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EL-16-351 Permit No. EL-2-16-351 Miami Shores Village t Permit Type:Electrical -Residential 10050 N.E.2nd Avenue NE Work Classification:Pool-Private - Miami Shores,FL 33138-0000 P te ri I I I Permit Status:APPROVED Phone: (305)795-2204 f<OR1Dp` Issue Date:312912016 Expiration: 09/25/2016 Project Address Parcel Number Applicant 10675 NE 11 Avenue �1122320280300 Miami Shores, FL 33138-2120 Block: Lot: GILDA GREEI4E LAWRENCE -__ Owne.,h-�onnation Address Phone Cell GILDA(REENE LAWRENCE 10675 NI--- 11 Avenue MIAMI SHORES FL 33161-2120 Contractor(s) Phone Cell Phone Valuation: $ 1,900.00 CONTRACTORS ELECTRICAL SERVI( (786)252-1284 __. _.. .... Total Sq Feet: 0 WWAIMTM.r.- Type^_f Work:NEW SWIMMING POOL AND SPA. � + ~! — � Available Inspections: Additional Info: Inspection Type: Clas:;i`i;_ti^�: �si�enti2l Final Scanning: 1 -- Light Niche Bonding Review Electrica;� Alarms g k.I �nw��at�stus��ru. Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# EL-2-16-58621 DBP r2a $4.50 DCA Fee $4.50 03/29/2016 Credit Card $265.20 $50.00 Education Surcharge $0.40 02/08/2016 Check#: 1010 $50.00 $0.00 Permit Fee-Additions/Alterations $300.00 r Scanning Fee $3.00 Technology Fee $1.60 F Total: $315.20 in Cor---,ite,r of +ha i—ttanre to n1p of thrc nern- c I-agree perfn-m the worl, c -erPd hereunder in Comp113nce with all ordinances and regulations pertain ny tnereto ano in strict conformity with the plans,drawings, statements or specifications submitted to the prof:er authorities of Miami Shores Village. In accepting this permit I assume responsibility for all c cork done by either myself, my agent, servants, or employes I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL woi:. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate, and that all work will be done in com fliance with all applicable laws regulating construction and zoning. Futhermor J authorize the above-named contractor to do the work stated. Mar;h 29, 2016 Authorized Signatur Owner / Applica it / Contractor / Agent .3ate Bu ldinn Department Copy Mairc:r1�'�+, iia ir; - — ------ ---------- ----------- -------- - ------------— -- 1 IVI Idt t l l JI IUt CJ V I I Id�C i Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit No. ��1 '_�� ` PERMIT APPLICATION Sub Permit No. t`—j C6' ,-�51 ❑BUILDING [)6 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP ,/ CONTRACTOR DRAWINGS JOB ADDRESS: 1 0 (O R5 NE I I A Y 19 City' Miami Shores County: Miami Dade Zip: 23),30? Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): 691je, �s/ �/'I �PCho nn;;* -3' Address: /04975 A.) nom. _ J1 4� City: t"W 6State: Zip: _3313 a D Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: O Q�Phone#: -233 -� a3 d 4� Address: �b 16 LA.) L L4 -7 A Ya- U v City: P State: FL Zip: c�33 ) 17 3 Qualifier Name: ) 'e� Phone#: 3�b ^ � Z�y State Certification or Registration#: EL' l 3co to S'S 5 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: �Value.of Work.forthis P_ it::$�' �� ��� • Square/Linear Footage of Work: Type of Work: ❑ Addition 99 ❑ Alteration Q New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: Submittal Fee$ �(7) � Permit Fee$ CCF$ 2_0 CO/CC$ Scanning Fee$ �•� Radon Fee$ (4' ST�) h DBPR$ Notary$ Technology Fee$ 'G I) Training/Education Fee$ 0. 4o Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE 5 261�; • 2_0 Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES,BOILERS, HEATERS,TANKS,AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "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." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature )e Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 1Z day of / 7 , ,20 /S • , by day of 20 1-5- , by ,5�1. 6zena tnrho is personally known to 7who is personally known to me or who has produced y,l Zz 045.E . as me or who has produced 'x kQ�rt _as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY,PUBLIC, Sign: Sign: DO is R ry I ION:& v Print: Print: Seal: .. r Commi8110!EE, Seal: Bonded through tet State Insurance APPROVED BY 7 ,�`L��_ Plans Examiner Zoning Structural Review Clerk From:Leonardo Rodriguez Fax: 888 972-2737 To: Fax: +1 (305)756-8972 Page 2 of 4 02/02/2016 11:35 AM o� STAT OF FLORIDA 'DEPARTMENT OF BUSINESS AND PROFESSIONALREGULATION :E�.ECTRICAL CONTRACTORS LICENSING BOARD (850) 487. 13.95 „... 194"ORTH MC�NROE STREET ; TALLAHASSEE FL 32399=0783 RODRIGUEZ, LEONARDO SR CONTRACTORS ELECTRICAL SERVICES, INC. 6821 SW 147TH AVENUE APT 3E MIAMI FL 33193 Congratulations! With this license you become one of the nearly one million.Floridians-licensed by the.Department of Business and Professional:Regulation. Our professionals and businesses range from architects to yacht.brokers,from boxers to ba rbeque restaurants, ,„”;� 'r T�TF QE FLQMDA DEPA T F C� 1111ESS ASD and they keep Florida's economy strong,. �I'RO t UI.ATIOt w" Every day we work to improve the way we do business in order to serye you.betterr. For information about o ur services, please log ontoC�1tti559 virww,myfloridaticense:com. There.you can find more information about our divisions and the regulations that impact you, subscribe C£ TiEIED E T �► R �«r to department newsletters and learn more about the Department's ttOUEZ, V nel initiatives. G3i1TAC�TO r � ESw t Our mission at the Department is: License Efficiently, Regulate Fairly, rM ""-X *F „° `• -dw We constant) strive to serve you better so that ou can serve our r,o Y Y Y ^' * customers, hank you for doing business in Florida, � .v F and congratulations on your new license! trex Re V, *egg s y per n date Baa �"" m •t� 0000q � DETACH HERE RICK SCOTT, GOVERNOR- ;. - ;_< KEN LAWSON, SECRETARY n.,r-.f`'�`. .,.rA �•.w+.roe ,� sr,.w o.'t�-:.A.w.,. :aw...,,L�:a,�,.>�ia.'� :�.« ,..1^.e,�M,�*`,... ,r••- ..,.� • :,� - . �� ,, . ,„�,.�,�,�r, ,�,. ,�:.,,.�;.r�:.,STATE t)F„;FtOE�1E�A"''��. xh"'���, � �,, 4 �,�;�.,�a ,°,��. �, ..:�• �� EN'C:. usttaEss�i+tl��i� � A '�?m„�"�°�a '^�„ �".`,''�ru" ..�',,°`'f .,, .,��'"' ._,�.:��•°r*_�,,,.. ,�'I,EDTI�ICI��.CO T�ACT4fI:S LICEt�SIN� EQARD�`a,'' �:� � ,• ' - _ ..s•;'c .ry,�,A,N.aw �t„+w,ca x .c.,, wk"R. w* .� "`' z - `" ue '"t.. > ASE.. . t a"'" ,.:vve _1.. ,°�",,`•w "ae'a'",,,,,e�M.wr, "r"k'.` ,r`"'E�' ow, .. *e'i"°"a", ,a. ?�,c,,:.,,;,,.,\`�e e'` `.»., "� a a.. O RICAI CC�NTRACTtR. °»KF. y 3g N� � 3 k �1 �1QI}7fi'(p fiefl> p1U 1 201& �" ..a9Mkaeur h � aha. i:,r,.v�*�'r �a �,.w,s+gxk �°► :i` �`�r i 0; WE, ' ��"q/� r 1h �x�•.�. M a1xY" 'f :,L. '�cn•M• � 5 r+tl :. fi ,�� ' y�In, ilt .. �Jy . A'rva �:[azll�}T�4p�K_ ,7>�7x....NNldl�'M��.v ' �.•� ... wu� � � -^.4 15SUED: 02)10!2015 DISPLAY AS REQUIRED BY LAW SE0# L1502100000431 From:Leonardo Rodriguez Fax:(888)972-2737 To: Fax: +1 (305)756-8972 Page 3 of 4 02/02/2016 11:35 AM 005642_ ..:. Nlncpa contaco � ci r Mtam-�E3ade Count S ..:.... .. ,.. y, fia# crf Flori t 0 9E O 0058 ........::. .. . auSINE881vAPARII. CA`t'ION it; C81ar N4 GONTRAC o9CrRtca SEftlItCES ttuc: ass�t� XI�Ii�S fi8?1 S1M447AV 3E st� "�f1BI �# Q7 fl11AMl FL 33193s „ • Pursos � �� Gouetcy Coda �c 4t1�}24 OWNERSEC TYPE OF BU.81N6SS. t GONTR/1GTOR5 ELECTRICAL SVCS INC ELECTRtAL COrifTRACTpR FAYti�tENT F)EGt:lvEtU 9Y TAx d.6LLRcT0JR- 2oo�q t3�/2R/2bi5 Ct!£G9C2 75—107342 For htc re information,visit ieEly ttvmiamidade Dov a-99i ih'' '.<::':.:;.:'. 004000 cal,Bins oeT ift ece t ' t Ic1T1,t 'made cL�r9t ��, x x Yr state 4fx :Ftarida .' TFIIS I5 NOTA$11,L.� f)p NC3TP +z' AY ,¢(f f 6517248. n , :. BtJSiNEBSiHAME/lClCATtC>N :��svau< ,� REt - sERutc ,vimX`P�IAez E$ canrrRacra� t^�tNc t s8sW 1'AAU�3 1 s7$�58 SEPTNBEG + �0'I MIAh?11 F13379 lyugt be a,spiayata tceof Pursuattt; busrrless RArr,s;&'ttt Y.: OWNt CpNTRAC,,QRS ELECTRICAL SVGS INC E OF 13U4, 196 ELECTRICAL pQfVTRRCTta R? AAYMEl�lf gEGfIVfD Worker{s) 1 09E000SOOY T"x $75.OA 07�28/2Q 9'S' This i ocel 6uslrtees Tak l;ece� ton! Recai CNECK2 t".?5-9 07598 partslt;oracenifiGa!lanofffieholdere ualificaztottsestsBNol$�Ttis not Orno(►yalrammertgtfayyJata la P tttcetae, rye �+fuireme+►tswhtcbe Ph!vuRheoY9oyaranlon3al Tha'R�t:EtPT N0,ahove'inust he d7 s d on ail c'" AIRY to the business spi 1!e ommercia!vahiclea M,erfya.Dpda code ' . For moro'fa[pm�ation, ,, SepBa-ZI6 '':r� vtstt: A From:Leonardo Rodriguez Fax:(898)972-2737 To: Fax: +1(305)275-0154 Page 2 of 2 02/0312016 2:59 PM A�® CERTIFICATE OF LIABILITY INSURANCE °A�2ozols ' • THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les)must be endorsed If SUBROGATION IS WANED, 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 CONTACT NAME: PABLO M CONDE A&A Underwriters I ric. PHONE 305 220-7447 a: 305-22D-4821 8778 SW 8st .MAR ADDRESS: pnicipIftaundewiters.com INSURER AFFORDING COVERAGE NAIC0 Miami FL 33174 INSURER A: Scottsdale Insurance Company 03292 INSURED INSURER B: RetailFirst Insurance Company 10017 Contractors Electrical Services INC. INSURER C: 6821 SW 147 th.Ave Ste 3E INSURER D: INSURER E: Miami FL 33193 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE WaPOLICY NUMBER POLICY M ONYYY M POLICY P LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $_1,000,000 CLAIMS-MADE Z OCCUR PREMISES Meoccurrence $ 1,00,000 MED EXP Ww oneperson) S 5„000 A CPS2294314 09108/15 09/08/16 PERSONAL&ADV INJURY S 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 R OTHER:POLICY LnJ JEFILOC PRODUCTS•COMPAOP AGG S 1,000,000 $ AUTOMOBILE LIABILITY COM81NED SINGLE LIMIT S (Es amident) ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Persodderd) S AUTOS AUTOS HIRED AUTOS NON-OWNED Y $ AUTOS Per soddent S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE S DED RETENTIONS $ WORKERS COMPENSATION NEX E AND EMPLOYERS'UASILITY ANY PROPRIETOWPARTR7ENECUTIVE YIN E.L.EACH ACCIDENT S 1,000,000 B OFRCERFMENWR EXCLUDED? N/A 520.40493 04/06/15 04/06/16 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 It yes de scribe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000 000 DESCRIPTION OF OPERATIONS'/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) License No.EC13006559 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WTH THE POLICY PROVISIONS. Building Department AUTHORIZED REPRESENTATIVE 10050 NE 2nd Ave Miami Shores FL 33138 --+ ©1988.2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL VP 1 �-3,qj a Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-264748 Permit Number: EL-2-16-351 Scheduled Inspection Date: August 04, 2016 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: LAWRENCE, GILDA GREENE Work Classification: Pool - Private Job Address: 10675 NE 11 Avenue Miami Shores, FL 33138-2120 Phone Number Parcel Number 1122320280300 Project: <NONE> Contractor: CONTRACTORS ELECTRICAL SERVICES Phone: (786)252-1284 Building Department Comments NEW SWIMMING POOL AND SPA. Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-264488. CREATED AS REINSPECTION FOR INSP-252461. Add disconnects in line of sight of moters,N.E.C.430.102. Failed Correction Needed Re-Inspection Fee �cqo*"r/ No Additional Inspections can be scheduled until re-inspection fee is paid. August 03, 2016 For Inspections please call: (305)762-4949 Page 23 of 31 From:Leonardo Rodriguez Fax:(888)972-2737 To:3057568972@rcfax.con Fax: +13057668972 Page 2 of 2 0412812016 11:08 AM ACORO� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/18/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION 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 IINTAII NAME: PABLO M CONDE A&A Underwriters Inc. ' I SLig PHONE 305 220 7447 305-220-4821 v A/C No Ezt: ( ) A/C No 8778 SW 8st E-MAIL ADDRESS: Pme aaunderwl ters.com INSURER(S)AFFORDING COVERAGE NAIC Miami FL 33174 INSURERA: Scottsdale Insurance Company 03292 INSURED INSURERB: RetailFlrst Insurance Company 10017 Contractors Electrical Services INC. INSURER C: 6821 SW 147 th.Ave Ste 3E INSURER D: INSURER E: Miami FL 33193 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE 5ZUPOLICY NUMBER MM/DD/YYYY MM/DDNYW LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS MADE OCCUR itu PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A CPS2294314 09/08/15 09/08/16 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY I I JECT F-1 LOC PRODUCTS-COMP/OP AGG $ 1,000,000 ROTHER: $ AUTOMOBILE LIABILITY COLI MBINED SINGLE MIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNEDPROPERTY DAMAGE AUTOS Peraccident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HEXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION AND EMPLOYERS'L[ABILITY - ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N STATUTE ER B OFFICER/MEMBER EXCLUDED? Y❑ N/A 520-40493 04/06/16 04/06/17 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) If yes,descr be under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) License No. EC13006559 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores FL 33138 / � "C---..---- O 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD