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ACT-18-763 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 F Inspection Number: INSP-303434 Permit Number: ACT-3-18-763 Inspection Date: May 08, 2018 Permit Type: Awnings/Canopies/Tents Inspector: Naranjo, Ismael Inspection Type: Final Owner: , BARRY UNIVERSITY Work Classification: Repair Job'Address: 11300 NE 2 Avenue { Miami Shores, FL 33161-6628 Phone Number I Parcel NutOW00050 Main Campus Project: BARRY UNIVERSITY Contractor: REY'S AWNINGS AND SHUTTERS CORP Phone: (305)820-9890 Building Department Comments REPLACE & RECOVER VINYL Infractio Passed Comments ( TENNIS COURT) INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-300106. REY SANTOS 561-523-0565 Failed Plans and permits missing FRANCIS 786-720-6481 Correction ❑ Needed I Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. i r For Inspections please call: (305)762-4949 May 09, 2018 Page 1 of 1 1 Permit,m0. ACT-3-18-763 �sNO1 S L,� Miami Shores Village Is MtPermit Type:Awnings/Canopies/Tents 10050 N.E.2nd Avenue NE WI I ork WorlcCtassitication:Repair Miami Shores,FL 33138-0000 Phone: (305)795-2204 Permit Status:APPROVED �, [ORLDA Issue Date:4/25/2018 Expiration: 10/22/2018 Project Address Parcel Number Applicant 11300 NE 2 Avenue 1121360000050 Main Campus I ' BARRY UNIVERSITY INC Miami Shores, FL 33161-6628 Block: Lot: Owner Information Address Phone Cell BARRY UNIVERSITY INC 11300 NE 2 Avenue MIAMI SHORES FL 33161-6628 11300 NE 2 Avenue MIAMI SHORES FL 33161-6628 Contractor(s) Phone Cell Phone Valuation: =1,760.00REY'S AWNINGS AND SHUTTERS CO (305)820-9890 (305)820-9890 Total Sq Fee Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved: : In Review Final Date Denied: Review Building Type of Work:REPLACE&RECOVER VINYL Additional Info:REPLACE&RECOVER VINYL Review Building Classification:Commercial Color Approved: In Review:In Review Review Planning Code Comments: : Code Approved: :In Review Code Denied: Scanning:3, Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 DBPR Fee Invoice# ACT-3-18-66905 $2.00 04/25/2018 Credit Card $66.20 $50.00 DCA Fee $2.00 Education Surcharge $0.40 03/26/2018 Cash $50.00 $0.00 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $116.20 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 it I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required fo E4RICAING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWN S AFFIat all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating con ruction are,I aut the ab ve-n med contractor to do the work stated. i April 25, 2018 ;�ir-ecl S' ure: caner / Appli ant / Con ractor / Agent Date i rtment Copy April 25, 2018 1 ;:�I6� �� Miami Shores Village it 26 18 �{ M R A tea,\ Building Department 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 By'.� _— Tel:(305)795-2204 Fax:(305)756-8972 iYil I INSPECTION LINE PHONE NUMBER:(305)762-4949 (0-f-h FBC 201 11' BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. QBUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 11300 NE'2 Avenue -Tennis Courts ;City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: ��[ J cp 00 6 3-0 Is the Building Historically Designated:Yes NO � Ik # ' Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER:Name(Fee Simple Titleholder):Barry University Phone#:305-899-3995 Address: 11300 NE 2 Avenue City: Miami Shores State: FL Zip: 33161 1305-899-3995 Tenant/Lessee Name_: Phone#: Email: PlCONTRACTOR:Company Name: 0- Phone#: ,Address: City: State:��4-_ Zip: K. Qualifier Name: Phone#: ?A 3 Y�- ��3 y T 4 nn ,1)' State Certification or Registration M (�K B SOQXS/ Certificate of Competency#:DESIGNER:Architect/Engineer: N(A Phone#: I'{ Address: X j6& Cit •� , �' I'' .U y: �1.� State• Zip. Value of Work for this Permit:$__� 7 j Square/Linear Footage of Work: 0 Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace / !� ElDemolition f. Description of Work: �c�l i��to � &f i)" I-e- it a. k Specify color of,color thru tile: Submittal Fee$_ f Permit Fee$ CCF$ CO/CC$ Scanning Fee$ + Radon Fee$ DBPR$ Notary$ j Technology Fee$ Training/Education Fee$ Double Fee$ "Structural Reviews$ Bond$ b' TOTAL FEE NOW DUE$ 2� �f (Revised02%24/2014) 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 Ljd SignatureI��-- OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 1 0K day / of 14W AV_ 20 1 �s by /c 1POday of rva 20 f 9 by SuS,r U.VSb �� who is personally known to 7 QOM6 h -R?fi ,1S ,who is personally known to me r who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOT4PU NOTARY PUBLIC: Sign: Sign:Print - Print: lldizl"a Gc �Cjn'/OS S �#0 Notary Public State of Florida Seal: Jeffry J Yao ot►�Y'usMARIA E PALACIOS �p� My Commission FF 188481 z .• ••, n a pd` ExpiM 11/12/2018 + + �� GG 109593 FOFFl° Bonded NohrySwvlos J/ APPROVED BY Plans Examiner Zoning c Structural Review Clerk (Revised02/24/2014) Property Search Application - Miami-Dade County Page 1 of 1 It n Q � .jr V t; 0"`E=1A'E OF THE PROPERTY APPRAISERI Summary Report Generated On:3/26/2018 Property Information j Folio: 11-2136-000-0050 r Property Address: 11300NE2AVE Miami Shores,FL 33161-6628 � Owner BARRY COLLEGE. 11300 NE 2 AVE LAVOIE BLDG 2ND Mailing Address FL RM 204 MIAMI SHORES, FL 33161-6628 PA Primary Zone 8200 SCHOOLS&CHURCHES iPrimary Land Use 7241 EDUCATIONAL/SCIENTIFIC- � EX:EDUCATIONAL-PRIVATE 4 y ale Beds/Baths/Half 0/0/0 Floors_ 2 Living Units 66i Actual Area Sq.Ft Living Area Sq.Ft Adjusted Area 623,362 Sq.Ft Taxable Value Information Lot Size 1,740,400 Sq.Ft 2017 2016 2015 Year Built 1954 County Exemption Value $48,008,208 $46,503,814 $43,013,559 Assessment Information Taxable Value $0 $0 $0 Year 2017 2016 2015 School Board Land Value $6,961,600 $6,961,600 $6,961,600 Exemption Value $48,008,208 $46,503,814 $43,013,559 Building Value $38,439,360 $36,913,434 $33,497,476 Taxable Value $0 $0 $0 XF Value $2,607,248 $2,628,780 $2,554,483 City Market Value $48,008,208 $46,503,814 $43,013,559 Exemption Value 1 $48,008,208 '$46,503,814 $43,013,559 Assessed Value $48,008,208 $46,503,814 $43,013,559 Taxable Value $0 $0 $0 Regional Benefits Information Exemption Value $48,008,208 $46,503,814 $43,013,559 Benefit Type 2017 2016 2015 Taxable Value $0 $0 $0 Educational Exemption 1 $48,008,208 $46,503,814 $43,013,559 Note:Not all benefits are applicable to all Taxable Values(i.e.County, Sales Information School Board,City, Regional). I Previous Sale Price OR Book-Page Qualification Description Short Legal Description 36 52 41 40 AC SE1/4 OF NE1/4 LESS E35FT&LESS W40FT LOT SIZE 1740400 SQUARE FEET The Office of the Property Appraiser is continually editing and updating the tax roll.This website may not reflect the most current information on record.The Property Appraiser and Miami-Dade County assumes no liability,see full disclaimer and User Agreement at hftp://www.miamidade.gov/info/disclaimer.asp r Version: http://www.miamidade.gov/propertysearch/ 3/26/2018 I 2017 FLORIDA NOT FOR PROFIT CORPORATION ANNUAL REPORT FILED DOCUMENT#711458 Apr 27, 2017 I Entity Name: BARRY UNIVERSITY, INC. Secretary of State CC2519040112 4 Current Principal Place of Business: 11300 N.E.SECOND AVENUE ROOM 105 FARRELL HALL MIAMI, FL 33161 Current Mailing Address: 11300 N.E. SECOND AVENUE ROOM 105, FARRELL HALL MIAMI, FL 33161 FEI Number: 59-0624364 Certificate of Status Desired: No Name and Address of Current Registered Agent: DUDGEON,DAVID 11300 NE SECOND AVE LAVOIE HALL#209 MIAMI, FL 33161 US v The above named entity submits this statement for the purpose of changing its registered office or registered agent,or both,in the State of Florida. ' SIGNATURE: Electronic Signature of Registered Agent Date Officer/Director Detail : Title S Title T Name DUDGEON,DAVID Name ROSENTHAL,SUSAN Address 11300 NE SECOND AVE Address 11300 N.E.SECOND AVENUE City-State-Zip: MIAMI FL 33161 City-State-Zip: MIAMI FL 33161 j Title D Title PD Name BUSSEL,JOHN Name BEVILACQUA,SISTER LINDA f Address 11300 NE SECOND AVE Address 11300 NE SECOND AVE City-State-Zip: MIAMI FL 33161 City-State-Zip: MIAMI FL 33161 I Title VP Name MURRAY,JOHN Address 11300 N.E.SECOND AVENUE City-State-Zip: MIAMI FL 33161 I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath;that I am an officer or director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 617,Florida Statutes;and that my name appears above,or on an attachment with all other like empowered. i SIGNATURE:DAVID DUDGEON GENERAL 04/27/2017 COUNSEL/SECRETARY Electronic Signature of Signing Officer/Director Detail Date w CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 08BS00851 REY AWNINGS&SHUTTERS CORP pD.B.A.: 4 SANTOS RAMON Is certified under the provisions of Chapter 10 of Miami-Dade County Y Report Viewer Page 1 of 1 i •f. 1 `G F JEFF ATWATER } CHIEF FINANCIAL OFFICER STATE OF FLORIDA a DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENS(4TION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW f CONSTRUCTION INDUSTRY EXEMPTION This Certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. `'' EFFECTIVE DATE: 7/16/2016 EXPIRATION DATE: 7/16/2018 PERSON: SANTOS RAMON SR FEIN: 263026587 ;? BUSINESS NAME AND ADDRESS: 'i REY AWNINGS AND SHUTTERS CORP 8041 W21STAVE HIALEAH FL 33016 SCOPES OF BUSINESS OR TRADE: i` IRON OR STEEL: ERECTION FRAME Pursuant to Chapter 440 05(14),F .an officer of a corporation who elects exemption from this chapter byY filing a certificate of elechon under Nis section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12).F.S.,Cortificetes of election to be exempt,..apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and cerbf,cates of elechpn to be exempt shall be subject to revocation if,at anytime atter the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413.1609 ;i i is C • I� It 1 i https:Happs8.fldfs.com/crreportviewer/reportV iewer.aspx?data=kdvpginc9D7Q3gH6TER6... 6/30/2016 y�� v CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ,..,..X` 11/02/17 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(ies)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 CONTACT MILTON L GAR] I NAME: FAX Best Class Insurance PON ,vHC o Ext: (305)512-1222 (A/C No: (305)512-1231 190 East 49th St. AD KESS: info@bestclassins.com Hialeah,FL 33913 INSURERS AFFORDING COVERAGE 7 NAIC# Phone', (305)512-1222 Fax (305)512-1231 INSURER A: UNTIED SPECIALTY INSURANCE COMPAMY INSURED INSURER B: Rey Awnings&Shutters corp ID#746728 INSURER C: 8041 W 21 Ave INSURER D: Hialeah,FL 33016- (786)3442762 INSURER E INSURER F: 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, EX, LUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. JNSR TYPE OF INSURANCE INSRADDWBR POLICY NUMBER MM DD/YYOLICY YY POLICY EXP LIMITS LTR INSR WVD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000-00 DAMAGE TO RENTED 100 000.00 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ FF-] CLAIMS-MADE a OCCUR USP-1346687 MED EXP(Any one person $ 5,000.00 A 11/02/2017 11/02/2018 PERSONAL&ADV INJURY $ 1,000,000.00 n. GENERAL AGGREGATE $ 2,000,000.00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000.00 ❑ POLICY ❑ PRO- ❑ LOC J $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ❑`ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED BODILY INJURY(Per accident) $ )AUTOS ❑ AUTOS ❑ HIRED AUTOS ❑ AUTOS ED FIR as.,Z t) $ El ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ ;EXCESS LAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION WC-STATU- OTH. ANEMPLOYERS'LIABILITY Y/pl ❑TORI`LIMITS ❑ R DS ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) F7 E.L.DISEASE-EA EMPLOYE 1 $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 6ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) AWWR NGS SHUYTERS Manufacturer of Commercial and Residential Awnings CERTIFICATE HOLDER CANCELLATION Miami Shore Village SHOULD ANY OF T�E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ATE THEREOF,NOTICE WILL BE DELIVERED IN Building Deparment ACCORDANCE W H THE PdLICY PROVISIONS. ' 10050 NE 2nd Ave. AUTHORIZED REP IVE Miami Shore Village 33138 ©1988-2010 ACORD CORPORATION. All rights reserved. ACCORD 25(2010/05)QF The ACORD name and logo are registered marks of ACCIRD 0057966 Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOT ABILL—DO NOT PAY LBT 6363410 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES W REY AVVNINIGS&STORM SHUTTERS CORP RENEWAL SEPTEMBER S 2O1$ 8041 21 AVE 5700225 HIALEAH FL 33016 Must be displayed at place of business Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS REY AWNINIGS&STORMSHUTTERS 196 SPECIALTY BUILDING CONTRACTOR PAYMENT RECEIVED O8BSCOH51 _ . BY TAX COLLECTOR Worker(s) 1 545.00 07/07/2017 FPPU10-17-014633 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is nota license, permit,or a certification of the holder's qualifications,to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles—Miami-pada Cotte Sec Ba-4276. For more information,visit www miamidade govttaxcollecEor .... ..,.. Miami hores Village Building Department ORtID�►` 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tet: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in.the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers'compensation coverage. Corporate officers or members of a limited liability company (LLC) in,the construction industry may elect to be exempt if: I. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will I be the only person allowed to work on your project. In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. ASignature _ Owner State of Florida County of Miami-Dade The f omg was acknowledme this day of t ,20�. By �a 7t;ewho is personally known to me or has produced as identification. r1NETTE MELCHIpRRE SEAL,: WWY Pvbk•StMe of ftida • COMWISIN N FF M285 of co"_ t - tAro�A MAN IN many Apn. Rfe AWNINGS SHUTTERS raan,rtarn,ro.or Gomnxxcml ,,- IaafuWnbil Aw�ingl Rey's Awnings&Shutters Corp. 8041 W 21th Ave Hialeah, FL 33016 Telephone: 305-820-9890 Email: Reysawnings@vahoo.com Date: State of D County of c� Before me this day personally appeared 7eAWLQA &Jt-65 who, being duly sworn deposes and says: That he or she will be the only person working on the project located at: /1300 kE , i�u- an x �.s- Lurt-. ntractor Signature Sworn to (or affirmed) and subscribed be this day of C 77iL 20,�k, by In j) 7 Sa n7�os Personally know i—'� OR Produced Identification Type of Identification Produced Ila/z/ � a laey%D S. Print,Type or Stamp Name of Notary MARIAEPALAC10S ` Commission M GG 109593 BOII w lin moo mI 11,2021 Swvbw T Certificate of Flame Resistance G R ►r • f A _ "I Issued By: �eR�70¢4 HERCULITE PRODUCTS INC Registered Fabric ABERDEEN ROAD COMPANY or Concern Number PO BOX 435 Date treated or manufactured: F-06901 EMIGSVILLE, PA 19175-8310 08/09/2017 This is to certify that the materials described below have been treated with a flame-retardant chemical or are inherently nonflammable. FOR: Trivantage, LLC ADDRESS: 1831 North Park Ave. .... .. .• CITY: Glen Raven STATE: NC 27217 •• e • • Certification is hereby made that: (Check"a" or"b") ••,• •• •. (a) The articles described at the bottom of this Certificate have been treated with a flame retardant chemical' '•; `• approved and registered by the State Fire Marshal and the application of said chemicgr�:A? lone irL(!&Jcrpance••• • L J with the laws of the State of California and the Rules and Regulations of the State Fir8 MefrShal. •• ... .. • • Name of chemical used: Chemical Registration#: •• •• . ... •. Method of application: " • (b) The articles described at the bottom of this Certificate are made from a flame-resistant fabric or material registered and approved by the State Fire Marshal for such use. Trade Name of flame-resistant fabric or material used: REINFORCED VINYL Registration#: F-06901 The Flame-Retardant Process Used Will Not Be Removed By Washing DONALD E. KAUFFMANN STEPHANIE MUMMERT, Q C MANAGER Name of Applicator or Production Superintendent Title RCNs# 00000000001057757558 CUSTOMER ORDER NO. CUSTOMER INVOICE NO. 1690260 YARDS OR QUANTITY 50.00 DESCRIPTION Wehlon Coastline Plus #CP-2711 62" Glade Green (Standard Pack BUYa--rdsT ITEM NUMBER 857211 We hereby certify the above to accurately reflect the information contained within a"CERTIFICATE OF FLAME RESISTANCE" issued to g Trivantage, LLC from the registrant set forth above. A copy of the original Certificate of Flame Resistance is availab � request to Trivantage, LLC and the registration information set forth above is on record with the California State,Ft kU hal. g a. t REY CANVAS 8041 W 21 AVE MAILING ADDRESS o HIALEAH, FL 33016 IIIIIIIIIIIi�IIIIIIIIBIIIIIIIIIVIIIIIIIIIIIIIIIRIIII�I 0000630673 ME Ormuz: ak Ing roi- _ 's 2 !! 10 �'+.. � � ,� 'r01r ■ ra rr�■ moi■ ra �� , j " IRj :- F .s:♦... �. ��) aiiiu) irfriiu- fibra)►' b,.i � _�••••�� q R Amb• .i �!�• A=O �' .9lC A.'♦. Yti 10 M • ��.! e,• � int �� --�,� �, � �i'' �N �► armor �_ ,v, warlit - �'—a.i' i I �4�� -moo.,.,. �.._^^-.�� —_�•� I `�' :.R� � 1� - 14 _ R�7�t�.i,��r - • i�n61s�['17R L��716^a�l+!•L`l O � !R'+'e1�'�'7�. .0 O O I / �.�'� �� 1r �• At i Lf D �-- �� 1 `Of�i...mbw ,., �wxrL �� A+�4 She �s�- a .4iav •r•a 'cr_ ./ �� _ ,r[� r��e�s O sly "4" • II � a�� .� Ila ��, ��► PA , • s rcrHLsi�'ti•�"r�'.. �c �� i 6�1�C � � f ,. � 1H v�( 1� r•