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HomeMy WebLinkAboutPermits and CertificatesQIY Cf E --:1 HOME OF PEUCAN ISLAND BUILDING DEPARTMENT 1225 MAIN STREET • SEBASTIAN, FLORIDA 32958 TELEPHONE: (772) 589-5537 • FAX (772),989-2566 E-mail: ciWcityofsehastian.org APPLICATION FOR BUILDING PERMITS Complete All Items In Sections 1, II, III, IV, V I. LEGAL DESCRIPTION: LOT BLOCK SU �o ��— CONSTRUCTION ADDRESS:/B INDIAN RIVER COUNTY TAX PARCEL #: 1y2.Va II. CONTRACTOR_ ADDRESS S79Z �� 50054-41. CITY: Ila ZIP:f y3 STATE or SEBASTIAN REGISTRATION #1�4G'' /5og-b93 ADDRESS_D I3/�n✓D�l1GScHi/G�JU/if2w'Cffl: ¢A: Aoxe STATE: Z_ DAYTIME PHONE NUMBER: ,;�ci/- Z/9-/ZY-3 ZIP: 3.3 Ar % IV. TYPE OF WORK: NEW ADD-1ALT. REPAIR_ DEMOLITION RESIDENTIAL: /] COMMERCIAL: MULTI -FAMILY: DESCRIPTION OF WORK•.�/�i�i�Lt, &W m tAA 14 t &-sf ilitll�7flrcl�S�/` Ia ................................................................ PUBLIC SEWER YES —'NO _ PUBLIC WATER: YES— NO TOTAL SO. FT. = Conditioned: + Non -Conditioned: POOL GALLONS: ESTIMATED FAIR MARKET VALUE: S %J;z C2 _n,n �O _ V. TOILETS _ BATH TUBS _ TUB/SHOWER— SHOWER— KITCHEN SINK, WELL _ LAVATORIES _ DISPOSAL _ WATER HEATER WASHING MACHINE HOOKUP_ LAUNDRY TUB _ . HOSE BIBS_ DISHWASHER_ ................................. .................................................................................. SERVICE AMPS-2et% TEMP. SERVICE –4 OUTLET S / SWITCHES A/C TONAGE _ HEAT STRIP_ APPLICANT MUST COMPLETE PAGE TWO AND SIGN PAGE THREE All of the below sub -contractors must be listed with state registration number, certification number, or Sebastian competency number, depending on contractor. The city provides pre- printed postcards that must be completed entirely for each sub -contractor listed and utilized by the contractor. Postage must be attached to each postcard prior to submitting application. Do not mail the postcards yourself, the city will mail them. Failure to complete the above will result in your application not being processed. SUB — CONTRACTOR NAME STATE REGISTRATION # AND/OR SEBASTIAN COMPETANCY# Electrical -Plumbing Mechanical Roofing Carpenter Drywall Insulation -Painting Lath/Plasterin Concrete Masonry Aluminum/Structural Aluminum/Non-Structural Septic Well " Carpet Tile ExcavaVin /Cleadn /Gradin , l Termite Control • r%n rw%lira[ion napc 2 of 6 �! ICATION IS HEREBY MADE TO OBTAIN A -PERMIT TO DO THE WORK AND INSTALLATIONS AS 4DICATED. 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, INSURANCE, AND WORKMAN'S COMPENSATION. I UNDERSTAND THAT A SEPARATE SUB -PERMIT MUST BE OBTAINED FOR ELECTRICAL, PLUMBING, MECHANICAL, POOLS, ETC. PROPERTIES SHALL BE KEPT CLEAN OF LITTER AND ALL STREETS. SIDEWALKS, AND CURBS DAMAGED DUE TO THIS CONSTRUCTION SHALL BE REPAIRED TO.THE SATISFACTION OF THE CITY ENGINEER PRIOR TO THE ISSUANCE OF A CERTIFICATE OF OCCUPANCY_ OWNER'S AFFIDAVIT: I CERTIFY THAT ALL THE FOREGOING INFORMATION IS ACCURATE AND THAT AL WORK WILL BE DONE IN COMPLIANCE WITH ALL APPUCABLE LAWS REGULATING CONSTRUCTION AND ZONING. —WARNING TO OWNER: YOUR FAILURE TO RECORD A IIIOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.— OF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT). A N.O._q. ISjfEQUIRED FOR ALL .LOBS VALUED AT $2.500 OR MORE SIGNATU OF R A NT SIGNATURE OF CO CTOR DATE: Z DD �^ DATE: 5E L10 10� i NOTARY AS TO. -OWNER OR AGENT NIY COMMISSION EXP !� ' DA'�ti.ENt#DD Nota NV COMMS]OD. EMRES- ft-£OD%%%WAW F! t 44 NOTARY AS T��� MY COMMISSION EXPIRES: 07-11-19& Notary Seal: oya* �atrcn, !loGcwaod • Mly/ C4iMNssim OD133265 %T/ 'Expires July 11. 2006. . ~ DO NOT WRITE BELOW THIS LINE — OFFICE USE ONLY . BUILDING PERMIT 4 �ZONING Ps TAZ 9 L APPLICATION RECEIVED BY: DATE: 1 / ers PAYMENT: ZONING REVIEWED BY: PLANS REVIEWED BY: ISSUANCE BY: COMMENTS: FEES PLANS REVIEW FEES BUILDING PERMIT PLUMBING PERMIT ELECTRICAL PERMIT MECHANICAL PERMIT RADON (STATE) REC. IMPACT FEES TOTAL FEES S PU�Af1�G Dk?t . 801858 Sprint 2.5 MI73XCO62 PERMIT # �cw R S �2t�to-t� fro ijL-�t�S'1 anoF SE T &N HOME OF PELICAN ISLAND BUILDING DEPARTMENT 1225 MAIN STREET • SEBASTIAN, FLORIDA 32958 TELEPHONE: (772) 589-5537 • FAX (772) 589-2566 3 pau O} 7'&,"A/6 K� o -T - PERMIT APPLICATION ALL OF THE FOLLOWING MUST BE FILLED IN BY APPLICANT, ACCORDING TO FS 713.135 INDIAN RIVER COUNTY PARCEL ID # 31-39-06-00005-0002-00001.1 BLOCK: SUBDIVISION: FLOOD ZONE: TYPE OF WORK: NEW = ADDITION =ALTERATION = REPAIR =DEMOLITION = WORK INCLUDES: STRUCTURAL ❑ ELECTRICALES PLUMBING ❑ MECHANICAL ❑ ROOFING ❑ OTHER ❑ WORKDESCRIPTION: upgrade antenna to existing structure ESTIMATED JOB VALUE: S 2,004.00 TOTAL S/F JOB NAME: Sprint 2. 5 nA Al (j JOB ADDRESS: 1201 St. Sebastian, FL UNDER AIR PROPERTY OWNER'S NAME: Bell South Mobility LLC PHONE: ADDRESS: 5201 Congress ST CITY/STATE: Boca Raton. FL LICENSE It: Ch CA q0 3S 1 PHONE: M 0241' 9000 ZIP CODE 3.4b 10 ARCHITECT/ENGINEER: PHONE: ADDRESS: CITY/STATE: ZIP CODE: PRESENT USE: Telecommunication PROPOSED USE: Telecommunications OCCUPANTLOAD: NUMBEROF: STORIES= BAYS= UNITS= BEDROOMS= HEIGHT= TYPE OF CONSTRUCTION:Telecommunications OCCUPANCY TYPE: IS THE BUILDING PRESENTLY EQUIPPED WITH AN AUTOMATIC FIRE SPRINKLER SYSTEM? YES = NO Q BONDING COMPANY: ADDRESS: MORTGAGE LENDER: ADDRESS: FEE SIMPLE TITLE H( ADDRESS: 5201 Cong ATE: �1 FL I 801858 -FL VERO i BSI 801858 -AT&T 3RD CARRIER (22awti5 R/IOIo *fL'Fos� Llrvtx �J NLat� it oI c1.�A!/ [- 5� sT HOME OF PELICAN ISLAND BUILDING DEPARTMENT 1225 MAIN STREET • SEBASTIAN, FLORIDA 32958 TELEPHONE: (772) 589-5537 • FAX (772) 589-2566 PERMIT APPLICATION ALL OF THE FOLLOWING MUST BE FILLED IN BY APPLICANT, ACCORDING TO FS 713.135 w2wi INDIAN RIVER COUNTY PARCEL ID # 31390600005000200001.1 RECEIVED B§:::Io LOT: BLOCK: SUBDIVISION: FLOOD ZONE:_ TYPEOF WORK: NEW= ADDITION =ALTERATION =REPAIR =DEMOLITION WORK INCLUDES: STRUCTURAL © ELECTRICAL ❑ PLUMBING Q MECHANICAL ROOFING OTHER WORK DESCRIPTION: REPLACE O IPM NT ON XI TIN TOWF10 ESTIMATED JOB VALUE: $ Z3, a'qU TOTAL S/F UNDER AIR JOB NAME: pnlRSA FI vFRO 6 RSI 801858 ATBT 3100 CAPPIG I F..1.SFI-2P (PAt'. JOB ADDRESS: PROPERTY OWNER'S NAME: BELL SOUTH MOBILITY LLC CITY/STATE: N/K/A NEW CINGULAR WIRELESS PHONE: CONTRACTOR: MASTEC NETWORK SOLUTIONS -STANLEY KEVIN MACLIN LICENSE #: CGC1515769 ADDRESS: 6100 BROKEN SOUND PKWY SUITE 6 PHONE: 561-967-9857 CITY/STATE: BOCA RATON FI ZIP CODE 33487 954.874.7870 CITY/STATE: PRESENT USE: TELECOMMUNICATIONS. PROPOSED USE: TELECOMMUNICATIONS. OCCUPANT LOAD: NUMBER OF: STORIES= BAYS= UNITS= BEDROOMS= HEIGHT= TYPE OF CONSTRUCTION: OCCUPANCY TYPE: AREA IS THE BUILDING PRESENTLY EQUIPPED WITH AN AUTOMATIC FIRE SPRINKLER SYSTEM? YES = NO = BONDING COMPANY: PHONE: ADDRESS: CITY/STATE: MORTGAGE LENDER: PHONE: ADDRESS: CITY/STATE: FEE SIMPLE TITLEHOLDER: BELL SODM MOBILITY u.0 (LESS), N/R/A NEW CINGULAR WIRELESS PHONE: ADDRESS: C/O DEBBIE LEWIS: VER065201 CONGRESS AVE CITY/STATE: BOCA RATON. FL 33487-5629 Indian River County, Florida Property Appraiser - Printer Friendly Map Print I Back Indian River County GIS i 8abaanan Page 1 of 1 �IL 1•t7 l —• ^ '.' N I� .ic :a: ^fit ... * , , — MAIN SI- _-'- AOL ParcelED OwnerName PropertyAddress 31390600005000200001.1 BELL SOUTH MOBILITY LLC (LESS) N/K/A CROSS ST SEBASTIAN, NEW CINGULAR WIRELESS FL 32958 http://www.ircpa.org/PrintMap.aspx 7/30/2014 Indian River County, Florida Property Appraiser - Property Data Data For Parcel 31390600005000200001.1 Base Data Parcel: 31390600005000200001.1 Owner: BELL SOUTH MOBILITY LLC (LESS), N/K/A NEW CINGULAR WIRELESS Site CROSS ST, SEBASTIAN, FL 32958 Address: [+] Map this property. Mailing Address Address: C/O DEBBIE LEWIS; VER06 5201 CONGRESS AVE City State BOCA RATON, FL 33487 - Zip: 3629 Legal Description -- click here for full legal description SCHOOL PARK SUB REPLAT OF Photos No photos were found for this parcel. Property Information Tax Code: 2 Property Use: 9000 - LEASEHOLD,GOVT OWNE Neighborhood: 990028.00 - CITY SEB W USl TO 512/PER Real Appraiser & WB - WAYNE BIBEAU - Date: 7/10/2002 Secondary Owners CITY OF SEBASTIAN, Notes Notes: Click here to view oblique imagery through Bing Maps. Report Discrepancy GIS parcel shapefile last updated 7/30/201412:15.•54 AM. LAMA database last updated 7/30/201412:36:30 AM. Page 1 of 1 http://www.irepa.org/Data.aspx?ParceUD=31390600005000200001.1 7/30/2014 I R ftAUKCITY OF SEBASTIAN, FLORIDA 1225 Main Street Sebastian, FL 32958 r -5 -5537 Fax: 772-589-2566 E -Mail : city@cityofsebastian.org 9300125 (�V BUILDING PERMIT EftI. ORMATION.,'` AOCAT,ION INFORMATIO :: Permit umber: Issue Address: Permit Type: ADDITION - COMMERCIAL Sebastian, FL Class of Work: Work Class NEW Township: 31 Range: 39 Proposed Use: COMMERCIAL Lot(s): Block: Section: 6 Sq. Feet: Est. Value: Book: Page: Cost: 1.00 Total Fees: Subdivision: SCHOOL PARK Amount Paid: Date Paid: Parcel Number: 06313900005000200001.0 `< CONTRACTOR INFORMATION I -OWNER INFORMATION Name: TY-OFSEBASTIAN Name:COMPANY Addr: 775 - 48TH Address: 1225 MAIN ST VERO BEACH FL 32962 SEBASTIAN, FL 32958-4165 Phone: (561)778-1480 Lic: Phone: Work esc: POLICE T_QVVER_ �NWJWLwAPPLICATION FEES Inspection MONTHS FROM ISSUANCE, OR IF CONSTRUCTION IS SUSPENDED, OR ABANDONED FOR A PERIOD OF 6 MONTHS AT ANY TIME. THE CONTRACTOR HAS CERTIFIED BY SIGNATURE OF APPLICATION, THIS DOCUMENT AND PLANS AND SPECIFICATIONS ARE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. * NOTICE * IN ADDITION TO THE REQUIREMENTS OF THIS PERMIT, THERE MAY BE ADDITIONAL RESTRICTIONS APPLICABLE TO THIS PROPERTY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY, AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER *" WARNING TO OWNER ** YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTENDTO OBTAIN FINANCING, CONSULT YOUR LENDOR OR AN ATTORNEY -BFFORF_RECORDING—YOLK N THIS PERMIT IS APPROVED ON THIS DATE PURSUANT TO THE FLORIDA BUILDING CODE. WAYNE, ESELTINE, BUILDING OFFICIAL - INSPECTIONS SHALL BE REQUIRED FOR ALL PERMITS. CITY OF SEBASTIAN, FLORIDA 1225 Main Street Sebastian, FL 32958 Ph: 561-589-5537 Fax: 561-589-2566 E -Mail : city@cityofsebastian.org 04-003540 BUILDING PERMIT R q MMINEORMAIr- N Permit #:04-003540 Issued: 10/27/2004 Address: 1201 MAIN ST Permit Type: ADDITION - COMMERCIAL Sebastian, FL Class of Work: MISCELLANEOUS Township: 31 Range: 39 Proposed Use: COMMERCIAL Lot(s): Block: Section: 6 Sq. Feet: Est. Value: Book: Page: Cost: 55,000.00 Total Fees: 757-00 Subdivision: SCHOOL PARK Amount Paid: Date Paid: Parcel Number: 06313900005000200001.0 �A V EW NN Name: ENGINEERED ENVIRONMENTS INC Name: CITY OF SEBASTIAN Addr: 7341 WESTPORT PLACE UNIT A Address: 1225 MAIN ST WEST PALM BEACH, FL 33413 SEBASTIAN, FL 32958-4165 Phone: (561)282-4111 Lic: CGC061570 Phone: Work Desc: ADDING ANTENAS ON EXISTING TOWER E EaLML-7',A BUILDING FEE 637.00 ELECTRIC 45.00 PLANS REVIEW FEES 75.00 i 4N 10 N, JUSPE.C.T, Mt.REQUIRED, ......... TIE BEAM ROUGH FRAMING SHEATHING NOTICE OF COMM. RECEIVED ELECTRICAL PERMIT PICKED UP SLAB MECHANICAL PERMIT PICKED UP ROUGH ELECTRIC EARLY ELECTRIC TOP -OUT FORMBOARD SURVEY RECEIVES ROUGH MECHANICAL COMPACTION TEST RECEIVED FINAL COMMERCIAL ROUGH PLUMBING PLUMBING PERMIT PICKED UP FINAL THIS PERMIT BECOMES NULL AND VOID IF CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 6 MONTHS FROM ISSUANCE, OR IF CONSTRUCTION IS SUSPENDED, OR ABANDONED FOR A PERIOD OF 6 MONTHS AT ANY TIME. THE CONTRACTOR HAS CERTIFIED BY SIGNATURE OF APPLICATION, THIS DOCUMENT AND PLANS AND SPECIFICATIONS ARE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. * NOTICE * IN ADDITION TO THE REQUIREMENTS OF THIS PERMIT, THERE MAY BE ADDITIONAL RESTRICTIONS APPLICABLE TO THIS PROPERTY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY, AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. ** WARNING TO OWNER ** YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTENDTO OBTAIN FINANCING, CONSULT YOUR LENDOR OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. THIS PERMIT IS APPROVED ON THIS DATE PURSUANT TO THE FLORIDA BUILDING CODE. WAYNE, ESELTINE, BUILDING OFFICIAL. INSPECTIONS SHALL BE REQUIRED FOR ALL PERMITS. CITY OF SEBASTIAN, FLORIDA 1225 Main Street Sebastian, FL 32958 Ph: 561-589-5537 Fax: 561-589-2566 E -Mail: city@cityofsebastian.org 02-001559 BUILDING PERMIT ` .._ ..g...._,Q-.,...-,...,a. ... ��:.. ., , t., «a „ t .. _ '11TH PERMIT -IN-5 ,RM: ,T1,0 1 ' , -, 7' t'S` i e e �z - �s P a _ '' LQCATI ON] IN R, MATI:0N: Permit #:02-001559 Issued: 6/06/200 Address: 1201 MAIN ST Permit Type: COMMERCIAL ALTERATION Sebastian, FL Class of Work: MISCELLANEOUS Township: 31 Range: 39 Proposed Use: COMMERCIAL Lots): Block: Section: 6 Sq. Feet: Est. Value: Book: Page: n Cost: 40,000.00 Total Fees: 417.00 Subdivision: SCHOOL PARK Amount Paid: 417.00 Date Paid: 5/31/2002 Parcel Number: 06313900005000200001.0 0 0126,NO - CQIVT'RA T'{U 1 FORMATIiO�V- "' § sb O,' N�R�INFO ATIU.N :�,. ` % Name: BTO CONSTRUCTION, INC. Name: CITY OF SEBASTIAN Addr: 1114 SOLANA AVE. Address: 1225 MAIN ST WINTER PARK FL 32789 SEBASTIAN, FL 32958-4165 Phone: (407)622-9333 Lic: CGC062892 Phone: Work Desc: ADD ANTENNA TO EXISTING TOWER; ADD CONCRETE PAD & EQUIP. CABINETS 'Y, .T.. ✓ u ... �. .nijeg. '.E :; w "f t{i3 L�'yi, 1 fix.`4df_ .p- G S Li i' J, Ytwl, sale F��r' LAPP-�ICATIO FEES BUILDING FEE 327.00 ELECTRIC 90.00 T' i�.Y. t i."'"'i: �..t '.,Pw-�.-. ��x ��� t.} tL.L E#i tl} !.T:• AS ,. '4 -F'. '- •.:l Y; �4'i�' � INSPEC�1'I�I�ISI`REQI�IR�D��:�;F.r e:��`�.��:��`�:���:�.� NOTICE OF COMM. RECEIVED ELECTRICAL PERMIT PICKED UP SLAB ROUGH ELECTRIC EARLY ELECTRIC FINAL COMMERCIAL THIS PERMIT BECOMES NULL AND VOID IF CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 6 MONTHS FROM ISSUANCE, OR IF CONSTRUCTION IS SUSPENDED, OR ABANDONED FOR A PERIOD OF 6 MONTHS AT ANY TIME. THE CONTRACTOR HAS CERTIFIED BY SIGNATURE OF APPLICATION, THIS DOCUMENT AND PLANS AND SPECIFICATIONS ARE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. * NOTICE * IN ADDITION TO THE REQUIREMENTS OF THIS PERMIT, THERE MAY BE ADDITIONAL RESTRICTIONS APPLICABLE TO THIS PROPERTY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY, AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. ** WARNING TO OWNER ** YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTENDTO OBTAIN FINANCING, CONSULT YOUR LENDOR OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. THIS PERMIT IS APPROVED ON THIS DATE PURSUANT TO THE FLORIDA BUILDING CODE. WAYNE, ESELTINE, BUILDING OFFICIAL. INSPECTIONS SHALL BE REQUIRED FOR ALL PERMITS. . • From the desk of A-kia. . Ve R. WHITE . m s= -••�.•-"-+J•- 't r.�. ll III... I III It. Iddd'd" I'.1 ill 1''11111 Il"I'll, II II 3475 Piedmont Road, NA, Suite 1'200 �j A �4 ~` Atlanta, GA 30305-1707 P p r; ` Z L A N MARSH c^j0 811b'00 .r• i PBMETER ; An MMC Company 7074788 �•g• PC75TAOE ; -••�.•-"-+J•- 't r.�. ll III... I III It. Iddd'd" I'.1 ill 1''11111 Il"I'll, II II ••ll.•.•• • : Y:I:.Vr......r::.V :.1':: •:.Y •: -: ' •: •:.•f.Y:: :.1 - .•J . •:.•:: r:: . ... .:: .•V.•...f.•.:.•Y.:r.Y :Yf: r.Y: ....................... :::...... . .vlv.�..: :.LYn1 rr .... ........................ . . }r.. ... ... ...... r ... ....... .. J. .. ............t r r. 1. .. rl.:.t :...:........ •: w .............. :. r.......:............: Y:: • Y: Y...; 1.t.......::.t v.•'F.}i}J:S1 '�}:{}•,:tr'•}:•}:•:•}}': i++V.{:•:Y:: w••v:?•}•: 1. •• r•.Y'({ : S r:v.. ' •11..........r.f.rL •: >}:•::?•}}}:•?•'' • L•(•� .1.1•. f•LV .Stiff : 1 J Y}•YhV . J. {f. �L• •: F•! J• •1 • • • •: r.V .• •:L .:}.L :L .1:•.:�fJ•.•..}. .F......L..A •..... f... 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L.L... l.t,.:L. — }::r}:{{:v:;•,.rL'{?.} .r jv'.•: .•. . ... .t rN•.YJ�:r.'A•Fr•Yh•••f:::.Y:.L•::.Y::S•::f.Yht{L.........VJ•••h.1.•11...1...h11{•::::::.YX:::I.Y::•,{.JV•}.Yfh.{-.Yl:::...•.•...:rvfv.•.1.::}.Y.Y:::.::..........}.{•...�}.�e?\.{:.:LthY:.Y?•}:{??:{•:•:•:•}:•:•r.•{•::•:r.•:•::?:•::.•:.:Y:::::.Y.Y: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS CER Marsh USA Inc. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN 3475 Piedmont Road N.E. THE POLICY, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE Atlanta, GA 30305 .. ,� ;; ;; � s r � ; � :.. N C t. � � r' i :� COVERAGE AFFORDED BY THE POLICIES DESCRIBED HEREIN. COMPANIES AFFORDING COVERAGE , COMPANY A HARTFORD FIRE INSURANCE CO ANGELA D. WILLIAMS 09W 9RW bbl 9 Ail 9 O 1 INSURED COMPANY BELLSOUTH CORPORATION INCL. B HARTFORD CASUALTY INS CO BELLSOUTH MOBILITY INC COMPANY ROOM15A01 1155 PEACHTREE STREET, NE 1155 C TWIN CITY FIRE INSURANCE CO COMPANY ATLANTA. 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L'• . .1.fi}:{{•:•:•:•:•:•:•}:-:{:•.•:.•.LY:.•.•}:•:•::•:•}:{1:Y.•.•:hY}k•3:•}f.•h.h'R•F�1.::..:lv:"'i+:til}h•{{: .. THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED.-, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY' BE. ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE IMM/DD/YY) DATE (MM/DD/YY)LIMITS LIMITS A GENERAL LIABILITY 20 CSE J42031 10115199 12101100 GENERAL AGGREGATE o 3.000.000 X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG 1,000.000 MCLAIMS MADE aOCCUR PERSONAL & ADV INJURY $ 1.000.000 OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE S 1. DDD, DDD FIRE DAMAGE (Any one fire) • 1,000.000 MED EXP IAny one person) S 10,000 A AUTOMOBILE LIABILITY 20CSEJ42032 - AOS 10115199 12101100 COMBINED SINGLE LIMIT X ANY AUTO 2.000.000 ALL OWNED AUTOS BODILY INJURY 3 SCHEDULED AUTOS {Per person) HIRED AUTOS BODILY INJURY S NON -OWNED AUTOS leer accident) PROPERTY DAMAGE 0 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ;f ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT 3 AGGREGATE 4 EXCESS LIABILITY EACH OCCURRENCE 0 UMBRELLA FORM AGGREGATE 0 OTHER THAN UMBRELLA FORM S B _ WORKER'S COMPENSATION AND 2014NJ42030 - DED. (AOS) 10115199 12/01 /00 WC STATU- OTH- :J.{: �:;:;:;::•}}:{{:::;:{;::: :;:•::;:; X TORY LIMITS ER > = :>: 5:` > ii cc `• ' r sic C EMPL°iiEEf;s' LIABtuTr — 20 WSRP37910-RETRO(MA. WI) _ 10/15/99 12101100 EL EACH ACCIDENT s 1,000,000 THE PROPRIETOR/ INCL EL DISEASE - POLICY LIMIT 1'000'000. PARTNERS/EXECUTIVE EEXCL EL DISEASE - EA EMPLOYEE 1,000,000 OFFICERS ARE: OTHER B EXCESS WORKER'S 83XWEQX0538 1/01/00 1/01/01 WC STATUTORY COMP. EL $1M EA ACC/EA EMPLOYEE -DISEASE EL $1M - AGGREGATE - ALL LOSSES DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / SPECIAL ITEMS RE: SITE NAME - VER06 SITE ADDRESS - 1201 MAIN STREET, SEBASTIAN, FL (See reverse and/or attached for additional information.) :.....................:.......:.:.:...... J ............................:..:.:::::::.}::.:.:::.:. Y .. Y:....:'::.::::::..::::. Y. Y::..:...:..... . ::::ti :•}::: r . ....... .. .. . . . ..........:. ::.Y.Y:::.Y:.Y:.Y:::.Y:.Y.Y.Y:r.Y.Y.Y:::.Y.YJ.Yr....................Y..Y..Y.:...Y::...... ......::......... ........................:..............:....::::.:Y:::::...�::.:::::::..Y:::.Y::.:.Y:.:.Y:.Y.Y.Y::..::•:.......r........... SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR SEBASTIAN POLICE STATION TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED ATTN: JOHN VAN ANTWERP HEREIN, 1201 MAIN STREET BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR SEBASTIAN, FL 32958 LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES. BY: Marsh USA Inc. !�'V • x. ::IFtKIt <:11X. 6 Certificate Holder SEBASTIAN POLICE STATION ATTN: JOHN VAN ANTWERP 1201 MAIN STREET SEBASTIAN. FL 32958 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES Cont'd. CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT. Marsh USA, Inc. 3475 Piedmont Road NE, Suite 1200 Atlanta, GA 30305 PLEASE REVIEW THE ENCLOSED CERTIFICATE AND ADVISE IF ANY CHANGES ARE NECESSARY OR IF CERTIFICATE IS REQUIRED. CONTACT: BRENDA BOOKER PH: 404/995-2594 FAX: 404/760-5638 MARSH USA INC. CERTIFICATE OF INSURANCE CERTIFICATE NUMBER ATL -000190589-00 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS Marsh USA Inc. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE 3475 Piedmont Road N.E. POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE Atlanta, GA 30305 AFFORDED BY THE POLICIES DESCRIBED HEREIN. Attn: ANGELA D. WILLIAMS 404-995-2762 COMPANIES AFFORDING COVERAGE COMPANY 01548—CAS- BMI A N/A INSURED COMPANY BELLSOUTH CORPORATION INCL. B HARTFORD CASUALTY INS CO BELLSOUTH MOBILITY INC COMPANY ROOM 15AO1 1155 PEACHTREE STREET, NE C TWIN CITY FIRE INSURANCE CO ATLANTA, GA 30309-3610 COMPANY D COVERAGES This certificate supersedes and replaces any previously issued certificate. 0 THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE O F INSURAN CE POLICYNUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE!MMIODNY) DATR(MM!DDNY) GENERAL LIABILITY GENERALAGGREGATE $ PRODUCTS -COMP/OPAGG COMMERCIAL GENERAL LIABILITY lE � $ OCCUR PERSONALS ADV INJURY EACH OCCURRENCE $ PROT FIRE DAMAGE (My we file) $ W0W�ELRZ&b=0NRACTOR'S MED EXP one n $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY $ ALLOWNEDAUTOS SCHEDULEDAUTOS (Per person) BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY -FA ACCIDENT $ OTHER THAN AUTO ONLY: ANY AUTO EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ UMBRELLA FORM $ OTHER THAN UMORFLLA FORM B WORKERS COMPENSATIOk AND - DED.(AOS) __ 12/01/00 12/6 1/01 X TORY LIMITS ER EMPLOY20WNJ42030 EMPLOYERS' LIABILITY EL EACH ACCIDENT Is 1,000,000 C 20WBRP37910 - RETRO (MA, WI) 12/01/00 12/01/01 EL DISEASE -POLICY LIMIT $ 1,000,000 THE PROPRIETOR/ INCL PARTNERSIEXECUT VE EL DISEASE -EACH EMPLOYEE $ 1,000,000 OFFICERS ARE: EXCL 8 OTHER 83XWEQX0538 01/01/00 01/01/01 WC STATUTORY EXCESS WORKER'S EL $1MM EA ACCIEA EMPLOYEE -DISEASE COMP. EL$1MM- AGGREGATE -ALL LOSSES DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESISPECIAL ITEMS (UNITS MAY BE SUBJECTTO DEDUCTIBLES OR RETENTIONS) RE: SITE NAME-VERO6 SITE ADDRESS - 1201 MAIN STREET, SEBASTIAN, FL CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED AS REQUIRED BY WRITTEN CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL I DAYS MITTEN NOTICE TO THE SEBASTIAN POLICE STATION CERTIFICATE HOLDER NAMED HEREIN. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR ATTN: JOHN VAN ANTWERP 1201 MAIN STREET iS L)d TI �3 OFANY FUNDUPONTHE INSURERAFFORDINO COVERAGE, RSAGENTSOR REPRESENTATIVES. SEBASTIAN, FL 32958 MARS ILUSA INC. •, I., t'. 7�!i7NI4 I"BY. q� � Walter Gilstrap h1rpt _4_d P MM1(9/99) VALID AS OF: 12/03/00 ADDITIONAL INFORMATION DATE IMM/DOP/Y) ATL -000190589-00 12/03/00 PRODUCER COMPANIES AFFORDING COVERAGE Marsh USA Inc. 3475 Piedmont Road N.E. COMPANY Atlanta, GA 30305 E Attn: ANGELA D. WILLIAMS 404-995-2762 COMPANY F 001548 --CAS- BMI INSURED COMPANY BELLSOUTH CORPORATION INCL. BELLSOUTH MOBILITY INC G ROOM 15AO1 1155 PEACHTREE STREET, NE ATLANTA, GA 30309-3610 COMPANY H IMAI CONTRACT. SEBASTIAN POLICE STATION ATTN: JOHN VAN ANTWERP 1201 MAIN STREET SEBASTIAN, FL 32958 INCLUDES COPYRIGHTED MATERIAL OF ACORD CORPORATION WITH ITS PERMISSION. ACORO �,,.. CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDO/YYYY) 06/232014 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 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 endomement(s). PRODUCER Aon Risk Services Northeast, Inc. Morristown N7 Office CONTACT NAME: (AIC. No. Ext): (866) 283-7122 � No.): (800) 363-0105 E-MAIL ADDRESS: 44 Whippany Road, Suite 220 Morristown NJ 07960 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: National union Fire Ins Co of Pittsburgh 19445 Cellco Partnership dba Verizon wireless 180 inWashington valley Road Bedminster N7 07921 LISA INSURER 8: New Hampshire Ins Co 23841 INSURER C: Illinois National Insurance Co 23817 INSURER D: PRODUCTS - COMP/OP AGG S2,000,000 INSURER E: A A A INSURER F: COVERAGES CERTIFICATE NUMBER: 570054248702 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limas shown are as requested INSR LTR TYPE OF INSURANCE ADD INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMID LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE X� OCCUR GL EACH OCCURRENCE S2,000,000 PREMISES Ea occurrence) S2,000,000 MED EXP (Any one person) S10,000 PERSONAL 8 ADV INJURY S2,000,000 GEWL AGGREGATE LIMIT APPLIESPER: X POLICY JELOC OTHER: GENERAL AGGREGATE S2,000,000 PRODUCTS - COMP/OP AGG S2,000,000 A A A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOSAUTOS HIRED AUTOS ED AUTOS AUTOS CA 350-06-58 AOS CA 350-06-59 MA CA 350-06-60 VA 06/30/2014 06/30/2014 06/30/2014 06/30/2015 06/30/2015 06/30/2015 COMBINED SINGLE LIMIT S2,000,000 Ea accident BODILY INJURY ( Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident UMBRELLA UABOCCUR EXCESS LIAR CLAIMS -MADE EACH OCCURRENCE AGGREGATE DED RETENTION B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/ PARTNER /EXECUTIVE OFFICERWE BER EXCLUDED? (Mandatory In NH) If yes, describe under -DESCRIPTION OF OPERATIONS below.E NIA WCO26035004 '-r6/30/2014 wort( Comp - Aos WCO26035006 IL KY NC NH VT 06/30/2014 06/30/2015 06/30/2015 X s PER OTH- E.L. EACH ACCIDENT $4,000,000 E.L. DISEASE -EA EMPLOYEE S4,000,000 L-.L`ISEASE _�� ICY L4MIT $ 4.000.-000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Named Insured includes: Verizon wireless Personal Communications LP dba Verizon wireless. RE: Lease Agreement Site ID#19/Sebastian Policy Tower. City of Sebastian is included as Additional Insured with respect to the General Liability and Automobile Liability policies where required by written contract. CERTIFICATE HOLDER CANCELLATION i J SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Sebastian AUTHORIZED REPRESENTATIVE Attn: Thomas W. Frame, City Manager 1225 Main street p �Q ,(%' �i Sebastian FL 39258 USA c an 1-4 c%t sc c0 c //a G c.o 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000035381 LOC #: AC IGtO O® �--- ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk services Northeast, Inc. NAMED INSURED Cellco Partnership dba verizon wireless POLICY NUMBER see Certificate Number: 570054248702 CARRIER see Certificate Number: 570054248702 NAIC CODE 1EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, I FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER SUBR WVD INSURER POLICY EFFECTIVE DATE MM/DD/YYYY INSURER LIMITS INSURER - - WORKERS COMPENSATION ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YYYY POLICY EXPIRATION DATE MM/DD/YYYY LIMITS WORKERS COMPENSATION B N/A wc026035007 AK AZ GA VA 06/30/2014 06/30/2015 B N/A wc026035008 NJ PA 06/30/2014 06/30/2015 C N/A wc026035009 FL 06/30/2014 06/30/2015 B N/A wc026035011 MN 06 30 2014 06/30/2015 B N/A wc026035012 MA,ND,OH,WA,WI,WY 06/30/2014 06/30/2015 -A N/A wc026035005 CA 06/30/2014 06/30/2015 B N/A wc026035010 ME 06/30/2014 06/30/2015 ACORD 101 (2008101) ® 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 0 A��® CERTIFICATE OF LIABILITY INSURANCE DATE(MMUYYYY) 0672012012013 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 Aon Risk Services Northeast, Inc. Morristown N7 Office 44 Whippany Road, suite 220 Morristown N7 07960 USA CONTACT PH ON (PJCNN Et): (866) 283-7122 AICNo.): (800) 363-0105 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Cel l co Partnership dba Verizon wireless one verizon way Basking Ridge NJ 07920 USA INSURER A: National Union Fire Ins Co of Pittsburgh 19445 INSURER B: New Hampshire Ins Co 23841 INSURER C: Illinois National Insurance Co 23817 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570050314824 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested INSR LTR TYPE OF INSURANCE ADD5uBR lNSR1 WVD I POLICY NUMBER POLICY EFF DrfYYYi (mvmDrYYynI LIMITS A GENERAL LIABILITY_91699 767767M 06/30/2014 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $2,000,000 CLAIMS -MADE a OCCUR MED EXP (Any one person) $10,000 PERSONAL 8 ADV INJURY S2,000,000 GENERAL AGGREGATE $2,000,000 GEITL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 X POLICY PRO- LOC A AUTOMOBILE LIABILITY 519645 06/30/2013 06 0 014 COMBINED SINGLE LIMIT $2,000,000 ADS BODILY INJURY ( Per person) A X ANY AUTO 5196458 06/30/2013 06/30/2014 BODILY INJURY (Per accident) ALL OWNED SCHEDULED MA A AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS 5196457 VA 06/30/2013 06/30/2014 PROPERTY DAMAGE Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAB CLAIMS -MADE DED RETENTION B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR l PARTNER / EXECUTIVE YIN N OFFICERIMEMBEREXCLUDED7 (Mandatory In NH) a N/A 049901115 AOS 049901117 IL KY NC NH VT 06/30/2013 06/30/2013 06/30/2014 06/30/2014 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $500,000 E.L. DISEASE -EA EMPLOYEE $500,000 It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT S500,000 -c DESCRIPTION OF OPERATIONS 1 LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Romarks Schodulo, If morn spaco is roqulrod) Named Insured includes: Verizon wireless Personal communications LP dba Verizon wireless. RE: Lease Agreement Site ID#19/Sebastian Policy Tower. City of Sebastian is included as Additional insured with respect to the General Liability and Automobile Liability policies where required by written contract. If certificate is no longer required, please fax to ACS at 1-800-363-0105 to have removed from our list. CERTIFICATE HOLDER CANCELLATION city of Sebastian Attn: Thomas W. Frame, City Manager 1225 Main Street Sebastian FL 39258 USA 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 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD v N LO Co LOh 0 Z A m V AGENCY CUSTOMER ID: 570000035381 LOC #: A p ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY'...... _ ... Aon Risk services Northeast, Inc. NAMEDINSURED Cellco Partnership dba verizon wireless POLICY NUMBER see Certificate Number: 570050314824 CARRIER see Certificate Number: 570050314824 NAIC CODE [EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER SUBRWVD VW INSURER POLICY EFFECTIVE DATE M/DD INSURER LIMITS INSURER - ----- - — — - - -- - - - -- ._ - - ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPE OF INSURANCE ADDLINSR NSR SUBRWVD VW POLICY NUMBER POLICY EFFECTIVE DATE M/DD POLICY EXPIRATION DATE M/DD LIMITS WORKERS COMPENSATION B N/A 049901118 AK AZ GA VA 06/30/2013 06/30/2014 B N/A 049901119 NJ PA 06/30/2013 06/30/2014 C N/A 049901120 FL 06/30/2013 06/30/2014 B N/A 049901121 MN 06/30 2013 06/30/2014 B N/A 049901122 MA,ND,OH,WA,WI,WY 06/30/2013 06/30/2014 If certificate is no longei fax required, pl from ow list. ACORD 101 (2008101) m 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Debbie Krueger From: Tracy Hass Sent: Thursday, March 17, 2005 6:48 PM To: Debbie Krueger Subject: Crown Castle Tower Deb, I spoke with Rich concerning the additional Bellsouth antennae to be placed on the Crown Castle Communications tower located behind City Hall, and he advised that placement of additional antennae is acceptable under their current lease agreement. However, he also advised that I provide you with a copy of the permit application so you can arrange for payment in accordance with lease provisions. I suggest that we not issue the permit until such time as we receive the outstanding payments already accrued. The application is in my office should we receive payment, at which time it may be forwarded to the building department for release. Thank you, Trace Tracy E. Hass, AICP Growth Management Director City of Sebastian, Florida (772) 589-5518 2-3-0& INA 2- 7. Ole - V612170d1 WOW t, -��, t t - � •� Karen Power Tower, LLC. 6180 S. Babcock St. #14 Palm Bay, FL 32909 Office (321) 7224444 Fax (321) 7224476 powertower(),nebutel.com www.karenaowertower.com QUOTE 10/09/05 City Of Sebastian Attn: Jesus Vieiro 1201 Main St Sebastian, FL 32958 Phone (772) 589-0743 E-mail: ivieiro(),cityofsebastian.ora Tower Location: 120' Freestanding Tower Behind the Sebastian Police Department Building This quote is for purchase and installation of a personal climbing ladder on the tower at the location listed above. This estimate is based on a time and materials basis. It is our understanding that we will provide all the materials required for the installation of the ladder. Per Mr. Jesus Vieiro's request we are submitting this quote for the ladder installation to two different heights on the tower. The first height would be to the 80' level where the majority of the antennas are mounted at this time. The second height would 120' to the top of the tower. This quote is for all the materials and labor required for the installation of the ladder. Any work requested outside the scope of the work as it is described herein would be billable at an additional $ 50.00 per man-hour plus expenses. Our quoted price for the installation of the ladder to the 80' level of the tower is $ 3500.00 Our quoted price for the installation of the ladder to the 120' level of the tower is $ 4750.00 Terms: 50% prior to scheduling the work and the balance due net 10 from completion. Payment: We except Visa, MasterCard and Checks. Please make checks payable to Karen Power Tower, Inc. This price will be good for 90 days from the date of this estimate. We may require an 8 to10 week lead-time to get materials delivered and for scheduling. Please feel free to call me with any questions that you may have. Cordially Wm. Eric Power fir LESSOR ATTEST: r/ Kath M. O'Halloran, CMC/AAE City Clerk THE CITY OF SEBASTIAN: Approved as to Form and Legality for Reliance by the City of Sebastian only: Rich Stringer, C ty_Attorney STATE OF ' FLORIDA COUNTY OF. The•o egoing- instrument was acknowledged before me this %�� day of 2.0 0 0 , -by Terrance * R . Moore and Kathryn M. O'Ha. oran,' as- City Manager and City Clerk, respectively, of - the City of Sebastian, a Florida municipal corporation, o are personally known to me or w as i entification and who - did ( 'd no ) ake an oath. 10 VOTARY PUBLIC Seal) Print Name: ,� ��ss�"�9� My Commission Expires ,,•"• .. ANN V. ROUSSEAU - *� :* MY COMMISSION # CC 725840 EXPIRES: March 18,20M bonded Thru Notary P.ubffc Urnderwdte, NOTE THIS DRAWING IS INTENDED TO DEPICT THE GENERAL LOCATION AND HEIGHT OF THE PROPOSED ANTENNAS ON THE EXISTING TOWER. IN ACCORDANCE WITH THE STRUCTURAL ANALYSIS REPORT PERFORMED BY GPD GROUP, INC. DATED 10/22/12, THE TOWER AND FOUNDATION SYSTEM ARE ADEQUATE TO SUPPORT THE PROPOSED AND EXISTING EQUIPMENT. CONSTRUCTION SHALL NOT PROCEED UNTIL A ANTENNA MOUNT ANALYSIS REPORT HAS BEEN COMPLETED BY A PROFESSIONAL ENGINEER REGISTERED IN THIS STATE, CONCLUDING THAT THE EXISTING ANTENNA MOUNTS ARE STRUCTURALLY ADEQUATE TO RESIST THE EXISTING AND PROPOSED LOADS. /L TOP OF TOWER D TOWER MOUNTED EQUIPMENT SCHEDULE (3) RFS APXVERRI8-C-X-19101 (72" x 11.8" x 7") (6) ERICSSON RRUS-11 190OMHZ (17" x 17,8" x 9.2") (3) ERICSSON RRUS-11 80OMHz (17" x 17.8" x 9.2") (3) ERICSSON RRU A2 MODULE (12.8" x 15.0" x 3.4") (1) H+S TSZ 999 067/xxxM (170'± IN LENGTH) (1) H+S TSZ 999 067/xxxM (170'± IN LENGTH) (1) H+S TSZ 999 067/xxxM (170'± IN LENGTH) (3) ERICSSON (800 ESMR) (9) RFS (ACU -A20 -N) REV I DATE I DESCRIPTION A 10 26 12 PRELIMINARY 0 2 7 13 FOR PERMIT PROJECT NO.: 110-509.15 DRAWN BY: CHECKED BY: H. CAMACHO M. ABBEY THIS DRAWING IS COPYRIGHTED AND IS THE SOLE PROPERTY OF THE OWNER. R IS PRODUCED SOLELY FOR USE BY THE OWNER AND ITS AFFIDATES. REPRODUCTION OR USE OF THIS DRAWING ANO/OR THE INFORMATION CONGINED IN IT IS FORBIDDEN WITHOUT THE WRITTEN PERMISSION OF THE OWNER. Telecom 3400 1AKESIDE DRIVE SURE 525 MIRAMAR, FL 33027 CERTIFICATE OF AUTHORIZATION 29214 Sprint' 0 ✓,, No.6 31 � •'.N' :Au • TATE F •. �At AN iP•'�♦ '•�ORi•O DATE OF �IEr; 2/7/13 FL3591 SEBASTIAN RIVER M 173XCO62-A 1201 MAIN STREET SEBASTIAN, FL 32958 ELEVATION ELEVATION 0 5' 10' 2D' SCALE 1" — In'—n" (srw,a") . r% r) i