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EL-17-669 F« mss* z, Miami Shores Villages ' id, �ti1 '4_k' 4± 10050 N.E.2nd Avenue NE ,3 work Cl� Oon AsI'"aw" `. "" " Miami Shores,FL 33138-0000 ., z � v. r� 4, Phone: (305)795-2204 �� F�BXtt7Ji€ SaA � ;,. Expiration: 0 /17/2017 94 Project Address Parcel Number Applicant 839 NE 97 Street 1132060142610 EDUARDO BECERRA Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell EDUARDO BECERRA 839 NE 97 Street (786)390-3312 MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 300.00 ALEX ELECTRIC SERVICES (05)888-8830 Total Sq Feet: 0 Type of Work:INSTALL ELECTRICAL FOR 2 FANS USING Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# EL-3-17-63288 DBPR Fee $2.25 DCA Fee $2.26 03/21/2017 Check#:23956 $ 109.10 $50.00 Education Surcharge $0.20 03/13/2017 Check#:23808 $50.00 $0.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $159.10 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 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 he foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction an ning. Futhermore, thorize the above-named contractor to do the work stated. March 21, 2017 Au ed Signature: wner Applicant / Contractor / Agent Date Building Department Copy March 21,2017 1 X\ a g Miami Shores Villa RECEIVED • Building Department ��� 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2014S-�A BUILDING Master Permit No. 1769 PERMIT APPLICATION Sub Permit No. ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: �2 7-57VL4-Er City: Miami Shores County: Miami Dade Zip: ► Folio/Parcel#: tokf -Z"15 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):�aC,1i91� A4, ®3��;�1�l9 Phone#:ja.5--5-7 Address: Y3 / lue 9 7 5rA- as City: -/ :9,�� .��� State: `L e Zip: 3/3 enant/ ee Na Phone#: tm CON CTOR:,,o//mpany Name: �D �f�P�3�� � Phone#: Address: ZzSC:yU.)' /6 City: oeow1 A, State: /-:zo Qualifier Name:4&kAU 24,F40- [/A ® Phone#: ZF-6- 012- State Certification or Registration#:/.0/5l. Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ .66 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: (� Submittal Fee$ Permit Fee$ 'A--Op zPA CCF$ CO/CC$ Scanning Fee$ Radon Fee$ IS DBPR$ 2 ' Z Notary$ Technology Fee$ t D Training/Education Fee$ ."Z- Double Fee$ ®' Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ Q8 (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. Ile Signature Signature OW R or AGENT CONTRACTOR The foregoing instrument wa ackno ledged before me this The foregoing instrument was acknowledged before me this day of 20 Z,by ® day of snA 20 ,by who is Bersonally known to 1J���0 ;Q��� ,who is aersonally known to me or who has produced as or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sig Sign:P4 - 4 4 Print Seal: ORLANDO PASCUAL Seal: ORLANDO PASCUAL NOTARY PUBLIC STATE OF FLORIDA ' e NOTARY PUBLIC STATE OF FLORIDA COMMISSION#FF153694 COMMISSION#FF153694 EXPIRES:AUGUST 24,2018 't,P,,. EXPIRES:AUGUST 24,2018 .x+x*w�x�*******�**��x*��+x***�**�k*x�m+���***�x*****�x*�x*�**•x*x•*x�*x�*a*** x� *�*�x***a�*x�+��a•+�*�*****w**�**+� APPROVED BY 1AVA -tz �� Plans Examiner Zoning Structural Review Clerk (Rev(sedO2/24/2014) . . ... . . . ... •• •• • • • •• •• • gwz, z lsnon S3UIdX3oy`�aY;, ... . 0 0 0 rseesLJA#rdolsslwwoO , • • • • • • • tlUlaOlj 30 31tl1S oI18(ld AHdloN ivnoSdd ®®Ndl is • • • • ••• • ••• • •• • • • •• ••• •• U2 7�d t6;02� jDOOC9 t0o h ,2,u cc uv i C I INTI F ICAT DATE(mmrD E OF LIABILITY INSURANCE °""") 03121/17 THIS CERTIFICATE 13 ISSUED AS ATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT FIRMA LY OR NE(3ATNELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETIIIil:IEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate bottler is an ADDITIONAL INSURED,the policy(les)must be endorsed. If$UBROC.ATION IS WANED,subject to the terms and contlltlohs the polity,oe' In Policies may require an endorsement A statement on this certificate does not confer rights to the cericate holder in lieu of such endorsehent(s). PRODUCER CCONNTACT P.Carrera Insurance Specialists Of South FIOr I P ONE { )�A-0003 2750 SW 87 Ave#f204 E-MAIMd L P O No: 305)226.7614 Miami,FL 33165 i DRE P3terStsod.nOt Phone 284-0003 INSURED I INSURER 3 AFFORIIINO COVERAGE NAEC a fax 226-7614 INSURERA: Scottsdale Ins Co INSURER a: NauLAUs Alex Electric Services,Inc. INSURER C.- 2245 :2245 West 10 Court INSURER D: Hialmh,I'L 33010, 305 INSURER E: COVERAGESlN&URER F CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES QF INSURANCE LISTED BELOW W e BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD (NDCATED. NOTVJIITHSTANDINO ANY REbUIREAMNT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH,RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY POTAEN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMIWS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN TYPE OF INWIIANCE I ADD SIIBR POLICY NUM15ER POLJOY EFF POLICY EXP oENERAL UABILITy UKT9 i EACH OCCURRENCE S 1000,000.00 ® COMMERCIAL GENERAL LIABILITY A ❑ ❑ corms-mADE © OCCUR P SES ence $ I00,000.OD ❑ ; Y y CPS258573 11/10/2016 11/10/201? MED EXP(Any $ 5,000.00 ❑ PERSONAL&ADV INJURY $ 1,000,nnn M $ 2,000 000.00 ry� OFJ`1'L AGGREGATE LIMITAPPUES PERGENERAL AGGREGATE: d POLICY PRO- 11L� PRODUCTS-COMP/CP AGG S 1,000,000.00 AUTOMODILE LIABILITY $ F1 ANY AUTO NIBS IINrtl D BJNoLE umrr ❑ AIS NED SCHEDULED BODILY INJURY tPcr person) $ ❑ NON�NED g(3MY INJURY(Per ecoide�h} S ❑ HIRED AUTOS E] AUTOS PReOP D AGE1-1 $ ❑ UMBRELLA LK6 ❑OCCUR $ B © EX0E83 UAB ❑CLAIMr MADE i n n 73411 V160ALI 11/10/2016 11/10/2017 EACH O A UR�CS $ 2. 000.00 ❑ DED ❑ RAN g $ 2,000,000.00 I WORIMERS COp1pENSATION g AND EMPLOYERS'LIABILJTy Y/N I WC STATU ❑�}{_ ANY PROPRIETORRARTNERmxECUrive ! OFRcERIMEMBER EXCLUDED? iN/A EL EAC!J A,{ p S (MAgd�awry In NN)bq under ❑ DESCRIPTITION OF OPERATIONS below EL DISEASE-E'A EMPLOYE S I EL,DISEASE.POLICY UMrr $ i I I DESCRIPTION OF OPERATION&I LOCATIONS I VENICtLES tAt4ch ACORD 101,Addluonel Remarks&cnedule,Hmors space Is r Electrical Service/Electrician squired) IlCenae#E13001444- I I i i CERTIFICATE HOLDER I CANCELLATION i SHOULD ANY OF THE ABOVE:DESCRIBED POLICIES BE CANCEL�cn g�� Miami Shores Wage Building L4epartment THE BXPIRATION DATE THEREOF,NOTICE WILL,BE DELIVERED IN 10050 NE 2 Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORED REPRESENTATLVE Insurance Speciallsts of South Flot1 ACORD 26(2010/05)4F 01882-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A`CIIIR EP® CERTIFICATE OF LIABILITY INSURANCE DATE(MmuoD1YYYY) 03/20/2017 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 pollcy(les)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). PRODUCER CONTACT NAME: Angel Timoteo Castro South Florida Commercial Insurance Planners PHONE (305) 819-8618 3 E-MAIL ac Nc: ( 05) 819-2543 15165 N.W. 77th Avenue, Suite 1004 MIMS& Miami Lakes, FL 33014 INSURER 3)AFFORD'NGCOVERAGE NAIC# INSURED INSURERA: Brid efield Employers Insurance Company 10701 R B Alex Electric Services, Inc. INSUREINSUREIB: 2245 W 10th Ct Hialeah, FL 33010-1910 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 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 I AD L SU R LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLIO EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑JECT PRO- F-]LOC PRODUCTS-COMP/OPAGG $ OTHER: AUTOMOBILELIABIUTY COMBIN D INGLELIMIT ANY AUTO Ea a&ent $ OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS ONLY AUTOS BODILY INJURY(Per accIdent) $ HIRED NON S ONLY PROPERTY DAMAGE ED AUTOS ONLY AUTOS ONLY Per acGdent $ UMBRELLA LIAR $ OCCUR EXCESS LIAR CLAIMS MADE EACH OCCURRENCE $DED RETENTION$ AGGREGATE $ WORKERS COMPENSATION $ AND EMPLOYERS,LIABILITY YIN 0830-32586 06/28/2016 06/28/2017 X STATUTE ER A ANYPROFFICER/MEMBEROP EXCLUDED? ❑ NIA Y E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) If yes,describe under E.L.DISEASE-EA EMPLOYE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached I more apace to required) Item 3.A.:Workers Compensation Insurance applies to the Workers Compensation Law of the states listed here: Florida Job: License#E130014444 CERTIFICATE HOLDER CANCELLATION Miami Shores Village Bldg Dept 10050 NE 2nd Ave SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores, FL 33138-2304 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Carol Sipe yec ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD DATE(MM/DD/YYYY) -0 CERTIFICATE OF LIABILITY INSURANCE 03/09/2017 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(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terns 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 Angel Timoteo Castro South Florida Commercial Insurance Planners PHONE . (305) 819-8618 a No): (305) 819-2543 15165 N.W. 77th Avenue, Suite 1004 ADDRESS: Miami Lakes, FL 33014 INSURERS AFFORDING COVERAGE NAIC# INSURERA: Brid efield Employers Insurance Company 10701 INSURED INSURER B: Alex Electric Services, Inc. INSURER c: 2245 W 10th Ct INSURER D: Hialeah, FL 33010-1910 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD MM/DDIYYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO R ED CLAIMS-MADE 1-1 OCCUR PREMISES Eaoccurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PRO E LOC PRODUCTS-COMP/OPAGG $ JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY YIN 0830-32586 06/28/2016 06/28/2017 x STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? El NIA Y (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below 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) Item 3.A.:Workers Compensation Insuranceappliesto the Workers Compensation Law of the states listed here: Florida 17- CERTIFICATE CERTIFICATE HOLDER CANCELLATION 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 33138-2304 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Carol Sipe 0ye�_ ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD A111% ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/09/17 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 pollcy(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 ofsuch endorsement(s). PRODUCER CONTACT p,Canera NAME: Insurance Specialists Of South Flor PHONE (305)264-0003 ac No): (305)226-7614 2750 SW 87 Ave#204 p IL peter@isosf.net Miami,FL 33165 INSURERS)AFFORDING COVERAGE NAIC# Phone (305)264-0003 Fax (305)226-7614 INSURER A: Scottsdale Ins Co INSURED INSURER B: Nautilus Alex Electric Services,Inc. INSURER C: 2245 West 10 Court INSURER D: Hialeah,FL 33010- 305 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ADD UBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD MWDD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 Q COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100,000.00 PREMISES Ea occurrence) $ A ❑ ❑ CLAIMS-MADE W OCCUR Y Y CPS2588573 11/10/2016 11/10/2017 MED EXP(Any one person) $ 5,000.00 ❑ PERSONAL BADVINJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000.00 ❑ POLICY 0 PRO- ❑ LOC $ AUTOMOBILE LUU3ILITY COMEaBINdentED SINGLE LIMIT acci ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ ❑ AUTOS ❑ AUTOS � TTyy ❑ HIRED AUTOS ❑ NON-OWNED (P OPEoiden?AMAGE $ ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ 2,000,000.00 EXCESS UAB 73411 V160ALI B � CLAIMS-MADE n n 11/10/2016 11/10/2017 AGGREGATE $ 2,000,000.00 ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑WC YTAMU- ❑OTH- AND EMPLOYER&LIABILITY Y/N 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 1 $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,K more space is required) Electrical Service/Electrician license#E13001444- CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2 Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE Insurance Specialists of South Florida ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/05)QF The ACORD name and logo are registered marks of ACORD . z Nippon mm RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY wjUrMM .OF BUSINESS AND PROFESSIONAL REGULATION •EL•E=MAL•• MRS'LICENSING.BOARD 'Rio-F-LECTRICAL CONTRA• TOR. �lartied betoini iS•C�RTIFfI: . Untlt B pins of Cb t 489 FS. 1 p2oll ?248L-%E4MAQ.. •; 1'e . rt; 0024M Local B.usi•ness.Tax Receipt •Miami—Dade County, State of Florida —THIS IS NOT A BILL—DO NOT PAY 3664464 'LBTJ M ® BUSINESS NAME/LOCATiON RECEIPT NO. EXPIRES ALEX ELECTRIC SERVICE INC RENEWALSEPTEMBER 30, 2017 2245 W 10 CT '3828566 Must be displayed at place.of business HiALEAH FL 33010 Pursuant to County Code Chapter SA—Art.9&10 OWNER SBC.TYPE OF BUSINESS PAYMENT RECEIVED ALEX ELECTRIC SERVICE INC 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR EC13001444 $45,00 09/15/2016 WCrker(s) t CREDITCARD-16-054021 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license; or noonngovvernmentall regulatory holder's and requirements which applyytto the busln�comply with any governmental The RECEIPT N0.above must be displayed on all commorcial vehicles-Miami—Dada Code See Ba-271L _ For more information,visit wvtw.miamidado gov/taxcollector