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EL-15-3164 ` Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL G "V l X70 Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-268038 Permit Number: EL-12-15-3164 Inspection Date: September 27, 2016 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: DEL CASTILLO,ALFONSO Work Classification: Addition/Alteration Job Address: 1051 NE 92 Street Miami Shores, FL Phone Number (305)613-5552 Parcel Number 1132050160010 Project: <NONE> Contractor: TRUE POWER ELECTRIC INC Building Department Comments REPLACE UNDERGROUND PANEL RELOCATION NEW Infractio Passed Comments WRING NEW RECEPTACLES AND SWITCHES INSPECTOR COMMENTS False Inspector Comments Passed Failed El (01W Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 September 27,2016 Page 1 of 1 Permit No. EL-12-15-3164 �swO1S y,� Miami Shores Village t Permit Type'Electrical-Residential 10050 N.E.2nd Avenue NE 'Per Work Classification:Addition/Alteration Miami Shores,FL 33138-0000 Permit Status:APPROVED "�. Phone: (305)795 2204 tonrvA issue Date:3/17/2016 F Expiration: 09/13/2016 Project Address Parcel Number Applicant 1051 NE 92 Street 1132050160010 Miami Shores, FL Block: Lot: ALFONSO DEL CASTILLO Owner Information Address Phone Cell ALFONSO DEL CASTILLO 1051 NE 92 Street (305)613-5552 MIAMI SHORES FL 33138- 1051 NE 92 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone TRUE POWER ELECTRIC INC Valuation: =20,000.00Total Sq Fee Type of Work:REPLACE UNDERGROUND PANEL RELOCATIO Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning: 1 Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical Underground W.W. Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $12.00 DBPR Fee Invoice# EL-12-15-58139 $10.50 03/17/2016 Credit Card $756.00 $0.00 DCA Fee $10.50 Education Surcharge $4.00 Permit Fee-Additions/Alterations $700.00 Scanning Fee $3.00 Technology Fee $16.00 Total: $756.00 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 conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS 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 zonin uttt r.mnre the above-named contractor to do the work stated. March 17, 2016 Authorize plicant / Contractor / Agent Date Building Department Copy March 17, 2016 1 Miami Shores Village ' � ;FB Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 EC 2'2 2015 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 j2_0 �r BUILDING Master Permit NoX! j2 3/ice PERMIT APPLICATION Sub Permit No. ��.5 ,/T� ❑BUILDING `® ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 10 b T �/�' � z-� �� City: Miami Shores County: Miami Dade Zip: 3W30 Folio/Parcel#: 11-320ar—2114-00( o Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type:- Flood Zone: BFE: FFE: OWNER: Name(Feed1"Simple Titleholder): ,, Otls� _ 1�3��a Phone#: Address: 1D� SSG 01- ",' sQ City: %OUA State: -Tt- Zip: aw 6 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: I C 1 ,7litNt(' +P. i�t C Phone#: i l' 1�l T? Address: City: n� Ir t2 ra �� State: Zip: 33,:> F; p� Qualifier Name: Z^c7/U y f i 0 N D Phone#:_`T N- State Certification or Registration#: CC f 3 D b� 3 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: Square/Linear Footage of Work: Type of Work: ❑ Addition ® Alteration ❑ Newnn ❑ Repair/Replace ❑ Demolition Description of Work: `�= 14" ypBidQ.(e1��J0 �� U00iili•OSS a4Gf em Specify color of color thru tile: Submittal Fee$ Permit Fee$ �7�©�4L� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ LY (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will.be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CQ/TRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged Before me this \ w,e) / _ day of 20 Ir by / day�of /; �/'L�f4/ 20 % by (QdUg&h& who is personally known to ��lJy l% ,�N"/� who is personally known to me or who has produced as me or who has producedX SQ)-ols'Y Z`�6 as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: t Notary Public State Florida Patricia Faggionato +� My Commission EE 179889 �o�. G ALTHABE OF p, Expires 03/15/2016 j , MISSION'I FF 042175 Sign: Sign: Print: Print: J''°oFrV ded Budget aroyServicea• Seal: Seal: ***i******************s*****ss**ss•r****s*******r*r*s********************s*s***s**s**s**s**********s*****s** APPROVED BY � Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) FROM :> FAX NO. ;1111111111 Sep. 09 2015 02:09PM P1 ' STATE OF FLORIDA DEPARTMENT OF"BUSINESS iAND',PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LIC04.$ING BOARD (850) 487.1395. 1940 NORTH'MONROE STREET. • . TALLAHASSEE FL 32399-0783•'.".-' * FINNO TONY P TRUE Odi&ELECTRIC INC 313 NW ,,,15TH STREET . . - ,.._ . . .. MARrATE FLIM _ ' -• ' ' '�15:•::;X16 .- . BROWARD COUNTY LOCAL, BUSINES&TAX RECEIPT` 116 8.Andrsk Ava,Rm.A-100,Ftlm�c$etthafe,FL �3309:�1895=95 4-83'9.400 VA(JD O'CiTOBLR 1, .SEPTEMBER 30, 2Ift§ 011A" Receipt p01Q8& BL ClRZIC INC Receipt it lei-334.0 9usIms HIM : Business Type:ZLBc':R1M/a:.:,)t...e/CQE..R►CTOR OwNer Naffw r y g'pn m BwAfts Opened:o,/ae/lose ' Businm i ocatbn:957 M 64 AV13 BgtslCaa�ttY ��BCI3COZe71 w►acs►T� lumption code:•• ' Business Ph4nt3:984-571-4969• • '.. .. tEoone .Scab impayeas 1�1cMiaea Nnhcsioork', *N*w ao mwhiaas: VO _ TAX A-MU1 TWt*r ae NSF!I* Nm4 •' prior Years ' WeGtb'i Cost Tota!paid ar.00 • •o.o . o: .. .aO a�'.an . . . •- waste �oaa-u-000asssa . . ft"09/2 i/2W 2740' RICK SCOTT,GOVERNOR KE"LAWSON,SECR6TARY ............._....,,. .. .,� STATE iW*R016A DEPARTMENT OF WMI AND PROFESSNWM REGULA71ON ELICTRIM CTORS U sti BOARD EC13MMI The ELECTRICAL CONTRACTOR , Named below IS CERTIFIED umet•tttp pmvBbns ofCh S Expiration deft: AUG 31,2716'48 F"o TONY Is ;• �:>: ;: uPP� c ;:- , '`fir 6103 NW 15TH$_T... .wwr w*w. www-ww•• PUAA� \I a uwavr►a%N 1 •.0 ___ r� DATE(MM/DD/YY) A ORD CERTIFICATE OF LIABILITY INSURANCE 12/18/15 PRODUCER City Insurance Agency THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 2929 N University Dr#107 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Coral Springs,FL 33065 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone (954)752-9876 Fax (954)752-9938 INSURERS AFFORDING COVERAGE NAIC# INSURER A: Federated National INSURED True Power Electric dba Electrical Workers, Inc. INSURER B: 6103 NW 15th Street INSURER c: 952 NW 66th Ave INSURER D: Margate, FL 33063-EC 13002831 INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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 OF MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR,INSRD _ DATE(MMIDDNY). DATE(MMIDDIYY) GENERAL LIABILITY EACH OCCURRENCE 1,000,000 V DAMAGE TO RENTED 100,000 COMMERCIAL GENERAL LIABILITY GL0000025526-01 12/14/15 12/14116 PREMISES(Ea occurence) i CLAIMS MADE J OCCUR MED EXP(Anyone person) 5,000 4 PERSONAL&ADV INJURY 1,000,000 GENERAL AGGREGATE 2,000,000 _.............................r. _• PRODUCTS-COMPIOP AGG 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 1; POLICY PROJECT LOC w... AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE OCCUR CLAIMS MADE AGGREGATE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS'LIABILITY TORY LIN41TS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICER f MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES t EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISION Electrical Contractor-EC 13002831 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL City of Miami Shores Building&Zoning 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 10050 NE 2nd Ave THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Miami Shores, FL 3313$ AUTHORIZED REPRESENTATIVE ACORD 25(2001108)OF ©ACORD CORPORATION 1988 _._....__...................... ......... Hou 04 2015 18:41:19 EST FROM: F2M/17074588210 MSG# 77375520-886-1 PACE 083 OF 003 CERTIFICATE OF LIABILITY INSURANCE 8022 THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAMEND,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 its an ADDITIONAL INSURED,the policy(iss)must be endorsed. if SUBROGATIONIS 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 j certificate holder in lieu of such endorsement(*). ! xEff- � . NAM1�: PA`'CHEX INSURANCE AGENCY INC ( c°4.E,r): tAC,Noi: (888) 1443-61=2 (888) 443•-61?2 E-MAILs PO LOX 33013 vau -vslA Fo;nw3 cov�Aes AIW3 S It ANTONIO TX 78263 INSUR'-Rn: rwi n City :iT6 1.1,- cc 29aaQ + gym INSUA_R B u:sus�st c: i TRUE POWER :ELECTRIC INC -EC 13002831 INSURERD: 6103 NW '_c 1 ST INSURER E: !MARGATE !?I, 33063 I IWSUi PIF: 1 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER! 1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE EOR THE POLICY PERIOD j 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 TERM S,EXCLUS IONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .4DOL Nusit• i N/LICY Err I PJt/CS'£?tF LWIT.S rYP£CirMVURANCEL7R ( Allt/Cr:YC+Pr78£R ti/;KiDD/y'YY}' i /14 COMMERCIAL GENERAL LIABILITY ( EACH OCCURRENCE CLAIMS MADE ❑OCCUR DAMAGE"ORENTED PREMISES(Ea oc4utta"CSI MED EXP(Ally one PC SOP; i ( PERSONAL 3ACV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE c POLICY JPRO- ECT ❑LOO PRODUL rr 5•C01d PIOP AGO 1 i OTM ER: !' } i AUTOMOBILES LIABILITY COV 88iE0 SINGLE LIMIT (Ea sCC!dml) �. 1 ANY AUTO I EODILY INURY(Pe pe:•sd^;, ALL OWNED SCHEDULED 11 BODILYIN URY,P61 Vdeni) '3 AUTOS -IAUTOS i i #NON.QWNED j PROPERTY DAMAGE HIRED AUTOS; i (Par aecldaatf 1 _ Auras ;EACH i ;UMBRELLA LIAB OCCUR OCCURRENCE EXCESS LAB j CLAIMS-MADE AOORrAATE I 1 E a 05D' IRETEM,fi�t �YuxA'£Artvurt.xc�rlov i X S3TATUTE i ERS s 'vY0♦:.Ni'LnYL'lP.4'LL�BILTY j ANY PROPRICTOR1rAR`NERI0XECUTIVE YIN I E.L EACH ACCIDENT �OFFICERAIENIBEREXCLUDE07 --f XA j n (RiRltdilfory lR NR) i� 'tE 6Y'EGV2-2b I.O-xx/12/2=.i7) '".;9/12/2U.16 E,V 013F-AGE-EA EMPLOYEE =l vU,+�•l,.v UU If yee,descnhe undar E.L.DISEASE-POLICY LMT DESCRIPTION OF OPERATIONS OBIOW f i I 1 I 1OE8QWPI7QN OF OPERATIONS/LOCA TION&/VEHICLEd(ACORD 101,Addltlonsl Ramsrks Bohadula,rAbY ba attsehad It MOM apsoa le N6ulr*dj S ;Those U5Uai to the InsU-ed's Operat_ons. Electrical Contractor-EC 13002831 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DE5CRIBED POLICIES BE CANCELLED City of Miami Shores Building&Zoning BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL RE i DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave i AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 I Q 1988.2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Hou 04 2015 10:41:19 EST FROM: F2M/17074SO0210 MSG# 773755ZO-006-1 PAGE 003 OF 003 CERTIFICATE OF LIABILITY INSURANCE 8022 11/4/20:15 THIS CERTIFICATEIS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS I 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, i IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ios)must be endorsed. If SUBROGATIONIS WAIVED,subject to the 1 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 endorsament(s). PA`'CH X INSUFLANCE AGENCY INC -HONE a. a (888) 443-61, 12 I vUi�t_ 210705 P: =: (888) 443-6112 aDDRE59 FO BOX 33013 Ivau�gs}a�o:nlNtlrDYeaaeE Haler S ANTONIO TX 78265 1N'SU .RA: rfi city :' In C0 7N$URm IN",5RO: 1f�SU.R9Z C: TRUE POWER ELECTRIC INC-EC 13002831 1NsuRERo: 6103 NW 1 STi ST INSURER a: C4.ARGATE FL 33063 INSURER F COVERAGES CERTIFICATE NUMBER REVISION NUMBER: j THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD i INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN i5 SUBJECT TO ALL THE TERM S,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I l;VSR .�DDL SL+$R' %X1CY£FF POL/CYE" Ll.#11T5 TYPE 11FGk5C�A.INC'E �, P!!L/C'Y,tYh}I'$fA Af.41 nyrr it 1 t COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE y i DAMAGE TO RENTED CLAIMS-MADE ❑OCCUR PREMISES(Es 01~Uar1ce} ( MED EXP(A:FY 010 WWI I PERSONAL 3ADV INJURY ' GENERALAGGREGATE 5 I GEN'L AGGREGATE LIMIT APPLIES PER: POLICY' PRO- LCC ' PRODUCTS•COMP/OP AGG I' JEOT D OTHER: I COVBblED SINGLE LIMIT AUTOMOBILE LIABILITY I (ED tCcldenR I� I ANY AUTO I EODILY INJURY(Per ovws ', 'p ALLONINED ! SCHEDULED BODILY KURY(For IEC dent) 5 AUTOS AUTOS HIRED AUTOSi AUTOS vNED ; PROPERTYDAMAGE I ' � ITC$ I (Per tcCideMJ I I ' EACH OCCURRENCE UMBRELLA EXCESS LIAR VR t CLAIMS-MADE A30RE3A?E. ` I I c=_e Rears-sov s 4 iFURXd'AY LYIMPd,'kV.171(M` xtlTN- I € iSTATUTE AND&.14PLUYNRS,UAINU7Y i 'ANY PROPRIETORIPARTNERICXECUTIVE YIN € i I C.L.EACH ACCIDENT i �OFFICERiMEMBEREXCLU0E07 I IM$ndPto?yInNH) wA 16 'NEG ZV232b 109/12/2,1n 0911212016 E.LDISEASE-EAEMPLOYEE 11 Yee,tleecn0e under I !E.L DISEASE.POLICY LIMIT t' r J()()I C o Lo E DESCRIPTION OF OPERATIONS 091DN s { � I E 1 j I I iOESGRIPnON OF OPERATIONS/LOCATIONS/VEHICLES WORD 101,Addltl0nal Rtmarkt 806111416,mtY be aNaahad ItmdYt apact Ie rtg¢Iladl Those usual to the Inst-red's Operat4Lons. Electrical Contractor-EC 13002831 I i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED i City of Miami Shores Building&Zoning BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave AUTHORIZEO REPRESENTATIVE Miami Shores, FL 33138 I ` 019882014 ACORD CORPORATION,All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD -°'%r'� CERTIFICATE OF LIABILITY INSURANCE °A 2118115rrYt PRODUCER City Insurance Agency THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 2929 N University Dr#107 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Coral Springs,FL 33065 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone(954)752-9576 Fax (954)752-9938 INSURERS AFFORDING COVERAGE NAIC# INSURER A- Federated National INSURED True Power Electric dba Electrical Workers, Inc. INSURER B: 6103 NW 15th Street INSURER C: 952 NW 66th Ave ,..INSURER..D: _........._..._ _:: Margate, FL 33063-EC 13002831 INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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 OF MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRD.;. .. DATE(MMlDDn'Y} DATE(MMIDD/YY) GENERAL LIABILITY EACH OCCURRENCE 1,000,000 J COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100,000 GL0000025526-01 12/14115 12/14/16 PREMISES(Ea occurence} CLAIMS MADE J OCCUR MED EXP(Any one person) 5,000 A PERSONAL&ADV INJURY 1,000,000 GENERAL AGGREGATE 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG 2,000,000 J POLICY PROJECT LOC ...._.. ............ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE AGGREGATE OCCUR ` CLAIMS MADE A _._ DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS'LIABILITY TORY LIMITS ER, ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISION: Electrical Contractor-EC 13002831 CERTIFICATE HOLDER CANCELLATION ................ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL City of Miami Shores Building&Zoning 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 10050 NE 2nd Ave THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE ACORD 26(2001/08)OF ©ACORD CORPORATION 1998 a t �- 3i Ce