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PL-16-370Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 V-, c tS-(O'77 Inspection Number: INSP-273942 Permit Number: PL -2-16-370 Scheduled Inspection Date: January 03, 2017 Inspector: Hernandez, Rafael Owner: ALLUARD, PHILIPPE Job Address: 1050 NE 105 Street Miami Shores, FL 33138-2106 Project: <NONE> Contractor: L&J CONSTRUCTION LLC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1122320280060 Phone: (786)255-1980 Building Department Comments INSTALL 1 TOILET 1 SHOWER 1 SINK REMODEL BATHROOM CONNECT TO EXISTING WATER SEWER SYSTEM Infractio Passed Comments INSPECTOR COMMENTS False Passed wi Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid Inspector Comments January 03, 2017 For Inspections please call: (305)762-4949 Page 18 of 20 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number. INSP-252592 Scheduled Inspection Date: April 07, 2016 Inspector. Hernandez, Rafael Owner. ALLUARD, PHILIPPE Job Address: 1050 NE 105 Street Miami Shores, FL 33138-2106 Project <NONE> Contractor. LBO CONSTRUCTION LLC Permit Number: PL -2-16-370 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1122320280060 Phone: (786)255-1980 Building Department Comments INSTALL 1 TOILET 1 SHOWER 1 SINK REMODEL BATHROOM CONNECT TO EXISTING WATER SEWER SYSTEM Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid Inspector Comments L-.-- 1 L—..—. —1----. --11. MI1!\o/AI1 ILII► BUILDING PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 CEIVT FEB 092016 BY: • Master Permit No. Sub Permit No.P,/ /6 - FBC 20 ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION 0RENEWAL (PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: IQc 0 Nib iar sr City: Miami Shores County: Miami Dade zip: 3 3 1 Folio/Parcel#: /, g2 fi 2 02 t 0 66c1 i1 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): L �(fl9/ %P ,11) (?, ILL 1/ Address: /40 co NE% /DSSt Phone#: JD IF,T • ) City: P19 /Ag / S#' //��f State: �� Tenant/LesP4iM€e ee Name: j/,4Email:QELL7-/./V57 CONTRACTOR: Company Name: 4._g il/ $' 17 c Address: f__ - 6.3SI fw s1^ City:4 4Pa , >0" State: , /4- • Zip: 336-33- Qualifier Name: 7---i.71 S��,/d//hi<do€2-- State Certification or Registration #: 0....11/4-4-- Certificate of Competency #: DESIGNER: Architect/Engineer: 4/WVV Jam ,* why A CMJ 760714 ZPhone#: 3 i r s 09g0 Address: OhiOSI -egz r City: O G4 tate: Zip: 313 Value of Work for this Permit: $ /4'50°1 Square/Linear Footage of Work: Type of Work: ❑ Addition g Alteration ❑ New ❑ Repair/Replace ❑ Demolition Phone#: Zip: 3 3 / . r Phone#:7f4-2,r-1 741°(= Phone#: 7I' ` 41 / 9,P6 Description of Work: /N1.7 -A -1.- c, / TO LL3T , / .�'A101A/ .. r Pt , W OPALS /A, /AI SA -774 i)oo.i... ('3ANv/Fd' O / /,S7/N& L41A9-I .Rtyvee ,S'YS715)1/• Specify color of color thru tile: Submittal Fee $ ✓ � Permit Fee $ CCF $ 1 '0 CO/CC $ Scanning Fee $ Radon Fee $ � DB`P'R $ 3-'3E? Notary $ b �� Technology Fee $ ® Training/Education Fee $ 6 ' `�� Double Fee $ 2 Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ Oro (RevisedO2/24/2014) 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 certifie. op of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days a : er th building permit is issued. in the absence of such posted notice, the inspection will no,,-.----, . s:iv- - • nd a reinspection fee' ill be a harged. OWNER or A The foregoing instrument was acknowledgebefore me this day of f'ld lse/thf , 20 )5 , by /`1 ip9 I/! awe/ , who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign Print: Seal: as sLNotary Public State of Florida . Joanna M Feliciano o° p*'f Exp My res 01/12/2018 ion FF 082753 *********** * Signature CONTRACTOR Theforeg ing instrument -was acknowledged before me this day of _ -Lf) , 20 (L , by 3 LLMAJAAJ- - , w o is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: tiuln.Ais-� as ************************** APPROVED BY (Revised02/24/2014) Plans Examiner 44* a Notary rsublic State of Florida s644****, Marlene Martinez A My Commission FF 906579 v* sc �,o� Expires 08/04/2019 . * ' * ,pli** *************** Zoning Structural Review Clerk IVliami Shores VHIage Building Department CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 A. COPY OF QUALIFIER'S STATE LICENCES B. AV COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: Z. g cd,, I e icrdio BUSINESS ADDRESS: `6 to SLi L,P5— S'T CITY its", eireAv STATEIC. 4 ZIP 33x33 BUSINESS PHONE: (7 #` ) 2—f ( ?at) FAX NUMBER ( ) / CELL PHONE r%f6) 2 % 9f QUALIFIER'S NAME: Lir /JM,Q4-2-- QUALIFIER'S LIC NUMBER: C ---F C % f 27.7 7 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 HERNANDEZ, LUIS L & J CONSTRUCTION LLC 16351 SW 285TH STREET HOMESTEAD FL 33033-1034 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 from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about 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, and congratulations on your new license! RICK SCOTT, GOVERNOR DETACH HERE (850) 487-1395 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CFC1427776 ISSUED: 06/23/2014 CERTIFIED PLUMBII`!G CONTRACTOR HERNANDEZ, LUIS L & J CONSTRUCTION LLC IS CERTIFIED underthe.provisions of Ch.489 FS. Expiration date : AUG 31.-2016 114052380130543 . . KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS: Expiration date: AUG 31, 2016 HERNANDEZ,LUIS L & J CONSTRUCTION. LLC 16351-.SW285TH STREET' HOMESTEAD FL 33033-1034 ISSUED: 06/23/2014 DISPLAY AS REQUIRED 8Y LAW SEQ # L1406230000543 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NO7A BILL -D0 NOT PAY 6281190 BUSINESS NAME/LOCATION L & J CONSTRUCTION LLC 16351 SW 285 ST MIAMI, FL 33033 OWNER L & J CONSTRUCTION LLC LUIS HERNANDEZ QUALIFIER Wlu(sr(s) 1 ran RECEIPT NO. RENEWAL 6546882 SEC. TYPE OP BUSINESS 198 PLUMBING CONTRACTOR CFC1427776 LBT EXPIRES SEPTEMBER 30, 2016 Must be displayed at place of business Pursuant to County Code Chapter BA -- Att. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR 75.00 08/13/2015 FPPU10-15-007003 This Loael Business Tax Receipt only confirms payment of the Local Business Tax, The Receipt is net a license. permit, sr a aarsigcatien oithe Widget; quellIceiions, to do business. Hahhur must comply with any pavemmentel or nongovernmental regulatory laws and requirements whish apply to the business. The RECEIPT.NO. shwa must be displayed on ail commercial vehicles- Miami -Dade Cade Sae Ea -216. For mere information, atrit yrwvr mtamidade garrtaxcollector Report Viewer 1 /1 100% Page 1 of 1 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: 3/10/2015 EXPIRATION DATE: 3/9/2017 PERSON: HERNANDEZ JUSTIN L FEIN: 205124568 BUSINESS NAME AND ADDRESS: L & J CONSTRUCTION LLC 16351 SW 285 ST HOMESTEAD FL 33033 SCOPES OF BUSINESS OR TRADE LICENSED GENERAL PLUMBING NOC AND WALLBOARD,SHEETROC PAINTING NOC & SHOP CONTRACTOR DRIVERS K,DRYWALL, P OPERATIONS ROOFING - ALL KINDS AND DRIVER Pursuant to Chapter 440.05(14), F.B., an officer of a corporation who eek exemption from this chapter by Ming a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12). F.8_ CeNficatea of eleWon to be exempt.. apply only within the scope otthe business or trade listed an 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 shalt be subject to revocation H, at any time alertly Bova of the notice erthe issuance office certificate, the parson narted on the notice or certificate no longer meets the requirements of this section for Issuance of a cert. The department shall revoke a DFS -F2 -DWG -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1608 https://apps8.fldfs.com/crreportviewer/reportViewer.aspx?data kd... 7/1/2015 ACORO® CERTIFICATE OF LIABILITY INSURANCE `.,moi DATE(MM>DDIYYTY) 02/04/2016 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 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 LaPlante Agency 2715 State Rd 580 Clearwater, FL 33761 License #: A149680 NAMEJessie Clemons PHONE FAX Ext): (727)7964568 (Arc, No): (727)791-1412 No. ADDRESS: Jessiegaplanteagency.com INSURER(S) AFFORDING COVERAGE NAIC 1 INSURER A: Accident Insurance Company COMMERCIAL GENERALUABIUTY INSURED L & J Construction LLC 16351 SW 285 St Homestead, FL 33033 INSURER B : CPP00202064 00 INSURER C: 09/05/2016 INSURER D: $ 1,000,000 INSURER E: $ 100,000 INSURER F : COVERAGES CERTIFICATE NUMBER: 00000000-0 REVISION NUMBER: 20 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. OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LTR TYPE OF INSURANCE ADDL INSD SUBR W VD POUCY NUMBER POLICY EFF (MMIDDOYYYYY) POUCY EXP (MM/DDIYYYY) LIMITS A X COMMERCIAL GENERALUABIUTY CPP00202064 00 09/05/2015 09/05/2016 EACH OCCURRENCE $ 1,000,000 GE RENTED PR�EMISSES Ea{ occurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one pin) $ 5,000 PERSONAL& ADV INJURY $ 1,000,000 $ 2,000,000 GENERAL AGGREGATE GENL X AGGREGATE POLICY OTHER: UMIT APPUES 78: PER: LOC PRODUCTS-COMP/OPAGG $ 2,000,000 $ AUTOMOBILE UABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ _AUTOS SCHEDULED AUTOS NOON -ON -OWNED (CE MBINED SINGLE UMIT$ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS UAIII _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) It yes, describe under DESCRIPTION OF OPERATIONS betas N I A PER OTH- STATUTE ER EL EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ EL DISEASE - POLICY UMIT $ SCRIPTION OF OPERATIONS 1 LOCATIONS 1 CLES (ACORD 101, Additional Remarks Schedule, may be attached It more space Is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. (JLC) ACORD 25 (2014101) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by JLC on February 04, 2016 at 02:34PM Notice to Owner — Workers' Com p IVI iami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ensation 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 project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the c �. r: ctor's company for day labor, part-time employees or subcontractors. BY SIGNIN .�;sem i W 'U ACKNOWLEDGE, T YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENT Signature: State of Florida County of Miami -Dade The foregoing was acknowledge before me this 9 day of ,20`� By /f? / L ` er 119_27personally known to me or has produced as identification. Notary: SEAL: Y cto, Notary public State of Florida ? .Joanna M Feliciano Commission FF 082753 Q4 Exaiteg 0f 11212018 1 COC 1511730 COIISTR®CTIOUII LLC L it1. 47,. .7.477179/451 7 - NEW NEW CONSTRUCTION, REMODELING REPAIRS, tlLOOFI?4 EC0001359 CCC1327803 Cell: (7864-2SS-1' 0 Fax: (7864-243-2488 Date: 2-05-2016 State of Florida County of Dade County Before me this day personally appeared Luis Hernandez who being duly sworn, Deposes and says: That he will be the only person working on the project located at 1005 N E 105 St. Miami shores Swom to (or affirmed) and subscribed before me this 02 day of February 2016. By sn' s Hernandez ersonally known Or produced identification Type of identification produced Print type or stamp name of no .49 oaar Poet Notary Publlc State of Florida Marlene Martinez{ gyp' My Commission FF 908579 4'or rtir EXpires 08/04/2019 /1/1✓kik"� ),L4 / -Tk lea AC R CERTIFICATE OF LIABILITY INSURANCE m►tEtBWoe+YYYYI 0211512016 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 fire 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 betides may require an endorsement A statement on this certificate does not confer rights to tis certificate holder In lieu of such endorsement(s). PRODUCER LaPlante Agency 2715 State Rd 580 Clearwater, FL 33761 License #: A149680 NAMES Jessie Clemons rPKcNE . (727)7864586 ow. No (727)7911412 jessie@laplanteagency.com INSURER{s►APFORDINa COVERAGE NA[C INSURED L & J Construction LLC 16351 SW 285 St Homestead, FL 33033 INSURER A: Accident Insurance Cgmpwly INSURER 1: INSURERC: MIBURER D: INSURER E: INR F : RAGES CERTIFICATE NUMBER000 853 SION NUN ER: THIS 1S 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. UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF mEUAANCE POLICY NUMBER (� L aATB A X COMMERCIAL GENBRA1..LIABILnY CPP00202064 00 09105/2015 0910512016 EACHOCCURRENbE $ 1,000,000 PRBAISES MR RODEO 1 CAMAGI3 TOMED $ 100,000 I Cines -BADE FT( OCCUR E02(Any aeperson) $ 6,000 PERSONAL&ADV INJURY $ 1.000,000 GENERAL AGGREGATE $ 2,000,000 GEM AGGREGATE UMIrAPPLES PER: POLICY D JECT D LOC CRHsr$ PRODUCTS. COMPJOP AGG $ 2,000,000 AUTOMOBILE .+ 4MED LIABILITY ANY AUTO ALLONMIED OS i SCHEDULED COMBINED SINGLE LOAM $ BODILY INJURY (Par person) $ BODILY INJURY (Par acoden3 $ DAMAGE $ $ UMBRELLA UAB EXC.ESSLa9 OCCUR MANMADE EACH OCCURRENCE $ AGGREGATE $ $ OEQ 1 RETENTION$�R Y601 COMpENSATDN AND EMPLOYERS* LIABBBY YIN ANY PROPRIETOR PARTNERSIECEC FWE Q OFFICERNEMBER E(CUIDE/ (MlndatoryInnrmq It e under D�N OF QpERATiONS below N /A (STATUTE $R E.I. EACH ACCIDENT $ EL DISi.A$E-EA EBIPLOYE0 $ EL DISEASE- POLICY MT $ DE$CRIP110NOFOP6RATiONS/LOCA11010/VEHICLES (WORD 101,Additional' Remits Schedule. may Leattached irampere's isreoked) Qualifier - Lul Hernandez Liz #:CGC1511730 & CFC1427776 CERTIFICATE HOLDER CANcELLATIGN Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, FL 33138 ACORD 25 (2014101) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WWII... BE OELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS. (JLC) ®1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by JLC on February 18, 2016 at 09:_08AM