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MC-14-839Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-216195 Scheduled Inspection Date: July 21, 2014 Inspector: Perez, JanPierre Owner: STEUTEL, JOHN & HOPE Job Address: 1519 NE 105 Street 1-2 Miami Shores, FL Project: <NONE> Contractor: GMC AIR CONDITIONING SERVICES Bulming Department comments Permit Number: MC -4-14-839 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1122300530500 Phone: (954)973-5980 REMOVE AND REPLACE EXISTING 3 TON SPLIT Infractio Passed comments SYSTEM AIR CONDITIONER INSPECTOR COMMENTS False 2111 P Passed Inspector Comments Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. July 18, 2014 For Inspections please call: (305)7624949 Page 20 of 23 • - Miami Shores Village I Building Department 1 _ 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 ,p.� APR 2 4, 2014 M FBC 20� Permit No. ��°° Master Permit No.fn Lel Permit Type: MECHANICAL -rh JOB ADDRESS: / 5-1 Q /<' I ® S •� 0 "�� i City: Miami Shores County: Miami Dade Zip: 3 D3 Folio/Parcel#: //— ZZ3 ® 065— OS® C Is the Building Historically Designated: Yes NO X Flood Zone: OWNER: Name (Fee Simple ., CI -. 9� if ���®_ Phone# aO3 3;Q—®;3G Address: o? q 31 S7 -Ls,) A 06A)L) & City: 41.r A AIX State: 51- Zip: Tenant/Lessee Name: ,��� Phone#: Email: CONTRACTOR: Company Name: 6;44 C_ Aa?= a ®jO�uCA Z'✓.* Phone#: ?'!5rq— 9'13 a 0 Address: 0t3 0! N vV Sol-, P( - A C C - City: L,20,mpf 4ja bse-A GW State: EL— Zip: Qualifier Name: a = A71 F__ Phone#: _ State Certification or Registration #: C I S1 6 33 S Certificate of Competency #: Contact Phone#: q�4 _/ . � '! 3 — V?Sr 0 Email Address: .T % GZA4C 41QX*t v � ®6 DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: SL laqverW Square/Linear Footage of Work:®� Type of Work: ❑Address OAlteration ONew ;(Repair/Replace ODemolition Description of Work: 1940-100& 1- IP -901 ACE 9XXSCM,L f—c?J!✓ Submittal Fee $so_, Permit Fee CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) A/® A 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. f 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 day of d, 20 L, by tMAa e&o— g4VAaV a who is personally known to me or who has produced Signature Contractor The foregoing instrument was acknowledged before me this�-� day of 2014, by XA-' F40TLA who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: ® Sign: Print: pru"ZzwwwoJ Print My Commission " ' % J� R FAR�IAS, M, My Commission pvk",- MY0MISM#EEHWi �MHEO 31 EXPIRES: AprN 25,2017 EXPIRES: ApdI 25,2017 BMW Ihm No" Pak Um*"fe . Bowl 7hiu Nolmy+Pdk Undewbm APPROVED BY PI Examiner Zoning Structural Review Revised 3/12/2012XRevised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Clerk This fo must idMhfiany ALL al d' oning replace nt permit applications. Each unit change -out must be on its own data sheet. ultip ' o single sheets are n a able. �j � Job d ��r a wor ' eing do ): / ® S .r � City i ' ho r illage Coun . !am! Dade . Zip Code: ;*f1; 8 BOG ALL OND UNITS M ST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UN T CO LY WITH F.E.M.A MINIMUM FLOOD ELEVATION A OPY OF T NTRACT IS REQUIRED WITH ALL SUBMITALS STgTf A��r �c©�jptr���� A (AHRI) DATA SHEET REQUIRED Chan ' corkne'fis��S ARHI Sheet Attached: YES X NO ❑ Contract Attached: YES AIVn „_ f 1. Minimum Circuit Ampacity (Wire Size): C 0 As 0 0 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 44 U Cg D C.®f'o s Ca 3. Voltage of Circuit (208/240/480): oZ ®fit 4. Size Disconnecting Means: (g 0 ld JA P> /� Contractor's Company Name: 6:A4 C �� C 0A -a0A 1.� na Phone: {'^ `°6 State Certificate or Registration N. ICA C -i; ) 3 3 Certificate of Competency N. Signature (Qualifier's signature only) Date: `/ 2-3 ZI t-� 0 UNIT B EP DATA NEW UNIT MANUFACTURER = � - I 1 l AHU or PKG. UNIT MODEL # 4 C jj *OZ74 o — ®3 COND. UNIT MODEL # icid 14 N ® G �® KW HEAT 10 ,A) NOM TONS -3.0 AHU CU lj,5PKG 1 M.C.A AHU CU/.(*PKG AHU CU 34 PKG 2 M.O.P AHU CU110 PKG AHU WCU PKG 3 VOLTS 7.,b -2-3' AHUjjXU PKG PKG UNIT / I PKG UNIT I l ® EER/SEER YES CN02 REPLACING DUCTS YES REPLACING THERMOSTAT E NO YES NEW 4000NCRETE SLAB YES NO NEW ROOF STAND YE NO YES NEW RETURN PLENUM BOX YES MON 1. Minimum Circuit Ampacity (Wire Size): C 0 As 0 0 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 44 U Cg D C.®f'o s Ca 3. Voltage of Circuit (208/240/480): oZ ®fit 4. Size Disconnecting Means: (g 0 ld JA P> /� Contractor's Company Name: 6:A4 C �� C 0A -a0A 1.� na Phone: {'^ `°6 State Certificate or Registration N. ICA C -i; ) 3 3 Certificate of Competency N. Signature (Qualifier's signature only) Date: `/ 2-3 ZI t-� 0 Florida Building Code Online Page 1 of 1 °g.r::R: i- .. ➢ ivr.,t ' �y :: -: � :.;. tee:-�.=_>: ,r tla;m:a= _._. _ .. r�.- r.l�_ . y° = � � : :iii ... °!aA lL'.li s11tr 9f. i __ _ i•Jiiao •. 'i1-19 .S�- >i �. - ° I L �S:ti°ll.�i➢:. 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J ➢.? _ !=_5:51 �J . htttpJ/floridahuilding orgfpr]pr_,pp_i L. x 8[9/2012 Florida Building Cade Online Page 2 of 1522 1604.8 1620.6 Product Approval Method Method 2 Option 8 [kite Submitted 06/07/2012 Date'Vall;la- i 06/28/2012 Date Pending FW Approval: 06129/209.2 Date Approved 08/07/2012 mmary of Products FL aModel, Number or Mame seat on 32D.1 HRDCA80 Telescopic AJC Stand jAhArninum AM Stand rov1 T c Crass: Men hitp:/lflar daiauxlci ng.orglprlpr_app_dtl. x?param=wGBVX,QwtDgidGm6wgJqxtBll 7y... 8/9/2012 i i7t i a tow Taet #2t A1C 91ANI? 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J0M W -AM 144 Denis Y{ Salado_ Y84fdp2 SL2Dfd.CQA.00009095 3 W 3 AHRI Certified Reference Number: 4584640 Date: 4/23/2014 Product: Split System: Air -Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: CA16NA036""**A Indoor Unit Model Number: FV4CNF002 Manufacturer: CARRIER AIR CONDITIONING Trade/Brand name: CARRIER AIR CONDITIONING Series name: 16 SEER PURON AC Manufacturer responsible for the rating of this system combination is CARRIER AIR CONDITIONING 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: 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 product(s) 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 www.ahridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for Individual, personal and AM 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 udllzed, in any form or manner or by any means, except for the user's individual, personal and confidential reference. AIR-CONDITIONING, HEATING, CERTIFICATE VERIFICATION & REFRIGERATION INSTrr= The Information for the model cited on this certificate can be verified at www.ahridirectory.org, click on "Verify Certificate" link we make life better - and enter the AHRI Certified Reference Number and the date on which the certificate was Issued, which is listed above, and the Certificate No., which is listed at bottom right 19042757$3i3A s) ©2014 Air -Conditioning, Heating, and Refrigeration Institute IFICATE NO.: CondPfi�o ,,777 PROPOSAL my � GMC Air Conditioning Services LLC 2301 N.W. 30th Place, Pompano Beach, FL 33069 CACA 1816M Phone 954.973.5980 • Toll Free 888.304.2653 " Fax 954.211.6895 www.gmcacearvlc".com - Find us on Facebook: facabook.conVGMCAIR Proposal submitted to: �� J50-- .1V -9.r40 Date W oro a Aot. VA41201 Street (SillingAddtass) ..- t Street (Job location, if diff®renO ATI q e O -s�. . trtty, ,slate, raP � City, state, zip rude t � Phone Ione Work 3 0-.'5r-- 3 8 T -- 02 3 G. Phone Location We 11caeby proposeto: Furnish. lastall and service the equipment, and materials listed below with 4be conditions and specifications set forth in this.pmposaL NEW EQUIPMENT System #1$ System #2 $ System #3 *i'Net. Rice After Incentives Manufacturer Conti Unit ! tro o0 G— Air Handler�� Furnace e Coil Package Unit 77rermostar Heal Strip Other Capacity ' a Seer Piping NM X��S Condensate fd Other Warranties _ Lamar _Yr. Parts_ Yr Labor Yr Pans Yr. Labor --Yr. Pans Yt: Compressor / � . , Yrs Compressor Yrs Compress" V- ELECTMISCELLANEOUS ITEM; 8y Conoco existing circuits ec satysag building p"alits 13 New insidee/outside disconnect or h=kcx amps �entave -existing trove uses ❑ Now cl =!cat wiring to new ate mutes including prolix brcakem piping and switc bes ❑ Provide new concxele stain ❑Increase Ctdral service to ._ mps E3 UV 0 Change fuse panel to circuit breakers Light DUCTWORK AND GRE LES ❑ Whole house air dcancr _ %rconne ct to esdstiag supply -&,wn tui- —�,, �Se^rvice mttintenanee agreement O Now supply outlets in Kit_ D.R __._L.It BIL l4 sis� I��-�.. D Bath FL:R Otter w ❑ New,con. air grille ? Ceiling Wats L j Tour Price .................... $ as .00 $ 00 $ .00 ! FP& -L Discotmi, ............ $ - .0o $ .0.0 $ :OO Other . .................. $ - "' "'" .00 $ - .Oil $ - .00 Net Payable .............. $ — r% .00 $ :00 _ $ .00 We propulse hereby to .install system # f as above Net. Due Q -1t_ .06 Deposit. $, -00 specified for the stun of: - Dollars Balance $_:. a• s;-'`.DCi due upon completion Signature: It is agreed and and by tete parties tW alltguip» cur and tarts which arc add parsuant huzo alma am betottm fititwea-a pori of ttce real state a+b= they are pkxW. E tCs°yq'aayl Said.pau . and catpanem diet! as all trains teunalo pma w property and the ulna thereto Signatures Date; shall ren- is with the setteruadl pga4m in foII is received. Buyer herby agrees ibo all t I pens and copuaent Wray be repossessed in ft event of son-paymeai. Signature- Date. 1 have andmity to ander *e wank as onttind above. t agmen pay as costa and seasonabte tCLsto> r} atioraws rocs If" proposal is *cc in die hankie of an attmq Fre w1leawn. This proposal .subject to approval by Qb4C Air Conditioning Services Estimating, Installation and Credit Departments, 1frejected, any payment made hereunder shall be refunded to the customer and this ptoposol shall be null and void amd of no effect. Pricing va id for 30 days from date of pioposal. Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D.. V" COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 BUSINESS NAME: <Sz/)l G A ra- C OA>0XITo,vi-lu . arc &X BUSINESS ADDRESS: o l AaeJ� 3o1s CITY p8ej4�o 46'cw STATE ZIP CODE *3*3 o 6 1 rl O BUSINESS PHONE: 3 7 d FAX NUMBER CELL PHONE 66 -'1, QUALIFIER'S NAME: � 4D VIA) 54T� c - QUALIFIER'S LIC NUMBER: 0 4t I je` 6 3' E-MAIL ADDRESS (IF APPLICABLE): 51�!q S � � � � °' - �A'%' Created on 3119109 BY MLDV I RV 3126109 MLDV I n 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014 DBA: GMC AIR CONDITIONING SERVICE LLC Receipt#:�TING/AIRCONDITION Business Name: JOHN FLATHE Business Type: (A/C CONTRACTOR) Owner Name: GMC AIR CONDITIONING SERVICE LLC iom8usiness Opened:08/23/2009 Business Location: 2301 NW 30 PLACE State/County/Cert/Reg:CAC1816335 POMPANO BEACH Exemption Code: Business Phone: 9549735980 Rooms Seats Fanployees Machines Professionals 5 For Vending Business Only Number of Machines: Vendina Tvae: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 ;2:fi0 ".-Q. 00 0.00 29.70 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: GMC AIR CONDITIONING SERVICE LLC J, 2301 NW 30 PLACE POMPANO BEACH, FL 33069 2013 -2014 Receipt #03A-13-00000547 Paid 10/30/2013 29.70 From:James Tate FaxID:561-684-5995 Page 1 of 1 DateAt24=14 02:17 PM Page:1 of 1 GMCAI-1 OP ID: JT CERTIFICATE OF LIABILITY INSURANCE1 DAT04124DNYYI) 04/24/14 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 lieu of such endorsement(s). PRODUCER Phone: 561-683-8383 SLATON INSURANCE P.O. Box 220537 Fax: 561-684-5995 West Palm Beach FL 33422 Casey Cunniff, C0CU cNAONTEA,cT PHONE c No E A!C No ADo L INSURER(S) AFFORDING COVERAGE NAIC S INSURERA: Southern Owners Insurance Co. 10190 INSURED GMC Air Conditioning Services, LLC 2301 NW 30th PI - Bay1 Pompano Bch, FL 33069 INSURMB:Auto-Owners Insurance Company 18988 INSURER C:Bridgefield Employers Ins.Co. 10701 INsuRERD: Hanover American Ins. Co. 36064 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, �NgEXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTRR TYPE OF INSURANCE Ana POLICY NUMBER MMID MMIDD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I A I OCCUR X Contractual Liab 7270318314 01MOI14 01/10/15 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurcence $ 300,000 MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,000 X Broad Form PD GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC PRODUCTS- COMP/OP AGG $ 2,000,000 $ D AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X AUTOSwNEO AZJ3310965-05 06/24/13 06/24/14 Ea aBINEDI$SINGLE LIMI 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident B C X UMBRELLA LIAB EXCESS X OCCUR CLAIMS MADE NIA 4750537200 83048731 01/10/14 08/15/13 01/10/15 08/15/14E.L. EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED I X I RETENTION $ 10000 WORKERS COMPENSATION AND EMPLOYERS' LIABLITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? $ WCSTATU OTH- X LIMITS I I ER EACH ACCIDENT $ 1 000 OO , , (Mandatory yes.describe andNHI) If yes, describe under E.L. DISEASE- EA EMPLOYEE $ 1,000 00 � DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00( DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required) 'r Conditioning Contractor treorrerrA-rr u.., --- MIAMISH Miam I Shores Village Building Department 10050 NE 2nd Avenue 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 A� O 1988-2010 ACORD CORPORATION. All rights reserved. ........ - %Aw, VrViJI I ne AGUKD name and logo are registered marks of ACORD