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MC-11-476REPLACEMENT OF A/C SYSTEM 3 TON UNIT 1-21 l' i V Passed Inspector Comments Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection Date: March 23, 2011 Inspector: Perez, JanPierre Owner: SOTO, IGNACIO Job Address: 137 NE 106 Street Project: <NONE> March 23, 2011 Miami Shores, FL Contractor: C &T AIR SERVICES INC Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Phone Number Inspection Number: INSP - 157326 Permit Number: MC -3 -11 -476 I Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Parcel Number 1121360060360 Phone: 305 -888 -6560 Page 1 of 1 Qualifier Name BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL Owner's Name (Fee Simple Titleholder) N/7 /V/ai 1R 4/ 6• NR c, o gc:e Phone # Owner's Address / i /4I t / U 6. c, ; , e e City lt,/, 51? c e 5 State e Tenant/Lessee Name Phone # Email Job Address (where the work is being done) City Miami Shores Village County Miami -Dade FOLIO / PARCEL # Is Building Historically Designated YES C 0 4- iea.rn 3 c_o Phone Contractor's Address Lis=t) Cc� 2- 2— ...1.— City 7 � ✓ erg 4 5 State /4'7( 4. 49 ,...,,-„ - 7' Contractor's Company Name State Certificate or Registration No. C.4 CO J-6 Certificate of Competency No. Contact Phone E -mail Architect/Engineer's Name (if applicable) Value of Work For this Permit $ C'.mc ') a `' ) Type of Work: EAddition DAlteration Describe Work: Submittal Fee $ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. MC2 l l-4lCp Master Permit No. Permit Fee $ 0 /ter C)4 / /tr.z. / 0 Training/Education Fee $ NO f� DPBR $ Zip .j 3 7 3 d'' Square / pRerirr Footage Of Work: /4/ r / Notary $ Scanning $ Radon $ Double Fee $ Violation date: Structural Review. $ e Zip 313V 8 0 Crco Zip 7 3a / o Phone # Phone # MAR 1 7 2011 � BY: Flood Zone I7O LINew Repair ❑ Demolition ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ************ * * * * * * * * * * * * * * * * * * * * ** * * * * * * ** e t • DO CCF $ CO /CC $ Total Fee Now Due $ Technology Fee $ Bond $ 7 See Reverse side ?-v Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) �I1 c% -E`'J5 / 7 v Mortgage Lender's Address / 0- / `I `-/ / 1 City F., S // c / . r. s State %4. 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 Sign: Print: APPROVED BY Owner or Agent The foregoi rument was acknowledged before me day of // , 20// , by , who is personally known to me or who has produced who is pers na known to me or who has produced - ' ion and who did take an oath. NOTARY PUBLIC: As identification and who did take an oath. NO PUBLIC: i My Commission Expires: * * * * * * * * * * * * * * * * * * * * * * * * * * * * *. * * * * ** Sign: ATE OF FLORIDA Print: a • eline Castellanos Commission # DD672780 Expires: MAY 10, 2011 8 ATLANTIC BONDING CO., INC. 6 /Plans Examiner Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Contractor The forego i = g inst r ment was ackno edge day o ' .A , 201\ , by My Commission Expires: Zip > 3 9 6 " l/ t o e sso . _ 1 a �h� * ************** ***** ************* ****** ******%. * * * * * * ** Zoning Clerk checked UNIT BEING REPLACED DATA NEW UNIT ,U) M PIC 1 MANUFACTURER /Zlteer� pi ) !`/�l.?`i✓1 ,,�. a AHU or PKG. UNIT MODEL # Ri4 /L/-im :3021 ZrA t'► N t v COND. UNIT MODEL # /i4441771 3 CA-0 / /O4- J KW HEAT 19 4g) 3- -0 hi S NOM TONS . +04.) 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 ^�•int) W j #.1 AHU CU PKG PKG UNIT / / PKG UNIT / / EER/SEER / rl' , ooe)) .J i l YES NO REPLACING DUCTS YES O YES NO REPLACING THERMOSTAT "..... YES YES NO NEW 4 "CONCRETE SLAB YES ✓ NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO ✓ City: Miami Shores Village County: Miami Dade (Qualifier's signature only) AIR CONDITIONING REPLACEMENT DATA Miami Shores Village Building Department 10050 N. E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 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. Job Address (where the work is being done): / .5'7 Ai re= / l3 6 ,r Zip Code: S' 3/-S 8 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 ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO ❑ ARHI Sheet Attached: YES[] NO ❑ Contract Attached: YES [ 1. Minimum Circuit Ampacity (Wire Size): Cill 3 C� /-'r°� !� �"r - p ' 2. Maximum Overcurrent Protection (Fuse /Breaker Size): C s p �` f I�/� -►�% 6d A 3. Voltage of Circuit (208/240/480): 2 - 'C) 4 ( � " fez 4. Size Disconnecting Means: 6 0 Ai t -alti 1 AtH L • / r d A4 r Pf SG 6-V 3 sf d e c/q Contractor's Company Name: c^ ` f ' ,Q ' L J J / Ce Phone: ? OJ L9 69- 6f? 0 State Certificate or Registration N. CA C O 7 f Certificate of Competency N. SYSTEM EQUIPMENT AND TYPE OF MATERIAL USED: FOR THE REPLACEMENT OF A 3 TONS CENTRAL AIR COND SYSTEM BRAND RHEEM 16.00 SEER & NEW METAL STAND, CONCRETE SLAB, DRAIN LINE, T STAT, FREON CHARGE AND CHECKING ALL THE SYSTEM. PART AND LABOR A/H M# RHLLHM3821JA C/U M# 14AJM36A01 NOTE: THE COST OF THE PERMIT WILL BE BILLED SEPARATE TERMS: Down payment $ % Subtotal $ 2 rough duct work, inspection $ % Tax $ Delivery of equipment $ % Job Price $ 2,000.00 On completion of job $ % Remarks: WARRANTY 10 YEAR ON COMPRESSOR 5 YEAR ON PART 1 YEAR ON LABOR BED RM. BATH MR. LIVING DINNING ROOM BREAKFAST ROOM Other KITCHEN FAMILY ADDITION A l l City MIAMI SHORES FL C & T Air Service, Inc. Air Conditioning & Refrigeration 40 west 22 street bay # 4 Hialeah, FL 33010 Phone: (305) 888-6560 PROPOSAL 'FAST SERVICE AVAILABLE" SERVICE, SALES & INSTALLATION Customer IGNACIO SOTO Date: 3/14/2011 Address 137 NE 106 STREET Job #: C0100670 Phone: 305- 962 -0099 We, C &T Refrigeration propose to furnish, instal and service under warranty (state on reverse side) heating and/or air conditioning products and related equipment for you in accordance with the conditions and specifications set forth in this proposal. RESPONSIBIUTIES: The following responsibilities will be assumed by each party as indicated. Local Permits and Licenses Equipment Foundation Writing from Building Panel to Unit Thermostat Control System New Electrical Service Panel Purchaser Seller Drain Lines Refrigerant Lines Dryer Exhaust Bathroom Exhaust Kitchen Exhaust Purchaser Seller CONTRACT EXPIRATION: This proposal will become a contract between us if accepted by you on/before 30 DAYS and subsequently by our credit department. INSTALLATION SCHEDULE: We will be ready to begin installation approximately by OWNER PURCHASE ACCEPTANCE: (Date) SELLER APPROVAL: 3/14/2011 (Date) '® 20010103 Apples & PCs, form Air-01 (IA e kty - 3 0 Akz-- /44A 31 if t 4 2 cid/e 2 3-c4p4r Alp t/t(/ A Lo zo 74- mi c,4/, oi/ ‘0 Certificate of Product Ratin This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2011. AHRI Certified Reference Number: 3805983 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 14AJM36 Indoor Unit Model Number: RHLL- HM3821 +RCSL -H *3821 Manufacturer: RHEEM MANUFACTURING COMPANY Trade /Brand name: RHEEM 14AJM SERIES Manufacturer responsible for the rating of this system combination is RHEEM MANUFACTURING COMPANY 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): EER 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 products) 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 wvaw,airidirectory,org. TERMS AND CONDITIONS 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. CERTIFICATE VERIFICATION The infonnaton for the model cited on this certificate can be verified at wwm.ahr directory.org, Air - Conditioning, Heating, click on "Verify Certificate" (Ink and enter the AHRI Certified Reference Number and the date on and Refrigt rsifion Institute which the certificate was issued, which is listed above, and the Certificate No, which is listed below. ©2010 Air- Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129443425535350326 THi;; IS TO t f2Til "Y TI IAt'n it :: FVI_IC.IL OF iNSUNANCt:. U5 T T-.0 HE.: tow HAVE I<LCN ISSUED TO THE INSURCD NAMED ABOVE FOR 'THE POLICY P11IQ0 INt nCATECI. NOTWITHSTANDING ANY NE- GUIFTCMFNT. TERM OR CONDiT K)N OF ANY CONTriAC T 014, °Tom f >oCt /MINT YVITH RESPECT TO WHICH THIS (:F.1':11/FICATL MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED HY THE POLICIES DESCRI8F..0 Ht Rf'IN 1:, ,1trJE;. , l TO AIL THE TE=RMS:. EXCLUSIONS AND coNDITIoNS OF SUCH POLIC11S. L.irI't'S SHowN MAY f1AVC:.131;L:N REDUCED DY PAID CLAIMS. '- .... .. ..._..- Antir- ,SOnit, -�__.. _._. ........ PUCtCV EF1' . Vel' r't:kr .. ................ -.. ..... 4NSI( De TYPE OF INSURANCE 1 yi �, AO9.1CY 241, 3MabGtt).01.11 /YTY)'pj Draws 'T 1iFNM L L/AIIHJt 1 IMM(pO 1 1'ACsOcrAINRF I S __- .... ........_.__ ...,�--,- .____._ j t.[NI. r C t)MMERCIAL WI': I IARn IIY GI„AIM;: -MA)t! i OCCUR ...... __....._..._................... .__._....__._._.. _.__..._.___.....__. _ . _ ... A( }GI(L,C:AFC LIMIT APPLILZ; 1 r'tuf.Y t 1 JCt:T J ! Co,' 1 , i I I' rIMAZ'•F i. 1 1�r�NTES'! i rNF.Mn;ic:`i (I 9 • . 1 .. i MGG EXY lAnv one ponont YF.R}:rSNAI R NW INJURY C.iFNIrKAl, ALA:AV:Alt ;S P12011111;1!;. - (.f;MnXN- -Art; ', — ! S 2 ..... A„,..„„,,.,„ ...- I,IAjIK,ITY ANY AfIT■ AL( , '>WNCI) C� t +ln > a, rtn, ^, ^, ",t:IM•00 p, 1, IYON.OINNE'O AU101; r - i ; CIMG{NLL INGLL 11M11 i 11'.e.lrc.yrnt) ; 110011Y ftN.IItri'/ ( lwgidnY'r UUOOlyy INJURY Par cer:adlnti S PQGPCt.IV DAM?tU i (bar to Mani . ' I �) $ — UMeii[:LLA LIAO torCVSS tote 1::17!:d 1 RFTFNYInns : ()C.CUR _ ' FAt:H ()f;(.tilltSVNC'F I .. (a a)M.`.••MAOC, AGGr2E :C?ATI: l I, ' 1 1 ( 2 A WORKERS COMI'[COMeN i ANO EMPLOYERS' LIAAtLITY i ' ANY 1'R(1FI •II I UWVAN 1 NEHIEXl1 YrN '. C7F'FICIr.R,'MriM(liit �XC1 UL'CLrF - N I NI A; tMOntenory In NN) r r ti1 lel. cl Ip r Io VW r vneur 1' l:(:1:11'rkm CR'FI'(At1VNf11.9,�w. ..... Ntlf`L110361 01 /Di :2011 01101001? lx1} Wt U jj Op1 +1 L.__t.:1:Vtftl.1M11$• ,,,, - ,t 1.12 ■ .. ...._ _ ..... ... r ! I:.L, 1cACNACGI).:Nr ;S 1.000.(100 I .. .. ...... ... ...... .. .... . • 1.I. po Es1:d^ , Fit IiMI'LOY11: 2; 1.01,20,0N.2 ... ►.t.. qKI =A >:R - POLICY UAW I S . ._..... .. 1.000,000 , Vti.:3 411 OF OP ERATION!+ / L0CATI01131 VC11ICLE3 1Al2ach ACORD IQ1. Almtion4el RmmArkn 9Ce011( )1, If reps, vpmer if r•qut2ed1 GclvurOPh is extended only to tIl Irlavrcrps (bogie (nis who ere teased :• the alien lorpan7?.1rtnployer: CAI Air Slav!(.ri Inc 0;r(I;>114 UISC :I.A ER: Coverage is net eXlelide n 10 NIW C:(mklyee or 111n client company empk)ylIr won 41 net f 'o :d , n 1 o 1 tote inwictI Tr.lo troy ioewri crnplvyve for Mach the CIie21 nny ernproyer is eat r(IporUrO payroll hoofs tO MI a insured. This lY1 1111y:ati, feNhitit1t: in Chore LrrwillC(f the) aiiont COmp;.4ufnptoyer'E acCOuhl IS in good standing to trio !littered. Ple•t;) COnt:ICt 1110 i11•.li0?(1 Ot NL+{i- 453 - %1:'! 194 414 4Iticolit)1) vt employees lowed 4o the Client company employe( my trig 1M,.ur 0.. Goironi It of luowd Ctnr)k)yctts i'S "'" ACRD HIS 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 on ADDITIONAL INSURED, the poticy(ies) meat be undersea. H SUBROGATION IS WAIVED, subject to the terms and conditions of pm policy, certain policies may require an endorsement- A slAtonl0nt on this certificate doter: not confer rights to the certificate holder in lieu of such endorsement(s). YAUUUI: Lk RIIit' Priori(4 IIW 90t F' +hi'I' Mwy Jaoh*OfN 1e1, Yl .1;2'56 1N3uaen M:AUIX Employer Serv;cvs 'i(103 P!'np1 Hwy Jackxanvdle, FL. 3225G COVERAGES CERTIFICATE HOLDER City of Miami. Shores 10050 NE 2 Ave. Miami Shores, Fl 33138 ACORD 25 (2010105) CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE NUMBER: Rar,FUHOw CDTMTACT NAME i'NON[i rC ._ AO[1,NE99'. t ( I 1a nn �+7N4t/AFA C • IN. °..AIRI:R lNSV1LCA F 1 �.)�„•_,��GrA ALI I O 1('4; Pr7t: SENTAT4VE PAX (AM. Nor {NSt1RCR4S) AFFOrreiNG COVCRtAGE t4ndy Harper Insurance Co40p41Ay, Irsr:. REVISION NUMBER: SHOULD ANY OF THE AROVE OESCI4II1Eb POLICIES (EE CANCELLED BEFORE THE EXPIRATION OATS THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH TFIC POLICY PROVISIONS. .TE IMM/OOhYYYi 01 /0G/2011 rage 11:11 «1988 -2010 ACORD CORPORATION. API rights reserved. The ACORD name and logo are registered marks of ACORD ACQRD CERTIFICATE OF LIABILITY INSURANCE 13 /1 011 PRODUCER (305) 551 -0590 FAX: (305) 551 -0857 Casualty $yeti$ 3331 SW 107 Ave Miami FL 33165 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC III INSURED C & T Air ServiCe Inc. 40 West 22 St Bay It 4 Hialeah FL 33010 INSURER A: Western World Insurance INSURER I3: INSURER C INSURER 4 INSURER E: COVFRAGES THE REOUIREMENT, THE A POLICIES INSURANCE • EC OF INSURANCE LISTED BELOW TERM OR CONDITION OF ANY AFFORDED BY THE POLICIES E LIMITS a SMQ NN MAY HAVE BE HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CIERYIFICATE MAY BE ISSUED OR MAY PERTAIN. DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. REDS/CFO SY PAID GIMP MAR • ■ 1. TYPE OF INSURANCE POLICY NUMBER US99B31 -A POLICY EFFECTIVE D ATEJMAMDD)YYI 4/20/2010 POLICY EXPIRATION DATE (ayDD/Ytll 4/20/2011 LIMITS HRE DAMAGE To RENTED FIFMIS S IEaL $ 500 000 A GENERAL D ■ IIII LIA9.ITY ►� ERC IAL GENERAL UAB CLAMS MADE C OCCUR 9 50, 000 up? V,(P (Any ononwxorll $ 5,000 PERSONAL & ADV INJURY s 500, 000 a 500, 000 GEML in AGGREGATE LIMIT APPLIES PER POUCV ■ PRO' LOC .9g5g551-Aoftgegg PADIX TS - Q)a/g•p 4GG $ S00 , 000 AUTOMOBILE III III LIABILITY ANY AUTO AU. OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON.OWNED AUTOS COMBINED SINGLE LIMIT (Ea eed eery $ BODILY INJURY Wu Prneol+) $ BODILY INJURY rer accident) $ PROPERTY DAMAGE (Pit accIdeM) $ GARAGE ■ L IABI JTY ANY AUTO - AUTOON�.Y. EA ACCIDENT $ OTHER THAN „ );/1AQli., i AUTO ONLY* AGG • EXCESSAIMBRELLA 111 UABILRY OCCUR a CAMS MADE DEOUCTIBLE P �ACI$ O['OUNRFNrF 9 S „A $ $ Y/ORKER3 COMPENSATION AND A EMPLOYERS' UARILITY ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER/MEMBER OCCLUDED? 11 yea. decor*/ under S PECI R4V13IONS below TTU� I � DI 1 R TD Y_tJAI S 1 F E . EACH ACCIDENT $ SASE. EA EMPLOYEE-$ E. fXSEASE PDLlCysPAT _$ OTMER DESCRIPTION OF OPERATIONSM1OCATONSAIEIICA ,Es/p[CLUS1pNS A008O BY END WI$EMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER City of Miami Shores 10050 NE 2 Ave. Miami Shores, Fl 33138 ACORD 25 X1/09) CANCELLATION Strom" ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THER$OF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO MALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINO UPON TIE INSURER. ITS AGENTS OR REPRESENTATIVES. AUTNORSIED REPRESENTATIVE Ethel Gruntler /BUNNY ACORD CORPORATION MIS