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MC-11-1307Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 ki Inspection Number: INSP- 162256 Permit Number: MC -7 -11 -1307 Scheduled Inspection Date: September 19, 2012 Permit Type: Mechanical - Residential Inspector: Perez, JanPlerre Owner: FORBES, JOHN Job Address: 304 NE 99 Street Miami Shores, FL Project <NONE> Contractor: RAINBOW AIR CONDITIONING INC Inspection Type. Final Work Classification: Addition /Alteration Phone Number (305)757 -7750 Parcel Number 1132060135600 Phone: 305 - 216.4594 Building Department Comments REPLACE HVAC SYSTEM TO ACOMMODATE EXISTING HOME & ADDITION l September 18, 2012 For Inspections please call: (305)762 -4949 Page 1 of 27 Inspector Comments Passed 10 Failed Correction Needed ❑ Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid September 18, 2012 For Inspections please call: (305)762 -4949 Page 1 of 27 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 162256 Scheduled Inspection Date: September 19, 2012 Inspector: Perez, JanPlerre Owner: FORBES, JOHN Job Address: 304 NE 99 Street Miami Shores, FL Project: <NONE> Contractor: RAINBOW AIR CONDITIONING INC uwamg Liepartment comments REPLACE HVAC SYSTEM TO ACOMMODATE EXISTING HOME & ADDITION l/ Permit Number: MC -7 -11 -1307 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)757 -7750 Parcel Number 1132060135600 Phone: 305 - 216 -4594 (2, September 18, 2012 For Inspections please call: (305)762.4949 Page 1 of 27 Inspector Comments Passed 10 Failed Correction Needed ❑ Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. September 18, 2012 For Inspections please call: (305)762.4949 Page 1 of 27 y 1 ! I: 0 _11FUMM 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 APPLICATION FBC 20 (f Permit Type: MECHANICAL 1i YVED FEB 0 8 292 Permit No. PC / / — Master Permit No. , r i ° I� ' OWNER: Name (Fee Simple Titleholder): J® H-K) p E:> Phone #: 30s- 9S'i - `7!St Address: 30 Y Al 6- `I9 S% City: M119441 SArAEFS State: /�_L Zip: 3-3 i 31 Tenant/Lessee Name: Email: A tr�oe JOB ADDRESS: -3C LI IN if 9 5;T City: Miami Shores County: Miami Dade Zip: 3 3 I.2 ° Foho/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: ` A) *o Phone #: Address: /,:� & 11 rill `? C-1- City: 14 k-1-1 v OLk L?s F State: A�a= Zip: 3 '> ®i c Qualifier Name: Y 0-3 �° r %Z � o � � cz /to Z- Phone #: 30 -7-6 7 -Y 0 J's � State Certification or Registration #: e" $ 6 Certificate of Competency #: Contact Phone #: �6r 1 - ®� 3 Email Address: x �� � �('� ¢�r�'��� c'� DESIGNER: Architect/Engineer: Value of Work for this Permit: $ 6�� Square/Linear Footage of Work: Submittal Scanning Fee $ Notary $ Permit Fee $ CCF CO /CC $ Radon Fee $ DBPR $ Bond $ 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 Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State zip zip r J 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 �h""' Owner or Agent The foregoing instrument was acknowledged before me this day of75 , 20 �by :S�Ht--J '(�r'�Qs , who is p rsonally kn a or who has produced 1-'L, 1 As identification and who did take an oath. NOTARY PUBLIC: ` � � 0 % J % I 1 I I I III//, /'/ 0 Sign: d Print: `D My Commission Expires: `�� '•. ° v' ��r APPROVED BY Si . q % Contractor • The foregoing instrument was acknowledged before me this day of dP A 2012, bY- foj� P PL <9'04? Z 4;1,02- who is personally known to me or who has produced 1 � r Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009 )(Revised 3/15/09) as identification and who did take an oath. NOTARY PUBLIC: My n _ ��� arm Zoning Clerk a • i Miami Shores Village Building Department 90050 N.E.2nd Avenue Miami Shores, Florida 33938 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. Job Address (where the work is being done): �C)q VC ri ci 5,' City: Miami Shores Village County: Miami Dade Zip Code: -3 31 3 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 ❑ UIN11 BEING REPLACED DATA NEW UNIT MANUFACTURER a Z AHU or PKG. UNIT MODEL # RAPAI MAI K ' COND. UNIT MODEL # KW HEAT I� NOM TONS S-- 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 I I EER/SEER d'-6 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): 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: Phone: —C 7V-6> -7J State Certificate or Registration N. Certificate of Competency N. Signature Date: `� /&/I alifie s signs re only) B I ILDING 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 APPLICATION FBC 20 Permit Type: MECHANICAL AUG 3 0' Permit No. i VA ( I k )� Master Permit No.1e c= I ` — S 5n OWNER: Name (Fee Simple Titleholder): ��� �'+ ' Phone #: 30-j'-' 7 57p- 2 2s-0 Address: ®LI Aje7 q � S °T City: i'1'1 ! a .5-At2t�:5 State: Tenant/Lessee Name: Email: OL, v6-, JOB ADDRESS: AZF % %� Sr City: Miami Shores County: Miami Dade Zip: 3i 3 Folio/Parcel #: Is the Building Historically Designated: Yes NO .2f Flood Zone: CONTRACTOR: Company Name: gg" /V e CV �6 d i� Phone#: 7 ® �y � Address:/ 5` 6 V e 7 '� C?c �i City: W/ r " _& ' State: "C-L- Zip: -3 3 O / -6 Qualifier Name; ,�`i�� y P d �4 2q /0 L Phone#: %jPV r-02 '7Vii- % V V '!) State Certification or Registration #: C t? C 6:�' 3,5 499 Certificate of Competency #: Contact Phone#: Zgj�_ oZ 90 ` 6 S,V© Email Address: DESIGNER: Architect/Engineer: Phones Value of Work for this Permit: $ Square/Linear Footage of Work: Type of.Work: ❑Address ❑Alteration ,Description of Work: L ' '4e C U Submittal Fee Scanning Fee $ ­a i%T Permit Fee Radon Fee $ ❑New , ❑Repair/Replace N+C)e, C SQ-Qh, imi Notary $ TraWng/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ ❑Demolition Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 7f?' day of , UL�- , 20 , by Signature Contractor The foregoing instrument was acknowledged before me this y day of 9,b O4, 20 _, byZ&5 -.e & By"�d0 2 who is me or who has produced who is personally known to me or who has produced NOTARY PUBLIC Sign: Print: As identification and who did tak �i'I oath. as identification and who did take an oath. aiiinul��� NOTARY PUBLIC: Sign. My Commission Expires: APPROVED BY Il1111111 Pill S Xaniiner Structural Review (Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) M of Flaft �xesa ' ;onan�Nn%�149M8 pd�° £an�*es 11fZ9171016 _ _ _ Zoning Clerk 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.' v V A e —MMaster Permit No. l i BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL Owner's Name (Fee Simple Titleholder) ff Q k YA tiV LQ,S Phone # :?�� -7,5 C — 7 Owner's Address City Cq1G( State —L_ Zip �D Tenant/Lessee Name Phone # Email er e- L�-� 0 O (0) L Igt_ Ooya . Job Address (where the work is being done) W (_�_ RL qQ S-7- City Miami Shores Village County Miami -Dade Zip :,S 3 1 3Y FOLIO / PARCEL # Is Building Historically Designated YES NO___)( _ Flood Zone rw Contractor's Company Name RHIAJ60LO aj /C d. 6 V V O °� � jn( Phone # 7 86_ � D Contractor's Address./ g V %( i? t r/ ? 7 C 4L City C G vi/ i'ar sGi $ State e_ Zip 3 Qualifier Name J-0 S'�' 6; ©-n 2 G1 Phone #, ? C>6— State Certificate or Registration No. 2 (f 0 3 Y S 8 certificate of Competency No. Contact Phone 786 - 1 6,— 4- SL 0 E -mail Architect/Engineer's Name (if applicable) Maeo . / % Phone # Value of Work For this Permit $ 1, & ©, 06 Square / Linear Footage Of Work: Type of Work: ®Addition ❑Alteration []New P- Repair/Replace Describe Work: Submittal Fee $ Permit Fee Notary $ Training /Education Fee $ Scanning $ Radon $ DPBR $ Double Fee $ Violation date: Structural Review. $ ❑ Demolition CCF $ CO /CC $ Technology Fee $ Bond $ Total Fee Now Due $ �_ ' See Reverse side Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 `rbee ap oved gnd�'reeinspection fee will be charged. Sign/fegoing;instrument Signature Owner or Agent Contractor ` The was acknowledged before me this* The foregoing instrument was acknowledged before me this /U // day / 20 , by /, day of 12- , 20 � / , by -Te,5 is personally known to me or who has produced As identification and who did take an oath. ARY PUBLIC: (Revised 07 /10 /07)(Revised who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: ns Or Mer Zoning Engineer Clerk checked -Miami Shores village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 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. Job Address (where the work is being done): LO—L MI QK-11 City: Miami Shores Village County: Miami Dade Zip Code: 3 eZ 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): 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: Phone: State Certificate or Registration N. Certificate of Competency N. Signature Date: f ®® (Qua ifler's signature onl UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG. UNIT MODEL # COND. UNIT MODEL # KW HEAT NOM TONS 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 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): 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: Phone: State Certificate or Registration N. Certificate of Competency N. Signature Date: f ®® (Qua ifler's signature onl Contract Rainbow Air Conditioning Service _ rainbowac.com (786) -413 -6052 Dear :John Forbes August 30, 2011 Thank you for considering our bid for 304 I IE 99. t Miami- landa.33138 1 have enclosed an outline of our contract. Please let me know if you have any questions or comments. My phone number is (786) -413 -6052, or email me at Pablo @rainbowac.com Overview • Add new 2 ton A/C unit and add duct work to home addition as per plans Unit to be used • AHU - Rheem RBHK17J06SFE • CU — Rheem RANDO24JBZ Schedule • Ready to start Warranty • 5 year warranty parts and labor Costs • $7500.00 Payment • 50% Down payment 50% after final inspection With kind regards, xcd��p�� � Pablo Lopez �� °& ♦piO " ®i ®! OR. .gS��- i S $ dip$ A e"iid i i g aa%ti till a1 aa1 ataQ a�maa�a�at� +E��t��r �a 1 r f P t. l ice. Q9/01/2011 12:19 #0247 P.001/001 CERTIFICATE OF LIABILITY INSURANCE I 09101/2091 FRODUCat THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION LItWIn Insurance AgBenCy,lnC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 12,16 E. Atlantic Boulevard. Sul#A2 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW_ Pompano Beach, FL 33060 Tel: (854) 630- 98441F= (954) 630-0376 INSURERS AFFORDING COVERAGE NA1C 11 9CAMm RAINBOW A1C INC. wwRERA: CAPACITY INSURANCE COMPANY 15476 NW 77TH CT BAY 434 INSURER & CASTLEPOINT INS MIAMI LAKES, FL 33016 WSURERC: _ ANY REQUIREMENT. TERM OR CONDITION OI MAY PERTAI N, THE I NSUR/ W CE AFFORDED SI POLICIES_ AGGREGATE LIMITS SHOWN MAY OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR 2JBEDHEREIN ISSUBJECTTOALI.THETERMS. EXCLUSIONSANDCONDITIONSO>` SUCH D BY PAID CLAIMS. %FcKIIr1%#^1CnVL •Jr-K uAnuri-LA I14JN SHOUWANY(WTHEABOVEDESOfOMPOLXWBBCAMCELLMMTCReTMMMATION MIAMI SHORES VILLAGE HALL ]DATE THEREOF. THE mum nomEpt wmL EN]DEAVoR To mAL 30 DAr3 vm TEN FAX: 305 - 7584972 NOTICE TO THE OERTHWATE HOLDER NAMED TO WE L� r, WTFMAIRETO DO SOSHALL 10050 NE 2ND AVENUE MPOSE No oBUOA OR LlAB1 M OF ANY IMM UPON IIS AGENTS OR MIAMI SHORES, FL 33138 REPTA Phone: AUTHORMD TINE Fax I r Z�- 2S (=9JM ) 10 1988 -x009 ACORD CORPCIOTION. All richis I ,®d_ Tile ACORD name and logo are reglstelaI marks of ACORD AWL TYWOPWINMIRANCE POLICY NUMBER EFFEOTIVE A 604ERAL U1ESITY RC1AI, MME AL UABUN CLAM MADE Lx-1 OCCUR CLM01001246A 04114/2011 0411412012 Mo OCCUR D�ICe 810{10,000 X TO RENT6D MED ge s 100,000 $6.000 PER$ &AM FN,N $ 1,000.000 _. $ 2X0,000 AGOREGATE GENT AIOC EOA LM11TAP"SPER: X LOC PRODUGTS-COMPIO GG s 2,000,000 AUTOMOBILE L104HU ► AW AWO ALL OWN= AUTOS Bct�DULEDaUTOs HM AVros NON -OVNid Mgff03 comemsm=UM (ES edWeM (P- Pte+ ) $ BODRY IN.IURY iP�aoddertt} $ H(,=0MA136 GARAGE UAW= ANYAVIV &0M"-FAAQCflD8U OTHERTTIAN EAACC AUTO ONLY AGO S �tsE3S {RIBRELLA OCCUR CLAIMS MADE DeDUCTIeI.E RETEDrnoa EACH OCCURRED CE AGGREGATE $ S s s Brc WORI�t18AT10N OFFICEWMEMBERP=LUD 2 LJJ ff i H) SYE b WCP760341200 07106/2011 0710612012 wcsrarw OTH - I? L �l ACCIDENT 1,p00 O00 EL - SAfiAdP 1.000,000 EL DISFAS$ - POl -tCY LE NT S 1,000, WO OTHER DESCR[PI IM OF OPERA71ONSI LOCATIONS I VE3flC M I IXCLUSUM ADDED BY ENDORSEMENT SPEMAL PROVOUM %FcKIIr1%#^1CnVL •Jr-K uAnuri-LA I14JN SHOUWANY(WTHEABOVEDESOfOMPOLXWBBCAMCELLMMTCReTMMMATION MIAMI SHORES VILLAGE HALL ]DATE THEREOF. THE mum nomEpt wmL EN]DEAVoR To mAL 30 DAr3 vm TEN FAX: 305 - 7584972 NOTICE TO THE OERTHWATE HOLDER NAMED TO WE L� r, WTFMAIRETO DO SOSHALL 10050 NE 2ND AVENUE MPOSE No oBUOA OR LlAB1 M OF ANY IMM UPON IIS AGENTS OR MIAMI SHORES, FL 33138 REPTA Phone: AUTHORMD TINE Fax I r Z�- 2S (=9JM ) 10 1988 -x009 ACORD CORPCIOTION. All richis I ,®d_ Tile ACORD name and logo are reglstelaI marks of ACORD