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ELC-13-702Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 188929 Permit Number: ELC -4 -13 -702 Scheduled Inspection Date: May 30, 2013 Inspector: Bruhn, Norman Owner: SHANDLOFF, NED Job Address: 9801 -9845 NE 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: ADT LLC Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration el000.0000 Phone Number 0 —, Parcel Number 1132060134380 Building Department Comments ALARM SYSTEM WORK FOR SPACE LOCATED AT 215 NE 98 ST Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments May 29, 2013 For Inspections please call: (305)762 -4949 Page 4 of 18 ¥/v9 68 /0?- 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 BUILDING PERMIT APPLICATION FBC 201,3 Permit No. rz LC—, t 3 --/O Master Permit No. Permit Type: Electrical JOB ADDRESS: 215 N c 6 8 City: Miami Shores County: Miami Dade Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): Address: 5 CAL T j tai City: ACA ?""O Tenant/Lessee Name: 101,1.9 410 Email: W Phone #: 30s-' 7 e --7733 State: R, ,���� �,�,,� \ Zip: `J3 t.•-� QE) s-Q» CD \..J( ADAA 11 tt ' Phone #: 4-5 CONTRACTOR: Company am : QDT L t. t.- ' Phone #: 1S9 -Z6 6 ^ c L Address: CO 13 . V) City: 1 VAAA �p State: Zip: 2S Qualifier Name: �GQ ✓ 09tllv� � p_AattKA Phone #: State Certification or Registration #: Fd7 ®O //02 -/ Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ \ D Square/Linear Footage of Work: Type of Work: OAddress ❑Alteration UNew ❑Repair/Replace Description of Work: It ❑Demolition * * * * * * * * * * * * * ** ** Fees************* * **** ** * * * *** * * * * ** * * * * * * ** ** ** Submittal Fee $" Permit Fee $ r474°o 00 (:(:F $ CO /CC $ Scanning Fee $ �-�° Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ 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 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 tk Owner or Agent The foregoing instrument was acknowledged before m day of A , 20 g , by IA S►�rse) who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 44--- be I LOS alS rer My Commission Expires:`. * * * * * * * * * * * * * * * * * ** APPROVED BY Signature Contractor The foregoing instrument was acknowledged before me this 9 .. �� day of 442 , 20/3, by (81/-121/4" i t* 4fil ( who is personally known to me or who has produced 00009101,t11/ , as identification and wh -j, ft', NOTARY PUBLIC: °:'4 *''`aavrd4e %.b S. '• :y Sign: 13. 6NNOisS • \' 43 i ; aa0, bi Rosi4Et.1 E L05, SANTOS Notary Pub00c - Sfatitwt Florida • e My Comm. Expires; pet 20, 2014 Print: My Commission Expires: ',ions. 8o s� t4 §1 k�,skskt sk?t ****,k,#,x,k +, i ksk**** �k�ksk, k, xsk: x�a,# ak�a�a, k*k,ksksk,k,#�k�k,k�k,x **** *** 9onded Through Natrdnal Notai Assn:. -. ♦ —40- d» 4.— Plans Examiner Zoning ,Pt ;P/ Structural Review (Revised 3 /12/2012)(Revised 07110 /07)(Revised 06/10/2009)(Revised 3/15/09) Clerk Property Information Map My Home Miami -Dade County, Florida Property Information Map Aerial Photography - 2012 This map was created on 4/1/2013 1:03:48 PM for reference purposes only. Web Site © 2002 Miami -Dade County. All rights reserved. 114 ft Page 1 of 1 MIAMI -DADE —mmary- Details. - -- - Feirn- lg - 1- -3206- 013=4380 RrQperty; = - -- {9844 =NE2- AUK= -��: Mailing SHAPAR- REALTY CO Address: 9497 OLD PINE ROAD BOCA RATON FL 33428- Property Information: Primary Zone: 6100 COMMERCIAL - NEIGHBORHOOD CLUC: 0011 RETAIL OUTLET Beds /Baths: 0/0 Floors: 1 Living Units: 0 Adj Sq Footage: 10,803 Lot Size: 13,000 SQ FT Year Built: 1953 Legal Description: 1 53 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 13 & LOT 14 BLK 32 LOT SIZE 100.000 X 130 OR 15605 -3244 0692 4 OR 15605 -3244 0692 01 Assessment Information: Year: 2012 2011 Land Value: $260,000 $260,000 Building Value: $442,937 $443,044 Market Value: 3702,937 $703.044 Assessed Value: $702,937 $703,044 Taxable Value Information: Year: 2012 2011 Taxing Authority: Applied Exemption/ Taxable Value: Applied Exemption/ Taxable Value: Regional: $0/$702,937 $0/$703,044 County: $0/$702,937 $0/$703,044 City: $0/$702,937 $0/$703,044 School Board: $0/$702,937 $0/$703,044 Sale Information: Sale Date: 6/1992 Sale Amount: $0 Sale O /R: 15605 -3244 Sales Qualification Description: Sales which are disqualified as a result of examination of the deed View Additional Sales http:// gisims2 .miamidade.gov /myhome /printmap. asp? mapurl = http: / /gisims2.miamidade.gov... 4/1/2013 Detail by Entity Name FLORIDA D tr A TAE Div ION OF CORP R Page 1 of 2 Return to Search Results etail by Entity Name Florida Profit Corporation SHAPAR REALTY CO. Filing Information Document Number 651158 FEI /EIN_ Number 222341174 Date Filed 11/02/1979 State or Country FL Status ACTIVE Last Event CANCEL ADM DISS /REV Event Date Filed 09 /30/2009 Event Effective Date NONE Principal Address 9497 OLD PINE ROAD BOCA RATON, FL 33428 Changed: 01/09/2008 Mailing Address 9497 OLD PINE ROAD BOCA RATON, FL 33428 Changed: 01/09/2008 Registered Agent Name & Address SHANDLOFF, NED M 9497 OLD PINE RD. BOCA RATON, FL 33428 Name Changed: 06/17/1992 Address Changed: 01/24/2007 Officer /Director Detail Name & Address Title PD SHANDLOFF, NED M 9497 OLD PINE RD. BOCA RATON, FL 33428 Title S http: / /search. sunbiz.org/ Inquiry /CorporationSearch /SearchResultDetai 1 /EntityN ame /domp -6... 4/1/2013 Detail by Entity.Name HANDLOFF, PATRICIA T 497 OLD PINE ROAD BOCA RATON, FL 33428 Re •o Report Year 2011 2012 2013 - ntact Us E- Filing Services Filed Date 02/16/2011 01/03/2012 0 //1/20' -3 Document Searches Forms Page 2 of 2 Help 02/01/2013 — ANNUAL REPORT 01/03/2012 - ANNUAL REPORT 02/16/2011 — ANNUAL REPORT 03/19/2010 — ANNUAL REPORT 09/30/2009 -- REINSTATEMENT 01/09/2008 -- ANNUAL REPORT 01/24/2007 -- REINSTATEMENT 03/30/2005 -- ANNUAL REPORT 02/04/2004 — ANNUAL REPORT 02/19/2003 — ANNUAL REPORT 02/13/2002 — ANNUAL REPORT 03/30/2001 — ANNUAL REPORT 02/10/2000 — ANNUAL REPORT 03/04/1999 -- ANNUAL REPORT 01/29/1998 -- ANNUAL REPORT 04/16/1997 -- ANNUAL REPORT 04/19/1996 -- ANNUAL REPORT 05/31/1995 — ANNUAL REPORT View image in PDF format - View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format Events No Name History Return to Search Results Home I Contact us 1 Document Searches 1 E -Filing Service Coovriaht `�' and State of Florida, Department of State [Entity Name Search Search orms 1 Help 1 http: / /search.sunbiz.org/ Inquiry / CorporationSearch /SearchResultDetail /EntityName /dome -6... 4/1/2013 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 189903 Permit Number: ELC -4 -13 -847 Scheduled Inspection Date: May 13, 2013 Inspector: Devaney, Michael Owner: , BARRY UNIVERSITY Job Address: 11300 NE 2 Avenue Library Miami Shores, FL 33138 -0000 Project BARRY UNIVERSITY Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Contractor: KRATOS PUBLIC SAFETY & SECURITY SOLUTIONS INC Phone Number Parcel Number 1121360010160 -03 Phone: (305)216 -4942 Building Department Comments INSTALLATION OF LOW VOLTAGE PCTV SYSTEM AND CAMERAS Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Ateey- May 13, 2013 For Inspections please call: (305)762 -4949 Page 17 of 39 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 BUILDING PERMIT APPLICATION Permit Type: Electrical ;0)--geugvmrol APR 2 2 JI 13 8 Y:. �ommo ®v..oa..00.v. FBC 20 Permit No..../01.314-1 Master Permit No. JOB ADDRESS: wow cv\i N si tl Ll & WA' Vi c1U S City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): iw,7( f (V t l Phone #: Address: U Zoo 146 2,4 06 City: M1 AM 1 °i?' State: Zip: X31(0 Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: Kratos Public Safety & Security Solutions, Inc. Phone #: 305- 216 -4942 Address: 5773 NW 158th Street City: Miami Lakes State: FL zip: 33014 Qualifier Name: Marlon Sebelen Phone #: 954-579 -9398 State Certification or Registration #: EC 13004971 Certificate of Competency #: Contact Phone#: Email Address: marlon.sebelen @kratospss.com DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 2 c V Square/Linear Footage of Work: Type of Work: ❑Address UAlteration UNew ❑Repair/Replace UDemolition Description of Work: 414, ,.z.-)e r /N %O Cc- eCyv SpR 77(c/3 / 6/6/zA 7 ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * ****** kph*** *+ k*********** **** **** * * *** Submittal Fee $ Permit Fee $ lir®,"0O CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 4 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 Owner or Agent The foregoing instrument was acknowledged before me this 1 day of , 20 a, by lLLt(.4 GO NA411,Of , who is personally known to me or who has produced . f. As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: f1 APPROVED BY Signature Contractor The foregoing instrument was acknowledged before me this / day of AP2 /Z , 20/ a ., by `" Fscz who is personally known to me or who has produced as identification a� pvho did take an oath. NOTARY PUBLIC: � : cpU °.�= ^Jees ssio :i 74/ iZ Plans Examiner Structural Review (Revised 3/ 12/ 201 ?)(Revisedd07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) �s �'oc EX RES;AUG•ii, ,�; o` www.AAROrvNOTAR Sign: Print: °stye C7 #yft 3 My Commission Expires: Zoning Clerk AP 704013 -2 Bu i SIS lori IOOAFETY SOLUTIONS INC 5773 NW 158 ST 33014 MIAMI LAKES ownER PUBLIC SAFETY AND SECURIT 5e1fLBICAL CONTRACTOR THIS IS NOT A BILL - DO NOT PAY NEW AND SECURITY STATC El3W04971 THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLIER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR UCENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 09/20/2012 02250020001 000045.00 SEE OTHER SIDE WORKER /S 1 DO NOT FORWARD FIRST -CLAS; U.S. PQSTAGI PAID MIAMI, FL PERMIT NO. Z 731632-6 KRATOS PUBLIC SAFETY AND SECURITY SOLUTIONS INC MARLON SEBELEN 5773 NW 158 ST MIAMI LAKES FL 33014 1 .11,1,11.11, su,111.1111 1 11111,1,1,11111,111,11,111 „112,18 3 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 SEBELEN, MARLON OSCAR KRATOS PUBLIC SAFETY & SECURITY SOLUTIONS, INC. 5773 NW 158TH STREET MIAMI LAKES FL 33014 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 barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business In order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and team more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE EC130049.7 1200379 118. DOCUMENT FIAS,A COLORED BAC CGROu D` MfiCROPR(NTTi1G • UNEMbt K ", PATENTED PAPER.- F.FLOIIDIk: AND PROk'E ;3`51�A),2EGULATION 2ACTQRS :LICENSI SEQ# L12072801632 DATE ! BATCH NUMBER LICENSE ualification elbF :; - CENTIF �: Under the��- provisi&is o ''Ohapt' E piration, date: AUG,: 1, 2014 R1'OR DISPLAY AS REQUIRED BY LAW KEN LAWSON SECRETARY '°�R °® CERTIFICATE OF LIABILITY INSURANCE DATE ( /2013 YYYI� 04/01/2013 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 Ileu of such endorsement(s). PRODUCER Marsh Risk & Insurance Services 4445 Eastgate Mall, Suite 300 San Diego, CA 92121 -1979 Ph 858- 552 -4200 Fax (4299) 600207 - Stand -GAWUE -13-14 CONTACT NAME: A/c No. Ext): FAX No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : American Zurich Insurance Company 40142 INSURED Kratos Defense &Security Solutions, Inc and Kratos Public Safety and Security Solutions Inc. 4820 Eastgate Mall San Diego, CA 92121 INSURER B Zurich American Insurance Co 16535 INSURER C : American Guarantee & Liability Ins Co 26247 INSURER D : WA N/A INSURER E : NA N/A INSURER F : COVERAGES CERTIFICATE NUMBER: LOS- 001500051-08 REVISION NUMBER:3 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 SUER WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY GL05747338 03/30/2013 03/30/2014 EACH OCCURRENCE $ 1,000,000 PR S (RENTED PREMISES (Ea occurrence) $ 1 ,000,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 GE PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 'L AGGREGATE POLICY X LIMIT APPLIES JECOT X PER: LOC $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS BAP5747337 03/30/2013 03/30/2014 COOMBBIINwEDD SINGLE LIMIT (Ea aent) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ DED:COMP. /COLL $ 2,500 UMBRELLALIAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENT ON $ 0 0 0 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS below Y / N N N / A WC5747393 W05747394 WC5747399 03/30/2013 03/30/2013 03/30/2013 03/30/2014 03/30/2014 03/30/2014 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) Re: Building Permits. Electrical Contractor / Low Voltage. Evidence of Coverage.' CERTIFICATE HOLDER CANCELLATION Miami Shore Village Attn: Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138 I 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 of Marsh USA Inc. Kristen A. Olson a. A. O t.aarri ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD