Loading...
RC-17-892 44/17 Tw VC.A "2.j + doe'_" P 47-892 at Miami Shores Village Permit Type'.Rpsl pntial Construction a�� 10050 N.E.2nd Avenue NE r ' � Work Cls �Gatfon-Alteration "" Miami Shores,FL 3313&0000 Pennit'Statu$.APPROVED Phone: (305)795-2204 F;ORA Ex Iration: 10/30/2017 Issue gate:5/3/2017 p� Project Address Parcel Number Applicant 1009 NE 104 Street 1122320290140 LENILAN INVESTMENT LLC Miami Shores FL 33138-2655 Block: Lot: Owner Information Address Phone Cell LENILAN INVESTMENT LLC 1009 NE 104 Street (305)608-9839 MIAMI FL 33138- 980 BELLE MEADE ISLAND Drive MIAMI FL 33138- Contractor(s) Phone Cell Phone _ $ 11,000.00 Valuation: AMF BUILD AND REHAB LLC (786)484-8710 Total Sq Feet 200 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final PE Certification Date Denied: Window Door Attachment Type of Construction:KITCHEN REMODELING AND ADD Occupancy:Single Family Framing Stories: Exterior: Insulation Front Setback: Rear Setback: Drywall Screw Left Setback: Right Setback: Window and Door Buck Bedrooms: Bathrooms: Fill Cells Columns Plans Submitted:Yes Certificate Status: Review Electrical Certificate Date: Additional Info: Review Electrical Review Building Bond Return: Classification:Residential Review Planning Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Planning CCF $6.60 Review Planning DBPR Fee $4.95 Invoice# RC-3-17-63530 Review Plumbing DCA Fee $4.95 05/03/2017 Check#: 1277 $605.50 $200.00 Review Structural Education Surcharge $P.20 03/31/2017 Check#:4710 $200.00 $0.00 Review Mechanical Penalty Fee $100.00 Permit Fee $330.00 Scanning Fee $18.00 Technology Fee $8.80 Work without Permit Fee $330.00 Total: $805.50 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 wi the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibi11 for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING H ICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify th all th foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhemi la oriz a above-named contractor to do the work stated. May 03, 2017 Authorized Signature:Owner pplicant / Contractor / Agent Date Building Department Copy May 03, 2017 1 ����� �� ��� � �1�-�� ' t RECEIVED Building � Miami Ores Village 12017 De art t MARS 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(30756-8972 INSPECTION LINE PHONE NU ER:(305)762-4949 s-41 1 1 FBC 2014 i'1 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1009 NE 104 ST City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-2232-029-0140 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):LENILAN INVESTMENT LLC Phone#:305-608-9839 Address:1009 NE 104 ST City: MIAMI SHORES State: FL Zip: 33178 Tenant/Leiser Name: Phone#: Email: �Q��© (—® H Aztiso L- :+ 6° - o r,- CONTRACTOR:Company Name: AMF BUILD AND REHAB LLC Phone#: " Address: 5530 NW 113 CT City: DORAL State: FL Zip: 33178 Qualifier Name: ARIEL BETANCOR Phone#: 786-484-8710 State Certification or Registration,#: CGC 1524148 Certificate of Competency#: DESIGNER:Architect/Engineer: JORGE D. MANTILLA (LIC# 14320) Phone#: 305-815-4649 Address:5901 SW 63 COURT City: SOUTH MIAMI State: FL Zip: 33143 Value of Work for this Permit:$11,000.- Square/Linear Footage of Work: goo Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: KITCHEN REMODELING ADD SHOWER AT OFFICE BATHROOM Specify color of coloorr�thru tile: Submittal Fee$2-� ' w Permit Fee$ 3(�JrO7I 0 CCF$ <o �10 CO/CC$ _ Scanning Fee$ Radon Fee$ T` —1 DBPR$ �' — r Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ GO 5 ' (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 TOO NE : YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS T 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 ap roved and a rein ection fee will be charged. Signature Signature AJ W N or A ONTRACTOR The foregoing instr acknowledged before me this The forego' instrument was acknowledged before me this _day of (L Y 1 20 J „by Bon day of {� IC(6ch 20 1 by RaiAry 2eI who is personally known to who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: �C � �`^-� Sign: OaU-41, Print: LLQ JIQ Print: 11- ffz .WN-4- )-ct(G'°i +•' y' NATA IA LARA Seal: a; 40 MYIFF903964 Seal: :•'"•'pi;� NATALIA r F:I, tit„is r M.r .2019 ' ISA 30 i ,'ow= E: nnerw B :•= MyCMUSSIOA'#FF9MS84 EXPIRES:�tember30,2019 � APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) •29/3/201/ Detail by Entity Name r g DIVISION OF CORPORATIONS Ora r Department of State / Division of Corporations 1 Search Records J Detail ByQocument Number/ Detail by Entity Name Florida Limited Liability Company LENILAN INVESTMENT LLC Filing Information Document Number L09000041215 FEI/EIN Number 27-0385091 Date Filed 04/29/2009 Effective Date 04/27/2009 State FL Status ACTIVE Principal Address 225 NORTH SHORE DRIVE MIAMI BEACH, FL 33141 Changed: 02/08/2010 Mailing Address 225 NORTH SHORE DRIVE MIAMI BEACH, FL 33141 Changed:02/08/2010 Registered Agent Name&Address ZENATTI,ALAIN 225 NORTH SHORE DRIVE MIAMI BEACH, FL 33141 Name Changed: 02/08/2010 Address Changed: 02/08/2010 Authorized Person(s)Detail Name&Address Title MGRM -7-ZENATTI,MAIN— --- 225 NORTH SHORE DRIVE MIAMI BEACH, FL 33141 Annual Reports http://search.sunbiz.org/Inquiry/CorporaUonSearch/SearchResultDetail?inquirytype=EnbtyName&direcdonType=lnitial&searchNameOrder-LENILAN IN... 112 29/3/2017 . Detail by Entity Name Report Year Filed Date 2016 01/11/2016 2016 01/23/2016 2017 01/08/2017 Document Images 01/08/2017--ANNUAL REPORT View image in PDF format 01/23/2016—ANNUAL REPORT View image in PDF format 01/11/2015—ANNUAL REPORT View image in PDF format 02/11/2014—ANNUAL REPORT View image in PDF format 04/14/2013--ANNUAL REPORT View image in PDF format 01/11/2012—ANNUAL REPORT View image in PDF format 01/06/2011 —ANNUAL REPORT View image in PDF format 02/08/2010—ANNUAL REPORT ` View image in PDF format 04/29/2009—Florida Limited Liability View image in PDF format http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EnbtyName&direcUonType=l nitial&searchNameOrder-LENILAN IN... 2/2 AMF Build and Rehab LLC 2500 NW 79 AVE STE 252 DORAL, FL 33122 US 1(800) AMF-7573 info@)amfbuild.com www.amfbuild.com ADDRESS Alain Zenatti - -- ---------- --- -- ---------- 1009 NE 104TH ST ---- --------- --------- ---- -- - MIAMI SHORES, FL Plans 2,700.00 Provide constructions plans drawn and signed by an Architect General Construction Requirements 1,500.00 General Contractor Fee: Master permit processing fee Plumbing 500.00 Plumbing permit processing fee by a qualified and licensed Plumber Plumbing 4,400.00 Remove existing work and build under FBG (Florida Building Codes) Labor and materials included Electrical 500.00 Electric permit processing tee by a qualified and licensed Electrician Electrical 2,500.00 Remove existing electrical work and build under FBC (Florida Building Codes) Labor and materials included -City Permits fees are not included in this estimate. .... •••• •••••• - yyuahtiti4y'Eat Q64`i'�(.&S. •••• • • ••• •• Tile installation fixtures on bathroom 600:0o •• •••••• Kitchen:appliances, cabinets, counter top and installation. •••••• 6 e • Walls,drywall replacement and painting •••••• •••••• • Framing •••• •••• ••••• ARE NOT INCLUDED IN THIS ESTIMATE """ •••••• • • - ••••••Plans and work completition are subject to city approval. • 000 • . . . . . . ...... •••••• - Payments shall be made: 0 0• • :-00-: 50% Payment when accepting this proposal ••; 30% Payment when the city permits are approved before start working on site 20% Payment when the job is completed. Accepted By March 7 2017 Accepted Date -¢- xrF 6atC.6 lg"d Amws p3 . O�, _ 2.0/--j- �f NATAUALARA MY COMMISS[ON i FF 903984 11,11h NATAUA LARA EXPIRES Semher 30,2019 =• _ MY COMMISSIOA9 FF 903984 BondedThruWMPubklJ*w dM Boomed Taw try Pub�cr 30,2019 Undewhm •••9 • • 6666 6666•• •• • • ••• 6 6666•• .• • 66.66• 609.• 6• • . • 6666•• 6666 •••� • • 6666 •••• 6666• 99•••6 • • s•••• be so • 6666•• • • • • • • •66.9• r..... RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION = CONSTRUCTION INDUSTRY LICENSING BOARDle ICUGC1524148 The GENERAL CONTRACTORY} F Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 MW P*d 0� BETANCOR,ARIEL FERNANDO- '� AMF BUILD AND REHAB LLC 5530 NW 113 CT f 1' DORAL FL 33118 ISSUED: 06/14/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1606140DO1162 008136 Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOT A BILL-DO NOT PAY 7200776 �_LBT_.') BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES AMF BUILD AND REHAB LLC RENEWAL SEPTEMBER 30. 2017 5530 NW 113 Cr 7483430 Must be displayed at place of business DORAL FL 33178 Pursuant to County Code Chapter 8A-Art.9&10 OWMER SEC.TYPE OF BUSINESS PAYMENT RECEIVED AMF BUILD AND REHAB LLC 196 GENERAL BUILDING CONTRACTOR BY TAE COLLECTOR C/O B TANCOR,ARIEL F CGC1524148 $45.00 09/21/2016 WorkCREDITCARD-16-055643 This Loral 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 requlroments which apply to the business. The RECEIPT NO.above must be displayed on all commercial vehicles-Miami-Dada Code Sec an-276. For more information.visit www.miamidadoxmvitexcollector AC40� CERTIFICATE OF LIABILITY INSURANCE DATE(MMDD/YYYY) 03127/2017 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 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 oa tifloste holder in lieu of such endorsemenks). PRODUCERECT MARTA ALONSO NAMFAX Florida Bankers Insurance PHONE 24: (305)266-6493 (AIC No, (305)262-0679 6874 SW 8 ST -MAIL DDRESSP mffce@floridabankersinsurance.com Miami,FL 33144 WSURE AFFMOINGCOVERAGE NAtC# Phone (305)266-6493 Fax (305)262-0679 INSURER A: FEDERATED NATIONAL INSURANCE COMPAN INSURED INSURER 0: AMF BUILD AND REHAB LLC INSURER C: 2235 Ova))Roost Drh/e INSURER D: INSURER I-: WESTON FL 33327- 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. ILTR TYPE OF IADDLNSURANCE INSR WVD BR POLICY NUMBER EFF POLICY EXP LIMITS ® COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 ❑ CJAIMS-MADE ,W OCCUR PREMISES occurrence! S 100,000.00 ❑ MED EXP(Any one person) $ 5,000.00 A ❑ N N GL-0504013328-01 04/1612016 04/16/2017 PERSONAL 8 ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 WJ POLICY ❑ SEPT- ❑ LOC PRODUCTS-COMPIOP AGG $ 2,000,000.00 ❑ OTHER $ AUTOMOBILE LIABILITY FO a cider SINGLE LIMIT $ ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ ALLOOWNED ❑ SCHEDULED BODILY INJURY(Per accident) $ F-1 HIRED AUTOS ❑ NONO-O,SAUTbN7dID ePROPERaccid t?AR?AGE $ ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ 3 ❑ EXCESS LIAS ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑PER E]OTH- AND EMPLOYERS'LIABILITY Y/N E— ANY PROPRIETORIPARTNER/EXECUTI EL.EACH ACCIDENT $ OFFICERWEMBER EXCLUDED? N/A (Mandatory In NH) EL.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is r"Wred) LIC#CGC1524148 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 2ND AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserVed. ACORD 25(2014101)OF The ACORD name and logo are registered marks of ACORD 8/4/2018 Report Viewer 5 1 ? looaia °F JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA 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: 4/8/2016 EXPIRATION DATE: 4/8/2018 PERSON: MONROY ARMANDO FEIN: 473562291 BUSINESS NAME AND ADDRESS: AMF BUILD AND REHAB LLC 2235 QUAIL ROOST DR WESTON FL 33327 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR Pursuant to Chapter 440.05(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...appy only wit n 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 cerfificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 https://apps8.fldfs.com/crreportviewer/reportViewer.aspx?data=kdvpginc9D7Q3gH6TER6ePl KMZ%2fSz5bXKYfBxkrekeESoPVy1 v4NPOPN42XeirDR... 1/2 8/4/2016 Report Viewer 1HP aLS h r e JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA 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: 4/8/2016 EXPIRATION DATE: 4/8/2018 PERSON: BETANCOR ARIEL F FEIN: 473562291 BUSINESS NAME AND ADDRESS: AMF BUILD AND REHAB LLC 5530 NW 113 CT DORAL FL 33178 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR Pursuant to Cihapue 440.05(14).F.S.,an offlwr of a cmparatan who°leas exemption from this c hapta by fling a cortificale of alecdon under thla section may not recover benefits or compensation undar this chapter.Puraumd to Chapter 440.05(12),F.&,certOrates of election to be exempt..apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter"0.05(l 3),F.S..Notices of election to be exempt and cerdflcates of election to be exempt shall be subject to revooden if,at any time after the filing of the natira w the issuanco of the certficate, the person named on the notite or certificate no lonsh ger eets the requirements of this sedan for issuance of a certificate.The department shall revokes DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 I https://apps8.fldfs.com/crreportviewerfreportNAiewer.aspx?data=kdvpginc9D7Q3gH6TER6eP1 KMZ°/a2fSz5bXKYfBxkrekeESoPVyl v4N POPN42XeirDR... 112 ACO® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/03/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICAYE 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 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: Sandra Perez Access Insurance Group PHONE • (305)592-7700 FACEa) No): (305)593-8785 8726 N.W.26th Street,Suite#11 E-MAIL Sandra@accessins rou com ADDRESS: 9 p• INSURERS AFFORDING COVERAGE NAIC# Doral FL 33172 INSURER A: WESTERN WORLD INSURANCE COMPANY 13196 INSURED INSURER B AMF BUILD AND REHAB LLC INSURER C: 2500 NW 79 AVE INSURER D: SUITE 252 INSURER E: DORAL FL 33122 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 M D M D X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ MED EXP(Any one person) $ 5,000 A NPP8357707 04/16/2017 04/16/2018 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY7 JE� F1 LOC PRODUCTS-COMP/OP AG $ 2,000,000 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-OWNEDPROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION I PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ H yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) License#CGC 1524148 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 1 AUTHORIZED REPRESENTATIVE 0050 NE 2ND AVENUE Miami Shores FI 33138 , � - @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD gorge D. Mantilla R.A. State Florida License#.14320 5901 SW 63d Coun South Miami,FL 33143 Office:3OS-8I5-4649 E-mail:mantillaarchitectC2, nnail.cam May 31,2017 Miami.Shores Village Building Department 10050 NE 201 Avenue Miami Shores,Florida 33138 Permit Number:RC-3-17-892 Project Address: 1009 NE 104"Street Owner. Lenilan Investment LLC. Dear Building Official: At the above referenced project the existing concrete slab was opened to install new plumbing lines in the office bathroom.Said slab shall be repaired as follows: I-Compact fill at patched concrete. 2-Install#4 rebar at 12"center to center,each way,drilled 4"into existing slab and set them with epoxy- 3-Pour 3000 p.s.i.concrete into patch. Should you have any question or need additional information please do not hesitate to contact me. Sin rely, jo e D.Mantilla R.A. S Florida License#:143.2fl