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PL-16-1713 Claudio A. Jofre P.E. 28531 334 NE 102 Sheet Miami FL 33138 Phone:786-382-1695 December 28,2016 Attention: Building Official. P L City of Miami Shores Village—Florida. RE: Engineer Inspection Certification for Plumbing Work. Case Address: Shores Village Condo.Unit#9005 9005 NE 4 Ave.Rd.Miami Shores. FL.33138 Folio Number: 31-3206-046-0030 Owner: Christopher D.Curtiss To whom it may concern: This is a Plumbing inspection by a third party engineer, after an ilegal renovation has been completed, and the case was presented to the City for legalization. 1. The plumbing work is associated with the removal of a one compartment sink, replaced by a two compartment sink. Faucets are new. Sanitary lines have been reworked to match the two compartment sink configuration. Hot water and cold water remain the same. 2. We certify that the fixture units count has not increased. There are no futher changes in the plumbing throughout the house. The plumbing work is of high quality, very professional. We have opened the kitchen counters to inspect the work. This work was done around year 2002. We conclude that this work meets Florida Plumbing Code enforced at the time of this renovation. We hold harmless the Cty of Miami Shores Village for mechanical work inspected by our firm in the address above. Claudio Jofre P.E.#28531 0 LT l -� PL446A 713 Miami Shores Village PeE7rt '.� (iMbI Rmti� ' 10050 N.E.2nd Avenue NE * Addit, Alt +p [[/ r Miami Shores,FL 33138-0000 Phone: (305)795-2204 Permit Status:APPRoVER,=; fi Rm� Expiration. 08/23/2017 Project Address Parcel Number Applicant 9005 NE 4 Avenue Road 1132060460030 Miami Shores, FL Block Lot: CHRISTOPHER &JESSICA L Cl Owner Information Address Phone Cell CHRISTOPHER &JESSICA L CURTIS 9005 4 Avenue Road MIAMI FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 1,500.00 LASSETER PLUMBING CO INC (305)525-5075 (305)893-7180 _.....__ .. Total Sq Feet: 60 Type of Work:CHECK ALL ELECTRICAL WORK DONE ILLE Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Return: Final Classification:Residential Scanning:1 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Change of Contractor Fee Invoice# PL-6-16-60269 $0.00 06/20/2016 Check*3252 $50.00 $260.70 DBPR Fee $2.25 DCA Fee $2.25 02/24/2017 Credit Card $260.70 $0.00 Education Surcharge $0.40 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $1.60 Work without Permit Fee $150.00 Total: $310.70 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 AFF VIT: I certify that t foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction nd ing. Futhermor ,I horiz he above-named contractor to do the work stated. February 24,2017 Authorized Sin ture:Owner / Applicant / Contractor / Agent Date Building Department Copy February 24,2017 1 Miami Shores Village s . Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ,p, Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 Jtl FBC 20t(4 BUILDING Master Permit No. A C lo^ to(Aq PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP 9 A /�,�`z� CONTRACTOR DRAWINGS /V JOB ADDRESS: ` ®� E OL 11t _ City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE:: FFE: OWNER: Name tFee Simple Titleholder): �V1 S S Phone#: 3o 725'' 7� 7f_ Address: V 19 City: d�1 6 wl GJ��` epi State: r c� Zip: �-zj Tenant/Lessee Name: l enu , r. z_ Phone#: Email: ( Q CONTRACTOR:Company Name: LASS I IE� �` �� PhdrTe#: 305 Address:— n"' 865,� /k)-e 1 .30 aST City: g-M Y 1 ,4 f4 l State: �L . Zip: �531G Qualifier Name: `1��V`1� A � ��� Phone#: 3t96 '.5'ZJ�–5�©;7S State Certification or Registration#: (ev4?(2:7 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: nn City: State: Zip: Value of Work for this Permit:$ t VD Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New (( El Repair/Replace ❑ Demolition Description of Work: Kt f"GVt I� I.I��S ����\�Ci` �\l.Si go+" e_F_s u9l l y t 00 Ml� S 0 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) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. SignatureZ OAZ7- Signature .,,4,2 "4NER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The forego' in was acknowledged before me this I S day of JCC D c 120 17-4 by 15 day of t'L_ ,20 `: by �-t-t��F-e-r W�, n li o'1�personally known to 'T��°11'1 �.C�Se"��.who is personally known rto t me or who has produced 3 Z toq— -4.S Srj me or who has produced L2.j(D-C -43—CoZ--18 -® identification and who did take an oat identification identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: MAHARAI K GONZALEZ 4'•: MY COMMISSION#GG 044802 Sign: • V 'EXPIRES:November 2,2020 Sign: a„PP•�t,o one ,�� Prin2020 t: Print: ; �. .4'. =�' •9'z My COMMISSION#GG 044802 -e WOFAFMAW2 Seal: Seal: ';F;. o?. Bonded Thtu Notary ism- APPROVED BY Z Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ....... u2nul2u17 16:19 #463 P.002/002 I 'lKAtiami Shores village Miami Shores, Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 n f CHANGE OF CONTRACTOR / ARCHITECT Permmit N. R " `( " 101 Owner's Name(Fee Simple Tide Holder): Cv v%� CA-V�i t Phone#: Owner's Address: 3410 �r'ert:-e 51. City: W�q„W oto, F-1 State: frl— Zip Code: 330'2 i Job Address(Of where work is being done):_ 9005 N E .4-VI A-4 M City: Miami Shores State: Florida Zip Code: ?37273 %..ontractor s�-onipany iName: 6 ffi -iY1 rnone�F !n r✓" :/V vo . I Address: / .SCl/ 3 (� City: l!1?'j'! State: Zip Code: 3,;3Z24/ Qualifier's Name: Lic. Number. Architect/ Engineer of Record Name. Phone#: Address: City: State: Zip Code: Describe Work: �vvh�i+�+.� - otic�'� :[aj Qv� I hereby certify that the work has been abandoned and/or the contractor/architect is unahlp nr unwilling"�� i @ �i� rriltc�s� ir�Gtrel "�� �� 5-,A;"r- rial anA 4-hoSignature )e— Signature N Owner Agent ttor or Architect The foregoing instrument was aknowiedged before me The foregoin instruent was aknowledged before me this j day of � ,20/1,by this to day of FCA .200 by /2fft-or /Z D4,--4MEz Who is personally known to me or who has produced who is personally known me or who has produced �i'1Ovi✓/� �O as indendfication, as indentification. Nota lic Notary Public Sign: Sign: Seal: Seal: Notary Public State of Florida kffifl ira e a Plaids ': My Commando Bion GaP '� qtr comm�se�on eo owesz aw Expires 10/08/2020+� F 974538Ri0 Miami Shores Village -- T" P�.' Building Department JUN 2 o 2016 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 BY: INSPECTION LINE PHONE NUMBER:(305)762-4949 J FBC 2014 BUILDING Master Permit No. c " PERMIT APPLICATION Sub Permit No ❑BUILDING [:] ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING [:] MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:] CANCELLATION ❑ SHOP {t CONTRACTOR DRAWINGS JOB ADDRESS: �� '�1 1k ® — v tA4 # 00!: o City: Miami Shores County: Miami Dade zip: 3313(9 Folio/Parcel#: f 1 ll 1D� 0 9-� 0030 Is the Building Historically Designated:Yes NO V Occupancy Type: e46 Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): S 061456160 0a 'Ph ne#: VJ05'6.7oolT 7 Address: MIS N6-2 City: Il fix' % tt�.�' �'" zip: 3302�I Tenant/Lessee Name: _ Phone#: 4 j 'q2 -i glq- Email: (�1'\1IS��t' a'S !1m iul. �1M CONTRACTOR:Company Name: -The, , i1 1 74-50-1-001 S �( G Phone#: IIS Address: 0 s w a M s • i o-7 mb4di City: State: Zip: 331.14- Qualifier Name: SIA ROAM Ab Phone#: State Certification or Registration M Certificate of Comp�Hcy 12,GP�0o DESIGNER:Architect/Engineer: L t 1 ngariPhone#: '7 Address �"[17 rIlo` Il City: �J State: Zip: 333 Value of Work for this Permit �l�0 Square/Linear Footage of Work: 1 L. Type of Work: ❑ Addition ❑ Alteration ❑ New LM Repair/Replace ❑ Demolition Description of Work: o - t !� • y Specify colorof�blo�F`�hr;�tile. ,� 00--�, p Submittal Fee$ Permrt dee$ ! 1�S'� CCF$ �� y CSO/,CC$ .. ,- Scanning Fee$ Radon Fee$ c� � DBPR$ o� v 1 Notary$ rA 5 Technology Fee$ rc>o Training/Education Fee$ q Double Fee$ie Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ P�®' (Revised02/24/2014) Bonding Company's Name(if applicable) 4 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."IP YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NgTICE.OF COMMENCEMENT," Notice to Applicant: As a condition to the issuance of a building permit with an estimated valde exceeding$2500;the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure-will oe,d�)(vdfted to the person whose orpperty is subject to attachment. Also,a certified copy of the recorded notice of commencement Must be posted at the job site for°the.iiist iiispec615n.which occurs seven (7) days after the building permit.is`isied. In-the apsence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. o . Signature Signature O ER or AGENT , CO TRACTOR The foregoing instrument was acknowledged before me this The foregoing instr ent was-acknowledged before me this /Qom- Jay of . �J,(J/l�e�e • ;` .20 16 ' by �/ / aypof_ �llil9� ,20 /6 by GhQ�c S aAe,� Cdr//S who is personally knownto $e Idy, /1 O� /C Ve_Z who is personally known to mg or vv(io has produced ADL G L3a1-!Dy-75-S1/7'-O as , me or who has produced FEL ,(�36��70,�1-2Qa.�D as identification and_w�10 did take an oath. identification and who,dill take,,a�ath. • 4 ..A NOTARY NOT a ' Sign: e , Sign: ` Print: S2 I7 Print: Seal: .�0Nz. Seal: '9G vWle/UI' -oft Form .s NONVAJI.Y.Cm APPROVED BY � 1 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 4..,DRIVER LICENSE GL4sS�, ` '-,R362-720-71292-0 KC)O tGUEZ MACFtl3W 116"SW 2RD STAP7147A �IAIAMI,'FI !!3174-1464 4x1B:4&12.1971 SEX: .-ISSUED,MIS-412 :6.0 4-1 EN15iltiSF: -REPLACED:+1 kx—& s R�aMn M a .i�pa�im mhauuu�eae.en re euv see.�v teo.s��q e� TQB Construct Trades Q�ali{yin9 Board BUSINESS CERTIFICATE OF COMPETENCY 12P000257 THE BIG ONES PLUMBING INC ., D.B.A.: ROAR311UK RELDY Is certified under the provisions of Chapter 10 of Miami-Dade County Local Busi ness Tax Fbcei pt M iami-Dade County, State of Florida THIS IS NOT A BILL-DO NOT PAY LBT 7016827 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES THE BIG ONES PLUMBING INC RENEWAL SEPTEMBER 30, 2016 11570 SW 2 ST APT 107 7292667 SWEETWATER,FL 33174 Muss be displayed at place of business Pursuant to County Code Chapter 9A-Art.9 8 10 OWNER SEC TYPE OF BUSINESS PA YM ENT RECEIVED THE BIG ONES PLUMBING INC 196 PLUMBING BY TAX COLLECTOR CONTRACTOR 45.00 09/182015 Worker(s) 1 12POD0267 CREDITCARD-15-047181 This Local Business Tax Pacelpt only cairn payrrent of the local BusinessTax.The Rxeipt is not alicarse, pemit,oraceaq"cationdikeholder'squali^cations,todobusinew.Rider mid cmTlywithanygonermi dd arrongovmvnm airegnietorylawsandrequirarerdswhichWOylathebusiness. The F MPTNQaboornustbedisplayedanalleomrerdaivehdes-MiaM-DadeOxieSecBa-V6. M®� Fbrmoreinionretlon.-isitwww.nimddadeaMwmdlector '' CIOR®Y CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) kli...••'` 04/18/2016 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: H the certificate holder Is an ADDITIONAL INSURED,the policypes)must be endorsed. N 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 endorsements). PRODUCER ACT LISSETTE AVILEZ Continental P&c PHONE , (305)207-7889 F:No)- (305 207-0565 12955 SW 42 St Ste 5 I'M: LAVILEZ@CONTINENTALPAC.COM Miami,FL 33175 INSURER(S)AFFORDING COVERAGE NAIC S Phone (305)207-7889 Fax (305)207-0565 INSURER A: ARCH SPECIALTY INSURANCE INSURED INSURER 13: COMMERCE&INDUSTRY INS COM The Big Ones Plumbing,Corp I SURER C: 11570 Sw 2ND St #107 INSURER D: INSURER E: Miami FL 33174 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. IL TYPE OF INSURANCE ADDLSU$ POLICY NUMBER M EFF I PO DY EXP LIMITS TR COMMERCIAL GENERAL LIABILITYEACH OCCURRENCETO RENTED $ 1,000 ImOAO ElCLAIMS-MADE ® OCCUR PDRGE RISES Ea O=MWMJ $ 100,000.00 A ❑ N N AGL0032569-00 12124/2015 12/24/2016 MED EXP(Any one person $ 10,000.00 F1PERSONAL&ADV INJURY- $ 1,090,000.00 GEWL AGGREGATE LIMIT APPLES PER: GENERAL AGGREGATE $ 2,000,000.00 POLICY 1-1 JECT ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000.00 ❑ OTHER $ AUTOMOBILE LIABILITY MBINSINGLE LIMIT acdLrri ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ AASOWNED ❑ SCHEDULED BODILY INJURY(Per acddent) $ ❑ AUTOS HIREDAUTOS ❑ AAUTOS ED PP OPE dmDAMAGE $ ❑ UMBRELLA LAB ❑OCCUR EACH OCCURRENCE $ 1,000,000.00 B © EXCESS UAB ❑cLAims-mAm APP124569111 12/24/2015 19/24/2016 AGGREGATE $ 1,000,000.00 DED ❑ RETENTION$ $ WORKED COMPENSATION ❑PERE ❑OR- AND EMPLOYERS LIABILITY Y/N ANY PROPRIETORIPARTNERIEXECUTWEn E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedut%If more space Is requhed) PLUMBER CONTRACTOR LICENSE#RF11067556 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 AUTHORUM REPRESENTATIVE �l ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01)QF The ACORD rmme and logo are registered marks of ACORD AG`®D® CERTIFICATE OF LIABILITY INSURANCE FDATE(�IMIDD1YYYY) - l / 04/18/2016 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: B the certificate holder is an ADDITIONAL INSURED,the pollcy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the tens and conditions of the policy,certain policies may require an ondorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsemen s. PRODUCER AMERICAN INSURANCE BROKER CONTACT Auda E.Lacayo 3650 N.W.82ND.AVE. PHONE(Ale N-EW (305)715-9956 PAX (305)715-7316 PH 504 &MAIL temp@amedcaninsurancebmkers.com DORAL FL 33166 N AFFORDING COVERAGE NAIC 0 INSUPERA:AMTRUST NORTH AMERICA INSURED THE BIG ONES PLUMBING INC INSURER 8: 11570 SW 2 STREET INSURER APT 107D INSURER 0: Miami FL 33174 INSURER E: 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. WSR TYPE OF INSURANCE ADDL SUBR :Y NUMBER POLICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE O OCCUR DAMAGE TO RENTED MED EXP one n $ PERSONAL 8 ADV INJURY $ GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ERC F LOC PRODUCTS-COMPIOP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per acddod) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (per UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB HCLAIMS-MADE AGGREGATE $ A WORKERS COMPENSATION AWC1049713 7/21/2015 7/21/2016 PER _g7' AND EMPLOYERS'LIABILITY YYY III NNN ANY PROPRIETOWARTNEWEXECUTIVE MIA A EL EACH ACCIDENT $ 100,000 OFFICERIMEMSER EXCLUDED? 500,()00(Martdatory In NH) E.L.DISEASE-EA EMPLOYE $ "r k t es,desaiba under 100,000 E.L.DISEASE-POLICY LIMIT $ PLSUMBP NG�N�BTIORNERS�NS I VEHICLES(ACORD 101,Aciftonal Remarks Schadul%may be attaolmd N more space is requireM LICENSE#RF11067556 CERTIFICATE HOLDER CANCELLATION Al 010078 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Miami Shores Village BLDG Dept ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami Shores, FL 33138- AUTHORIZED REPRESENTATIVE ©1988-2014 A60RD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD