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WS-17-239
Permit NO. WS-1-1 7-239 Miami Shores Village Permit Type:Windows/Shutters 10050 N.E.2nd Avenue NE ' Work Classification:Garage Door W4 r Miami Shores,FL 33138-0000 PA'v Phone: (305)795-2204 Permit Status:APPROVED FLORIDA Issue gate: 2/22/2017 Fxpiration: 08/21/2017 Project Address Parcel Number Applicant 10205 NE 4 Avenue 1132060170770 Miami Shores, FL Block: Lot: ROBERT PAULSON Owner Information Address Phone Cell ROBERT PAULSON 10205 NE 4 AVE (305)751-8593 MIAMI FL 33138-2416 Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 JCAB ENTERPRISES INC (954)288-4798 Total Sq Feet: 0 Type of Work: REPLACE EXISTING GARAGE DOOR WITH N Available Inspections: No of Openings: 1 Inspection Type: Additional Info:REPLACE EXISTING GARAGE DOOR WITH N Final Classification:Residential Review Building Scanning:4 Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# WS-1-17-62769 DBPR Fee $2.00 DCA Fee 02/22/2017 Credit Card $82.60 $50.00 $2.00 Education Surcharge $0.20 01/30/2017 Check#:2404 $50.00 $0.00 Notary Fee $5.00 Permit Fee $110.00 Scanning Fee $12.00 Technology Fee $0.80 Total: $132.60 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 regoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructio nd zo ng. F er re, I au rize the above-named contractor to do the work stated. February 22, 2017 Authorized ature:Owner / Applicant / Contractor / Agent Date Building Department Copy February 22, 2017 1 s , Miami Shores Village i-z:�c---�T-VFD JAN 3 042017 Building Department Q-. � 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �.�'�. -- n`� Tel:(305)795-2204 Fax:(305)756-8972 I- ;U,' INSPECTION LINE PHONE NUMBER:(305)762-4949 S` `1;,�� FBC 20182 q BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. OBUILDING F-1 ELECTRIC ROOFING REVISION EXTENSION RENEWAL PLUMBING [—] MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION [:] SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 10205 NE 4TH AVENUE City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-3206-017-0770 Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: CONCRETE Flood Zone: BFE: FIFE: OWNER:Name(Fee Simple Titleholder): ROBERT PAULSON Phone#:954 647-1235 Address: 10205 NE 4TH AVENUE City: MIAMI SHORES State: FL. Zip: 33138 Tenant/Lessee Name: N/A Phone#: Email: CONTRACTOR:Company Name: JCAB ENTERPRISES INC ti�(/' Phone#: 954 288-4798 Address: 1553 NW 102 DRIVE City: CORAL SPRINGS State: FL. Zip: 33071 Qualifier Name: ROBERT ANDRADE Phone#: 954 288-4798 State Certification or Registration#: CGC059638 Certificate of Competency#: DESIGNER:Architect/Engineer: N/A Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 1000.00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑■ New ❑ Repair/Replace ❑ Demolition Description of Work: REPLACE EXISTING GARAGE DOOR WITH NEW DOOR Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$. Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) A , , Bonding Company's Name(if applicable) N/A Bonding Company's Address _ City State Zip Mortgage Lender's Name(if applicable) N/A 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 on 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 a 0 P� 4k-,nr. Signature _ OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 7 � r day Uh-ot u--Z-`1 20 ib by /ASO day of I,Qr ,20 , by i`0i5o f+ l- VA L-L5 d/�J,who is ersonally know to 1^Qbr,(4 141 -who is personally known to me or who has produced as me or who has produced 'S3�0 identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: 6Z(JSign. m Print: Print: ' = MY COMMISSION#GG 04 Seal: ROBERT AUBREY ANDRADE Seal: :4 EXPIRES:November 2.' �'3 Bonded Thru Notary Public l', Z y MY COMMISSION#FF902163 F EXPIRES No ber 13,2019 N a g o 414 NZZ C N D APPROVED BY ij ZA (� Plans Examiner Z i a Structural Review Clerk (Revised02/24/2014) l L ao :3ora v4s P, dip veld 93!s Miami Shores Village W :w Z 3a 3DVa LI.OZ'SZuer APPROVED BY DATE 31r0 3lV09 01 ION ZONING DEPT 3nx aas3ew3a-3 arau.ao� BLDG DEPT 7 D SURJFCT TO COMPLIANCE WITH ALL FEDERAL O = ;TATF-AND COUNTY RULES AND REGULATIONS U) o mD z ch Z v9x90L -p M X C r -n < N wm O • ..... .... ...... ..... . .. .... ...... . ...... 000.00 ! •••• • • 'IMP-" • �o N e O_ I � 6,8 X BOC 1N08J) MOOD 3E)V8V0 'l, Buluedo Property Information Building Information Owner: THEA PAULSON Wind Zone: 175 MPH. Address: 10205 NE 4th AVE. Exposure Category: C , MIAMI SHORES. FL 33138 Minimum Building Dimension: 50 ft. Mean Roof Ileight: 15 ft. Risk Category: _ III Design Pressure Calculations Opening =Location Device Device Max Posttwe Max NegattveNumber Width m Height m [:E=1evationt Pressure s Pressure sf)g (_) (p fl (P C1 End 108 -- __- —84 15 32.3 40.3 "TATE p� R ' r gRCH►TEC, . . . . . . . . . . . .. . . . .. . . ... . . ... . . Prepared in accordance frith:ASCE. 7-10,Chapter 30. It Loa•( -C(anponeety jpYk Gy ldh(,.,ith Edition(2014)Florida Building Code. Pi e•lpfT• . .. .. . . . .. .. ... . . . ... . . w MIAMI•DY4DE MIAMI-DADS COUNTY PRODUCT CONTROL SECTION 11805 SW 26 Street,Room 208 DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES(RER) Miami,Florida 33175-2474 BOARD AND CODE ADMINISTRATION DIVISION T(786)315-2590 F(786)315-2599 NOTICE OF ACCEPTANCE (NOA) www.miamidade.eov/economy Clopay Building Products Company 8585 Duke Boulevard Mason,OH 45040 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed and accepted by Miami-Dade County RER-Product Control Section to be used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction(AHJ). This NOA shall not be valid after the expiration date stated below.The Miami-Dade County Product Control Section(In Miami Dade County)and/or the AHJ(in areas other than Miami Dade County)reserve the right to have this product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may immediately revoke,modify,or suspend the use of such product or material within their jurisdiction. RER reserves the right to revoke this acceptance, if it Is determined by Miami-Dade County Product Control Section that this product or material fails to meet the requirements of the applicable building code. This product is approved as described herein,and has been designed to comply with the Florida Building Code, including the High Velq. ' DESinSCRIPTION gle Car W�Stiecl are,ge Door up to 9'-0"Wide / Optional Impact Reslstan I e �, i APPROVAL DOCUMENT: Drawing ogle Car W7 Pan Doorwith Impact Resistant Lites",sheet 1 of 1,dated 06/13/2008,with revision 06 dated 02/2015,prepared by Clopay Building Products Company,signed and sealed by Scott I-Iamilton,P.E.,bearing the Miami-Dade County Product Control revision stamp with the Notice of Acceptance number and expiration date by the Miami-Dade County Product Control Section. MISSILE IMPACT RATIN . Large and Small Missile Im act Resistant LABELING:A permanent label with the manufacturer's name or logo,manufacturing address,model number,the positive and negative design pressure rating,indicate impact rated if applicable,installation instruction drawing reference number,approval number(NOA),the applicable test standards,and the statement reading'Miami-Dade County Product Control Approved'is to be located on the door's side track,bottom angle,or inner surface of a panel. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials,use,and/or manufacture of the product or process.Misuse of this NOA as an endorsement of any product,for sales,advertising or any other purposes shall automatically terminate this NOA.Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami-Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed,then it shall be done in its entirety. INSPECTION: A copy of this entire NOA s4aiPbeepTvided to he twet by"manufacturer or its distributors and shall be available for inspection at the job site at the Leque st of the•Bt il&ni Cllil�1. This NOA revises NOA# 13-0625.06 aniFjs fln§ of$i;page,I end evidence pages E-1 and E-2,as well as approval document mentioned above. The submitted documentation was.reviewed by Carlos M.Utrera,P.E. . ... . . e r . • . NOA No 15-0225.16 ism . . . . . . . . . MIAMI-DADE COUNTY • •• ••• •• • ••• Expiration Date: August 21,2018 Approval Date: May 14,2015 Pagel , ... . . . ... . . M M Clopay BuiIdine Products Company NOTICE OF ACCEPTANCE: EVIDENCE SUBMITTED A. DRAWINGS 1. Drawing No. 101702,titled"Single Car W7 Pan Door with Impact Resistant Lites", sheet 1 of 1,dated 06/13/2008, with revision 06 dated 02/2015,prepared by Clopay Building Products Company,signed and sealed by Scott Hamilton,P.E. B. TESTS "Submitted under NOA #08-0618.03" 1. Test reports on 1)Uniform Static Air Pressure Test,Loading per FBC TAS 202-94 2)Large Missile Impact Test per FBC,TAS 201-94 3)Cyclic Wind Pressure Loading per FBC,TAS 203-94 4)Forced Entry Test,per FBC 2411 3.2.1,TAS 202-94 5)Tensile Test per ASTM E8 Along with marked-up drawings and installation diagram of 9'x 8',24ga steel garage door Model 94W7 with windows,prepared by American Test Lab,Inc.,Test Report No. ATLNC 0305.01-08,dated 05/28/2008,signed and sealed by David W.Johnson, P.E. 2. Test report on Salt Splay per ASTM B 117 of painted G40 galvanized coated panels, prepared by Stork Materials Technology,Test Report No.30160-04-63365,dated 01/26/2005,signed by John D. Lee,P.E. C. CALCULATIONS "Submitted under NOA#08-0618.03" 1. Jamb anchor calculations,prepared by Clopay Building Products Company,dated 06/13/2008, signed and sealed by Scott Hamilton,P.E. D. QUALITY ASSURANCE 1. Miami-Dade Department of Regulatory and Economic Resources(RER) • •• • • • • ••• • .. ... .. . . . .. Carlos M.Utrera,P.E. 0:6 ••• Product Control Examiner ' • NOA No 15-0225.16 . . . . . . . . . . :.. ;•. ;• ••• Expiration Date: August 2l,2018 i Approval Date: May 14,2015 E-1 . . . . . . . . . . . .. .. . . . .. .. ... . . . ... . . Clopay Buildine Products Company NOTICE OF ACCEPTANCE: EVIDENCE SUBMITTED E. MATERIAL CERTIFICATIONS "Submitted under NOA #08-0618.03" 1. Test report on Accelerated Weathering Using Xenon Arc Light Apparatus per ASTM G155 of Lexan SLX2432T Clear Polycarbonate,prepared by Hurricane Engineering &Testing, Inc.,Test Report No. HETI-06-A002,dated 12/04/2006,signed by Rafael E. Droz-Seda,P.E. 2. "rest report on Tensile Test per ASTM D638-96 of Lexan SLX2432T Clear Polycarbonate, prepared by Hurricane Engineering &Testing, Inc.,Test Report No. HETI-06-T566,dated 12/04/2006, signed by Rafael E. Droz-Seda,P.E. 3. Test report on Tensile Test per ASTM D638-96 of Lexan SLX2432T Clear Polycarbonate,prepared by Hurricane Engineering&Testing,Inc.,Test Report No. HETI-06-T634,dated 12/04/2006, signed by Rafael E. Droz-Seda,P.E. 4. Test report on Self-Ignition Temperature per ASTM D1929,Rate of Burnper ASTM D635, and Smoke Density per ASTM D2843 of the Lexan Plastic,prepared by ETC Laboratories, Test Report No. ETC-06-1024-17496.0,dated 05/26/2006,signed by Joseph L. Doldan, P.E. F. STATEMENTS 1. Statement letter of code conformance with the 2010 and th 5th edition(20 14)FBC issued by Clopay Building Products Company, dated 02/18 , sign an ea ed by Scott Hamilton,P.E. "Submitted under NOA #13-0625.06" 2. Statement letter of code conformance to 2010 FBC, dated 06/13/2013,signed and sealed by Scott Hamilton,P.E. 3. Statement letter of ro financial interest issued by Clopay Building Products Company, dated 06/13/2013, signed and sealed by Scott Hamilton,Y.E. .. ... . . . . . .. .. ... .. . . . .. Carlos M.Utrera,P.E. ' '•' ... Product Control Examiner . . . • • • • • NOA No 13-0625.06 . . . . . . . . . ... . . ... . ' •• • •• • • Expiration Date: August 21,2018 . . Approval Date: May 14,2015 E-2 . . . . . . . . . . . .. .. 00 . .. .. ... . . . ... . . 4 1 3 lY Mit .-AH CC OP Df LS MIS 84A, 94. 98. H94 33Y 0a 3 AOOto nrtro[D RIGHT ESISMI IQEP_L-MORELS: 4RST, H4ST, 4F [ND SECS AIIAD49 10 G-10C CL 00011 AT T P A MI[MCD rOTHAL AC SYSTEM FROENDNT SFACE C/�T o. la/dl inwo oitaw Dpfn NcusaNr utcs I1MC i1)IOG-L-LOC CLINCHES AT TOP AHD(:)AT BOr10Y ALONG TNL rRONi fACE' .�yAy ION B-8 Rue of 17 NAMIED ODE EOMI' fn/N I[R 1070. HOLMES MODELS: 48 29SECTIONS HAVE(6)TOG-LAOC CLMCNES:9 i-LRua V a o2/2OIs LiDAtED CODE CDY0.w000 SfAI[dNi. ISE SICIONS HAVE(4)TOG-I-Lot CIOOMIS. HCeI AVIA NMCK LImm TRACK CONFlGRU ATION BY DOOR NS1ALLCR 110 SLAP. INi[RYIOMI[silo BETWEEN EACH[MOSS. MtAtgMf051® aaa IIMIM MOMOts ra LNR toogoLI9ARNcJA1 i'^^ HW eDlo TATE. 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SHEET(SIAL SCR(SrS. •_FIRST ■SIARTNG TROY BD,1o4 N NP LNIl[i NPGOV FAIT 1 •NSIMItO N IrASF Af IEdI -LIQ 1, 12 G.C7FASI RACN - :C, '7 •. / q IN1ACAti FAwow ALUI•RM tSIRYAaI B VNTL iFWmmrw.[OAUsv)H A NNB CMN ON -1/7' ATTACHED IRAN IDES/7 SELF TArPINF SCREWS N E t c. IQESIGN LOADS: +42.0 PSF do -48.0 PSF. MOW LAG SCRCIET, ON CENTER SPACING I("SCREWS ON ww ODOR) 4 GA WV.STEEL NIDI IMRC rAUUtO 10 CNIIA ---2- [AOC• IIAE-.I,,.0 1-GALV.STFAS1ENV0 S1kf PRI)EACH CIL1W SHUT KIMERANCES y° •z os y.' Nol[� ) of 1 9.O.1V . E2'o'N 10!IIS.GCl/ �®p�� ,ACTT.5M1..aAMw1 : :,DISL.BRACACIMIN ONE 1/IC NAIAD rV11Wr 1S NSMUD OH EACH Hal".WVfr. .0000 A.00J• OP '.b6i/r3 B: OLSCRIPTTCK I/1•.S/B'Balt MAI IN DR 4 G CKY snit ONO INC EAS11NLo 10[he 10uf W O[ADI Dw.;,,H+{.1/7 . !;- SINGE!I:/11 w7 PAN DOOR t/1•Awl Is. fTA.s/6•SKLI INIM SCREWS•N)t/4'ULF IJFPLIG SatK T9• ^ . e, WITH tktPAC1 (2LSISTANT LITES AY l �' .�N`• THIS PP00'.ICI COMaIMS w w Building Products 8585 OUKE etVO. '.c,.•' okAvu`w wu[t V[n RIDUAIM[MIS OF DA 2010 IOC 2•10 44L SiECI ROLLER(1-7/1017/4.47 9 IAASON.01010 45040 CNSC(ISO(Y•SHd (J 1 O 1 702MID AND we KIN Ca1GN FLK. .110 SI[EL GR MILION PRI. Co/)•) (]rl 513 770-45M .-- - ---- -- 4 -.��- 3 2 1 ` A STATE OF FLORIDA ,;- DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 ANDRADE, ROBERT AUBREY JCAB ENTERPRISES INC 1553 NW 102ND DRIVE CORAL SPRINGS FL 33071 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 STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque DEPARTMENT OF BUSINESS AND restaurants,and they keep Florida's economy strong. PROFESSIONAL REGULATION Every day we work to improve the way we do business in order CGC059638 ISSUED: 07/04/2016 to serve you better. For Information about our services, please log onto www.myfloridalicense.com. There you can find more CERTIFIED GENERAL CONTRACTOR information about our divisions and the regulations that impact ANDRADE, ROBERTAUBREY you,subscribe to department newsletters and learn more about JCAB ENTERPRISES INC. the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly.We constantly strive to serve you better so that you can the provisions of Ch 489 FS CERTIFIED under serve your customers. Thank you for doing business in Florida, IS CEapaaEnate :UG 37, er U607W00F S and congratulations on your new license! DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION F. CONSTRUCTION INDUSTRY LICENSING BOARD CGC059638 The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 D ANDRADE, ROBERT AUBREY JCAB ENTERPRISES INC 1553 NW 102ND DRIVE CORAL SPRINGS FL 33071 0 ce• an. nwn•��.e nICDI AV AC DC:nl IIDC:n RV I AIA/ QFrlB 1 /rn7nAnnn'IF16 1/24/2017 11:16:04 AM PST (GMT-8) FROM: 100005-TO: 19546886707 Page: 2 of 2 ' ! 7 0 DATE(MMIDDIMY) ACORN CERTIFICATE OF LIABILITY INSURANCE 1/24/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or 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 endorsement(s). CONT PRODUCER SUNZ Insurance Solutions, LLC. ID: (TLR) NAMEA T Workers'Comp Department c/o TLR of Bonita, Inc PHONE 727-520-7676 x 3 CNO: 727-525-3862 700 Central Ave, Suite 500 E-MAIL St. Petersburg, FL 33701 ADDRESS: certs encorehr.com INSURERS AFFORDING COVERAGE NAIC fl INSURERA: SUNZ Insurance Company 34762 INSURED INSURERS: TLR of Bonita, Inc EnterpriseHR INSURERC 700 Central Avenue Suite 500 INSURERD: St. Petersburg FL 33701 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 33906256 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBIR POLICY EFF POLICY E-XP LTR D WVD POLICYNUMBER MMIDDIYYYY MMIDD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ A CLAIMS-MADE OCCUR PREMISES(Es occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ POLICY LOC PRODUCTS-COMP/OPAGG $ OTHER: $ COMBINED LIMIT AUTOMOBILELIABILITY Ea accident SINGLE $ ANYAUTO BODILY INJURY(Perperson) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMSRELLALIAS OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ A WORKERS COMPENSATION WCPE0000000112 6/1/2016 6/1/2017 ,/ STATUTE ERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECL rIVE Y/N E.L.EACH ACCIDENT $ 1,000,000.00 OFF ICER/MEM BEREXCLUDED? r--1E.L. (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) Coverage Provided for all leased employees but not subcontractors of:JCAB Enterprises Inc Client Effective:5/3/2015 CERTIFICATE HOLDER CANCELLATION 8525 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10051 NE 2nd Avenue Miami Shores FL 33135 AUTHORIZED REPRESENTATIVE Glen J Distefano ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 33906256 Master Certificate Andrea Oelucchi 1/24/2017 1:12:37 PM (COT) Page 1 of 1 ACo® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) Illk� 1/30/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT(Maria Benitez NAME: Jackson Insurance Agency PHONE FAX (AIC.No . (305)824-3464 AIC. IC No:(305)822-8535 2075 West 76th St E-MAIL ADDRESS: g y'� enc' mbenitez@acksona corn INSURERS AFFORDING COVERAGE NAIC# Hialeah FL 33016 INSURERAArch Specialty Insurance Company 21199 INSURED INSURER B: JCAB Enterprises Inc. INSURERC: 1553 NW 102 Drive INSURER D: INSURER E: Coral Springs FL 33071 INSURER F: COVERAGES CERTIFICATE NUMBER?017-2018 COL REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR rypE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY YEF MNU I EXP LIMITS LTR1=WVD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TI I A CLAIMS-MADE ❑R OCCUR PREMISES (E.="..) E.occu ence) $ 100,000 AGL0021804-02 1/31/2017 1/31/2018 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ PRO 2,000,000LOC PRODUCTS JECT OTHER: $ AUTOMOBILE LIABILITY MBINED S $INGLE LIMIT EaCOaccident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PPReO�PERdT ntDAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION SPER OTH- AND EMPLOYERS'LIABILITY TAT YIN UTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) This certificate is solely for the use as " Evidence of Insurance" CERTIFICATE HOLDER CANCELLATION (305)795-2204 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd ave Miami Shores Villag, FL 33138 AUTHORIZED REPRESENTATIVE Maria Benitez/MARIAB ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS02512014011 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT j I 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2016 THROUGH SEPTEMBER 30,2017 i DBA: Receipt#:180-268963 Business Name: JCAB ENTERPRISES INC Business Type:GENERAL CONTRACTOR Owner Name:ROBERT ANDRADE /QUAL Business Opened:05/06/2015 Business Location: 1553 NW 102 DR State/County/Cert/Reg:CGC059638 CORAL SPRINGS Exemption Code: Business Phone: 954-288-4798 Rooms Seats Employees Machines Professionals I 2 For Vending Business Only I Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior YearsCollection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 i THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. f Mailing Address: i ROBERT ANDRADE /QUAL Receipt #03A-15-00009713 1553 NW 102 DR Paid 09/09/2016 27.00 CORAL SPRINGS, FL 33071 LIN- 0E2f%1A1A 2016 - 2017 Mr% -- - • —• ------- — — - --