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HomeMy WebLinkAbout27337 docscity of san Luis oBispo .�,, Building & Safety Division • 919 Pdi 8trU01. jC)rPiPerf#01-3218 • (805) 781-7180 Project Address 692 MARSH Assessor's Parcel Number 002-422-024 Legal Description CY SLO MRY & CH ADD BL 7 OTN LTS 15 & 16 Project Description INSTALL 5 ELECTRICAL OUTLETS (7 ELEVEN STORE) Permit Type X Building Mechanical X Electrical Plumbing Sign Demolition Grading Property Owner GORDON SYLVIA THE Occupant/Business Name REDBOX AUTOMATED RETAIL;7-ELEVEN FOOD Mailing Address 12 GEARY ST #303 Architect/Engineer City/State/Zip SAN FRANCISCO CA, 94108- License # Contractor POWERHOUSE RETAIL SERVICES INC Contractor's Phone No. Mailing Address 812-A SOUTH CROWLEY RD Contractor's State Lic. No. 974217 City/State/Zip CROWLEY TX 76036 Project Manager JOSH HARGRAVE Project Manager's Phone No. 817/297-8575 Lender Name Lender Address C.B.C. Group B C.B.C. TypeV-B Stories 0 Codes: CBC10 CEC10 Census 437 Commercial Alteration or Addition Dwelling nl i�0 Motel Rooms 0 Valuation Total Building Value $0.00 Fees Le al Declarations g Building Permit 0.00 Plumbing+Electrical+Mechanical Permit 216.00 2a - CALIFORNIA LICENSED CONTRACTOR'S DECLARATION Grading Permit 0.00 S.M.I.P. 0.50 Green Building Fee 0.00 1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 Demolition Permit 0.00 commencing with Section 7000 of Division 3 of the Business and Professions Code, and Sign Permit 0.00 my license is in full force and effect Misc Charge/Credit 0.00 Administrative Permit 115.00 Contractor: POWERHOUSE RETAIL Class: B. C10 License #: 974217 Archival Fee 0.00 Subtotal 331.50 Investigation Fees 0.00 Building Plan Review Fee 0.00 Fire Safety Plan Review 0.00 Plan Review Subtotal 0.00 Development Review Fee 0.00 Fire Safety Surcharge 0.00 3a(2) - WORKERS' COMPENSATION DECLARATION -1 have and will maintain Fire Systems 0.00 workers' compensation insurance Fire Sur/Sys Subtotal 0.00 Construction Unit Tax 0.00 Water Impact 0.00 Area - 0.00 as required by Section 3700 of the Labor Code, for the performance of the work for which Water Meter Installation 0.00 this permit is issued. My workers' compensation insurance carrier and policy number are: Wastewater Impact 0.00 Area - 0.00 Carrier: VALLEY FORGE INSURANCE Policy #:4025670115 Expires 02/01/14 Traffic Impact 0.00 Area - 0.00 Affordable Housing 0.00 Public Art 0.00 Code Enforcement 0.00 Park Improvement Area - 0.00 Engineering Development Review Fee 0.00 Open Space In -lieu Fee 0.00 Total Fees 331.50 Balance Due 0.00 Payments Amount Date Receipt FPayment 331.50 06/27/13 61221 Total Paid 331.50 Application Number130626 Permit Number 27337 Application Date 06/27/13 Issuance Date 07/02/13 Fee Exemptions: Comments: Construction File /s/ Signed Original on File Signature of Contractor, Authorized Agent or Owner Date =TURBCHEF ENCORETM PERFORMANCE The TurboChef Encore oven uses radiant heat, high-speed air impingement, and side -launched microwave to cook food rapidly without compromising quality. VENTILATION ■ UL 710E (KNLZ) listed for ventless operation.' ■ EPA 202 test (8 hr): Product: Pepperoni Pizzas - Results: 0.13 mg/m3 ventless Requirement: <5.00 mg1m3 ■ Internal catalytic filtration to limit smoke, grease, and odor emissions. 1. Impingement Heater 6. Catalytic Converter 2. Bottom Browning Element 7. Vent Catalyst 3. Side -Launched Microwave 8. Air Filter 4. Blower Motor 9. Inlet Air for Cooling 5. Impinged Air Electrical Components Project Item No, Quantity M n O X m EXTERIOR CONSTRUCTION ■ Powder coated, corrosion -resistant steel outer wrap ■ Powder coated, corrosion -resistant aluminum front panels and door ■ Cool -to -touch exterior; all surfaces below 122°F (50°C) ■ Ergonomic door handle INTERIOR CONSTRUCTION ■ 201 stainless steel ■ Fully welded and insulated cook chamber ■ Removable rack and lower jetplate FEATURES ■ Easy to clean ■ Integral recirculating catalytic converter for UL 710B (KNLZ) listed ventless operation ■ Variable -speed High h recirculating impingement airflow ■ Independent bottom temperature offset ■ Smart menu system capable of storing up to 256 recipes ■ Light ring provides visual cues for cooking ■ Built-in self -diagnostics for monitoring oven components and performance ■ Stackable design (requires stacking kit) ■ USB and Smart card compatible ■ Smart Voltage Sensor Technology* (U.S. only) ■ Includes plug and cord (6 ft. nominal) ■ Warranty - 1 year parts and labor STANDARD ACCESSORIES ■ 1 Baking Stone (ENC-3012) ■ 1 Oven Rack (ENC-1279) ■ 1 Aluminum Paddle (NGC-1478) ■ 1 Bottle Oven Cleaner (103180) ■ 1 Bottle Oven Guard (103181) ■ 2 Trigger Sprayers (103182) ■ 2 Non-stick Baskets (NGC-1331) ® UKc us AN 81Y5 #4 t ,5 This product conforms to the ventilation recommendations set forth by NFPA96 using EPA202 test method. *Smart Voltage Sensor Technology does not compensate for lack of or over voltage situations. It is the responslVility of the owner to supply voltage to the ur it according to the specYncaYions on the back of Ynls sheet. t Ventiess certification is for all food items except for foods classified as 'Tatty raw proteins" Such foods include bone -in, skim -on chicken, raw hamburger meat, raw bacon, raw sausage, steaks, etc. Itcooking these types of foods, consult local HVAC codes and authorities to ensure compliance with ventilation requirements. Ultimate ventless allowance is dependent upon AHJ approval, as some jurisdictions may not recognize the UL certification or application. If you have questions regarding ventless certifications or local codes please email ventless.heip@turbochef.com TurboChef reserves the right to make substitutions of components or change specifications without prior notice. DOC-1314/Revision E/ October 2012 LU 0 U z W DIMENSIONS Single Units Height 19" 483 mm with legs 23" 584 mm Width 21 A" 544 mm Depth (footprint) 28.6" 726 mm with door closed 32.7" 831 mm with dooropen 39.4" 1000 min Weight 185 lb 84 kg Stacked Units (Stacking Kit Required) Height 38.5" 978 mm with legs (bottom oven) 425" 1080 mm Width 21.4" 544 mm Depth (footprint) 26.6" 726 mm with door closed 32.7" 831 mm with door open 39.4" 1000 mm Weight 370lb 168 kg Cook Chamber Height 6" 152 mm Width 15.5" 394 mm Depth 14.5" 368 mm Volume 0.78 cu.ft. 22.1 liters Wall Clearance (Oven not intended for built-in installation) Top 5" 127 mm Sides 2" 51 mm El ECTRICAL SPECfFICATIONS-SINGLE PHASE Encore US Model (ENC-9500-1) - North America Voltage 208/240 VAC 1 i / NEMA 6-30P Frequency 60 Hz Current (Max Circuit Requirement) 30 amps (30 amps) Max Input (MW Input) 208: 5.99 kW (33 kW) 240: 6.675 kW (3.5 kW) Encore UK Model (ENC-9500-2-UK) - Europe/Asia Voltage 230 VAC O I IEC309, 3-pin Frequency 50 Hz Current (Max Circuit Requirement) 30 amps (30 amps) Max Input (MW Input) 6.7 kW (3.5 kW) Encore BK Model (ENC-9500-6-BK) - Brazil Voltage 220 VAC ° ° �o IEC 309, 3-pin Frequency 60 Hz Current (Max Circuit Requirement) 30 amps (30 amps) Max Input (MW Input) 6.7 kW (3.5 kW) Encore LA Model (ENC-9500-7-LA) - Latin America Voltage 220 VAC � o NEMA 6-30P Frequency 60 Hz Current (Max Circuit Requirement) 30 amps (30 amps) Max Input (MW Input) 6.7 kW (3.5 kW) TurboChefiSlobalOperations 4240International Pkwy, Suite 105 / Carrollton,Texas 75007 USA US: 800.90TURBO (800.908.8726) / International: +1 214.379.6000 Fax:+1 214.379.6073/www.turbochef.com (102 mm) X- Encore JK Model 50 Hz (ENC-9500-8-JK) -Japan JK Model 60 Hz (ENC-9500-10-JK) -Japan Voltage 220VAC Frequency 50 or 60 Hz Current (Max Circu it Requi rement) 30 amps (30 amps) NEMA L6-50, PSE, Max Input (MW Input) 6.7 kW (3.5 kW) 3-blade ELECTRICAL SPECIFICATIONS-MIULT1 PHASE Encore ED Model (ENC-9500-3-ED) - Europe/Asia Delta Voltage 230 VAC 0 \ �p I J IEC 309, 4-pin Frequency 50 Hz Current (Max Circuit Requirement) 30 amps (30 amps) Max Input (MW Input) 10.5 kW (3.5 kW) Encore EW Model (ENC-9500-4-EW) - Europe/Asia Wye Voltage 400 VAC O 0 (ti� IEC 309, 5-pin Frequency 50 Hz Current (Max Circuit Requirement) 16 amps (20 amps) Max Input (MW Input) 10.5 kW (3.5 kW) Encore AV Mode) tENC-9500-5-AU)-AustralialNetvZealand Wye Voltage 400 VAC v O ° Ciipsal, 5-pin Frequency 50 Hz Current (Max Circuit Requirement) 16 amps (20 amps) Max Input (MW Input) 10.5 kW (3.5 kW) Encore JD Model 50 Hz (ENC-9500-9-JD) -Japan Delta JD Model 60 Hz (ENC-9500-11-JD) -Japan Delta Voltage 200 VAC NEMA L6-50, PSE, 4-blade Frequency 50or60Hz Current (Max Circuit Requirement) 30 amps (30 amps) Max Input (MW Input) 10.5 kW (3.5 kW) Encore KW Model (ENC-9500-12-KW) -Korea/Middle East Wye Voltage 400 VAC / o� o � ° IEC 309, 5-pin Frequency 60 Hz Current (Max Circuit Requirement) 16 amps (20 amps) Max Input (MW Input) 10.5 kW (3.5 kW) Encore SD Model (ENC-95W-13-SD) - Koye&JMiddle East Delta Voltage 230 VAC 0 60 Hz O 0� 30 amps (30 amps) J 10.5 kW (3.5 kW) IEC 309, 4-pin Frequency Current (Max Circuit Requirement) Max Input (MW Input) SHIPPING. • U.S.: All ovens shipped within the U.S. are packaged in a double -wall corrugated box banded to a wooden skid. International: All International ovens shipped via Air or Less than Container Loads are packaged in wooden crates. Box size: 35.8"x 26.4"x 26.3" (909 mm x 671 mm x 668 mm) Crate size: 40"x 36" x 35" (1016 mm x 914 mm x 889 mm) Item class: B5 NMFC #26770 HS code 9419.91 Approximate boxed weight: 235 lb. (106.6 kg) Approximate crated weight:310 lb. (140.6 kg) Minimum entry clearance required for box: 26.8"(681 mm) Minimum entry clearance required for crate: 35.5" (902 mm) 0 TurboChef requires installing a type D circuit breaker for all installations. © 2011-2012TurboChefTechnologies, Inc. Turbo Oven Specs 2dA 28 C4EMn t I �manca mo wa E e68 u 4LEW� tCLEYO 1 O � i O 196 eeas ey � 68 30' ---�i ansrtd n3� TURBOCHEF NGCZ OVEN - ALL MODELS -M7 �� 11.45 7.1-7--30' oaHiEa mn 2757 2 1=2 14 HFD Combo Serve HFD Mini HFD Low Profile HFD HFDXXX)= HFDCXXM HFDMXX)(XX HFDLXX)DD( 6ft'(170titers) 6ft(170liters) 4.1 ft3 (116 liters) 2Aft3(681itprs) 27.6'(700rnm) 27.6'(700mrn) 27.6* (700mm) 15.0 (361 mm) 35.3'(896mm) 35.3'(896mm) 24.9*(632mm) 35.3* (896mm) 19-7'(S00rnrn) 193"(50I)mm) 19-7'(SOOmm) 19-7'(500mm) 154 lbs (70 kg) 160 lbs (73 kg) 122 lbs (55 kg) 94 lbs (44 kg) (6) 141 IN (6) 141 IN (4) 141W (2)147W (6)40WXenon (6) 40W Xenon (3) 40W Xenon (2) 40W Xenon ANSI Standard Z97.1 Tempered (6)Temperature (6)Temperature (4)Temperature, (2)Temperature Controls 1 00-F - 255'F Controls I 00'F - 2551 Controls 1 00'F - 255'F Controls 1 Wl' - 2551 12 Timers. programmable from I to 4 hours 11 SVAC, 6OHz, 9.2 amp I I 5VAC, 60Hz, 0.2 amp 11 5VAC, 6OHz, 6.2 amp 11 5VAC, 60Hz 3.4 amp Model 5 only Standard Standard Standard Rectangular Trays& N/A N/A WA Round pans UL File # E314888 UL File # E314888 UL File # E314888 UL File # E314888 UL File # E314888 ef-HYMMV42, NSF Listing Serial 4 NSF Listing Saris) # W Listing Serial NSF Listing Serial # D052450 0052450 D052450 D052450otrLwx=,x) CI&US 0 LISTEDNERANSI STANDARD 4 16 REFR/GERATORMANMFACTURER air more durable,convenient, beautiful 1250 Victoria St Carson, CA 90746 Tel. 310-900-10 Fax. 310-900-107777 www.turboairinc.com Project Model # : Item # Available W/H : Approval : Qty : EXCEPTIONAL 2 YEAR Model: TWO-28SO PARTS & LABOR WARRANTY FERFUBES / BENEFITS- ■ STAINLESS STEEL CABINET CONSTRUCTION in HIGH -DENSITY POLYURETHANE INSULATION The Turbo Air Super Deluxe model boasts a stainless steel interior The entire cabinet structure and solid doors are foamed -in - and exterior (galvanized steel back & bottom). It guarantees the place using high density, CFC free polyurethane insulation. utmost in cleanliness and long product life. The Super Deluxe can add a touch of style to the most refined setting. ■ ERGONOMICALLY DESIGNED DOORS Customers' fatigue fades away with easy grip handles and ■ STURDY, CLEAN STAINLESS SHELVING doors that open effortlessly. These features along with Shelves are the most important part of cleanliness as they come in self -closing doors make this the ultimate choice in customer direct contact with food. After a while, PVC coated wire shelves may convenience. ABS sheet door liners resist water condensation peel, rust and lead to unsanitary conditions. Only the Turbo Air Super with thermal efficiency. Deluxe series uniquely provides stainless shelving. ■ HOT GAS CONDENSATE SYSTEM Through TurboAir's creative innovation, the condensate system surfaces have been specially treated to resist corrosion. This not only increases efficiency without the risk of refrigerant leakage from corrosion, but also prevents the overflow of condensate water. ■ EFFICIENT REFRIGERATION SYSTEM Turbo Air's solid door refrigerators are designed with oversized and balanced (CFC Free R-134A) refrigeration systems. These include efficient evaporators and condensers for faster cooling and greater efficiency. ■ MAGNETIC DOOR GASKETS Magnetic door gaskets are of one piece construction, removable without tools for ease of cleaning and replacement. ■ REFRIGERATOR HOLDS 330F — 380F FOR THE BEST IN FOOD PRESERVATION NSf r 0% ;, M1„£ ENERGY STAR® ` % - 2 111T!Z'11 Qualified interteh IS09001 Model Swing Door CU./FT. #of Shelves HP AMPS Crated Weight (tbs.) L x D`x Ht (inches) TWR-28SD 1 7 1 1/4 6.6 175 271/2 x 30 x 331/2 Vec201203 "Depth does not Include 1 "for rear spacers. t Height does not include 5-718- Tor caster neignt. Model: TWO-28SO ELECTRICAL DATA Voltage 115160/1 Plug Type 0 NEMA-5-15P Full Load Amperes 6.6 Compressor HP 1 /4 Cord Length ft. 9 Refrigerant R-134A DIMENSIONAL DATA Net Capacity cu. ft. 7 Ext. Length Overall in. 271/2 (699mm) Ext. Depth Overall in" 30 (762mm) Ext. Height Overall in! 33v2 (851 mm) # of Doors 1 # of Shelves 1 Gross Weight lbs. 175 Net Weight lbs. 157 Design and specifications subject to change without notice. Actual shipping weight may differ due to extra packing materials for product protection. Depth does not include 1 "for rear spacers. i Height does not include 5-7/8' for caster height. ■ WARRANTY, Exceptional 2 Year Parts and Labor Warranty Additional 3 Year Warranty on Compressor ■ SELF-CONTAINED SYSTEM ■ 411 SWIVEL CASTERS ■ 2.5" DIA. CASTERS AVAILABLE (OPTIONAL) ■ LEGS AVAILABLE FOR ALL MODELS (OPTIONAL) ■ OPTIONAL ACCESSORIES: ❑ 2.5" Diameter casters ❑ 5" Diameter casters ❑ 6" ABS plastic legs ❑ Additional stainless steel shelves ❑ Additional PE coated Wire shelves Vec201203 PLAN VIEW (unit: inch) PLAN VIEW 30(762mm) --31/2" E 235/8 (599mtn) N —A[ 127!8 (328mm) — I I -, 143!4 (373tmn) SIDE VIEW F-,� ■ ENERGY STAR Turbo Air: 800-627-0032 ■ GK : 800-500-3519 4AINNL 11 Qualified ■ Warranty: 800-381-7770 ■ AC: 888-900-1002 Intertek IS090t11 Turbo GERlFE IlRaoianceRairair HGV� Model : TWF-28SO ELECTRICAL DATA Voltage 915i6Q/9 Plug Type NEA1A-5.15P R41 Load Amperes 5.3 Compressor HP 113 Cord Length it. 9 Reldgentnt R-404A DIMENSIONAL DATA Net Capacity eo it. 7 Ext. Length Overall in. 27t (899mrn) Ext. Depth Overall in: Ext. Height Overall in.t of Dom 33 (762rnm) 33vr (f3 9mm) 1 N of Shelves t Gross Weight lbs. 175 Net Weight Ibs. 157 )EK}`JI :rf:1 Sf[.YS'.CNNfS w!'[�t IJ.P. ti fC KnF.ou MYi:�. .1sei tpP s wciglA rue sit't� dL': 1, csaa F_kir.>;m�enai. rarpn du�t}�r,�Ie:tion ■ WARRANTY: Exceptional 2 Year Parts and Labor Warranty Additional 3 Year Warranty on Compressor ■ SELF-CONTAINED SYSTEM ■ 4" SWIVEL CASTERS ■ 2.5" DNA. CASTERS AVAILABLE (OPTIONAL) ■ LEGS AVAILABLE FOR ALL MODELS (OPTIONAL) ■ OPTIONAL ACCESSORIES: ❑ 2.5' Diameter casters ❑ 5" Diameter casters ❑ 6'ABS plastic legs ❑ Additional stainless steel shelves ❑ Additional PE mated wire shelves ti_r.2nIXQ I PLAN VIEW funit - inch PLAN VIEW rep -,a!—) SIDE VIEW I ■ Turbo Air:900-627-6032 ■ GK: 8W-500-3519 '""" • Warranty: 8DD-381 '"%^(> ■ AC: 88b 9(!lt-1[tD2 InWWr I5o9L111 �� ki1Gv a onamance w�oa� &,► v"aEi Q ACORE® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIMY) 1/28/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER E:CT Amanda Villanueva Higginbotham 500 W. 13th Street PHONE 247 7 FAX No: 7- 7 81 EREss: i i Fort Worth TX 76102 INSURERS AFFORDING COVERAGE NAIC # INSURER A 'COnfinental Insurance INSURED POWERH INSURER B: rrIndernnfty & LiaVility1 Powerhouse Retail Services, LLC iNsuRERc:Nabonal FireHartford The Powerhouse Retail Services, LLC of Iowa INSURER DMalley ForForne InsuranceCompany 0 508 Powerhouse Partners, LLC INSURER E: 812-A South Crowley Road Crowley TX 76036 1 INSURER F : L:vvtKAUrb GEKIIFIGATC NUMBER: 153R573311 REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF IMMIDOnnrM POLICY EXP (M1M11DQ(YYYY)LIMITS A GENERAL LIABILITY 5082984796 1/2013 1/2014 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR PRA M SES EaGE ENTEL) occurrence) $100,000 MED EXP (Any one person) $5,000 X Ded:$1,OD0 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS - COMP/OP AGG $2,000,000 $ A AUTOMOBILE LIABILITY 5082984880 1/2013 21112014 Ea accidentLIMIT ) $1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ( ) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE p�den; $ Comp/Coll ded $500 B X UMBRELLA LIAR X OCCUR SISCCCLO1754213 1/2013 1/2014 EACH OCCURRENCE $5,000,000 AGGREGATE $5,D00,000 EXCESS LIAR CLAIMS -MADE DED RETENTION $ $ C D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? NIA 5082984846 025670115 1/2013 1/2013 1/2014 1/2014 X WCSTATU- OTH T �S E.L. EACH ACCIDENT — $1,000,000 E.L. DISEASE - EA EMPLOYEq $1,000,000 (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT I $1,000 D00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, AddMonal Remarks Schedule, M more space is required) The General Liability and Automobile Liability policy includes a blanket automatic additional insured endorsement that provides additional insured status (gl includes completed operations) and General Liability, Automobile Liability and Workers' Compensation policy includes a blanket waiver of subrogation endorsement to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. The General Liability policy has a blanket Primary & Non Contributory endorsement that affords that coverage to certificate holders only See Attached... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED ©1983-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: POWERH A4 ORo0 ADDITIONAL REMARKS SCHEDULE Pagel of 1 AGENCY NAMED INSURED Higginbotham Powerhouse Retail Services, LLC The Powerhouse Retail Services, LLC of Iowa POLICY NUMBER Powerhouse Partners, LLC 812-A South Crowley Road CARRIER NAIC CODE Crowley TX 76036 EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE there is a written contract between the Named Insured and the certificate holder that requires such status. he General Liability and Automobile Liability and Workers Compensation policies include a blanket notice of cancellation to certificate olders endorsement, providing for 30 days' advance notice if the policy is canceled by the company other than for nonpayment of premium, 0 days' notice after the policy is canceled for nonpayment of premium. Notice is sent to certificate holders with mailing addresses on file with ie agent or the company. The endorsement does not provide for notice of cancellation if the named insured requests cancellation. is follow form. ALVKU TUT ILUUO/UT) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD LAN Paul Schifino Board Chair 13L-241REV. 12.071 ® 04p n7 1ncarn STATE OF CALIFORNIA Pursuant to Chapter 9 of Division 3 of the Business and Professions Code and the Rules and Regulations of the Contractors State License Board, the Registrar of Contractors does hereby issue this license to: POWERHOUSE RETAIL SERVICES LLC License Number 974217 to engage in the business or actin the capacity of a contractor in the followingclass i fication(s): B - GENERAL BUILDING CONTRACTOR C10 ELECTRICAL Witness my hand and seal this day, January 14, 2013 Issued June 25, 2012 This license is the property of the Registrar of Contractors, is not transferrable, and shall be returned to the Registrar upon demand when suspended, revoked, or invalidated for any reason. It becomes void if not renewed. 4- Stephen P. Sands Registrar of Contractors AUDIT NO: s48678