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DS-17-1155 er � Pe 1 `g88o!? s tt Miami Shores Village y JL Pmt Type Drivew,41(9/61dBYIi i)C i1 �n 10050 N.E.2nd Avenue NE brkCle iyca n,,Add n tlon Miami Shores,FL 33138-0000 77I) Permit StatVIV 'PROVED Phone: (305)795-2204 �ioxivA 51512017 Expiration: 11/01/201 Project Address Parcel Number Applicant 650 NE 88 Terrace 1132060110190 Miami Shores, FL 33138- BISCAYNE 88 TERR LLC Block: Lot: Owner Information Address Phone Cell BISCAYNE 88 TERR. LLC 1951 NE 149 Street (305)868-8203 MIAMI FL 33181- s 1951 NE 149 Street MIAMI FL 33181- Contractor(s) Phone Cell Phone Valuation: $ 3,785.00 _ z' k GUZMAN CONSTRUCTION INC (954)682-3727 Total Sq Feet 0 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final Date Denied: Foundation Type of Work:RESTRIPING OF PARKING Additional Info:RESTRIPING OF PARKING Review Planning Bond Return: Classification:Commercial Review Building Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 Invoice# DS-4-17-63827 DBPR Fee $2.00 DCA Fee $2.00 05/05/2017 Check#:5018 $69.40 $50.00 Education Surcharge $0.80 04/26/2017 Check#:4994 $50.00 $0.00 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $3.20 Total: $119.40 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 constructionz ning. F e,I authorize the above-named contractor to do the work stated. {// May 05, 2017 Autho iz d Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy May 05,2017 CL�vp JR J�i �► �K.u� � ��') 3oe. �a�2 . Miami Shores Village R�cEly � IPPR V MYBuilding 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 201'') BUILDING Master Permit No D PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Gp (3 pie, B�5 'famcc City: Miami Shores County: Miami Dade Zia: Folio/Parcel#: 11'3,,2010 "oil- Q I-1q Q Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): �3b rb15C0.Vrl2. �AU2�x fi Phone#: 061 1 O 56� Address: .131(5' e)rr'Cv_(I A v� S°Fe E3®U c/o 0-1 c City: mick l' State: LOtfcU Zip: 33131 Tenant/Lessee Name: Phone#: Email: n 1 /� �Q1 d CONTRACTOR:Company Name: G_,V,,B " C, W)"RUGT(o tJ INC Phone#: {5q 6 6X 3 r1V7 Address: /�6910 &0 1kL V4N City:. �W KM State: T-%' Zip: -�3// a32A Qualifier Name: Y()1Zu ciU�i'M l� Phone#:95194 U Z� 1ry V State Certification or Registration M uz 1606302, Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ �, 5 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: VM P O INN Of FA I W N4 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$ 69 • '-46 (Revised02/24/2014) r -r Bonding Company's Name(if applicable) r I 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 whi h occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be ap r ved and a reinspection fee will be charged. Signature Signature WNER or AGENT CONTRACTOR The foregoing instru nt was acknowledged before me this The foregoing instrum nt�s acknowledged before me this 2-® day of �Kit 20-�--F by day of C i L ,20 ,by AAe­-c- who is personally known to 2'' Adl_;koh, who is personally known to me or who has produced 6J as me or who has produced -4ZX-5"--9G 2 -7-0 a�7 Cox��� identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: A NDROF.MASCKAUCM� sN y 34263 X1"4"" N#FF2 7 :May 25,2019 6 v1. gn Sign Print: M N P * ` SHARON ANN COX Seal: U'y COfJmisSION# Seal: _ FF124989 C?!°IR[S:fUAY 20,2018 s Insu tante «*x*�*r*r•�r�*�*�****e**x**xw.. _>«�•** *�*�r******�**r*r*sw*r*���rr*xrx*�*��*xxrx*sxx**x*�*x*xw�*��+x�x*�* APPROVED BY v` I � Plans Examiner Zoning Structural Review Clerk (RevisedO2/24/2014) Property Search Application - Mi... Property Search Ap .,]kation - Miami-Dade County - � OFFICE OF THE '11 � ra - I tF 0 AP0"`AI`hER �, :,x Summary Report Generated On:3/29/2017 Property Informationi ��T a � Folio: 11-3206-011-0190 ti' q�� 650NE88TER Property Address: ` Miami Shores,FL 33138-3363 88 BISCAYNE MANAGEMENT LLC4 � Owner C/O CJ LAW A 75 P 1395 BRICKELL AVE 800 Mailing Address , MIAMI,FL 33131 USA PA Primary Zone 6200 COMMERCIAL-ARTERIAL N,��^ [ Primary Land Use 1111 STORE:RETAIL OUTLET Beds I Baths I Half 10/10/0 U'`` § 7 Floors 1 � i .wTM Living Units 0 fib '� p �`� -:. �• # Actual Area Sq.Ft � Living Area Sq.Ft ' Adjusted Area 9,537 Sq.Ft Taxable Value InfARttll��ldn' Lot Size 125,621 Sq.Ft w ti , ` 2016 2015 2014 Year Built 1954 County. Assessment Information Exemption Value { Yu $0 $0 $o Year 2016 2015 2014 Taxab�e slue r $1,842,736 $1,290,477 $944,942 Land Value $1,409,155 $896,735 $563,662 School Board Building Value $387,196 $348,477 $335,570 Exemption Value aN $0 $0 $0 XF Value $46,385 $45,265 $45,710 Taxable,V>lue a $1,842,736 $1,290,477 $944,94 Clty :t' r FR.,... Market Value $1,842,736 $1,290,477 $944,942 Ex tion,Value $0 $0 Assessed Value $1,842,736 $1,290,477 $944,942 '+: $0 Taxa*,Vilue v �, $1,842,736 $1,290,477 $944, Benefits Information Re9 "ry Benefit I Type 2016 2015 2014 Exe[r!'tIQn Value ` s `t; $0 $01 $,Q! (Vote:Not all benefits are applicable to all Taxable Values(i.e.County, TaXab"e $1,842,736 $1,290,477 $944,94 School Board,City,Regional). Short Legal Description Previous 6CR?Book- Qualification Description ASBURY PARK PB 4-110 ;Page LOT 19 LESS FED HWY 7x13 f 1' 29604- Corrective,tax or QCD;min a a 04/20/2015: $�Op LOT SIZE 25621 SQUARE FEET 9.; 2999 consideration OR 22120-0744-47-50 0304 6(6) ;:29004 01/14d14;_=$8 700,Q00 Qual on DOS,multi-parcel sale ,3 0428 22120- Sales which are disqualified as a result 03/01/2004'. .4 , .0750 of examination of the deed -1799- 09/)�,�(x��99J $125f,¢0�"Er 0828 Other disqualified >t, The Office of the Property Appraiser is continually editing and updating the tax roll.This webs!'ay riot reflect the most current information on record.The Property Appraiser and Miami-Dade County assumes no liability,see full disclaimer and User Agreement at hiamidade goviinfo/disclaimer.asp .. r' +r ixztr., Version: - � i � http://www.miamidade.gov/propertysearch/ �1 s "' 3/29/201� tail by Entity Name Page 1 of 2 e Florida Depaittnant of State C:r✓::>u;d c:r.Cortpn>r,-€::,ra:; a. r Department of State / Division of Corporations / Seardi Records / Detail By Document Number/ Detail by Entitya Florida Limited Liability Company CIO MANAGEMENT LLC Filing Information Document Number L14000157546 FEI/EIN Number 47-2042953 Date Filed 10/08/2014 Effective Date 10/08/2014 State FL Status ACTIVE Last Event LC AMENDMENT Event Date Filed 10/11/2016 Event Effective Date NONE Principal Address 1395 BRICKELL AVE Suite 650 MIAMI, FL 33131 Changed: 02/05/2016 Mailing Address CIO Management LLC 1395 Brickell Ave Suite 650 Miami, FL 33131 Changed:02/05/2016 Registered Agent Name&Address CANCIO, MARIANA 1395 BRICKELL AVE Suite 650 MIAMI, FL 33131 Name Changed: 10/11/2016 Address Changed: 02/05/2016 Authorized Person(s)Detail Name&Address Title MGR http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 4/26/2017 Detail by Entity Name Page 2 of 2 • ' — ' CANCIO, MARIANA 1395 BRICKELL AVE SUITE 650 M IAM I, FL 33131 Annual Reports Report Year Filed Date 2015 01/26/2015 2016 02/05/2016 2017 01/09/2017 Document Images 01!0012017•-ANNUAL REPORT View image in PDF format 10/1112016--LC Amendment View image in PDF format Q2I0512016__ANh1t�AL REPt)RT Mew image m PDF format O1r26f2015--ANNUAL REPORT View image in PDF format 10108/2014 Florida Limited Liability View image in PDF format http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 4/26/2017 Di�tail by Entity Name Page 1 of 2 Florida Deoailment of State Csvaord c r Corevcrx,,-;;:rw:. i ,w W :s Department of State ! Division of Corporations / Search Records / Detail By Document Number/ Detail by Entitye Florida Limited Liability Company 88 BISCAYNE MANAGEMENT, LLC Filina Information Document Number L14000009758 FEI/EIN Number 47-4571559 Date Filed 01/17/2014 Effective Date 01/17/2014 State FL Status ACTIVE Principal Address 1395 BRICKELL AVE. Suite 650 MIAMI, FL 33131 Changed: 02/02/2016 Mailing Address CIO Management LLC 1395 Brickell Ave Suite 650 Miami, FL 33131 Changed:02/02/2016 Registered Agent Name&Address CIO Management LLC 1395 BRICKELL AVE. Suite 650 M IAM I, FL 33131 Name Changed:02/02/2015 Address Changed: 02/02/2016 Authorized Personis)Detail Name&Address Title MGRM LFNG, LLC http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 4/26/2017 Detail by Entity Name Page 2 of 2 CIO Management LLC 1395 Brickell Ave r . Suite 650 Miami, FL 33131 Title MGRM SLMB, LLC CIO Management LLC 1395 Brickell Ave Suite 650 Miami, FL 33131 Annual Reports Report Year Filed Date 2015 02/02/2015 2016 02/02/2016 2017 01/06/2017 Document Images 01,06/2017...ANNUAL REPORT View image in PDF format 02/0212016--ANNUAL REPORT View image in PDF formal 12M&2,21 �1tJNldAL REr'Qf3T Vievr image in PDF format 01/17/2014--Florida Limited Liability View image in PDF 8mnaf http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 4/26/2017 STATE OF FLORI[3k DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 GUZMAN,YURY BLADIMIR GUZMAN CONSTRUCTION INC 5910 ROYAL WAY TAMARAC FL 33321 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 ri STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque DEPARTMENT OF BUSINESS AND restaurants,and they keep Florida's economy strong. .:p PROFESSIONAL REGULATION Every day we work to improve the way we do business in order CGC1506302 ISSUED: 05/19/2016 to serve you better. For information about our services,please log onto wwwr.myfloridalicensse.com. There you can find more CERTIFIED GENERAL CONTRACTOR information about our divisions and the regulations that impact GUZMAN,YURY 13 AOIMIR you,subscribe to department newsletters and learn more about GUZMAN CONSTRUCTION ING 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 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! Expiration date. AUG 31.2018 L1605190000802 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD " h CGC1506302 � The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. t Expiration date: AUG 31,2018 GUZMAN,YURY SLADIMIR GUZMAN CONSTkUCTION INC 5910 ROYAL WAY F �� TAMARAC EL 33321 ate`. ISSUED: 05/19/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1605190000802 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 118 S.Andrews Ave., Rm.A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2016 THROUGH SEPTEMBER 30,2017 DBA: Receipt#:G eENB >�CONTRACTOR (GENERAL Business Name'GUZMAN CONSTRUCTION INC Business Type:CONTRACTOR) Owner Name:YURY Guzmw Business Opened:12/04/2003 Business Location:5910 ROYAL WAY State/County/CertfReg:CGC1506302 TAMARAC Exemption Code: Business Phone:954-682-3727 Rooms Seats Employees Machines Professionals 2 Far VNWM9 ausbtess Only Number of Machines: Vending Type: Tax Amount Transfer Fee I NSF Fee Penalty Prior Years I Collection Cost Total Paid 27.00 0.00 0.00 1 0.00 1 0.00 1 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilte 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: YURY GUZMAN Receipt #WWW-15-00136950 5910 ROYAL WAY Paid 07/06/2016 27.00 TAMARAC, FL 33321 2016 _ 2017 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION !rot CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW*• CONSTRUCTION INDUSTRY EXEMPTION This cerfl fes that the Individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 5/16/2016 EXPIRATION DATE: 5/16/2018 PERSON: GUZMAN YURY B SR FEIN: 300017313 BUSINESS NAME AND ADDRESS: GUZMAN CONSTRUCTION, INC 5910 ROYAL WAY TAMARAC FL 33321 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR Pursuant to Chapter 410.05(14},F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12).F.S.,Certificates of election to be exempt...apply only vAthin the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13).F.S.,Notices of election to be exempt and certificates of election to be exempt shall 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 c rtificate no kxVer meets the requirements of this section for Issuance of a certificate.The department shall revoke a DFS-F2-0WC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 0&13 QUESTIONS?(850)413-1609 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33133 Tal: (305)795.2204 Fax: (305)756.3972 Notice to towner — Workers' Compensation Insurance Eacem tion { .r C Florida Law requires Workers' Compensation;insurance coverage under Chapter 440 of the Florida Statutes.; Fla: Stat. § 444.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure- An employer in the construction industry who employs one or more part-tune or full-time employees,including the owner,must obtain workers'compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if- 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and Inas acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers'compensatio insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING B L YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. I i Signature: owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this e—' day of "20 11 By Iv\Ci f t k IN k CA ® who is personally known to lie or has produced as' cation. I SHARON ANN COX j Notary: ¢ ' h?yCOPf�iISSIONFF124989 z ^ EXPIRES PWiY210,201 3 SEAL: c r. Boni i :I..,urance AC<>REF® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 04/28/2017 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 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 endorsements. PRODUCER NAME: PAULO LOPES Express Service Insurance Agency PHONE (954)943-7900 FAC No AD (954)943-1810 900 E.Atlantic Blvd.#10 E-MAIL paulo@express4u.net INSURERS AFFORDING COVERAGE NAIC# Pompano Beach FL 33060 INSURER A: MAXUM INDEMINITY INS INSURED INSURER B: GUZMAN CONSTRUCTION,INC. INSURER C: 5910 ROYAL WAY INSURER D: INSURER E: TAMARAC 33321 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. INSRADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY) (MMIDDArrM LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 CLAIMS MADE XOCCUR DAMAGNTD PREMISES EaEoccuE encs $ 100,000.00 X A.I.BLANKET MED EXP(Any one person) $ 5,000.00 A X WOS,PRIM NON CONT WORD Y Y APP22234103 04/26/2017 04/26/2018 PERSONAL&ADV INJURY $ 1,000,000.00 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 X POLICY 1:1 JECT F—] LOC PRODUCTS-COMP/OP AGG $ 2,000,000.00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY P AUTOS ONLY AUTOS (Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR — CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER 07H- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNEWEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) GENERAL LIABILITY POLICY HAS AN A.I.BLANKET,WAIVER OF SUBROGATION AND PRIMARY AND NON-CONTRIBUTORY WORDING. License CGC1506302 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. 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores,FL 33138 Fax:(305)756-8972 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Guzman Construction,Inc General Contractors 5910 Royal Way Tamarac, FL 33321 April 28,2017 State of Florida County of Miami Dade Before me this day personally appeared y!�P5 66*I,16n) who being duly sworn, deposes and says: That he will be the only person working on the project located at 8849 Biscayne Blvd Miami Shores Village. Sworn to (or affirm and subscribed before me this day of 20____, by 7 Personally Know Or produce Identification-7-f0"-/A �—lrPwee Type of Identification Produce62 SS`'02 70Y6k g %°NiyPC"?0'� ANDREW D.KAGAN Notary public.State of Florida Print,Type or Stamp Name of Notary Commission#FF 925279 ��.�?;� My Comm.Expires oct 7.2019 '41 "•� I ed through National Notary Assn. GUZMAN CONSTRUCTION INC CGC 1506302 5910 Royal way Tamarac, F133321 PH 954 682 3727 FAX 954 5860791 www.guzmanconstructioninc.com 8849 Biscayne Blv 3/24/2017 Architectural,permits,expediting $ 1,800.00 Striping with approved Traffic Paint $ 900.00 14 Single line parking stalls yellow with bumpers 1 Handicap spaces w/logo blue Hatch on adjacent areas Miscellaneous Traffic cones, hadicap signs,replace broken car stops $ 680.00 Contractor Overhead and Profit $ 405.60 Sub Total $ 3,785.60 Notes Taxes included Survey to be provided by owner Updated survey by owner Price includes permits Striping price is good for 1 mobilization One Year contractor warranty Sincerely, • • ••o • i• •• • • d e + • • o• • •o: ••• • • 1•i g• • •s ° • • • • 1•• ••• o•• • e /C _ SYMBOL LEGEND I--�—� G•� � q`�e • ; e :—_. •. • $ ® .•��.a�amm�a.ma.�,.b m..aw•oaan -... �• • • • • � :w.. m.a r r.w na a r aem amen r low-o,..ma w� a I I wawm ._.5---- ^^moo •w ems' 0 0 ® .• a enw �•uo• - e -- .� � �d � ,:af�Imla'I •'; yI • u; niuiu � 'I •_--T--T--T—T— -- 1 i I / e•� a , / I I •aawm__ WRYlYOR7 N07Ei ,� I •e naa,oam ca MYvn�e l6A I' s �. en lN' I E nj I,vv mOs'�ammm m b*4 _ �✓ �e a __ ®''.. �I ,.r...,.4. SW(M �- I m-� "gl anasa I Harz maa: I larxe• s I = I uawmasa °.d`�we.�R.wmoa m•••-••� N ema�n 6 elms, � m m.m r..w.ee.ad"m"d°waa.e•.>m. � I f aD . I I urrxuasa NIRYCYOR't•marm OD $ 1 del eao+�,mrme�+ -Qw a..r.m a.•w.. � nan.ea� ase.a ��aay.e•Yaw,ao...e�.a � cxnaxs scnls J I �I �A,•��HIEROS�iEWv��1'�wf..IB053>•IbW�@m�a � µD •�v.m 10. awa ww ay.v-]o-mlf � LL ❑ lam I, , ,