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HomeMy WebLinkAboutState Interagency AgrmtSTATE INTERAGENCY AGREEMENT DBPR INTE.RAGENCY AGREEMENT • BETWEEN TFIIe DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS AND CITY OF MIAIVH - FOR DELEGATION OF STATUTORY AUTHORITY TO REGULATE • AND ENFORCE ELEVATOR SAFETY. This Agreement is made and . entered by and between the Department of Business and Professional Regulation, Division of FIotels and. Restaurants, hereinafter referred to as the DEPARTMENT and the City of Miami, by and through the Depaitrnent of Building and Zoning, whose principle address is 444 SW 2nd Avenue, 41h 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 61 C-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 manner 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) COMMI.JNICATIONS: The DEPARTMENT agrees to 'liave 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 Teclmical 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 limes of communication with the DEPARTMENT, by providing City of Miami Building Department staff telephone numbers to DEPARTMENT designated personnel, and by agreeing to provide ad.vance 1 I Page 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 retainthose 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..ce tific.ation..,. 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 I 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 sum eons 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 g• shall maintain all such records according to the retention schedule employed by the DEPARTMENT'S Bureau of Elevator Safety. 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 Afficlavit, the • certificate and form which is attached hereto and incorporated as Attaclunent "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 condtict 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 DEPARTMENT'S '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 deterrniiation .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 DEPARTMENT'S 'LicenseEase' licensing data software, or any successor and then current licensing data management software. 4 j 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), Speecl 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 Ntunber, 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.or.. the .p.urp.ose .of_ ens.uriug. 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 51Page 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 patty 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 Agreement. 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 intentto renew. IN WITNESS WHEREOF, the parties hereto have made and. executed this Agreement between the Department 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, Department of Business and Professional Regulation, Division of Hotels and Restaurants, authorized to execute same. 7 I Page STATE OF FLORIDA BILL VBACH, DIRECTOR Department of Business and Professional Regulation • Division of Hotels and Restaurants 1940 North Monroe Street • Tallahassee, -Florida 32399-1011 KEN LAWSON, SECRETARY . Department of Business and Professional Regulation 1940 North Monroe Street . Tallahassee, Florida 32399-0750 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: , 2011 91Page By: Js iy Martinez, PE, City Manager Approved as to legat form and -le al sufficiency By: Julie O. Buii. City Attorney, Approved to Ins rR,eqiirerflentS anager Requirements Mariano Feinand4, uilding Official ATTACIEMENTS I. DRPIt Forms "A" - DBPR Elevator Inspection Report (Form FIR 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 BR 7016) II. CITY OF IVITA1VII 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 III. City of Miami to provide a list of data elements not collected fref: Special Provisions 7)b. and 7)c.] rsr:Ducumenl 252993 .7 0) 0 a CV 3 Lm 0 tt N 0 CC 0 d CO 0 • INSPECTION DATE r:tpr :4 art.4-2r L ©@ ®® el .00000 O o 0 06 O O 0 O tD 0 0 0 0 CD 0 CD -CA ldJ 0 g CERT FIFO ELEVATOR IrISPECTOP, (CEI) m 0 0 0 0 O 6 0 (0(� ''� 0 0: O 0. 0' 0 0 0 0 0 0 0 O 0 0 0 2 0 0 5 0 .0 TYPE OF INSPECTION . 0 Routine 0 Alteration Acceptance 0 C211bacic.. OConstruction 0 Initial Acceptance 0Temporary Operating la pectien O Accident • 0 Colnplaint 8 Compliance Nlonitoring • Inldustry OversighUAudit VIOLiATIONS FOR VIOLATION CODES, PLEASE GO TO THEINTEP,NET AT:•nruvw.MyFlorida_comldbpdhdelevators-html TIME IN TIME OUT Building I•larne Building Address City Stale of Florida _ Page of DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Diyisloh of Hotels and. Restaurants - Bureau of Elevator Safety Northwood Centre, '1940 North Monroe Street, Tallahassee, FL 32399-1013 P)1: 850-487-1395 • wtwv.MyFloridaLicense_com/dbpr/hr- Fax: 850-922-6208 ELEVATOR INSPECTIOI.1 REPORT DEFINITIONS CEI - FL Certified Elevalor Inspector CET- FL Certified Elevalor Technician REC - FL Registered Elevalor Company VIOLATIOII 1 VIOLATION 2 • 0 0 0 O CD OD 0000 00000 ®000 0000 ©000 000© 0000 0000 0000 • 0000 00000 00000 ooCD. 0 00000 0CD©0 Oo0:0 o. CD CD I� 000,0 00oo VI0LA1101.1 4 _Ip Code ",i'•ezi4. sup1411t15x�'�#zp SERIAL NUtvMBE 0 n 0 5 0 0 0 C) 0 lCD 0 C CD t p 0 0 0 0 0 4 0 6 0 0 0 0 0 CD CD CD 0 8 0 0 CD 0 0 (0 0 CD 0 0 0 81 1 certify that as the elevator company supervisor, I directly supervised the consInxtion or Inc allallon of this elevator. Or see attached elevator Installation arndavit. Signature . Print Warne Cali CETi Phone Number 0 0 0 0 0 1C)1O0 ®®g®CD O®OCDCD ©00DCD 0.000 00CD0 0 0 0 0 0000 VIOLATION 5 0 CD0 C Q I0000 00000 00000 OOo00 0000 0000 • J000 7 7 7 0•00.o 0000 VIOLATIOII5 CD 0 0 C CD CD o000 00000 00000 000.00 00©© 0000 0000 0000 OOOC ti.'•r.1C1:$'E?:Uiit� : �t�: , ,.�Z:r:�: ;_la _s.�•rt;� If violations are cited,this report constjiute.s'an Order to Correct as outlined in s_ 399.061(4), Florida Statutes. Violations must be corrected within 30 days in accordance with s. 399.105(A). Florida Statutes. Signature VIOLATIOOOT VIOL/MOH 5 VIOLATION 9 L000®OOOQ@CDOOCDL I-1 C OoC CD COoo®80C100 CD000c,cCD0®CDcCD0o© 0®®®O NI.LC'OOfln®®O oo0oCDco00©OOoO 0000. 0000 ©®0QD 001�CD COrCC CD®.00 000 CD71oc 0000 .0000 O 00o - 000.0 •oo00 0000 0000 Kif Ex = ArA ittb NSi Ztov-. h_-tztg:' 44tk-,:.-s . I certify that I have personally performed or witnessed: 0Y Routine inspection 0 Periodic tests es prescribed by ASME A17.1 O Acceptance inspection of new or altered installation as recommended by the ASME A17.2 inspectors Manual Violations cited on the previous inspection report have been corrected. OInstallation meets or exceeds minimum standards or Chapter 399, Florida Statutes, and Chapter 30 of the Florida Building Code adopted by Pule 9B-3.047, Florida Administrative Code_ . Print Flame .( Title .I . Signature CBI Flint Name • Phone Number This device 0 Complies with 0 Does Not Comply With Is Exempt From • Section 399.15, Florida Statutes: Regional emergency elevator accessltire key requirements. AND 0 Complies With 0 Does Not Comply With 0 Is Exempt From • Section 553.509, Florida Statutes: Alternate. power requir_menls_ Completed inspection report must be returned to the Bureau or Elevator Safety within five (5 ive(5) tiorlcino days of i nspection_p1 aty©NUp:1t .1p161C®HR MEE ©dEI A1Nt C.PspEREIra a I • Phone Number r_ LE?SE b0 NOT WRITE BELOW THIS .LINE NOTICE TO CERTIFIED ELEVATOR INSPECTOR CENTRAL OFFICE COPY TO: ..FROM: STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION MONTHLY CONTRACTED ACTIVITY REPORT Bureau ofElevator Safety - Compliance Section Reedy Creek Improvement District X City of Miami City of Miami Beach Miami -Dade Broward County SUBJECT: ELEVATOR INSPECTION FOR. T HE 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 ACCIDENT INSPECTIONS PERFORMED 9 ELEVATORS SEALED FROM PUBLIC USE 10 NEW ELEVATORIESCALATOR 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 DATE 0) 0 0 N OBPR•Form HR 50 INSPE- CTION DATE OOO as CD CD g5 CD CD C5 V 0 UgI U CI 11 0 12 13- CERTIFIED ELEVATOR INSPECTOR (CEi) f TYPE OF INSPECTION . 0 P,cutine Alteration Acceptance Callback donstruclion . O Initial Acceptance OTemporary Operating Inspection TIME IN ' TIME OUT a.'� F .6Pf2eU�S O.IVL r . O,accident O Oomplaint (J Oompliance Monitoring O industry Oversight/Audit - Building hlame . Building Address • Stale of Florida Page of. DEPARTMEiNNT 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: B50-487-1395 - www.MyFloridaLieense.com/dbpr/br - Fax: 850-922-620 ELEVATOR _INSPECTION .REPO DE PIN I T I 0 115 CEI - EL Certified Elevator Inspector CET - FL Certified Elevator Technician P.EC - EL Registered Elevator Company VIOUAT1ONS FOR VIOLATION CODES, PLEASE GO TO THE-INTERNETAT: www.MyFtorida-com/dbpr/lu-lelevators.html VIOLATION VIOLATION 1 VtOLATIOII 3 • 21p Code �r SERIAL NUMBER 7 'L 0 g. 3 r v) I certify Thal as Ilse elevator company supervisor. I directly supervised the ernslmcren or lee Or see attached elevator installation affidavit Et Y Slgnelure C C) CO r0 'l 0 O 0 Punt Name 0 O 00 JL 00 C] 0 CD QB I0 0I 0 O Izl L1 ttCD (0^ 0 0 C 0 0 0 0 0 CO) isl allalion of !tins elen CETt- Phone Number VIOIJ,TIOIIA vIOLATION 5 VIa1.ATION e 0 0 O 0 H CO 0 CD0 00000 r:a 0 CD ®00008 OD .©©00 0000 e 00tr 0000. �000 O O Or�1 O�' 0 0 CD C�QD 000.0 OOO@ ®- • ©0®0 0:© 00 .O O O CD 0 @ @ 00000 000l0© 00010 00000 0000 000© 0CD00 0000 OOOGD OOOL'OA II OOOCD ®C 1010�l0 NI 0 03 V 0 0 0 0 0 CD CD QD ©©©0 OD Ot7000 IDOOUO 0010(��j� 0 0 0 0 10 Q 0 0 0 0 10 . 00©0 10000 C)0(00 tei r.i J,..Y}^ .i.4:17:41._. r:fe5:` sp1�1F,i .-A l 4 1, .iilyr,�t:(ufa. $,.. •!.,,, �i'iw,-.���il.¢; °;i+. rPMRS.Fit itt:CBrit€ it , elOLATIO117 OE CIUOO B CDOCO 10000 0000 QDO.OcD .1000© 10 0 H .0000 0 10 10 VIOLATION O @ V iI 0 O [i @ 0-0000 00000 0L00 10©00 0001�) 00QDCD n 0 0 0 VIOLATION 3 0 00 0 A! 0000© L OI1,O© nn 00 0 0 L 0000 OOQDO 0000 C 00t 0 0 C0 CD c0 I certify that I have personally performed or will essed: n Routing it spection 0 Periodic tests as prescribed by ASME A17-1 OAcceptance inspection or new or altered installation as recommended by Uwe ASME A172 lnsper:tors Manual 0 Violations cited on the previous Inspection report have been -corrected. OInstallaticn meets or excaedsminimum standards of Chapter 399, Florida Statutes, and Chapter 30 of the Florida Building Code adopled by Rule 9B 3.047, Florida Administrative Code. If violations are cited, this report constitutes an Order to Correct es outlined in s. 399.06'(4), Florida Statutes. Violations must be corrected within 30 days in accoFdance with s. 399.105(4), Florida Statutes. Signature • Print flame Tills Phone Number. PLEASE DO PIOT WRITE BELOW' THIS LIN E E I E • 9 tl: HMt3 I E R fa Signature CEI a RELY Paul Nance Phone Number This device 0 Complies With 0 Does Not Comply Ylith 0 Is Exempt From Section 399.15, Florida Statutes: Regional emergency elevator access/5re. Irey requirements.. AND Complies Willi O Does Not Comply With Is -Exempt Froth Seclion 553.509, Florida- Statutes_ Alternate power requirements. NOTICE TO CERTIFIED Compl=_led inspection report -must be ELEVATOR INSPECTOR • returned to the Bureau of Elevator safety vdi[hin Eve (5) working days of inspection. CENTRAL OFFICE COPY 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. 9 Ranarmx ,r > a Graz ....._ k �' ' , i SECTION,1 EQUIPMENT LOCATION 6 `:..,.... f ,: t ..ti... l,t. ? <<:,:_.t>: t'.: .. rrr,., ... _ .: _.:•irfi•,:: License ■ Elevator ■ Moving Walkway Accident Date (mm/dd/yyyy) Number • ■ Escalator ❑ Wheelchair Lift Time of Accident Hour Minute ■ AM ■ PM r Owner Name Business Name t Building Address City ' k County State I Zip Code Phone Number ,, SECTION2 SERUICEMAINENANCE1, 1.I '; t!i?.r. ^'1�:.+t .._1_..'''. � f i� �:1 ,'' 'r r �r�i •:.. r . .... '. �... �,t .!:.r�r �,.:. :rd ' ...t :..:. r r .�,.�'n i . ._ Is the elevator or escalator under a service maintenance contract? ■ Yes ❑ No ❑ Unknown Name of Elevator Maintenance Company Was • Yes the •No elevator service maintenance company notified? ■ If yes, indicate date (MM/DDIYYYY) Most recent ■ 6 months required test performed? • 1 ❑ 3 yearyearsyears(m 115 Test Date /yyyy) , � F � I tii , _?�-;. `:, " ^Y' SECTION 3 IACCIDENt� DETAILSr r n� Y i ' l� . ,1c Brief Narrative: (attach additional sheets as necessary) PLEASE CHECK ALL THAT APPLY . Medical Attention ❑ Fall ■ Bruises 1 ❑ Entrapment ■ Hand I ■ Fingers 1 ■ Hair ■ Other Req'd • Y ■ N ■ Trip • Cuts 1 ■ Arm ■ • Leg ■ Knee I ❑ Foot ■ Toes I ❑ Torso Other Factors: ■ Carryon Items/Packages ■ Stroller ■ Safety Issues ❑ Mechanical ❑ Other Clothing/Footwear Involved: ❑ Sleeves ■ Purse ■ Shoes ■ Dress/skirt ■ Pants . ■ Coat ■ Other Equipment Involved: ■ Door Open I ❑ Step —Stair Tread ■ Floor Leveling ❑ Esc, Side Wall I II Esc. Railing Witnessed Activities: ■ Unsafe Rider Behavior ■ Equipment Malfunction ■ Other Post Event Inspection Req'd ❑ Y ❑ N I Performed by: Date (opironar) Unit Cleared for Continued Use: ■ Y ■ N Cleared By Date ::,:, �. r-,..•,:'� �;��.. ._,.,,,?-, 1 - .,trI. �+ r , r r `r SECTION 4 REPORTING SIGNATURE ,, ., „ d �t ; 4.1 Ir 1 r..} 1r11 ?-t:. .•! 1 r ti. f (. .. :...,1 / .... rI. ..Y.. J'. -... .n fJrf: a., r-,:rn . .: ... ... .. .•. ... r :{. ra .. . AI Y ..xr ...r ..•j lr'ir.Tn .... r. Report Submitted by Date (print name) Title Current ■ Y. Certificate ? ■ N ■ NA Signature j 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 •— -ElevatbrSafety within 5 days of' the' accident." You niay fill in -the Online'forni-or'Portable Document -Format (PDF) Version of this report, save it to your hard drive and e-mail it to: dhr.elevators(7dbor.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