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EL-14-1763 Permit No. EL-8-14-1763 `SORES�Q Miami Shores Village 01 ON Permit Type:Electrical -Residential 10050 N.E.2nd Avenue NW Pen ' Work Classification:Addition/Alteration Miami Shores,FL 33138-0000 Permit Status:APPROVED ryfNtf `` Phone: (305)795-2204 ---- - - - FLORIDp` 03/16/2016 Issue Date:9!1812015 Expiration: Project Address Parcel Number Applicant 10616 NW 2 Avenue 1121360020060 CRISTINA CRUZ ESCALONA Miami Shores, FL 33150- Block: Lot: Owner Information Address Phone Cell CRISTINA CRUZ ESCALONA 619 E CROSBY Avenue EL PASO TX 79902- 619 E CROSBY Avenue EL PASO TX 79902- Contractor(s) Phone Cell Phone Valuation: $ 10,000.00 DANCE ELECTRIC INC (954)236-8824 Total Sq Feet: 0 Type of Work:PROVIDE NEW WIRING,RECONNECT EXIST Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning:3 Meter Box Alteration Relocation Fire Alarm Service Change Underground W.W. Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $6.00 Invoice# EL-8-1452608 DBPR Fee $5.25 DCA Fee $5.25 09/18/2015 Credit Card $335.50 $50.00 Education Surcharge $2.00 08/12/2014 Credit Card $50.00 $0.00 Permit Fee-Additions/Alterations $350.00 Scanning Fee $9.00 Technology Fee $8.00 Total: $385.50 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 zoning. Futhermore,I authorize the above-named contractor to do the work stated. September 18, 2015 Authorized Signature:Owner / Applicant / Contractor / AgenP Date Building Department Copy September 18,2015 1 • Miami Shores Village A Building Department DDrr/'� TT� 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 c�'IVFiD Tel:(305)795.2204 Fax:(305)756.8972 AUG 2014 INSPECTION'S PHONE NUMBER:(305)762.4949 BY FBC 20 [__� BUILDING Permit NoA I q— k� PERMIT APPLICATION Master Permit N0?0_' I`f �b Permit Type: Electrical JOB ADDRESS: 106/6 AA) Q Ave City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: // 2 i 3600aoo6o Is the Building Historically Designated:Yes J NO Flood Zone: OWNER:Name(Fee Simple Titleholder): �i�s7�n�i 0-1Z E3Gc%hti 61ajl' Phone#: �9/S 333"�l Address: 611 C . Croft i 19VQ City: &-/ Pjo State: 7X Zip: 25 S 02 Tenant/Lessee Name: Phone#: Email: t CONTRACTOR:Company Name: I)rV`►QF_ GLEC-T'POLk �t Kj Phone#: C�53" 23wS2ZLi Address: 2 CC 3 e I %01s�\^<_ C-\C2 C_(_- ' City: � tf State: Zip: 33 3Z.`rj Qualifier Name: 'A'QL-. C*4'N C-E Phone#: 14 SLA- 23 G%-" State Certification or Registration#: EC.a(ZOS7 Certificate of Competency#: Contact Phone#:954-236$8Z`-) Email Address: boy sC-e e L4'C_\y.'k1C.C C.oM rz ST T' DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit:$ /L9! Square/Linear Footage of Work: Type of Work: ❑AddressAlteration ONew ORepair/Replace ❑Demolition Description of Work: Q/Qu i d/Q �t/P�./ (,�i r► ., /e Novi n P�� NYi�� ^� C ;�� �s- ***************************************Fees******************************************** Submittal Fee$5�A,00 Permit Fee$ 7: �/�� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ , Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ 35 I9rrrrding Company's Name(it applicable) NM_ q Boudi ng Company`s Address Caty ........................__— State N/ Zip Mortgage Lender's Narne(it applicable) .._....................._..__�..._...... Mort±laµge Lender's Address Citv State: _ Lr p__ Application is hereby made to obtain it permit to do the wink and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a perrnit and that all weak will he perfonned to meet the standards of all laws regulating Construction in this jurisdiction. I understand that a separate permit mast be secured for FI..k.C:"I'RICAI_WORK, Pl..UNIRING,SIGNS, WF LLS, POOLS,FURNACES, BOILERS. t1F A'1't:RS,`FANKS and AIR CONDI'HONF RS,EA*C..... OWNER'S %FFIDAVIT: I certify that all tyle foregoing infonnation is accurate and that all work will he 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 INIPROVEMENTS TO YOUR PR(.)YER`I'Y. IF YOU' INTEND TO ()tiTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN :-ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition it)the issuance of a.budding permit with an estimated value txceeclirrg$2.500, flit, applicant must promise in,good fitith that a cope of the notice of cornmencemew and construction lien lom,brochure will he delivered it) the person whose propert-v is subject to anachnrent. Also, o certified copy of the recorded notice of c;owmencerrte w must he posted en the Joh site fnr the first inspection which occurs seven (7) days after the building permit is issuetl, hr the absence of>such posted notice. the inslrec:tion will not be approved and a reinspection fee will be chatged. signature Owner or Agent Contractor The fore:goin€*instrument was acknowleclgecl beforc me this A0 7# `I'he forcgoin<w instrument was acknctwl idged before me this,3 clay o1 QG oBe,20 M7 by�fs't'ic stZr.__ pa"G, day ai E"I'�} 2(t I��_,by �I �FN cC who is personally known to rile or who has prcxluced. --._..._ who is personally known to me or who has As identification and who did take an oath. as identification and who did take.an oath. NOTARY PUBLIC: NOTARY PUBLIC: f Sign: Sign:_ -_....._ - 1111--l-al - _ __.......................................................................... Print: — .1Q>✓AICt.........._......... __.___.......... f rint: DEB(ilE A m (I � ri'�' My Can t' dire IA MORENO ' z PORN o NOIJ►y Public•State of Florida � F f Nota Public. Stcrte of/T�ex�c[re j��AAt 7, :m.�,.,..•.'vZ� .:.a':!i�I ,�4R?(i147 :k:k::a#:#:#:$ :'s a:;::::r r£=d;cs. r,.^3� ..s..«-. r'4! ��•�:i....:4-' C>;�k<#+�z.�^.:^l!'�.::. r,l z�iy A1111ROVE_D 14Y _.. t7L Plans Fsxarniner Zonim, Structural Review Clerk iReviscxl3/I2/?012j(ILevi I07/10/07)(R(-%,iw'tttMill0t;?tH JitRe_.i cc�_�llilrK)j Hca d'° CERTIFICATE OF LIABILITY INSURANCE "nowtow"M THIS CERTIFICATE IS ISSUED AS A MATTER OF GAEONLY AND CONIFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, TW5 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY LYA 8/5/2014 EHD, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE pOLIC1ES BELOW. THIS CERTIFICATE OE INSURANCE 0003NOT CgNSTRUTE A CONTRACT BETWEEN THE ISSUING INS REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER URER(S), AUTHORIZED wIPORTANT: R th4 C&dW7*y 1101der 10 an ADDMONAL INSURED,tho P011CA19s)roust be anaoraee- !f SUBR0GATIOM IS WAIVED,subjuct to the teens and condlHons of the polky,cwtaln poHcl s may Lsputre sn andoraament A a>a91M-t 11 thte csltl dOeB not confer jlghts to tho Detwkaw holder In lieu of such oodoraonant(a. EA krue ninr,T EA--Commercial T-ineB �eiaslaraaoe i'1fO� (954)tl73-1tl06 � 2700 S. COMMeree Parkway cysisayy-iacz Suite 210 A°O" weatan FI, 33331 a AFrara m E NAICK INSURED r Dance ElActrie, Inc.2663 S Abiacar Circle Davie FL 33326 COVERAGES CERTIFICATE NUMBER:C=48504150 REVISION NUMBER. F. THIS 1S TO CERTIFY THAT THE PO CER OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NANIfO A6OVE FOR THE POLICY PERIOD INDICATED, NOTVNTHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TC 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 PO E$.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CL111i1S. flmA TYPE OF WWRANCE ,y T4&M10MJkAL LJAMILWYucv NureERLMTS EACH cE a 1,000,00dERcw G rtvLkAL unearrv100,D00CLNM3#1ADE �OCC 60�-SQB5264i /1/201 /1/20iy $,00 MED EXP wn rsu, i PERSONAL A AIT/INJURY a 1,000,000 GENERAL A(3GREEGATE s 2,000,0001 GVNt AGGREGATE UMrr APPLIOU PER ►�ROaucrs-GOa1PAPAGO s 2,DOO,DON % POLICY IAC AUTOMODU LZAMKJTY f ALIMIML,� UMIT ANY oWW9 HODILY ff"Ay(PWjMFr _ BOG EDOD .....�.� NGN�4INED k100fLY INJURY(P�vf UNUHAILLAU AUTOS ' a S UM9RELlJI UAB OCGi)R exCE35LIM CLAIM&AIADE EACH i AGGREGATEi DED RETENTK7NS woRlces$coMpeN$AnaN s AND EMPLAYEW LMLLfry A LL ANY PROP9JABEREXCLLEWEJ(Ecu'flvelY�i E,LEACHACCnENTj1i:�M NHR EXClLk7Ep7 N!A u Ym,do=rft w14oT EL 018EAbE.-EA EM OE6CRIPTION OF OPERA below �-�SEASE-POLICY uMlr f Oe3CaIPTIDN OF OPElLT14NIS/40CATION6/VEHICLE$YAri�rcb^CORD 191,Addb*40 Rmwks scMauft■mon yum be 10"bao Please rater ro policy :for terms, eorulittions acid exclusions. Florida License #EC0000569 Unlimited Electrical Contractor Classification 5190 Wiring within buildings CERTIFICATE 14 LDER CANCELLATION $MOULD AMY OF THE ABOVE DESCRIE(E'D PCLICW5 BE CANCELLED BEFORE THE OUNRATION DATE THEBEOF:, MDR= WILL BE DELIVERED IN Miami Shotes Village ACCORDANCE WITH THE PouCY PROVIBIOrhL 10050 NE 2 Ave Miami Shores, IPL AUTHORDrDR&POWSWITATft 3• Bradley' Hxtxvrr,:LTLg/IP ACOIZD 25(2010/0b� ®1988-2010 ACORD CORPORATION.Ah rights reserved, INS0221 nniw)n 1 '1 N..ArY►on a..a bvlrr mm lwni-h roA n rar.of Ar:lwrl J I EO/Z0 39Vd LLgl 30Idd0 X3Q3d Lt0LT56b96 Ls; ET tTOZ/ZZ/80 �CtQ�ddm CERTIFICATE OF LIABILITY INSURANCE osrmsr` ' TMS CeNTIMCATE IS ISSUED AS A MATTER OF INFOKDAATION ONLY AND COW15RS NO RIGHTS UPON THE CERTIFICATE HOLMR.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATnMLY AMEND, EKTENP OR ALTER THE COVERAGE AFPORDFD BY THE POLICIES BELOW. TkM CERTIFICATE OF INSURANCE DOES NOT CONSTITM A CONTRACT BETWEEN THE i68UING INSURER(SL AUTHOREW REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPMTANT-.M Tim certlAaatp holder Is an ADDITIONAL INSURED,thu potley((as)must tm ondoryed.If SUBROGATION IS WAIVED,suWuct to tho terms and Whd6tlone of the policy,cur4Tln poppies may require url 046weemam A of ww4nt an this corblicato does not corder riphtm to to cortificaho holder in Hou of such andamcment(s PWIWJCM « RICHARD M.GALT INSURANCE AGENCY P eya-752 42aa — � '-- Sbhel5rrm 9367 MST SAMPLE ROAD antNL�P"' r<-ttak95t rS21{821-- CORAL SPRINGS,FL 33065-4329 _ 41EWT43i(S}FFFORDINGSOMLt%GE !wCii IIOAUP&RA Stdla Fid M P4fbft Iti8l1rY1(x CgnIR-Y 1Q7]9 IN umm DANCE ELECTRIC IWC—. — c:juj.L B siste Farm MuBs11 AutarloWn Irulurenoa C yT Mh7l1 2663 EAST ABLACA CIRCLE IN.WIWR C: FORT LAUDERDALE,FL 33328 !W!D: ocunmR C• — -- COVERAGES ="JFICATE NUMIR REVISION NUMBER_ THIS LS TO CERTIFY YNAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOvE FOR THE POLICY Pr,:RIOD INDICATETJ.NOTWITHSTANDING ANY RL•OVIREMFNT,TERM OR COW&ITION OF ANY CONTRACT ON OTHER DOCUMENT VWW RESPECT TO WHICH rH15 CERTIFIf'J\TE MAY BE ISSUED OR MAY PERTAIN, T11E INSURANCE AFR)RO 0 8Y THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS$HOWN MAY HAVE BEEN REDUCED BY PAID CI._All4, ZR TYPL'OF INSURANCE A.silo vaucrxDnwlLYi 'F ! uauru COMEMAL QENERAL UA LILY EACH OCCVRR0=- 3 OLAINWS..MAOt p XCUR D--•.. _ - uE0 r7o� aw aw*an s PER50NAL�AW/MlUkY S �-__...-- CENT.AGCar�nY6PLIRyY�ffN+LIES PER: GENERALAQQRGGATE s Pfh.1CY +r=cr EJ WC PRQM=S.COMPIOPAM i OTNFM i ._`.... i kwomonaz UNKLT1Y M s ANY AUTO SC91Ib 7$7DDt13 S9C "0=014 101C&-2DM sonar iN.AIRY owPrr M s_ 250.000 i x :"L1, [ MAV p;S BODILY WAM(PorC�1p s SiW,W(i 19RE:DAU•ID9 x ww AIrrQ4 63TT t ' 1 i L UMBRELLA WB c'Ae"W.Mmu'ICE S EICCES91JA8 CLNMEiYhOE nGGra1;P,7E y -Y.. PFJ] RETgWIONx A / LOYE14{'L1gEM-11Y YIH PLA Fn __- nNYPIOPRIEYaruPnRtNeTLEXECUTivE E.LEAC1iAGGO 'IT $ 10R90O oPFiceR�uEw,e+e>reuroEDr U NIA 98�K-T715+1 osr0lr20id 0810yrIs (Mma.6wrin HH�p)o� tt_UAMP Ll-FA EYth c 100.000 q R i�iv oP�PFIW •.-- ---.... - F,-L 07TjFi15E POLICY Utalr a 90O,OCO I o5scpiPOON OP OPIA010"i LOCATIONS 11 CHICLU(ACARO 10 AthllW-RM-d-t6bodW*AW Pd MUC.4 C V u upw In State of Florida Unlimited Electrical Contractor ECO000569 Classification #5190 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE SHOLLL.D ANY OF THE AWVE DF.SCRIM-D POLIMES eE CAhCELL W CEFOW BUILDING DEPARTMENT THE EXPIRATION [LUTE "MtEREpF. N YME WILL OF Dti NDUM IN 10054 KE 2ND AVENUE ACCOI DANCE WUH THC POLICY PROVISION& MIAMI SHORES,FL 33135 Aataiortlzsn Resrr Fes. - I ib 19$8-2014 ACORLI'j0ORPORATION.All rights re3erwocl- ACOTiO 25(301+101) The^CORD name and 10SO am ni&tamd marks of ACORD 10014" 13284.0 02-042014 E0/E0 3Jtid LLST 30I330 X3G33 LTOLISEb96 LE:ET bTOZ/ZT/80 BROWARD COUNTY LOCAL BUSINESS TAX REd I8P3-�000 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,2015 Receipt#"ELE�Z3CP VALARMS/CoNTRACTOR DBA:DANCE ELECTRIC INC Business Type:(ELECTRICAL CONTR) Business Name: Owner Name:PAUL A DANCE Business Opened:03/01/1986 State/County/Cert/Reg:EC 0 0 0 0 5 6 9 Business Location:830NEPARK Exemption Code: Business Phone:771-0707 Rooms Seats Employees Machines Professionals 10 For Vending Business Only Vending Type: Number of Machines: Total Paid Penalty Prior Years Collection Cost Tax Amount Transfer Fee NSF Fee 0.00 0.00 27.00 27.00 0.00 0.00 0.00 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 BrowN County ening is non-regulatory in nature.You must meet all County and/or Municipality p 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. Mailing Address: Receipt #30B-13-00003414 PAUL A DANCE paid 09/16/2014 27.00 2663 E ABIAGA CIR DAVIE, FL 33328 2014 - 2015 _...............---...._ ...-.........----........._�__RICK SCG,�TT,GOVERNOR _ _ —._.._....---.--_---.___.--......................__..._...---...-- KEN LAWSON,SECRETARY c STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD EC0000569 The ELECTRICAL CONTRACTOR , Named below IS CERTIFIED a • Under the provisions of Chapter 489 FS. _ VM Expiration date: AUG 31, 2016 aa DANCE, ARTHUR JR „ f DANCE ELECTRIC INC R„ : 2663 E ABIACA CIR °- �.•s� ... * "*, r. .r, . �• DAVIE FL 33328_A ISSUED: 08t26i2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408260002240 i1 CERTIFICATE OF LIABILITY INSURANCE F DATE(MM/DD/YYYY) 8/31/2015 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(les) 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 Commercial Lines Bruening Insurance PHONE (954)473-1406 FAX (954)473-1662 A/C No): 2700 S. Commerce Parkway E-MAIL ADDRESS: Suite 210 INSURERS AFFORDING COVERAGE NAIC# Weston FL 33331 INSURERA:Travelers INSURED INSURER B Dance Electric, Inc. INSURER C: 2663 E Abiaca Circle INSURER D: INSURER E: Davie FL 33328 INSURER F: COVERAGES CERTIFICATE NUMBER CL158504615 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 ADDLSUBIR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE FOOCCUR A 100,000 PREMISES Ea occurrence $ 660-10852844 8/1/2015 8/1/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY F-1 PRO ❑LOC JECT PRODUCTS-COMP/OPAGG $ 2,000,000 X l0 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Florida State License #EC0000569 Unlimited Electrical Contractor Classification 5190 Please refer to policy for terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE J Bradley Bruening/HO ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 rgnl4nrl i CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYy) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.-THIS CERTIFICATE DOES N07 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 ADpITIONAL 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 CON T RICHARD M. GALT INSURANCE AGENCY PHONe StateFarm 9367'WEST SAMPLE ROAD 954-752 4200 FAX E-MAIL A/C No):954-752-4321 r.a o, CORAL SPRINGS,FL 33065-4321 AODRE INSURERS AFFORDING COVERAGE State Farm Florida Insurance Company N INSURED INSURERA: p y 100739739 DANCE ELECTRIC INC. INSURER B:State Farm Mutual Automobile insurance Company 25178 2663 EAST ABIACA CIRCLE 1NSURERC: FORT LAUDERDALE, FL 33328 INSURER D: INSURER E: COVERAGES CERTIFICATE NUMBER: INSURER F: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO .....THE INSURED NAMREVISIOD ABOpVEBPOR 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, INSR EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L LTR TYPE OF INSURANCE POLICY EFF POLICY EXP COMMERCIAL GENERAL LIABILITY POLICY NUMBER MM/DD/YYYY MMI ,D/YYYY LIMITS CLAIMS-MADE 1:1 OCCUR EACH OCCURRENCE $ PREMfSSE'SEa�irrence $ MED EXP(Any one person) $ GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ POLICY❑JECOT FILOC GENERAL AGGREGATE $ OTHER: PRODUCTS-COMP/OP AGG $ A AUTOMOBILE LIABILITY $ ANY AUTOO aBBIIt ED SINGLE LIMIT $ ALL OWNED X SCHEDULED 946 7370-D05-59C 04/05/2015 10105/2015 (Per BODILY INJURY person) $ 250,000 AUTOS HIRED AUTOS NON-OWNED BODILY INJURY(Per accident) $ 500,000 AUTOS PROPERTY DAMAGE Per accident $ 100,000 UMBRELLA LIAR OCCUR $ EXCESS L1A8 CLAIMS-MADE EACH OCCURRENCE $ DED RETENTION$ AGGREGATE $ F WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN $ ANY PROPR)ETOR/PARTNER/EXECUTIVE STATUTE ERN OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) 98-BK-T713-1 08/01/2015 08/01/2016 E.L.EACH ACCIDENT $ 100,000 If yes,describe under DESCRfPTION OF OPERATIONS below E.L.DISEASE-EA EMPLOYEE $ 100,000 E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space Is required) FLORIDA STATE LICENSE#EC0000569 Jnlimted Electrical Contractor 'lassiffcation 5190 :ERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2nd Avenue THE EXPIRATION ACCORDANCE WITH DFHE POLICY PROVISIONS.ATE THEREOF, E WILL BE DELIVERED IN Uliarrti Shores, Florida AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. CORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1001486 132849.9 02-04-2014