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DS-17-406 8447,11,111 M Miami Shores Village Perrrr/t Type t f yfi<,'�y Sidewall s/Sl� , 10050 N.E.2nd Avenue NE �� 'ertdrrli � �otftration Miami Shores,FL 3313&0000 PoPPROVED 1� Phone: (305)795-2204 Issur;z pate;2t16/2Q'i7 Expiration: 08/15/2017 Project Address Parcel Number Applicant 1411 NE 101 Street 1132050240300 ELVIA BECK Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell JEFFREY S BECK 1411 NE 101 Street (646)235-8637 MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 4,013.57 CABRERA PAVING 8 ENGINEERING (305)889-3511 (786)247-2786 _.. ,..... _ __ _. ,_.. . .... Total Sq Feet: 2000 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final Date Denied: Foundation Type of Work:DRIVEWAY ASPHALT Additional Info:DRIVEWAY ASPHALT Review Planning Bond Return: Classification:Residential Review Building Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.00 DBPR Fee Invoice# DS-2-17-62966 $3.00 02/16/2017 Credit Card $223.00 $0.00 DCA Fee $3.00 Education Surcharge $1.00 Permit Fee $200.00 Scanning Fee $9.00 Technology Fee $4.00 Total: $223.00 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 zoni uthermore,I thorize the above-named contractor to do the work stated. February 16, 2017 Authorize gnature:Owner / Applicant / Contractor / Agent Date Building Department Copy February 16,2017 1 Miami Shores Village f ` Y Building Department `L B � (6 _ 'r 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 Y Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20AL4 (,� BUILDING Master Permit No. � S t� -Uko(o PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: "�'�/ �"� ��� ��� City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: ,��— �®e� ®2 Y—tu®o Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): k Phone#: C O/�7 I g,/l tol 1-9:2—) Address // Alk 16)" 05 ,KJE City: A /&.ref State: ��® � Zip: X33/3? Tenant/Lessee Name: g Phone#: ( Email: rJ�C; ,d,t'L�> �'S'FGZ � G!"d'1G(�I• CGf'Y1 CONTRACTOR:Company Name: i ,Ql/f�� /�i��P Phone#: Address: 634: w A ig T City: State. Zip: Qualifier Name: Phone#: State Certification or Registration#: Certificate of Competency#: °� � ve DESIGNER:Architect/Engineer: Phone#: Address: City: State: -- Zip: Value of Work for this Permit:$ �` ��� ���' Square/Linear Footage of Work: o2 Type of Work: ❑ Addition ® Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 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$ (Revised02/24/2014) A , A 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 p(ure it ' iss ed. In the absenc of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature � Sign �---� OWNER or AGENTONTRACT R The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 490 day of 20/ by 00 day of � '� 20 by ho is personally known to �a�o5 Z � , ho is personally known to me or who has produced a� me or who has produced as identification and-7ho take an oath. identification d w o did take,an oath. NOTARY PUBLIC:// NOTARY P BLIC: d Sig ° Sign: ` Print: ' / .5!>t� l ,��� Print: Seal: Seal: NMIPdit-StWeofFlorida NOMY Pdb-ft"d Flbdd� t C 08201'9 .ymy cow. aonum As>po APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Mission: Mak Scott To protect,pm-de&Inprokethe health Go%em of all people in FloddabDugh integrated Costs Phmp,MD,MPH side'minly&=mu*efforts. HEALTH state sqpon c -a and seoretwry Vision:To be the Healthiest State In the Nation February 09,2017 Elvia Beck 1411 NE 101 Street Miami, FL 33138 RE: Modification to a Single Family Residence-No Bedroom Addition Application Document Number: AP1274654 Centrax Permit Number: 13-SC-1737814 1411 NE 101 Street Miami, FL 33138 Lot: 13 Block:3 Subdivision: Dear Applicant, This will acknowledge receipt of a floor plan and site plan on 02/06/2017 for the use of the existing onsite sewage treatment and disposal system located on the above referenced property. Proposed repair and redesign location of driveway. No objection letter was issued by C. Icaza on 02/09/17. This office has reviewed and verified the floor plan and site plan you submitted,for the proposed remodeling addition or modification to your single-family home. Based on the information you provided, the Health Department concludes that the proposed remodeling addition or modification is not adding a bedroom and that it does not appear to cover any part of the existing system or encroach on the required setback or unobstructed area. No existing system inspection or evaluation and assessment, or modification, replacement, or upgrade authorization is required. Because an inspection or evaluation of the existing septic system was not conducted,the Department cannot attest to the existing system's current condition,size, or adequacy to serve the proposed use. You may request a voluntary inspection and assessment of your system from a licensed septic tank contractor or plumber, or a person certified under section 381.0101, Florida Statutes. If you have any questions, please call our office at(305)623-3500. Sincerely Ca s Ic Engineer III Department of Health in Dade County Fla"Wim!of NpNi aw.11aYda w in Dade County• •,Florida TWITTER:HealthyFLA PHONE: (305)623-3500 FACEBOOK:FLDepartmentofHealth YOUTUBE:ftdoh AC�® DATE(MMIDDIYYY ) w...- CERTIFICATE OF LIABILITY INSURANCE 02/0612017 THIS CERTIFICATE IS ISSUED ASA 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 certBicate holder is an ADDITIONAL INSURED,the policy(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 __.._.__o—i NAME: Jorge L.Gonzalez -- Florida Bankers InsurancePo �1_ (305)225-1243 (305)225-5053 j 961-963 SW 122 Ave R Ss, —jorgeiuis@flohdabankersinsurance.com Miami,FL 33184 INSURER(S)AFFORDING COVERAGE MAIC k Phone (305)225-1243 _ Fax (305)225-5053 INSU RRA: EVASTON INSURANCE C. OMPANY — __. ,__.. ---............. INSURED INSURER 8: ---- - ...__-_._.-.-.__........... CABRERA PAVING&ENGINEERING INC INSURERC: ---._ 9048 NW 93rd St INSURER D: --- -- ---- INSURER E...__..._...---.......... ._._ Miami F( 33178- - -- - --.......__...._._._ --................... ---_._.._....._.. INSURER 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 _DD - ADDLSUBR POLICY EFF POLICY EXP LTR, TYPE OF INSURANCE POLICY NUMBER tMM/D.---- - -- MMroomvY�' __. _.._ unarcs COMMERCIAL GENERAL LIABILITY - - EACH OCCURRENCE $ 1,000,000 ❑ CLAIMS-MADE OCCUR DAMAGE TO RENTED 100,000 -ERMIE SES fEa accurcenCal g D EXP(Any one person) $ 5,000 A ❑ _ ._.._ -- 1602127 01/2612017 01/26/2018 --- --.. - --- PERSONAL 6 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APP;LI-LI-K�ES PER. f ! GENERAL AGGREGATE S 2,000 000 F-1 POLICY PRO- J LOC PRODUCTS-COMP/OP AGG $ 1,000,000 JECT OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea aWdentl $ ANY AUTO BODILY INJURY(Per person) $ OWNED AUTOSULED BODILY INJURY(Per acx tlentk $ - --y ❑ AUTOSNLY - ❑ HIRED ❑ NON-0WNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per ac�tiderrt)_,- g __ g UMBRELLA LIAR ❑OCCUR -- _. EACH OCCURRENCE $ ---- EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ----- _� __-_-- -. ❑ DED ❑ RETENTION$ WORKERS COMPENSATION .7. PER OTH- AND EMPLOYERS LIABILITY Y/N _3TATllTE.__.. ❑_ER _. ANY PROPRIETORJPARTNER/EXECUTIVE i - E L EACH ACCIDENT ;$ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE$ If yes,describe under — DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT g DESCRIPTION OF OPERATIONS/LOCATIONS t VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Driveway,Parking Area or Sidewalk-Paving or Repaving and Excavation --- CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BLDG DEPT THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2nd AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FL-33138 ----- — — __— AUTHORIZED REPRESENTATIVE ---- .._........_........__..... _.._.... ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103)OF The ACORD name and logo are registered marks of ACORD LU, T 0 R - - `IC - 11 . 45 . 13 ae ISSUE DATE. O',�'0_!?QJ� TEiIiPORARI' ?IC ( '!1�') rr.'JarrL DATE r"1/C:2/20G ;Y NIAME C _EP Eiv-IZe E%ITvC Im�d S� NAM _!' `?RAitiCE EXPIRATION DATE U-1726/201-6 STATUS A LAST RENEWAL /0I 2015 C':�i TP.ACTOR TYPE D DADE BUSINESS TYPE G CORPORATION D KESS -048 hTW 73 ST PHONE 305 889-3511 FAX: 786 554-e762 10DLEY STAT—EF L CLASS EXP DATE 030 2 1 / QIP 3L517NAICS CODE U60000 WORK COMP DATE 10/24/2015 Ei,lAIL: WORK COMP EXEMPT (YIN) i --- Q U A L I F I E R --- SKILL CAT ST REG NUMBER EXP DATE IRDS 201100926 CLASS ENGR LEVEL P 0003 N ,ME SUAREZ LLANES CARLOS 0007 -P-SS STATUS A ONLINE EXP DATE 09/30/2017 PRINT (Y/N) SSid 000001938 PF3 = AUDIT INQ PFI = UPDATE PF2 = ADD MORE QUA PF6 = PRINT CERTIF NEXT SCREEN NEXT KEY DEST= TCPP877S OVEPTYPE FIELbS�TO— MODIFIED. . . EPRESS PF Construct Trades`Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY E0700707 C;ABP,EPJ,.PEEVING&ENGINEERING INC D.B.A.: SUAREZ LL'ANES CARLOS is certified under the provisions of Chapter 10 of Miami-Dade County PIPE LINE ENG IFYING 7-p Q007 RAVING ENGINEERING Jui:d;M H.Saias C,t.. arm-"owl p C Miarm-Dd ' v"'�.r+namulade,gpvlecor�Y 005540 v Lf D —THIS IS NOT A BILL—DO NOT PAY K Ir 6307011 EUSINESS NAME/LOC<:.TION — E�— -,�� � t NO. ��..�c n��,.� CABRERA PAVING&ENGINEERING INC �'olrala� 9048 NW 93 ST 7/418 22V0 1E L! E Ir612,,L=R 2,0, G1vl� MEDLEY FL 33178 Must be displayed at place of business Pursuant to County Code Chapter BA—Art.9&10 0VVNER SEC.TYPE OF BUSINESS CABRERA PAVING&ENGINEERING INC MMC SPECIALTY ENGINEERING CONTRA( WENT RECEIVED ` �M E0700707 COLLECTOR Cate;Onr(s) 2 $200.00 08/24/2016 FPPU06-16-022647 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, Permit,or a certification of the holder's qualifications,to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles—Miami—Dade Code Sec Ba-276. For more information,visit wvvw.miamidadeoov/tarcollector 003354 c a J111 BE U 2 2' Miami—Dade Count/, State of Florida —THIS IS NOT A BILL—DO NOT PAY 6307011 BUSINESS NAME/LOCATION RECEIPT NO. CABRERA PAVING&ENGINEERING INC R[EbMEWA,L � � �� ®D ��� 9048 NW 93 ST 6557321 7 MEDLEY FL 33178 Must be displayed at place of business Pursuant to County Code Chapter SA—Art.9&10 OWNER SEC.TYPE OF BUSINESS CABRERA PAVING&ENGINEERING INC 196 SPECIALTY ENGINEERING CONTRACTIA rMENT RECEIVED E0700707 BY TAX COLLECTOR Worker(s) 5 $45.00 08/18/2016 CREDITCARD-16-048003 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit,or a certification of the holders qualifications,to do business. Halder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0,above must be displayed on all commercial vehicles—Miami—Dade Code Sec Ba-276. For more information,visit www.miamidade unit/taxcollector Feb. 16. 2017 9: 24AM No, 3300 P. 1/1 / � DATE(NIM/DDlYYYY) ACO D CL*TJF1CATE ar I-JA311-1 l IN-SURA��C= 2/1-5/1-017 THIS CBRTL=ICATE IS ISSUED AS A PAATTBR OF INFORiIAATIOPI ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDLR. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, S:,T4ND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 3GLO10J.'THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTI-IORIZED Rc°RE55MTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the carificate holdor is an ADDITIOiNAL INSURED, the polley(las) muss be endorsed. If SUBROGATION IS WAIVED, subject to II Ule terms and conditions of the policy,carain policies may require an �ndorumenl. A Statement on this eeRificata does not Confer rights to the certificate holder in lieu of Such endorssmomt(s). PRODUCER NAMCT Christi-ae Jo.-op? Xa_n Battla Mead S Company PHONE (305)559-1101 EAC Na;t305)A:C-a7z: 7950 t4a t:2twest 14$t:h 3=eet ADbRIL ,cjo,CpYs@Swmco.cam Sultz 200 INSURER S)APPCROING COVERAGE MAIC: Miami. Lams FL 33015 INSURERATrVA Mutual TnsuxaaCe INSURED INSURER B L Can' ===s. Paving & Engi.nee=ing =nC. INSURER C: c/o .Z-X5 235 E Commexcial Blvd # 20J. INSURER D 1 INSURER 9: La.uderdaLla by the FL 33308 INSURER COVERAGES CERTIFICATE NUMBER:16/l7 -fTC 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 CONOITiON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTJFICAT$ MAY 2E ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIS90 HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS Of SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, I TR TYPE Of INSURANCEI C LI wv POLICY Numa0i FOULmmin , tMNOVLICY E;CP LIMITS COMMERCIAL GENERAL LIABILITY SACH OCCURRENCE 3 CLAIMS-MADE 7 OCCUR !QpT NtNIMry�Arf� 5 -ME-1.1 EXP(Any one peroral 1 S PERSONAL v ADV INJURY $ 02M4 AGGREGATE LIMITAPPLIES PER: I ? POLICY GEN6:AL AGGREGATE I g LOC J PRODUCTS-COMPtOP AGO b OTHER: 3 ) AUTOMOBILE 4IA91UTYBINtD I p, aelNtin MINGLELIMITjMINGLELIMIT ANY AUTO JII BODILY INJURY(Per person) j 3 ALL OWNED SCHEDULED AUTOS I AUTOSNED i BODILY INJURY(PeramdMt)NON-O15 HIP.ED AUTO$ AUTOS i ( P aload mOAMAGEH 5 UMBRELLA LL4B OCCUR SACH OCCURRENCE EXCESS LJAB CLAIMS-MADE I AGGREGATE DED I I RETENTIONS I I s WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY yt,y � 3 TATUTe R ANY DROPRIETOR/PARTNERMECUTIVE :,OOO.00O I OFFICER/MEMBER EXCLUCSO't C N t A E,L EACH ACCIDENT 3 (Mandcrory In NH) TC3400032843:013+1 10/24/2010 10/:4/2017 E.L.DISFASE.EA EMPLOYE 5 It qes,dexrbe under DESCRIPTION OF OPERATIONS below i E.L.OISEASE-POLICY IMIT 15 1.000,000 I I ( I { i I DESCRIP T ION OF OPERATION£t LOCATIONS!VEHICLES (ACORD 1M.Additional Romartd Schedule,may ba mchm If Tore Spade L required) I Driveway,Parking,Area-Paving or Sigewalk• I CERTIFICATE HOLDER CANCc1.LAT'ION SHOULD ANY OF T'rIE ABOVE DESCRIBED POLICIES BE CANCSFLLED 9$5ORE V I.vVll SHORES V141-AGE:LDS DEPT 7H9 EXPIRATION DAT;: THEREOF, NOTICE WILL BE OEL;VERc17 IN 1 OVO PIE 2nd AVE ACCORDA,NICE WITH THE POLICY PROVISIONS. I AUTHORIZED REPRESENTATIVE I-.,... .Ei_=/rte •:�•�..�.��" -'-���� I ©1583-20.1AACORO CORPORATION. All rights reseried. aCO150"sa(2011401) Tr t AC0'AD name and logo ar?,29istered marks of J.'CORO INS023a'!+4111, A C CERTIFICATE ®� LIABILITYINSURANCE FDATE(MMIDD/YYYY) 11� 2/15/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFnA'TE 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 Christine Joseph NAME: P Keen Battle Mead & Company PHONE o (305)558-1101 FAX No):(305)822-4722 7850 Northwest 146th Street E-MAIL c'ose ADDRESS: h@kbmco.com P Suite 200 INSURERS AFFORDING COVERAGE NAIC# Miami Lakes FL 33016 INSURERA:FFVA Mutual Insurance INSURED INSURER S: Cabrera Paving & Engineering Inc. INSURERC: c/o EMS 235 E Commercial Blvd # 201 INSURER D: INSURER E: Lauderdale by the FL 33308 INSURER F: COVERAGES CERTIFICATE NUMBER:16/17 WC 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 SUER POLICY EFF POLICY EXP LTR I vivo POLICY NUMBER MMIDD MM/DD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE 71 OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) S PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY F7 JECT LOC PRODUCTS-COMP/OP AGG S OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident S UMBRELLA LAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S DED I I RETENTIONS S WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY Y/N S STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE F7 E.L EACH ACCIDENT S 1,000 000 OFFICER/MEMBER EXCLUDED? N/A A (Mandatory in NH) WC84000328432016A 10/24/2016 10/24/2017 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 it more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BLDG DEPT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES. FL-33138" AUTHORIZED REPRESENTATIVE Alex Perez/CJ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1NS025r?m4nn raerea by: E 105th St NE 1051h St _- NE l Od[.h y t"�" As"iliht Y y �' ,♦�I NE 1031d StNE " 7 NE101skS' NE 99th SI NE 98th St �" I @ B &ay •e• 971h St IMP date C"12015 Google LOT SLOCK s ��� ti N82°15'22"E 60.58'(P) o.er �.Jt1; gT�� A!-I Pl'1C'VFD BY r)ATE z 01,!6NG FrF-PT ILI DE PT 0 0 - ;I IIIJI U10 COP Pl W,K-F WITH N L FFnFR,,\I_ NO 6`;IAIi /r,n(' `!HITYITl115 nPJT) 1F�i!I ��1!I�NR -GENE RATOF' _ 25.30_/4 �.:10 •. .�;:.. _ 57�.A 10.88'�,T it 0.48TJu ,70 t D I .QS' 31.65• u ,p' 1056 fi � � o.rs•- N �a.ou T` CV s'' ONE STORY m 3 Q) w���`� RESIDENCE Q U, #/4// � r b o o i F0.30 ®�J .vase w _ \k\*\0o \A19r0 to S a�ea Oe Z w o ASPHALT„ k��NO.. ro.rsORIVE6V4Y � D�vari 1 - 5. N i R`598.66 A,3 ao t b ' 4=00.b0' 69.36 - - P. �.0'-„ FLP I,'Z y N T - o0;004'_ - -HAS T PAVS - -----------9— 19, A s P _JS T R E E T_ 10 St nvw vel ad -I- �j 9W aM-0- VCk\f� `2. Kao IPat r t" ll�`kot- I%2 ,asp Accepted By: Property Address: Notes: NO NOTES 1411 N.E.101 Street Miami Shores,Florida 33138 SURTnyOR'S eeRrcFIC T'IOw I Hi UW CERTIFY THAT nus WUUNDARY SURVEY IS A TRJJE AND CORRECT M.E.Land Survey In Inc. REPRFSBdTAT7ON OF A SUR. UNDER MY DIRECTION.TrHIS COMPLIES VKTH THE MINIM UIM TECHNICAL y 9. STANDARDS,A5 SET FOR THE STA ORMA SOAR°OF PROFESSIONAL LAND SURVEYORS IN CHARTER 10665 SW 190th Street 53.17,FLORIDA ADMIT ATNF jR TO 472.027,FLORIDA STATUTES. A-7 rt♦H _ ? Suite 3110 SIGNED " FOR THE FIRM Miami,FL 33157 EFRAIN LO z .. • Phone:(305)740-3319 STATE OF F' DA °Rf P.S.N.No.6792 Fax:(305)669-3190 NOT VALID WCTTHOtJT O C SIGNATURE AND AUTHENTICATED ELECTRONIC SEAL AMJOi THE MAP Is Nor VALID AND THE ORIGINAL RAISED SEAL OF A LICENSED SURVEYOR AND LB#:7989 �. MAPPER.