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HomeMy WebLinkAboutPermit M15-0117 - XFINITY - DUCTWORK, EXHAUST FANS, GRILLES ETCXFINITY 301 STRANDER BLVD M15-0117 Parcel No: Address: City of Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206-431-3670 Inspection Request Line: 206-438-9350 Web site: http://www.TukwilaWA.gov MECHANICAL PERMIT 2623049064 Permit Number: M15-0117 393 STRANDER BLVD Project Name: XFINITY Issue Date: Permit Expires On: 9/28/2015 3/26/2016 Owner: Name: Address: Contact Person: Name: Address: Contractor: Name: Address: License No: Lender: Name: Address: REGENCY CENTERS LP PO BOX 790830 C/0 PROPERTY TAX DEPT, SAN ANTONIO, WA, 78279 SHANE SCOTT 4102 B PL NW , AUBURN, WA, 98001 UNIVERSAL REFRIGERATION INC PO BOX 614, AUBURN, WA, 98071- 0614 UNIVER1159RF Phone: (253) 939-5501 Phone: (253) 939-5501 Expiration Date: 4/2/2016 DESCRIPTION OF WORK: INSTALL DUCTWORK FOR TENANT IMPROVEMENT/REMODEL USING THREE EXISTING PACKAGE ROOFTOP UNITS. INSTALL (4) EXHAUST FANS, GRILLES AND REGISTERS Valuation of Work: $11,505.00 Type of Work: NEW Fuel type: GAS Fees Collected: $350.42 Electrical Service Provided by: PUGET SOUND ENERGY Water District: TUKWILA Sewer District: TUKWILA SEWER SERVICE Current Codes adopted by the City of Tukwila: International Building Code Edition: International Residential Code Edition: International Mechanical Code Edition: Uniform Plumbing Code Edition: International Fuel Gas Code: Permit Center Authorized Signature: 2012 2012 2012 2012 2012 National Electrical Code: WA Cities Electrical Code: WAC 296-46B: WA State Energy Code: 2014 2014 2014 2012 Date: (' �� I hearby certify that I have read and examined this permit and know the same to be true and correct. All provisions of law and ordinances governing this work will be complied with, whether specified herein or not. The granting of this permit does not presume to give authority to violate or cancel the provisions of any other state or local laws regulating construction or the performance of work. I am authorized to sign and obtain this development permit and agree to the conditions attached to this permit. Signature: Print Name: Sri Ju I't Date: q —0 6 This permit shall become null and void if the work is not commenced within 180 days for the date of issuance, or if the work is suspended or abandoned for a period of 180 days from the last inspection. PERMIT CONDITIONS: 1: Work shall be installed in accordance with the approved construction documents, and any changes made during construction that are not in accordance with the approved construction documents shall be resubmitted for approval. 2: All permits, inspection record card and approved construction documents shall be kept at the site of work and shall be open to inspection by the Building Inspector until final inspection approval is granted. 3: All construction shall be done in conformance with the Washington State Building Code and the Washington State Energy Code. 4: Remove all demolition rubble and loose miscellaneous material from lot or parcel of ground, properly cap the sanitary sewer connections, and properly fill or otherwise protect all basements, cellars, septic tanks, wells, and other excavations. Final inspection approval will be determined by the building inspector based on satisfactory completion of this requirement. 5: All electrical work shall be inspected and approved under a separate permit issued by the City of Tukwila Permit Center. 6: 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. 7: ***MECHANICAL PERMIT CONDITIONS*** 8: All mechanical work shall be inspected and approved under a separate permit issued by the City of Tukwila Permit Center (206/431-3670). 9: Manufacturers installation instructions shall be available on the job site at the time of inspection. PERMIT INSPECTIONS REQUIRED Permit Inspection Line: (206) 438-9350 1800 MECHANICAL FINAL 0701 ROUGH -IN MECHANICAL CITY OF TUKWILA Community Development Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http://www.TukwilaWA.gov Mechanical Permit No. Project No. Date Application Accepted: Date Application Expires: (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: ,FQ/ env o�Py /t d Tenant Name: • i7y /Zt Irh✓i /C( PROPERTY OWNER Name: /c t s�/ x • Address: /to / �O,ox 79'ef3d City: ti A , J State: - j Zip:78�77 CONTACT PERSON — person receiving all project communication Name: Address: 4102 B Plc NW City: Auburn State: WA Zip: 98001 Phone: (253) 939-5501 Fax: Email: shanes@universalrefrig.com King Co Assessor's Tax No.: 2&%'Z jby " 966 K Suite Number: 39 Floor: / New Tenant: Er Yes ❑ ..No MECHANICAL CONTRACTOR INFORMATION Company Name: Universal Refrigeration Address: 4102 B Plc NW City: Auburn State: WA Zip: 98001 Phone: (253) 939-5501 Fax: (253) 735-3432 Contr Reg No.: UNIVER1159RF Exp Date: 04/01/2012 Tukwila Business License No.: z45.. O.7, 3/2y Valuation of project (contractor's bid price): $ Describe the scope of work in detail: S r " Al Cy 74-r-vt a be 7 / gyp v-o v /` tc c (t/s $ iv'ee_ 4 )c (S 7 � q a e vc 1��P adit/75. ��a...� /., s�, / �y � s f.4.7s y P7e.s `lr i^e rs1-P-try Use: Residential: New ❑ Replacement ❑ Commercial: New [ Replacement ❑ Fuel Type: Electric ❑ Gas [t Other: H:Wpplcations\Forms-Applications On Line\2011 Applications\Mechanical Permit Application Revised 8-9-11.docx Revised: August 2011 bh Page 1 of 2 Indicate type of mechanical work being installed and the quantity below: Unit Type Qty Furnace <100k btu Furnace >100k btu Floor furnace Suspended/wall/floor mounted heater Appliance vent Repair or addition to heat/refrig/cooling system Air handling unit <10,000 cfin Unit Type Qty Air handling unit >10,000 cfm Evaporator cooler Ventilation fan connected to single duct Ventilation system Hood and duct Incinerator - domestic Incinerator - comm/industrial Unit Type Qty Fire damper Diffuser Thermostat Wood/gas stove Emergency generator Other mechanical equipment PaCAVor/( 7 Boiler/Compressor Qty 0-3 hp/100,000 btu 3-15 hp/500,000 btu 15-30 hp/1,000,000 btu 30-50 hp/1,750,000 btu 50+ hp/1,750,000 btu 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 OWNER OR AUTHORIZED AGENT: Signature: Print Name: ‘5hv Pie Mailing Address: 4102 B Plc NW Date: 7—/ - 2-OlS Day Telephone: (253) 939-5501 Auburn WA 98001 City State Zip 11:\Applications\Forms-Applications On Line\2011 Applications\Mcchanical Permit Application Revised 8-9-11.docc Revised: August 2011 bh Page 2 of 2 Cash Register Receipt City of Tukwila DESCRIPTIONS PermitTRAK ACCOUNT QUANTITY PAID $474.95 EL15-0814 Address: 301 STRANDER BLVD Apn: 2623049005 $124.53 ELECTRICAL $118.60 PERMIT FEE MULTI-FAM/COMM R000.322.101.00.00 0.00 $118.60 TECHNOLOGY FEE $5.93 TECHNOLOGY FEE R000.322.900.04.00 0.00 $5.93 M15-0117 Address: 301 STRANDER BLVD Apn: 2623049005 $350.42 MECHANICAL $336.94 PERMIT ISSUANCE BASE FEE R000.322.100.00.00 0.00 $32.50 PERMIT FEE R000.322.100.00.00 0.00 $237.05 PLAN CHECK FEE R000.322.102.00.00 0.00 $67.39 TECHNOLOGY FEE $13.48 TECHNOLOGY FEE TOTAL FEES PAID BY RECEIPT: R6191 R000.322.900.04.00 0.00 $13.48 $474.95 Date Paid: Thursday, September 17, 2015 Paid By: UNIVERSAL REFRIGERATION INC Pay Method: CHECK 49926 Printed: Thursday, September 17, 2015 3:49 PM 1 of 1 CSYSTEMS INSPECTION RECORD Retain a copy with permit INSON NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila: WA 98188 (206) 431-3670 Permit Inspection Request Line (206) 438-9350 MCS-0C( 7 Projec:�r� ( 11 Type fInspiot_rr Address: vikr 6 („0,4 Date Called: Special I ructions: it Date Wanted: to—� —,� a.m. p.m. Requester: Phone No: Approved per applicable codes. Corrections required prior to approval. OMMENTS: Inspector: Dated REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be paid at 6300 Southcenter Blvd., Suite 100. Catt to schedule reinspection. INSPECTION RECORD Retain a copy with permit PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670 Permit Inspection Request Line (206) 438-9350 Project: S TyprNOIns h --.. ,: _ _ e Address: 3qi Sri if,✓a Date Call : Special Instructions: Pi Date 1ya�tedi I' _ _� 6 a.m. m. Requester: Phone No: litApproved per applicable codes. Corrections required prior to approval. COMMENTS: A-1E> co t/P.V` Inspector: - rs REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection. INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670 Permit Inspection Request Line (206) 438-9350 k®�`\ --r MIS -Of 17 Project: Type of inspec ioxf. ‘ Address: 3C ;fr ' - - 6fJo( Date Called: Specia I structions: �� nted: cc Date W4-3o _J a.m. P.m. Re 6° VO ( @ 5 S E Phon No: 1-cbeN-1137, Approved per applicable codes. Corrections required prior to approval. COMMENTS: zcc t" rrr ev( A. 5-1-vikc-kkrcar . &cFf trvitYP re.ke:+n;( O,�I� Inspector: P Dateq 1 REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection. NuTone® •"f 3 Architectural & Engineering Specifications September 2004 DESCRIPTION BLOWER: • Plug-in, permanently lubricated motor - engineered for continuous operation • Dynamically balanced centrifugal blower wheel for quiet, efficient performance • Low RPM for quiet operation • Resilient anti -vibration motor mounts HOUSING: • Rugged, 26 gauge, galvanized steel construction • Polymeric, 4" round duct connector with tapered sleeve and no metallic clatter • 7-5/8" height allows for 2" x 8" (nominal) joist installations • Sturdy, easy, fourpoint mounting directly to joist • Includes unique spacer (patent pending) for m untito engineered •1" joists ,�;�'i�:C7e, • Can be mounted in ceilings up to 12/12 pitch GRILLE: -NODE C • Polymeric construction • Innovative design - the result of extensive rese designers and consumers CONTROLS (Purchase separately): • Refer to NuTone's one's catalog for a complete line accesrsO�,�� to effectivelyadapt these fans to your construct n ••YY ch wittEP 2 5 QTRN / QTR.EN Series Fans MODELS QTRN080, QTRN110, QTREN080, QTREN110 D FOR L NCE 2015 requirements. MOLDING %mom U.L. Listed for use over bathtubs and showers wh ri uonnecten A I IITE T'S SPECIFICATION to a GFCI protected branch circuit (ceiling mount only). 3-Year Warranty 2100 HVI CERTIFIED II IC, mover nT Arlo com•oi Assoc anon. Inc . ENERGY STAR Models QTREN0808 QTREN110only INSTALLATION Complete installation instructions are included with each Fan. • Ceiling Ventilator shall be NuTone Model QTRN080 (QTRN110) (QTREN080) (QTREN110). • Ceiling Ventilator shall have corrosion resistant galvanized steel housing with four -point mounting capability. It shall be ducted to a roof or wall cap using 4" round ductwork. • Blower assembly shall be removable, have a centrifugal -type blower wheel and a permanently lubricated motor designed for continuous operation and mounted with resilient anti -vibration mounts. • Non-metallic damper/duct connector shall be included. • Air delivery shall be no Tess than 80 (110) CFM and sound level no greater than 1.0 (1.5) Sones. All air and sound ratings shall be certified by AMCA and/or HVI. • Ceiling ventilator shall be Energy Star® qualified and have an energy efficient permanent split capacitor motor (Models QTREN080 & QTREN110 only). • Ceiling Ventilator shall be U.L. Listed for use over bathtubs and showers when connected to a GFCI protected branch circuit. NuTone, Inc., 4820 Red Bank Road, Cincinnai, OH 45227 (1-800-543-8687) REFERENCE QTY. f I °tili D :l.0 Project i fAf ' . �F/ 3 � V CITY OFTUKV!lILA SEP 1 7 2015 PERMIT CENTER Location t %C— " Architect Engineer Contractor Gr. Submitted by 52.3 Date 4//GS' M(SOI17 ." 9904t3403A PERFORMANCE RATINGS„ V QTRN SERIES FANS HVI PERFORMANCE Model Sones 00.1"Ps CFM @0.1"Ps QTRNO5OF 0.4 50 45TRN080 1.0 80 QTRN110 1.5 110 2100 HVI CERTIFIED AMPS HVI-2100 CERTIFIED RATINGS comply with new testing technologies and procedures prescribed bythe Home Ventilating Institute, for off -the -shelf products, as they are available to consumers. Productperforrnanoe is rated at0.1 in. static pressure, based on tests conducted in AM CA'sstate-of-the-arttest laboratory. Sones area measureof humanly-percelved loudness, based on laboratory measurements. Model Amps QTRNO5OF 0.3 OTRN080 0.7 QTRN110 0.9 WEIGHT Model Shipping Weight QTRNO5OF 6.91bs. OTRN080 10.6 Ibs. OTRN110 , 10.6 Ibs. NuTone, AIR FLOW PERFORMANCE 0.6 0.5 6 0.4 C 0.3 0.2 0.1 -w, Ali. 0.0 0 0.9 0.8 0.7 0.6 0.5 `g 0.4 4 0.3 0.2 0.1 0.0 0 MODEL QTRNO5OF 10 20 30 40 Airflow (cfrn) MODEL QTRN080 50 60 70 0.9 0-6 0-7 W 0.6 0.5 C O-4 a O-3 0.2 0.1 0.0 0 10 20 30 40 50 60 Airflow (ctm) MODEL QTRN110 70 80 90 100 10 20 30 40 50 60 70 60 90 100 110 120 Airflow (ctm) Broan-NuTone LLC Hartford. Wisconsin www.nutone.com 888-336-3948 Igor, ?"-- Fantech THE INDUSTRY STANDARD FOR INLINE DUCT FANS JUST GOT BETTER! The company that invented the circular duct fan more than thirty years ago, now introduces new improved inline fans that are virtually airtight. New production processes eliminate manufacturing variances to ensure tight tolerances for optimal performance of every fan. Galvanized steel housings meet code requirements for both residential and commercial applications. High quality ebm-papst motors ensure long life and dependable performance. Simplified Installation: The FG Series features new longer duct connections for easier installation. Fans are prewired and include bracket for mounting to wall or ceiling. Straight -through airflow allows fans to be installed at any angle at any point along the ductwork. M.. HARD WORKING. LONG LASTING. HERE'S WHY: • Airtight galvanized steel housing — perfect for commercial code applications • Powered by ebm-papst external rotor motorized impeller for excellent heat dissipation, even at low RPM • Backward curved impeller • Permanently lubricated sealed ball bearings for maintenance - free operation • Automatic reset thermal overload protection Fantech external rotor motor AUGUST 2009 ENERGY STAR Look for w cgs star Bared Modell in Performarrn Deur Chars on back page WE'VE SET NEW STANDARDS FOR: • Performance • Efficiency • Reliability Also Available FGC SERIES Same fans prewired with six foot cord and plug. • Air Tightness • Ease of Installation 13 MODELS TO CHOOSE FROM: • 4' to 12' duct diameters • 135 to 940 CFM • 100% speed controllable • Rated for airstream temperatures up to 140° F • Rated for outdoor use • Five-year factory warranty • UL Listed; CSA Certified IP,.PROV NG INDOOR AI,R CUALIT'.THROUGH BETTER www.fantech.net us &h. Wok ec .o re..e 14_1 ant, tot A ado* TOM bozo M e sed e.lrr h Alto Sal TN noggin bow' WWI WO pa ed.n m.+taco, ,mh ...IonW of tl. ONG OWN Kea Frow. :eb. I HV CERT1F ED VIEWEL) i-OR— ,a COMPLIANCE Av APPROVED SEP 2 5 2015 tftcf Tukwila !WING DIVISION 4 FROM RESIDENTIAL TO COMMERCIAL DIMENSIONAL DATA r-33/4"--•1 Or Model to C D E FG 4 4 83/4 61/2 1 FG 4xt 4 93/4 615/18 1 FG 5 5 83/4 51/2 1 7/8 FG 5xi 5 93/4 515/te 1 1 FG 6 6 113/6 6 1 1 F6 6xtJFG 6m 6 131/8 65/e 1 1 FG 8 8 133/a 6 11/s 11/e FG 8xt. 8 133/8 6 11/8 11/e FG 10 10 133/e 411/fe 11/e 1 FG loxt 10 133/8 57/e 11/e 1 FG 12 12 16 81/4 11/18 13/18 FG 12xL 12 16 81/4 11/18 13/16 All dimensions in inches. ° Duct connections are 1/8"smaller than duct size. PERFORMANCE DATA Fan Energy RPM Voltage Rated Max. Model Star 0 Watts Amps FG 4 ✓ 3000 120 20 0.19 FG 4xi - 2750 120 71 0.66 FG 5 ✓ 3000 120 20 0.19 FG 521. - 2700 120 73 0.68 FG 6 ✓ 2700 120 72 0.68 FG 6m ✓ 2350 120 120 1.02 FG 6xt ✓ 2900 120 153 1.48 FG 8 , V 2550 120 119 1.14 FG 810 V 2950 120 142 1.45 FG 10 ✓ 300t 120 138 1.43 FG 10xi V 3100" ;120 196 1.96 FG 12 ✓ 2600'()120 181 1.87 FG 12xt V 2900 120 301 3.01 F 1 1 r.;ttn Mc old rnam Lanai m ay that nn I. ' n▪ OMR f•e re I. ..NM toter IMAM SW TM nakn rt terl an I. 41 W pm.'Lm .na.•a A &min a MICA %m alk, 711 mal en.* tha n warm al AMCA CnirraNrpRtpr. HV1 CERTIFIED Cous SPe tool to Ma Enemy Sur %d0 Models ill %d mrnn DIN Chum 1 x A AIR PERFORMANCE GRAPHS I]11 3.00 2.50 1.50 1.00 0.0 om , FG 12 s,FG 19, �'.\-......... • FG 11 FG6 Fs 4\\ \ "�� 100 200 300 403 500 600 Row Rate (CFM) 700 800 900 1000 aau 3.00 2.50 2.00 1.50 lm \ NN.FG FG 12/4 66:0.50 6t FG10xi \ FG 6xi FG4,� FG5xi\�., Row Rate (CFM( Static. Pressure u1 Inches W G 0.1" 135 123 170 160 156 143 220 205 303 287 418 394 483 466 461 435 502 486 513 497 589 574 741 711 940 910 0" 0.2" 0.4" 0.6" 0.8" 110 83 55 25 150 134 119 103 130 99 66 33 190 160 135 112 270 232 196 164 370 317 268 224 450 409 369 329 410 351 295 243 470 428 388 351 480 444 407 366 560 531 503 472 680 601 515 434 880 819 746 670 1.0" 1.25" 1.5" 86 63 40 91 66 41 134 97 58 186 144 101 289 243 201 191 143 97 313 266 218 324 269 216 441 400 355 363 290 236 596 505 425 Max. Duct 2.0" 2.5" Ps Dia. - 0.94 4" - 1.98 4" - - 0.99 5" - - 1.89 5" - 1.88 6" - 2.10 6" 103 - 2.41 6" - 2.11 8" 100 - 2.40 8" 89 - 2.36 10" 257 137 3.02 10" 146 72 2.99 12" 259 B0 2.74 12" Performance certified is for installation type D • Ducted inlet, Ducted outlet. Speed (RPMJ shoo n is nominal. Performance is based on actual speed of test. Performance ratings do not include the effects of cppurtenarces (accessories/. Fan to c h United States 10048 Industrial Blvd. • Lenexa, KS 66215. 1.800.747.1762 • www.fantech.net Canada 50 Kanalllakt Way • Bouctouche. NB E4S 3M5 • 1.800.565.3548 • www.fantech.ca Item 0: 450286 Rev Date: 081109 Fantech, reserves the right to modify, at any time and without notice, any or all of its products' features, designs, components and specifications to maintain their technological leadership position. PERMIT COORD COPY PLAN REVIEW/ROUTING SLIP PERMIT NUMBER: M15-0117 PROJECT NAME: XFINITY SITE ADDRESS: -TRANDER BLVD X Original Plan Submt�ttal� Response to Correction Letter # DATE: 09/17/15 Revision # before Permit Issued Revision # after Permit Issued DEPARTMENTS: Alq Building Division Public Works ,9-M N1f1- q-13aS Fire Prevention Structural Planning Division Permit Coordinator PRELIMINARY REVIEW: Not Applicable ❑ (no approval/review required) DATE: 09/22/15 Structural Review Required REVIEWER'S INITIALS: DATE: APPROVALS OR CORRECTIONS: DUE DATE: 10/20/15 Approved Corrections Required Approved with Conditions Denied (corrections entered in Reviews) (ie: Zoning Issues) Notation: REVIEWER'S INITIALS: DATE: Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: 12/18/2013 UNIVERSAL REFRIGERATION ITT' Page 1 of 2 Home Inicio en Espanol Contact Search L&I A-Z Index Help My Secure l.&I Safety Claims & Insurance Workplace Rights Trades & Licensing 0 Washington State Department of Labor & Industries UNIVERSAL REFRIGERATION INC Owner or tradesperson Principals GATES, CHRISTOPHER A, PRESIDENT GALVIN, BRYAN S, VICE PRESIDENT VERNON, GUY E (End: 01/01/1980) JACKSON, SHELDON G (End: 01/01/1980) OSENBAUGH, CHARLES R (End: 01/01/1980) RAEDER, STEVEN C, PRESIDENT (End: 03/29/2012) Doing business as UNIVERSAL REFRIGERATION INC WA UBI No. 600 599 723 PO BOX 614 AUBURN, WA 98071-0614 253-939-5501 KING County Business type Corporation Governing persons BRYAN GALVIN CHRIS GATES; License Verify the contractor's active registration / license / certification (depending on trade) and any past violations. Construction Contractor Active. Meets current requirements. License specialties COMMERCIAL/INDUSTRIAL/REFRIG License no. UNIVERI159RF Effective — expiration 12/06/1985— 04/01/2016 Bond ........._...... AMERICAN STATES INS CO Bond account no. EX903622 $6,000.00 Received by L&I Effective date 03/18/2002 12/06/2001 Expiration date Until Canceled Insurance ............................ American Economy Insurance Co $1,000,000.00 Policy no. 01 C179965210 https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600599723&LIC=UNIVERI 159RF&SAW= 09/25/2015