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HomeMy WebLinkAboutState Interagency Agrmt. FR/SRSTATE INTERAGENCY AGREEMENT DBPR INTERAGENCY AGREEMENT • BETWEEN TI-i if, DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS AND CITY OF MIANII 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 Hotels and. Restaurants, hereinafter referred to as the DEPARTMENT and the City of Miami, by and through the Department of Building and Zoning, whose principle address is 444 SW 2nd Avenue, 4th Floor, Miami, FL 33130-1910 hereinafter referred to as the CONTRACTOR Pursuaufto 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) COMMUNICATIONS: The DEPARTMENT agrees to 'have open and direct linos 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 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 stalceholders. 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..aiiinspector:s professional .creclential..cerlific.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 Cocle, 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, cormnitted 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) clays 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 3jPage shall maintain all such records according to the retention schedule employed by the DEPARTMENT'S 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 sighs an Affidavit, the certificate and forum 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. Ai. 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, specked 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 Iicensing 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 front 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 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: J 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 Ao •eement. 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 (G0) days prior to and until termination of this Agreement. _ _...11).C.OMPLIANCE:..Eor.. the .purp.ose of.. ensuring .compliauce 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 J Page effectiveness of the CONTRACTOR'S inspection and enforcement activities and verify the accuracy of the inspections performed. The DEPART1vIENT 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) clays 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 Agfeeinent 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 Agreement. 6IPage 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 cane] this Agreement by giving CONTRACTOR immediate written notice of cancellation. 18)RENEWAL: This Agreeir ent may be renewed for -one additional -ten -year -term -provided the DEPARTMENT is satisfied with the CONTRACTOR'S 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. 7IPage STATE OF FLORIDA BILL VEACH, DIRECTOR Department of Business and Professional Regulation Division of Hotels and Restaurants 194.0 North Monroe Street • Tallahassee, Flbrida 32399-1011 tri*A -F�BProue� Dale iVioved: 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 Sniith, General Counsel 81Page CITY OF MIAMI ATTEST: Priscilla Thompson Cleric of the City of Miami Date: 9jPage 2011 By: J iy Martinez, PE, City Manager Approved as to legal form an -le—al sufficiency By: Julie 0. Bru City Attorney, fAPProV,d'aS to Ins CalvuBllis, Ri /i Approved as to .\ Mariano Feinandtiz, irements anager Requirements uilding Official ATTAC IMENTS I. DBPR Forms "A" - DBPR Elevator Inspection Report (Form RR 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. crrr OF MIgAMI 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 [ref: Special Provisions 7)b. and 7)c.] rsr:Document 2E2993 2 • INSPECTION DATE F.ar,,gitt Lr:i 7-1r 0 0 00000 0000 0 - 0� 1 V 0 c 0 0 I ® 0 0 O 0 V 0 0 0 lI_". CERT FIEQ ELEVATOR IMSPECTOR (CEI) m r0 0 0 CD 0 0 CID 0 ® 0 5 0 CD 0 0 1 O 3 0 0 D l _J TYPE OF INSPECTION O ROuline O Alteration Acceptance O Cllback.. 0 CI nstruction -.0 Initial "Acceptance 0 Temporary Operating In'speclion TIME IN TIME OUT 0 Accident ' - 0 Complaint 8 Cbmpliance Monitoring inldustry Oversight/Audit Building Name Building Address Clly State of Florida , Page of DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Divisloh or Hotels and Restaurants - Bureau of Elevator Safety Northwood Centre, 1940 I`•lorth Monroe Slreel Tallahassee FL 32399-101 3 Ph: 850-487-1395 •'www.Mvrlorida License eomldbpr/Fax:-922-6208Ir F S50 ELEVATOR INSPECTION REPORT b a F i r1I TI01•1S CEI - FL Certified Ete}ator Inspector CET- FL Certified Elevator Technician REC - FL Registered Elevator Company VIOLIATIONS • FOR VIOLATION CODES, PLEASE GO TO :THE INTEP,NET AT;•xuvw-MyFlorida.comldbpr/hdelevators_html VIOLATION 1 • VIOLATION 2 VrOViTloll] VIOLATOn n VIOLATION 5 D 0 0 0CD CD CD CD (^�\ ®000© ®®®®0 0 D O O D 000'�QD 0 CDV -J000 CD000 rabblzs �k- - 77' ";c:bfNl41.�-•:�'�rl� _ ..,..:_'-•:y-•;ta is ,.c.%;W'i+u'> 000CD, O O.OQO© ®0000 0CD, •D 00000 • ©©DO ©©©:© 0. 0 0 ti ©0®,0 DODO 0 0 0 0 CD CD 0 CD 0 0 ®0 02 ® 0 ®®®D O®®®O QD CD QD 0 000•0 0 CD CI QD TTTO O T O 0 htp Coda -;sup_ , .V10.4 .2 ta: y :5tgat I certify that as Hie ��r4 signature Print Name VIOLArloli s L 0 ( l" 5 0 0 D SERIAL NUiv1BER O CD 0 0 CD 0 D 0 ® 0 0 QD 0(� 0 elevator company supervisor, I, directly supervised the construction or inslanallon Or see allaehed elevator Installation affidavit cI ass elevatof. CE111 CET • 00000 1t OOO B ©000 ®®®'�®®� 0•�000 0 0 T 0 O 0 O I -I 0 0TTTI 00 VIOL5T109 T VIOLATION a Phone_ Number I certify that I have personally performed or witnessed_ ORoutine inspection OPeriodic tests as prescribed by ASME A1T.1 OAcceptance inspection of new or i altered installation as recommended • by the ASME A172 inspectors Manual 0 violations cited on the previous inspection report have been corrected. VIOLATION2 CD000@ 11OoO0 ®000© rv®ODD D O d O L ©000 CD©©© 0000 QD QD CD QD CD QD CD OInstallation meals or exceeds minimum standards or Chapter 399. Florida Statutes. and Chapter 30 of the Florida Building Code edopled by Rule 9B-3.047, Florida Administrative Code_ - P iFfe' If violations era cited,. this report conslilutgs'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(4). Fldrida Statutes. Signature Print Nary 1 Title Phone Number (PLEASE 00 I10T InIP.I'rE BELOW THIS .LINE signature CEI REG: Print Name Phone plumber This device O Complies With O Does Not Comply With 0 Is Exempt From - • Section 399.15, Florida_ Statutes: Regional emergency elevator access/fire key requirements. AND 0 Complies With 0 Does Not Comply With 0 Is Exempt From Section 553.509, Florida Statutes: Altemale power requirements. NOTiCE.TO CERTIFIED ELEVATOR INSPECTOR Completed inspection report must be returned to the Bureau of Elevator Sanely within rive (5) viorlcina days of Inspection_ CENTRAL OFFICE COPY To: -FROM: � U, ATE OF FLORIDA ospxnrweNnornumw, sxwornoF-=oumxAL REGuunmw MONTHLY CONTRACTED ACTIVITY REPORT Bureau of'E]ovobxSafety 'CompUoncoSeoton Ready Creek ImprovementDisthct x city ofMiami City ofM|am|Beach M|am|^Dado ` 8mwardCountY SUBJECT: ELEVATOR INSPECTION FOR THE MONTH DF 1 ROUTINE INSPECTIONS PERFORMED 2 PERIODIC INSPECTIONS PERFORMED 3 INITIAL INSPECTIONS PERFORMED (F|NAL) 4 CALLBACK INSPECTIONS PERFORMED 5 ALTERATION INSPECTIONS PERFORMED (F/NAL) G CONSTRUCTION INSPECTIONS PERFORMED 7 COMPLA|' INSPECTIONS PERFORMED 8 ACCIDENT INSPECTIONS PERFORMED g ELEVATORS SEALED FROM PUBLIC USE 10 NEW ELEVATORIESCALATORPERMITS ISSUED 11 ALTERATION PERMITS ISSUED 12 TEMPORARY OPERATION PERMITS ISSUED 13 NUMBER OFACCIDENTS REPORTED �- '- '14 N--U'Mu�"' ER� OFCO�PLANTSREPDRTED " 1� NUMBER OFELEV/TDRGESCALATORS TOTAL INSPECTIONS (1THROUGH 8) REPRESENTATIVE orcOIqmACTEoAGENCY � m •o N T r0 INSPECTION DATE 09 Q3 Q3 Cg 11 12 13_ CERTIFIED ELEVATOR IhISPECtOR (CEI) ft. 0 C CD 8 CI qj O n�n CD 0 TYPE OF INSPECTION . 0 Routine 'Alteration Acceptance Callback dan=truction . O Initial Acceptance O Temporary Operating Inspection TIME IN TIME OUT �.s 17.6Pi2EU, S�OIVLair�y��s OAccident O dompiaint O dompliance Monitoring O Industry Oversight/Audit Building (Jame . aly 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: 850-18T-1395 - wwlrw.MyFloridaLicense.com/dbprnlr - Fax: 850-922 500 / ELEVATOR 6NSPECTION.REPO DEFINITIOt•IS CEI -FL Ceilifled Elevator Inspector CET - R. Certified Elevator Technician Bee -FL Registered Elevator Company VIOLATIONS FOR VIOLATION CODES, PLEASE GO TO THE-INTERNETAT: wtnrw_Nlyt-lorida_com/dbprJlirlelevators_html VI0LtT101-12 ve3LM1Tlorl 3 . O @� O V 0r�� _0 0n CI CD ® QD CD CD O000CD ®®.Og •C©©0 l0 CD CD CD �=� 0 0 O H O®CJ -CD 00CD O O O 1@ O CD 0 0 0 0 0000© 1�yC'�®l�Q CD CD C ©0 0 ©©©© CD000 C©CO 0000 VIOLATION 5 21p Code r SERIAL NUMBER 7 C 0 0 CD AI). 0 n C^�I� 0 C CD f, 0 CD C' O n I7] CD /D I certify That as the elevator company supervisor.' directly supervised the construction or lnaenasnn m Ihis elevelcq or see attached elevator installation aIndavi5. Signature I CEIr: CET# Print Name Ph©ne Number g CD CD OOC_O I 1 1� ' O CI CD 0 CD CD CD0C100 5 0 C 0 0000 UOCCD 0000 VIOLATION 5 v1OV1T1011 7 VIOL0TICN iI CD 0 @ C-000© t^ OC®O 00007CD CD CD 0 CD CDC]U 00 D ©CDUe 0 (mil CD 0 0 I certify that 1 have personally performed or witnessed: n Roulina inspection O Periodic tests as prescribed by ASME A17.1 OAcceptance inspection of new or altered Inslatlallon as recommended by the ASME A17.2lnspeotors Manual ' 0 Violations cited on the previous Inspection report have been.con- cled. O Installation meets or exceeds minimum standards of Chapter 399, Florida Statutes, and CI apler 30 of the Florida Building Code adopted by Rule 92-3.047, Florida Administrative Code. 1'I0LATION 3 ds'-• ••• --•A^• _-••-••-•�—:i-SYt:C'i'ILVY, 91L.4Vr/HJiC.'11RNr7,YY7 l violations are cited, this report constitutes an Order to Correct as outlined in s_ 399.051(4), Florida Statutes_ Violations must be corrected within 30 days in ecco'rdance with s. 399.105(4), Florida Statutes. Sforr9_lure Tills Print Home Phone Number_ PLEASE DO NOT ,'SF.IITE BELOtJ THIS LIhf Signs taro CEt ^ Fee, Mint Name Phone Number Tnis device 0 Complies With L Does Nbt Comply With 0 Is Exempt From Section 292.15, Florida Statutes Rational emergency elevator access/fire key requirements, . AND O Complies With ri Does Not Comply With Is Exempt Front Section 553.509, Florida Statutes: Alternate power requirements. NOTICE TO CERTIFIED Completed Inspection report -muss be returned to the Eureau of Elevator Safety ELEVATOR INSPECTOR rithin five (5) working days of inspection_ 9: • CENTRAL OFFICE COPY DBPR HR-70'16 — 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. ::rt . (:.�t Ir y. :7 �:��. .,...:_...i.. u.: _I,rSI:.::: .,• .lr.:i. rv.'i. � 1 :�: "'� ��:• . .u. .. :. _.....•. �>:�,,,,:,,_.,:,. ,..t:l•,'.s:.:..,::-,•�....:_ ..�.�`' ir�'f; ECTONs1�:-=rEQ�I/IPfVIEt. T_,.,L.�.i:,•.rt,,:•...,.,...r.:•<�4 .. �•r•�r1ihY��'r� �•�. ��'4:ii rA;:✓ i License ■ Elevator ■ Moving Walkway' Accident Date (mm/dd/yyyy) t 1 Number '! Escalator ❑ Wheelchair Lift Time of Accident Hour Minute ■ AM ■ PM Owner Name Business Name Building Address----- - _-- -. _____ City _ _ ____-__-- County I State I Zip Code I Phone Number 1 ,Yr} ' ?r sl, Eh , SEC'IION12, SERViOE,MAINfiENANCE ;iyi,li `i t'. ,.... ,. .,,, • , •. T f::T ,. Is the elevator or escalator under a service maintenance contract? ■ Yes ❑ No ■ Unknown Name of Elevator Maintenance Company Was • Yes the elevator service maintenance company notified? ❑ If yes, indicate date (MM/DD/YYYY) • No Most recent ■ 6 months required ■ 1 year test performed? ■ 3 ❑5 years years Test Date (mm/dd/yyyy) •• AILS 1 . ,, c SECTION 3 IACCIDEN IY DEW` _ ,,. - ,.,.• . , _. �: .,....�.., Brief Narrative: (attach additional sheets as necessary) • PLEASE CHECK ALL THAT APPLY Medical Attention ❑ Fall 1 ■ Bruises (❑ Entrapment ■ Hand 1 ❑ Fingers ■ Hair 1 ■ Other Req'd ■ Y ■ N ■Trip 1 ■ Cuts I ■ Arm ■' Leg 1 ■ Knee ❑ Foot 1 ■ Toes 1 ■ Torso Other Factors: IN 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 'Esc. Railing Witnessed Activities: • Unsafe Rider Behavior ■ Equipment Malfunction ■ Other Post Event Inspection Req'd ■ Y ■ N Performed by: Date • (optional) Unit Cleared for Continued Use: ■ Y • N Cleared By: CEI # Date ,f ti li fir, , ,,; r r ;(n .i 'gg: IDN;4'' RERDRTING SIGNATURE ii, `.• ,., s .,.., ' „ F.w:,M!'r 2i:.. , '. Report Submitted by Date (print name) 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 -EI'evator.'Safety•within 5•days of the accident,- You May fill in -the oiiii:ie form or Porta61e'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 mall 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.comlhr Page 1 of 1