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PL-14-1687 Permit NO. PL-8-14-1687 `5gUREs L�� Miami Shores Village Permit Type:Plumbing-Residential g`* 10050 N.E.2nd Avenue NW s;•� ��M ' work Classification:Addition/Alteration Miami Shores, FL 33138-0000 Perl" 11 "tPermit Status:APPROVED Phone: (305)795-2204 fLOR1Dp issue Date:91,18/20'15Expiration: 03/16/2016 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: $ 7,000.00 GANZ PLUMBING CO INC (954)473-8255 ----- Total Sq Feet: 00 Type of Work: INSTALL NEW BATH AND KITCHEN FIXTUR Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Return: Final Classification:Residential Scanning:3 Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $4.20 DBPR Fee Invoke# PL-8-14-52490 $3.68 08/04/2014 Credit Card $50.00 $222.56 DCA Fee $3.68 Education Surcharge $1.40 09/18/2015 Credit Card $222.56 $0.00 Permit Fee $245.00 Scanning Fee $9.00 Technology Fee $5.60 Total: $272.56 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 theabove-named contractor to dot work stated. September 18, 2015 Authorized Signature:Owner / Applicant / Contractor / Agent ate Building Department Copy September 18,2015 1 Miami Shores Village Building Department AUG O i 2014 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 $Y: Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 2010 BUILDING Permit No.N /L/— PERMIT APPLICATION Master Permit No.& / Permit Type: PLUMBING JOB ADDRESS: 10614 /11 k,/ 1 Ave City: Miami Shores County: Miami Dade Zip: .3 Folio/Parcel#: // - R 13 6 00,;L 00 O Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name Z(Fee Simple Titleholder)): Cr s���< CYvL`ScdA��nq &OdPhonek 515'—n-7-&UD/ Address: 0/15 //5 4,- 4 t/P City: Cl I0ti.so State: 7Y Zip: :2 4 5 02 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Ganz Plumbing Co., Inc. Phone#: 954-473-8255 Address: PO Box 290068 City: Davie State: Florida Zip: 33329 Qualifier Name: William H. Ganz Phonek 954-473-8255 State Certification or Registration#: CFC041715 Certificate of Competency#: Contact Phone#: 954-473-8255 Email Address: Ganzplumbing@bellsouth.net DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ ao, Square/Linear Footage of Work: Type of Work: ❑Address OAlteration &A ONew .�Repair/Replace (]Demolition Description of Work: —TIS-411 tV Pv✓ &Ag� h-i jcZg, P�r_j Submittal Fee$ Permit Fee$ Z LIS, '`` CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ 2722- Bouding Coinpany's Nance(if applicable) Bonding Conipany's Address City State ___--- —_--._ ___.__....._...__...._.....__....._. Zip Mortgage Lender's Name(if applicable) _._-- Nlortsage Lender's Address City State Zip -- Application is hereby made to obtain a permit to do the tm-ork and installations as indicated. I certify that no work or installation Inas commenced prior to the issuance of a permit and that all work will be performed to meet the standards o£all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK. PLIJIMBINNG, SIGNS, WELLS. POOLS, FURNACES, BOILERS.HEATERS,TANKS and AIR CONDITIONERS,ETC..... CJWNFR'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable la-%k5 regulating constniction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF CO1NI iE`CEMENT MAY REST.LT IN YOUR PAYING TWICE FOR IMPROVEMENTSTO YOUR PROPERTY. IF YOU INTEND TO OB'T'AIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY:' BEFORE RECORDING YOUR NOTICE OF C:;OYIMENCEMENT•" Atonce to Applicont: As a con(htion to the mvionce of cl budding perim,ivah an estmultell7'ahle alcee&ng 2500. the oplflcont imist pi omil e m flod fienth that t7 copy pf the notice of commencement and collvruction hen lent, brochure will be delivered to the person whose properti- is Pbllect to clttcichment. Also,ti certified cajt v of the recorded notice of cotPtmunc6etl int must be po:ved cit thejob ite'for lhe•firsr Insliecilon Ithich orcias seven {'J da}'s of er the building permit is issued In the obsence ofswch jyosteal IYGJ ice, the inspection ivill not be ctl)prorcel and C1 rem.sf)c.-cttort,fee hill be rharged. . � / Sinnatutrc Siwuature /WA.-7 X.J Oimier or A-int Contractor The fore<�oina instrument was ackno-wledged before me tln�,; /Q7?4The.foregoing instrument was acknovdedoed before me this: clay of..OS Qf2_•'41 tly ►�Tt.tw..ta�._ 2. . 5..• clay'of,._.... (.. .__.... — ?� 7 .by (�i ikti ..�'....._f%7rn Z....... who i4 personally known to me or who has produced who is personally=knovni to rte or who has produced tits identification and who did take an oath, as identification and who slid take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sian: y SiWn: . ....._..._. _ Print:................... .. ....1..L1..19'_..__.._. Rfl? -- ._._...._.. .....__...-__:.._..... Print: ...-. .. 1,:ty Corrr i �• • MORENOy ,"SY' f = Notary Public, 4s atom 1FR10 State of Texase• = Notary PYbtk• rioriQa i; • ' --Yxx •� ��r� ,�w�w�r,r:�t�;r��: r'ssar .. .M�:C2��� M:e�:r�:�',11I� Bi#u��Y�S*�0 Commiuipn i FF p:� ••�� "nission I ff 021536 AXPROVED B1' i/'�`7 glans .xanurr r _..... ............ _-_. ..._.1 _._ . Structural Review Clerk ?� iscd 3 1 12012)(Rerisrd 0710'07)(Rcvxsed 0610 200 )(R raised ;,15 09) SNX.- logo 11111M Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A$30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. '� COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE(CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. ✓ COPY OF WORKERS COMPENSATION(EITHER CERTIFICATE OR EXEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE(CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE(EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: AZy.�? �O. 04 c, BUSINESS ADDRESS: �O �o1C a�f OCA �$ CITY LJI STATE FL ZIP CODE BUSINESS PHONE:r 9�� ) 0 - FAX NUMBER(" 1 4-73- CELL `73-CELL PHONE&q' i 0 O� (9/31 QUALIFIER'S NAME: W 1 I II A iM N N�-- QUALIFIER'S LIC NUMBER: (21 F e (0 q I "I/ // , 8's ,gyp , IE-MAIL ADDRESS pF APPLICABLE): -"A�Z- +LL'� 'e 0 u r A Av 'v' Created on 919/09 BY MLDV 1 RV MW MLDV 06-14-2012 JEFF ATWATER STATE OF FLORIDA CHIEF FIMWCM OFFICER DEPARTMENT OF. FINANCIAL.SERVICES DIVISION OF WORKERS' COMPENSATION * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 08/07/2012 EXPIRATION DATE: 08/07/2014 PERSON: GANZ WILLIAM H FEIN: 92042947 BUSINESS NAME AND ADDRESS: GiANZ PLUMBING COMPANY INC POST OFFICE BOX- 290068 DAVIE FL 33319-0000 SCOPES OF BUSINESS OR TRADE: I— PLUMBING CONTRACTOR 2— CERTIFIED PLUMBING CONTRACTOR IMPORTANT: Pursueat to Chapter 440 . 05(141, F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election odder ibis saetios may not.recover benefits or come insation under this chapter. Pursuant to Chapter 440.06111), F.S., Certificates of election to be exempt... apply only within the scope of Ike business or trade listed on the notice of election to be exempt.'Persueat to Chapter 440.051131, F.S., Notices of election to be exempt and certificates of election to be exempt skill be subject to revocation If, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or It ertificate no longer meets the requirements of this section for issuance of a cortifictle. The department shall revoke a certificate it any time for failure of the perion named on ike certificate to most the requirements of this section. ' OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 QUESTIONS? (850) 413-1609. } V. J. ail ;�� •��s t.^' �� � X i<`� >, ;ri � J'.. ',.. ((,�•` � �� F i .;•f.:,.�'f, �•"�. � VSs +� ... �'e7;, /,...r 'iy '� ,: :t^ , , 1 i rf 'a fii !) fl J t"�j \• i� } un 3 : s r>- .., ...,,!\�fr.J �:•f•.t: i,ti. �'% Ta r1• �.,, t ^� _'.R:j.`: •%�:�:::r', •:Y�. 1=Q#L1Z07:3403r���.' e -4 HN. NB. 24 T- 66, L' $n er the':31r oisioiy :a ►. a=t Exrat3, n c e. G1 0 p. Y. .£ 1.;:.`''/ Zig f f� /•�- - J < PO BOX 2.90"Or'dWE Q yL�,qA GSD t1`' i J. 0— :)TI :;.r: .: ,{ iaN �_ 1 :L:AW� ~C40R � CERTI: F51 FlCATE OF LIABlLlTY INSURANCETEIMM1DDlYYYY) 13/2014 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(Sh AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER:. ; IMPORTANT. If the cortlflcats holder Is an ADDITIONAL INSURED,the polk jr(les)m bs endorsed If SUBROGATION 18 WANED,subject to the terms and conditions of the policy,certain polleles may require an endersen ent, A statement-on this cord"Cab does not confer rights to the —certificate`holder-In lieu of such endorsers s). PrmDUCER Keyes Coverage Insurance M s Nielson PHONE 5900 Hiatus Road C A-724-701710, No: g�24-702 Tamarac FL 33321 ss anieisen®ke escovera e.com too:.1533 —..._........ INSURED WSURER(SAfsFORDINO tXOE NAIL■ Ganz Plumbing ersu - RERA:DepoSitors Ins Co/Nationwide Co --`-mpanY, Inc. Attn: Bill Ganz "URERB:TechnologL Ins. Co. 142376 PO Box 290068 SRC; —- Davie FL 33329moo: __.__—._...._..._ INSURER E: INSURERF: COVERAGES CERTIFICATE NUMBER:2007866111 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 ORMAY pERTAIK THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF S POLICIES:LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE y-^^ LTR POUCYNUMBER M LIMITS A GENERAL LIABILITY ACPS91509OS38 9/1/2013 9/1/2014 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY 1119WE TO RENTEDPREMISES 9E*MqX=q*J $100,000 CLAIMS-MADE a OCCUR '- .f. _...-. ,...«.•..-7q(:v m%�.:....... ,.. ..,. MEOW eros pMelMl) $5,000 PERSONALtAW INJURY_51,ODD,ODD GENERAL AGGREGATE $2,000,000 GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/AP AGG $2,000,000 17 POLICYE7.2 PRO- LOC 5 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 ANY AUTO (En BODILY OLMY(Per penes $ ALL OWNED AUTOS BODILY INJURY(Per ecdow t) S SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (PerI f NON-OWNED AUTOS - S UMBRELLA LIAB EACH OCCURRENCE S EXCESS UAB SDE AGGREGATE ;.___._....,_.__._._..- 1 DEDUCTIBLE ' Is RETENTION S r S B WORKERS COMPENSATION TWC3372002 9/1/2013 9/1/2014 WC STATU- DTH-' AND EMPLOYERS'LIABAJTY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE .L.EACH ACCIDENT f OFFICFJ7AIEMBER EXCLUDED? © N 1 A EAA $1.,000,00 0) E.L.DISEASE EA EMPLOYE $1,000,000 I ea,d"albe Wider DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $2.000,000 L -T- it DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attech ACORD 101,Ad"Ormd Remarks 3dwaft b m me spew Ie reryulled) License # CFC041715 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED Miami Shores Village IN ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE. 2nd Ave. AUTHOROMREPRESENTAYM Miami Shores, FL 33138 0 l NO-22 7009 ACORD CORPORATION. Ail rights reserved. ACORD 26(2009109) The ACORD name and logo are registered marks of ACORD THIS CERTIFICATE SUPSRSSDSS PREVIOUSLY ISSUED CBRTIPICATI BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2013 THROUGH SEPTEMBER 30,2014 DBA:GANZ PLUMBING COMPANY INC Receipt#:182 SPRNKL/CONTRJ OR Business Name: Business Type- (PLUMBING CONTRACTOR) (( Owner Name:WILLIAM H GANZ Business Opened:lo/11/1993 Business Location:7031 SW 22 CT State/County/Cert/Reg:CF C041715 DAVIE Exemption Code: Business Phone:473-82.55, Rooms Seats Employees 5 7 Machines Professionals I For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF fee „Penalt Prior:Years Collection Cost Total Paid y 27.00 0.00' 0;:00. ,. .. 0.460" 0•A0 0.00 27.00 i i f i I THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS i 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 ipusiness is legal or that it is in compliance with State or local laws and regulations. Mailing Address: WILLIAM H GANZ Receipt #04C-12-00003016 i P 0 BOX 290068 Paid 07/08/2013 27.00 j DAVIE, FL 33329 � I I 2013 - 2014 Aug 21 15 02:33p Ganz Plumbing 954-473-9644 p.5 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD r' _ CFC041715 The PLUMBING CONTRACTOR Named beJow IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 GANZ, WILLIAM HOWARD.. .. . Q.r GANZ PLUMBING CO ING..- .. PO BOX 290068 :._,. ......;. DAVIE FL 33329 � iSSUEa: 08!1012014 DISPLAY AS REQUIRED BY LAW SEQ 4 L1408100002172 Aug 21 15 02:33p Ganz Plumbing 954-473-9644 p.4 R 011F BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S, Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2015 THROUGH SEPTEMBER 3o,2016 DBA: Receipt#:182-198' Business Name:GANZ PLUMBING COMPANY INC Business Type:PLUMBING/L�vN SPRNKL/CONTRA OR (PLUMBING CONTRACTOR) Owner Name:WILLIAM H GANZ' Business Opened:l0/11/1993 Business Location: 7031 SW 22 CT State/County[Celrt/Reg•CP C041715 DAVE Exemption Code: Business Phone:473-8255 Rooms Seats Employees Machines Professionals 5 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection 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. Mailing Address: WILLIAM H GANZ Receipt #ICP-14-00013202 P O BOX 290068 Paid 07/13/2015 27.00 DAVIE, FL 33329 07/10/2015 Effective nate 2015 - 2016 A�Rte® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 8/21/2015 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(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 CONTANAME: Gina Barra ato Keyes Coverage InsurancePRONE 954-724-7000 FAX 954-724-7024 5900 Hiatus Road E-MAIL Tamarac FL 33321 gbarragato@keyescoverage.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:Allled Property&Casualty Ins Co 42579 INSURED 1533 INSURERB:Associated Industries Ins. Co. 23140 Ganz Plumbing Company, Inc. INSURER C: Attn: Bill Ganz PO Box 290068 INSURER D Davie FL 33329 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:739406208 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 POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/WYY A X COMMERCIAL GENERAL LIABILITY Y ACP GLPO 5945098538 9/1/2015 9/1/2016 EACH OCCURRENCE $1,000,000 CLAIMS-MADE FX OCCUR PREMSESOEaEoccu IITEence $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY D PRO ❑ LOC PRODUCTS-COM P/OPAGG $2,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY Ea aSINULE LIMIT ccident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ I I $ B WORKERS COMPENSATION AWC1051733 9/1/2015 9/1/2016 x AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN NIA E.L.EACH ACCIDENT $1,000,000 D OFFICER/MEMBER EXCLUDE (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $_1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) License#CFC041715 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2nd Ave' AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 * � ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD