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RE-16-1837 "9l 3,7 Miami Shores Village P �` � - ' 10050 N.E.2nd Avenue NE '� UVOrsfct; ort Flat= Miami Shores,FL 33138-0000 Phone: (305)795-2204 Permit Statcrs APPROU'El�;` i �:.71ir �l`1 Expiration: 12/28/2016 ? Project Address Parcel Number Applicant 1201 NE 102 Street 1132050250160 Miami Shores, FL 33138- Block: Lot: MacDAM&DENISE GLINN Owner Information Address Phone Cell [,.MaCDAM&DENISE GLINN 1201 NE 102 Street MIAMI SHORES FL 33138-2600 Contractor(s) Phone Cell Phone Valuation: $ 2,500.00 ' ALMEIDA INDUSTRIES 954-229-2346 Total Sq Feet: 275 Type of Work:Repair Available Inspections: Additional Info:NEW ROOF FOR STRUCTURED ALUMINUM PO Inspection Type: Classification:Residential Tin Cap Scanning:1 Final Roof Review Roof Roof in Progress Renailing Affidavit Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.60 Invoice# RF-6-16-60418 DBPR Fee $3.75 07/01/2016 Credit Card $270.30 $0.00 DCA Fee $3.75 Education Surcharge $0.60 Notary Fee $5.00 Permit Fee-New Roof $250.00 Scanning Fee $3.00 Technology Fee $2.40 Total: $270.30 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 const ion a zonMg. Futhe e, authorize the above-named contractor to do the work stated. July 01, 2016 Autrorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy July 01,2016 1 Miami Shores Village PX Building in Department J N � ��'� 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: lm (305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 201 BUILDING Master Permit No.-k a 1 (0 I CO PERMIT APPLICATION Sub Permit No. V_- 6` [8 5[ ❑BUILDING ❑ ELECTRIC Q ROOFING ❑ REVISION EXTENSION ❑RENEWAL F_JPLUMBING [:] MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1201 NE 102nd Street City: Miami Shores County: Miami Dade Zip: �1 Folio/Parcel#:11-3205-025-0160 Is the Building Historically Designated:Yes NO k Occupancy Type:_ Load: Construction Type: C Flood Zone:�BFE: FFE: OWNER:Name(Fee Simple Titleholder):MacAdam Glinn Phone#: :�OS C1 Ll a Q Address: 1201 NE 102 Street City: Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: a Phone#: Email: -- CONTRACTOR:Company Name: Almedia Industries, Inc. Phone#: 954-772-9957 Address: 4420 NW 12th Ave City: Fort Lauderdale State: FL Zip: 33309 Qualifier Name: Keith Almeida Phone#: 954-772-9957 State Certification or Registration M C``C//CO57851 Certificate of Competency#: N/A DESIGNER:Architect/Engineer: T Phone#: Address: '\'f -/' City: De,f td I bruvlf. State:I—C Zip: Value of Work for this Permit:$ 3LS OC3. 00 uare/Linear Footage of Work: a-7 Type of Work: Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition Description of Work: !iO Ca- 1 Specify color of color thru tile: Submittal Fee$ 0 Permit Fee$ 1D CCF$ 1 , 90 CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ 23' ?g Notary$ Technology Fee$ -2 0 Training/Education Fee$ ® "G0 Double Fee$ 1� Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ /`� 1® ' (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable)C An a Sa `� C J Mortgage Lender's Address City aS 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. JutSignature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this �Q day of 3QN� ,20 IG ,by day ofyyke- .20 l Co by Mpp— ?4M J Q(?�r4 GIANN3 ,who is personally known to 10-44'#I^ )IMA IS w o is personally kno to me or who has produced'F',- as me or who has produced as identification and who did take an oath. identification and who NOTARY PUBLIC: NOT Y PU Nota=aoll oridaChriMy C725o►aExpi Sign: Si n• Print: Prin . 1✓� � �� Seal: ' oo Seal: 4Y Notary PLibiic State of Florida Sindia?Ivarez "'on FF 018My Commis 156750 ' 03,12 APPROVED BY Plans Examiner /; Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 Notice of Violation DATE: December 7, 2016 TO: Keith Almeida Almeida Industries, Inc 4420 NW 12th Ave. Fort Lauderdale, Florida 33309 RE: RF-6-16-1837 Roof for MR.and Mrs. MacAdam Glinn 1201 NE 102 St. Miami Shores, Florida 33138 FOLIO: 11-3205-025-0160 YOU ARE HEREBY NOTIFIED that an inspection of the above premises revealed that you have violated the provisions of the Florida Building Code which have been adopted as the uniform building code for Miami Shores Village, Florida or provisions of the Code of Miami-Dade County. The building official has found work regulated by this code being performed in a manner contrary to the provisions of this code that are dangerous or unsafe. Thereby the building official has issue a stop work order for your project. Type of Violation: Failure to pass required roofing inspections and performing work beyond the point indicated by the Building Official on the rejection comments dated September 23, 2016 without first obtaining the approval of the building official. Chapter: 1, Section 110.1, and section 110.6 of the 5th Edition, 2014 Florida Building Code. To wit: [A] 110.1 General. Construction or work for which a permit is required shall be subject to inspection by the building official and such construction or work shall remain accessible and exposed for inspection purposes until approved. Approval as a result of an inspection shall not be construed to be an approval of a violation of the provisions of this code or of other ordinances of the jurisdiction. Inspections presuming to give authority to violate or cancel the provisions of this code or of other ordinances of the jurisdiction shall not be valid. It shall be the duty of the permit applicant to cause the work to remain accessible and exposed for inspection U.S. Postal Service-r. CERTIFIED MAILT. RECEIPT (Dothestic Mail • , Insurance Coverage Provided) m Ln Postage $ CO Certified Fee M Postmark C3 Return Receipt Fee Here C3 (Endorsement Required) C3 Restricted Delivery Fee (Endorsement Required) rU Total Postage&Fe O as M Sent To M M1Z_f.#A as Me n�p -54N-P------------------------- r9 Sheet Apt.No.; 0 or PO Box No. (10 1 NS l OZ itQST --------------------------------------------------•------------------------------------- ~ City,State,ZIP+4 PS Form 3800,August 2006 See Reverse for Instructions M�pM( sk-I�mFS' L. 331� Postal CERTIFIED MAILT. RECEIPT M (Doinestic Mail only, -0 m Ln r% r-q Postage $ Lr) to Certified Fee Postmark O Return Receipt Fee Here G (Endorsement Required) O Restricted Delivery Fee (Endorsement Required) O rUTotal Postage&Fees M Sent To m _ LM:g?14A_lnl Sl¢t s V-� ----------- rl Street Apt.No.44. O or PO Box No. N �5�,ZIP+4 TV purposes. Neither the building official nor the jurisdiction shall be liable for expense entailed in the removal or replacement of any material required to allow inspection. [A] 110.6 Approval required.Work shall not be done beyond the point indicated in each successive inspection without first obtaining the approval of the building official.The building official, upon notification, shall make the requested inspections and shall either indicate the portion of the construction that is satisfactory as completed, or notify the permit holder or his or her agent wherein the same fails to comply with this code. Any portions that do not comply shall be corrected and such portion shall not be covered or concealed until authorized by the building official. REQUIREMENTS FOR CORRECTION. 1. Remove all work performed without authorization and approved inspection by the Building Official up to the point of the first required inspection. 2. Request inspections as required under section 110.3 of the 2014 Florida Building Code and as specified on the permit card issued for the project. Therefore,you are hereby directed that on or before Tuesday, December 27, 2016 you are to correct said VIOLATION and NOTIFY THE UNDERSIGNED BUILDING INSPECTOR that the VIOLATION has been corrected. Failure to make the correction(s)will result in one or more of the following actions: Disconnect utilities services, initiation of an unsafe structures case requiring demolition of the structure. Also, failure to comply with this notice may result in the department withholding issuance of other permits to you, referral of this matter to the appropriate licensing board or the filing of a lien against your property in the amount of any unpaid ticketing fines. In accordance with the provisions of Section 8-17 of the Code of Miami- Dade County, you are also responsible for the reasonable costs and expenses incurred by the Building Official in enforcing the provisions of the Building Code. In the event further clarification or assistance is required, please contact Ismael Naranjo, B.0 at (305) 795-2204 between the hours of 8:30 A.M. and 5:00 PM. Except in the case of life-safety hazards,you may be granted upon request an extension of time up to 90 days to correct the violation provided your request is submitted prior to the expiration of this Notice of Violation and enforcement costs incurred by the department to date are paid in full. To request an extension, please contact the Building Department by telephone at (305) 795-2207 or by e-mail to naranioi@miamishoresvillage.com. Thank you for your cooperation in this matter. ( P �- Y71'( Ismael Naranjo, B.0, CF Building Director. Mail Date Mailed: By: S. Return Receipt Number: czrTv-1--Cw'OP— �a 13 30 20 00(50 > �� S3 63 CC: Mr. MacAdam Glinn owm€e- 10201 NE 102 St. Miami Shores, Florida 33138 =-�0 v'3 30213 Owo 8S1-4 'S3�40 ACTIN- �1.go Glinn Residence — 1201 NE 102nd Street, Miami Shores 1� r- r� � a a _ 1 y i 'a 6/2016 or� IF f! 09/16/2016 Glinn Residence — 1201 NE 102nd Street, Miami Shores f Glinn Residence — 1201 NE 102nd Street, Miami Shores ,., 4 , MOL Glinn Residence — 1201 NE 102nd Street, Miami Shores WM- FA yl . �r �A �• y STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 ALMEIDA, KEITH LOUIS ALMEIDA INDUSTRIES INC 4420 NW 12TH AVENUE FT LAUDERDALE FL 33309 Congratulationsl 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 restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFES$I ?AIAL REGULATION Every day we work to improve the way we do business in order to CCC057851 : ISSUED: 09/02/2014 serve you better. For information about our services,please log onto www.myfioridalicense.com. There you can find more informationCERTIFIED Rp0l=1NG CON about our divisions and the regulations that impact you,subscribe ALMEIDA,KEITH LOUIS to department newsletters and learn more about the Departments initiatives. ALMEIDA INDUSTRIES INC Our mission at the Department is:License Efficiently,Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! i Expuatian date:AUG 31,2016 L140M0001453 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CCC057851 The ROOFING CONTRACTOR Named below IS CERTIFIED V . Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 ALMEIDA, KEITH LOUIS ALMEIDA INDUSTRIES INC 4420 NW 12TH AVENUE 26,& FT LAUDERDALE Ft:33309 ffl .. .._.. .. .._ _ ��.� _.. ... e2 ._. ISSUED: 09/02/2014 DISPLAYAS REQUIRED BY LAW SEQ# L1409020001453 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT R FL 33301-1895—954-831-4000 115 S.Andrews Ave., m.A-100, Ft. Lauderdale, ° VALID OCTOBER 1,2015 THROUGH SEPTEMBER 30,2016 DBA; Receipt#:ROOFINGSHEET METAL CONTRA(,, OR Business Name: 780 ALMEIDA INDUSTRIES INC Business T Ype:(ROOFING CONTR) Owner Name:KEITH LOUIS ALMEIDA Business Opened:08/10/1999 k Business Location:4420 NW 12 AVE State/County/Cert/Reg:CCC057851 FT LAUDERDALE Exemption Code: Business Phone:954-772-9957 E� Rooms Seats Employees Machines Professionals 1 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 w 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 and zoning requirements. This Business Tax Receipt must be transferred when WHEN VALIDATED 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: KEITH LOUIS ALMEIDA Receipt #52A-14-00006851 4420 NW 12 AVE Paid 08/20/2015 27.00 k FORT LAUDERDALE, FL 33309 nr 2015 . 2016 - -- -- --- Q�nssiw-bli'n�c`�it=il►�i n�r�_� Q-ue�`I�+�e_te. ��YI� _ _---- -=- A a DATE(MMfODMfYY) CERTIFICATE OF LIABILITY INSURANCE 6/30/2016 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(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). PRODUCER CNAME. Jeff Lampert Presidential Insurance Services, LLC Pa"c°Ne M: 305-423-0350 �No:305-423-0351 2665 South Bayshore Drive#704 E-MAIL SS: jell@insurancequotelive.com Miami, FL.33133 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:United Specialty Insurance Company INSURED INSURER B: Almeida Industries, Inc. INSURER C: 4420 NW 12th Ave INSURER D: Fort Lauderdale, FL.33309 INSURER E: State License#CCC057851 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 S BR POLICY NUMBER MMMIDD EFF MMM/DD EXP LIMITS LTR A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE I OCCUR PRREGE TO RENTED MISES Ea occurrence $ 50,000 PC-92754-03 2/4/2016 2/4/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑PRO-JECT LOC PRODUCTS-COMPIOPAGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY L AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLALUAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ 0 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STER ER ANYPROPRIETORIPARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If as,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) FL State Lic. # CCCO57851 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 VALL BE DELIVERED IN Miami Shores, FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ATE i4t�`o lJ� CERTIFICATE OF LIABILITY INSURANCE D p6/30/2016 n 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.ff SUBROGATION IS WAIVED,subject m the terry 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 endomement(s). PRODUCER CONTACT NAME: PHONE AIC,No,E)d: 14300-277-1620 x4800 FAX A/C No): 2 797-0704 FrankCrum Insurance Agency,Inc. E-MAILADDRESS: 100 South Missouri Avenue INSu S)AFFORDING COVERAGE NAIC0 Clearwater,FL 33756 INSURER A: Frank Winston Crum Insurance Co. 11600 INSURED INSURER B: INSURER C: FrankCrum UC/F Almeida Industries,Inc. INSURER D: 100 South Missouri Avenue INSURER E: Clearwater FL 33756 INSURER F: COVERAGES CERTIFICATE NUMBER: 365162 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 NUMBER POLICY EFF POLICY EXP LIMITS LTR INSRD WVD (mMI)DNYYY) (MMIDDNYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGES(Ea TO RENTED $ PREMISES occuaence MED EXP(Arty we Person) $ PERSONAL B ADV INJURY $ GENT.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY =PROJECT =LOC PRODUCTSCOMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COM�NED acdderd SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ OWNED ALTOS SCHEDULED ONLY AUTOS BODILY INJURY(Per acdderd) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ ONLY AUTOS ONLY UMBRELLA LUUT OCCUR EACH OCURRENCE EXCESS IJAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND WC201600000 01/01/2016 01/01/2017 =ENIPLO:YEE OTH- A EMPLOYERs,LIABILITY Y/N ANY PROPRIETORIPARTNER/EJCECUTIVE N/A $1,000,000 OFFICER/MEMBER EXCLUDED? (Mmrda"in NH) If yea,deam'�ands E.L. LOYEE $i 000 Q00 DESCRIPTION OF OPERATIONS below LIMB 1000 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Effective 03/14/2012,coverage is for 100%of the employees of FrankCrum leased to Almeida Industries,Inc.(Client)for whom the client is reporting hours to FrankCrum.Coverage is not extended to statutory employees. (Client Ref.: Qualifier. License* CCC057851) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village Bldg Dept AUTHORIZED REPRESENTATIVE 2nd Avenue Miami Miami Shores,FL 33138 ©1988-2016 ACORD CORPORATION.All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD