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MC-16-675 Crr- � 1p —t lQVn Inspection Worksheet Miami Shores Village F� 10050 N.E. 2nd Avenue Miami Shores, FL t Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-265580 Permit Number: MC-3-16-675 Scheduled Inspection Date: October 31, 2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: MUSAFFI, NICOLE&JEFFREY Work Classification: Addition/Alteration Job Address: 1178 NE 99 Street Miami Shores, FL 33138- Phone Number (561)414-9398 Parcel Number 1132050180120 Project: <NONE> Contractor: TRIUMPH AC& REFRIGERATION CORP Phone: (786)512-0548 Building Department Comments RENOVATE A/C DUCT AND PLANS. INSTALLED NEW Infractio Passed Comments A/C UNIT 3.5 TON. INSPECTOR COMMENTS False V Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-254717. NEED APPROVED REVISED PLANS Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 28,2016 For Inspections please call: (305)762-4949 Page 10 of 31 � � p 6 � 5 Permit NO. MC-3-16-675 ,SORES`�` Miami Shores Village Permit Type: Mechanical-Residential �� 10050 N.E.2nd Avenue NE � ' Work Classification:Addition/Alteration II " Miami Shores,FL 33138-0000 Permit Status:APPROVED Phone: (305)795-2204 Issue gate: 3118/2016 Expiration: 09/14/2016 Project Address Parcel Number Applicant 1178 NE 99 Street 1132050180120 Miami Shores, FL 33138- Block: Lot: NICOLE&JEFFREY MUSAFFI Owner Information Address Phone Cell NICOLE&JEFFREY MUSAFFI 1178 NE 99 Street (561)414-9398 (954)993-5151 MIAMI SHORES FL 33138- 1178 NE 99 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 9,700.00 TRIUMPH AC&REFRIGERATION COF (786)512-0548 Total Sq Feet: 0 Tons:3.5 Available Inspections: Additional Info:RENOVATE A/C DUCT AND PLANS. INSTAL Inspection Type: Classification:Residential Final Approved:In Review Rough Duct Comments: Date Approved: :In Review Review Mechanical Date Denied: Type of Work: Underground Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $6.00 Invoice# MC-3-16-59016 DBPR Fee $5.09 DCA Fee $5.09 03/15/2016 Credit Card $50.00 $323.68 Education Surcharge $2.00 03/18/2016 Credit Card $323.68 $0.00 Notary Fee $5.00 Permit Fee $339.50 Scanning Fee $3.00 Technology Fee $8.00 Total: $373.68 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work 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 work. OWNERS AFFIDAVIT: I certify that all h f regoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futher or ,I o e the above-named contractor to do the work stated. March 18, 2016 Authorized Signature:Xent / plicant / Contractor / Agent ate Building DeparCopy March 18, 2016 1 Miami Shores Villa e RECEIVED " g M R 15 2016 Building Department BY: - 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 tt 11 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 ( LAI BUILDING Master Permit No.V—O—((: - 1�6 PERMIT APPLICATION Sub Permit No. �&i C` ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBINGMECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP a CONTRACTOR DRAWINGS JOB ADDRESS: I l 7� ' /C,ss 99 S4 • City: Miami Shores County: Miami Dade zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: e Flood Zone: q r�BFE: / FFE: 04 OWNER: Name(Fee Simple Titleholder): im / (� �'e '� �•wot /y ° �� V/Phon#: 14 1- V/Y_- !p-?QS Address: I l -7 � N N" 'q 9 City: /4) A-XA,� Cho i° e State: 1 l - Zip: } Tenant/Lessee Name: ���� Phone#: J Email: e ffir e-'1 � �� S 4 All—f' -d 16L ( eo e N • CO" CONTRACTOR:Company Name: IA!,,, dC Phone#: 6 - A:-)'a 0 Address: 10 c() A'A_ %?, City: . 4 State: F zip: -B'30 to - Qualifier Name: P r e Z Phone#: C1_1115-9 State Certification or Registration#:� - �8/ t`oZZ9 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: / Address: City: State: Zip: J Value of Work for this Permit: Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New IDRepair/Replace ❑ Demolition Description of Wor t e ri 2 31_ JA Specify color of color thru tile: ��,,ll Submittal Fee$ Q �� Permit Fee$ CCF$ W CO/CC$ Scanning Fee$ L� ` ,�� /7 Radon Fee$ w' 9 DBPR$ 5- d"1 Notary$ tK-) • Technology Fee$ cJ /w Training/Education Fee$ G •(3 Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ �� 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 issue . 1 h absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT TRACTOR The foregoing instrument was acknowledged before me this The foregoing instrunien was acknowledged before me this day of `� 20 1,6 by ,1 day of M,��� 201/o by TE TES' v I� MUSH `�s personally known to A Itt CL J;-A4 e;d c?'Z, ,who i ersonally known t me or who has produced Vl� �" N�a3 me or who has produced as identification and who did take an oath. identification and who d' LENER CASTRO NOTARY P ELIC: NOTARY PUBLIC: MY COMMISSION#FF093479 EXPIRES:FEB 17,2018 0F1 Bonded through 1st State Insurance Sign: Signer Print: `� Print: �13��' Z �O r�� LENER GASTRO Seal: rooRY P�'4� Notary Public State of Florida Seal: " . MY COMMISSION*FW93479 Sindiia Alvarez EXPIRES:FEB 17,2019 oe My Commission FF 156750 of Mom Expires 09/0312018 a Bonded through 1st 80 11111101111111141 APPROVED BY A Plans Examiner Zoning Structural Review Clerk �gt%OR„�s Miami Shores Village Building Department Bn. , egoist" 10050 N.E.2nd Avenue Miami Shores, Florida 33138 xxo iDp Tel: (305) 795.2204 Fax:(305)756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change-out must be on its own data sheet. Multiple units on single sheets are not acceptable. 1 Job Address(where the work is being done): 7 �� 212 S'r City: Miami Shores Village County: Miami Dade Zip Code: � I ( .5 ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED Change disconnecting means:YES❑ NO❑ ARHI Sheet Attached:YES ❑ NO ❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT 12 We aa4 MANUFACTURER AHU or PKG. UNIT MODEL# f./ !,/ Z N COND. UNIT MODEL# re.4/6 c(z 4 KW HEAT ? S kW • NOM TONS /7 AHU CU PKG 1)M.C.A AHU CU PKG AHU CU PKG 2)M.O.P AHU CU PKG AHU CU PKG 3)VOLTS AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER t S nn YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity(Wire Size): 0 2. Maximum Overcurrent Protection (Fuse/Breaker Size): (:�7 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: U _ Contractor's CompanyNa e: 14 Alt Phone: State Certificate or Reg tra ' o. 7i2 Certificate of Compet!pn y No. Signature Date: 0 511146 ( ua ure) ®W This combination qualifies for a Federal Energy I Efficiency Tax Credit when placed in service between Feb 17,2009 and Dec 31,2016. Ceftificate of Product Ratings AHRI Certified Reference Number: 7942888 Date: 3/15/2016 Product:Split System:Air-Cooled Condensing Unit,Coil with Blower Outdoor Unit Model Number: RA1642AJ1 Indoor Unit Model Number: RHIT4821STAN Manufacturer: RHEEM SALES COMPANY,INC. Trade/Brand name: RHEEM;RUUD Region:All(AK,AL,AR,AZ,CA,CO,CT,DC,DE, FL,GA,HI,ID, IL,IA,IN, KS,KY,LA,MA,MD,ME, MI,MN,MO,MS,MT, NC,ND,NE,NH, NJ,NM,NV,NY,OH,OK,OR, PA,RI,SC,SD,TN,TX, UT,VA,VT,WA,WV,Will,WY, U.S.Territories) Region Note: Central air conditioners manufactured prior to January 1,2015,are eligible to be installed in all regions until June 30,2016. Beginning July 1,2016,central air conditioners can only be Installed in regions)for which they meet the regional efficiency requirement. Series name: Manufacturer responsible for the rating of this system combination is RHEEM SALES COMPANY,INC. Rated as follows in accordance with AHRI Standard 210/240-2008 for,Unitary Air-Conditioning and Air-Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored,independent,third party testing: Cooling Capacity(Btuh): 41500 EER Rating(Cooling): 13.00 SEER Rating(Cooling): 16.00 IEER Rating(Cooling): 'Ratings followed by an asterisk(')indicate a voluntary rerate of previously published data,unless accompanied with a WAS,which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s)listed on this Certificate and makes no representations,warranties or guarantees as to,and assumes no responsibility tor, the product(s)listed on this Certificate.AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s),or the unauthorized alteration of data listed on this Certificate.Certified ratings are valid only for models and configurations listed in the directory at www.ahridirectory.org. TERMS AND CONDITIONS 1--� This Certificate and Its contents are proprietary products of AHRI.This Certificate shall only be used for Individual,personal and confidential reference purposes.The contents of this Certificate may not,In whole or in part,be reproduced;copied;disseminated; f?Ji'�+iLml entered Into a computer database;or otherwise utilized,in any form or manner or by any means,except for the user's individual, personal and confidential reference. AIR-CONDITIONING,HEATING, CERTIFICATE VERIFICATION &REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.ahridlrectory.org,dick on"Verify Certificate'link we make life better- and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above,and the Certificate No.,which is listed at bottom right. ©2014 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 131025133351972078 This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17 2009 and Dec 31 2016. r ► Certificate ®f Product Ratings AHRI Certified Reference Number: 7942888 Date: 3/15/2016 Product: Split System:Air-Cooled Condensing Unit,Coil with Blower Outdoor Unit Model Number: RA1642AJ1 Indoor Unit Model Number: RHIT4821STAN Manufacturer: RHEEM SALES COMPANY, INC. Trade/Brand name: RHEEM; RUUD Region:All(AK,AL,AR,AZ,CA,CO,CT,DC, DE, FL,GA,HI, ID,IL,IA,IN, KS,KY,LA, MA, MD, ME, MI, MN, MO,MS,MT,NC,ND,NE,NH, NJ, NM, NV,NY,OH, OK,OR, PA,RI,SC,SD,TN,TX, UT,VA,VT,WA,WV,WI,WY,U.S.Territories) Region Note: Central air conditioners manufactured prior to January 1,2015,are eligible to be installed in all regions until June 30,2016. Beginning July 1,2016,central air conditioners can only be installed in regions)for which they meet the regional efficiency requirement. Series name: Manufacturer responsible for the rating of this system combination is RHEEM SALES COMPANY,INC. Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air-Conditioning and Air-Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, independent,third party testing: Cooling Capacity(Btuh): 41500 EER Rating(Cooling): 13.00 SEER Rating(Cooling): 16.00 IEER Rating(Cooling): Ratings followed by an asterisk(')indicate a voluntary rerate of previously published data,unless accompanied with a WAS,which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s)listed on this Certificate and makes no representations,warranties or guarantees as to,and assumes no responsibility for, the product(s)listed on this Certificate.AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s),or the unauthorized alteration of data listed on this Certificate.Certified ratings are valid only for models and configurations listed In the directory at www.ahridirectory.org. TERMS AND CONDITIONS EM This Certificate and Its contents are proprietary products of AHRI.This Certificate shall only be used for individual,personal and confidential reference purposes.The contents of this Certificate may not,in whole or in part,be reproduced;copied;disseminated; entered into a computer database;or otherwise utilized,In any form or manner or by any means,except for the user's individual, personal and confidential reference. AIR-CONDITIONING,HEATING, CERTIFICATE VERIFICATION &REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.ahridlrectory.org,dick on"Verify Certificate"link we make life better- and enter the AHRI Certified Reference Number and the date on which the certificate was Issued, which is listed above,and the Certificate No.,which is listed at bottom right. ©2014 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 131025133351972078 . ^ ` . ^ STATE OFFLORIDA DEPARTMENT OFBUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING GAC 1816229 . ^' The CLASS 8AJRCOND/TlON|'` NRmedbelow /SCERTF.B] Under the pnmm'CroofChap�/48gFS Exp/sUcndaLe AUG 31,, 20`6 r J|/WENEZ_4R|EL TR/UK4PH4C & REFR/GERAIDON, CO�P GO21NVV112THTER NALEAHGAROENS FL33U18 /n8uEoA 06111 znw DISPLAY AS RE(}U|REO BY LAW aeoft 1-1406/-10000732 ` Local Business Tax Receipt Miami—Dade County, State of Florida --THIS IS NOTA BILL - DO NOT PAY 6441430 LBT BUSINESS NAMEILOCATION RECEIPT NO. EXPIRES TRIUMPH AC&REFRIGERATION CORP RENEWAL SEPTEMBER 30, 2016 9810 NW 80 AVE#8L 6709910 7-1st be displayed at place of business HIALEAH GARDENS FL 33016 Pursuant to County Code Chapter BA-Art.9&10 OWNER SEC.TYPE OF BUSINESS TRIUMPH AC&REFRIGERATION CORP 1C.6 SPEC NIECHAN,CAL CONTRACTOR PAYMENT RECEIVED CAC1816229 BY TAX COLLECTOR Worker(s) 545.00 07/10/2015 CHECK21-15-086472 This Local Business Tax Receipt only confirms payment of the Local Business Tax The Receipt is nota license. permit,or a cernbcation of the holder's que!*fications,to do business. Holder must comply with any governmental or nongovernmental tellwatory laws and requirements which apply to the business. The RECEIPT NO.above must be displayed on all commercial vehicles-Miami-Dade Code Sec 83-276. For more information,visit www nliamied;t,"v ACCIOR& CERTIFICATE OF LIABILITY INSURANCE °A��114/16'"" 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. NdPORTANT: M the certificate holder is an ADDITIONAL.INSURED,the poliey(ies)must be endorsed. M SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this cartiBcate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER 9wVCT NAME• First General Insurance PHONE • I(305)817-0303FAX No: ,(305)817.0333 79W NW 155 St,Suite 102 EMAIL 'din= _ oom Miami Lakes,FL 33016 INSURERS AFFORDING COVERAGE MAIC i Phone (305)817-0303 Fax (305)817-0333 INSURER A: 'ASCENDANT INSURED INSURER B: 'ASCENDANT TRIS U AC&REFRIGERATION CORP 1INSURER c (PROGRESSIVE 'L8821 N W 112 TERRACE- I INSURER D: IALH EAP GARDENS,FL 33018 -, 305 I INSURER E: I ------------ - INSURER f• I COVERAGES CERTIFICATE NUMBER: ) I 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 POLICES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LAR ADOL TYPE OF INSURANCE uLNt POLICY NUMBER Mom Y EFF MPO�Y EXP LIMITS GENERAL.LIABIIJW EACH OCCURRENCE E 11.00D,000AO I DAMAGE TO RENTED © COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ `1w'0w.00_ CLAIMS© F-1 ❑F_ �� r IOCCUR71 GL-45822-1 10/24/2015 10/24!2016 MED EXP(Any one person) $ ,5,000.00 I F L_i PERSONAL 6ADV INJURY $ 1,000.000.00 I ❑ I I GENERAL AGGREGATE s 2,000.000.00 I GEN'L AGGREGATE LMR APPLIES PER: PRODUCTS-COMPIOP AGG f 1,000,000.00 I ❑ POLICY ❑ PRO-JECT ❑ LOC I $ AUTOMOBILE LIABILITY COMBINED SINGLE LMR 11��.� i a accident F 1 ❑ ANY AUTO BODILY INJURY(Per person) $ I ALL OW08 NED SCHEDULED BODILY INJURY(Per accident) E ❑ AUTOS © AUTOS 7 ❑ 02103/2016 0?JD3 I I NON-OWNED PROPERTY DAMAGE $ ( I ❑ HIRED AUTOS AUTOS P accident ❑7-7 ❑F- IPERSONAL INJURY $ 10,000.00 ❑ UMBREL.LALIAB ❑OCCUR EACH OCCURRENCE f E] ❑ EXCESS LIAB ❑CLAIMS-MADE a 1 ' AGGREGATE $ f I ❑ DEO ❑ RETENTION s I r� $ I WORKERS COMPENSATION ®W C STATU- ©OTH- NONE AND EMPLOYERS'LIABILI Y YIN - ------ ANY PROPRIETORIPARTNERIEXECUTIVE W C63906.3 E.L.EACH ACCIDENT $ 'SOO,000.00 I 'A I (Mandatory EXCLUDED? El 051018015 ,05101/2016 r (Mand+ y In NH) E.L.DISEASE-EA EMPLOYE $ 'SOO.000AO Kdescribe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 JII DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(Attech ACORD 101,Additional Remarks Schedule,I more space Is required) AJC REPAIR 3INSTALLATION !TRIUMPH AC 8 REFRIGERATION CORP STATE OF FLORIDA CERTIFIED CONTRACTOR ',ARIEL JIMENEZ OFFICE(EXCLUDED FROM COVERAGE ON WORKS COMPENSATION) CLASS B AIR CONDITIONING CONTRACTOR CAC1816229 I I .CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE _MU"SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN BUILDING DEPARTMENT - - ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 AVENUE___ _ AUTHORIZED REPRESENTATIVE MIAMI SHORES,FL 33138 -- - I ROSIE BRUZON ®1988-29'10 ACORD CORPORATION. All Tights reserved. ACORD 2S(2010105)OF The ACORD name and logo are registered marks of ACORD