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IN THE COUNTY COURT OF SARASOTA COUNTY, FLORIDA
Division: Case Number: au & 4-7 4 Se
CIVIL
PLANTIFF VS. DEFENDANT PLANTIFF
Impact Fire Services, LLC dba
Alliance Fire & Safety George Smith dba: Mangia Mangia
Name ‘Name Name
500 Base Avenue East 4321 Pawtucket St
Address Address Address
Venice, FL 34285 North Port, FL 3428
City, State & Zip Code City, State & Zip Code City, State & Zip Code
Phone: 941-485-5402 Ext. 120 941-822-6342 Phone:
Name Name |
Address Address
City, State & Zip Code City, State & Zip Code
Phone: Phone:
STATEMENT OF CLAIM
The above named Plantiff (s) sue the above named Defendant(s) and alleges:
1. This is an action for damages which do not exceed the amount of $5,000 exclusive of cost interest and
and attorney fees.
2. The Plaintiff(s) claims the amount of $ 810.79 as being due from the Defendant(s) and alleges as the basis
of such suit:
To Collect on Past Due April 2023 Invoices
Supression Inspections for Kitchen and Fire Extinguishers
Wherefore, Plaintiffs(s) demands judgment for damages against Defedant(s) in the above amount
plus all costs of this action.
7 Dary sunt, Dist t Géneral Manager
Signature of Plantiff
Filed 07/09/2024 08:40 AM - Karen E. Rushing, Clerk of the Circuit Court, Sarasota County, FL
Invoice All
Fire &
lance
Satety
Date: 4/27/2023. P.O, Box 208°.
Customer ID:_ 8179 Venice, FL: 34284. -
Invoice No.: AFS85035 © (941).485-5402 | (941) 483-3321 (fax)
Reference: Work Order ‘atone 1 Field Invoice PE7360
Mangia Mangia'@ VFW Post 10476 VEW Post # 10476
3725 Cape Haze Dr. 3725: Cape Haze Dr
Roturida West, FL. 33947 Rotunda West, FL 33947
P.O. Number:
Description: Terms. : Due Upon Receipt
Work-Order 104002 supression Inspection
Item Deseription : Quantity Unit Price ‘Amount
Parts
GAGOML Link Fuislbie, Model ML-ASodeg 6.00 $18.5000 $111.00
551059 CO26 16.GRAM CO2 ACTUATION CARTRIDGE - P 1,00: $27.0000 $27.00
ASER Rod,Break,Ansul Style,24915 P10 1.00 $15.0000 $15.00
Parts Subtotal: $153.00
Flat Rate. .
.INS-ANNUAL Arinual Syst stern inatsteianée Inspection 1,01 $160,000 $160.00
INS-ADUNIT System Inspection Additional:Cylinder 4.00 $45.0000 $45.00
INS-AHJRQ1 Required 3rd Party Fees & Processing 1.00 $9.7500 - $9.75
Fiat Rate Subtotal $214.75
Miscellaneous :
‘Flush piping 1,00. $20.0000 $20.00
Miscellaneous Subtotai: $20.00
Additional Notes: Subtotal $387.75.
Sales Tax: $27.14.
Payments: $0.00
Total Due: $414.89
Thank You For Your Business
* CONVENIENCE FEE-OF 3.5% 1S CHARGED FOR ALL CREDIT CARD PAYMENTS *
INVOICES ARE SUBJECT TO a FINANCE CHARGE OF 1.5%/MO (18% / ANNUM) FOR BALANCES DUE BEYOND ‘OUR NORMAL TERMS
r = —= -
cust #4174
__ wo #:,
techs 4S4_
tee
pate LL.
All
a
PO#.
1iance Name
Address 372. Upete
Bosh a_Dw.t teEbest a ALT
Fire & Safety
Ci de. cf Email
County/City/Other A: Ewpeb
SEND PAYMENT TO: P.O. Box 208.Venice, FL 34284 Owner or Manager:
941.488.1267 941.925.1599
Portable Florida FED20-000053 FED22-000019 PE Systems Florlda FED12.000018 FED16-000012 DOT Rin # C343 & D084 Contr# FPC17-000019
UL-300; Yes Noo | Wet Dry 9 System operation from terminal link checked/operational.
Annual a Semi-Annual’ Recharge o_Installo Modification o 40 Sys. operation w/manual & remote manual checked/oper.
ion of System Cylinders Model No. 41 Test operation of gas valves.
Manufac:, 42 Test operation of micio switch(s).
Slave
15 oy Sie |Slave Cyl. Size | 13 Grease cleaned (conduit @ comer. pulieys/components)
Sn{ 44 Replace fusible links (every 6 months)
Serial No. ‘erial No. 15 Filters are of proper type.
Aim so us]
Fuse Links 360°F
ae
Fuse Links {$9 *FML Thermostat
416 Filters are clear of grease.
—"*F | 17 Hood and duct are clean of grease.
Date:
— # — Date:74)3 #:(, Date:— 18 All filters
are replaced In hood.
v3 Hood #2 size: = 19 Exhaust fan(s) are in operationg conditions.
Hood #1 size:
Duct #1 size: Wyt2 Duct #1 size: = 20 Replace & seal safety pins in manual remote releases.
Duct
#2 size: adel? Duct#2 size: = ‘21 Fuel shutoff is in on positions.
Last 6-yr maint: Last HydroTest: 267: Last Rech: 22 Cleaned system cylinder
Manufacturers Manual Reference ‘23’ Reset/cock control head
Page: Drawing: 24 Fan waming sign on hood.
Cartridge: Inspected o Replaced » -25. Cartldge(s) installed (type.
26.Are hand portable ‘extingulsher(s) properly serviced?
Weight: bb
gam. Pressure Last Test:
a Prortable extingulsher(s) have proper rating
Fuel Shut Off
Electric: Shunt-Tripo Gas: Mey lectrica Si | HS. 28:Is fire alarm connected to the fire suppression system?
Electrical Shunt-trip Location: }:29 is fire alarm reset
Fire Alarm Panel Location: MW,
«Bt
Close Out Items
e Cyl. 31 Changes in hazardfayout noted & drawing updated?
1 Pressure gauge operable range for stored pressur
32 Replace system covers.
2.No visible signs of system fired or tampered with. 33:Customer it plot ights (tech asst __yes, fo)
3 Piping & conduit immobilized wiproper hangers/brackets Y @
4:Hood penetrations welded orhave grease tight fittings.
34 Educated to Inadequate protection of cooking ‘Surface. On
35 Inspection safety pins/lock bars are removed
5 All nozzle positioning/type correct?
M
6 Protective nozzle covers/seals replaced?
7 Nozzles Cleaned.
36. Inspection/svc tag on systém cyl. & femote pull station
37 ‘Personnel Instr. on operation of system(s) & partabots)
8 Picture taken (file names: _ >
@ h
Y YP
8 Cable nut travel tolerances checked.
COMMENTS:
iH pity rales wt “Ub
Kd Le dun dani
ZA
te
0 Ye bias pei be heh, ue {up. C ert QTE 110115
TOF ae TO,
MUA gt aed
rl Ft
x
TE
2 fe he
‘4
4 hilt! 9 Nah
Spae [Boxy ab 10h Oveduag
rdance with procedures ofthe presently adopted €Sditions Of NFPA 7 TTA,
On this date, the above systemwas etied ‘and/or inspected in
10,99, and thy manufacturer's manual and was ope! rated.
according to. these, procedures with results indicated above.
[Customer Signature
Frecnntan Signature” 7 P~ 7 OF 7 Wainess Signature
LZ
Fenn FERS pole! eae aa Tren TEtkarn, [rime out Ei pr
that they persorially inpsected the: system and found the conditions
The above named technician who ‘holds ‘a State of Florida p ermit certifies 18
tobe as indicated on this report. Alliance Fire & Safety, Florida | Lic, No.:FED12-0000
iJ CamScanner
Invoice All
Fire &
lance
Safety
Date: 412712023 P.O. Box 208
Customer ID: 8179 Venice, FL 34284
Invoice No. AFS85036 (941) 485-5402 (941) 483-3921 (fax)
Reference: Work Order:104001 / Field Invoice FX1 01908
Mangia Mangia @ VFW Post 40476. VEW- Post #10476
3725 Cape Haze Dr 3725.Cape. Haze Dr.
Rotunda West, FL 33947". Rotunda West, FL 33947
P.O. Number:
Description: Terms: Due Upon Receipt
Work Order 104001 Inspection.
Item Description Quantity Unit Price. Amount
Parts
REFURBS 5# ABC Refurburbished Extinguisher “4.00; $55.0000 $55.00
REFURB-K K-class, 6L Refurbished Extinguisher 4.00, - $200.0000 $200.00
Parts Subtotal: $255.00
Flat Rate
AM1-1STEXT. Anniial FX /-ELU ‘inspection = Min Service charge 1.00 $70.0000 $70.00
AM2-AM Annual Maintenance ABC 5.00 $9.0000 $45.00
Flat Rate ‘Subtotal ‘$115.00
Additional Notes:
Subtotal: $370.00
Sales Tax: $25.90
Payments; $0.00
Total Due: $395.90
VISA BD
~Thank You For Your Business
* CONVENIENCE FEE OF 3.5% {S CHARGED FOR ALL CREDIT CARD PAYMENTS *
INVOICES ARE ‘SUBJECT TO A FINANCE CHARGE OF 1.5%/MO (18%. ANNUM) FOR.BALANCES DUE-BEYOND OUR NORMAL TERMS
i
Hallionce
cUST #,
‘FIELD. INVOICE TECH #__
Pe
FX 101908
ast trepalectiInspon D atoe
“Annu Date: — T
SEND. PAYMENT ‘TO: P.O. Box 208, Venice, FL 34284 - Phone: 841.486.5402
| Portabte Florids FED20-000053 FED22-000019 PE Systems: rise FEDI2 000018 FED16-000012 DOT Rin.W C349 & D084 Contr W FPC17-000018
:
Customer Information
= Bill-to In formation
Bill-to Name:, Ejay Hain LUE Pa
Site Name:
Address:
Address:
ZHY7Z City, State, Zip:
City, State, Zip: Contact:
Mob:
iContact: Fac
Fax: Phone:
Phone: Email:
Email:
Call Type / Reason:
Problem / Scope: 7 Lh
Resolution / S CLIF,
Total
Total New Equip’ aart Number] QTY. |, Unit
init.
‘Flat Rate Flat Rate Code | QTY
Celt. Tag& Seal Ann ‘LE
ICo2 BeverageRi Valve Stem:Dry o'Ca2o Ott
Bench Charge. 1O-Ri
[Annual Maintenance (otter) GIST: erIb. ABC. 3.00.
[ABC PowdPer
C Mb ( JType Foil al =K-Class
Cc jib( JType. Jest ( yb ( dye
( oC JType Ext ( yee dye
C yb Yype * [Extinguisher Cover
Recharge _ (Brackets. wall / vehicle
feyr
/ other ( yb Jiype.
rostaile Testing! 12yrType. Te
=
flayr J other ( Hb
2 =
-
Emergent Light Inspections - pai ted on nee pa Pars
=
Flat‘Rate Service Sub. Totals: S$ RICE |
DESCRIPTION
3216 14:30 2k
fey 3 be Anaal
NFPA- 10-6.27 Emergency Lights Inspected Tieggea? None
AML exing uishers inspected and tagged per -Per NFPA-101? ¥ ‘esiNo ‘Other Operational Test? Yes/No
es 1p N/A (none present) 0 NO: (0
Initials:
Rin needed.
a QteWO# g Declined). Customer Initials:
co QtefWOF 1p Declined) Customer order for the above referenced proporty ‘to be in compliance
with LIFE
‘of "NO" @
const itute s ‘deficiency that must be "addressed in ng: , litigation, cancellation
of Insurance and/or non-
‘Any question recei ving an answo r
cyis not ret solved or repal rect may
that
fead to any of the foltowi fines, liability
SAFETY CODES: Adeficlen from 8 foty tasue related to these doficle ncle
isnt of any claim arising life-sa
jechni ‘Signature: EER ate: by, Next annual approximately 20 tn.
. Ta Efe. List FOR MY.20, HOURS ARE. "Flat Rate Total 370"
LO STOPAN SERVICE \LL FOR APPT.
o Recommend
lations on Se)
AY EROM-THIS I ICE**: ‘Equip & Parts:
"TERMS: DUE UPON-REC! IPT
‘described work and I am AUTHORIZED to oyapprove payment. Your signature
It Herby Acknowledge the satisfactory completion of the above: above.Merchandise remains property. of Seller: ‘unt for.in full paymentaf
paid il Labor Total |$
[constitutes full ceeptance ‘of the work performe d as indicated
the service date, your arcount will become delinquen t and a delinquenc y
charge
|service fees afd charges is notreceived in full within 30 dys afler
rate of 1% ofthe unpaid amount foras long ea your account eins unpaid in
will be added to your account at the end ofeach month atthe INVOICE SUB TOTAL $ 3707
addition 16 ay collection charges Incurred.
Thank you for your Business!
TAX $25 ze
Print x it Method: Pes,
Signature X. Cash Rev’ CHECK # CREDIT CARO FEE s a
XXXX—__
|uate: Tesms and Condiions on reveréo sige are inteprat parts ofthis Contract ICC gest Dots) 7 yore
inv # . _ Initials,
Use Only: RTB:_ WTB
Date.
sh
‘Ver-06-2015 SEC #
Billing Postal # Billi
Ming Zip:
TOTAL DUE|$
.
245%
Allianice Fire & Safety
‘All
Flee
lance
& S aty
Fire Extinguisher Locations P.O; Box 208 = Venice, FL 34284
Phone: (941): 485-5402
Location: w Pst 1b Page! of 1 Customer #:
Tech Name:
Date: “ie
Work O1 der#:
Invoice#: 12
This Year 23(VR) |Next Year,
TT Telalel
‘Cab
3/2alii Tech Notes:
Location | siee type Yeat Ma Serial Number 2 £13
bn Ste fie: 92 fb. | WBhiC dea t
1é
2Neaime Room lo Al, A lne. [G-sxcsuca2 ||
3 [Be by debs
pool | [LY723200 HL
Dui, |. Bre.
4| Bar, Entaale, GABE | Bile | Fant
5| Bae Bd |S Aee Bua Maus L Bang.
Soft
10)
1
42)
13)
14)
45)
16)
17
18
19)
21
23
Totals}
ine iter ref. No. Recommendations/Comments "0"=Service Due: "=Complete Ver.01-2014
Parts: (G) gauge (VS) valve stem (OR) o-ting (L) lever (P) pull pin (S) siphon (0) other - Cabinet: SMS, SM10, MIM, M2JM, M2M- Service: (AM) annual maint,
yt) sixyoar, maint, (Hyd) Hydro Testing, (/e- recharge.
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Preview
IN THE COUNTY COURT OF SARASOTA COUNTY, FLORIDA Division: Case Number: au & 4-7 4 Se CIVIL PLANTIFF VS. DEFENDANT PLANTIFF Impact Fire Services, LLC dba Alliance Fire & Safety George Smith dba: Mangia Mangia Name ‘Name Name 500 Base Avenue East 4321 Pawtucket St Address Address Address Venice, FL 34285 North Port, FL 3428 City, State & Zip Code City, State & Zip Code City, State & Zip Code Phone: 941-485-5402 Ext. 120 941-822-6342 Phone: Name Name | Address Address City, State & Zip Code City, State & Zip Code Phone: Phone: STATEMENT OF CLAIM The above named Plantiff (s) sue the above named Defendant(s) and alleges: 1. This is an action for damages which do not exceed the amount of $5,000 exclusive of cost interest and and attorney fees. 2. The Plaintiff(s) claims the amount of $ 810.79 as being due from the Defendant(s) and alleges as the basis of such suit: To Collect on Past Due April 2023 Invoices Supression Inspections for Kitchen and Fire Extinguishers Wherefore, Plaintiffs(s) demands judgment for damages against Defedant(s) in the above amount plus all costs of this action. 7 Dary sunt, Dist t Géneral Manager Signature of Plantiff Filed 07/09/2024 08:40 AM - Karen E. Rushing, Clerk of the Circuit Court, Sarasota County, FL Invoice All Fire & lance Satety Date: 4/27/2023. P.O, Box 208°. Customer ID:_ 8179 Venice, FL: 34284. - Invoice No.: AFS85035 © (941).485-5402 | (941) 483-3321 (fax) Reference: Work Order ‘atone 1 Field Invoice PE7360 Mangia Mangia'@ VFW Post 10476 VEW Post # 10476 3725 Cape Haze Dr. 3725: Cape Haze Dr Roturida West, FL. 33947 Rotunda West, FL 33947 P.O. Number: Description: Terms. : Due Upon Receipt Work-Order 104002 supression Inspection Item Deseription : Quantity Unit Price ‘Amount Parts GAGOML Link Fuislbie, Model ML-ASodeg 6.00 $18.5000 $111.00 551059 CO26 16.GRAM CO2 ACTUATION CARTRIDGE - P 1,00: $27.0000 $27.00 ASER Rod,Break,Ansul Style,24915 P10 1.00 $15.0000 $15.00 Parts Subtotal: $153.00 Flat Rate. . .INS-ANNUAL Arinual Syst stern inatsteianée Inspection 1,01 $160,000 $160.00 INS-ADUNIT System Inspection Additional:Cylinder 4.00 $45.0000 $45.00 INS-AHJRQ1 Required 3rd Party Fees & Processing 1.00 $9.7500 - $9.75 Fiat Rate Subtotal $214.75 Miscellaneous : ‘Flush piping 1,00. $20.0000 $20.00 Miscellaneous Subtotai: $20.00 Additional Notes: Subtotal $387.75. Sales Tax: $27.14. Payments: $0.00 Total Due: $414.89 Thank You For Your Business * CONVENIENCE FEE-OF 3.5% 1S CHARGED FOR ALL CREDIT CARD PAYMENTS * INVOICES ARE SUBJECT TO a FINANCE CHARGE OF 1.5%/MO (18% / ANNUM) FOR BALANCES DUE BEYOND ‘OUR NORMAL TERMS r = —= - cust #4174 __ wo #:, techs 4S4_ tee pate LL. All a PO#. 1iance Name Address 372. Upete Bosh a_Dw.t teEbest a ALT Fire & Safety Ci de. cf Email County/City/Other A: Ewpeb SEND PAYMENT TO: P.O. Box 208.Venice, FL 34284 Owner or Manager: 941.488.1267 941.925.1599 Portable Florida FED20-000053 FED22-000019 PE Systems Florlda FED12.000018 FED16-000012 DOT Rin # C343 & D084 Contr# FPC17-000019 UL-300; Yes Noo | Wet Dry 9 System operation from terminal link checked/operational. Annual a Semi-Annual’ Recharge o_Installo Modification o 40 Sys. operation w/manual & remote manual checked/oper. ion of System Cylinders Model No. 41 Test operation of gas valves. Manufac:, 42 Test operation of micio switch(s). Slave 15 oy Sie |Slave Cyl. Size | 13 Grease cleaned (conduit @ comer. pulieys/components) Sn{ 44 Replace fusible links (every 6 months) Serial No. ‘erial No. 15 Filters are of proper type. Aim so us] Fuse Links 360°F ae Fuse Links {$9 *FML Thermostat 416 Filters are clear of grease. —"*F | 17 Hood and duct are clean of grease. Date: — # — Date:74)3 #:(, Date:— 18 All filters are replaced In hood. v3 Hood #2 size: = 19 Exhaust fan(s) are in operationg conditions. Hood #1 size: Duct #1 size: Wyt2 Duct #1 size: = 20 Replace & seal safety pins in manual remote releases. Duct #2 size: adel? Duct#2 size: = ‘21 Fuel shutoff is in on positions. Last 6-yr maint: Last HydroTest: 267: Last Rech: 22 Cleaned system cylinder Manufacturers Manual Reference ‘23’ Reset/cock control head Page: Drawing: 24 Fan waming sign on hood. Cartridge: Inspected o Replaced » -25. Cartldge(s) installed (type. 26.Are hand portable ‘extingulsher(s) properly serviced? Weight: bb gam. Pressure Last Test: a Prortable extingulsher(s) have proper rating Fuel Shut Off Electric: Shunt-Tripo Gas: Mey lectrica Si | HS. 28:Is fire alarm connected to the fire suppression system? Electrical Shunt-trip Location: }:29 is fire alarm reset Fire Alarm Panel Location: MW, «Bt Close Out Items e Cyl. 31 Changes in hazardfayout noted & drawing updated? 1 Pressure gauge operable range for stored pressur 32 Replace system covers. 2.No visible signs of system fired or tampered with. 33:Customer it plot ights (tech asst __yes, fo) 3 Piping & conduit immobilized wiproper hangers/brackets Y @ 4:Hood penetrations welded orhave grease tight fittings. 34 Educated to Inadequate protection of cooking ‘Surface. On 35 Inspection safety pins/lock bars are removed 5 All nozzle positioning/type correct? M 6 Protective nozzle covers/seals replaced? 7 Nozzles Cleaned. 36. Inspection/svc tag on systém cyl. & femote pull station 37 ‘Personnel Instr. on operation of system(s) & partabots) 8 Picture taken (file names: _ > @ h Y YP 8 Cable nut travel tolerances checked. COMMENTS: iH pity rales wt “Ub Kd Le dun dani ZA te 0 Ye bias pei be heh, ue {up. C ert QTE 110115 TOF ae TO, MUA gt aed rl Ft x TE 2 fe he ‘4 4 hilt! 9 Nah Spae [Boxy ab 10h Oveduag rdance with procedures ofthe presently adopted €Sditions Of NFPA 7 TTA, On this date, the above systemwas etied ‘and/or inspected in 10,99, and thy manufacturer's manual and was ope! rated. according to. these, procedures with results indicated above. [Customer Signature Frecnntan Signature” 7 P~ 7 OF 7 Wainess Signature LZ Fenn FERS pole! eae aa Tren TEtkarn, [rime out Ei pr that they persorially inpsected the: system and found the conditions The above named technician who ‘holds ‘a State of Florida p ermit certifies 18 tobe as indicated on this report. Alliance Fire & Safety, Florida | Lic, No.:FED12-0000 iJ CamScanner Invoice All Fire & lance Safety Date: 412712023 P.O. Box 208 Customer ID: 8179 Venice, FL 34284 Invoice No. AFS85036 (941) 485-5402 (941) 483-3921 (fax) Reference: Work Order:104001 / Field Invoice FX1 01908 Mangia Mangia @ VFW Post 40476. VEW- Post #10476 3725 Cape Haze Dr 3725.Cape. Haze Dr. Rotunda West, FL 33947". Rotunda West, FL 33947 P.O. Number: Description: Terms: Due Upon Receipt Work Order 104001 Inspection. Item Description Quantity Unit Price. Amount Parts REFURBS 5# ABC Refurburbished Extinguisher “4.00; $55.0000 $55.00 REFURB-K K-class, 6L Refurbished Extinguisher 4.00, - $200.0000 $200.00 Parts Subtotal: $255.00 Flat Rate AM1-1STEXT. Anniial FX /-ELU ‘inspection = Min Service charge 1.00 $70.0000 $70.00 AM2-AM Annual Maintenance ABC 5.00 $9.0000 $45.00 Flat Rate ‘Subtotal ‘$115.00 Additional Notes: Subtotal: $370.00 Sales Tax: $25.90 Payments; $0.00 Total Due: $395.90 VISA BD ~Thank You For Your Business * CONVENIENCE FEE OF 3.5% {S CHARGED FOR ALL CREDIT CARD PAYMENTS * INVOICES ARE ‘SUBJECT TO A FINANCE CHARGE OF 1.5%/MO (18%. ANNUM) FOR.BALANCES DUE-BEYOND OUR NORMAL TERMS i Hallionce cUST #, ‘FIELD. INVOICE TECH #__ Pe FX 101908 ast trepalectiInspon D atoe “Annu Date: — T SEND. PAYMENT ‘TO: P.O. Box 208, Venice, FL 34284 - Phone: 841.486.5402 | Portabte Florids FED20-000053 FED22-000019 PE Systems: rise FEDI2 000018 FED16-000012 DOT Rin.W C349 & D084 Contr W FPC17-000018 : Customer Information = Bill-to In formation Bill-to Name:, Ejay Hain LUE Pa Site Name: Address: Address: ZHY7Z City, State, Zip: City, State, Zip: Contact: Mob: iContact: Fac Fax: Phone: Phone: Email: Email: Call Type / Reason: Problem / Scope: 7 Lh Resolution / S CLIF, Total Total New Equip’ aart Number] QTY. |, Unit init. ‘Flat Rate Flat Rate Code | QTY Celt. Tag& Seal Ann ‘LE ICo2 BeverageRi Valve Stem:Dry o'Ca2o Ott Bench Charge. 1O-Ri [Annual Maintenance (otter) GIST: erIb. ABC. 3.00. [ABC PowdPer C Mb ( JType Foil al =K-Class Cc jib( JType. Jest ( yb ( dye ( oC JType Ext ( yee dye C yb Yype * [Extinguisher Cover Recharge _ (Brackets. wall / vehicle feyr / other ( yb Jiype. rostaile Testing! 12yrType. Te = flayr J other ( Hb 2 = - Emergent Light Inspections - pai ted on nee pa Pars = Flat‘Rate Service Sub. Totals: S$ RICE | DESCRIPTION 3216 14:30 2k fey 3 be Anaal NFPA- 10-6.27 Emergency Lights Inspected Tieggea? None AML exing uishers inspected and tagged per -Per NFPA-101? ¥ ‘esiNo ‘Other Operational Test? Yes/No es 1p N/A (none present) 0 NO: (0 Initials: Rin needed. a QteWO# g Declined). Customer Initials: co QtefWOF 1p Declined) Customer order for the above referenced proporty ‘to be in compliance with LIFE ‘of "NO" @ const itute s ‘deficiency that must be "addressed in ng: , litigation, cancellation of Insurance and/or non- ‘Any question recei ving an answo r cyis not ret solved or repal rect may that fead to any of the foltowi fines, liability SAFETY CODES: Adeficlen from 8 foty tasue related to these doficle ncle isnt of any claim arising life-sa jechni ‘Signature: EER ate: by, Next annual approximately 20 tn. . Ta Efe. List FOR MY.20, HOURS ARE. "Flat Rate Total 370" LO STOPAN SERVICE \LL FOR APPT. o Recommend lations on Se) AY EROM-THIS I ICE**: ‘Equip & Parts: "TERMS: DUE UPON-REC! IPT ‘described work and I am AUTHORIZED to oyapprove payment. Your signature It Herby Acknowledge the satisfactory completion of the above: above.Merchandise remains property. of Seller: ‘unt for.in full paymentaf paid il Labor Total |$ [constitutes full ceeptance ‘of the work performe d as indicated the service date, your arcount will become delinquen t and a delinquenc y charge |service fees afd charges is notreceived in full within 30 dys afler rate of 1% ofthe unpaid amount foras long ea your account eins unpaid in will be added to your account at the end ofeach month atthe INVOICE SUB TOTAL $ 3707 addition 16 ay collection charges Incurred. Thank you for your Business! TAX $25 ze Print x it Method: Pes, Signature X. Cash Rev’ CHECK # CREDIT CARO FEE s a XXXX—__ |uate: Tesms and Condiions on reveréo sige are inteprat parts ofthis Contract ICC gest Dots) 7 yore inv # . _ Initials, Use Only: RTB:_ WTB Date. sh ‘Ver-06-2015 SEC # Billing Postal # Billi Ming Zip: TOTAL DUE|$ . 245% Allianice Fire & Safety ‘All Flee lance & S aty Fire Extinguisher Locations P.O; Box 208 = Venice, FL 34284 Phone: (941): 485-5402 Location: w Pst 1b Page! of 1 Customer #: Tech Name: Date: “ie Work O1 der#: Invoice#: 12 This Year 23(VR) |Next Year, TT Telalel ‘Cab 3/2alii Tech Notes: Location | siee type Yeat Ma Serial Number 2 £13 bn Ste fie: 92 fb. | WBhiC dea t 1é 2Neaime Room lo Al, A lne. [G-sxcsuca2 || 3 [Be by debs pool | [LY723200 HL Dui, |. Bre. 4| Bar, Entaale, GABE | Bile | Fant 5| Bae Bd |S Aee Bua Maus L Bang. Soft 10) 1 42) 13) 14) 45) 16) 17 18 19) 21 23 Totals} ine iter ref. No. Recommendations/Comments "0"=Service Due: "=Complete Ver.01-2014 Parts: (G) gauge (VS) valve stem (OR) o-ting (L) lever (P) pull pin (S) siphon (0) other - Cabinet: SMS, SM10, MIM, M2JM, M2M- Service: (AM) annual maint, yt) sixyoar, maint, (Hyd) Hydro Testing, (/e- recharge.