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RC-16-1125 Miami Shores VillageP81r ypL' Residef> al;�rt tfll�C l 10050 N.E.2nd Avenue NW +, INOrk. Alteretlow, Miami Shores,FL 33138-0000 LZ Phone: (305)795 2204 Ferrnit status:, P PRt 1tEb Date."I 2t2/20 6 Expiration: 06/20/2017 Project Address Parcel Number Applicant 9555 NW 2 Avenue 1131010240150 859 Willow Grove Associates LL Miami Shores, FL 33150- Block: Lot: Owner Information Address Phone Cell 859 Willow Grove Associates LLC 9555 NW 2 Avenue Miami Shores FL 33150- 859 Willow Grove Street Hackettstown NJ 07840- Contractor(s) Phone Cell Phone Valuation: $ 500.00 CAMO CONSULTING LLC (786)253-9551 .. .......... ....._ _. Total Sq Feet: 2100 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Window Door Attachment Date Denied: Framing Type of Construction:REPLACE TILE THRU OUT ENTIRE Occupancy:Single Family Insulation Stories: Exterior: Drywall Screw Front Setback: Rear Setback: Final PE Certification Left Setback: Right Setback: Window and Door Buck Bedrooms: Bathrooms: Fill Cells Columns Plans Submitted:Yes Certificate Status: Review Building Certificate Date: Additional Info: Review Building Review Building Bond Return: Classification:Residential Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Planning CCF $0.60 Review Electrical DBPR Fee $2.00 Invoice# RC-4-16-59546 Review Plumbing DCA Fee $2.00 12/22/2016 Check#:345 $64.60 $50.00 Review Structural Education Surcharge $0.20 04/27/2016 Credit Card $50.00 $0.00 Review Mechanical Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $114.60 In considerationf he issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining theret in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this p i I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELE R AL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. I OWNERS AFFI )A I I certify th egoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zo ' rmore,I rize the above-named contractor to do the work stated. December 22, 2016 Authorize nature:Owner / Applicant / Contractor / Agent Date Building Department Copy December 22,2016 1 �\NMiami Shores Village ,- f ,-CF—TV�, r ��© Building Department i DEC 13 2010 Go� 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 0 Tel:(305)795-2204 Fax:(305)756-8972 "�rT INSPECTION LINE PHONE NUMBER:(305)762-4949 A L - FBC 20 q" BUILDING Master Permit No. �'c 2-5 PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION E]RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP I�I CONTRACTOR DRAWINGS JOB ADDRESS: t V 4�\Y/ City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Typ V Flood Zone: BFE: F-Z FE: OWNER:Name(F a Simple Titleholder): —q� kk Phone#: C. Address: City: —State: Zip: Tenant/Lessee Name: Phone#: Email: ® i CONTRACTOR:Company Name: Phone#: ��t Address: Iz City: S1 ate: Zip: Qualifier Name: Phone#: e ` State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ X Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ AAlterati n ❑ Ne QUI Repair/Replace ❑ Demolition Description of Work: �O f K0V-t C 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) f 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 vdVue exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien/6w brochure will be delivered to the person whose property is subje chment. Also,a certified copy of the recorded notice of co ncement must be posted at the job site for the first inspect* which o curs seven (7) days after the building permit is issued. n he absence of such posted notice, the inspection will not a approved nd a reinspection fee will be charged. Signature Signature OWNER or AGENT NTRACTOR The for going instru r as tknowledged befo me this The foregoing instru as nowledged befo me this day of !\ ZO by day of �� 20 by who is personally known to S who is personally known to me or who has pr as me or who has o as identifica ' n and ho did take oath. identificatio a who di ake oa NOTA PUBLIC: NOTARY P LIC: Sign: Sign: Print: Print: `' "''' CLEMENTE F VERA Seal: , ro;'"'�eLSeal: ;,:.......cis CLEMENTE F VERA �3 • 'i '� MY COMMISSION#FF128310 MY COMMISSION#FF1283lo a;` "s� EXPIRES °e?o►E EXPIRES June 2, 2018 orn •` June 2, 2018 "Cam' APPROVED BY v`" Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA - DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 SERRANO, CARLOS MARIANO CAMO CONSULTING LLC 33SW2AVE PH2 MIAMI FL 33130 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 F STATE OF FLORIDA ' from architects to yacht brokers,from boxers to barbeque j DEPARTM ' FSUSINESS AND restaurants,and they keep Florida's economy strong. p% PESSkC ROFREGULATION T� Eve da we work to improve the waywe do business in order `' CGG061689 SL w ` 0/18/2016 t to serve you better. For information aout our services,please log onto www.myfloridalicense.com. There you can find more ! CERTIFIED G � information about our divisions and the regulations that impact j' SERRANO C 1941Idles tAtO;: p you,subscribe to department newsletters and learn more about 4 CAMO CONSILTiNGr` 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, as.ci=ttTiFtEo under f11E-p�ouisi'ons of c, �e� and congratulations on your new license! E waii dW.:AU631 26'6--- 0610180000793 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD w CGC061689 k r ' The GENERAL CONTRACTOR Named below IS CERTIFIED Urider the provisions of Chapter 489 FS., °amuw. Expiration.date: AUG 31, 2018 ERRANO CARLOS MAR ■� SI -'CAMO:CONSULTING LI�� �_ =33 SW -:MIAMI 1 TM _ h ISSUED: 10/18/2016 DISPLAYAS REQUIRED BY LAW SEQ# L1610180000793 016147 Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOT A BILL—DO NOT PAY LBT 7194590 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES CAMO CONSULTING LLC RENEWAL SEPTEMBER 30, 2017 33 SW 2 AVE#PH2 7476693 Must be displayed at place of business MIAMI FL 33130 Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED CAMO CONSULTING LLC 196 GENERAL BUILDING CONTRACTOR BY TAX COLLECTOR C/O CARLOS SERRANO QUALIFIER CGC061689 $45.00 07/18/2016 Worker(s) I CHECK21-16-090981 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 www miamidade aov/toxcollector A`Ol2UDATE(MM/DD/YYYY) ® CERTIFICATE OF LIABILITY INSURANCE 12112/2016 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 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). PROWCER CONTACT NAME: Lourdes Martinez Martinez S.Ins.Ag DBA Great FI PHONE ; (561)640-9890 ac No): (561)640-9803 937 Belvedere Road ADMAIL DRESS: Lourdes.Martinez@greatflorida.com INSURER(S)AFFORDING COVERAGE NAIC# West Palm Beach FL 33405 INSURERA: ATLANTIC SPECIALTY INSURED INSURER B: Camo Consulting LLC INSURER C: 33 SW 2nd Avenue INSURER D: PH2 INSURER E: Miami FL 33130 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 INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTEI5__ CLAIMS-MADE FRI OCCUR PREMISES Ea occurrence) $ 100,000.00 MED EXP(Any one person) $ 5,000.00 A Y L030004988 07/01/2016 07/01/2017 PERSONAL&ADV INJURY $ 1,000,000.00 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 X POLICY❑JEa LOC PRODUCTS-COMP/OPAGG $ 1,000,000.00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ ALTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS ParacadeM UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (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 I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Lic#CGC061689 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 Bldg Dept ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores FL 33138' ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD DATE(MM/DD/YYYY) A�REP CERTIFICATE OF LIABILITY INSURANCE 12/9/2016 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 policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED,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 SUNZ insurance Solutions, LLC. ID: (TLR) I- T Workers'Comp Department c/o TLR of Bonita, Inc PHONE 700 Central Ave, Suite 500 727.520-7676 x 3 N No): 727-525-3862 St. Petersburg, FL 33701 ADDRESS: certs encorehr.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: SUNZ Insurance Company 34762 INSURED INSURER B: TLR of Bonita, Inc EnterpriseH R INSURER c 700 Central Avenue Suite 500 INSURER D: St. Petersburg FL 33701 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 33158350 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. TR TYPE OF INSURANCE ADDL SUBR POLICY POLICY NUMBER MM/DD EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER., GENERAL AGGREGATE $ POLICY❑JPE Q E-1 LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LU16tLITY COMBINED SINGLE LIMIT $ E, accdent ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per acddenl UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION WCPE0000000112 6/1/2016 6/1/2017 7/ STATUTE ERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE � N/A E.L.EACH ACCIDENT $ 1,000,000.00 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more apace is required) Coverage Provided for all leased employees but not subcontractors of Camo Consulting LLC Client Effective:11/17/2016 CERTIFICATE HOLDER CANCELLATION 1845 Miami Shares Village Bldg. Dept. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami h r 2nd Ave g P THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores FL 33138 AUTHORIZED REPRESENTATIVE Glen J Distefano ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 33158350 1 Naster Certificate I Jillian Nally 12/9/2016 1:42:38 PM (CDT) I Page 1 of 1 KBC BUILDING INSPECTIONS, INC. ENGINEERING & INSPECTION SERVICES NOV 2 8 2 16 11Y"o November 23,2016 G ( I ZS Miami Shores Village Building Department 10050 NE 2 Ave Miami Shores, FL 33138 Subject: 9555 NW 2 Ave Miami Shores, FL Folio#11-3101-024-0150 An inspection was performed at 9555 NW 2 Ave Miami Shores, FL in order to determine if the wooden floor structure was sufficient to support a cement-set porcelain tile floor throughout the house. Our findings are as follows: Joist type: Florida Pine, fair condition. Joist size: 2' X 10" Span: 18" Joist length: 14' Deflection: L/548 Note that calculations were done per room,joist dimensions are nearly identical. Cement-set porcelain tile requires a minimum deflection of L/360,the floor structure exceeds the minimum requirement. The floor is suitable for installation of cement-set porcelain tile. There are no further recommendations at this time. Should you have any questions concerning this report,please feel to contact us at 305 662 5073. Sincerely, KBCB g Inspections, Inc. t7 a;;;, OV 2 e 7016 Gu's7a6undo Re e B ' P President Proj ct er •• +•• . •• PE-40 9 . .. . . . . ... . Attachments ••• •• ••s •+• i i ••• woo 6.0 ••• • • r • ••• s • ••• • • • ••+ • • 8724 SuNsET DRIVE.,#427,MIAMI,FL.33173/TELEPHONE:305 662 5073/KEYBuILDING@a GMAIL.COM • '' 9555 N.W. 2ND AVE. MIAMI SHORES, FL 33150 Description of work: Demolition of floors. Replace with tile throughout the entire house. 71w 0-1 erF 7 APR 2 7ss GARAGE FLORIDA ROOM ROOM 17X12 19X25 closet bathroom 6 KITCHEN x2 9x9 13X11 DINNING ROOM 16X10 closet closet 6x2 5x9 LIVING ROOM BATHROOM CLOSET 17X15 ROOM 6X8 6X2 15X14 ROOM tnn 13X10 vj;�'MP IS!-or in!")g� 1 a Porcelain Tile " • • .• • • •••• see , oto • •••••' ' o 1/4"layer min.of Porcelain Tile 50 lb. fortified Thinset Mortar by Custom �" - - •• •. ,0090 �'••: ¢ -veto vote •seer -.4�;,,�r� ���` _ '�_. � _ � •coos• • see • • v - •a' ' • • t•••• Next Gen 1/2 in.x 4 ft.x 8 ft. s. - •••••. •••':' Cement Board by DUROCK taped • : •• ' joints mech;fastened @ 6"O.C. �r • • '••••• with screws #9 x 1-1/4 in. Phillips ,�.�^F £.,, '.,' ; �,• • ;••••; High Low Threaded by Rock-0n - •e e• r • 1/4"LAYER OF VersaBond Gray 50 Ib.—�" �' Fortified Thin-Set Mortar 1/8'CHAP BETWEEN PLYW00D SHEETS 23/32"x 4 x 8ft RTD Sheathing Syp., �\ "t \ ,0 oc• TONGUE&GROOVE.(EXISTING) 2 x 8 Floor Joist @ 16"O.C.(EXISTING) PORCELAIN TILE INSTALLATION PORCELAIN TILE INSTALLATION PROCEDURE AT PROPERTYADDRESS-9555 NW 2 AVE. MIAMI SHORES,FL 33150-1705 KBC BUILDING INSPECTIONS, INC® c� ENGINEERING & INSPECTION SERVICE 7KIOV 28 201 BY:---f _ November 23,2016c--t� Miami Shores Village Building Department 10050 NE 2 Ave Miami Shores,FL 33138 Subject: 9555 NW 2 Ave Miami Shores, FL Folio#11-3101-024-0150 An inspection was performed at 9555 NW 2 Ave Miami Shores, FL in order to determine if the wooden floor structure was sufficient to support a cement-set porcelain tile floor throughout the house. Our findings are as follows: Joist type: Florida Pine, fair condition. Joist size: 2' X 10" Span: 18" Joist length: 14' Deflection: L/548 Note that calculations were done per room,joist dimensions are nearly identical. Cement-set porcelain tile requires a minimum deflection of L/360, the floor structure exceeds the minimum requirement. The floor is suitable for installation of cement-set porcelain tile. There are no further recommendations at this time. Should you have any questions concerning this report,please feel to contact us at 305 662 5073. Sincerely, 141 7KBC4Bing:Inspections, Inc. N 2016 Gus do ReWeult P.E. Preside Preer •• ... •• PE-40869 . .. . . . . ... . Attachments 000 ••. •• • • • .• 0.: : 0 000 . .. . • . • •• .• • • • • • • • • • • • •• •• • • • •• •• ••• • • • ••• • • 8724 SuNsET DRivE.,#427,MiAmi,FL.33173/TFLEPxoNE:3o5 662 5073/KEYBuiLDING@a GmAiL.coM Miami Shores Village \6 `�` Building Department 1" g p �1 V 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 ASR 0 7 01 Tel:(305)795-2204 Fax:(305)756-8972 ITRY: INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 Int BUILDING Master Permit Nogg(O— PERMIT APPLICATION Sub Permit No. UILDING ❑ ELECTRIC ROOFING REVISION EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF CANCELLATION SHOP q CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: 33l Folio/Parcel#: � 3/o/. Dai- 61"5v Is the uilding Historically Designated:Yes NO L.� Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): < ) l� #: �`OJ�o�i—J6�U Address: LI/,f efVV b City: State: Zip:90e- Email: Tenant/Lessee Name: Phone#: ✓©o - ' 'a �Jm Email: �J ��eE.J�l �� J����'u-t C �(� CONTRACTOR:Company Name: ��- �� �Frhone#: Address: ��y0 �E'.3t ley .- City: �i a-�-� State: z,sz Zip: 3T 3 oZ v Qualifier Name: �CG�k ���J�'�-�� Phone#: State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 0191&i Square/Linear Footage of Work: n?i Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace Demolition Description of Work: oyl�' —lel /2-e-Ll Specify color of color thru tile: Submittal Fee$-so 63' D.Permit Fee$ 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspectinn which occurs seven (7) days after he b,jilding permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection ee will b charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrume t as acknowledgerbe a methis day of til�eAa. 20 IK , by day of ) fU --, by who is personally known to -,V,-IIw is personally known to /� me or who has producedJca--'PA PaA &kzw-gc� as me or who has prpdu `� 7—)- Y identification and who did take an oath. identificatjim and w oath. NOTARY PUBLIC: NO Y PURL ign: Sign: C Print: Print: Seal: Seal: MiChaB) Blandon �Y Pr' TOBIAS J.PAUU Comm�sian # FF9 _' �• 40895 ?., +: MY COMMISSION FF 07051 December 3,2019 ; ,•x: EXPIRES:December 2,2017 `SAP fop. Bonded Thru Nota Pu61ic Underwriters rie rte Ac ek ek yeiek ek rk ok eke `iTek eke�(�If ��°Ie ek ek ek ek ek ek ek ek rk ek rk Ae ek ek Me Me ek Me ete ekfe ek Me rk>)e$ ek�k rk>(e>te>fe$ete>fe APPROVED BY -'`� Plans Examiner Zoning Structural RevieClerk (Revised02/24/2014) •' 559 Willow Grove Associates, LLC 859 Willow Grove Street Hackettstown, NJ 07840 Tel 908-852-5868 Apri126,2016 Miami Shores Village Hall 10050 Northeast 2"d Avenue Miami Shores,FL 33138 Re: 9555 NW 2"d Avenue, Miami Shores, FL 33150 To whom it may concern: Ms. Brittani Feinberg is an authorized agent of the company and has power of attorney to do all things necessary to secure permits for improvements to the address above. John Li . Mana6rrg Member State of Vw County Sworn to(affirmed)and subscribed before me this2day of 2016 by John Lizza, Managing Member. Signature Personally know �Y/-- Or Produced identification Type of Identification Produced 1./-(A 11! Print,Type or Stamp Name of Notary. LISA M. FEUCET17 NOTARY PUBLIC OF NEW JERSEY My Commisslon Expires 7/1/2020 559 Willow Grove Associates, LGC 859 Willow Grove Street Hackettstown, NJ 07840 Tel 908-852-5868 April 26,2016 Miami Shores Village Hall 10050 Northeast 2nd Avenue Miami Shores, FL 33138 Re: 9555 NW 2nd Avenue, Miami Shores, FL 33150 To whom it may concern: Ms. Brittani Feinberg is an authorized agent of the company and has power of attorney to do all things necessary to secure permits for improvements to the address above. John L' M i g Member State of .4/z.uJ County of Sworn to(affirmed)and subscribed before me this26 day of 2016 by John Lizza, Managing Member. 1 Signature Personally know Or Produced Identification Type of Identification Produced _ Print,Type or Stamp Name of Notary LISA M. FEUCETTI NOTARY PUBLIC OF NEW JERSEY My Commission Expires 7/1/2020 r ' CFN:20160109836 BOOK 29971 PAGE 4166 DATE:0212312016 08:49:48 AM DEED DOC 1,830.00 This ImsRamwt prepared br. I HARVEY RUVIN,CLERK OF COURT,MIA-DADE CTY Name. Jam A.Rrpoae,Esq. I Address~ RAPOSO WALLED.P.L I 216 N.NL4W AYE. I Mani.Florida 73128 1 Parcel Identification Ne-1 13101.824 O I SO WARRANTY DEED THIS WARRANTY DEED phis-&ED Is me&as of the 7 of jm . Q1yf•1 6 6om PROVIDENCIA PEREZ. widowed woman, with an addnas of f/, TX ��oIIZ (' etor� 0854 LLO GROLtE ASSOCIATES.1 a Navt L Liability Compmal: with an dress WCTNESSETH• THAT Grantor,for and in consideration of Ore smm of Ten and No/100 Dollars(SIO-001 and od w good and vain"cotsidaraim the receipt of which is hereby adaowkdged,by these Presents does grant,bm in.and sell,unto Gram,and Gsmitec's saooessms and assigns,for-or.the followkg dascabed land situe to Miami-Dade Canty.Florida regally described as follows: South Ya of Lot 4 and all of Lots S and 6 and Norris Ver of Lot 7 is Block 4,of Boumar Park,aecord(ag to the plat thoreo4 as recorded In Plat Book 17,Pace 11,of the Public Records of Miami-Dario County,Florida(the' "), Subject to resuictian, re ions and easements of record, if any and twms subsequent to 2016,Out yet due and Payable. Grantor does hereby warted the tide to mid PtoPerty mrd w01 defend the same agamg the IavN claim of all persons whomsoewzr. IN WITNESS WHEREOF.Grantor has eaecmed this Waranty Deed 00 the day and yete firer above vvriuerr. WlTNESS FS: C—pr --�e Pma PROVIDENCIA PEREZ Print Na e:_ STATE OFfI�RIBtr COUNTY OF M64Mi-9A��� The foregoing insmusm was admowkdgad before am thr y of jammy.2016,by PRGV0Wj,PERE� posonally'fknown ito me a who have produced f .RISD M PamV t Q No/my PuhOr; My caP� STATE UP rum a N Carate,gra t ammummmye J4APR 15 '99 02:1 $06 � Cbl' FILING Stemlleb d DoAd P,A003/003 MTMCATSCWFORMTM FILED of0 14 wvmmowmwvz TSS 13 TO C RIM TBAT lbws is bamlW foewed a L vftd UaW ty iutdet'sad by virtue of tt Mew Jamey UmftW Imo►A`T. WA& 42034 id MW ($e "A ,sa fol�vvs: i. . �a�of the Li:�d LU�tuy r� ass�Yfuow Qii+c�ve �; L= z. The a&huG�** LkbWCcmpmWxh"Tcffidcm4cMwand of the I knitad LiWUW Caggy's bOd regfstaed agnt at dm area a ce as follows: • St�lieb&T�owd.L��..C. . Subv4OO Hack $►NercvJeta�e7641 3: The l AmitedLidOW CamponYbotwo or asoge nwnft . 4. The Y hnbed.Lidx ty Coate► 4M have pet PWA the Limited Lidgb r Cooa=r is dualvod In acconk s wl&tM provoico of 1% op agre emmatt oAcL 3. The mdadgmd b =&mind to ft.tb cWXtMon bdWdf of the Lbnlud- Liebli TN WI1- ZS8 W ZRZOF, tmda-dp lhm=muted dds ca mome of Fwmld=l as of APW Sm 1999. AMENDED AND RESTATED OPERATING AGREEMENT 859 WII.LOW GROVE ASSOCIATES,LLC dated June 24,2014 among Carl J.Lizza John F.Lizza Managing Members and Carl J.Lizza John F.Lizza Members OPERATING AGREEMENT OF 859 Willow Grove Associates,LLC Table of Contents Article 1. Formation Article 2.Name Article 3. Purposes Article 4. Place of Business Article 5. Term Article 6. Capital Contributions Article 7. Loans and Advances by Members Article 8.Allocations and Distributions Article 9. Books,Records and Tax Returns Article 10. Bank Accounts Article 11. Management of the Limited Liability Company Article 12. Meetings of Members Article 13. Assignment of Interests Article 14.Right of First Refusal Article 15.Admission of New Members Article 16. Purchase of a Deceased Member's Interest Article 17. Purchase Price Article 18.Dissolution and Liquidation Article 19.Representations of Members Article 20. Certificates Evidencing Membership Article 21.Notices Article 22. Arbitration Article 23.Amendments Article 24.Miscellaneous 2 THIS AGREEMENT, made June 24, 2014, among Carl J. Lizza, having an address at 7 Beacon Hill Drive, Chester, N.J. 07930 and John F. Lizza, having an address at 17 Adams Court, Oyster Bay, NY 11771 (hereinafter, collectively, "Managing Member" or "Managing Members'), John F. Lizza, having an address at 18 Adams Court, Oyster Bay, NY 11771 and Carl J. Lizza, having an address at 7 Beacon Hill Drive, Chester, N.J. 07930 (collectively hereinafter referred to as"Members"). WITNESSETH: WHEREAS,the parties hereto desire to amend,modify and restate the Operating Agreement of 859 Willow Grove Associates, LLC dated as of April 1999 (the "Qperating Agreement")as set forth herein; WHEREAS, Carl Lizza, Jr. is no longer a member of the Company due to his death as of July 2011,the assignment of his interest pursuant to the Act(as defined below)to the Estate of Carl Lizza Jr (the "Estate") as a Non-Member Assignee and the redemption of the interest of the Estate in 859 Willow Grove Associates, LLC pursuant to a Membership Redemption Agreement dated April 17,2013 WHEREAS, the Non-Member Assignee has not become a member of the Company as prescribed by the Operating Agreement or the Act(as defined below); NOW, THEREFORE, in consideration of the mutual covenants set forth herein and other valuable consideration, the receipt and sufficiency of which hereby are acknowledged, the Managing Member and Members agree as follows: 1.Formation 1.1 Formation. The parties hereby confirm that they have formed a limited liability company (the "Limited Liability Company') pursuant to the provisions of the New Jersey Limited Liability Company Act (the "Act"), for the purposes and the period and upon the terms and conditions hereinafter set forth. The parries have caused to be filed the Certificate of Formation, in the office of the Secretary of State of New Jersey, of the Limited Liability Company, and shall execute, acknowledge, swear to and file any other documents required under applicable law. A Certificate of Formation in the form annexed hereto as Exhibit A. 2.Name 2.1 Name. The name of the Limited Liability Company shall be 859 Willow Grove Associates, LLC, and all business of the Limited Liability Company shall be conducted under said name, or such other name as the Members from time to time may determine. 3 3.Purposes 3.1 rMose. The purposes of the Limited Liability Company are to engage in any lawful act or activity for which limited liability companies may be formed under the Act; to engage in any and all activities necessary or incidental thereto; to incur indebtedness, secured and unsecured; to enter into and perform contracts and agreements of any kind necessary to, in connection with or incidental to the business of the Limited Liability Company; and to carry on any other activities necessary to, in connection with or incidental to the foregoing, as the Managing Member in his discretion may deem desirable. 4.Place of Business 4.1 Business Address. The principal place of business of the Limited Liability Company shall be at 859 Willow Grove Street,Hackettstown New Jersey 07840 in the County of Warren, or at such other or additional places of business within or outside of the State of New Jersey as the Managing Member from time to time may designate. The Managing Member shall notify the other Members of any change of the principal place of business. 4.2 Registered Agent. The Limited Liability Company hereby designates Robert S. Dowd, Jr. Esquire as Registered Agent of the Limited Liability Company for the service of process,whose post office address is Law Office of Robert S.Dowd,Jr., Three University Plaza., Suite 207, Hackensack,NJ 07601. The Registered Agent may be changed from time to time by the Managing Member by filing the prescribed forms with the appropriate governmental authorities. 5. Term 5.1 Term. The term of the Limited Liability Company shall commence on the filing of the Articles of Organization of the Limited Liability Company, and shall continue until the occurrence of an event hereinafter set forth which causes the termination of the Limited Liability Company. 6. Capital Contributions 6.1 Initial Contributions. The Managing Member shall not be required to contribute to the capital of the Limited Liability Company either on formation of the Limited Liability Company or at any time thereafter. Each of the Members, upon the execution of the Operating Agreement, contributed to the capital of the Limited Liability Company the amount set forth opposite his name below: Carl J. Lizza-- $20.00 John F. Lizza-- $20.00 4 f 24.9 Binding Agreement. Subject to the restrictions on Transfers set forth in this Agreement,this Agreement shall inure to the benefit of and be binding on the Members and their respective heirs, executors, legal representatives, successors and assigns. None of the provisions of this Agreement is intended to be, nor shall the provisions be construed to be, for the benefit of any third party. Whenever, in this Agreement, a reference to any party or Member is made, such reference shall be deemed to include a reference to the permitted heirs, executors, legal representatives, successors and assigns of such party or Member. IN WITNESS WHEREOF, the arties hereto have executed this Agreement on the date first above written. In the presence of: Carl LTENK --7�tit�s In the presence of John i 25 f a � .. 4 r a € c � �. Ofy -T m °a5;4 F ,,,,,Ai NI & FLOORING INC Al .B. . .. Ct . 11tiat p i-1 �tttY U1 G C7L-c-)o r2-j rJ---) 4- 1,ci.A N—r," Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOT ABILL—DO NOT PAY LBTJ 7181888 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES FAJARDO PAINT&FLOORING RENEWAL SEPTEMBER 30, 2016 INC 7462396 3640 W 14 AVE Must be displayed at place of business HIALEAH, FL 33012 Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED FAJARDO PAINT&FLOORING INC 196 SPECIALTY BUILDING BY TAX COLLECTOR C/O FELIX A DELGADO,PRESIDENT CONTRACTOR 45.00 08/28/2015 Worker(s) 1 11BS00254 CHECK21-15-118080 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.Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO.above must be displayed on all commercial vehicles—Nliiami—Dade Code Sec 8a-276. MIM For more information,visit www.miamidade govltexcellector Municipal Contractor's Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL-DO NOT PAY CC NO: 11 BS00254 "I M C BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES FAJARDO PAINT&FLOORING INC 3640 W 14 AVE 7483142 SEPTEMBER 300 2016 HIALEAH,FL 33012 Pursuant to County Code Sec 10-24 OWNER TYPE OF BUSINESS PAYMENT RECEIVED FAJARDO PAINT&FLOORING INC SPECIALTY BUILDING CONTRACTOR BY TAX COLLECTOR C/O FELIX A DELGADO,PRESIDENT 31.25 04/21/2016 0229-16-006181 Restricted to City of Miami Shores MIAMI amFor more information,visit www miamidade govRaxcollector n ' Report Viewer Page 1 of 1 f Q 1 F1 W--/. JEFFATwATER •�`� �"�. CroEF FWANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKEPO COMPENSATION "CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION TMs certifies that the individual listed below has elected to be exempt from Florida Workers'Compensatlon law. EFFECTIVE DATE: 7/30!2015 EXPIRATION DATE 7/29/2017 PERSON: DELGADO FELIX A FEIN: 451905201 BUSINESS NAME AND ADDRESS: FAJARDO PAINT a FLOORING,INC. 1205 WEST 25TH PLACE#2 HALEAH FL 33010 SCOPES OF BUSINESS OR TRADE: DOOR AND WINDOW CERAMIC TILE,INDOOR PAINTING NOC&SHOP INSTALLATION STONE MA OPERATIONS PwUmMwclmpfa,aaoosp<? vmcnao+� Fs°�`ce �aoemrt�mae:.a�,o�arms Pq,mrr eW440a scope ofam businessa7dde fttad as bm deletlimbhe arpl,Pmwmdm P— W Mrmamd alamonMa m�o��dmate aReO Da-Yfldbf�DG0-1E et A7l6WaCe a. M''-BmfM—tm e6 bageameefs am mgoUewnh daftsemnwisum Ce ofa Cada@ Thedepamue oaere k s DFB-F247WC-252 CERTIFICATE OF ELECTION TO BE OU34PT REYISED 6&13 • QUEBTION3?(650y613-1869 file.///C:/Users/RUTHL/AnnT)ata/T n,-Ifr,-,,,"/unrT^MTen1i7 ' R�s shores Boom Miami V Building Department OR1UA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 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-time 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 has 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 ect.In ese circumstances,Miami Shores Village does not require verification of workers' compensation insurance covera fro the c n ctor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU AC WL GET T YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: weer State of Florida County of Miami-Dade >+1 The foregoing was acknowledge before me this day of 104?u- ,20_/Z. By�jllr�s� •✓ who is personally known to me or has produced p,o as identification. •leo-d&l- S-q- e e-/- D Notary: SEAL: `. Mid fta BNdtId00 f'"y COMM ion t Ff940W _"• "= Fxpirn iemler 3,2019 BondedOlru Aaron FAJARDO PAINT & FLOORING INC 3640 West 14 Ave Miami, FI. 33012 (786)229-8137 March 9, 2016 State of Florida County of Dade Before me this day personally appeared FELIX DELGADO who being duly sworn, deposes and says: That he will be the only person working on the project located at: 955 NW 2nd Ave, Miami Shores, FI. 33150. Sworn to (or affirmed) and subscribed before me this 9 day of March, 2016 by FELIX DELGADO FELIX DELGADO DL/D423-241-72-136-0 'r4`•'nY` �: RUTH LEDESMA =' * MY COMMISSION M FF 172019 �EdX�PIRES:January 18,2019 ru Notary Public Underwriters Notary Public ` ' A" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) ---1 04/26/16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND XCONFIERS 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 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). CONTACT - -- -- - - PRODUCER NAME_ ODALYS ALPIZAR Estrella Insurance#106 , PHONE 305 FAX /C (A ,No,Ext): (305)825-2613 2613-------------((AIC,No)_-(305825-0625-- )- --0625 ffI 1140 West 68th St.Ste. B E-MAILADDRESS-:- Manager106@estreliainsurance.com Hialeah, FL 33012 INSURER(S)AFFORDING COVERAGE I _ NAIC# Phone (305)825-2613 Fax (305)825-0625INSURER A ASCENDANT INSURANCE COMP INSURED INSURER B: NIA FAJARDO PAINT&FLOORING INC INSURER C: N/A 3640 W 14 AVE INSURER D: N/A HIALEAH,FL 33012- (786)229-8137 INSURER E: N/A-- -------------- -- - - INSURER F: N/A 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 ADD SUBR EACH OCCURRENCE LTRL TYPE OF INSURANCE INSR WVD POLICY NUMBERS POLICY EFF POLICY EXP GENERAL LIABILITY (MM/DD/YYYY) (MM/DDlYYYY)_ __ _ LIMIT $ 300,000.00 Q COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 1 OO,000.00 -PREMISES(Ea occurrence) -j_$ _ ❑ ❑ CLAIMS-MADE ❑ OCCUR GL-37204-3 MED EXP(Any one person) II $ 5,000.00 A 05/04/2016 05/04/2017 —-- — ❑ PERSONAL&ADV INJURY $ 300,000.00 ❑ __-__-__ ___ GENERAL AGGREGATE $ 300,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG' $ 300,000.00 ❑ POLICY ❑ PRO-- ❑ LOC -- _ -- $JECT -- AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaccidenl)- ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED id P INJURY er accent B ❑ AUTOS ❑ AUTOS BODILY ( ) $ ❑ HIRED AUTOS ❑ AUTO QED Perr ac idenDAMAGE $ ❑ ❑ $ F1UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ C ❑ EXCESS LIAB —EI-CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ - - ---- ----- --- - --- WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ❑_TORY LIMITS ❑ER- ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ D OFFICERIMEMBER EXCLUDED? N/A ----- - - --- (Mandatory in NH) [� E.L.DISEASE-EA EMPLOYEE$ If yes,describe under -- ----- DESCRIPTION OF OPERATIONS below - - E.L.DISEASE-POLICY E DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) PAINTING AND FLOORING 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 ODALYS ALPIZAR ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)QF The ACORD name and logo are registered marks of ACORD