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MC-16-684 Permit NO. MC-3-16-684 Miami Shores Village Permit Type: Mechanical-Residential 10050 N.E.2nd Avenue NE Wotk Classification:Addition/Alteration Miami Shores, FL 33138-0000 Pen It Permit Status:APPROVED ^ � Phone: (305)795-2204 �<OR1Dp` Issue Date:4/12/2016 Expiration: 10/09/2016 Project Address Parcel Number Applicant 1116 NE 92 Street 1132050270420 Miami Shores, FL 33138- Block: Lot: SUSAN PINNAS Owner Information Address Phone Cell SUSAN PINNAS 1140 ALFONSO Avenue CORAL GABLES FL 33146- 1140 ALFONSO Avenue CORAL GABLES FL 33146- Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 COOLING FX INC (954)916-6640 Total Sq Feet: 50 Tons: Available Inspections: Additional Info:RELOCATE EXISTING AHU FROM GARAGE T Inspection Type: Classification:Residential Final Approved: In Review Rough Duct Comments: Date Approved:: In Review Review Mechanical Date Denied: Type of Work: Underground �JEE Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# MC-3-16-59026 DBPR Fee $2.25 03/15/2016 Credit Card $50.00 $259.10 DCA Fee $2.25 Education Surcharge $0.20 04/12/2016 Credit Card $259.10 $0.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $0.80 Work without Permit Fee $150.00 Total: $309.10 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict onformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assu responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,P MBING,MECHANICAL,WINDOWS, DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFI VIT- ify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction an ing. ermore, I authorize the above-named contractor to do the work stated. April 12, 2016 Authorized Sig ature:Owner / Applicant / Contractor / Agent Date Building Department Copy April 12, 2016 1 Miami Shores Village g 14RBuilding Department CE Jr 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 '6 2018 Tel: (305)795.2204 Fax: (305)756.8972 BY; INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 201`1 BUILDING Permit No. mG 1 (o - Cady PERMIT APPLICATION Master Permit No. 12GI 6 Permit Type: MECHANICAL JOB ADDRESS: I I IG fie- Ct 2 !T City: Miami Shores County: Miami Dade Zip: 2a Folio/Parcel#: l I 3 205" ©21 " © 20 Is the Building Historically Designated: Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): SQ"tA pp_ iPhon�e#-� Address: MCP 1-1E 9Z (;;T City: State: Zip: Tenant/Lessee Name: Phone#: Email: , j CONTRACTOR:Company Name: - h Phone#" q�� Address: r��� Z t- Si62. H.7 Av( 0 in 121 City: ;�Ic l -P State: r Zi 33 l y Qualifier Name: "-X Phone#: elf`( --66 C) State Certification or Registration#: g (q b t ( q SS z_ Certificate of Competency#: 13 M O O D O f& Contact Phone#: � `/Oq - LI(-f(6 Email Address: d11 an.,,,P:4-di G 1�2 A o i •COv►1 tDESIGNER: Arc}iitect/Engineer: yl:{� 6L-VW;91 Phone#: 2� Vil eu of-Work�for,this'_Permit: $ / Db 0 Square/Linear Footage of Work: �0 Type of Work: ❑AddressAlteration ONew ❑Repair/Replace ❑Demolition Description of Work: m 4-,M WN dot. C,IA,5j'ST r.4 EX S �-wor Submittal Fee$ Permit Fee$ f OtgCF$ b CO/CC$ 0 Scanning Fee$3 Radon Fee$ ' �� DBPR$ �' chi Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ t ;q0 (M Structural Review$ r TOTAL FEE NOW DUE$ �'LSJCI C O Bonding Company's Name(if applicable) Y Bonding Company's Address City y State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application-is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING, SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will-be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs se (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a re A pection fee will be charged. Signa "re� — _' -Signature ?/yiC • O r or Agent AContractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me-this y day of Jq rPQf4rc 20 ,by j�>.5 4 ,,�'t day of JAIV• ,20 1 L,by ;7'0 c,� who ' zona y kno me or who has produced who is pe sonally known to a or who has produced tucN,t�y k - ` As identification and who did take an oath. as identification and who did take an oath. NUTARY-PUBLIC: NOTARY PUBLIC: Sign: _ _ Sign: Print: Prin /G41 My Commission Expires:► ��ei M Commission Ex it VERONICA PHILLIPS }' p14W 'RY po-MYCOMMISSION ii FF 068609 ;�;, ROBERT C.SMITH _ Notary Public-State of FloridaEXPIRES:February 22,2018 'e r$ p°,,; My Comm Expires Jul 14,2017 * ;�5"',*** +§t�rvrw�ilhr ,tf135935 t APPROVED BY 1 x ner Zoning V U Structural Review Clerk (Revised 3/12/2012MRevised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) SNORES Miami Shores Village logo ogggg� Building Department Rtup 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel. (305) 795 2204 AIR CONDITIONING REPLACEMENT DATA Fax: (305) 756.8972 PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change-out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done):__ 1116 N-0- . q s� City: Miami Shores Village County: Miami Dade Zip Code: ?31 3 l ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI(AHRI)DATA SHEET REQUIRED Change Disconnecting means:YES ❑ NO❑ ARHI Sheet Attached:YES❑ NO❑ Contract Attached:YES UNIT BEING REPLACED DATA NEW UNIT MANUFACTURE AHU or PKG. UNIIVODEL# COND.UNIT MODE # KW HEAT NOM TONS AHU CU PKG 1 M.C.A AHU CU PKG AHU CU PKG 2 M.O.P AHU CU PKG AHU Cu PKG 3 VOLTS AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER (YES.2Q REPLACING DUCTS 11y,E NO YES REPLACING THERMOSTAT YES NO YES NEW 4"CONCRETE SLAB YES YES NEW ROOF STAND YES 0 YES &01 NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity(Wire Size): 2. Maximum Overcurrent Protection(Fuse/Breaker Size): 3. Voltage of Circuit(208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: TY16 Phone: 9 �q —6C State Certificate or Registration N. ificate of Competency N. 6GLb 16 Signature Date: i �! (Q ifier's signature only)Yl ou ESTIMATE,/ INVOICE Y COOLING INC 3921 SW 477TH AVE �Air Conditioning & Refrigeration 910, � SUITE 1012 DAVIE, FL 33314 O �, ♦n C FAX#954-343-1098 Honesty * Integrity • Reliability Info@coolingfx.com BROWARD:954-916-6640 PALM BEACH:561-482-5343 No. 011806 NAME: -5v S-), Y.0. Q',A C' 5 DATE: Urensed&Insured Broward #10-CMM-16080-X ADDRESS: U-2181 6 C Z S Miami Dade# 016 Palm Beach#U-21819 r CITY: `lno(es ZIP: X31 3 D MAKE MAKE PHONE: ` MODEL MODEL EMAIL: J�x 1Gt�C_pY�•.r c` o" cw\ .co" , C.. �A ar J;n SERIAL SERIAL TECHNICIAN: Y •• DESCRIPTION OF • ' AMOUNT R vh: COMPRESSOR HEATING ASSEMBLY 1oc�; o� 1t Nle SUCTION AMPS_- r` _rl � C– � C O —41006 DISCHARGE HEATER SIZES KW AMPS p CONNECTIONS TIGHT&CLEAN 1 p TERMINALS TIGHT&CLEAN p CONTACTS/LIMITIS CONDENSER COIL TEMP IN_TEMP OUT p WASH COIL ELECTRICAL COMPONENTS D CHECK FIN CONDITION p CHECK FOR CORISION/LEAKS p CONNECTIONS TIGHT&CLEAN C3 START KIT p REPLACED/ADDED REFRIGERANT'R- p CONTA&I Cl REPLACED p LEAK CIREMOVE p CAPACITOR,�j REPLACED p VACUUM / ADD LBS p COMPRESSOR TERMINALS FAN MOTORS THERMOSTAT C3 CONNECTIONS TIGHT&CLEAN TYPE AMPS:IDF �ODF p BATTERIES p REPLACED p LUBRICATE N/A p CONTACTS / CONDENSATE DRAIN RECOMMENDATION BLADE/WHEEL / AIR FILTER a STACKED\ I CLEAN DRAIN LINE [3 CLEAN p FLOAT SWITCH CI REPLACE CI CLEAN PAN p ORD R p CLEAN CONDENSATE PUMP SIZE: COOLING DIFFERENTIAL BELT: TEMP IN MPOUT PAYMENT: CK# FINANCE: TOTAL S / CIADJUST NEXT TUNE UP: Cc # DEPOSIT 13 REPLACE p 3 MTS p 6 MTS p 12 MFS C3 ORDER EXP: SEC: BALANCE DUE SIZE: 0MONTHLY FILTER CHANGE REMINDER BILLING HOUSE#/ZIP CODE: / TERMS:1 HAVE THE AUTHORITY TO ORDER THE ABOVE WORK AND DO SO AS OUTLINED ABOVE. IT IS AGREED THAT THE SELLER WILL RETAIN TITLE TO ANY EQUIPMENT OR MATERIAL FURNISHED UNTIL FINAL PAYMENT IS MADE.IF SETTLEMENT ISNOT MADE AS AGREED,THE SELLER SHALL HAVE THE RIGHT TO REMOVE SAME AND E R WILL BE HELD HARMLESS FOR ANY DAMAGES RESULTING FROM THE REMOVAL THEREOF. COOLING FX INC.IS NOT RESPONSIBLE FOR WATER DAMAGE.ALL WARRANTY WORK TO BE DONE M-F 9 M-SPM. SMOKE DETECTORS,TEST AND BALANCE,CITY PERMIT FEES AND HEAT LOAD CALCULATIONS IF NOT MENTIONED ABOVE ARE NOT INCLUDED IN PRICE.THERE WILL BE A 1.5VA INTERES CHARGE PER MONTH ON PAST DUE INVOICES AFTER 30 DAYS. PARTS WARRANTY:ALL PARTS AS RECORDED ARE WARRANTED AS PER MANUFACTURERS SPECIFICATIONS. LABOR WARRANTY:ALL LABOR IS WARRANTED FOR A PERIOD OF 30 DAYS OR AS OTHERWISE INDICATED IN WRITING BY THE BOV COM LY. Customer Signature X Technician Signature X Date:qspoctia Thank You For Your Business! Visit us at www. oolingfx.com for monthlyls! ;A CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 13M000016 COOLING FX INC D.B.A.: G 1170N JESSE Is certified under the provisions of Chapter 10 of Miami-Dade County 6wouoaa�no6apepiweiw-n+,vm -wavy sly u pa of pe swela� ]unop ape4-iweiW - -- - �® ��yy Ci�_/� pieoH a4110 tiela�oag 30tq JWVIW 'lbOIN`dH031N 1,000 �S)3ab'ZIl JNUI�I�tlf1D ' 000320 K.7r- Local Business Tax Receipt Miami—Dade County, State of Florida I -THIS IS NOTA BILL - DO NOT PAY LBT 7100282 `BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES II COOLING FX INC RENEWAL SEPTEMBER 30, 2016 DAING BUSINESS IN DADE COUNTY 7378284 Must be displayed at place of business Pursuant to County Code Chapter,BA-Art.9&70- OWNER I SEC.TYPE OF BUSINESS COOLING-FX INC 196 GENERAL MECHANICAL CONTRACTCI�AYMENT RECEIVED a 13M000016 - y TAX COLLECTOR Worker(s) 4 I $75.00 07/14/2015 . CREDITCARD-154W 17 This Local Business Tax Receipt Only confirms payment of the Local Business•Tax:The Receipt is not a license, permit,ore certification of the holder's qualifications;to do business. Holder must comply with any governmental _or nongovernmental regulatory laws and requirements which apply to the business. 1 t ti The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sec Ba-276. For more information,visit www.miamidade.govhaxcolleytor- - � STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION FF ' CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 po *tom 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 GUYTON, JESSE Z COOLING FX INC. 2906 SW 79TH TERR DAVIE FL 33328 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range ' 3: STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, iDEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. ,' PROFESS(bNAU'REGULATION Eve da we work to improve the way we do business in order to •.'- f �' Y P Y RM14016982 .�, t SSUED .. 07/07/2015 serve you better. For information about our services, please log onto •.��+ ��` ' ...�.. www.myfloridalicense.com. There you can find more information ' �' t about our divisions and the regulations that impact you,subscribe REGISTERED.MECHANICAI;CONTRACTOR GUYTON,JESSE Z,IjIj' �.. to department newsletters and learn more about the Department's initiatives, COOLING FX IN,Crt (INDIVIDUAL Ml'1ST EST* l.�tLOCAL � Our mission at the Department is: License Efficiently, Regulate Fairly. LICENSING REC biREiVI IOR jVT� . ,� We ronstantly strive to serve you better so that you can serve your TO CONTRACTING'IN ANDY AREA) customers. Thank you for doing business in:Florida, J HAS REGISTERED under the provisions of Ch.489 FS, and congratulations on your new license! Expiration date:AUG 31,2017 L1507070000508 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD RbM14ot8s82 *tib N The MECHANICAL CONTRACTOR Named below HAS REGISTERED - Under the provisions of Chapter 489 FS. Expiration bate: AUG 31, 2017 (INDIVIDUAL MUST MEET ALL 40C"CLICENSING REQUIREMENTS PRIOR TO G©k-T:RA: -1 ,G IN ANY AREA) z GUYTON, JESSE Z COOLING FX INC. ,;v." 3921 SW 47TH AVE Y` ~' -^'• - SUITE 1012 •�^ ._ a. }� DAVIE FL33314 ISSUED: 07/07/2015 DISPLAY AS REQUIRED BY LAW SEQ# L1507070000508 CERTIFICATE OF LIABILITY INSURANCE 081'15115 THIS CMTMICATE 15 ISSM AS A MATTER OF/fIFORIATHON ONLY AND CONFERS NO I==UPON THE CERTM/ATE HOLAER.THIS CERTFICATE DOES NOT AFFtRUATNELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAW ARS BY THE POLICES BELOW THIS CEI FIGTE OF WKWANCE DOES NOT COl4Wn E A CONTRACT BETWEEN THE ISSUING INWWW^AllnIORIIED RFpRESENTA711rE OR PRODUCER.AND THE CERTNWATE HOLDEFL IMIPORTANT. ■the aoEWmft Addw b an AODMONAL OWRO.Se SoYoyllaa}sv*bo mWmsad. M 0 UQROGATJI0IE 0 WANM UCleet b Ari lanes and omdMoes of Sts;A-, omtdn Polides ow newwo on Alfaifmaet aw tJEb prEN, I don eat c m I E1DIds lethe aottrluAs hold ar In Now of such endmasnta go( PRODUCER Argeless 16etrance Group 561 4338808 561 433-9624 1855 IrK%n Road Sulb#204 West FWm Boo t.FL 39408 COWEaAaE NM Phone 4338806 Fax (561)433-MA M@UR m A- COUWf INSURANCE COMPANY INSURED fllumma. Cool ng FX Inc C 3921 SW 47&Aiemn Sulb 1012 Ereunet 0. Davis.FL 33314 954-0164M so a; COVERAGES CERT(ACATE NUMBER REVISION NUMSM- THIS 18 TO CERTFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUQI13AiT.TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT W ITH RESPECT TO WHICH THIS CERTWATE MAYBE ISSUED OR MAY PERTAIN,THE DMIRANNCE AFFORDED BY THE POLICES DESCRY HEREIN IS SUBJECT TOALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICES.LMS SHOWN MAY HAVE BEEN REDUCED By PAD CLAIMS TYPE Of SIMNEAMCE L,MMTi oENmALLMrJTY EACEHOCI>)11ai8aCE 1000 .00 E/] COMMERCE t-GENBMLV utY 1 i 100,000.00 D ❑ CLM040M 0 GDS GL3988749 IMM E)(Pw» s 5.=.00 A ❑_ N «112412015 0324x1016 PERSOWL&ADVN,xrn s IAWAW-OD ❑ GENEUA.A GIREGATE s 3 DDD.00 GEA.AGGIFEQATE LAST APPLE$PErt PRODUCM-COWMP AOr3 i 1.011OAD0.00 ❑POLICY ❑ 29 ❑ Loc l AUTCHOEnEUARK Y r ALlrrr ❑ MYAM sGtxtraLrJRrta.rP.twtl $_ ❑ IW Oma ❑ IMINM « 9ootrNJlJRr�roodr. i El ttwwarms ❑ � Wo $ i ❑ t Rans-L tf M ❑OOQJR EACH OCCLWGUUCE i Excels LIAe 0 qj,, wAOE ABATE i DED U wmmnmsi IN)RXERS CQEl6iRATpHH0 Wo A AND LIMINUrT Yin $ t�LUDED? MIA MV E1611CMAECi1E11T i daaeYtlm0la ELGMEA2-FABiLDYE S OFOP9MTROMM iw E.LowAxE-PmocYuwrl i D peOFOPgnxfMiLacxnM I%SM N JkI Nt, EY1�MrsuMlMucMnuwyr�Ews IN ,Contractor*subcw*ac*d work-ttuaaM WMVuetbn.tspol;Art on*or two/fmlly oweltrnps Air CondJl W"System:or Equo~t daalm or dtstrNwtats A utstsxatbn. "Mr inp or repair CERTIFICATE HOLDER CANCELLATION 1E1IM"ANY OF THE AISIM DdCRMED POLI[IEs BE CANCELS I&MI SHORE$VILLAGE BLDG DEPT THE EXPRATl01f GATE THEREOF.NDTICE ATILT.Be DEJMEM N 10060 NE 2ND ANE ACCORDANCE WITH TW POLICY PRONIs!>ONIL MlAhll SHORES FL 33138 AEmEDIE�nE3tAeratrwtwE IAAattargdes Psnehn Boom O 1Mf oMQ ACORD CORPORATION. All ddb rasow ACORD 25(MN"QF The ACORD none and loco Uri niodwrod w flcs of ACORD. 06 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/30/2015 Ig 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 s. PRODUCER Iron Fidelity Insurance Services,LLC CONTACT NAME: 2004 LaPrada Pkwy PHONE A/C,No,Ext Mesquite,TX 75150 FAX A/C No): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: XL specialty Insurance Compan 37885 Payroll Management Inc INSURER B: For:COOLING FX,INC DBA COOLING FX INSURER C: 348 Miracle Strip Pkwy Suite 39 Building H INSURER D: Fort Walton Beach,FL 32548 INSURER E: COVERAGESINSURER F: CERTIFICATE NUMBER: REVISION NUMBER: ;EXCLUSIONS IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD DICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS RTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMADD'L SUER TYPE OF INSURANCEINSRD WVD POLICY NUMBER POLICY EFF POLICY EXP MMIDD MM/DD/YYYY LIMITS GENERAL LIABILITY Not Applicable EACH OCCURRENCE $ XXXXXX COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ XXXXXX CLAIMS MADE❑OCCUR MED EXP(Any one person) $ XXXXXX PERSONAL&ADV INJURY $ XXXXXX GENERAL AGGREGATE $ XXXXXX GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ XXXX)CX POLICY PRO- LOC JECT $ XXXXXX AUTOMOBILE LIABILITY Not Applicable COMBINED SINGLE LIMI ANY AUTO JEa accident $ XXXXXX ALL OWNED SCHEDULED BODILY INJURY (Per person) $ XXXXXX AUTOS AUTOS NON-OWNED BODILY INJURY (Per accident) $ XXX )CXX HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ XXXXXX UMBRELLA LIAB OCCUR Not Applicable EACH OCURRENCE $ XXX)0(X EXCESS LIAB CLAIMS MADE �<X DED RETENTION $ AGGREGATE $ XXX $ XXXXXX $ x== A WORKERS COMPENSATION $ XXXXXX AND EMPLOYERS'LIABILITTY RWE943545301 05/01/2015 05/01/2016 X TORY LIMITS ER ANY PROPRIETOR/PARTNER/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Y/N N/A E.L.EACH ACCIDENT $ 1,000,000.00 (Mandatory in NH) if yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,AddltIona]Remarks,Schedule,If more spaee Is required) THIS CERTIFICATE CONFERS NO ADDITIONAL INSURED RIGHTS UPON THE CERTIFICATE HOLDER. H Only the co-employees but not subcontractors of COOLING FX,INC DBA COOLING FX H COVERAGE ONLY APPLIES TO ACTIVE EMPLOYEES OF PAYROLL MANAGEMENT INC, THAT ARE LEASED TO COOLING FX INC..COVERAGE ONLY APPLIES TO INJURIES INCURRED BY PAYROLL MANAGEMENT INC.&SUBSIDIARIES ACTIVE EMPLOYEES WHILE WORKING IN THE STATE OF FLORIDA.COVERAGE DOES NOT APPLY TO STATUTORY EMPLOYEES OR INDEPENDENT CONTRACTORS OF THE CLIENT COMPANY OR ANY OTHER ENTITY.**DOES NOT COVER USL&H.EMAIL PAYROLL@PMIPEO.COM FOR ACTIVE CLIENT LIST HVAC CO.STATE LICENSE#RM14016982 COUNTY:13M000016 CERTIFICATE HOLDER 166e ICANCELLATION MIAMI SHORES VILLAGE BLDG DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2ND AVE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN MIAMI SHORES,FL 3313 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Adam Goldberg $$-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of AC RD