EL-11-1539Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 165580 Permit Number: EL -8 -11 -1539
Scheduled Inspection Date: October 18, 2011
Inspector: Devaney, Michael
Owner: TEIGLAND, MELBOURNE
Job Address: 9780 NE 5 Avenue Road
Miami Shores, FL
Project: <NONE>
Contractor: ZIMY ELECTRONIC INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number (305)751 -3981
Parcel Number 1132060171490
Phone: (305)940 -0880
Building Department Comments
INSTALLATION OF TWO SECURITY CAMERAS
Passed
■
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
October 17, 2011
For Inspections please call: (305)762 -4949
Page 18 of 20
ki26\1,-
BUILDING
PERMIT APPLICATION
FBC 20
Miami Shores Village
Building Department
to 72-4j7EWE
L AUG 222011
l\
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
Master Permit No.
Permit Type: Electrical _
OWNER: Name (Fee Simple Titleholder ):..,�i�' t4E iY�,JheW Phone #: G� %�/35%
o
°
ma
City: State: dr./ /% - Zip:
Address:
/
_'ice
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes NO
CONTRACTOR: Company Name:
Address: i 1\11
City: I-- & Ljt State:
Qualifier Name: Phone #:
Flood Zone:
1 M �jrO� Phone #:
a-5'-atke-a
State Certification or Registration #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ Z Square/Linear Footage of Work:
Zip: -5 ® L
Certificate of Competency #:
Type of Work: ❑Address ❑Alteration UNew epair/Replace
Descr'on o : A `
❑Demolition
C_C4n'a'I9n CQ/�
* * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * *x * * * * * * * *x * * * **
Submittal Fee $ Permit Fee $ / -4et2 ie C CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 161: f )
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 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 . , J Signature
Owner or Agent
�''f Contractor
The for going ' s •.+ ment was ackno ledged before m this eaq The for- _oing in trument was acknowl� d -d b fore thiiSL 1 day of O � ,20 , by �G�� i �4"4' % 1'/ day of ,20 11 , by
who is p o . lly kn to me or who has produced /[ who is, . erso u ally known to me or who has produced
-i� )Q- 2�
1 � identification and who did take . n oath.
entification and who did take an oath.
NOT
Sign:
Print:
My Commission Expires:
OTARY PUBLIC:
APPROVED BY
6
s
/ % 2 61-fblans Examiner
Structural Review
(Revised 07 /I0 /07)(Revised 06 /10 /2009XRevised 3/15/09)
Sign:
Print:
My Commission Expires:
Zoning
Clerk
08/21/2011 23:33 3059400880
Nttt •r.r4,
CITY OF HOLLYWOOD
TREASURY SERVICES DIVISION
LOCAL BUSINESS TAX RECEIPTING
2600 HOLLYWOOD BLVD, RO04 103
�: •• HOLLYWOOD, FL 33020
ZIMY ELECTRONICS
3725 PEMBROKE RD
##A- 9
HOLLYWOOD FL 33021
ZIMV ELECTRONICS
#3038 P.002/003
S8S2 33299
CITY OF HOLLYWOOD LOCAL BUSINESS TAX RECEIPT PRINT DAT 9/20/10
1
THIS IS YOUR LOCAL BUSINESS TAX RECEIPT. PLEASE DETACH AND POST IN A CONSPICUOUS
PLACE AT THE BUSINESS LOCATION. PLEASE DO NOT REMIT ANY PAYMENT. THIS IS N(T A BILL.
Busi ess Name:
Business Location:
Business Class:
Tax Basis:
Receipt Number.
Receipt Year.
Expiration Date:
ZIMY ELECTRONICS
3725 PEMBROKE RD
CONTRACTOR /BURGLAR ALARM
5 - 25 WORKERS
11 00023948
10/01/10
09/30/11
N W CHARGES (Itemized Below)
Base Fee
Additional Charges:
316.00
316.00
TOTAI. SIEW CHARGES -
Penalty Amount:
Previous Balance Due:
IOTALAMOUNLP
316.00
.00
.00
316.00
Comments:
PURSUANT TO STATE LAW, THE LOCAL BUSINESS TAX IS LEVIED ON THE PRIVILEGE OF
DOING BUSINESS WITHIN A CITY'S LIMITS, AND IS NON - REGULATORY IN NATURE.
ISSUANCE OF A LOCAL BUSINESS TAX RECEIPT BY THE CITY OF HOLLYWOOD DOES NOT
MEAN THAT THE CITY HAS DETERMINED THAT THE EXISTING OR PROPOSED 'USE OF A
LOCATION IS LAWFUL ISSUANCE OF A LOCAL BUSINESS TAX RECEIPT ES NOT
LEGALIZE OR CONDONE THE NATURE OF THE BUSINESS BEING CON UCTED IF
CONTRARY TO ANY LOCAL, STATE OR FEDERAL LAWS OR REGULATIONS. •
08/21/2011 23.34 3058400880
ACCP O®
ZIMY ELECTRONICS 43038 P.003/003
CERTIFICATE OF LIABILITY INSURANCE
I►)
8/22/2011
THIS CERTIFICATE 1S 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 E POUCIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORRED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER
IMPORTANT: If the ceitificate 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 endorsentent(s).
PRODUCER
The Della Porta Group, Inc.
7807 5aymeadows Road Bast
Suite 301
Jacksonville SL 32256
TraugEn
Zimy Electronics Inc
3725 Pembroke Rd, Unit A7
Efollywood
COVERAGES
Am& " sharop !leery
j (904) 646 -0310 FAX (904}646 -1149
EADPAREILm sbeeryedel1a rtagroup,com
IMBODUCER m4.00008950
INSURER(S) AFFORDING COVERAGE
NAI a
wsuReRA..Everest Indemnity Insurance Co
INSURHIsiTschnOlogy Insurance Company
10851
a}SURER C :
INSURER D:
_}SURER E
FL 33023. INSURER P,
CERTIFICATENUMBER:10 -11 -12 Master
4237€
THISU3M)OERTIFYTHATTHEPOLICESOFWISOM*MELMTEDSEIXANWNESManSaMOTOTHEMMUREDNAMEDAMAMJ*RTHSOOLICYPERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY
OR OTHER
DESCRIBED
PAID CLAIMS
}'' Pow/ExP
} LNEIUOO/YY`M
DOCUMENT WITH RESPECT TO WHICH THIS
HEREIN 1S SUBJECT TO ALL THE TERMS,
MN
L'I$
TYPE OF
ADDL
atSR
SR
4NIn
POLICY WARM
POUDYE
55i25IYYYYj
4/9/2011
CONS
A
COSDMHtCIALGQNERAL u BILRY
Slew:00009.111
4/9/2012
EACH OCCURRENCE
$ 1,000,000
X
DPRE}srs,( ,ea�nren�i_
LIED E}0, (Any one xr-�1
9 ; 50,000
_
0
. CIAIMSNIADE
X OccuR
$ 5,000
PERSONAL aADV INJURY
$ I 1,000,00D
GENERAL AGGREGATE
$ E 2,000,000
NL AGGREGATE I.IJOT APPLIES PER
{ POLICY [ 1 & r-1 LOC
PRODUCTS - c0MP P AGO
$ i 1,000,000
a
$
AUTOMOBILE
LIAB4UW
ANY AUTO
ALL OWNED AUTOS
SCHEDULED Ayes
HIRED AUTOS
NON-OWNED AUTOS
I COMBINED GakoLE WAY
(Es
$
BODILY INJURY (Per person)
1 $
$
500E.Y I aw& (Per =Nene
PROPERTYDAMAGE
(Per eeei en$
$
$
$
WIBREL L e UAB
EXCESS r.IAO
OCCUR
EACH OCCURRENCE
$ i
1 a.A MS44ADE
$
—}
D®ucna.E
I RETENTION 5
MAGGREGATE
$ •
s
8
ANYL
`�
(Nta„da�ymNFQ
E Yee.
DE5CF4PT10NOFOP9iATWNSI>etoa
LLA91i rrr Y/ N
N/A
TWC3257979
12 /aa /aD>.D
1a /aa /soil
X t SUM S 1 1 FR
``
8.1— EACH ACC}DEetT
$ iE 500,000
TCrsm�CUrnE
ocav�r
da3t1DS undo
EL D}SEASE- EA PLOYEE
$ f 500, 000
El. DISEASE - POLICY Lag
$ i 500,000
cascasenos OF OPERATIONS / LOCATIONS / VEHICLES (Atte ACORD 101. Adddiea l Rm rk8 Schedule, T Mere 6Pace Is mqublid)
Ulami Shores Village Building Department is an additional insured ea respects conmeroial general liability policy.
CERTIFICATE HOLDER
CANCELLATION
(305)756 -8972
Miami. Shores Village Building Department
10050 NB 2nd Ave
IIIiaEL shores, YII 33138
811OULD ANY OF THE ABOVE DESCRIBED POLICIE7S BE CANED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE wmi THE POLICY PROVISIONS.
AUTt}O mo REPRESENTATIVE
V Della Porta, CIC/DP tkilakidagatAa
ACORD 25 (2009109)
INS02S(ooeas)
01988-2009 ACORD CORPORATION. All lights reserved.
The ACORD name and logo are registered marks of ACORD
08/21/2011 22:58 3059400880 ZIMY ELECTRONICS
#3037 P.002/002
ACCORD CERTIFICATE OF LIABILITY INSURANCE I
DATE (MWPVI'IYWI
4/8/2011
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 POUCIF'1
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUREt (S), AUTHORIZE
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER
IMPORTANT; If the certificate holder is an ADDITIONAL INSURED, the poticy(ies) must be endorsed. If SUBROGATION IS VirAlVED, subject fo
the terms and conditions of the'pollcy, 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
The Della Porta Group, Inc.
78Q7 Baymeedows Road East
Suite 301
Jacksonville FL 32256
INSURED
Zimy Electronics Inc
3725 Pembroke Rd, Unit A7
Hollywood FL 33021
NAKG7TA,GT Sharon !leery •
' (904)646 -0310
FF�f
SAID.
,� �.eheeryBdella8ortagroup.00m
P1i001t ER 00008950
CUSTOMER ID 8: , , ,
INSURERS) AFFORDING COVERAGE
(304)646-1143
NAIC 0
INSURER A :Everest t Indemnity' Insurance CO 0851
.esURERe!Technology Insurance Company +42376
INSURER Cr
INSURER O :
INS4RE[t E :
INSURER F :
COVERAGES
ERTIFICATE NUMBER :10 -11 -12 Mater
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUC1ES DESCRIBED
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
.. ... .. y u�y pip
CYYY),•
NAMED ABOVE FOR 1HE POLICY PERIOD
DOCUMENT WITH RESPECT TO WHICH THIS
HEREIN IS SUBJECT 710 ALL THE TERMS,
; LAEIr3
cm: POLICY WIRIER : 111M/ MAID
%R
GENERAL LUIBILRY
+�.
!
? 8 1 COMMERCIAL GENERAL LtABnt Y , • i
•
' EACH OCCURRENCE
- -
t $ 1, 000, 000
r DAMAGETO RENTED
I•PREMpSEB (En 6oqu,enos)
•
i•MEOEXP(Amyoneperson),
i PERSONAL 8 ADV Scum.
GENERAL AGGREGATE
S 50, OOO
r S 5,000
i $ 1,000 4! 000
I s
--.7 {
' JCLAI RE I X ,OCCUR 1GLM00009 -111 x)/9/2011 4/9/2012
^. •
! . !
i OEM AGGREGATE LIMIT APPLIES PER: i ! •
i S i POUCY r- ? ESL ! Roc i •
i PRODUCTS • COMP/OPAGG
_2,009,000
, $ 1,0 00, S)
E $
AU iOMOBI.E LA31LnY : i 1
E
? t
ANY AUTO
4 •: ' •
ALL OWNED AUTOS
• • SCHE0IR E0 AUTOS • E
•
MIRED AUTOS • •
NON•OVD AUTOS ?
T
: CO INED SE UMI
: (Ee accident)
: BODILY IN rtjRY (Pa person)
_ ..
' BODILY INJURY (Per accident
. PROPERTY DAMAGE
• (Per accident)
'
i S
__ .. .. •_•_ •_
It S
_ ........ _
i $
?
i S
$
; • • ___013
S
I E(�5 LIAB
• CLAIMS-MADE!
•
DEDUCTIBLE :
• • RETENTION__ $ :
1 WH O:CURRENCE
• i '
i AGGREGATE : S
t ; S
i $
I AND EMP60YER5• L1A61�UTr ? '
'
- X ! TM' LENTS I! ER
EJ.FACHACCI0ENT
e•L,OISEASE_EAEMPLO
: E.L. DISEASE - poucv LIt
; .
S 500 000
i ... 1.._
$ 500, 000
$ 00 + 00
• ANY PROPRIETOR/PARTNER/EXECUITYS -
1 OFPICERIMEMSER FXGIUDem ! N 1 A t
f (Me>we ! •'tiC3257979 p.2/22/201012/22/2011,
' DESCRIPTION OF OPERATIONS Wow ?
i
DESCRIPTION OF OPERATIONS 1 LOCATIONS /VEHICLES (Mime ACORD 161, Ad4Itlonol Remarks Schedule, if mere space to repaired)
.
CANCELLATION
SHOULD ANY OF THE ABOVE DESORIBED POLICIES BE
The EXPIRATION DATE THEREOF, NOTICE WILL
ACCORDANCE WITH THE POLICY PROVISIONS.
:ANOELLED BEFORE
BE DELIVERED IN
AUfliorozeD R£PRESENTATNE
V Della Porta, CIO /DP ZNI,Ottlegatt
se. /l,
ACORD 25 (2009/09)
INS025(2ooaoa)
CO 1988-2009 ACORD CO
The ACORD name and logo are registered mark$ of ACORD
1
8/22/2011 11:17 AM FROM: Della Porta Group Della Porta Group TO: +1 (305) 7568972 PAGE: 001 OF 001
`; tig CERTIFICATE OF LIABILITY INSURANCE
8/22/2011
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 certMcate holder Is an ADDITIONAL INSURED, the pollcy(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
The Della Porta Group, Inc.
7807 Baymeadows Road EaSt
Suite 301
Jacksonville FL 32256
CONTACT
NAME: Sharon Beery
la/c°Nwn I::s: (904)646 -0310 1 ((AA/C,No: (904)546-1143
ADDRESS: sheerysdellaportagroup.com
PRODUCER 00008950
CUSTOMER ID*:
INSURER(S) AFFORDING COVERAGE
NAICtf
INSURED
ZiIIly Electronics lac
3725 Pembroke Rd, Unit A7
Hollywood FL 33021
INSURER A :Eye rest Indemnity Insurance Co
10851
INSURERB:Tec13no10gy Insurance Company
42376
INSURER C :
INSURERD:
X
INSURER E :
$ 5,000
INSURER P :
COVERAGES
CERTIFICATE NU .10-11-12 Master
•
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 MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ADDL
INSR
SUBR
WIND
POLICY NUMBER
51GLM00009 -111
POLICY EFF
IMM/DD/YYYY)
4/9/2011
POLICY EXP
(MM/DD/YYYY)
4/9/2012
LIMITS
EACH OCCURRENCE
$ 1,000,000
A
GENERAL
LIABILITY
COMMERCIAL GENERAL LIABILITY
1 OCCUR
X
DAMAGE TO RENTED
(Ea occurrence)
$ 50,000
CLAIMS -MADE
X
MED EXP
MEOEXP(Anye„eper�n)
e persn
$ 5,000
PERSONAL &ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L
AGGREGATE UMIT
POLICY n JEST
APPLIES PER:
PRODUCTS - COMP/OPAGG
$ 1,000,000
]--el
LOC
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per went)
$
PROPERTY DAMAGE
(Per accident)
$
$
$
UMBRELLA IJAB
EXCESS LIAB
_
OCCUR
CLAIMS-MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
s
WORKERS COMPENSATION
AND
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If Yes, describe under
DESCRIPTION OF OPERATIONS
Y/ N
N / A
TWC3257979
12/22/201012/22
/2011
STATU- OTH-
X I TORY LIMITS I I ER
EL EACH ACCIDENT
$ 500,000
below
E.LDISEASE - EAEMPLOYEE
$ 500,000
E.L DISEASE - POLICY LIMIT
$ E00,000
DESCRIPTION OF OPERATIONS / LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more apace Is required)
Miami Shores Village Building Department is an additional insured as respects commercial general liability policy.
CANCELLATION
(305)756 -8972
Miami Shores Village Building Department
10050 NE 2nd Ave
Miami Shores, FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
V Della Porta, CXC /DP i s 1J5(ki JU W��lll
ACORD 25 (2009/09)
INS025 (200909)
m 1988 -2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD