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HomeMy WebLinkAboutExhibit 1DBPR INTERAGENCY AGREEMENT BETWEEN TNT' DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS AND CITY OF MIAMT FOR DELEGATION OF STATUTORY AUTHORITY TO REGULATE AND ENFORCE ELEVATOR SAFETY This Agreement is made and entered by and between the Depaituwent of Business and Professional Regulation, Division of Hotels and. Restaurants, hereinafter referred to as the DEPARTMENT and the City of Miami, by and through the Depai tuient of Building and Zoning, whose principle address is 444 SW 2nd Avenue, 4th Floor, Miami, FL 33130-1910 hereinafter referred to as the CONTRACTOR. Pursuant to this Agreement, the CONTRACTOR shall issue elevator construction permits, repair and alteration permits, temporary elevator operation permits and certificates of operation; shall provide and conduct elevator inspections; and, shall enforce the applicable provisions of the Florida Building Code, as required by Chapter 399, Florida Statutes, ("Elevator Safety Act"); and Rule Chapter 6IC-5, Florida Administrative Code, ("Florida Elevator Safety Code") on elevator equipment located in and throughout City of Miami not already subject to a contracted delegation of authority pursuant to the requirements of Chapter 399, and Rule Chapter 61C-5, Florida Administrative Code, In recognition of jurisdictional Agreements between the Department and Miami -Dade County, Miami -Dade County will retain contracted jurisdictional authority of equipment located in its own properties owned and/or operated by Miami -Dade County, irrespective of location within the City of Miami. Contractual services shall begin upon full execution of this Agreement, and services shall end on June 30, 2020. This Agreement, is subject to the following provisions: SPECIAL PROVISIONS 1) INDEPENDENT CONTRACTOR: The CONTRACTOR shall perform and render the agreed upon services herein as an independent contractor and not as an agent, representative, or employee of the DEPARTMENT, in a proper and satisfactory mariner as determined by the DEPARTMENT in its sole discretion. 2) INCORPORATION: This Agreement incorporates in full, as if fully set forth herein, the provisions of the Elevator Safety Act, Florida Elevator Safety Code and Chapters 30 and 35 of the Florida Building Code, as these provisions exist and as they may be amended in the future. 3) COMMUNICATIONS: The DEPARTMENT agrees to have open and direct lines of communication with the CONTRACTOR, by providing DBPR staff telephone numbers to CONTRACTOR designated personnel, and by agreeing to provide advance copies of Industry Bulletins and Technical Articles to the CONTRACTOR before they are published and released to vendors, elevator contractors, license holders and other industry stakeholders. The CONTRACTOR likewise agrees to have open and direct lines of communication with the DEPARTMENT, by providing City of Miami Building Department staff telephone numbers to DEPARTMENT designated personnel, and by agreeing to provide advance 1 Page VA1 copies of Local Ordinances and/or Industry Bulletins and Technical Articles and other key documents to. the DEPARTMENT before they are published and released to vendors, elevator contractors, license holders and other industry stakeholders. 4) ASSIGNABILITY: This Agreement is exclusive and personal and may not be assigned by the CONTRACTOR in whole or in part, except that in the event an emergency situation temporarily prevents the CONTRACTOR from performing its obligations hereto, the CONTRACTOR may request written permission from the DEPARTMENT to solicit assistance from any other municipality or county that has entered into a similar interagency Agreement with the DEPARTMENT to issue elevator construction permits, temporary elevator operation permits and certificates of operation; provide and conduct elevator inspections; and enforce applicable provisions of the Florida Building Code, as required by the Elevator Safety Act and Florida Elevator Safety Code. Emergency assistance shall not exceed six (6) months without prior approval from the DEPARTMENT. 5) CONSIDERATION FOR SERVICES: Except as otherwise stated herein, in consideration for the services performed pursuant to this Agreement, the CONTRACTOR is entitled to collect and retain those statutorily authorized fees and administrative fines, as provided in the Elevator Safety Act and Florida Elevator Safety Code, associated with the responsibilities and obligations to be performed herein, which fees and administrative fines would otherwise be collected by the Division. This Agreement does not address, prohibit nor endorse, legally or otherwise, any additional or supplemental fees and administrative fines imposed by the local jurisdiction. 6) CONTRACTOR SERVICES.: The CONTRACTOR shall perform the following services: a. The CONTRACTOR shall conduct elevator inspections in accordance with sections 399.061 and 399.13, Florida Statutes. The CONTRACTOR shall ensure that each inspection is competently performed by the holder of a valid certified elevator inspector credential, issued by the DEPARTMENT, and maintained in good standing. As provided in Section 399.13, Florida Statutes, the certified inspector shall be independent or an employee of the CONTRACTOR. For each inspection performed the inspector shall complete an Elevator Inspection Report, the form which is attached hereto and incorporated by reference as Attachment "A" or use of an equivalent form approved by the DEPARTMENT. The CONTRACTOR shall assume responsibility for inspector compliance with elevator inspection standards referenced in ASME A17.2, Guide for Inspection of Elevators, Escalators, and Moving Walks and for correcting any deficient performance by inspectors it supervises through employment or contractual relationship. The DEPARTMENT, however, shall retain sole authority for disciplining an inspector's professional credential certification. b. The CONTRACTOR shall enforce the applicable provisions of the Florida Building Code, as required by the Elevator Safety Act, Florida Elevator Safety Code, and all other applicable and authorized elevator laws, rules and local 2 Page ordinances, against any elevator owner or other person in violation thereof, except as otherwise provided in this section. All enforcement activity shall be conducted in accordance with the provisions of Chapters 120, 162 and 399, . Florida Statutes, Florida Building Code, Chapter 2, Article X ("Code Enforcement") and Chapter 10, ("Buildings") City of Miami City Code of Ordinances; and applicable Florida Administrative Code Sections or other applicable Codes or State Statutes, as amended. The DEPARTMENT, however, shall retain all authority with respect to professional credentials issued pursuant to Chapter 399, Florida Statutes. The CONTRACTOR shall not issue professional credentials nor shall it enforce the credentialing provisions of Chapter 399, Florida Statutes. The CONTRACTOR may issue local jurisdiction summons and collect administrative fines from credentialed persons or credentialed companies for violating the provisions of the Elevator Safety Act and the Elevator Safety Code. However, the CONTRACTOR shall report to the DEPARTMENT all known or suspected violations of Chapter 399, Florida Statutes, or the Elevator Safety Code, committed by holders of a DEPARTMENT issued professional credential within thirty (30) days of discovery. c. The CONTRACTOR shall provide the DEPARTMENT with a Monthly Activity Report, the form of which is attached hereto and incorporated by reference as Attachment "B", or use of an equivalent form approved by the DEPARTMENT, which shall include the number of elevator permit applications received and issued, the number of elevator inspections and callbacks conducted, complaints and accidents received, inspected and resolved, and the .number of actions initiated to enforce the provisions of the Elevator Safety Act and Elevator Safety Code. Such report is due to the DEPARTMENT within thirty (30) days of the end of the month in which activity is reported. d. The Elevator Safety Act requires that an elevator owner or representative report any accident occurring on or in an elevator within five (5) working days of the accident to the DEPARTMENT using the Elevator Owner Accident Report attached hereto and incorporated by reference as Attachment "D". However, if the accident occurs -within the corporate limits of the City of Miami, a copy of any accident report, shall be forwarded to the DEPARTMENT within thirty (30) days. e. The CONTRACTOR shall maintain accurate records and documentation, including copies of all elevator permit applications received and issued, all elevator inspection reports issued and all elevator certificate of operation applications received and issued, pursuant to the requirements of Section 399.13, Florida Statutes. f. The CONTRACTOR acknowledges and agrees that all records and reports required by this Agreement, the Elevator Safety Act, or Florida Elevator Safety Code, are subject to inspection by the DEPARTMENT. The CONTRACTOR 3Page shall maintain all such records according to the retention schedule employed by the DEPARTMENTS Bureau of Elevator Safety. g. The CONTRACTOR shall not issue an elevator Certificate of Operation until, the elevator or vertical conveyance passes its final or initial inspection, the elevator company supervisor signs an Affidavit, the certificate and form which is attached hereto and incorporated as Attachment "C", or use of an equivalent form approved by the DEPARTMENT, and witnessed by a certified elevator inspector, which sets forth that the elevator company supervisor directly supervised construction or installation of the elevator. h. The CONTRACTOR agrees to establish a Quality Assurance Program in consultation with, and approved by, the DEPARTMENT, to conduct quality assurance inspections and to provide the DEPARTMENT with copies of the quality assurance inspection reports. The DEPARTMENT will conduct oversight and monitor inspections as necessary. 7) CONTRACTOR RESPONSIBILITIES: The CONTRACTOR shall be responsible for: a. CONTRACTOR agrees to process all certificates and permits it issues, and electronically store data, specified below, related to the regulation of elevators, issuance of permits, certificates of operation, for each item specified in section 399.13, Florida Statutes until this Agreement terminates. b. CONTRACTOR agrees to provide the electronic data specified below to the DEPARTMENT, not later than sixty (60) days prior to and until termination of this Agreement by either party, in comma -delimited text format that will merge into the DEPARTMENTS 'LicenseEase' licensing data software, or any successor and then - current licensing data management software, with minimal need for data conversion programming. CONTRACTOR'S failure to provide the specified data in such a format not later than sixty (60) days prior to the termination of this Agreement is a breach of this Agreement. CONTRACTOR will reimburse the DEPARTMENT within sixty (60) days of receipt of an itemized invoice from the DEPARTMENT for all actual and reasonable costs incurred in good faith by the DEPARTMENT to merge the specified data into the DEPARTMENT'S 'LicenseEase' licensing data software, or any successor and then current licensing data management software, whether such costs are attributable to work performed by the DEPARTMENT or a source external to the DEPARTMENT. If the need arises, in the sole determination by the DEPARTMENT, to undertake data conversion in anticipation of the termination of this Agreement, the Contractor agrees to provide full cooperation and unobstructed access to the DEPARTMENT'S staff or any external resource engaged in the conversion work to merge the CONTRACTOR'S data with the DEPARTMENTS 'LicenseEase' licensing data software, or any successor and then current licensing data management software. 4 Page c. The following specific electronic data is required for conversion at a minimum, for each item specified in section 399.13, Florida Statutes, to include: elevator permit applications, permits issued, and certificates of operation issued, and the following: 1. License information, continually maintained: City of Miami Elevator Certificate Number, prior State Serial Number, Licensee Name, Classification Code (equivalent to state codes current at time of migration), Mailing Street Address, Mailing Address Line 2, Mailing Address Line 3, Location City, Location State Code, Location Zip Code, Location County Code, Location Phone Number, License Status Code (equivalent to state codes current at time of migration), License Secondary Status Code (equivalent to state codes current at time of migration), Original Date of Issue, Expiration Date, Number of Landings, Capacity (in pounds), Travel distance (in feet), Speed Up (feet per minute), Speed Down (feet per minute), and installing Company and date installed. In addition: Service Contract Number and Status: Current; Maintenance Company Name, Address, and License Number; Beginning and Ending Date (of service contract). 2. Inspection information, maintained for the preceding five years: City of Miami Elevator Certificate Number, prior State Serial Number, Inspection Date, Inspection Type Code (equivalent to state codes current at time of migration), Violation Codes, Number of Violations, Certified Elevator Inspector Number. 8) CONTRACTOR may grant variances and waivers to the Florida Elevator Safety Code, as authorized in rule and consistent with the provisions of Chapter 120, Florida Statutes. GENERAL PROVISIONS 9) APPROPRIATION: This is a no -cost Agreement for the DEPARTMENT. The CONTRACTOR is responsible for all costs associated with the performance of this Agreement. 10) CANCELLATION: This Agreement may be terminated by either party by giving one hundred and eighty (180) days written notice of cancellation to the other party; said notice shall be sufficient if it is delivered to the party personally or mailed by certified mail to the mailing address as specified herein. In case of cancellation, only the costs actually accrued for services satisfactorily performed prior to the date of cancellation shall be considered incurred, and all work in progress shall remain the property of the DEPARTMENT and shall be. delivered to the DEPARTMENT. The CONTRACTOR shall abide by the •electronic data merge and cost reimbursement requirements due the DEPARTMENT within sixty (60) days prior to and until termination of this Agreement. 11) COMPLIANCE: F.orthe purpose of . ens.uring compliance with the provisions of this. Agreement and the provisions of the Elevator Safety Act and Florida Elevator Safety Code, the DEPARTMENT may at any time verify compliance with applicable standards, assess the 5 I Page effectiveness of the CONTRACTOR'S inspection and enforcement activities and verify the accuracy of the inspections. performed.. The DEPARTMENT will notify the CONTRACTOR in writing of any deficiencies noted and provide appropriate documentation when necessary. The CONTRACTOR shall remedy the deficiencies noted within ninety (90) days of receipt of notice, Upon a finding by the DEPARTMENT that the CONTRACTOR has failed to comply with or enforce the applicable provisions of the Florida Building Code, as required by the Elevator Safety Act and Florida Elevator Safety Code, or has violated the terms of this Agreement, the DEPARTMENT may cancel this Agreement by giving CONTRACTOR immediate written notice of cancellation. 12)ENTIRE AGREEMENT: This Agreement and attachments "A" Elevator Inspection Report or, approved equivalent, "B" Monthly Activity Report or approved equivalent, "C" Certificate of Operation and Construction Supervisor Affidavit or approved equivalent, and "D" Elevator Owner Accident Report attached hereto, constitute the entire Agreement of the parties; and no other Agreement or modification, expressed or implied, shall be binding on either party unless same shall be in writing and signed by both parties. This Agreement may not be orally modified. Any modification must be in writing, expressly titled a modification, amendment, or addendum to this Agreement, attached to this Agreement, and signed by both parties. 13) LIABILITY: Each party hereby assumes the acts or omissions of that party or its officers, agents or employees. Nothing herein is intended to serve as a waiver of sovereign immunity by any party to which sovereign immunity may be applicable. Nothing herein shall be construed, as consent by a state agency or political subdivision of the State of Florida, including the Contractor, to be sued by third parties in any matter arising out of this Agreement or any other Agreement. The CONTRACTOR shall be responsible for all costs incurred for performance of the delegated responsibilities herein and to the extent provided by law and subject to the limitations provided in Section 768.28,- Florida Statutes, as same may be amended, indemnifies the Department of Business and Professional Regulation, the Division of Hotels And Restaurants, the Bureau of Elevator Safety, their employees and representatives for any action brought as a result of Contractor's acts or failure to act under this Agreement. 14) PUBLIC DOCUMENTS: The CONTRACTOR shall allow the public and DEPARTMENT access to all documentation relating to any action required pursuant to the provisions of this Agreement. Failure to permit such access may result in an action to enforce disclosure pursuant to Chapter 119, Florida Statutes, and the DEPARTMENT canceling this Agreement by giving CONTRACTOR immediate written notice of cancellation. 15)ATTORNEY'S FEES: Except as otherwise provided by law, the parties agree to be responsible for their own attorney's fees incurred in connection with disputes arising under the terms of this Agre ement. 6 I Page 16) DISPUTES: This Agreement shall be governed.by and construed in accordance with the laws of Florida. The CONTRACTOR agrees that venue to enforce any provision of this Agreement shall be in Leon County, Florida. 17) NOTICE TO CONTRACTOR: The DEPARTMENT shall consider the employment by any contractor of unauthorized aliens a violation of section 274A of the Immigration and Nationalization Act. If CONTRACTOR violates this section, the DEPARTMENT may cancel this Agreement by giving CONTRACTOR immediate written notice of cancellation. 18) RENEWAL: This Agreement may be renewed for one additional ten-year term provided the DEPARTMENT is satisfied with the CONTRACTORS performance and provided that the CONTRACTOR notifies the DEPARTMENT in writing at least 180 days prior to expiration of its intent to renew. IN WITNESS WHEREOF, the parties hereto have made and executed this Agreement between the Depaitinent of Business and Professional Regulation, Division of Hotels and Restaurants and City of Miami on the respective dates under each signature: CITY OF MIAMI, signing by and through its Chair or designee, authorized to execute same by commission action, and the STATE OF FLORIDA, signing by and through its Director, Depaitaient of Business and Professional Regulation, Division of Hotels and Restaurants, authorized to execute same. . 7 I Page STA1'h OF FLORIDA BILL VEACH, DIRECTOR Department of Business and Professional Regulation Division of Hotels and Restaurants 1940 North Monroe Street Tallahassee, Florida 32399-1011 Date Approved: 31 - 11 KEN LAWSON, SECRETARY Depaituient of Business and Professional Regulation 1940 North Monroe Street Tallahassee, Florida 32399-0750 Date Approved: 9 " 2 Approved as to Form and substance J. Layne Smith, General Counsel 8 I Page CITY OF MIAMI ATTEST: Priscilla Thompson Clerk of the City of Miami Date: 9jPage 2011 By: J. y Martinez, PE, City Manager Approved as to legal form an sufficiency By: Julie City Attorney Approve as to Ins -1>✓ al /e • o.B W /I ce 0 irements lvij Ellis, Ris Appro . ed as to :In anager Requirements Mariano Fei nan z uilding Official ATTACB ENTS I. DBPR Forms "A" - DBPR Elevator Inspection Report (Form HR 5023-003) "B" - DBPR Monthly Activity Report "C" - DBPR Construction Supervisor Affidavit signatory form for Certificate of Operation (see Supervisor of Construction attestation on Attachment A) "D" - DBPR Elevator Owner Accident Report (Form HR 7016) II. CITY OF MIAMI APPROVED DBPR. EQUIVALENT Forms (provided by the CONTRACTOR)• "A" - City of Miami Elevator Inspection Report Form "B" - same "C" - City of Miami Construction Supervisor Affidavit (similar to attestation on DBPR Attachment A) "D" - same 111. City of Miami to provide a list of data elements not collected [ref: Special Provisions 7)b. and 7)c.] rsnDocument 282993 h DBPR Form, HR 5023-003 (July 2009 ) INSPECTION DATE DAY Tamar CERT FED ELEVATOR INSPECTOR (CEI) # TYPE OF INSPECTION . O Routine 0 Alteration Acceptance O Callback . OCbnstruction Initial 'Acceptance 0 Temporary Operating Inspection O Accident O Complaint OCompliance Monitoring O Industry Oversight/Audit TIME IN TIME OUT Building Name Building Address City State of Florida . Page of DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Division of Hotels and. Restaurants - Bureau of Elevator Safety Northwood Centre, 1940 North Monroe Street, Tallahassee, FL 32399-1013 Ph: 050-487-1395 • www.MyFloridaLicense.com/dhpr/hr- Fax: 850-922-6208 ELEVATOR INSPECTION REPORT VIOLATIONS FOR VIOLATION CODES, PLEASE GO TO THE INTERNET AT: www-MyFlorida-co nldbpr/hr/elevators.htmt VIOLATION 1 000 0000.0 0 0 0 0 0 CD 0 0 0 0 O®�c7 CD 0 V 0 V 0000 0000 0 0 0 0 VIOLATION 2 000CI0 000000 ®®0CD. 0 �� 0 ' 3 0. 0 CD 0 0 0 C 0 nn eD 5 lam' •000.0 0 0 0 H 0 0 C :0 .0 0 0 0 • VIOLATION 3 DEFINITIONS CEI - FL Certified Elevalor Inspector CET- FL Certified Elevator Technician REC - FL Registered Elevator Company Zip Code ;i4.*• L'.:i . S:"...99.14,. V I S P gib ' r 1 certify that as elevator company supervisor, I directly supervised We construction or ins allailon of Ih Or see attached elevator Installation affdavl . SERIAL NUMBER O C�� 0 0 (n� Signature Print Name the l" J O CD 0 C(5 ,0 0 80n 0 0 0 0 CD 0 CO CD CD 0 1 CD CD 0 / CD 9 CEI # CET# I^o�l CO 0 0 0 0 0 L 0 is elevator. CD CO CD 0 0 0 0 C(� C) 0 Phone Number VIOLATION 4 OOOOOCD 0.0000 5 2 2 2 C 00OCD 00 ED ECD.CD��D�C�D 00CD' 0 000���000 CD C;� J 0 0 CJ 0 VIOLATION 5 00 000 H I 1 I� M0000 0000O 0,0© 0000 7 7 7 I -I 0 0 0 .L 0000 VIOLATION 6 000D00 ��'�/�0�J�00 I-1 OO 1�/ 1 B 0 0 0 0 0© CD 0 0 0 0 0 0 C OOCJO 0 CD CD H 0 0 0 0 OOOCD :,:•'. :.. %? -7PEE%SO)tr. AL.C(_b1dlN$&t1 :Igr E P.Cic:::: ;:.;.•:_._::,..:_ .,_:.. �.. If violations are cited,. this report constitutes an Order to Correct as outlined in s. 399.061(4), Honda Statutes. Violations must be corrected within 30 days in accordance with s. 399.105(4), Florida Statutes. Signature Title Print Name Phone Number VIOLATION 7 VIOLATION 9 CD00-CDCD tnnI CD O O CD l�I CD CD CD QD 0 0 0 0 0 0 0 0 0 0050 C0�000 l�D 0(�0_D� H CD 0 l`0 CD000 00000 H 0 0 0 0 l 0 l :' 0 0 0000 % NrM00 rA � O 0 0000 VIOLATION 9 CD0000 0®CO00 00000 1 0 0 C 0 0 0 0 0 CD 0000 0 0 0 00 00 O C0/^�� 0 0 0 .l_1 0000 •-=1:ni 9•4;:-::F::-.:i•;! :: rli'Elit::lP•1't:b'3O.4.L.V.AT,QR•.:1'NB:p•�C.tOI2's.`•S. I certify that I have personally performed or witnessed: 0 Routine inspection 0 Periodic tests as prescribed by ASME A17.1 OAcceptance Inspection of new or l� altered installation as recommended by the ASME A17.2 Inspectors Manual OViolations cited on the previous inspection report have been corrected. OInstallation meets or exceeds minimum standards of Chapter 399, Florida Statutes, and Chapter 30 of the Florida Building Code adopted by Rule 9B-3.047, Florida Administrative Code. Signature CEDE REC# Print Name • Phone Number This device O Complies With O Does Not Comply With OIs Exempt From • Section 399.15, Florida Statutes: Regional emergency elevator access/tire key requirements. AND 0 Complies With 0 Does Not Comply With OIs Exempt From section 553.509. Florida Statutes: Alternate power requirements. Completed inspection report must be returned to the Bureau of Elevator Safety within five (5) Working days of inspection. ®111111®11p".111®N1EI®I111II®1®IIM®1li1N®N.ME®11E1®1 PLEASE 00 NOT wo rE BELOW TIIIS .LINE NOTICE TO CERTIFIED ELEVATOR INSPECTOR 3 C A tl f R 0 ri' E'N-2B3209-1:554321 CENTRAL OFFICE COPY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION MONTHLY CONTRACTED ACTIVITY REPORT TO: Bureau of Elevator Safety - Compliance Section FROM: Reedy Creek Improvement District X City of Miami City of Miami Beach Miami -Dade Broward County SUBJECT: ELEVATOR INSPECTION FOR THE MONTH OF 1 ROUTINE INSPECTIONS PERFORMED 2 PERIODIC INSPECTIONS PERFORMED 3 INITIAL INSPECTIONS PERFORMED (FINAL) 4 CALLBACK INSPECTIONS PERFORMED 5 ALTERATION INSPECTIONS PERFORMED (FINAL) 6 CONSTRUCTION INSPECTIONS PERFORMED 7 COMPLAINT INSPECTIONS PERFORMED 8 ACCIDENT INSPECTIONS PERFORMED 9 ELEVATORS SEALED FROM PUBLIC USE 10 NEW ELEVATOR/ESCALATOR PERMITS ISSUED 11 ALTERATION PERMITS ISSUED 12 TEMPORARY OPERATION PERMITS ISSUED 13 NUMBER OF ACCIDENTS REPORTED 14 NUMBER OF COMPLAINTS REPORTED 15 NUMBER OF ELEVATORS/ESCALATORS TOTAL INSPECTIONS (1 THROUGH 8) REPRESENTATIVE OF CONTRACTED AGENCY 'SATE INSPECTION DATE 1:1or,in Tear CERT FLED ELEVATOR INSPECTOR (CEI)8 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TYPE OF INSPECTION ORoutine OAlteration Acceptance 0 Callback 0 Construction . O Initial Acceptance °Temporary Operating Inspection MKT aiktif:LIJEKilitWa °Accident 0 ciomplaint ° Compliance Monitoring 0 Industry Oversight/Audit • TIME IN TIME OUT Building Name Building Address Cly State of Florida Page of DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Division of Hotels and Restaurants - Bureau of Elevator Safety Northwood Centre, 1940 North Monroe Street, Tallahassee, FL 32399-1013 Ph: 050-487-1395 • www.MyFloridaLicense.com/dbpr/hr • Fax: B50-922-620 ELEVATOR INSPECTION REPO DEFINITIONS CEI - FL Certified Elevator Inspector CET - FL Certified Elevator Technician REC - FL Registered Elevator Company VIOLATIONS FOR VIOLATION CODES, PLEASE GO TO THE INTERNET AT: www.MyFlorida.com/dbprlhrlelevators_himl VIO• ATION 1 VIOLATION 2 VIOLATIONS : - VIOLATION 4 VIOLATION 5 Zip Code =E•1:1191•If :t21.11• 0 0� l 0 5 0 ((0� �0nJ SERIAL NUMBER 0 ID 0 84 0 0 ��7 0 0 0 0 0 0 G �(0 0 0 0 0 0 G CD 0/��r��� 0 0 0 0 ° nnB 0 0 0 C0� certify Thal es the elevator company supervisor. I directly supervised the construction or Ins allalion of 111 s elevat or see attached elevator Installation amdavit. Signature Print Name CEI # CET# Phone Number VIOLATION 6 VIOLATION 7 VIOLATION 6 VIOLATION 9 \.-.• O O O goon© S0�C0© 0000� ©.0 J'0 0000 0000 0000. OO@ 0 0 0 0 0 li 000��0 0 0 0 0 0 00000 4 4. 4 5 5 5 00a0 0000 :...., •- .- � ..... .... ... .. ..r;LQ...(lf�• if,:$ia,'.��''.',.+r7:•2:c'lyrgzit ".i:z;i;;'i.:T''�l�.ar..: a�;�.;,.......:..�. 0 0 0 0 0 0000 0 0 02 C �0 CD 0 � / l" J 33 D 0 0\ � 0. E 0 5 0 0 00 000.0 0 0 0 0 O 0 01 0 0 0 0 0 0 O 0000 0 0 0 0 CD @ 0000 0 J 0 0 0000 0 0 0 0 0000 0 0 0 0 00009 H 00 10CD 0 0 0 0CD CD 0 4 0 r 5 0 0 G 0 0000 0 -0 0 O C00000A OO(O1 0 0 0 10 0 CD CD 0 0 0 0© CD 0. 0 0 0 5 5 05 r CD CD 8 O O 7, H 00J0 0 L1.' 9 0 :..',4 pe:R'SONctifittIVIN'G ;'• I. .P r '>' .:•_...:.�:., till:. If violations are cited, this report constitutes an Order to Correct as outlined In s. 399.06'1(4), Florida -Statutes. Violations must be corrected within 30 days in acco{-dance with s. 399.105(4), Florida Statutes_ S1, nature 000 H DCVO 0.�0-� 0 0 CD V'll l�J E� 0 0 O . 0 D0�00 000 Ia 0000 0000 00000 CD CD I� CD 0.0 CD CD 0 C 0 00000 CD GD CD CD CD 0 0 O O 0O00 0000 000L 9° 0 0 0 ..+,s9rnaar �rwv�rw�uemcct�•.r:�.w.�yn-n •'�=4��•p•RL•A I certify that I have personally performed or witnessed: 0 Routine inspection 0 Perlodic tests as prescribed by ASME A17-1 OAcceptance inspection of new or altered Installation as recommended by the ASME A17.2Inspectors Manual 0 Violations cited on the previous inspection report have been corrected. ° Installation meets or exceeds minimum standards of Chapter 399, Florida Statutes, and Chapter 30 of the Florida Building Code adopted by Rule 9B-3.047, Florida Administrative Code. 0 C 0 0 1I °,.._°0° 0 0 0 0 O 00000 a CD CD CD C' 0 0 C 000C 00010 0 0.0 0 0 0 O 0 Print Name Title Phone Number PLEASE D0 NOT ',yRI fE BEL-OVJ THIS LIFT Signature CEI # REC Print Name NOTICE TO CERTIFIED ELEVATOR INSPECTOR Phone Number This device O Complies With L Does t'fot Comply With 0 Is Exempt From Section 399.15, Florida Statutes: Regional emergency elevator access/fire key requirements.. AND ° Complies With ° Does Not Comply With Is Exempt From Section 553.509, Florida Statutes: Alternate power requirements. Completed inspection report must be relurried to the Bureau of Elevator Safety within five (0) working days of inspection. DBPR HR-7016 — Division of Hotels and Restaurants, Bureau of Elevator Safety Elevator Owners Accident Report Florida law requires certificate of operation holders,to submit the following form to the division in the event of an elevator accident. Failure to file this report within five workings days of the accident could result in a fine of up to $1,000. ECTION 1' QUIPMENT LOGATiON License Number ❑ Elevator ❑ Escalator ❑ Moving Walkway ❑ Wheelchair Lift Accident Date (mm/dd/yyyy) Time of Accident Hour Minute ❑ AM ❑ PM Owner Name Business Name Building Address City County State Zip Code Phone Number ECTION 2 ERVICEMAIN t ENANCE" is the elevator or escalator under a service maintenance contract? ❑ Yes No ❑ Unknown Name of Elevator (Maintenance Company Was the elevator service maintenance company notified? ❑ ❑ If yes, indicate date (MM/DD/YYYY) Yes No Most recent required test performed? ❑ 6 ❑ 1 ❑ 3 05 months year years years ECTION,3 ACCIDENT DETAILS Test Date (mrri/dd!yyyy) Brief Narrative: (attach additional sheets as necessary) PLEASE CHECK ALL THAT APPLY Medical Attention Req'd ❑ Y ❑ N ❑ Fall ❑ Trip ❑ Bruises ❑ Cuts ❑ Entrapment ❑ Hand I ❑ Fingers ❑ Arm ❑ Leg I ❑ Knee ❑ Hair ❑ Foot ❑ Other Toes Other Factors: E Carryon Items/Packages ❑ Stroller ❑ Safety Issues ❑ Mechanical ❑ Other ❑ Torso Clothing/Footwear Involved: E Sleeves ❑ Purse ❑ Shoes ❑ Dress/skirt ❑ Pants ❑ Coat ❑ Other Equipment Involved: Witnessed Activities: D Door Open I ❑ Step —Stair Tread ❑ Floor Leveling I ❑ Esc. Side Wall ❑ Unsafe Rider Behavior I ❑ Equipment Malfunction ❑ Other ❑Esc. Railing Post Event Inspection Req'd ❑ Y ❑ N Performed by: Date (optional) Unit Cleared for Continued Use: ❑ Y ❑ N Cleared By: CEI Date `ECTION'4:. REP.ORTI'NG SIGNATURE` Report Submitted by (print name) Date Title Current Certificate ? ❑Y. ❑N ❑NA Signature Phone Number Contracted Jurisdiction Disclaimer: This report will assist the division in identifying ways to improve rider safety and will not be used to assign blame or liability. Florida law requires the elevator's certificate of operation holder to submit the report to the Bureau of -Elevator Safety within 5 days of the accident. You may fill in the online forni-orPortable Document Format (PDF)-version of this report, save it to your hard drive and e-mail it to: dhr.elevators(�dbpr.state.fl.us, or you may fax or mail the report to: Department of Business and Professional Regulation, Division of Hotels and Restaurants, Bureau of Elevator Safety, 1940 North Monroe Street Tallahassee, FL 32399-1013 Phone: 850.487.1395 FAX: 850.922.6208 2008 March 10 www.MyFloridaLicense.com/hr Page 1 of 1