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MC-17-2571Project Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Issue Date: 11 Permit NO. MC -10-17-2571 Permit Type: Mechanical - Residential Work Classification: A/C Replacement Permit Status: APPROVED /2017 Expiration: 05/05/2018 Parcel Number Applicant 165 NW 96 Street Miami Shores, FL 33138-0000 1131010250130 Block: Lot: PROVIDENT FUNDING ASSOCIA Owner Information Address Phone Cell PROVIDENT FUNDING ASSOCIATES L P165 NW 96 Street MIAMI SHORES FL 33150- 165 NW 96 Street MIAMI SHORES FL 33150- Contractor(s) PICON DESIGN CORP Phone (305)599-8282 CeII Phone Valuation: Total Sq Feet: $ 3,095.00 0 Tons: 3 Additional Info: EXACT CHANGE OUT 3 TON 7KW A/C Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 3 Date Approved:: In Review Type of Work: Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $2.40 $2.00 $2.00 $0.80 $108.33 $9.00 $3.20 $127.73 Pay Date Invoice # 11/06/2017 10/30/2017 Pay Type MC -10-17-65489 Credit Card Credit Card Amt Paid Amt Due $ 77.73 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Review Mechanical 1 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 certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructisp .zoning,,uthermore, I authorize the above-named contractor to do the work stated. Oe Gf Authorized Signature: Owner / Applicant / Contractor Building Department Copy November 06, 2017 Date November 06, 2017 1 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 17114 FBC 220 ( LI MO -1-4-25. Master Permit No. 1" O-14 2S.I Sub Permit No. ❑BUILDING ❑ E CTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1.0 N k) c S -1-2P. City: Miami Shores County: Miami Dade Zip: 33 i 5 f Folio/Parcel#: 11-3101-025-01 3 t) Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: /2D V/.04,1/7 -/f Ar pleVo-e.r P. 4,P t OWNER: Name�j(Fee Simple Titleholder Phon #: Address: 851 1-17c19er refve, di 10D , J City: art 'Brute a State: !��! r)/� /�`f Zip: -/ 06-6 Tenant/Lessee Name: Phone#: Email: 3De.1SCor 2-V Company Name: .71 LO✓1 1 N� ` Phone#: 3(256-99-X Address: q4 b 0 /1 U) 13 sl' City: -0(2-4i State: FL012-i(Lk Zip: .33l77a. Qualifier Name: e.1\ 'T) co in Phone#: -?b&-.St5 01,2.5'3- State 15State Certification or Registration #: eif&fv/ -5/ Z Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ .6o 1 1- 0 0 Square/Linear Footage of Work: Type of Work: ❑ Addition E Alteration ❑ New 14 Repair/Replace ❑ De olition ciCj e 'u -- 3 Tbkii 7 /CLA) ri' 1, Description of Work: Specify color of color thru tile: of Submittal Fee $ E J - (n Permit Fee $ t D 1 �)*"..aF $ CO/CC $ \ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature &L6 OWNER or AGENT The fore oing instrument was acknowledged before me this 21 day of lete+ , 20 11 , by U r t BYCG&G , who is personally known to me or who has produced '1 ' U Grirrr:C" as identification and who did take an oath. NOTARY PUBLIC: Sign: Print Seal: � ti 4r3ytiti \` d Ir'' AIEKtgr ****************** APPROVED BY (Revised02/24/2014) * ** ******* ** III4 Al *** CONTRACTOR The foregoing instrument was acknowledged before me this ,,off- Li 441 daycofofbelt. , 20 _, , by \ r ( co ✓N. , who is personally known to me or who has produced 2J.5an4, ttoi know rt as identification and who did take an oath ) NOTARY PUBLIC: Sign: Print: /V e�( co Rene Lourido COMMISSION 0 FFI81724 EOM Joe 11, 2010 MNaIRONIIOTARY.COY Seal: **************** aminer ******************************** Zoning Structural Review Clerk 1 .• . .v 1 k 141riv \ \.;,,,,,, c. . y . • • 1 .11- , '?'"ic;4 ‘'..... 'iSo . ......1„ , ..... • ; f. , v '': ` . CO s 7,3t . ,4,1., . . 1.. • () v ts*- r • 4 - V 70 PAT:1;;;II) Property Search Application - Miami -Dade County http://www.miamidade.gov/propertysearch/#/reportisummary OFFICE OF THE PROPERTY APPRAISER Summary Report Property Information Folio: 11-3101-025-0130 Property Address: 165 NW 96 ST Miami Shores, FL 33150-1714 Owner PROVIDENT FUNDING ASSOCIATES L P Mailing Address 851 TRAEGER AVE STE 100 SAN BRUNO, CA 94066 USA PA Primary Zone 0800 SGL FAMILY - 1701-1900 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY : 1 UNIT Beds / Baths / Half 2 / 1 / 0 Floors 1 Living Units 1 Actual Area 1,455 Sq.Ft Living Area 1,065 Sq.Ft Adjusted Area 1,285 Sq.Ft Lot Size 8,625 Sq.Ft Year Built 1946 Assessment Information Year 2017 2016 2015 Land Value $189,543 $189,543 $140,036 Building Value $89,436 $89,436 $89,436 XF Value $2,890 $2,927 $2,396 Market Value $281,869 $281,906 $231,868 Assessed Value $274,512 $249,557 $226,870 Benefits Information Benefit Type 2017 2016 2015 Non -Homestead Cap Assessment Reduction $7,357 $32,349 $4,998 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description RESUB OF BLK 3 OF BONMAR PARK PB 42-60 LOT 13 BLK 3 LOT SIZE 75.000 X 115 OR 18222-3007 0798 1 Generated On : 10/25/2017 Taxable Value Information Previous Price 20171. 2016_1 2015 County Exemption Value $0 $274,512 $0 $249,557 $0 $226,870 Taxable Value School Board 01/01/2008 Exemption Value $0 $01 $0 Taxable Value $281,869 $281,906 $231,868 City 21423-4143 Exemption Value $0 $01 $0 Taxable Value $274,512 $249,557, $226,870 Regional Exemption Value $0 $0 $0 Taxable Value $274,512 $249,557 $226,870 Sales Information Previous Price Qualification Description Sale gookOPage 08/03/2017 $240,500 30645-2543 Federal, state or local government agency 01/01/2008 $470,000 26204-3182 Other disqualified 12/01/2007 $360,000 26199-3520 Sales which are qualified 07/01/2003 $245,000 21423-4143 Sales which are qualified The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.govfnfo/disclaimer.asp Version: This tztte z f C� xHi :��x caurell c'inn `u , errztarg afState CERTIFICATE OF LIMITED PARTNERSHIP IMPORTANT—Read Instructions on back before completing this form Certificate Is presented for filing pursuant to Section 15621, California Corporations Code. Form LP -1 I. NAME OF LIMITED PARTNERSHIP Provident Funding Associates, L.P. 2. STREET ADDRESS OF PRINCPAL EXECUTIVE OFFICE 1050 East Evelyn Avenue CITY AND STATE Sunnyvale, CA ZIP CODE 94086 3. STREET ADDRESS OF CALIFORNIA OFFICE IF EXECUTIVE OFFICE 13 IN ANOTHER STATE CITY CA ZIP CODE 4. COMPLETE IF LIMITED PARTNERSHIP WAS FORMED PRIOR TO JULY 1. 1984 AND 1S 1N EXISTENCE ON DATE TH15 CERTIFICATE IS EXECUTED. THE ORIGINAL LIMITED PARTNERSHIP CERTIFICATE WAS RECORDED ON 19 RECORDER OF COUNTY. WITH THE FILE OR RECORDATION NUMBER 5. NAMES AND ADDRESSES OF ALL GENERAL PARTNERS: (CONTINUE ON SECOND A.NAME: Provident Funding Group, Inc. ADDRESS: 1050 East Evelyn Avenue CITY: Sunnyvale STATE: CA ZIP CODE: 94086 PAGE. IF NECESSARY) C. NAME: ADDRESS: CITY: STATE: ZIP CODE: H. NAME: ADDRESS: CITY: STATE: ZIP CODE: D. NAME: ADDRESS: CITY: STATE: ZIP CODE: 8. NAME AND ADDRESS OF AGENT FOR SERVICE OP PROCESS: NAME: Ralph A. Pica ADDRESS 1050 East Evelyn Avenue crrY: Sunnyvale STATE: CA ZIP CODE:94086 7. ANY OTHER MATTERS TO BE INCLUDED IN THIS CERTIFICATE MAY BE NOTED ON SEPARATE PAGES AND BY REFERENCE HEREIN ARE A PART OF THIS CERTIFICATE. NUMBER OF PAGES ATTACHED: 0 8. INDICATE THE NUMEER OF GENERAL PARTNERS SIGNATURES REQUIRED FOR FILING CERTIFICATES OF AMENDMENT. QLON. CONTINUATION AND CANCELLATION. Q OF GENERAL PARTNER(S) SIGNATURE(S) IS/ARE: 9. IT 1S HEREBY DECLARED THAT I AM (WE ARE) THE PERSON(SI WHO EXECUTED THIS CERTIFICATE OF LIMITED PARTNERSHIP WHICH EXECUTION IS MY (OUR) ACT AND DEED. (SEE INSTRUCTIONS) Provide pFun ing Gro ,,Inc. By:1t SIGNATURE President 11/6/92 POSITION OR TITLE SIGNATURE DATE POSITION OR TITLE DATE SIGNATURE SIGNATURE POSITION OR TITLE DATE POSITION OR TITLE DATE 10. RETURN ACKNOWLEDGEMENT TO: NAME ADDRESS CITY STATE ZIP CODE Steven K. Denebeim, Esq. Feldman, Waldman & Kline, APC 235 Montgomery St., #2700 )San Francisco, CA 94104-3160 7 1 5961.0000 1 (PLEASE INDICATE NUMBER ONLY. SEC/STATE REV I SS ,moo FORM :F•1—)LING RE 170 Appeared by S.c,.ury of Sun THIS SPACE FOR FIUNG OFFICER USE CV1.3\"iccc�� FILED In the oRki of t)u S. rr try of State of 1M Stah of Cerifortlio NOV 1 O 192? MARCH FONG Eu SECREL)Y OF STATE s. FLORIDAULPARI ML'r of STATE' I :f \'QRI'OP.- IOUS Olt (iglu/ Srnre uJ 1:1(>1 4(111 trr btiilr Qjrtment of State / Division of Corporations / Search Records / Detail By Document Number / Detail by Entity Name Foreign Profit Corporation PFG LOANS, INC. Cross Reference Name PROVIDENT FUNDING GROUP, INC. Filing Information Document Number F98000004548 FEI/EIN Number 77-0293745 Date Filed 07/30/1998 State CA Status ACTIVE Last Event CANCEL ADM DISS/REV Event Date Filed 10/27/2008 Event Effective Date NONE Principal Address 851 TRAEGER AVENUE SUITE 100 SAN BRUNO, CA 94066 Changed: 02/21/2012 Mailing Address 851 TRAEGER AVENUE SUITE 100 SAN BRUNO, CA 94066 Changed: 02/21/2012 Regjstered Agent Name & Address CORPORATION SERVICE COMPANY 1201 HAYS STREET TALLAHASSEE, FL 32301-2525 Officer/Director Detail Name & Address Title PDVC http://search.sunbiz org/Incuiry/CorporationSearch/SearchResu...clung&listNareOrder=PROV;DcNTFUND'NG%20F990000022710 10/25/17, 2:43 PM Page 1 of 3 PICA, R. CRAIG 851 TRAEGER AVENUE, SUITE 100 SAN BRUNO, CA 94066 Title DSVP PICA, DOUGLAS 851 TRAEGER AVENUE, SUITE 100 SAN BRUNO, CA 94066 Title DSVS BLAKE, MICHELLE 851 TRAEGER AVENUE, SUITE 100 SAN BRUNO, CA 94066 Annual Reports Report Year 2015 2016 2017 Filed Date 04/13/2015 04/29/2016 04/24/2017 Document Imaggi 04/24/2017 -- ANNUAL REPORT VU w mage in PDF formrt 04/29/2016 - AN!NUAL REPORT View image in PDF format J 04/13/2015 -- ANNUAL REPORT View imago in PDF format 95/01/2014 -- ANNUAL REPORT 04/16/2013 -- ANNUAL REPORT 02/21/2012 -- ANNUAL REPORT 04/04/2011 -- ANNUAL REPORT 0421/2010 -- ANNUAL REPORT 04/24/2009 -- ANNUAL REPORT 10/27/2008 -- REINSTATEMENT 04/30/2007 -- ANNUAL REPORT X42006 -- ANNUAL REPORT 04/06/2005 -- ANNUAL REPORT 05/03/2004 -- ANNUAL REPORT 02/17/2003 - ANNUAL REPORT 05/29/2002 -- ANNUAL REPORT 09/06/2001 -- ANNUAL REPORT 05/08/2000 -- ANNUAL REPORT 07/30/1999 -- ANNUAL REPORT 07/30/1998 -- Foreign Profit View image in PDF format View image m PD.= format View image 11 PDF format View image .n PDF format View image in PDF format View Image in PDF format View image in PDF format View imrge in PDF format _JI View image in PDF format View image in PDF format View image in PDF fo;mc.t View !maga in PDF format View imacp ,n Por format View imago in PDF format`j View image in PDF format j View image in PDF format ^� View image in PDF format http://search.sunhiz.orcg/Inqurry/CorporltionSearchfSearchResu...ding&listNarleOrder=PROV'DEN-MUNL`ING7,20,,990000022710 10/25/17, 2:43 PM Pago 2 of 3 8017 FOREIGN PROFIT CQR_POBATLOILANNUAL REPORT FILED DOCUMENT# F98000004548 Apr 24, 2017 Entity Name: PFG LOANS, INC. Secretary of State CC5588344593 Current Principal Place of Business: 851 TRAEGER AVENUE SUITE 100 SAN BRUNO, CA 94066 Current Mailing Address: 851 TRAEGER AVENUE SUITE 100 SAN BRUNO, CA 94066 FEI Number: 77-0293745 Name and Address of Current Registered Agent: CORPORATION SERVICE COMPANY 1201 HAYS STREET TALLAHASSEE, FL 32301-2525 US Certificate of Status Desired: No The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Officer/Director Detail : Title PDVC Title DSVP Name PICA, R. CRAIG Name PICA, DOUGLAS Address 851 TRAEGER AVENUE, SUITE 100 Address 851 TRAEGER AVENUE, SUITE 100 City -State -Zip: SAN BRUNO CA 94066 City -State -Zip: SAN BRUNO CA 94066 Title DSVS Name BLAKE, MICHELLE Address 851 TRAEGER AVENUE, SUITE 100 City -State -Zip: SAN BRUNO CA 94066 Date I hereby earthy that the Information indicated on this repon or supplemental report Is true and accurate and that my electronic signature shall have the same legal effect as It made under oath; that 1 am an officer or director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 607, Fonda Statutes; and that my name appears above, or on an attachment with all other like empowered. SIGNATURE: MICHELLE C. BLAKE SECRETARY 04/24/2017 Electronic Signature of Signing Officer/Director Detail Date Corporate Resotution Michelle C. Blake, Secretary of Provident Funding Group, Inc., a corporation duly organized and existing under the laws of the State of California, and General Partner of Provident Funding Associates, L.P., do hereby certify that the following is a true and correct copy of a resolution of the Board of Directors of said corporation, adopted at a special meeting held on the 2" day of May in the year 2012: RESOLVED, that any one of the following: • Stephanie Contreras, Assistant Vice President • Kimberly Doyel, Assistant Vice President • Ernie Brede, Assistant Vice President • Rebecca Brede, Assistant Vice President is authorized and directed to cause the Company to take all steps necessary to effect the sale of any real property pursuant to a notice of time and place of a foreclosure sale; to bargain, sell, transfer, assign, set over and deliver the real property; and to sign the name of Provident Funding Associates, L.P., to all deeds, contracts of sale or other instruments necessary to carry out this resolution, all of the acts in the premises undertaken by each of these individuals being ratified as the act and deed of this corporation. FURTHER RESOLVED, that any and all actions taken these individuals in connection with the matters contemplated by this resolution be, and are hereby, approved, ratified and confirmed in all respects as full as if such actions had been presented to the Board of Directors for its approval prior to such actions being taken. (tit LL µi Miami Shores Village 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. 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: TiCof, s1 In Coa / BUSINESS ADDRESS: ciLl b N i& ) 3 Si CITY DDeA I STATE -FL ZIP 3313-2 BUSINESS PHONE: (3 05 ) 599' A ge,2 FAX NUMBER (,05) 599 - g2gq CELL PHONE (776) 35-012.57 QUALIFIER'S NAME: 'e.-1 p► (or) QUALIFIER'S LIC NUMBER: ePtc__ Is 1 595_6 I .1' Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6285050 BUSINESS NAME/LOCATION PICON DESIGN CORP 9468 NW 13 ST DORAL FL 33172 OWNER PICON DESIGN CORP Worker(s) RECEIPT NO. RENEWAL 6550744 EXPIRES SEPTEMBER 30, 2018 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art9 & 10 SEC. TYPE OF BUSINESS 196 GENERAL MECHANICAL CONTRACTOprAYMENT RECEIVED CAC1815956 -aY TAX COLLECTOR S45,00 07/11/2017 CHEW 1-17-059400 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 NO. above mint be displayed on all commercial vehicles - Miami -Dade Code Sec Ba -276. For more infoisnation, visit www.mrisraidodo,govilexcollegler *134#.17141.11,113111,447.11. 2017-2018 LOCAL BUSINESS TAX RECEIPT TY OF DORAL FLA)RIDA 8401 NorthvieSt 5;,,ir" Terrace !Dora, Elora 331ao (35) 593-633-i 213WAR WAREHOUSE DISTRIBUTION CENTER -OR THE RMRIOD ENE AND ENDING NAEINTHE#OL Nally, PI ON DESIGN CORP 9468 NW 13 ST UNIT 73 DORAL, FL 33172 NO RETAIL SALES, NO OUTSIDE STORAGE OR DI DRY USE ONLY. 2018002382 MACHINES. SEATS STATE LIC #: EMPLOYEES LICENSE FEE: 6 $60.00 NW 53ro lerrace, Dorai,F1 *.:$314,„kArotoo,olt of rat m.305-5 3- W T RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD The CLASS B AIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date AUG 31, 2018 PICON, NEIL PICON DESIGN CORP 4050 SW 139 AVE - MIAMI FL 33175 A Rh° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/27/2017 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 Accurate Group Llc 8300 West Flagler Suite 114AODRLE.SS;_ Miami, FL 33144 Phone (305) 226-8727 Fax (305) 226-8767 CONTACT NAME: Lucia Estrella PHONE FAX 305 226-8767 (AIC. N yE�ctj (305)226-8727 (AIC. No): ( ) accurate.certificates@gmail.com INSURER(S)AFFORDING COVERAGE NAICf INSURER A: United Specialty Insurane Company 12537 INSURED Picon Design Corp dba Picon Air Conditioning & Insulation Corp 4050 SW 139th Ave Miami FL 33175-6406 INSURERB: AmTrust North America Insurance Company 13012 INSURER C : $ 5,000.00 INSURER D : M INSURER E : $ 1,000,000.00 INSURER F: GENERAL AGGREGATE E 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. ILTR TYPE OF INSURANCE L N UBR N POLICY NUMBER SI1100513204566 (POLICY M DDY�) 12/26/2016 (MMIDDY�) 12/26/2017 LIMITS EACH OCCURRENCE I $ 1,000,000.00 A M COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) $ 50,000.00 M CLAIMS -MADE t!7 OCCUR MED EXP (Any one person) $ 5,000.00 IIN M PERSONAL BADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 2,000,000.00 0 POLICY • PRO- • LOC PRODUCTS - COMP/OP AGG S 2,000,000.00 ■ OTHER Emp.Ben $ 1,000,000.00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ a ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED • SCHEDULED • AUTOS AUTOS PROPERTY DAMAGE $ accident) HIRED AUTOS NON -OWNED III(Per $ El II EACH OCCURRENCE $ • UMBRELLA LIAB • OCCUR • EXCESS LIAB • CLAIMS -MADE AGGREGATE $ • DED • RETENTIONS $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIV OFFICER/MEMBER EXCLUDED? In NH) N IA Y AWC1071196 08/22/2017 08/22/2018 ituPER OTH- S29TUTE 1 F$ $ 500,000.00 E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ 500,000.00 (Mandatory If yes, describe under 1 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Contractor License Number CAC1815956 CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 NE 2nd Avenue 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. AUTHORIZED REPR Lucia Estrella ACORD,25 (2014101) QF D CORPORATION. All rights reserved. The A ORD name an • logo are registered marks of ACORD a pc al AIR CONDITIONING 9468 NW 13th St - Doral, FL 33172 Ph: (305) 599-8282 F: (305) 599-8284 picondesigncorp@yahoo.com October 25, 2017 To: PROVIDENT FUNDING ASSOCIATES L P 165 NW 96 St Miami Shores, FL 33131 flrbc1@aol.com A/C Full Replacement Invoice No. 158883 Subject: Air Conditioning System Furnishing and Installation • 3 Ton 14 SEER Rheem complete Air Conditioning system with new ecological refrigerant R -410a [C/U- RA1436AJ1 NA] [NH- RH1 P3617STANJA] Total Amount $3,095.00 Includes: City Permit, digital thermostat, float switch, heater, hurricane C/U straps, equipment, materials, labor, and warranties Warranties: Compressor 10 years and Parts 10 years by manufacturer: Labor: 1 year Kind regards Neil Picon President Picon Design Corp Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax:(305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): 1 i! 5 N l,J q a - City: Miami Shores Village County: Miami Dade Zip Code: 3 3 f 50 ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED Change disconnecting means: YES ❑ NO ❑ ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER 121‘2.00^ AHU or PKG. UNIT MODEL # {Z41 ?3,6 n.sTgNSot COND. UNIT MODEL# RA 14-1104710A KW HEAT NOM TONS 3 AHU CU PKG 1) M.C.A AHU CU PKG AHU CU PKG 2) M.O.P AHU CU PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / / EER/SEER i 4 YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT (E) NO YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: �/1 \ Contractor's Company Name: 1 i co, X_�,S 1 et910 Phone: (3o& cl State Certificate or Registration No. CAC \ S Jkb Certificate of Competency No. Date: 101021 I (9-D Signature n (Revised02/24/2014) Qualifier's signature) ``�� roduct Ratan s ... i CERTIFI .D° www.ahridirectory.org Ce, ificate of AHRI Certified Reference Number: 7499174 Date: 10/25/2017 Product: Split System: Air-Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: RA1436AJ1 Indoor Unit Model Number: RH1P3617STAN Manufacturer: RHEEM SALES COMPANY, INC. Trade/Brand name: RHEEM; RUUD Region: Southeast and North (AL, AR, DC, DE, FL, GA, HI, KY, LA, MD, MS, NC, OK, SC, TN, TX, VA AK, CO, CT, ID, IL, IA, IN, KS, MA, ME, MI, MN, MO, MT, ND, NE, NH, NJ, NY, OH, OR, PA, RI, SD, UT, VT, WA, WV, WI, WY, U.S. Territories) Region Note: Central air conditioners manufactured prior to January 1, 2015, are eligible to be installed in all regions until June 30, 2016. Beginning July 1, 2016, central air conditioners can only be installed in region(s) for which they meet the regional efficiency requirement. Series name: Manufacturer responsible for the rating of this system combination is RHEEM SALES COMPANY, INC. Rated as follows In accordance with AHRI Standard 210/240-2008 for Unitary Air-Conditioning and Alr-Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, independent, third party testing: Cooling Capacity (Btuh): 34000 EER Rating (Cooling): 11.50 SEER Rating (Cooling): 14.00 IEER Rating (Cooling): ' Ratings followed by an asterisk (*) indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an Involuntary rerate. DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s), or the unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed in the directory at www.ahridlrectory.org. TERMS AND CONDITIONS N rit;D This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and A e_y confidential reference purposes. The contents of this Certificate may not, in whole or in part, be reproduced; copied; disseminated; a;� entered into a computer database; or otherwise utilized, in any form or manner or by any means, except personal and confidential reference. CERTIFICATE VERIFICATION for the user's individual, AIR-CONDITIONING, HEATING, & REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.ahrldlrectory.org, click on "Verify Certificate" Zink we make life better'" and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above, and the Certificate No., which is listed at bottom right. ©2014 Air-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 131534135979201622 t C. b t 1 1 Si CERTIFIED° www.ahridirectory.org Certificate of Product Ratings AHRI Certified Reference Number: 7499174 Date: 10/27/2017 Product: Split System: Air-Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: RA1436AJ1 Indoor Unit Model Number: RH1P3617STAN Manufacturer: RHEEM SALES COMPANY, INC. Trade/Brand name: RHEEM; RUUD Region: Southeast and North (AL, AR, DC, DE, FL, GA, HI, KY, LA, MD, MS, NC, OK, SC, TN, TX, VA AK, CO, CT, ID, IL, IA, IN, KS, MA, ME, MI, MN, MO, MT, ND, NE, NH, NJ, NY, OH, OR, PA, RI, SD, UT, VT, WA, WV, WI, WY, U.S. Territories) Region Note: Central air conditioners manufactured prior to January 1, 2015, are eligible to be installed in all regions until June 30, 2016. Beginning July 1, 2016, central air conditioners can only be installed in region(s) for which they meet the regional efficiency requirement. Series name: - _ - - -- - - f Manufacturer responsible for the rating of this system combination is RHEEM SALES COMPANY, INC,. 1 Rated as follows in`a Icorldance with AHRI Sta I dard'210/240-2008 for Unitary Air-Conditionrng and Air-Source HeatlPump Equipment subject to verification of rating accuracy by AHRI-sponsored, independent,�third party ttesting: _ , , I _ �- i - � __ — I .. I ' Cooling Capacity (Stun): 34000, /, rt, 1;t .f_ ;• ii ,� ;1 11)I-' +1 `G` EER Rating (Cooling): 11.50/ SEERRating(Cooling): 14:00- IEER Rating (Cooling): ' Ratings followed by an asterisk (') indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models directory at www.ahridlrectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used confidential reference purposes. The contents of this Certificate may not, in whole or in part, be reproduced; entered into a computer database; or otherwise utilized, in any form or manner or by any means, except personal and confidential reference. CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified at www.ahridirectory.org, click and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above, and the Certificate No., which is listed at bottom right. ©2014 Air-Conditioning, Heating, and Refrigeration Institute or guarantees as to, and assumes no responsibility for, arising out of the use or performance of the product(s), or the and configurations listed in the for individual, personal and copied; disseminated; •"sa 1 for the user's individual, AIR-CONDITIONING, HEATING, & REFRIGERATION INSTITUTE on "Verify Certificate" link we make life better' 1 CERTIFICATE NO.: 131535911571009485