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EL-15-2037Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Perr»lt grit T. e. `Elect Parcel Number 7 i an: AdditionlAiteration PermitStatus: APPROVED 12015 Expiration: 05/02/2016 Applicant 952 NE 91 Terrace Miami Shores, FL Owner Information MICHAEL MOLINA 1132060030130 Block: Lot: Address 952 NE 91 Terrace MIAMI SHORES FL 33138- 952 NE 91 Terrace MIAMI SHORES FL 33138- Contractor(s) LEWDI ELECTRIC Phone 954/782-0006 Cell Phone MICHAEL MOLINA Phone (305)672-7131 Valuation: Total Sq Feet: Cell (786)554-6017 $ 1,100.00 { 0 Type of Work: INSTALL NEW RECESSED LIGHT, INSTALL Additional Info: Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $1.20 $2.25 $2.25 $0.40 $150.00 $3.00 $1.60 $160.70 Pay Date Pay Type Amt Paid Amt Due Invoice # EL -8-15-56695 11/04/2015 Credit Card $ 160.70 $ 0.00 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical Underground W. W. In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I ce i , that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating nAV/ construction a rmore, I authorize the above-named contractor to do the work stated. Aut • rized ature: Owner Building Departmen opy Contractor / Agent November 04, 2015 Date November 04, 2015 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL f Phone: (305)795-2204 Fax: (305)756-8972 C 0 1 5 - I q Inspection Number: INSP-241290 Permit Number: EL -8-15-2037 Scheduled Inspection Date: August 18, 2016 Permit Type: Electrical - Residential Inspection Type: Final Owner: MOLINA, MICHAEL Work Classification: Addition/Alteration Job Address: 952 NE 91 Terrace Inspector: Devaney, Michael Miami Shores, FL Project: <NONE> Contractor: LEWD' ELECTRIC Phone Number (305)672-7131 Parcel Number 1132060030130 Phone: 954/782-0006 Building Department Comments INSTALL NEW RECESSED LIGHT, INSTALL NEW VANITY LIGHT, INSTALL NEW EXHAUST FAN, INSTALL NEW SWITCHES 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. -- /69 /g -a7:6' August 17, 2016 For Inspections please call: (305)762-4949 Page 3 of 33 PERMIT APPLICATION ❑ BUILDING ELECTRIC ❑ PLUMBING ❑ MECHANICAL mi 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 Master Permit No. ❑ ROOFING ❑ REVISION NOV 20 2015 Art In. CLC,-- FBC 20 v0 cg— Sub Permit No. e L-8 - / S- of o3 ? ❑ EXTENSION ❑RENEWAL ❑PUBLIC WORKS ❑ CHANGE OF CONTRACTOR JOB ADDRESS: q52_ 1.1E -1 IItszvta City: Miami Shores County: Folio/Parcel#: ,13200 00 2)0 IO Occupancy Type: ❑ CANCELLATION ❑ SHOP DRAWINGS Miami Dade zip: Load: Construction Type: Is the Building Historically Designated: Yes NO OWNER: Name (Fee Simple Titleholder): t)t 1 4 L‘11OUvPc Address: 95.2- 0.e qt TavkAte City: H tP f 15iko2Eei Flood Zone: BFE: FFE: Phone#: SCLF ip01'j State: C i. Zip: -S3`'30D Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: [...Et, ID I . Tl2-1C. C_ Address: g®1� Phone#: l'Stt q 2- bOb6 City: f L ' e ?- P f State: Qualifier Name: Laki 15 .7-r�%-�--5Ji° A � Phone#: State Certification or Registration #: LrC_ ( 7500 19)?) Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 1 Square/Linear Footage of Work: /On sc 0 ft_ zip: 3s oci Type of Work: ❑ Addition [V Alteration ❑ New Description of Work: Mewl An- ,,iiZ 1 � J ❑ Repair/Replace Lei. nc ) Amari ❑ Demolition A0.1 /AA. 4 Specify color of color thru tile: Submittal Fee $ Permit Fee $ )"S me>' Scanning Fee $ Radon Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Training/Education Fee $ CCF $ DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ -18 _oz) 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 approve ' and a reinspection fee will be charged. Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this c20 I'Q` day of "re -4-1,1k-) , 2013— , by ok day of 07,e , -"-Ace---) , 20/ S , by ,M k'h A(1611..,14 , 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. NOTARY PUBLIC: Sign Print: iGno ?. /224. 20 Seal: * LINDA D. MAURO Notary Public - State of Florida 4, F.E. My Comm. Expires May 14, 2017 *' Commission # FF 001078 ;q ,,,1,,,„ ***Boum ihrrou'gn Natiorf i 16ia' itit'1ht" APPROVED BY (Revised02/24/2014) identification and who did take an oath. NOTARY PUBLIC: Sig Gv 773a) Print: ,Z-tN') e9 - Seal: ***************** ;47 1-'420" rs Plans Examiner !,,,p,., LINDA D. MAURO 1. Notary Public - State of Florida My Comm. Expires May 14, 2017 Commission # FF 001078 *44444*** etittestclfgoisiptfletivel4NoteAlisi * Zoning Structural Review Clerk • •• • • • • • • ••• • • •• • • • • • • • • • • • • • • • • • • • • • •••• • • •••• •• •• • • •• • •••• • • • • • • • • •• •••• • • • • • • • • • • •• • • • "e0 -19 Miami Shores Village APPROVED 'tel._. 21444+63 -DEPT BLDG DEPT UE3 11 C'T TO BY DATE S COMPI IANCF WITH AIL FEDFEIAL STATE ANI) COUN IY Rt 1.FS AND REGI 11 ATIONS 4-1.4e./2/C._ ® NEM VAi i 1...\ GNAT (Z NEW GF.oyt ca ao A MQ C.02.c.u6r NLv)e K Kspo37 F ta+J © a aiEvo c," RccESSED tc CClan® it U w,'? Te IL)AZ F0D4+ 0216 heist) 12-1 Locm-c f cecr Doan_ PERMIT APPLICATION mi Shores Village ding Department NOV 20 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 /4'i rl Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 2010 Master Permit No. 0 - IJP 1 -1Q Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL El PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 2_ I `tE `II I C'i“2-r<ci City: Miami Shores County: Miami Dade Zip: 33'k t) Folio/Parcel#: '10 32.060030 l •0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): \--4 tit-( I -1 L v4 01.4 NA Phone#: 1 %(O 564 loO f Address: 'I S52.t�C 1 T.a. v c City: \I IIkI W3Q- State: .L— Zip: 'j3`7.°0 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: VA I el -'i4 L tOLIN A- 6-10IMEcxul•}02.- Phone#: 7g CSLI (4)0 L cissa. l SZ 'I h Tef2404..6 City: U 4'tti 0+R—ES State: 0.. Zip: ��«'60 Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City:State: Zip: Value of Work for this Permit: $ ® Square/Linear Footage of Work: / CIO sy Type of Work: ❑ Addition /:r Alteation ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: P I LI> .awn y. Yc›z.J�� e Av-A it./ elo ,u-vvri 1 ",k) ) %Q c YALVITt WekI,1 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$ 8y ,�� (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 ELECERIC, 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. Signature OWNER or AGENT The foregoing instrum nt was acknowledged before me this The foregoing instrument was acknowledged before me this ae, day of , 20/5 , by C�O(-' day of0."-Qir► , 20)S , by /4((r,p 4.,, who is personally known to /14(Mame , who ispersonall ky nown to oz me or who has produced as me or who has produced as Signa ure CONTRACTOR identification and who did take an oath. NOTARY PUBLIC: Sign Print: Seal: ******* co/a,,,//„D �P� �• in4WLD `,,,!!,••,, LINDA D. MAURO `.,, =: Notary Public - State of Florida • ; v : • My Comm. Expires May 14, 2017 Bonded Through N.ional Notary Assn. •,11111 APPROV (Revised02/24/2014) identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 41 i1)s9-lam- /441,M2D Seal: **************** Plans Examiner Structural Review s,1 -"P,',,, LINDA D. MAURO ;r•„ Notary Public - State of Florida • E My Comm. Expires May 14, 2017 a" Commission # FF 001078 "*tend` t*Til tltilitttibiii`Melt?ifNIL Zoning Clerk • BUILDING PERMIT APPLI ATION ❑BUILDING ELECTRIC 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 ❑ ROOFING ❑PLUMBING ❑ MECHANICAL PUBLIC WORKS JOB ADDRESS: 152. 1v6 I xv— AUG 1 2 2015 I FBC 20 14 Master Permit No. J D 1Cf Sub Permit No. E L - IS -2039 ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Folio/Parcel#: 11 3010C, (DC:)- C) 13 C) Occupancy Type: Load: Construction Type: Miami Dade Zip: / 31 Is the Building Historically Designated: Yes NO Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):�%'�I 141,- til. 0 1.4.164_.Phone#: 0(66) 554 60/ Address: 152_ NE %i s4- 7.�ry City: J ` i rota. J kariS State: Zip: 331 3$ Tenant/LesseeLName: j Phone#: Email: tko 11/4-1,1;144— C../�•� C.J &L tJtav .0-61,k CONTRACTOR: Company Name: LE --1.0.0 i E C 12 /x. 2—/u( Address: ,C/ A/W S-2' 3'r Phone#: City: T 1.•44d/ lJ,ttk Qualifier Name: State: L510L5 SPASTA�r� State Certification or Registration #: EC/3CX)/3Sig DESIGNER: Architect/Engineer: Address: Zip: 33 3d? Phone#: Certificate of Competency #: Phone#: City: State: Zip: Square/Linear Footage of Work: L{5 s� ❑ Demolition Value of Work for this Permit: $ (,106 Type of Work: TrAddition ❑ Alteration ❑ New ❑ Repair/Replace Description of Work:. _ INS (,(; 2iciSss tom} L, ,15 1 i iJS T as Airtk1 (' ar it 44144T; Ake%J V 4 1— CA4 ricfriSs Specify color of color thru tile: Submittal Fee $ Permit Fee $ /...4-0/A9 CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ - TOTAL FEE NOW DUE $ q- (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. OWNER or AGENT Signature CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged I �A day of , 20 15 , by A47dayof jAl J ,'tom I , who is personally known to L 4-z-` S Pd -J '60""`Q , who is per we- r who has produced as me or who has produced "A>Ob Bei identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: P�u/C1z ANDRE J. DEPAGNi`.ER 0 MY COMMISSION # FF24555,2 EXPIRES June 30, 2019 I FIendallowelor ee cCa: 140/) 3914153 identification and who did take an oath. NOTARY PUBLIC: Sign: before me this 20 ) ,by Tonally known to as Print: Sea: *****************************-****-*********************** A/l�J/A ,fro% 1 P� _ APPROVED BY Zoning (Revised02/24/2014) ROBERT CALDWELL Notary Public - State of Florida Commission # FF 231075 Mi4pwiw, c My Comm. irei *IZ .:.#:. '1'(h ough National Notary Assn, Structural Review Clerk RICK SCOTT, GOVERNOR STATE OF FLORIDA ND PROFESSIONALL, REGULATION KEN LAWSON, SECRETARY LICENSE NUMBER SC13001388 The ELECTRICAL CONTRACTOR Named !Mow IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 SPASIANO, LEWIS LEWDI ELECTRIC INC 1680 NELSON TER THE VILLAGES FL 32162 ISSUED: 08/11/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1408110001619 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100. Ft. Leuderdsde, FL33301-1895 _ 954-831 VAUD OCTOBER 1,2014 THROUGN SEPTEMBER 34 MS Business Name: LE9DI ELECTRIC INC Owner Name: LEWIS SPASM/SAL Locallograusiness 2585 SE 6 ST 1 memo BEACH • SurlinessPhone: 954-782-0006 A Rooms Seats entgorces 10 Ret#18 1- 3401 Bis Types c � Business Ope10/d1/1988 Stet :BC13d01388 Number of Truer Fee 1 io 0.00 • For VendingRogness Only NSF Fee 0.00 0.00 Polar Yews iClonsoffon Cost 0.00 THIS RECEIPT MUST DE POSTED CONSMUOUSLY D1 YOUR PLACE OF TRW B $.ATAX RECEPT VALh DATED. • 6144 Address: SPABIANOrtL NW ST /Qum• •'. FORT LAUDERDALE , FL 33309 0.00 "Ms tax is Levied for the privilege of doki business wade Swam in rhe. You must meet all County andkr and zonbuir requkemente This Business Tax Receipt must be the bis s sold, name has changed gr business location. TthIs receipt does not t e sZer t is in comprrance Will State or loam laws and 2014 - 2015 Lewdi Electric 801 NW 57 St Fort Lauderdale, FI. 33309 954-895-5308 Date: State of J,14 -'l_ County of Before me this day personally appeared &i.01.6.4who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 9S- N ,1. 9/rtie,, ca-ge / ,, z Sworn to (or affirmed) and subscribed before me this /0 day of . 20 , by Low Personally know OR Produced Identification Type of Identification Produced 41 -1 -e -L9 Print, Type or Stamp Name of Notary LI IV p . 4. /quart) "",,, LINDA D. MAURO r , Notary Public - State of Florida • My Comm. Expires May 14, 2017 ir9. t, Commission # FF 001078 , ,,,, '" Bonded Through National Notary Assn. Notice to Owner — Workers' Com p Miami Shores Viiiage 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 contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. State of Florida County of Miami -Dade The fore ing was acknowle ge before me this I I day of 4jug / , 2015. iG 4 //II/o. who iserso anally kno t� iii iSap oduced �•.1% J�1y18-2o,,,off:. Notary - W i N0IARY �y; m PUBLIC SEAL: • ,, Aire .f.0 -•S• By as identification. ifs on silt 08/05/2015 15: 40 5619959677 • ACCORD 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. VAN AMERINGENS PAGE 01/01 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD1YYYY) 8/5/2015 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must ba endorsed. If SUBROGATION IS WANED, subject to the teens 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 Phone: (561)995-9577 Fax: (5661)995.9677 Van Ameringen s lnau anee and Financial Services 902 Clint Moore Rd Suite 132 Boca Raton, Florida 33487 CONTACT Renee Small NAME: Neaxa'I�s°�'�' (561)995-9577 FAX o X ANo); 561)995-9677 t ADDRESS- renes@vaaameringEals.cont INSURERS) AFFORDING COVERAGE INSURER A : Scottsdale Insurance Company NAIC O INSURED LEWDI ELECTRIC, INC. 2149 NE 63RD CT. FORT LAUDERDALE, FL 33308 INSURER 8: 41297 IN$TIRER C : INSURER D : INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: 125 L THIS le TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIB EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED SY PAID CLAIMS OR POUCY EFF FOUCYExe 71t TYPE Of INSURANCE D WVD _ppUCY NUMBER tolINDOLYYYYI memoir -ern I COMMERCIAL GENERAL LIABILITY A CLAIMS -MADE I I OCCUR GEN'L, AGGREGATE LIMIT APPLIES PER: POLICY jRG LOC Il QYH R: AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS — AAUTOS LED _, A VJWED AVMs T„ -, CP82105E88 1/3/2015 1/3/2016 UMURELLAUA8 axcess LIAR OCCUR CLAIMS -MADE DED i J RETENTION S WORKERS COMPENSATION AND EMPLOYERS' UASILIY Y IN ANY PROPRIETORJPARTNELE(ECU11VE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA DESCRIPTION OP OPERATIONS /LOCATIONS I VEHICLES (ACORD 1101. Additlenai Remarks SdreduJe, may ba efach ad K mora OneIs raga REFERENCING LICENSE 8 EC13001388 ELECTRICAL cONTRA.CTXNG CERTIFICATE HOLDER CANCELLATION EVISION NUMBER: ED NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHICH THIS ED HEREIN IS SUBJECT TO ALL THE TERMS, kad) Mrs EACH OCCURRENCE $ 1,000,000 TENTED PREMIISIESEStEaO 4lTEnete $ 10!),000 MED EXP (Any one person) 5 5,000 PERSONAL $ ADV INJURY $ 1,000,000 +ENERAL AGGREGATE $ 2,000,000 PRODUCTS • coMPlOP AGO S 2,000,000 $ r COMSiNEDSINGLE LIMIT $LIMI $ (Par person) BODILY INJURY (Par person) $ $INJURY BODILY INJURY (Per aooklant) 5 IrROPERTY 9AC1AGE (Per segos $ S _ EACH OCCURRENCE $ AGGREGATE 5 $ on STATUTE SR-i., EL EACH ACCIDENT $ EL. DISEASE - EA EMPLOYE$ $ E.L DISEASE. POLICY LIMIT $ 1-roldet'a Nature of Interest = Certificate Holder VILLAGE OF MIAMI SHORES 10050 NE 2ND AVE MAIMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WrrH THE POLICY PROVISIONS. AUTHORDED REPRESENTATIVE 0198&2014 ACORD CORPORATION. All right$ reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD 2016 details - Business Tax Account LEWDI ELECTRIC INC - TaxSys - Broward Count... Page 1 of 1 dECORD TAXES A EAS Records, Taxes & Treasury Div. Home Search Reports Shopping Cart ATTENTION TAXPAYERS: Please be advised of the NON-REFUNDABLE processing fees for credit and debit card transactions. Credit cards are charged 2.55% of the amount charged ($2.00 minimum fee). Domestic Visa Consumer Check cards will be assessed a fee of $3.95 per transaction if you select 'Debit Card'. Thank you. 2015 Annual Tax Bills will be mailed prior to November 1, 2015, and will also become available on this website November 1st for viewing, printing or online payment. Tax bills are mailed to the current mailing address of the property, as listed on the Property Appraiser website www.bcpa.net . We recommend that everyone verify their current mailing address listed for their property at www.bcpa.net — and immediately report any mailing address change by using the link at the bottom of your property record for reporting errors. T Accou LEWD E ECTR1C Business Tax Account #5425 Account details Account history 2016 2015 2014 2013 900 2009 PAID PAID PAID PAID PAID Account number: 5425 Business start date: 10/01/1988 Business address: LEWDI ELECTRIC INC 2585 SE 6 ST POMPANO BEACH, FL 33062 Physical business location: POMPANO BEACH Owner(s): LEWIS SPASIANO/QUAL 801 NW 57 ST FORT LAUDERDALE, FL 33309 Mailing address: LEWIS SPASIANO/QUAL 801 NW 57 ST FORT LAUDERDALE, FL 33309 Cr Print account application (PDF) ©' Print exemption application (PDF) CONTRACTORS ELECTRICAUALARMS/CONTRACTOR Additional documentation required: EC13001388 State Certification OR Broward Cert. of Comp. (each year) 10/01/2015-09/30/2016 PAID 2015-09-29 $27.00 Units: 10 Receipt #13B-14-00011116 https://www.broward.county-taxes.com/public/business tax/accounts/5425 11/2/2015