR COMMONS
Est. Value: Parcel Number: 35-25-21-0010-00700-0000
Improv. Cost: �-E/� �3� dd
Date Issued: 5/16/2011 Name: ZEPHYR COMMONS LLC
Total Fees: 150.00 Address: 3629 MADACA LANE
Amount Paid: 150.00 TAMPA FL 33618
Date Paid: 5/16/2011 Phone: (813)927-0011
Work Desc: INSTALLATION FIRE ALARM FIVE GUYS
AL L IN I A 5. W 5.
FIRE INSPECTION FEES 50.00
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FIRE ELEVATOR RECALL
Chapter 633, Florida Statutes, authorizes the City to charge and collect user fees to pay for the costs of fire
prevention and protection related activities such as inspections, plan review, administrative fees, and other
costs related to the aforementioned.
Complete Plans, Specifications and Fee Must Accompany Application. Commencement of work without written approval of
the Fire Department's Fire Marshal or required permits or opening up for commercial activity without an approved final
inspection shall be charged double permit fee per day of operation or a minimum of $100.00, whichever is greater. All
work shall be performed in accordance with City Codes and Ordinances.
"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."
__.-__�-_ �.._
__.------ �---�-="�._ �..
ONTRA OR SIGNA URE I IC R
PERM XPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOURS NOTICE REQUIRED
ZEPHYRHILLS FiRE RESCUE DEPT - Fire Marshal Office - 813-780-0041
s�saso-oo2o City of Zephyrhills Fire Fax
Permit Appiication
Date Received ' � Z� Phone Contact for Pertnit � 3 9� L//�
Owner's !'�/V�.= �r(J i�.s � Owner's Phone Number �� �
Owners Address 7,5 L � (>—� L�— ''v L V J
Fee Simple Titleholder Name TiUeholder Phone Number �� �
Fee Simple TiUeholdar Address
Job Address Lot # ��
Sub Division Parcel #
� Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent
Q Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier il or RQ Facility) ANNUAL
� Controlled Bum � Hood Instailation
� Emergency Generator < 30 kw � LP/Natural Gas-Installation
� Emergency Generator> 30 kw � LP/Natural Gas-ANNUAL Sale q
� Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL I j���
�y em� �n er � I
Sprinkler � ❑ ❑ ❑ � � Recreational Bum
Fire Alarm � ❑ ❑ ❑ � � Sparklers
Hood Cleaning � ❑ ❑ O� � Sprinkler System Installations
Ho pp� s 'o� � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys)
� Fire Ala I tallation � Torch Roofinglfar Kettle
� Fire Pumps � Waste Tire Storage ANNUAL
� Fire Works �
� Flammable Application- ANNUAL Valuation of Project
� Fuel Tanks /
Q Other:
. -- .�,�..�,_�- . . . , .
Contractor Company �G ,s ST� n'1 LV lD f-
Signature Registered Y/ N Fee Current Y/ N
Address SGtlFJP�Y I _S7� �O S'• F1� - 3 7/( l.icense# —ZO00
ELECTRICIAN Company
Signature I Registered Y/ N Fee Current Y/ N
Address License #
PLUMBER Company
Signature Registered Y/ N Fee Current Y/ N
Address License #
MECHANICA Company
Signature Registered Y/ N Fee Current Y/ N
Address License #
OTHER Company
Signature Registered Y/ N Fee Current Y/ N
Address License #
Directions: . > , , � V �� � u x
Fill out application completely.
Owner & Contractor sign back of applicalion, notarized (Or, copy of signed contract with owner)
If over $2500, a Notice of Commencement is required (Mechanical worlc over $5000)
Supply Mro (2) sets of drawings with applicable documentation
Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http:/lappraiser.pascogov.com)
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance wit+� any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the °contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the "owne�', I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the "owner" prior to commencement.
- CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and
that all work will be done in compliance with all applicable laws regulating construction, zoning and land
development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify
that no work or installation has commenced prior to issuance of a permit and that all work will be performed to
meet standards of all laws regulating construction, County and City codes, zoning regulations, and land
development regulations in the jurisdiction. I also certify that t understand that the regulations of other
government agencies may apply to the intended work, and that it is my responsibility to identify what actions I
must take to be in compliance.
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension
may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate
justifiable cause for the extension. If work ceases for ninery (90) consecutive days, the job is considered abandoned.
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.
FLORIDA JURAT (F.S. 117.03) ci�Z�/� �:r �!1�G
OWNER OR AGENT CONTRACTOR
Subscribed and swom to (or affirmed) before me this Subscribed and swom to or affirrned) before me this
b by /il�Yl SfJa2YtLLp
Who is/are personally known to me or has/have produced Who is/are personally known to me or haslhave produced
as idendfication. as identification.
Notary Public Notary Public
Commission No. Commission No.
Name of Notary typed, printed or stamped Name of Notary typed, printed or stamped
Zephyrhills Fire Rescue
6�)O7 L),�iry Road, Geph��rhi115, f� L;�5�2
i�'irc• Marshal L3us (813) 7bO-0041
Kerry I3;�rnett I�ax (81 ;) 780-U04�4
�-mail: kbarnett�ci�lire.�e�hyrhills.fl.us
Plan Review #: 11-054
Project: Fire Alarm Modification
Number of Pages: 1 plus spec sheets
May 13, 2011
1 have received and reviewed the plan for the fire alarm modification located at 7954 Gall Blvd
and will allow the project to move forward. Paying for permit, contractor acknowledges
complying with the comments listed below. Should anyone have any questions, please do not
hesitate to contact the Fire Marshal's office.
l. Ensure installation is conducted in accordance to NFPA 72, 2002 edition.
2. Ensure all devices have corresponding addresses/labeling to match the fire alarm
panel when activation occurs.
3. Ensure that when devices activate (pulls, duct detectors, ansul} is addressed to Five
Guys address.
4. Tag panel noting fire alarm work conducted at five guys with date.
lnspections Required:
I . Acceptance Test
_.-�----
KERRY B TT, 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 tlieir 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.
, Z���iYI�HILLS FIRE DEPARTMENT'
6907 Dairy Road, Zephyrhilis, FL 33542
Fare Chief Keith Wiiliams Bus (813)780-0041 Fax (813)78U-OU�94
FIRE SERVICE USER FEES
Occupancy No.: �°
Plan No.: ' Contractor: Cr, � J�,�C� y�,,.5 c.{,,.�
Business Name: �� � Biliing Address:
Business Address: � � �� 'vr
Business Phone No.: Billing Phone No.: ST Z� __�� "7 /�,
Business Fax No.: Billing Fax No.:
Contact: Contact:
PLAN REVIEW FEES INSPECTION FEES PERMIT FEE FALSE ALARM FEE
8 Site Plan N/C Annual NIC Sprinlder $50 1stAlarm N/C
Muni-Family/Commercial .06 sf 15t 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
� Plan Revisions D6l 3rd Re-inspection $250 Hoods $50 4th Alarm $100
4th Re-Inspection $500 Fire Alarm � 5th Alarm $150
SPRINKLER SYSTEMS (Business closed until LP Gas 6th A1aRn a2pp
a 0- 25 Heads $50 violations corrected) Natural Gas $50 NON COMPUANCE at 50
26 plus Heads $100 SPRINKLER SYSTEMS F�1 Tanks- �r e�nk $50
STANDPIPE SYSTEM Hydro Undergrounds a45 Sparklers $100
� Per Riser $50 Hydrostatic Test $65 per syste�„ Fire Works E500
FIRE PUMP Acceptance Test a45 Persys�em Camp Fi�e a25
� Per Pump $100 Hydrant Flow $75 CoMrolled Burn $100
IRE ALARM SYSTEM Hood/Duct $50
- 25 Devices � FIRE ALARM SYS7EM Place of Assembly $SO Annual
26 plus Devices $100 �System Acceptance � Fire Pratection $25
SUPPRESSION SYSTEMS Recall Acceptance Flammable Application $50 Annual
Wet $50 OTHER Waste Tire Storage S$O Annual
Dry $50 Fire Wall/smoke Wall $15 perwall G2ltet'dtOr � KW $100
CO2 $50 LP GaS $25 pertank Gel�2retor>30 KVN 150
Other $50 Natural Gas $25 Pe� syscccm Bio-Hazard Waste a100 Annual
KITCHEN EXHAUST Fumigation Tenting a50
� HoodlDucts $50 TeM 10'x10' or greater $15 PerteM Torch Pot/Applied a50
OTHER Fire Pump �45 Haz. Materials $100 Annual
LP Installation per tank S50 Fire Suppression $30
Fuel Tank Installation 350 System Acceptance
(Per Tank) S50 Exhaust Hood/Duct S30
� Natural Gas Installation 350 Re DBL
( Per System ) (other than annual)
� Spray Booth $50 � Inspection scheduled DBL 8
and cancelled less than
24 hours
Construction Insp. N/C
PLANS TOTAL ��J� INSPECTION TOTAL��� PERMIT TOTAL� FALSE T ALARM I_ I
GRAND TOTAL v
Comments:
Date. ___����,L�—
/" �
Insq��ctor� �� �'r' G. � � ��
� (New Address)
2830 Scherer Drive Suite 300
, St. Petersburg, Florida 33716
CRITICAL SYSTEM SOLUTIONS� INC Ph.727.209.�122or
FIRE � SECU2ITY � NURSE CALL � ACCESS CONT20L + CCTV � MONIYORING 813.341 5 l02
Fx. 727.209.5126
Revised as of 2-23-2011
To Whom It May Concern:
At a meeting of the Board of Directors of Critical System Solutions, LLC held on February 23, 201 l, it was
duly and jointly resolved that the following individuals whose signature is hereby attested, is
empowered on behalf uf Critical System Solutions, LLC and David Kirk Owner of
Critical System Solutions, LLC and State of Florida E tr' al Contractors Licence holder EF20000427
to perform in behalf of David Kirk.
For the Owner/ Licensee: Date: �� �
l � /
av' Kirk, Owner
Designated individual listed below:
y ✓ �M �- �ar- �a����
Trac Mintz
(S' ature) �._ �
�
Jeffrey Durham � j ' � �� —y3"l•��— aD�'' �J'
(Si e)
Pete Mueller ✓ �%.�%c-� �/ �/,��G'��Y/L.-- � 'T �" �/ �Q �"� 5g � j ° ' �
(Signature)
T�, so�i��o ,,/ � ,������ S Gi �l - � as�6 � ° ` l�._o
(Signature)
John Wolfley � , � �f' ° � 1 V `C�Q ��
/ '��g� e)
�
Bilt Rhodes � �-3 ZO�� t% �C+ �.s � � Z�' b
(Signature
State of: Florida
County of: Pinellas
or to and subs b before m t is�, f
day of ���_�—,
��
N ary Publi ate of / lorida at Large
r.+
; �.�:"rv,� : JENNIFER MITCHELL MEHRANI
_*. ,_ MY COMMISSION # DD 806380
�•. % EXI�IRES: September 25, 2012
'�Rfi���' Bonded Thtu Notary Public Undetwriters
CRITICAL SYSTEM SOLUTIONS, LLC
�• s�c�,�rr�r •�rrro�rn� •.►cc� co�o�• ccr,►• wc,� cw�.�.
vvww c�
��osafss
Contact:
Tim Sorvillo
Email: tsorvillo@criticalsystemsolutions.com
Cell Number: 813-690-4104
Project:
Five Guy's
Famous Burgers & Fries
7954 Gall Blvd.
Zephyrhills, Florida 33541
Pa rts:
2ea. D355 Duct Detectors
2ea. CRF-300 Relay Modules
1ea. MMF-300 Ansul Monitor Module
�U�MTTTED PLAN(S) AVE EEN F��V1EWf�i
3Y ZEPHYRHILLS � S A' ICE
Date: �
'.2eviewer:
. .
' df-60430:b • E-650
InnovairFlex � ��.L1TemALarYY1S
Intell�gent Non Relay Photoelectric
Duct Smoke Detector by H o n eywe I I
- �-
General
The Fire•Lite InnovairFlex D355PL intelligent non-relay photo-
electric duct smoke detector and DNRW watertight non-relay
photoelectric duct smoke detector feature a pivotlng housing
that fits both square and rectangular footprints capable of
mounting to a round or rectangular duct.
DNRW duct smoke detector, with its NEMA-4 rating, is listed as W : y;:
a watertight, UV resistant enclosure providing protection against
falling dirt, rain, and windblown dust, splashing and hose
directed water, allowing operators to use the detector in the
most extreme environments.
These units sense smoke in the most challenging conditions,
operating in airflow speeds of 100 to 4,000 feet per minute, tem-
peratures of -4 degrees F to 158 degrees F, and a humidity ��
range of 0 to 95 percent (non-condensing.) �° �° '` ' '_' "� ; " `. ` -
An improved cover design isolates the sensor head, which Specifications
aliows for ease of maintenance. A cover tamper feature indi-
cates a trouble signal for a removed or improperly installed sen- Size: (Rectangle) 14.38 in (37 cm) Length; 5 in (12.7 cm)
sor cover The Fire•Lite InnovairFlex housing provides a 3/4- Width, 2.5 in (6.6 cm) Depth
inch conduit knockout and ample space to facilitate easy wiring Size: (Square) 7 75 in (19.7 cm) Length; 9 in (22.9 cm) Width;
and mounting of a relay module. 2.5 in (6.35 cm) Depth
The Fire•Lite InnovairFlex duct smoke detector can be custom- yyeight: 1 6 Ib (0.73 kg)
ized to meet local codes and specifications without additional Operating Temperature Range: -4 degrees F to 158 degrees F
wiring. The new InnovairFlex product line is compatible with all �_20 degrees C to 70 degrees C)
previous Innovair models, including remote test accessories.
Storage Temperature Range: -22 degrees F to 158 degrees F
Features (-30 degrees C to 70 degrees C)
Operating Humldity Range: 0% to 95% relative humidity (non-
• Photoelectric, integrated low-flow technology condensing)
• Air velocity rating from 100 ft/min to 4,000 ft/min (0.5 m/s to Air Duct Velocity: 100 to 4,000 ft/min (0.5 to 20.32 m/s)
20.32 m/s)
• Versatile mounting options: square or rectangular configura- ACC@SSOI'1@S
tion
• Broad ranges for operating temperature (-4F to 158F) and Fire•Lite provides system flexibility with a variety of accessories,
humidity (0% to 95% non-condensing) including two remote test stations and different means of visible
• Patented sampling tube installs from front or back of the and audible system annunciation. As with our duct smoke detec-
detector with no tools required tors, all duct smoke detectors accessories are UL listed.
• Cover tamper signal D355PLs and DNRWs with a date code of 0013 or higher do
• Increased wiring space with a newly added 3/4" conduit not require external 24VDC for remote test applications when
knockout used with a remote-test-capable detector.
• Available space within housing to accommodate mounting of ACCESSORY CURRENT LOADS AT 24 VDC
a relay module
• ate lly accessible code wheels on sensor head (sold sepa- Device Standby Alarm
Y)
• Clear cover for convenient visual inspection RA100Z OmA 12 mA Max
• Remote testing capability
• Requires com line power only RTS151/ OmA 12mA Max
• Accommodates the installation of an addressable relay mod- RTS151 KEY
ule, sold separately, (CRF-300) for applications requiring a
Form-C relay
df-60430:b • 3/12/10 — Page 1 of 2
Agency Listings and Approvals
Consult product manual for lists of compatible UL-Listed
devices. In some cases, certain modules may not be listed by
certain approval agencies, or listing may be in process. Con-
sult factory for latest listing status.
• UL Listed: S911
• ULC Listed: S911
• CFSM Listed: 3242-1653:209
Product Line Information
D355PL: Intelligent non-relay photoelectric low flow smoke
detector housing.
DNRW: Watertight intelligent non-relay photoelectric low flow
duct smoke detector housing.
SD355: Addressable low-profile photoelectric smoke detector
SD355R: Remote test capable addressable low-profile photo-
electric smoke detector
NP-100: Addressable low-profile photoelectric smoke detector
for FireWarden series panels.
NP-100R: Remote test capable addressable low-profile photo-
electric smoke detector for FireWarden series panels.
DCOIL: Remote test coil. Required for older DNR(W) duct
detector housing.
DSTi: Metal sampling tube duct width up to 1 ft(0.3m)
DST1.5: Metal sampling tube duct widths up to 1 ft to 2 ft(0.3 to
0.6 m)
DST3: Metal sampling tube duct widths up to 2 ft to 4 ft (0.6 to
1.2 m)
DSTS: Metal sampling tube duct widths up to 4 ft to 8 ft(1.2 to
2.4 m)
DST10: Metal sampling tube duct widths up to 8 ft to 12 ft(2.4 to
3.7 m)
DH4000E-1: Weatherproof enclosure
ETX: Metal exhaust tube duct, width 1 ft(0.3 m)
MO2-04-00: Test magnet
P48-21-00: End cap for metal sampling tubes
RA100Z: Remote annunciator alarm LED
RTS151: Remote test station
RTS151 KEY: Remote test station with key lock
Important Note
• DNRW duct detector housings with a date code of 0013 or
higher do not require a DCOIL or auxiliary 24 VDC for remote
test applications when used with a remote test capable
detector
• DNRW duct detector housings with a date code of 0012 or
earlier require a DCOIL and auxiliary 24 VDC power for
remote test applications.
Fire�Lite� Alarms is a registered trademark of Honeywell Internadonal Inc.
Bayblend� is a registered trademark of Bayer Corp.
�2010 by Honeywell International Inc. All rights reserved. Unauthorized use
of this document is stricUy prohibited.
' �O 9001 This document is not intended to be used for installation purposes.
We try to keep our product information up-to-date and accurate.
We cannot cover all specific applications or anticipate all requirements.
61iII�Ni � MNiiAilrli All specifications are subject to change without notice.
l�ALITr S►BiEM MadeintheU.S.A.
For more information, contact Fire�Lite Alarms. Phone: (800) 627-3473, FAX. (877) 699-4105.
www.firelite.com
Page 2 of 2— df-60430:b • 3/12/10
- DF-52121 •C • E-325
MMF-300(A) Series, � FlY�•LITe°ALarl'Y1S
MDF-300(A) b Hone well
Addressable Monitor Modules y y
_ ,
General
Four different monitor modules are available for Fire�Lite's
intelligent control panels to suit a variety of applications. Moni-
tor modules are used to supervise a circuit of dry-contact input
devices, such as conventional heat detectors and pull stations, °°�^
or monitor and power a circuit of two-wire smoke detectors '"" � 0
(MMF-302(A)) ���
MMF-300(A) is a standard-sized module (typically mounts to a �_,.,*�
4" [10 16 cm] square box) that supervises either a Style D .�:"
(Class A) or Style B(Class B) circuit of dry-contact input �""�:,� •�".,'�
devices. �•�•� �
MMF-301(A) is a miniature monitor module a mere 1.3" (3.302 'M�•�
cm) H x 2.75" (6.985 cm) W x 0.5" (1.270 cm) D used to super- M,:, '� ��
vise a Sryle B(Class B) circuit of dry-contact input devices. Its
compact design allows the MMF-301(A) to be mounted in a
single-gang box behind the device it monitors. �
MMF-302(A) is a standard-sized module used to monitor and ;
supervise compatible two-wire, 24 volt, smoke detectors on a `°
Sryle D(Class A) or Style B(Class B) circuit.
MDF-300(A) is a standard-sized dual monitor module used to MMF-300(A) (Type H)
monitor and supervise two independent two-wire Sryle B
(Class B) dry-contact initiating device circuits (IDCs) at two may be wired as an NFPA Style B(Class B) or Style D(Class
separate, consecutive addresses in intelligent, rivo-wire systems. A) Initiating Device Circuit. A 47K ohm End-of-Line Resistor
LiteSpeedT"' is a communication protocol developed by (provided) terminates the Style B circuit. No resistor is
Fire•Lite Engineering that greatly enhances the speed of com- required for supervision of the Sryle D circuit.
munication between analog intelligent devices. Intelligent MMF-300(A) OPERATION
devices communicate in a grouped fashion. If one of the
devices within the group has new informatlon, the panel CPU Each MMF-300(A) uses one of the available module
stops the group poll and concentrates on single points. The addresses on an SLC loop. It responds to regular potls from
net effect is response speed greater than five times that of the control panel and reports its type and the status (open/nor-
other designs. designs. mal/short) of its Initiating Device Circuit (IDC) A flashing LED
indicates that the module is in communication with the control
MMF -300(A► Monitor Module panel. The LED latches steady on alarm (subject to current
limitations on the loop)
• Built-in iype identification automatically identifies this device
as a monitor module to the control panel. MMF-300(A) SPECIFICATIONS
• Powered directly by two-wire SLC loop. No additional power Nominal operating voltage: 15 to 32 VDC
required. Maximum current draw: 5.0 mA (LED on).
• High noise (EMF/RFI) immunity. Average operating current: 350 NA (LED Bashing), 1 com-
• SEMS screws with clamping plates for ease of wiring. munication every 5 seconds, 47k EOL.
• Direct-dial entry of address: 01 — 159 on MS-9600 series Maximum IDC wiring resistance: 40 ohms.
panels, 01 — 99 on other compatible systems.
LED flashes during normal operation and latches on steady EOL resistance: 47K ohms.
• to indicate alarm. Temperature range: 32°F to 120°F (0°C to 49°C).
The MMF-300(A) Monitor Module is intended for use in intelli- Humidity range: 10% to 93% noncondensing.
gent, two-wire systems, where the individual address of each Dimensions: 4.5" (11 43 cm) high x 4" (10 16 cm) wide x
module is selected using the built-in rotary switches. It pro- 125" (3.175 cm) deep. Mounts to a 4" (10.16 cm) square x
vides either a two-wire or four-wire fault-tolerant Initiating 2 � 25" (5.398 cm) deep box.
Device Circuit (IDC) for normally-open-contact fire alarm and
supervisory devices. The module has a panel-controlled LED
indicator The MMF-300(A) can be used to replace M300(A)
modules in existing systems.
MMF-300(A) APPLICATIONS
Use to monitor a zone of four-wire smoke detectors, manual
fire alarm pull stations, waterflow devices, or other normally-
open dry-contact alarm activation devices. May also be used
to monitor normally-open supervisory devices with special
supervisory indication at the control panel. Monitored circuit
DF-52121:C • 10/06/2010 — Page 1 of 4
MMF-301(A� Mini Monitor Module Dimensions: 1.3" (3.302 cm) high x 2.75" (6.985 cm) wide x
0 65" (1 651 cm) deep.
• Built-in type identification automatically identifies this device
as a monitor module to the panel. Wire length: 6" (15.24 cm) minimum.
• Powered directly by two-wire SLC loop. No additional power
required. MMF-302(A) Interface Module
• High noise (EMF/RFI) immunity. • Supports compatible two-wire smoke detectors.
• Tinned, stripped leads for ease of wiring. • Supervises IDC wiring and connection of external power
• Direct-dial entry of address: 01 — 159 on MS-9600 series source.
panels, 01 — 99 on other compatible systems • High noise (EMF/RFI) immunity.
• SEMS screws with clamping plates for ease of wiring.
3 � o � ADDRESS o � • Direct-dial entry of address: 01 — 159 on MS-9600 series
o � 3/� 2� � 2 panels, 01 — 99 on other compatible systems.
3 12 � (I� ) LOOP �� ) 3 • LED flashes during normal operation.
i� C"' a ��� 4 • LED latches steady to indicate alarm on command from
��� 6 5 � 9�_/ 5 control panel.
$� 8 � The MMF-302 A Interface Module is intended for use in intelli-
TENS ONES � �
gent, addressable systems, where the individual address of
each module is selected using built-in rotary switches. This
i module allows intelligent paneis to interface and monitor two-
� I � wire conventional smoke detectors. It transmits the status (nor-
� I J � v mal, open, or alarm) of one full zone of conventional detectors
Q back to the control panel. All two-wire detectors being moni-
�; � � m tored must be UL compatible with the module. The MMF-
302(A) can be used to replace M302(A) modules in existing
i systems.
I MMF-302 (A) APPL/CATIONS
u Use the MMF-302(A) to monitor a zone of two-wire smoke
The MMF-301(A) Mini Monitor Module can be installed in a detectors. The monitored circuit may be wired as an NFPA
single-gang junction directly behind the monitored unit. Its Sryle B(Class B) or Sryle D(Class A) Initiating Device Circuit.
small size and light weight allow it to be installed without rigid A 3.9 K ohm End-of-Line Resistor (provided) terminates the
mounting. The MMF-301(A) is intended for use in intelligent, end of the Style B or D(class B or A) circuit (maximum IDC
two-wire systems where the individual address of each module loop resistance is 25 ohms). Install ELR across terminals 8
is selected using rotary switches. It provides a two-wire initiat- and 9 for Style D application.
ing device circuit for normally-open-contact fire alarm devices.
The MMF-301(A) can be used to replace M301(A) modules in MMF-302(A) OPERATION
existing systems. Each MMF-302(A) uses one of the available module
MMF-301(A) APPLICAT/ONS addresses on an SLC loop. It responds to regular polls from
the control panel and reports its type and the status (open/nor-
Use to monitor a single device or a zone of four-wire smoke mal/short) of its Initiating Device Circuit (IDC). A flashing LED
detectors, manual fire alarm pull stations, waterflow devices, or indicates that the module is in communication with the control
other normally-open dry-contact devices. May also be used to panel. The LED latches steady on alarm (subject to current
monitor normally-open supervisory devices with special super- limitations on the loop)
visory indication at the control panel. Monitored circuiUdevice
is wired as an NFPA Style B(Class B) Initiating Device Circuit. MMF-302(A) SPECIFICATIONS
A 47K ohm End-of-Line Resistor (provided) terminates the cir- Nominal operating voltage: 15 to 32 VDC.
cuit.
Maximum current draw: 5 1 mA (LED on).
MMF-301(A) OPERATION Maximum IDC wiring resistance: 25 ohms.
Each MMF-301(A) uses one of the available module Average operating current: 300 NA, 1 communication and 1
addresses on an SLC loop. It responds to regular polls from LED flash every 5 seconds, 3.9k eol.
the control panel and reports its type and the status (open/nor-
mal/short) of its Initiating Device Circuit (IDC) EOL resistance: 3.9K ohms.
MMF-301(A) SPECIF/CATIONS External supply voltage (between Terminals T3 and T4):
DC voltage: 24 volts power limited. Ripple voltage: 0.1 Vrms
Nominal operating voltage: 15 to 32 VDC. maximum. Current: 90 mA per module maximum.
Average operating current: 350 NA, 1 communication every Temperature range: 32°F to 120°F (0°C to 49°C).
5 seconds, 47k EOL, 600 uA Max. (Communicating, IDC Humidity range: 10% to 93% noncondensing.
Shorted).
Maximum IDC wiring resistance: 40 ohms. Dimensions: 4.5" (11 43 cm) high x 4" (10 i6 cm) wide x
125" (3.175 cm) deep. Mounts to a 4" (10 16 cm) square x
Maximum IDC Voltage: 11 Volts. 2.125" (5.398 cm) deep box.
Maximum IDC Current: 400 NA.
EOL resistance: 47K ohms.
Temperature range: 32°F to 120°F (0°C to 49°C).
Humidity range: 10% to 93% noncondensing.
Page 2 of 4— DF-52121 �C • 10/O6/2010
MDF-300(A� Dual Monitor Module Product Line Information
The MDF-300(A) Dual Monitor Module is intended for use in NOTE: A"suffix indicates ULC-listed model.
intelligent, two-wire systems. It provides two independent two- MMF-300(A): Monitor module.
wire initiating device circuits (IDCs) at two separate, consecutive
addresses. It is capable of monitoring normally open contact fire MMF-301(A): Monitor module, miniature.
alarm and supervisory devices. The module has a single panel- MMF-302(A): Monitor module, two-wire detectors.
controlled LED.
NOTE: The MDF-300(A) provides two Sry/e B(C/ass B) 1DC cir- MDF-300(A): Monitor module, dual, two independent Class B
cuits ONLY St /e D Class A/DC circuits are NOT su circuits.
y ( ) pported in
any application. SMB500: Optional surface-mount backbox.
MDF-300(A) SPECIFICATIONS NOTE: See installation instructions and refer to the SLC Wiring
Manual, PN 51309
Normal operating voltage range: 15 to 32 VDC.
Maximum current draw: 6.4 mA (LED on). AI'Chlt@CtS� Specifications
Average operating current: 750 uA (LED flashing) Specifications of these devices and all FireLite products are
Maximum IDC wiring resistance: 1,500 ohms. available from FireLite.
Maximum IDC Voltage: 11 Volts.
Maximum IDC Current: 240 NA
EOL resistance: 47K ohms.
Maximum SLC Wiring resistance: 40 Ohms.
Temperature range: 32° to 120°F (0° to 49°C)
Humidity range: 10% to 93% (non-condensing)
Dimensions: 4.5" (11 43 cm) high x 4" (1016 cm) wide x
2.125" (5.398 cm) deep.
MDF-300(A) AUTOMATIC ADDRESS/NG
The MDF-300(A) automatically assigns itself to two address-
able points, starting with the original address. For example, if
the MDF-300(A) is set to address "26", then it will automati-
cally assign itself to addresses "26" and "27"
NOTE: "Ones" addresses on the MDF300(A) are 0, 2, 4, 6, or 8
only. Terminals 6 and 7 use the first address, and terminals 8 and
9 use the second address.
Q CAUTION:
Avoid duplicating addresses on the system
Installation
MMF-300(A), MMF-302(A), and MDF-300(A) modules mount
directly to a standard 4" (10.16 cm) square, 2.125" (5.398 cm)
deep, electrical box. They may also be mounted to the
SMB500 surface-mount box. Mounting hardware and installa-
tion instructions are provided with each module. All wiring
must conform to applicable local codes, ordinances, and regu-
lations. These modules are intended for power-limited wiring
only.
The MMF-301(A) module is intended to be wired and mounted
without rigid connections inside a standard electrical box. All
wiring must conform to applicable local codes, ordinances, and
regulations.
Agency Listings and Approvals
In some cases, certain modules may not be listed by certain
approval agencies, or listing may be in process. Consult fac-
tory for latest listing status.
• UL: S2424
• ULC: S2424
• FM Approved
• CSFM:7300-0075�0185
• MEA:72-01-E
DF-52121 •C • 10/06/2010 — Page 3 of 4
Fire•Lite� and LiteSpeed� are registered trademarks and FireWatch'"' is a
trademark of Honeywell International Inc.
�2010 by Honeywell International Inc. All rights reserved. Unauthorized use
of this document is strictly prohibited.
I�O 900 This document is not intended to be used for installation purposes.
We try to keep our product information up-to-date and accurate.
We cannot cover all specific applications or anticipate all requirements.
��� `� All specifications are subject to change without notice.
lUAlli► S1SiEMS MadeinmeU.S.n.
For more information, contact Fire�Lite Alarms. Phone: (800) 627-3473, FAX. (877) 699-4105.
www firelite com
Page 4 of 4— DF-52121:C • 10/06/2010
• df-60379:A1 • E-400
CRF-3oo(A) � ��•�iTe�A�arms
Relay Module by Honeywell
-� -
General
The CRF-300(A) Addressable Relay Module provides the sys-
tem with a dry-contact output for activating a variety of auxil-
iary devices, such as fans, door holders, dampers, control
equipment, etc. Addressability allows the dry contact to be
activated through panel programming, on a select basis. �■
LiteSpeedT"' is a communication protocol developed by �'�
Fire•Lite Engineering that greatly enhances the speed of com- """ � ��~�
munication between analog intelligent devices. Intelligent ,�,,,,, .�,.,,,
devices communicate in a grouped fashion. If one of the T
devices within the group has new information, the panel CPU •°""_ ""�"*_
stops the group poll and concentrates on single points. The ��_ °,..: ��
net effect is response speed greater than five times that of m �
other designs.
wa
Features
• Built-in type identification automatically identifies these �
devices to the control panel.
• Internal circuitry and relay powered directly by two-wire �
SLC loop.
• Integral LED "blinks" green each time a communication is CRF-300(A)
received from the control panel and turns on in steady red
when activated.
• High noise immunity (EMF/RFI)
• Wide viewing angle of LED.
• SEMS screws with clamping plates for wiring ease. S pecifications
• Direct-dial entry of address: 01— 159 for MS-9600(A) series Normal operating voltage: 15 to 32 VDC
panels, 01 — 99 on MS-9200UDLS(A) and MS-9050UD(A). Maximum SLC current draw: 6.5 mA (LED on).
Applications Average operating current: 230 NA direct poll (CLIP mode),
255 NA group poll (LiteSpeed mode) with LED flashing.
The CRF-300(A) may be programmed to operate dry contacts EOL resistance: not used.
for door holders, Air Handling Unit shutdown, etc., and to reset
four-wire smoke detector power Temperature range: 32°F to 120°F (0°C to 49°C)
Humidity range: 10% to 93% non-condensing.
Construction Dimensions: 4.5" (11 43 cm) high x 4" (10.16 cm) wide x
• The face plate is made of off-white heat-resistant plastic. 1.25" (3.175 cm) deep. Mounts to a 4" (10 i6 cm) square x
• Controls include two rotary switches for direct-dial entry of 2•125" (5.398 mm) deep box.
address setting.
• The CRF-300(A) is configured for a single Class B(Style Y) Relay Contact Ratings
or Class A(Style Z) Notification Appliance Circuit. Maximum Current
• The CRF-300(A) provides two Form-C dry contacts that Load Description Application Voltage Rating
switch together
Resistive Non-Coded 30 VDC 3.0 A
Operation Resistive Coded 30 VDC 2.0 A
Each CRF-300(A) uses one of the addresses on a SLC loop. It Resistive Non-Coded 110 VDC 0.9 A
responds to regular polls from the control panel and reports its Resistive Non-Coded 125 VAC 0.9 A
type and status, including the open/normal/short status of its
Notification Appliance Circuit (NAC) The LED blinks with each Inductive (UR=Sms) Coded 30 VDC 0.5 A
poll received. On command, it activates its internal relay. Inductive (L/R=2ms) Coded 30 VDC 1.0 A
NOTE: Open/short supervrsion rs suspended with the CRF-300. Inductive (PF=0.35) Non-Coded 125 VAC 0.5 A
Rotary switches set a unique address for each module. The
address may be set before or after mounting. The built-in
TYPE CODE (not settable) will identify the module to the con-
trol panel, so as to differentiate between a control module and
a relay module.
df-60379:A1 • OS/04/09 — Page 1 of 2
Agency Listings and Approvals
In some cases, certain modules may not be listed by certain
approval agencies, or listing may be in process. Consult fac-
tory for latest listing status.
• UL: S2424
• ULC:S2424
• FM approved
• CSFM: 7300-0075 185
• MEA:72-01-E
Product Line Information
CRF-300(A): Intelligent addressable relay module.
: Intelligent addressable relay module, ULC listed model.
SM8500: Optional surface-mount backbox.
NOTE: For installation instructions, see document /56-1190-005
and refer to the SLC Wiring Manual, document 51309.
LlteSpeedT" is a trademark and Fire•Lite� Alarms is a registered trademark
of Honeywell International Inc.
�2009 by Honeywell International Inc. All rights reserved. Unauthorized use
of this document is strictly prohibited.
' � O � This documerit is not intended to be used for installation purposes.
We try to keep our product information up-to-date and accurate.
We cannot cover all specific applications or anticipate all requirements.
BIiNEB� S■M�AL�■li All specifications are subject to change without notice.
l�ALIT► S�SiEMS MadeinmeU.S.A.
For more information, contact Fire�Lite Alarms. Phone: (800) 627-3473, FAX. (877) 699-4105.
www.firelite.com
Page 2 of 2— cif-60379:A1 • 08/04l09
STATE OF FLORIDA
'..;;� DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
� ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395
'� 1940 NORTH MOIVROE STREET
���t'"�� TALLAHASSEE FL 32399-0783
KIRK, DAVID S
CRITICAL SYSTEM SOLUTIONS LLC
11628 HARBORSIDE CIRCLE
LARGO FL 33773
__ _ ��.�_._._.�,,
� STATE OF FLORIDA �C� 4 9 8 8 l� ] � �
Congratulations! With this license you become one of the nearly one million ���, DEPARTMFsNT OF BUSINESS A1VD
Floridians licensed by the Department of Business and Professional Regulation �„ pROFESS20�]AL REGULATION
Our professionals and businesses range from architects to yacht brokers, from �= "''
boxers to barbeque restaurants, and they keep Florida's economy strong EF20000427 06/OS/�:0 090470904
Every day we work to improve the way we do business in order to serve you better
For information about our services, please log onto www.myfloridalicense.com. CERT ALARM SYSTEM CONT�2ACTOR I
There you can find more information about our divisions and the regulations that ICTRK, DAVID 3
impact you, subscribe to department newsletters and learn more about the CRITICAL SYSTEM SOLUTTONS LLC
DepartmenYs initiatives
Our mission at the Department is. License Efficiently, Regulate Fairly. We
constantly strive to serve you better so that you can serve your customers. Is CERTIFISD under e�,a provisiona oe ch.489 Fs
Thank you for doing business in Florida, and congratulations on your new license! 6xpiration aate: AUG 31., 2012 L10060801124
_ _��.._.—._.._.t=�J,.�.�.._,s.�ffi..r�..�.�...
DETACH HERE
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� - --. .._. _ __...- ----�----- - ---- �----- - -. _..__�
Ac# 4 9 8 S 610 STAT�E O� FLO��De4 �
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ;
ELECTRICAL CONTRACTORS LICENSING BOARD
SEQ# Lioosasoiia4 !
, . - LICENSE DIBR t
06/08 2010 090470904 EF20000427 �
The ALARbI SYSTEM CONTR.ACTOR I
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS,
Expiration date: AUG 31, 2012
(
KIRK, DAVID S �
CRITICAL SYSTEM SOLUTIONS LLC
2830 SCHERER DRRIVE
STE 300 !
ST.PETERSBURG FL 33716 �
CHARLIE CRIST CHARLIE LIEM I
GOVERNOR INTERIM SECRETARY
DISPLAY AS REQUIRED BY LAW �
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�3llli,_1G: i° i ..'(?r.i �. ��I� � �7L t;T 1 f:�l�i�l _ � � .
Form �' Request for Taxpayer Give form to the
(Rev.October200� Identiflcation Number and Certification requester. Do not
Department of ihe 7reasury Se�d to th9 IRS.
intemal Revenua Servico
Name (as shown on your income tax return)
� Critical Syslem Solutions LLC
a Business name, if different from above
c
O
a o Check appropriate box: ❑ Ind(vidual/Sole proprietor ❑ Corporation ❑ Partnership Exem t
`� A' P Y• ( 9 tY P P P) p
�" Limited Ilabili com an Enter the tax classitication D=disre arded enti C=cor oration. P= aRnershi ►.Cr_. __ ❑
a � ❑ Other (see insWctio�) 1
L � Address (number, street, and apt. or suite no.) Requester's name and address (optional)
a� 2830 Scherer Drive, Suite 300
�� City, state, and ZIP code
y Saiot Petersburg, Florida 33716
� List account number(s) hero (optfonal)
Taxpayer ldentification Number IN)
Enter your TIN in the appropriate box. The TIN provided must rnatch the name given on Line 1 to avoid Social security number
backup withholding. For individuals, this is your social security number (SSN}. However, for a resident
alien, sole proprietor, or disregarded entity, see the Part 1 instructions on page 3. For other entities, it is
your employer identification number (EIN). If you do not have a number, see How to get a T1N on page 3. or
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose Employer ldentification number
number to enter 20 ; 3072689
Certification
Under penalties of perjury, I certify that:
1 The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me}, and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal
Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has
notified me that I am no longer subject to backup wilhholding, and
3. I am a U.S. citizen or other U.S. person (defined below).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to re all interest and dividends on your tax return. For real estate transactions, item 2 does not apply
For mortgage interest paid, acquisition ab ndonm secured property, cancellation of debt, contributions to an individual retirement
arrangement (IRA), and generally, pa ent other an in rest and dividends, you are not required to sign lhe Certification, but you must
provide your correct TIN. See the i truc ' ns on age 4
Sign Signature ot
Here U.S. person . Date ►
General Instru t10 Definition of a U.S. person. For federal tax purposes, you are
considered a U.S, person if you are:
Section references are to e Internal Revenue Code unless • An individual who is a U.S. citizen or U.S. resident alien,
otherwise noted.
• A partnership, corporation, company, or association created or
Purpose of Form organized in the United States or under the laws of the United
A person who is required to file an iniorrnation return with the States,
IRS must obtain your correct taxpayer identitication number (fIN) • An estate (other than a foreign estate), or
to report, for example, income paid to you, real estate • A domestic trust (as defined in Regulations section
transactions, mortgage interest you paid, acquisition or 301.7701-7).
abandonment of secured property, cancellation of debt, or
contributions you made to an IRA. Specia� rules for partnerships. Partnerships that conduct a
Use Forrn W-9 only if you are a U.S. person (including a trade or business in the United States are generally required to
resident alien), to provide your correct TIN to the person Pay a withholding tax on any foreign partners' share of income
from such business. Further, in certain cases where a Form W-9
requesting it (the �equester) and, when applica6le, to: has not been received, a partnership is required to presume that
1. Certify that the TIN you are giving is correct (or you are a partner is a foreign person, and pay the withholding tax.
waiting for a number to be issued), Therefore, if you are a U.S, person that is a partner in a
2. Certify (hat you are not subject to backup withholding, or Partnership conducting a trade or business in the United Slates,
provide Form W-9 to the parinership to establish your U.S.
3. Claim exemption frorn backup withholding if you are a U.S. status and avoid withholding on your share of partnership
exempt payee. If applicable, you are also certifying that as a income.
U.S. person, your allocable share of any partnership income from The person who gives Form W-9 to the partnership for
a U.S. trade or business is not subject to the withholding tax on purposes of establishing its U.S. status and avoiding withholding
toreign partners' share of effectively connected income. on its allocable share of net income from the partnership
Note. If a requester gives you a form oiher than Form W-9 to conducting a trade or business in the United States is in the
request your TIN, you must use the requester's form if it is following cases:
substantially similar to this Form W-9. • The U.S. owner of a disregarded entity and not the entity,
Cat. No. 10231X Form w-9 (Rev. 10-200�
05/11/2011 WED 14:09 FAX 813 637 8484 IOA_TAMPA (�001/001
ACORD,.., CERTIFICATE OF LIABILITY INSURANCE �ATE�MMIDDIVVri)
05/11/2011
THIS CERTIFICATE IS ISSUED AS A MAT'fER OF INFORMATION ONLY AND CONFERS N� RIGHTS UPON THE CERTIFICATE HOLdER. THIS
CERTIFICATE DOES NOT AFFIRMATIVE�Y OR NEGATIVEIY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTlTUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPOR7ANT: !f !he certificate holder is an AUDlTIONAI INSURED, the policy(ies) must be e�dorsed. if StfBROGATlpN 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 NAME: Meif'JC SI10�E
Insurance Office of America, inc. {ac,NO,ex�y (813)637-8877 ___ (�a N ,�_(813)637-8484
4915 W. Cypress Street A D DRE SS:
Tanq�a, FL 33607 - - ---._... ._..._._...__.._ ........ ... ..._.. _..._.. .. ._._..__._._.._.._..---•---_
� PRODUG`ER -- �--.. ._
��£LQM�IiJD�� ------- ---.. ._ _----------�---------� ----_.. .. .. __._...�._ _._..._...
�N$Ul2ER(S�AFFORDlNG COVERAGE � NAtC M
.._. ..... .._ ..._.. ... _...._.. ._..---.._---`---.._.__.._.._. .-°--. ..............__.._---..___-'-'----'-�---'-'— ------.._..-'---"---..�_. _.......__.._.. .._.
INSURED INSURERA: F'll'SL M@I'CGI'y IttS Co 10657
-----------..._...__.__.._.__....--...- - ----__ _ . ......... ....._.. _. ._._. ... .._._._...__.,...r__-----------..
Critical System Solutions, LLC �NSUReRa: Auto-Owners Ins Co. 18988
______...--- --......_..__.. ...... .. .. .. . . ..... ........__. _.. _. _;_. ._._._.�___.-----
2830 5cherer Drive �NSUReRC Conme & Industry Ins Co ].9410
....r._—_ �_�_.___--------�--------___.._ ..__. ! _-------
Suite 300 INS URERD Bridgefield Employers Ins Co } 10701
St.Petersbur FL 337I6 -- -----------�-----------�----------------._. .__..-. _•.__--------._.._-....
g f 1NSURER E :
._......____.. ._. .. .. ._ ... ... _. ._.. �
-- --- ---' .. ..--`-
_ ..._.
INSURER P : _.._..._.._.
COVERAGES CERTIFICATE NUMBER: 2010.2011 Master REVI510N NUMBER:
THIS IS TO CERTI�Y 7HAT 7HE POL1ClES OF INSURANCE L1STE0 BELOW HAVE BEEN ISSUED TO THE INSURED NAMEO ABOVE fOR 7HE POLICY PERIOD
lNDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITIQN OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO W HICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFOROEO BY THE POLICIES DESCRIBED HEI2EIN IS SUBJECT TO AlL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMlTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
.---.._....._ ....._ _. ._ _. _.... ....__
INSR --- ri.pE Of INSURANCE ADOL SUBR �.��.._._.__..__.._...._. __...._. ...... EFF� ��POLICI' E7(P I--...��. UMITS
I.TR i INSR WVO POLICY NUMBER MM1001YYYY MtAlDD/YYYY
GENERAL LIABILiTY � FMMT008116 0814 5/2010 08N 512011 EACH OCCURRENCE $ 1� OOO � O�
l...._.._. ' i
I UAN�"A�GE�7�f'R�"t�PP�6 ---- �-------.-_.,.......___._._�._.__
; X � COMMERCIAL GENERAL LiAB1iITY ! I � P12�MI,�ES�{��occur�gn��_ __$.._.. ..______ SO � OOO
�--- -- ' : t ---
' J CIAIMS•MADE �X� OCCUR i ; � ; MEO EXP (My one person� $ S� OO�
. _.
-�-'-- � _
._._.._..._._.._ .___... ....._...---� -� --�-�---------�---. _..._._....... ....-
/� X LTO Contract . Li ab ' I i ; PERSONAL & ADV INJURY � S _�� OOO � ���
_. . _ .............. ._._.._. � :
� I °------------- ' I ; j i GENERAL AGGREGATE $ -------'- 2 � OOO � OO
r----• -------.._.._...__. ._...... .-•------------ � � �.._._.._.__._.._...,._.�._.
! GEN L AG6REGATE LtM1T APPLtES PER: s I � 4 PRODUCTS_ COMPlOP AGG � S 2� OOO � OO
I...._. � POUCY � X � JEC _...; LOC ` � �
� i I
I AU70M081LE I.IABILITY ; 4 4773205600� 08N5I2010 08/t5l2011 � COMBlNED SINGLE llMli i g
' � (Ea accident)
, � � ; __ _ _ � 1 � Q�0 , �0�
� � X; ANY AUTO ! i � � BODILY INJURY (Per person) `$
---- � ALL OWNED AUTOS i � i i �--.--- ---------....... __. .._._._
; ; BODILY INJURY (Per acdd6nl) h S
B; � SCHEOULE� AUTOS { I � I i PROPERTY OAMAGE
�___;
x� 111RED AUTOS � j I (Per accideM) i
----: . _.._.._- _ _ ,
, --._. __..-- ------ — - -- ---, _... .
-- --- ----
X� NON-OWNED AUTOS ( � ( I$
� ' --------------.__.___..._ _--------- ----- --- _
I � I�
, UMBRELUI LIAB X j OCCUR � � BE06245 740� 08/1512010 � 08/1512011 F�qCFt OCCURRENCE � 5 �{ � Q�0 � Q0�
..._..._ .
_....._..
.. -. ' I � -.__.._ ... ..-1'--'-'-'---
! � EXCESS LIAB � CLAIMS MADE I ; AGGREGATE ; 5 4 OOO OOO
I L_,�
C �—•;--- -- ; � ; r------------�--..._..__. �_ �
__. .; _. _.. - --
' DEDUCTIBLE ! ; UMBRELLA FORM � ; ; $
, ; . ;..—._ ___.._........,.._ ....... .:........ .... ._..._.
X � RETENTION $ 0 j � I � g
�ANDEMPLOYRS�LABI � I ; 083039728 ;08115l2010 08J15l2011' X�����T�I ER �
; Y!N i � � ; �._...�._ ... .... _r__.__..__._.._.
' ANY PROPRIETOR/PARTNER/EXECUTIVE ; ; ;_E _L. EACH ACCIOENT : S 1� OOO � QO
O OFFIC£RlMEMBER EXCLtJDED? � I N 1 A � �
• -- -
�Ma�dafory in NH) ' � I � E.L. OISEASE - EA EMPIOYEE; S 1 OOO � ��
I(yes. describe under I � � ; � �.....�. __. ._.__._. ..... .........._..._.;.
DESCRIPTION OF OPEi2ATIONS beiow i ( i E.L. OISEAS£ - POLICY LIMIT ; 5 1 OOO OO
I � i i ; � i
. i � � � '
I
DESCRlPTION OF OPERA710NS 1 �OCATIONS ! VEMICLE5 (ANach ACORD 101, Addittonal RemaAcs Schedule, If more space Is required)
CERTIFtCATE HOLDER CANCELLATION
FAX: 813.780.0021
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELIED BEFORE
THE EXPfRATION DATE THEREOF, NOTICE WILL BE DE�IVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Clt of Ze h rhills Bui7din De t AU7NORIZEDREPRESEN7ATIVE � l� ^
Y p Y 9 P '�� �e'..,.. v,-::. �.. a �.:_
5335 8th Street
Zephyrhills, FL 33542 Mark Shobe ELAZA
01988-2009 ACURD GORPORATION. All rights reserved.
ACORD 25 (2099/09) The ACORD name a�d logo are �egistered marks of ACORD
AC�RDµ CERTIFiCATE 4F LIABILITY 1NSURANCE DATE{MM1DDfYYYY}
05/11/2011
THIS CEF2TIFlCATE IS ISSUED AS A MA7TER O� INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
GERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY T1iE POLICIES
BELOW. THIS CERTIFfCATE OF INSURANCE OOES NOT CONSTITi1TE A CONTRAC7 BETWEEN THf ISSUING INSURER(S), AUTNORfZEd
REPRESENTATIVE OR PRODUCE1t, AND 7HE CER71FfCATE FfOLDER.
tMPORTANT: If the cartiflcate holder is an ADDITIONAL 1NSURED, the policy(iss} must be endorsed. If SUBROGATION IS WAIVED, subJect to
the te�ms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certif{cate holder in lieu of such endorsement(s}.
PROOUCER " Mark Shobe
NAIYEE:
Tnsurance Office of America, Inc. tac,Na�exg,.( �^� Na � (813)637-8484
4915 W. Cypress Street E-MAIL
--. .._..._.,. .... .,..__. .. ...
ADDRES$:
--------------____. _ _. ....._..._..�__
Tampa, FL 33607 PRODUCER
..�.�ts�f� .._.... ._.._. .- - -----
INSURER(S� AFFORDING COVERAGE __ _ Nq�C �I 4
_�...........
----- - - -__-___._. ... ._-- .. __ ._. --._. .,------ -------
INSURED INSURERA: F'II'St Mercury Ins �O ��( )S]
---------------------------------- - ... _..---- ------ _.
Critical System Soiutions, LLC �NSUaERS: Auto-Owners Ins Co. 18988
--._.......__._..____...�..__..._.._...__ ._._...._..._._.__._.____�______... ._------�- - ------------ ----------.............._.._
2830 Scherer Drive �NSUeeRC: Com�rce & Indust Ins C 1941
Suite 300 - -- -----,--_.._...---.._.._.._-- —
�HSUReR o: Bri dgef i el d Emp oy ers Ins Co 1070I
-- �___....__�___.._ .... ....... .................---..-� -------- - --...._.._. ----- - - - -----_....__.. ._
St.Petersburg, FL 33716 IHSURERE:
INSURERF: - - ------ - .°-. .---------
COVERAGES CERTIFICATE NUMBER: 2010.20I1 Master REVISION NUMBER:
THtS IS TO CEF2TIFY Th1AT THE POLICIES OF lNSURAEVCE LISTEQ BELOW HAVE BEEN ISSUEO Tb THE INStJRED NAMED ABOVE FOR TME POLICY PERI00
I�lDICATED. NOTWITNSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CON7RACT OR OTWER OOCUMENT WITH RESPECT TO WFIICH TH�S
CERTIFICATE MAY BE tSSUED OF2 MAY PERTAtN, THE INSURANCE AFFOROED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT FO ALL THE TERMS,
EXCLl3SIO ANO C ONDITlONS OF SUCH POLfCIES. LIMITS SHOWN MAY HAVE BEEIV REDUCED BY PAfD CLAIM
INSR . ___...__-.- ,-•----..__ .__.._....._..._..._.._..----ADQL$UBR ------------------- - POLICYEFF POLICYEXP ----- -----------°--- .__�_� --
�� TYPE OF tN3URANCE INSR VYND POLICV NUMBER AtM1DD MMIDDIYYYY LIMITS
CaENERAL UABILITY Fr�M�oaxiz 08115l2010 08/95/2011 EACH OCCURRENCE $ 1� � � QQQ
.._..
DAMA R NTED-----------._._......._.._.---
X COMMERCSAI GENERAL I.IA91LfTY pR������� _$ __ SO � OOO
- - ---
CLAtMS-MADE X OCCUR MED EXP (Arty one person) $ S OOO
........,._---- __...> >
._ ...._ �._. _.___--.,—
A X LTD ContraC L1 3I7 ^ PER30NAL8ADVINJURY _$ 1,0 00,000
—.____.---- -----
.._.__ .,......._._-------...._.._.__...._..---.�___ G ENERAL AGGREGATE $ Z� OOO � OQO
• .......... ....._�
GEN'L AGGREGAT� LIMIT APPLIES PER: PRODUCTS - COMPlOP AGG $ _ 2� U(}O � OQO
PRO ----._..__.._......_......._.._._._---------
POLICY X ,JECT LOC 3
AUTOfAOBILE UABILITY 477320560 081'15/2010 08/1512091 COMBINEfl SINGLE i.IM1T
---- s
X ANY AUTO (Ea accidenty 1 Q�� QQ�
..r._._._�._.__....._......--°-°_-- ------------'.._..___._.t-•---�-
---- BODILY INJURY (Per person} $
AILOWNEDAUTOS - -------._......_._. .--------------- �
-- - 80DILY INJURY (Per accident� $ �
B SCHEpULEDAUTOS -----------------------___.-°---------+
X HIRED AUTOS {�Per accide t DAMAGE $
X NON-OWNED AUTOS � $
__'_... --------. ..- ---_...------- -,._......_..._._�..__._..�.�
$
UMBREL.LA UAB X OCCUR BE05245740 08l15/2010 08l1512011 Eq OCC $ 4��� � � 0
__° __ — ------ -----------.... ..............
EXCE33 LIAB CLAIMS-MADE AGGREGATE s a aoa o0
C _----...�_.�_._.�..___._....--- — � �
p�oucrie�� .__ UMBRELLA FOR s --------------..�
-- ....._._. ._--------
X RE7ENTION $ Q y
WORKERB COMPENSATION d83034728 08/15l2010 08l1512011 X W STATU- OTH-
AND EMPLOYERS' LIABILITY Y r N T RY I T __ �F2, ,,____
ANY PROPRIETOR/PARTNER/EXECUTIVE E.l. EACH ACCIDENT $ �. � OOO � OOO
D OFFICER/MEMBER EXCLUAED? � N! A
(Mandat in NH --•-••--�--------- --------- ---..._�______._.__
aY 1 E.L. DISEASE - EA EMPLOYE $ 1� OOO � OOU
Ifyes, describe under ------------..-....-_... --- -- -- -
DESCRIPTION Of OpERA710NS below E.L. DISEASE - POLICY E.IMIT $ 1� OOO OO
PESCRfPTtON OF pAERATION$ ! LOCA7tONS ! YEMICLES (AttdCh ACORD 101, AdtllUonal Remarks Schedule, If more apeoe is requlred)
CERTIFICATE HOLDER CANCELL.ATION
FAX: 813.780.002I
SHOULD ANY OF THE ABOVE DESCRIB£D POLICIES BE CANCELLED BEFORE
THE EXPIRATION QATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
�l ty of Ze �1 1"�'1l � � S BUl � al Jl ��pt AUTHORIZED REPRESEIJTATIVE � `* � r �� �
p Y 9 �� ��. ��. r-:.::- ., �.t.. ..�,:_.
5335 8th Street
Ze hyrhi1ls, FL 33542 Mark Shobe ElAZA
�O 1988-2009 ACORD CORPORATtON. Alf rights reserved.
ACORD 25 (2009109} The ACORD name and logo are registered marks of ACORD
, � 2830 Scherer Drive Suite 300
St. Petersburg Florida 33716
Ph. 727.209.5122 or 813.341.5 ( 02
CRITICAL SYSTEM SOLUTIONS, INC Fx. 727.209.5126
FIRE � SECU2ITY � NURSE CALL � ACCESS CONTROL � CCTV � MONITORING
February 23, 2011
To Whom It May Concern:
At a meeting of the Board of Directors of Critical System Solutions, LLC held on February 23, 2011, it was
duly and jointly resolved that the following individuals whose signature is hereby attested, is empowered
on behalf of Critical System Solutions, LLC and David Kirk Owner of Critical System Solutions, LLC and
State of Florida Electrical Contractors Licence holder EF20000427 to perform in behalf of David Kirk.
This letter supercedes ALL previous submissions. Please ensure that ONLY the individuals listed below
are authorized to represent Critical System Solutions andlor David Kirk.
For the Owner/ Licensee: Date: ��"�3 �°��r
d Kirk, Owner
Designated individual listed below:
Jeff Durham FL DL # D650-437-66-201-0
Tracy Mintz FL DL # M532-801-62-375-0
Pete Mueller FL DL # M464-667-58-177-0
Bill Rhodes FL DL # R320-920-56-024-0
Tim Sorvillo FL DL # S614-805-67-416-0
John Wolfley FL DL # W414-476-70-466-0
State of: Florida
County of:
Sworn to and subscribed before me this: , � yIELI�SA MORLAN
3 rd day of ��r :�� �= p�Y COannAISSION # DD790285
� ":�i��df}'f� EXPIRES May 19, 2012
�s n;,�
(407)39g-0155 �Rnr�rlaN��aryServtce.com
�1���
Notary Public State of Florida at Large
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