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EL-16-1228Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Rc (6-isoo Inspection Number: INSP-269487 Permit Number: EL -5-16-1228 Scheduled Inspection Date: October 24, 2016 Inspector: Devaney, Michael Owner: DAMMRICH, DANIEL & MARYANNE Job Address: 1223 NE 102 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: MG ELECTRICAL CONTRACTOR Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1132050250140 Phone: (786)385-5637 Building Department Comments ADD 1 NEW SMOKE DETECTOR IN FAMILY ROOM, RELOCATION A/C, NEW HIGH HATS LIGHTS (KITCHEN & FAMILY ROOM 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 CREATED AS REINSPECTION FOR INSP-258337. Add receptacles to kitchen counter. N E C 210.52 C). 2yB'�T/6 October 21, 2016 For Inspections please call: (305)762-4949 Page 36 of 44 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number Itri idential n dditiatlt� *tion r ! $ /uAPPROVED Expiration: 06/2016 Applicant 1223 NE 102 Street Miami Shores, FL 33138- 1132050250140 Block: Lot: DANIEL & MARYANNE DAMMRII Owner Information DANIEL & MARYANNE DAMMRICH Address 1223 NE 102 Street MIAMI SHORES FL 33138- Phone Cell 1223 NE 102 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone MG ELECTRICAL CONTRACTOR (786)385-5637 (786)385-5637 Valuation: Total Sq Feet: $ 3,800.00 0 Type of Work: ADD 1 NEW SMOKE DETECTOR IN FAMILY Additional Info: Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $2.40 $3.38 $3.38 $0.80 $5.00 $225.00 $3.00 $3.20 $246.16 Pay Date Pay Type Invoice # EL -5-16-59679 06/01/2016 Credit Card 06/09/2016 Credit Card Amt Paid Amt Due $ 50.00 $ 196.16 $ 196.16 $ 0.00 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical W. W. Underground 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 FFID certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating const, ction, zonin•. 1��� A � June 09, 2016 uthorized Sin ure: Owner / Applicant / Contractor / Agent Date rmore, I authorize the above-named contractor to do the work stated. Building D - partment Copy June 09, 2016 1 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 BUILDING PERMIT APPLICATION ❑BUILDING ItILECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL JOB ADDRESS: 1 1.23 r 54i FBC 20Iq Master Permit No. �., 16 a (2, 2� Sub Permit No. ❑ REVISION ❑ EXTENSION El PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION CONTRACTOR 1o2&S-k- ❑ RENEWAL ❑ SHOP DRAWINGS Citv: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name1(Fee Simple Titleholder): pa� cA Address: 621,2) 1,0 1, City: MAAMAA SWO(Pe State: Phone#;_ss(Q --31 l.Q "-opo Zip: Tenant/Lessee-esJ�. M �"Name: Phone#: Email: 4�i. DO.A 1 Oratii1 • ( --,. CONTRACTOR: Company Name: M r . V ` (-CO1 V V Phone#: - 1 Address: \4\ 2A-2- Sw \c\ (; 1' a City: XOLA .A ,.A State: . o Cau e ie_Act Qualifier Name: State Certification or Registration #:\S'ACk DESIGNER: Architect/Engineer: Zip:LQ Phone#: ICGlM S(.0 —i Certificate of Competency #: Phone#: State: Zip: Address: Value of Work for this Permit: $ �€30-0 • 6-0 City: Type of Work: ❑ Addition ❑ Alteration Description of Work: *ND' M 1 h0 LAI j n vii 1,+'\ Rte . . Specify color of color thru tile: Submittal Fee $ - C Permit Fee $ i J7 6 CCF $ `1/440 Radon Fee $ 3 39 DBPR $ 8 ` 3 co Training/Education Fee $ 0 - Square/Linear Footage of Work: ❑ New El Repair/Replace ❑ Demolition Scanning Fee $� Technology Fee $ 3 2..9 Structural Reviews $ (Revised02/24/2014) co/cc $ Notary $ . Double Fee $ Bond $ 9 TOTAL FEE NOW DUE$ ( 6 . 1� Lf 1 �t l c� i20bYY1) 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property -is subject to attachment. Also, a certified copy of -the -recorded notice of commencement must b -e p stectat the jots site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not brapproved and a reinspection fee will be charged. Signatu L0110/ r---;;;4 'OWNER or AGENT The foregoing instrument was acknowledged before me this l( day of , 20 l �.i( , by T2_Y 44N NE A -iv he i (personally known to me or who has produced FL a-t� L( was identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: ( *,F********Oak ptc,i,Jr1L L? [•1o,/ Y'.!': : State of Ficrida sittdia Aivar z My ^otnmiss,o., 1=F 156750 Expires 09/03/2018 APPROVED BY (Revised02/24/2014) • CONTRACTOR The foregoing instrument waswalacknowledged before me this day of �!-t"� , 20 ( , by q r GO `��ETvbho is personally known to me or who has produced C �--�' L.1 -Dg --L as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 1-(, Seal: > cgp4Y °c Notary 7.1'.;tiL. Sate of Florida ^t; Sindia Arvarez My Commission FF 156750 Expires 00!03!2018 6„' y .tf,s,0f: �z,f° ,7.�... ?,''a.� ,moo *+kk,krk>f*****B******i**$****#******#**549 ,41 Ar•****•****** i***• 1.7,54-s%6 Plans Examiner Structural Review Zoning Clerk CTQB Construction Trades uaing Board BUSINESS CERTIFICATE OF COMPETENCY 14E000507 MO ELECTRICAL CONTRACTOR CORP D.B.A.: ETTI MARIO R Is certified under the provisions of Chapter 10 of Miami -Dade County STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 GUIDETTI, MARIO R MG ELECTRICAL CONTRACTOR CORP 14242 SW 154CT MIAMI FL 33196 Congratulations! With this license you become one of the naarly -- 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! R1CK.SCOTT,GOVERNOR____ DETACH HERE STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ER13015049 ISSUED: 12/09/2014 REG ELECTRICAL CONTRACTOR GUIDETTI, MARIO R MG ELECTRICAL CONTRACTOR CORP (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) HAS REGISTERED under the provisions of Ch.489 FS. Expiration date : AUG 31, 2016 L1412090000557 KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD LICENSE NUMBER ER13015049 The ELECTRICAL CONTRACTOR Named below HAS REGISTERED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) GUIDETTI, MARIO R MG ELECTRICAL CONTRACTOR CORP 14242 SW 154CT MIAMI FL 33196 Incl'c11• 4^1ffN1Mn4A r1ICDl AV ©C RFfli IIRFrl RY 1 AW SEO # L1412090000557 To find out about business and economic opportunities for Florida veteran business enterprises, as well as Florida's small minority and women -owned businesses, please contact or visit the Department of Management Service's Office of Supplier Diversity at: lutp://www.thusanvflorida.com/other progroms/offiee of supplier diversity osd ''•a To find out about State of Florida tools supporting statewide centralized procurement activities which have streamlined interactions between vendors and state government entities. please contact or visit the Department of Management Services' MyFloridaMarketPlace at: litips.r/A,eudor.mrfloridamarketplace.com AC#870069 SIGNATURE (For the protection of our professional license holders, this license contains hidden security features to prevent counterfeiting. Unauthorized reproduction is strictly prohibited and will be prosecuted to the fullest extent of the law) The Department of Business and Professional Regulation (DBPR), issues licenses for many licensed businesses and practitioners in the State of Florida. DBPR is changing the way you interact with state government. Many of DBPR's services are available online at www.MyFloridaLicense.com. We encourage you to utilize these services to make address changes, licensing changes or to renew your license. Name changes require legal documentation verifying the name change. which must be mailed to the DBPR. An original, a certified copy or a duplicate copy of an original or certified copy of a document that shows the legal name change will be accepted, unless the DBPR has a question about the authenticity of the document. If applicable. the DBPR will send a renewal notice to your Last known address or email address of record. If you have not received your renewal notice. please call our Customer Contact Center at 850.487.1395 or online atwww.MyFloridaLicense.comlcontactus. Please refer to your profession's governing statutes and Administrative codes for further information regarding renewals. These may be accessed from our website. AC* t :059 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOTA BILL - DO NOT PAY 7179913 BUSINESS NAME/LOCATION MG ELECTRICAL CONTRACTOR CORP 14242SW154CT MIAMI, FL 33196 OWNER MG ELECTRICAL CONTRACTOR CORP NO MARIO R l l iinFTTI Worker(s) 1 RECEIPT NO. RENEWAL 7460227 SEC. TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR 14E000507 LBT EXPIRES SEPTEMBER 30, 2016 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR 75.00 07/20/2015 0226-15-005106 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is nota Oconee, permit. ora certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which appl' to the business. The RECEIPT NO. above mast be displayed on all commercial vehicles - Miami -Dade Code Sec Ra -236. MIAM MEM For mare intonation, visit www.miamidade.gov/taxcofector Municipal Contractors Tax Receipt Miami—Dade County, State of Florida THIS IS NOTA BILL — DO NOT PAY NO: 4 CC 1 E000507 BUSINESS NAME/LOCATION MG ELECTRICAL CONTRACTOR CORP 14242 SW 154 CT MIAMI, FL 33196 OWNER MG ELECTRICAL CONTRACTOR CORP C/O MARIO R GUIDETTI RECEIPT NO. 7469303 TYPE OF BUSINESS ELECTRICAL CONTRACTOR C J EXPIRES SEPTEMBER 30, 2016 Pursuant to County Code Sec 10-24 PAYMENT RECEIVED BY TAX COLLECTOR 200.00 07/20/2015 0226-15-005106 This receipt is not valid in the talluwing Mmdcipalltem Aventare. Doral, Hialeah, Key Biscayne. Miami Gardens, Miami lakes. Palmetto Bay, Piaecrast. Sm ay Islas Beach. Town of Cutler Bay. For more information, visit www.miamidada.gov/taxcolleetar 06/05/2016 10:27 305 740-0518 Mabel Felipe Page 2/2 AftWIZU7 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/Y1W) 05/06/16 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 certtcate does not confer rights to the certficate holder in IIeu 01 such endorsement(s). PRODUCER Acceptance Insurance Services 6887 S.W. 40th St. Miami, FL 33155 Phone (305) 740-0515 Fax (305) 740-0518 NAME: Rene E Samayoa PHONE 305 740-0515 FAX (A/C, No, Ext): () (A/C, No): (305) 740-0518 E-MAIL ss: rene@acceptanceinsservices.com INSURER(S) AFFORDING COVERAGE NAIC 4 INSURER A : Canopius U.S. Insurance 12961 INSURED MG Electrical Contractor Corp 14242 SW 154th Ct Miami, FL 33196- (786) 385-5637 INSURER B : Integon Preferred Insurance Company 31488 INSURER C : Scottsdale Insurance Company 41297 INSURER D : $ 1,000,000.00 INSURER E : $ 100,000.00 INSURER F : occurrence) MED EXP (Any one • THIS INDICATED. CERTIFICATE EXCLUSIONS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER (MM/LDIDID/YCY YYY) (MM POLICY LIMITS A GENERAL LIABILITY n COMMERCIAL GENERAL LIABILITY N N ACE0014975 11/062015 11/06/2016 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED PREMISES (Ea $ 100,000.00 II a CLAIMS -MADE n OCCUR occurrence) MED EXP (Any one 5,000.00 person) PERSONAL & ADV INJURY $ $ 1,000,000.00 ■ GENERAL AGGREGATE $ 2,000,000.00 GENL AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $ 2,000,000.00 51 POLICY • JPERO-YT • LOC B AUTOMOBILE LIABILITY N N 2003385986 11/05/2015 11/05/2016 COMBINED SINGLE LIMIT (Ea accident) $ $ • ANY AUTO BODILY INJURY (Per person) $ 10,000.00 AUTOOSED 0 DOES ULED BODILY INJURY (Per accident) $ 20,000.00 HIRED AUTOS NON -OWNED AUTOS RTYr OPERTe DAMAGE $ 10,000.00 • IIIer ( C UMBRELLA LIAB 11 OCCUR N N XBS0051664 05/19/2015 05/192016 EACH OCCURRENCE $ 1,000,000.00 Ell EXCESS LIAB II CLAIMS MADE AGGREGATE $ • DED • RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A $ • TWORY LIMC STATUITS • OTERH E.L. EACH ACCIDENT $ (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe unde DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Electrical Contractor CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 NE 2nd Ave MIAMI SHORES, FL, 33138 I FAX 305-756-8972 ACORD 25 (2010/05) QF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Report Viewer 100% Page 1 of 1 JEFF ATWATER CHIEF RNANCW.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 caritas that the individual fisted below has elected to be exempt trot Florida Workers' Compensation taw. EFFECTIVE DATE : 12/12/2014 EXPIRATION DATE: 12/11/2015 PERSON: GUIDETTI MARIO FEIit 270668971 BUSINESS NAME AND ADDRESS: MG ELECTRICAL CONTRACTOR CORP 14242 SW 154 COURT MIAMI FL 33196 SCOPES OF BUSINESS OR TRADE: LICENSED FI FrTRiCAL CONTRACTOR Pwstmtdm Mager 4480E041 F.S.snemcee aa unissaaran rdmetrsr ezenuaton Cara Vas chaser iwtrin0 a insinficide al donnas sudarms semen may nmmoms benefits atcam war ens dandlesPu ammm Mager440.09I121,F.S. nrigndia. is asesagL- aPDhan! satin the scope sass laasmsssrtraaerated =Meantorarelection toOa mit Fosaarsm Chanter 440 0(14 FS. tmkms orefemon in lee manse and emaileaesaaimant* be enema shall be subject in re d. atany time earths Ong eau sat= ortete issuance aline ae . to praantrnted on Om atter in centicate as tenger insets Use .Eq winesenientsWrens seem. for Irma= ala crilificals. The depaaamdsena may DFS-FZ-OWG252 CERTIFICATE OF ELECIION TO BE EXEMPT REVISED 08-13 OUESIIONST (550)413-1608 e••e10-rIt so ,emir.r.% 1x141.4 41A1 A IVG Electrical Contractor Date: May 16, 2016 State of Florida County of Dade Before me this day personally appeared JAVIER CANTERO who being sworn, deposes and says: That he will be the only person working on the project located at 1223 NE 102" STREET, MIAMI SHORES, 33138. Sxorn to (or affirmed) and subscribed before me this 16th day of May 2016, by 61.v ter Cal Yii-e rD Personally know OR Produced Identification Type of Identification Produced Print, Type or Stamp Name of Notary ��' MY COMMISSION # FCASTI055358 kiEXPIRES: January 19, 2018 Bonded Thor Notary Public Underwriters IVliami Shores Viiiage Building Department 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 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. Signature: State of Florida County of Miami -Dade The foregoing was acknowledge before me this 0 C day of , 20 (. By NIWZ-1nrJ -NE.VP (V N\ RIwho is personally known to me or has produced Notary: SEAL: Z 1— NSC as identification. w c.., Notary public State of Florida , 0 Sindia Aivarc;z oR Ay ommiccion FP 1FR7,0 Expires 09/0312018