Loading...
DBPR Interagency Agreement • d /1- 2 7S 7 • 110/1/ DBPR INTERAGENCY AGREEMENT BETWEEN THE DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS AND CITY OF MIAMI BEACH FOR DELEGATION OF STATUTORY AUTHORITY TO REGULATE AND ENFORCE ELEVATOR SAFETY D‘ccm gat-- Agreement is made and entered into this d / *7 day of_Octobar, 2010, by and between the Department of Business and Professional Regulation, Division of Hotels and Restaurants, hereinafter referred to as the DEPARTMENT, and City of Miami Beach, by and through the City of Miami Beach Building Department, Office of Elevator Safety, 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 Beach not already subject to a contracted delegation of authority pursuant to the requirements of Chapter 399, and Rule Chapter 61C -5, Florida Administrative Code. In recognition of a jurisdictional Agreement 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 Beach Contractual services shall begin, November 1, 2010, or upon full execution of this Agreement, whichever is the earlier date 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 lines of communication with the CONTRACTOR, by providing DBPR staff telephone numbers to CONTRACTOR designated personnel, and by agreeing to provide advance copies of Industry Bulletins and Technical Advisories to the CONTRACTOR before they are published and released to vendors, elevator contractors, license holders and other industry stakeholders. 1 1 Page • The CONTRACTOR likewise agrees to have open and direct lines of communication with the DEPARTMENT, by providing City of Miami Beach staff telephone numbers to DEPARTMENT designated personnel, and by agreeing to provide advance copies of Industry Bulletins and Technical Advisories and other key documents to the DEPARTMENT before they are published and released to vendors, elevator contractors, license holders and other industry stakeholders. 4) ASSIGNABILITY: This Agreement is exclusive and personal and may not be assigned by the CONTRACTOR in whole or in part, except that in the event an emergency situation temporarily prevents the CONTRACTOR from performing its obligations hereto, the CONTRACTOR may request written permission from the DEPARTMENT to solicit assistance from any other municipality or county that has entered into a similar interagency Agreement with the DEPARTMENT to issue elevator construction permits, temporary elevator operation permits and certificates of operation; provide and conduct elevator inspections; and enforce applicable provisions of the Florida Building Code, as required by the Elevator Safety Act and Florida Elevator Safety Code. Emergency assistance shall not exceed six (6) months without prior approval from the DEPARTMENT. 5) CONSIDERATION FOR SERVICES: Except as otherwise stated herein, in consideration for the services performed pursuant to this Agreement, the CONTRACTOR is entitled to collect and retain those statutorily authorized fees and administrative fines, as provided in the Elevator Safety Act and Florida Elevator Safety Code, associated with the responsibilities and obligations to be performed herein, which fees and administrative fines would otherwise be collected by the Division. This Agreement does not address, prohibit nor endorse, legally or otherwise, any additional 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 "IA" and "IIA ", 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 AI7.2, Guide for Inspection of Elevators, Escalators, and Moving Walks and for correcting any deficient performance by inspectors it supervises through employment or contractual relationship. The DEPARTMENT, however, shall retain sole authority for disciplining an inspector's professional credential certification. 21Page 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 ordinances, against any elevator owner or other person in violation thereof, except as otherwise rovided in this section. "All enforcement activity shall be conducted p tY in accordance with the provisions of Chapters 120, 162 and 399, Florida Statutes, and Chapter 14 - City of Miami Beach City Code and applicable Florida Administrative Code." The DEPARTMENT, however, shall retain all authority with respect to professional credentials issued pursuant to Chapter 399, Florida Statutes. The CONTRACTOR shall not issue professional credentials nor shall it enforce the credentialing provisions of Chapter 399, Florida Statutes. The CONTRACTOR may issue local jurisdiction summons and collect administrative fines from credentialed persons or credentialed companies for violating the provisions of the Elevator Safety Act and the Elevator Safety Code. However, the CONTRACTOR shall report to the DEPARTMENT all known or suspected violations of Chapter 399, Florida Statutes, or the Elevator Safety Code, committed by holders of a DEPARTMENT issued professional credential within thirty (30) days of discovery. c. The CONTRACTOR shall provide the DEPARTMENT with a Monthly Activity Report, the form of which is attached hereto and incorporated by reference as Attachment "IB" and "IIB ", or use of an equivalent form approved by the DEPARTMENT, which shall include the number of elevator Pp ermit applications P 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 "ID" and "IID". However, if the accident occurs within the City of Miami Beach, 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. 3IPage 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 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 initial or final inspection as applicable, the elevator company supervisor signs an Affidavit, the certificate and form which is attached hereto and incorporated as Attachment "IC" and "IIC ", or use of an equivalent form approved by the DEPARTMENT, and witnessed by the CONTRACTOR'S inspector, which sets forth that the elevator company supervisor directly supervised construction or installation of the elevator. h. The CONTRACTOR agrees to establish a Quality Assurance Program in consultation with, and approved by, the DEPARTMENT, to conduct quality assurance inspections and to provide the DEPARTMENT with copies of the quality assurance inspection reports. The DEPARTMENT will conduct oversight and monitor inspections as necessary. 7) CONTRACTOR RESPONSIBILITIES: The CONTRACTOR shall be responsible for: a. CONTRACTOR agrees to process all certificates and permits it issues, and electronically store data, specified below, related to the regulation of elevators, issuance of permits, certificates of operation, for each item specified in Section 399.13, Florida Statutes until this Agreement terminates. b. CONTRACTOR agrees to provide the electronic data specified below to the DEPARTMENT, not later than sixty (60) days prior to and until termination of this Agreement by either party, in comma - delimited text format that will merge into the 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 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 41 Page DEPARTMENT'S 'LicenseEase' licensing data software, or any successor and then - current licensing data management software. 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 Beach 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 Beach 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 1) APPROPRIATION: This is a no -cost Agreement for the DEPARTMENT. The CONTRACTOR is responsible for all costs associated with the performance of this Agreement. 2) 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 Wage 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. 3) COMPLIANCE: For the purpose of ensuring 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 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 thirty (30) 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 g � Y g Yg g immediate written notice of cancellation. 4) ENTIRE AGREEMENT: This Agreement and attachments "IA" and "IIA" Elevator Inspection Report or approved equivalent, "IB" and "IIB" Monthly Activity Report or approved equivalent, "IC" and "IIC" Certificate of Operation and Construction Supervisor Affidavit or approved equivalent, and "ID" and "IID" 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. 5) LIABILITY: Pursuant to this Agreement, the CONTRACTOR acts in the place of the Division and not on behalf of the Division as an agent or representative. 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. 6) 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. 61 Page 7) 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. 8) 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. 9) NOTICE TO CONTRACTOR: The DEPARTMENT shall consider the employment by any contractor of unauthorized aliens a violation of section 274A(e) 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. 10) RENEWAL: This Agreement 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 intent to 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 Beach on the respective dates under each signature: City of Miami Beach through its City Commission, signing by and through its Mayor 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. 71 Page STATE OF FLORIDA BILL VEACH, DIRECTOR Department of Business and Professional Regulation Division of Hotels and Restaurants 1940 North Monroe Street Tallahassee, Florida 32399 -1011 Date: iP r6 Approved: 15 CHARLIE LIEM, SECRETARY Department of Business and Professional Regulation 1940 North Monroe Street Tallahassee, Florida 32399 -0750 Date: Approved: (1,(C/(2_, Approved as to Fo - • substance ' .41G.k. — Regina i z Gene r ounse 8IPage '. : ( i CITY OF MIAMI BEACH BY: . / 11 �. � • . �•— , .�►_ a• ATTES J S r day of Nr.0146042010 (Name) Clerk of the City of Miami Beach the A Approv -d as.. • • and substance � g 30 1� •, twr C it y Attorney 9IPage ATTACHMENTS I. DBPR Forms "A" - DBPR Elevator Inspection Report (Form HR 5023 -003) "B" DBPR Monthly Activity Report "C" - DBPR Construction Supervisor Affidavit signatory form for Certificate of Operation (see Supervisor of Construction attestation on Attachment A) "D" - DBPR Elevator Owner Accident Report (Form HR 7016) II. CITY OF MIAMI BEACH APPROVED DBPR EQUIVALENT Forms (provided by the CONTRACTOR). "A" - City of Miami Beach Elevator Inspection Report Form "B" - City of Miami Beach Monthly Activity Report "C" - City of Miami Beach Construction Supervisor Affidavit (similar to attestation on DBPR Attachment A) "D" - City of Miami Beach Elevator Owner Accident Report (Form HR 7016) III. reserved IV. City of Miami Beach to provide code enforcement language 10IPage • 4ZEVS9:4 sozEaZ - M3 .14 o a�J nd(?� 3U13�0 1d2�1N�� CODE-DOUOEOO)OOO) > ESE C@UE�C) X E)( ) MI CO OC)EiEJOO@OU ! OOO Bo 00100 . u NE Z 0000 JUO O 6 W o OOUOOCO0000 E E a E li @C@J 2 To if, ci C °JC�=�0000000 O u- 4_ c 0 P 0 1" a c CO O@CJC�OOOOC.�00 z O � O� )CD 92 Z E a Y Z U t t R a:. a) w . — OC)C)UO(OOOOOC� - s OO�)OOC)UOE W y o N _ o — 2-t V a. C.)02 _ _ o ° U 0 o f � _ >, co o g OU N 00 OO�O O a.• . N 000 N 8 8 000 z ' o f — N u E y (n m Q (n Q U • ° `° = v, o O8@o0O@ 9( ) - z cai 0 I E .3 INN N -o o N o O C °�UEOEOOO�OC �O�O o 8 . , o o v = 1- c CN — N � _ f.' o > _ ����� a " 0 co • a . a G > CT E t U > �. L . G . v v > OOH OOOOOOC� � € Q ` a _ z j re D 0 It x . ltt E Y C c? P W o w Q �i U W LL U' 2 -� ut o in E rn at c U . - al a) cn a - °' 0) c i E 0 m w . 1 1 ill D- W n N o N u ' �JOOOO OOOOV W a 2 • m c c m& v a. ! 1• 11. a o Le. a o` o • co: a =I �' ' OOO V �J cm, a . o y i ! H! m LL' Q. • (/) ! e 1 [n' c> @ = C/) O > . 2 cy : O Ts ? W co O (�� ��� C Q V O O O co Cl_ C .V 7 m r _ o m d C _ O O C rn r C- LL U V Z L o g a OOOI_ )00E3C000 U m E ` w . o w w a N O O Q u, - Q m U � W IL U 2 � i0 m o m rn . c - ��.o r- � , c a� �� y> ��v W t- co, v EL 'n � w o '- ¢ o Q m ¢ — �� _Z -0 z . m z z O O OOO E O EO O0 03 • _ °' ;, o Q o o E o f — Cn'oo o a¢ > o z Z W CO a, T! 0 65 II- a OaOOOOOOOO 000 0 0 , — co a) n H - 2 o a > o y (E) 001 - o Q . . ..1 Z o . .o .1? o N CO) d cn ca (r, 1• a) 13.. .c7) co 0 m T > O�OOOOO�O 2, w o z a �- I it o OO000000030 .— y • z OOO OO �� C — m L IL .y a. a co i • Z _ o J OOOC�G s `� z < -a w cn �' O 1• O m ,LU. E w. m m 0 W W ° ©00000)0000 W— t OOO tOOOOC)OO CO �t 11111 di 0 o o m _ 0 00.00000000 a -- Q Zfi . . o g 3 s 000000C 1 • • 111111 o °- O W O f 000 00 co •- • E o m Z a) Z'a f fn c, - " Q Qai �° ?' F O OOC �OOCOCO00 0 a — O H -o - U @ o -- a U - 1 - o -� • IX - - - -- _caci- O -`0-- O -c°O- -O-- s . .. W _. _ __-- ____— • --. U i- 2 S U S J W � . m 000000 00 00 o z p 0S00000 00 0 No 7 t_ a: t > _ . 0000000000 U . ° 65 - . ., • w - . `' Ii. • 12 - 0000000000 ° 00000 Z w o N M �t to W ti ao rn W= v) O o O o E . co a OOOOOOOOOO (9 OOgOOC�OOOO . W s — w 0 OO sOOOOQOO a LLJ O OC)0000000 a . 3 - ua . —. d.,.: Z OOOOOOOOOO) a- o OB0000 0 0 -_ w • -I Lu - 00e8000000 a MN l�J ��MSO. C © U Ol'= 1L:10C cn — z 0000OOOOI =J� J ©OOD�J N — �^ - a P - OD OO o O - O000O l' - J � OO H — OOOOQO0000 o • EOOO)O)OS00 0O > � — Z (gas ° OS000OOOOO _ m$ — > • 2, c 6002 �mr) goo - �zo5 �! Wao� �dsa 0®00.0 U) - A. -r- .. , t t. KA : d 1 • ,' A i s ; STATE OF FLORIDA t ipr i-L; : f li DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION MONTHLY CONTRACTED ACTIVITY REPORT TO: Bureau of Elevator Safety - Compliance Section FROM: Reedy Creek Improvement District City of Miami X City of Miami Beach Miami -Dade Broward County SUBJECT: ELEVATOR INSPECTION FOR THE MONTH 01 Aug -10 1 ROUTINE /PERIODIC INSPECTIONS PERFORMED 128 2 PERIODIC TESTS PERFORMED Cat.1,3,5 100 3 INITIAL INSPECTIONS PERFORMED (FINAL) 8 4 CALLBACK INSPECTIONS PERFORMED 18 5 ALTERATION INSPECTIONS PERFORMED (FINAL) 5 6 CONSTRUCTION INSPECTIONS PERFORMED 23 7 COMPLAINT INSPECTIONS PERFORMED 4 8 ACCIDENT INSPECTIONS PERFORMED 0 9 ELEVATORS SEALED FROM PUBLIC USE o 10 NEW ELEVATOR /ESCALATOR PERMITS ISSUED 3 11 ALTERATION PERMITS ISSUED 21 12 TEMPORARY OPERATION PERMITS ISSUED 11 13 NUMBER OF ACCIDENTS REPORTED o 14 NUMBER OF COMPLAINTS REPORTED 4 15 NUMBER OF ELEVATORS /ESCALATORS 2,096 TOTAL INSPECTIONS (1 THROUGH 8) 286 John Antona, CEI # 53. 9/10/2010 REPRESENTATIVE OF CONTRACTED AGENCY DATE f . Mfr � iI • - I.ZE499 : /-60ZE8Z-M� N UU 8�:� AdO� W�Id�O - V J-N3� D @S C( 00 '� ' O ��CODUOC�uUCOC) • W r - c>i (-,�.��)��- L N w ME (. � O r c M 1 � � CO I CO d1 a� �O` r �JL.J �I• V7 k ( O n OD O � P. � y "' � SON OOGUJ _..) N ...� OG . 000 .� o Z a E) W o @C) a r . o •• _1 - o U J _ . 0 E O •� >. E O 8= 1 0 0 U Q �� �-. O - U L.- u O' • .L2 a) = O - O ��- �N M V 1f) (D 1� 00 O� m O O r- N l-/ c} lf) (O �f� l �" LL - C Q O LL - N L t] — ik in O,� �O OO O O O C� y GGG O --� U u ( v _ a; ` � ° GC)G O �) G��GG�) _ G C M G _ ) G z E r 9 z E o L 3, E 1/11 cr) o r N M (v u) co r ao � w` 2 fA r O. ,� `� O r ( Nk E -)�� O ¢ 0�)��t.1Jg � ) )EX ) > E d w G N p ° . W = a I co all ij O9c) 2 OO O 6 o z OCjO Q o .2 • y. Z 1B , m 4 m O a) L. O p . a�, : ° a @8 JC:=JVVVVI=JV d 3 0 8 - o o I WI --- �, w iii _ U) E l ° � � t - � S cn7(f) O -› w r vas ° ; acs — • • O al m u . u1 E 0 a . z E j .E rn W > a) C� + i x 0 - 0C)OOEOO©OCJ , u € Q y = ch 4* o 0 2 3 — 0 a) N L n cn• - . • 0 w To' o E U m w •c i ` • • fV . 2, 8 d � fir^ N M C Lh rr(D n � C - O O Q r 2 m C V U 0. d Q W w Z G OOGG G`�G CM 111 _ ° . a E c • .� C Q O: - u m co c m O = m o . C.) E. A r N M ED O'S �-n-• acs rn c ›. o N co E 0) u, «s 1- E _ o �� • 0000 GOO G : � o O 0 m � . . W 0 .. to N o - - c E • - '5 •a co a W a� ° m a m , � m m m m o ( • u. m a) ai V a.. E p o t��` �OVI ° ' �10� =10 u a '� a a��1 v a, a X m m <j !- W LH fl• v> u. CS V Z MI co 8 Q= g •,_ n- m ▪ a N m co o ,°) rg c' p %3 _O Z =' w i- _ _ a> v m > o W 1-- (!1 rn -.5 u_ fr � m m G �OGM �"JOV'` Io' m . m Q c ° a Q U < NM W a) O >' ..� __ E (1) i � . c o a ° i c m 0 o v H Z 1Y Z �/ t o z z �0�00000 � o a� $ a� �, o o . �v U o o m g I o 1 NI 'O o 14. C c o IL Q m :n (' 5: 0 ` `o ti u. Z W CO al c °'i v1 a` OEOOOO 00 G L J c ... Li. ° °' > OOGGG —J m,_ O o M c W `�" oo© O ..., Z 2 ` ` 16 C a a) r - O CO E • w .� I.!. / § a .� ( 2 O -a o a . s o �Z��V W G�O�J O� ` — 0 ° . Z L ~ ° 0000000000 - co o a z W ' o O0-OOO�O<O0) . — H _ C.` O 0000SGG \JGG _ MN M z f0 iz ¢ - a w v m O — Z rr w .�. cn � O - O c c m 'u_ 73 W w 1 " . 2 r N l�'t`t'JOC • O ....... -i — Z w z o N M d u7 cD n co rn Q 0. 0 ° xZ o s GGGG .E��GGGGG 0 C �. . a. � � o � � ' o ff� ' r �� c M mot• u7 co r� co rn • � c ro � MN ° c. �, O 40 0> Z VVV ®O N L E Q - cn Z ° ° ° `° ° ii � ' c 6000000000 = ° z u' im m Q a v tCV a) .n = Q m U W u Uc = I mo - . 0 U m o Ctt w a `m 2:, c cn E 0- un z E E Z z:: o Cr @ . a w 'Q O r N M v I O n flD rn 1L - Z ti :0 i-- ME - a -- -CC ° = o = �, N 1:):, U -0- ° ° ° -. __. - - . GC O G O O G OCOOG 000000 2 0000 o z i COC)00000 OOCR ro : IN > 1 > (DODO 0 U � , :.- " - >, o w OEOC30®000(OC� ° goo g© 0 0 0 0 • Q —. 0 v) C M ili LU 0 0000000000 0000000000 _ _ (�y w ° a o W jr. ° • OOOOOOOO(�O Q 000 ;000000 0.0.- = U3 Z g00 O0 DOCDO a o Oc-)oo oo 100 Tn. --1 - Lux cri 0. 0000000000 0 � w M ®®l�?JteepV 0 �� o 00 (0) . MI ° 000000c�oo O o 000000c o0o i „ • in C • ° -,. 0800 OS0000000 0 Mr w GGG GGGGGGG 5 a GGGGGOGGGG a) ° Q� O r N M �• I.C) CD n o0 O Z O r-- N M I 1C) CD n aD O y � MI Z • ° a OCOOO00000 . . ° z — j O 2 C ( 600Z'hf) £00 i:1H twos 1d9Q 00000 in a` • ht ( '.lai' i L l% A Y' ..I. 'T' - 0 41 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. SECTION 1- .EQUIPMENT LOCATION • License ❑ Elevator ❑ Moving Walkway Accident Date (mm /dd /yyyy) Number _ ❑ Escalator ❑ Wheelchair Lift Time of Accident Hour Minute ❑ AM ❑ PM Owner Name Business Name Building Address City County State Zip Code Phone Number SECTION 2 - SERVICE MAINTENANCE Is the elevator or escalator under a service maintenance contract? ❑ Yes ❑ No ❑ Unknown Name of Elevator Maintenance Company Was the elevator service maintenance company notified? Most recent required test performed? Test Date ❑ ❑ If yes, indicate date (MM /DD/YYYY) ❑ 6 ❑ 1 ❑ 3 05 Yes No months year years years (mm /dd /yyyy) SECTION 3 — ACCIDENT DETAILS • Brief Narrative: (attach additional sheets as necessary) { PLEASE CHECK ALL THAT APPLY Medical Attention ❑ Fall ❑ Bruises ❑ Entrapment ❑ Hand ❑ Fingers ❑ Hair ❑ Other {, Req'd ❑ Y ❑ N ❑ Trip ❑ Cuts ❑ Arm ❑ Leg ❑ Knee ❑ Foot ❑ Toes ❑ 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 ❑ Step —Stair Tread ( Floor Leveling ❑ Esc. Side Wall ❑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: OE! # Date SECTION 4 — REPORTING SIGNATURE Report Submitted by Date Title Current Certificate ? (print name) ❑ Y ❑ N ❑ NA Signature Phone Number Contracted Jurisdiction • Disclaimer: This report will assist the division in identifying ways to improve rider safety and will not be used to assign blame or liability. Florida law requires the elevator's certificate of operation holder to submit the report to the Bureau of Elevator Safety within 5 days of the accident. You may fill in the online form or Portable Document Format (PDF) version of this report, save it to your hard drive and e -mail it to: dhr .elevators�a?dbpr.state.fl.us, or you may fax or mail the report to: Department of Business and Professional Regulation, Division of Hotels and Restaurants, Bureau of Elevator Safety, 1940 North Monroe Street Tallahassee, FL 323994013 Phone: 850.487.1395 FAX: 850.922.6208 2008 March 10 www.MyFloridaLicense.com /hr Page 1 of 1 44-NrirPICi-kMEed-( i.,.. _' E O -' u) N O O t'--- 5 O 1 - . (21 ' N§ �«- O C c (ll O (TS Q) �, O � S2 cu a) W o O E 0 0 E - a .n 7) L ii i a: L..) U U- O U (7) o . ([ CD 0 co >' I- O L7 L__ CL O o O "�S Q > 2 - 0 CI) l.L E 0 (t5 Ti : a) u) U Q) W O L CTS O> 4? c (tS c•- (tS E Z ► j > 6 a- Q) 7 1 ,' a) O .... z t- 0 o 7 3 W c u ° •° a� S >, J Z 0 H > ll ai > .- Ci P cp c cz Z E Z a L �--0 co E >, cP E 0 --1 Q u) - o w o c" "3 c n. o c c '- a) o O CO m U Z I 0 DO c0 a) ....q. (3 u) c.) ct co .- (n U J fY Q _ . J z� cr' E O O O N oo O Q V I= LlJ co L U. > >Q0> cD o CO W WmU - wco o s _ LL H z O �WOo� c O 1 2 w J H o U QQLLz LL �� c6 a) Q 2 1-1-I E) a) a; a) W � U U u m t-- coo is 1- J z Q X E 0 ❑ ❑ U W Ooo a3 Z W �Uwz2~ T J O O U 0 o 0. . 1- W u cD o 0 -0- .6 a; Z 7.- ∎ U) c z Z ~ Ti 1- U = O a Z ;+=' O (n O 0 a o U - Q a U) . n • Z m U Q > as W p.-.. o m a te ) 0 N a W o a. v) O C CU U) a a U) °' a E o LO a) E > ❑ ❑ ❑ ❑ i a' a aa) o 0) L E a) U U U > o 0 E v> Z fl c) u ) 0' 0 L o _ 0 L1J a) a) a) as fl - H c 0 N U a) U a) o o c o 0) W a c ° o o a c> cv ° c o - 0.. a a) ai W c • • • 7 (o 0 L °) � a) a) (B ct; f- to t- O 'LT_ a a CD o Z as 0- Z o o c • E -0 E Z ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 0 U n °' o Z < 0 f- N cO ' Lf) ( 0 "E:3 ° U 0)) W Q a) Q) O Q •,--- r - ,-- r e- N M �O 0 d a) •� — a) __J N N N N N N N N ❑ Q) H r N M 0 0 O > O r e- e- r r N N- a) > a) 5 i a) - �-- �- �- r- s-- - c- (O (9 _c a) ❑ ❑ ❑ 0 Co o_ W > 00 00 00 00 00 00 00 00 00 00 - W 0 (1 N 5-►C. t km 1: \. it - A . QW WWWOWQ WZOWWR 00 }-00JUI- HkII' Z= Z ~ :g! w° WZ W QQ Q �_ J E 0 <w 0 °M-51- • t- O 0U ) U UZ � W Z i m o Z z Q a Zw � J LU0o 2GO cn __I W-! - Z ...1 - =Q� O O O F W p re p — U�oUai W►- Q� -F- '^ z O F- I- m w i-z H ozm o�m -moo oW W Q O Z 0 0 ct LLI Z W02mWo __o¢ OC ce F.. Z N a WI- F- i ii F" ~ L U- WZ�W (l) O w M a Z wao ,_C000aw =w =F- >o W W m U ? a co0 7 a2UZ2 I••- ULI -ooU H w co I z • � -a =Q O `- O C) p:uaM (") -- W 0 Zm�o CO a (1) }� m w �2Ww2 m • J W Qw h C0 E W w ¢ �'� CO Z 1- W Z 2�w=�, z U ti co O ¢ ¢ ¢ ¢ ¢ a Q ¢ ¢ ¢ ¢ O } - �u z Q � z z z z z z z z z o 0 E_ OOQwa,. p " f -m w CC a u _ > -¢E-_� O cG OHwWQH 0 LL I— V W Z= W O ~ O O Q m a) 0)i a a) i a a) i a) -° a a)) a) cu 1- c) U) LL L Ii l i IL � i ° u _ L L cn CL. H W T z z O 1— 0 0 Z o LL 0) m 0) m (1) m (1)) 0) (n z c 0) 0) co u u) 0 ) u ) u) 0)) V ) 5 E O M M M M M M M M M w 1 Z a. a. a. (1_ a. a. a. a. a. Z . • H v) vi W c u) ✓ z Z U U O • O F_ m c as O w • U E cQ s a ' z a) 0 o . o o E O E m o' 0 M O N a c � U U cn o a o c n t W a c a• o U (n L U) Z Q a N o a> cu c o a) W 0 ❑.❑ , 0 a h7 c ca E Q a. r > c E -° 0 Z w 06 0 it W W T R U m = • CD o _ •.- o JD U m p L-. E _ � v O ® 10 U Q (I) a. fl c V1 ( c N m (0 o c, o o co o o¢ o a. a cc . C U L G al r 0 cn 0 c Z w (n o m ` '� - ° 0 z' U (a U a) 22 0- u) Z U LL o ° ili m o T ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ O v a ' 0) - c Z Q U < N c� v LO Co oo a) 0 0 w Q o O) > `O W Ni Ni Ni Ni N Ni Ni N N u) Q Q a- a > - ) N N N N N N N N N m > > N () C 'D a- > r- r v- r- ,- c- v- C LU 1 ? N '5 O a) (1) c- ,-• r . - ,- .- = w J ❑ ❑ O 0 m a. w Q ai o0 00 00 00 co 00 ao co w W tl Ptl A}NIV. NI ` T -A it WW cnwwowO WZOwwj 00 I UU -JUF- 2 - ZIO--- - 1-Z W 1-M ~Zo • (1 li >Z ~ WW � WZ`• OW 0Zrn J (� (n In Q W 7 wz +� z �1- § W 10 HQ =QaO� � � N � F- -mill- Z -62F O O w M 1 - >O► C1� WI U: lC?..- :: U -U_� = - U >u°,i O <W <� UOUm >1- OQ UcwnU ozo�z� m 1- Q Zw .- ca DEOzwO z. ' .0 - -1 EL J oU� QWU=Q Z W WO - w - zwc 2Z W D O 0 O 1 O U > OUai t.t_► = Ly - Z O H 1- a0_ - i-z,0 • O�D - _1 z U z U ZzUwzz �Dzu.. ow CV) < O W w U w w�mwo o¢ww u- Z _ }-- 1- - O w w w CO O W Q N W � w < 00 ‹w mw = - W 0 V) m 0 ? awo 7 1- LLI -o00D C4 LL Z= rn 7 O 0 =ON 0 M > Q U > Q O C w Z WWI •jr` U _ 1-1-1W0 w ca x� � ›,- _ w Z w w c° CO O W QU- Z LL�CO E W w w Q �ccnvv��o 2 L Q ¢ ¢ ¢ ¢ ¢ Q ¢ ¢ ¢ Q Q — u- Q < CO O , Z Z Z Z Z Z Z Z Z Z 0 0 o � F - 1 - 0 m c a ce U H >z - cam 0 i 0 v -' >aI- W 111 (— W z 1"' -o - o - o is - 0 - 0 - 0 - 0 W Ce O Q a) a) a) a) a) a) a) a) a) a) LL a O O LL L.L. LL Li. IL L.L. LL LL U u) W ~ 1- Z Z m w w 0 w 1 0 0 1 - o LL. LL Z iri 0 U) v 0 u o ) u o ) c u*) c u u o ) O .c U) U) u) u) 0 u) u) V) u) u) 0 ca CO CO CO CO CO m CO CO ca Z W a) F- Z Z c o p o H o U H co T. J 6 Q E („) m a - a v o a) O Z a) U v 0 O a) w E "C as 0 a) F- o co m U U a 2 (n o CI. u) 0 o oz5 m c w W a. a c ca LL >, o i '� "ii) co Q a D. �° U) 0 0 M u) c no 0 J a) LU ❑ ❑ ❑❑ N E o - ° c 0 a Q a E m m N o z W CO F- c U) LX H c c C 0 5- o a 0 a) O o U c a) a � o ca a) t- Z 0 . o 0 O co N - = 0) C ` -0 0 Q w a. y >, N > m a) a) c ap a) a) W a. c c 1° CO t 0 C O m w W 0_ J W m 0 N Q cn Z O E a) m 73 o ❑ ❑ ❑ ❑ ❑❑❑ ❑ o m x 0 a o a) M Z < 0 Q N re) �t co - co o O 0 w n. U a Q a) >, 'n- c6 c r) C) M M cr) cr) cr) ch M w 1- H n. c o w 0 •� 0 to N N N N N N N N N N W > > >- e- N M C U Z3 Q > V- e C N r e r C W W a) 5 8 a) e- r e-- r- r r e- . c- r - J ❑ ❑ ❑ O rY m a. CO Q 00 00 00 00 cci 06 cc) cd 00 00 W W 1 ' r U) L •. - L , t- O � O a) 0 0 0 = O �`- = r , - cn U i ti- (T3 ; Hz ! : , "--!- - 7( a ) 7 .0 ! 1 0 . . . 0. i i O L U) O cu > , 0 o w I— 0 � . c cn «. L ti `� a E-- 0 < U) L O r a O C) a) O .- Q - a . O cz ,_, U) U a) 0 W O c c5 O > a)= co r .— (6 E z Ili co `> ti a W a O = E O O _cz a) a) _ .� o _ Z O N 0 O W O O Q U> Go J Q Z U I- U c ..- CO U >, E E O a) Z Q z w a a)U a° a cua�oa).�a co Q O w < .c o a) o o- c a o c M' a) o J O c n m U - H o m Urn .E_ co cn o cu cc (n o I— `_ _i z a) E co O = O _ 0 O > >cCY'(D CO Q C� w W O X� o > � w O 1 -Wo L. W Q Q� ~ � o (0 U 7.1 U Q ► � u L ) a a) i e Q 1 O ❑ ❑ W ""'l O�p `° z _ 2 o z . I f—>Z o C1 1 ° 1 O v.WZ "C O E" a) O o O o w Q 0o 1- W N O o z Q L }r ca CJ) ° o O a) a; O Q > E- 1- U ~ C z W ■ a. ° (1) C a) z O i.. L U z - v O 0 O ' 0 P. ca 'sue O U . a) E ¢ N .0 w a. z > 0 .Q co c� S.. r N U v a cn O ` � _ W O o a 'a Z a a U7 >, 0 U C E o E E ° 0 0 0 L O ° LL1 (7; 0- a) c z L 0 a) a) a) a) U o O - CO -r a) 1- I F = a) H 0 U a) U U U 6 C 7,- Cr) 74 U • O.. Fri" a> 2 cri 0 CO o .6., Q) N Q Q CO .= -= - L V) E 2 E-- rn co to I•- O a iL 0_ a a_ 0 2 ° >, ° a) °) a Z ° "_ o 11••• o --E). a) m a) -0 0 0 0 ❑ ❑ ❑ ❑ ❑ ❑ ❑ Li ❑ El :=H-- a) o > O a v a a) - z < 0 E- c � co Q ° U a) w Q a) p >' < r - ,- ,- ,- N c-) �t >, L" ❑ d a) Q) co .-I c6 07 c� c'6 ce) c) M m c6 ❑ a) a) >. T• N M C U b 0- > 0 r - - c- r- �- �- - �- T > c a a) "5 2 CU t c •- r r r r •- N- 6 CC; a) ❑ ❑ ❑ 0 m d W > 06 00 00 00 00 00 00 00 0ci o6 xi — uJ 0 • it r-i_ �� CC coWwowp WZOWWR Oz - 00 -I = - Z =U- Y �� p of p Wv ii ( Iii UJ ~ LEI Q J Z Q z 1 Q F = - Qm ii li ~ E v CC Z J app U) _ w co 1 Wi 0 CD w V > �U =° QwUO U= LL >o ° w g E2 UWU co SE F- �> `_'�� oho °wo J co � J ",ZU JoU tnU�Q� Z W f❑❑ 5— 'W W Z Q 2 w O O 0 �0t d U 0Uai u. u) ° ❑ L . a- - Z ►-- a w 1- Zf....UZM p �W - � --I O Z U = U w Z " W Z Cr ZLL -U CO Q z W W � � _ w � _ U oda!wce W 0 V) O W J < Z w < WW OOdw =wiF 0- W O 0 m U - av)U y Q Uz t-u � oO c3_ F— u- , 1L °) co O SO (NI `r)CD o O 0QU >`r)m ra O Z mc)p =CI Wa) m 7- ft m d d d Q d d Q d d d d d W O O _ `r Z Z Z Z Z Z Z Z Z W t!) w o w W ...is Ill U- hi. E w d � ra Z w w :... „O . 4 0 0 0 d F- m w - O ct -0 V ID D - a V ID - D V V D Q y. > Z r ? 0 a) a) a) a) > a) a) a) a) a) a) a) , >' d UW�Qf� LL LL u t LL ti tL LL LL LL = J u. E-- W z h o cc 0 0 0 0 0 a_ CU n a a a - a - o - a o 0 W uJ r F- a) m a) a) a) a) a) a) a) a) a) a) O F- CO) v) Cl) v) u) u) v) to u) co u) to Lo Z Z U) f/) (1) (1) U) W U) co G) U) U) U) tt. U co co as cc co co co as a) co cu co W 0 O E-- a s a. a. a a a a_ a. a. a. a. U U • z Z Q N • a) cn Ca w Z a) U Z Z I-- . (1) CI 0 c N j 2 1-: ( • Q) a) W ¢ C,) °) o o E .o n- z a. 0 a:. O m E Ell O . a c - E a) ) > , - � U v n i n o CL > , (0 O a o aa) d tLl u) ii >• o e- c n. c >, CO n• Q Q. of : c U e Z Q a CI) . a O n 11 c a) • - 0) c • - - w CD Q) c C a) o ca ■ r c W H 3 .a w ii ` m >> 0 w a) CI) LX Z ° to U) o O c a) ° O c = a) > CA O o a ti E = a a °) .5 ch co i- Z U E 0 , a) > a m C 3 a) X - 0 Q LLI a a �. N .- a) a) W a. N co O z CD cn O it cn n_ w 0 Z v co v a) Q. N Z O $ •a f') y, - E 1 co --- U �- E Q 0 t to Z -° 0 a) s) 0 - a a) .- Cr) .0 co 73 cc C-- O U - N co c c c*) CO c CO Cr) ' n'. u) 0 0 LL w _ 7 , N N N cV N N N N N N N N vi �” 0. ?• a) cr m ri cri cfi c(5 cii cei ri ri cii cri ri cYi u) r N M y C 0 a a. > .- T r r T r T T c c- r- r C w w ❑ ❑ ❑ 0 c: m G. w < ad co co czi as co cd cd co co co oc w w I` PK D+C:,i 't C4- 1. i A 1 t * t 4, \ STATE OF FLORIDA Or d ; w" - DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 0' MONTHLY CONTRACTED ACTIVITY REPORT TO: Bureau of Elevator Safety - Compliance Section FROM: Reedy Creek Improvement District City of Miami X City of Miami Beach Miami -Dade Broward County SUBJECT: ELEVATOR INSPECTION FOR THE MONTH 01 Aug -10 1 ROUTINE /PERIODIC INSPECTIONS PERFORMED 128 2 PERIODIC TESTS PERFORMED Cat.1,3,5 100 3 INITIAL INSPECTIONS PERFORMED (FINAL) 8 4 CALLBACK INSPECTIONS PERFORMED 18 5 ALTERATION INSPECTIONS PERFORMED (FINAL) 5 6 CONSTRUCTION INSPECTIONS PERFORMED 23 7 COMPLAINT INSPECTIONS PERFORMED 4 8 ACCIDENT INSPECTIONS PERFORMED 0 9 ELEVATORS SEALED FROM PUBLIC USE 0 10 NEW ELEVATOR /ESCALATOR PERMITS ISSUED 3 11 ALTERATION PERMITS ISSUED 21 12 TEMPORARY OPERATION PERMITS ISSUED 11 13 NUMBER OF ACCIDENTS REPORTED 0 14 NUMBER OF COMPLAINTS REPORTED 4 15 NUMBER OF ELEVATORS /ESCALATORS 2,096 TOTAL INSPECTIONS ( 1 THROUGH 8) 286 John Antona, CEI # 53. 9/10/2010 REPRESENTATIVE OF CONTRACTED AGENCY DATE CITY OF MIAMI BEACH CITY HALL 1700 CONVENTION CENTER DRIVE MIAMI BEACH, FLORIDA 33139 www.miamibeachfl.gov Building Department - Elevator Safety Section Telephone 305 673 7000 ext 6413 Johnantona @miamibeachfl.gov Facsimile 305 673 7857 ELEVATOR INSTALLATION AFFIDAVIT REQUEST FOR INSPECTION certify that I am a construction supervisor employed by the elevator company which installed the elevator identified below and that I directly supervised construction or installation of the elevator. I also certify that all elevator work and related installations by other trades have been completed and tested and that the project is now ready for inspection. Elevator Company Name: Project Address: CMB Serial No.: Date installation completed: (Date of Affidavit) (Signature) (Type or Print Name) Contact person to arrange for inspection Tel. No. State of Florida County of BEFORE ME, the undersigned authority, on this day of 200_, personally appeared who is personally known to me or presented the following identification and who took oath. Notary Public, State of Florida Printed Name COMMISSION NUMBER: MY COMMISSION EXPIRES: Rev. 12/04 ti AMCWAF-Or '31-- 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. SECTION 1 — EQUIPMENT LOCATION License ❑ Elevator ❑ Moving Walkway Accident Date (mm /dd /yyyy) Number ❑ Escalator ❑ Wheelchair Lift Time of Accident Hour Minute ❑ AM ❑ PM Owner Name Business Name Building Address City County State Zip Code Phone Number SECTION 2 - SERVICE MAINTENANCE Is the elevator or escalator under a service maintenance contract? ❑ Yes ❑ No ❑ Unknown Name of Elevator Maintenance Company Was the elevator service maintenance company notified? Most recent required test performed? Test Date ❑ ❑ If yes, indicate date (MM /DD/YYYY) ❑ 6 ❑ 1 ❑ 3 05 Yes No months year years years (mm /dd /yyyy) SECTION 3 — ACCIDENT DETAILS Brief Narrative: (attach additional sheets as necessary) PLEASE CHECK ALL THAT APPLY Medical Attention ❑ Fall ❑ Bruises ❑ Entrapment ❑ Hand 1 ❑ Fingers ❑ Hair ❑ Other Req'd ❑ Y ❑ N ❑ Trip ❑ Cuts ❑ Arm I ❑ Leg 1 ❑ Knee ❑ Foot ❑ Toes ❑ 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 ❑ Step —Stair Tread ❑ Floor Leveling ❑ Esc. Side Wall DEsc. 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 SECTION 4 — REPORTING SIGNATURE Report Submitted by Date Title Current Certificate ? (print name) ❑ Y ❑ N ❑ NA Signature Phone Number Contracted Jurisdiction Disclaimer: This report will assist the division in identifying ways to improve rider safety and will not be used to assign blame or liability. Florida law requires the elevator's certificate of operation holder to submit the report to the Bureau of Elevator Safety within 5 days of the accident. You may fill in the online form or Portable Document Format (PDF) version of this report, save it to your hard drive and e-mail it to: dhr .elevators(a.dbpr.state.fl.us, or you may fax or mail the report to: Department of Business and Professional Regulation, Division of Hotels and Restaurants, Bureau of Elevator Safety, 1940 North Monroe Street Tallahassee, FL 32399 -1013 Phone: 850.487.1395 FAX: 850.922.6208 2008 March 10 www.MyFloridaLicense.com /hr Page 1 of 1 Page 1 of 2 , Parcher, Robert NIL IA irt From: Montoya, Rhonda Sent: Thursday, December 16, 2010 2:30 PM To: Parcher, Robert; Tigner, Kristin Cc: Gomez, Jorge; Antona, John Subject: RE: Agreement with the State Importance: High This is the same agreement, just with a new date. Building and I have reviewed and the City Attorney form approved. Raul just advised that if the original contract provided for renewal, then it would not ha e to go back to Commission. I will have to review that with Chief Antona. , 2 t� John, let's discuss first thing in the morning. Thanks. U MIAMIBEACH W Rhonda Montoya Hasan, First Assistant City Attorney (J" OFFICE OF THE CITY ATTORNEY 1700 Convention Center Drive, Miami Beach, FL 33139 k V�' Tel: 305 - 673 -7000 ext. 6731 / Fax: 305 - 673 -7002 www.mi.ambe.ac.hfl.gov rhondamontoya @mambeachfl (1/W We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community\ \O\ From: Parcher, Robert Sent: Wednesday, December 15, 2010 4:13 PM To: Montoya, Rhonda; Tigner, Kristin Cc: Gomez, Jorge Subject: FW: Agreement with the State Rhonda, please see the City Commission action below. FYI — the City already has an agreement with the State. Is this a new /revised agreement? Has the Administration reviewed? Does the Commission need to approve? Thanks Bob July 12, 2000 C7E Commission Memorandum No. 526 -00 A Resolution Authorizing the Mayor and the City Clerk to Execute, on Behalf of the City, an Agreement with the State of Florida, Department of Business Regulations, Division of Hotels and Restaurants, Delegating to the City of Miami Beach the Authority under Chapter 399, Florida Statutes, to Issue Construction Permits, Temporary Operation Permits, and Certificates of Operation, Provide Inspection of Elevators, and Enforce the Elevator Safety Code Within the City of Miami Beach for All Elevators, Except for Elevators Owned by Miami -Dade County. Administration Recommendation: Adopt the Resolution. (Building Department) ACTION: Resolution No. 2000 -23986 adopted. Phil Azan to handle. MIAMIBEACH 12/17/2010 Page 2 of 2 Robert Percher, City Clerk CITY CLERK'S OFFICE 1700 Convention Center Drive, Miami Beach, FL 33139 Tel: 305 -673 -7411 / Fax: 305- 673 -7254 / www.miamibeachfl.gov We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. From: Tigner, Kristin Sent: Wednesday, December 15, 2010 2 :46 PM To: Parcher, Robert Subject: Re: Agreement with the State No. Something I need to know/ follow up on? Perhaps someone else in Building has been involved. If there is some action needed, let me know and 1 will see if I can find the right person for you... MIAMIBEACH Kristin Tigner, Assistant Director BUILDING DEPARTMENT 1700 Convention Center Drive Miami Beach, FL 33139 Tel: 305 -673 -7610 / Fax: 305- 673 -7529 / www.miamibeachfl.gov We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. Sent from my BlackBerry Wireless Handheld, so please excuse any spelling or grammatical errors! From: Parcher, Robert Sent: Wednesday, December 15, 2010 02:19 PM To: Tigner, Kristin Subject: Agreement with the State Rhonda Hasan, First Assistant City Attorney, has sent me an agreement to be executed between the State of Florida, Department of Business and Professional Regulation, Division of Hotel and Restaurants and the City of Miami Beach for the delegation of statutory authority to regulate and enforce elevator safety. Have you spoken with Rhonda regarding this agreement? Bob MAIM I BEACH Robert Percher, City Clerk CITY CLERK'S OFFICE 1700 Convention Center Drive, Miami Beach, FL 33139 Tel: 305 - 673 -7411 / Fax: 305 -673 -7254 / www.miamibeachfl.gov We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. 12/17/2010