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HomeMy WebLinkAboutPermit M11-072 - COMP VIEWCOMPVIEW 652 INDUSTRY DR Mi 1 -072 City okukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -431 -3670 Inspection Request Line: 206 -431 -2451 Web site: http: / /www.TukwilaWA.gov MECHANICAL PERMIT Parcel No.: Address: 0223400020 652 INDUSTRY DR TUKW Project Name: COMP VIEW Permit Number: M11 -072 01r /llt Permit Expires On: (Z (11 1i Issue Date: Owner: Name: SBP GENERAL PARTNERSHIP Address: 617 INDUSTRY DR , TUKWILA WA 98188 Contact Person: Name: Address: Email: BUD WARE 109 WASHINGTON BL, SUITE B , ALGONA WA 98001 BUDW @FIVESTARMECH. COM Contractor: Name: FIVE STAR MECHANICAL Address: 3902 W VALLEY HY STE 200 , AUBURN WA 98001 Contractor License No: FIVESM *010JT Phone: 206 786 -8276 Phone: 253- 833 -8284 Expiration Date: 04/30/2012 DESCRIPTION OF WORK: TENANT IMPROVEMENT TO INCLUDE RELOCATING SUPPLY AIR GRILLS, ADD JUMPER GRILLS, AND REPLACE (2) EXISTING UNIT HEATERS 50K BTU WITH SAME SIZE. ALSO ADD (1) EXHAUST FAN FOR SERVER ROOM AND (1) EXHAUST FAN FOR NEW BATHROOM. Value of Mechanical: $13,500.00 Type of Fire Protection: UNKNOWN Electrical Service Provided by: Permit Center Authorized Signature: I hereby certify that I have read an governing this work will be compli Fees Collected: $355.06 International Mechanical Code Edition: 2009 Date: t/te l Li l L` ed this permit and know the same to be true and correct. All provisions of law and ordinances whether specified herein or not. The granting of this permit does not p construction or the performance of work. back of this permit. e to give authority to violate or cancel the provisions of any other state or local laws regulating I am authorized to sign and obtain this mechanical permit and agree to the conditions on the Signature: Print Name: (,- ,e✓rZ %Q z, Goa Date: 7'1/ // This permit shall become null and void if the work is not commenced within 180 days from the date of issuance, or if the work is suspended or abandoned for a period of 180 days from the last inspection. doc: IMC -4/10 M11-072 Printed: 06 -17 -2011 • PERMIT CONDITIONS Permit No. M11 -072 1: ** *BUILDING DEPARTMENT CONDITIONS * ** 2: No changes shall be made to the approved plans unless approved by the design professional in responsible charge and the Building Official. 3: All permits, inspection records, and approved plans shall be at the job site and available to the inspectors prior to start of any construction. These documents shall be maintained and made available until final inspection approval is granted. 4: All construction shall be done in conformance with the approved plans and the requirements of the International Building Code or International Residential Code, International Mechanical Code, Washington State Energy Code. 5: Ventilation is required for all new rooms and spaces of new or existing buildings and shall be in conformance with the International Building Code and the Washington State Ventilation and Indoor Air Quality Code. 6: All plumbing and gas piping work shall be inspected and approved under a separate permit issued by the City of Tukwila Building Department (206- 431- 3670). 7: All electrical work shall be inspected and approved under a separate permit issued by the City of Tukwila Building Department (206- 431- 3670). 8: VALIDITY OF PERMIT: The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of the building code or of any other ordinances of the City of Tukwila. Permits presuming to give authority to violate or cancel the provisions of the code or other ordinances of the City of Tukwila shall not be valid. The issuance of a permit based on construction documents and other data shall not prevent the Building Official from requiring the correction of errors in the construction documents and other data. doc: IMC -4/10 M11-072 Printed: 06 -17 -2011 CITY OF TUKWILA Community Development Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http://www.ci.tukwila.wa.us Mechanical Permit No. Project No. (For office use only) MECHANICAL PERMIT APPLICATION Applications and plans must be complete in order to be accepted for plan review. Applications will not be accepted through the mail or by fax. * *please print ** SITE LOCATION Site Address: 652 industry drive tukwila Tenant Name: Comp View Property Owners Name: Reit Management & Research Mailing Address: 617 industry drive King Co Assessor's Tax No.: Suite Number: Floor: New Tenant: ❑ Yes ❑ .. No tukwila wa 98188 City State Zip CONTACT PERSON — who do we contact when your permit is ready to be issued Name: Bud Ware Mailing Address: 109 Washington Boulevard Suite B E -Mail Address: budw @fivestarmech.com Day Telephone: (206) 786 -8276 Algona WA 98001 City State Fax Number: (253) 852 -8285 Zip .MECHANICAL CONTRACTOR INFORMATION Company Name: Five Star Mechanical Mailing Address: 109 Washington Boulevard Suite B Contact Person: Bud Ware E -Mail Address: budw @fivestarmech.com Contractor Registration Number: FIVESM`010JT WA 98001 City State Day Telephone: (206) 786 -8276 Fax Number: (253) 852 -8285 Expiration Date: 04/30/2012 Zip ARCHITECT OF RECORD — All plans must be stamped by architect of record Company Name: Mailing Address: Contact Person: E -Mail Address: City Day Telephone: Fax Number: State Zip ENGINEER OF RECORD — All plans must be stamped by engineer of record Company Name: Mailing Address: Contact Person: E -Mail Address: H: Applicahons\Fonns- Applications On Line\2010 Applications \7 -2010 - Mechanical Permit Applicatioudoc Revised: 7 -2010 bit City Day Telephone: Fax Number: State Zip Page 1 of 2 • Valuation of project (contractor's bid price): $ 13500 Scope of work (please provide detailed information): Tenant improvement relocate supply air grills, add jumper grills, replace 2 existing unit heaters 50k BTU with same size. Add 1 exhaust fan for server room and Add 1 exhaust fan for new bathroom. Use: Residential: New ❑ Replacement ❑ Commercial: New ❑ Replacement m Fuel Type: Electric ❑ Gas Other: Indicate type of mechanical work being installed and the quantity below: Unit Type: Qty Unit Type: Qty Unit Type: Qty Bioler /Compressor Qty furnace <100k btu air handling unit >10,000 cfm fire damper 0 -3 hp /100,000 btu furnace >100k btu evaporator cooler diffuser 3 -15 hp /500,000 btu floor furnace ventilation fan connected to single duct thermostat 15 -30 hp /1,000,000 btu suspended/wall/floor mounted heater 2 ventilation system wood/gas stove 30 -50 hp /1,750,000 btu appliance vent hood and duct emergency generator 50+ hp /1,750,000 btu repair or addition to heat/refrig /cooling system Incinerator — domestic other mechanical equipment air handling unit <10,000 cfm incinerator — comm/ind PERMIT APPLICATION NOTES - Value of construction — in all cases, a value of construction amount should be entered by the applicant. This figure will be reviewed and is subject to possible revision by the permit center to comply with current fee schedules. Expiration of plan review — applications for which no permit is issued within 180 days following the date of application shall expire by limitation. The building official may grant one extension of time for additional periods not to exceed 90 days each. The extension shall be requested in writing and justifiable cause demonstrated. Section 105.3.2 international building code (current edition). I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER PENALTY OF PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT. BUILDING 0 R OR A HORj D ENT: Signature: i ��ff /rJ'�� Date: 06/06/2012 Print Name: Gerald L. Ware Jr Day Telephone: (206) 786 -8276 Mailing Address: 109 Washington Boulevard Suite B Algona WA 98001 Date Application Accepted: n I ��I I City Date Application Expires: FIAApplicanoos\Fonns- Applications On Line \20I0 Applications \7.2010 - Mechanical Permit Application.doc Revised: 7 -2010 bh 12In311 State Zip Staff Initials: Page 2 of 2 • J��1�A wq� City of Tukwila C 1908 • Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Fax: 206 - 431 -3665 Web site: http: / /www.TukwilaWA.gov Parcel No.: 0223400020 Address: 652 INDUSTRY DR TUKW Suite No: Applicant: COMP VIEW RECEIPT Permit Number: M11 -072 Status: APPROVED Applied Date: 06/03/2011 Issue Date: Receipt No.: R11 -01244 Payment Amount: $284.05 Initials: JEM Payment Date: 06/17/2011 01:16 PM User ID: 1165 Balance: $0.00 Payee: GERALD L WARE JR TRANSACTION LIST: Type Method Descriptio Amount Payment Credit Crd VISA Authorization No. 01556C ACCOUNT ITEM LIST: Description 284.05 Account Code Current Pmts MECHANICAL - NONRES 000.322.102.00.00 284.05 Total: $284.05 doc: Receipt -06 Printed: 06 -17 -2011 • City of Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Fax: 206 - 431 -3665 Web site: htt•: / /www.TukwilaWA.gov Parcel No.: Address: 652 INDUSTRY DR TUKW Suite No: Applicant: COMP VIEW RECEIPT Permit Number: M11 -072 Status: PENDING Applied Date: 06/03/2011 Issue Date: Receipt No.: R11 -01121 Payment Amount: $71.01 Initials: JEM Payment Date: 06/03/2011 01:04 PM User ID: 1165 Balance: $284.05 Payee: GERALD WARE TRANSACTION LIST: Type Method Descriptio Amount Payment Credit Crd VISA Authorization No. 513030 ACCOUNT ITEM LIST: Description 71.01 Account Code Current Pmts PLAN CHECK - NONRES 000.345.830 71.01 Total: $71.01 doc: Receiot -06 Printed: 06 -03 -2011 .."""" INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 - (206) 431 -367 Permit Inspection Request Line (206) 431 -2451 WII -072 Project: C A P \/ t EuL) Type of Inspection: c-I 1.1+4 L Address: (052 _r_tA w6-- eci be Date Called: Special Instructions: Date Wanted: et- m Requester: Requester: Phone No: Approved per applicable codes. Corrections required prior to approval. COMMENTS: A eiP- %i Nii CAA,)c, Date: ❑ SPECTION FEE UIRED. Prior to next inspection. fee must be pat at 6300 Southcenter. B10.. Suite 100. Call to schedule reinspection. \ v. 4 $ • INSPECTION RECORD . Retain a copy with permit rn11-072- ro PERMIT NO. INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION .• 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670 - Permit Inspection Request Line (206) 431-2451 Project: CiervAP \I If c-L) Type of Inspection: ‘ Ce3N14,1-k- % IQ Address: Gs2 _14.1Duclizq it Date Called: Special Instructions: 0-512e 8 -0 I Date Wanted: -1--- lq—tt a.m• ev-.7■12: Requester: Phone No: acc..-706 8z7 (0, ',proved per applicable codes. El Corrections required prior to approval. 8.. COMMENTS: • nspect ../ (Date: EIN PECTION FEE REQUIRED. nor t9,fext inspection fee must be- pal at 6300 Southcenter Blvd., Sul 10 . Call to schedule reinspection. . • INSPECTION NO. INSPECTION RECORD M 11 -Y7?. 4.0 Retain a copy with permit PERMIT NO. CITY OF TUKWILA BUILDING DIVISION • 6300 Southcenter Blvd., #100, Tukwila. WA 98188 6r- (206) 431 -3670 Permit Inspection Request Line (206) 431 -2451 P jeyl r Type of Inspection: Address:,, (4 5 Z .a- Am uivy Date Called: Special Instructions: D S as- q 5- 01 - Date Wanted: (_22-1/ , . Requester: Phone No: ' Approved per applicable codes. ® Corrections required prior to approval. ci COMMENTS: spect Dat : PECTION FEE REQUI D. Prior to next inspection, fee must be pal' =t 6300 Southcenter Blvd. Suite 100. Call to schedule reinspection. O CONSTRUCTION PLAN o 11 1C 24 • 0 4• Yt Imo% A.� II 4> ©ENLARGED RESTROOM PLAN 0 e' to u 1/1. , 1'_ o. cam. eft`(` /;0 c.0 1 1101211 0640 © STOREFRONT ELEVATION a 111' a 1'- 0' AOIMOI 1W 001011{1171 11112454 COWAN To N0a04E3 00100 Ma 40115 41. DORN NOES 1114 mow NoRGOom 00x130160. 000 06710 11.0 AMC 11416a Naas )ggpO11W /MmrN • 0210 Ale. • WIN MONO 014006 00 NM OR= OM10 • Rau NI IND 4111.4 • 410120•3 NM INN Mc ISM11411.ALIMIG s14I0l0 SILL 00 O STOREFRONT SECTION a e 1C 10 1' a 1'- a' SYMBOL LEGEND COW 00.2012111• IO 1911® NOM WW1 06N0001P OM a/ul. 0 40.2001 MID 00e1 W 4504011145201/1•1 d.."_14044. MO MT UM 11013 u�ao:.as� O 10 0101120000000 GENERAL CONSTRUCTION NOTES I. 20 121087 40112001100611006 4 OM COMMD ROD IW1u 000650670/ To OC•0•105 51.10. l • OR Cm0 balm •0 ROM MOM NUM/ t • NO COI/0119114��I=i4 MUM DM WO ®II ie FHB 014510 a MCI 00 NX 00004200000010.•000.11003 000 • 1'r10a6 NO D a 1444 MOM IL. IN CCM ROOM LC1n 70ON•41. U N NM Kt 10•144 1. 006 • CND NOM NOOK 010®03 OM M TN t man f fO AWN •1N P NON CWfa =CM KEYED SHEET NOTES O 10•Pw MU 000. F. WA 012:224 NO 01P =RIMS EN POW 11-77764 Y1- 1611400 11•5111411045 NUB NI 40 001011.0[ COD Om100MF04P1mF. 00000 PO Oen 8 Im ON act O 1000 A00 Mon • IOW 0 F® No41 ILL 100®6 • 02 Q 1001200110 010 7440 011 NONC 10,4141. © W� 0.0 007x11WT WM 50030.4 O In 11/4,2 N 21O 0001 O MI RA110 WNW 1ROt • • are 0i 01o61PCa 101110 $ uul. p IMO ROOM 50 be H0 3r M 504101 ® 201 MOW =AM A MO F IMMO 3NIIR ® au7000012 01®00 ® 10LONIAlla TO 1613/I % WON 100210010 WOO WAX ® Ia NAM wit Meat 201 0.44150••• 12 0042 204100101.7 40 1040 0 0 11120 NAL 60121071/6 ® 1204011200 10001. Dlf Mali • 0101016 PLUMBING CALCS OM104&l123/ 120. If .1x0/ 1. 1001MO4I10 aR nuns )I) nt 0)200450n200 4104411 0112 1112 9 / 3452 • 1 Oa0N1 woc000N�1I0Rg1 •1am11)IO.•0rn1OIDI4 EQUIPMENT LIST - 0.IO11.ua.Mmn. arrRSEMIu JUN 0 2011 PERMIT C REVIEWED FOR CODE COMPLIANCE APPROVED JUN 16 2011 • 9t, AAA City of u ila BUILDING VISION • FILE COPY Permit No.. M — (1 2-- Plan review approval is subject to errors and omissions. Approval of construction documents does not ai!tho rz e the violation of any adopted code or ordinance. Receipt of approved Fief Copy and conditions is acknowledge • By • Date: 7 -1/ City Of Tukwila BUILDING DIVISION TON COMP VIEW MI00001 Oa:C01NE P* I 01)OUS1MPWE 7141.14 W RIR •T.2541) 3112011015 REIT MANAGEMENT E. RESEARCH MOWER ECECUTNEPNOt n/E000TIN PINE 110MIA W Rt. •I 124216111341 RHO a3 10001 R7 117144 MIT Rrn 117 MAT 517 2/4/11 •/7/11 4/)2/71 •n /11 •••• • n 1....12 r4 ••• s 10-5441-0 CONSTRUCTION PLAN A.2A.1 M1VO12 SEPARATE' PERMIT REQUIRED FOR: ❑ Mechanical Electrical Plumbing Gas Piping City of Tukwila BUILDING DIVISION REVISIONS No changes shall be made to the scope of work without prior approval of Tukwila Building Division NOTE: Revisions will require a new pin submit?, and may include additional plan review foes. 1 4 CON TO DP ,y/ © STOREFRONT ELEVATION a 111' a 1'- 0' AOIMOI 1W 001011{1171 11112454 COWAN To N0a04E3 00100 Ma 40115 41. DORN NOES 1114 mow NoRGOom 00x130160. 000 06710 11.0 AMC 11416a Naas )ggpO11W /MmrN • 0210 Ale. • WIN MONO 014006 00 NM OR= OM10 • Rau NI IND 4111.4 • 410120•3 NM INN Mc ISM11411.ALIMIG s14I0l0 SILL 00 O STOREFRONT SECTION a e 1C 10 1' a 1'- a' SYMBOL LEGEND COW 00.2012111• IO 1911® NOM WW1 06N0001P OM a/ul. 0 40.2001 MID 00e1 W 4504011145201/1•1 d.."_14044. MO MT UM 11013 u�ao:.as� O 10 0101120000000 GENERAL CONSTRUCTION NOTES I. 20 121087 40112001100611006 4 OM COMMD ROD IW1u 000650670/ To OC•0•105 51.10. l • OR Cm0 balm •0 ROM MOM NUM/ t • NO COI/0119114��I=i4 MUM DM WO ®II ie FHB 014510 a MCI 00 NX 00004200000010.•000.11003 000 • 1'r10a6 NO D a 1444 MOM IL. IN CCM ROOM LC1n 70ON•41. U N NM Kt 10•144 1. 006 • CND NOM NOOK 010®03 OM M TN t man f fO AWN •1N P NON CWfa =CM KEYED SHEET NOTES O 10•Pw MU 000. F. WA 012:224 NO 01P =RIMS EN POW 11-77764 Y1- 1611400 11•5111411045 NUB NI 40 001011.0[ COD Om100MF04P1mF. 00000 PO Oen 8 Im ON act O 1000 A00 Mon • IOW 0 F® No41 ILL 100®6 • 02 Q 1001200110 010 7440 011 NONC 10,4141. © W� 0.0 007x11WT WM 50030.4 O In 11/4,2 N 21O 0001 O MI RA110 WNW 1ROt • • are 0i 01o61PCa 101110 $ uul. p IMO ROOM 50 be H0 3r M 504101 ® 201 MOW =AM A MO F IMMO 3NIIR ® au7000012 01®00 ® 10LONIAlla TO 1613/I % WON 100210010 WOO WAX ® Ia NAM wit Meat 201 0.44150••• 12 0042 204100101.7 40 1040 0 0 11120 NAL 60121071/6 ® 1204011200 10001. Dlf Mali • 0101016 PLUMBING CALCS OM104&l123/ 120. If .1x0/ 1. 1001MO4I10 aR nuns )I) nt 0)200450n200 4104411 0112 1112 9 / 3452 • 1 Oa0N1 woc000N�1I0Rg1 •1am11)IO.•0rn1OIDI4 EQUIPMENT LIST - 0.IO11.ua.Mmn. arrRSEMIu JUN 0 2011 PERMIT C REVIEWED FOR CODE COMPLIANCE APPROVED JUN 16 2011 • 9t, AAA City of u ila BUILDING VISION • FILE COPY Permit No.. M — (1 2-- Plan review approval is subject to errors and omissions. Approval of construction documents does not ai!tho rz e the violation of any adopted code or ordinance. Receipt of approved Fief Copy and conditions is acknowledge • By • Date: 7 -1/ City Of Tukwila BUILDING DIVISION TON COMP VIEW MI00001 Oa:C01NE P* I 01)OUS1MPWE 7141.14 W RIR •T.2541) 3112011015 REIT MANAGEMENT E. RESEARCH MOWER ECECUTNEPNOt n/E000TIN PINE 110MIA W Rt. •I 124216111341 RHO a3 10001 R7 117144 MIT Rrn 117 MAT 517 2/4/11 •/7/11 4/)2/71 •n /11 •••• • n 1....12 r4 ••• s 10-5441-0 CONSTRUCTION PLAN A.2A.1 M1VO12 SEPARATE' PERMIT REQUIRED FOR: ❑ Mechanical Electrical Plumbing Gas Piping City of Tukwila BUILDING DIVISION REVISIONS No changes shall be made to the scope of work without prior approval of Tukwila Building Division NOTE: Revisions will require a new pin submit?, and may include additional plan review foes. 1 111.1) COPY, PLAN REVIEW /ROUTING SLIP ACTIVITY NUMBER: M11 -072 PROJECT NAME: COMP VIEW DATE: 06/03/11 SITE ADDRESS: 652 INDUSTRY DR X Original Plan Submittal Response to Correction Letter # Response to Incomplete Letter # Revision # after Permit Issued DEPARTMENTS. A s ll d' g misio `� 1 B m Ivislon Public Works iC1M IJ k Fire Prevention 1 Structural Planning Division ❑ Permit Coordinator DETERMINATION OF COMPLETENESS: (Tues., Thurs.) Complete t Incomplete DUE DATE: 06/04/11 Not Applicable Comments: Permit Center Use Only INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED: Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: TUES/THURS ROUTING: Please Route NA Structural Review Required No further Review Required n REVIEWER'S INITIALS: DATE: APPROVALS OR CORRECTIONS: DUE DATE: 07/05/11 Approved Approved with Conditions Not Approved (attach comments) Notation: REVIEWER'S INITIALS: DATE: Permit Center. Use Only • • CORRECTION LETTER MAILED: Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: Documents /routing slip.doc 2 -28 -02 Contractors or Tradespeoliter Friendly Page • General /Specialty Contractor A business registered as a construction contractor with L81 to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. Business and Licensing Information Name FIVE STAR MECHANICAL UBI No. 601937083 Phone 2538528284 Status Active Address 109 Washington Blvd Ste B License No. FIVESM'010JT Suite /Apt. License Type Construction Contractor City Algona Effective Date 4/30/1999 State WA Expiration Date 4/30/2012 Zip 98001 Suspend Date County King Specialty 1 General Business Type Corporation Specialty 2 Unused Parent Company Other Associated Licenses License Name Type Specialty 1 Specialty 2 Effective Date Expiration Date Status COMFOM1015LAMECHANICALConstruction COMFORT INC Contractor Heating /Vent /Air -Conditioning And Refrig (Hvac /R) Unused 6/1/1999 6/1/2012 Active COMFOP "064D2 COMFORT PLUS Construction Contractor Air Conditioning g ir Heat,Ventilation,Evaporat 3/22/1994 3/21/2000 Archived FIVESSE941 KU FIVE STAR ENERGY SOLUTIONS Construction Contractor General Unused 5/24/2006 5/24/2008 Expired Business Owner Information Name Role Effective Date Expiration Date WARE, GERALD LAVON Member 01/01/1980 Bond Amount WARE, JOHN EDWARD Member 06/10/2010 9899743 ALLEN, ANGELA RENEE Member 06/10/2010 WARE, BETTY J Member 06/10/2010 OLD REPUBLIC SURETY CO Bond Information Page 1 of 2 Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date 3 FEDERATED MUTUAL INS CO 9899743 06/25/2006 Until Cancelled $12,000.0006/05 /2006 2 OLD REPUBLIC SURETY CO YLI237591 04/30/2002 Until Cancelled 06/25/2006 $12,000.0003/04 /2002 Assignment of Savings Information No records found for the previous 6 year period Insurance Information Insurance Company Name Policy Number Effective Date Expiration Date Cancel Date Impaired Date Amount Received Date 8 FEDERATED SERV /MUT INS CO 9434226 04/27/2007 04/27 /2012 $2,000,000.00 03/21/2011 7 FEDERATED MUTUAL INS CO 9434226 04/27/2005 04/27/2007 $1,000,000.0003 /27/2006 6 FEDERATED MUTUAL INS CO 5048251 04/27/2005 04/27 /2006 $1,000,000.00 04/26/2005 Summons /Complaint Information No unsatisfied complaints on file within prior 6 year period https://fortress.wa.gov/lni/bbip/Print.aspx 06/17/2011