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PL-15-965Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 f?1(/5- '767 Inspection Number: INSP-233162 Permit Number: PL -4-15-965 Scheduled Inspection Date: January 21, 2016 Inspector: Diaz, Osvaldo Owner: Job Address: 5 NE 107 Street Miami Shores, FL 33161-7029 Project: <NONE> Contractor: ACA CONSTRUCTION INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1121360070330 Phone: (305)788-8914 Building Department Comments CHANGE VANITY AND SHOWER PAN IN MASTER BATHROOM 2 BATHROOM CHANGE VANITY AND TOILET ADD WATER LINE FOR REFRIGERATOR 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 7,1 January 20, 2016 For Inspections please call: (305)762-4949 Page 3 of 32 G'6 STATE OF FLORIDA c r 41ARTMEP4T OF BU31$eSS A PROFESSIONAL R Gu[.A i ,f=:.) coormu T)ON Nets' YocePtS!!O BOARD ORES `'RUCTIONTER 33/65 SLAY AS REQIJR BY tAW 6 A -4 J4 • Oct 22 1511:43p Delta Insurance Und. Inc. t 1 3052691108 p.1 ACC) Lj �,,,� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYI'Y) 10/22/2015 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 1NSURER(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 DELTA INSURANCE UNDERWRITERS, INC. 777 N.W. 72nd AVENUE. SUITE 3133 MIAMI, FLORIDA 33126 CONTACT LUIS DE LA LLERA PHONE 305-269-1107 IFS` 305-269-1108 Ext): A/ . Nol: `E ACi(ANiL ADDRESS: DELTAINSUND@AOL.COM INSURERS) AFFORDING COVERAGE NAIC s INSURER A: ARCH SPECIALTY INSURANCE COMPANY 21199 INSURED ACA CONSTRUCTION, INC. dba ACA PLUMBING 10725 SW 55 TERRACE MIAMI, FLORIDA 33165 INSURER B: INSURER C: AGL003117-02 INSURER D: 08/05/2016 INSURER E: $ 1,000,000. INSURER F: 100,000.RE S COVERAGES CERTIFICATE 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 CONDI'17ON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE AWL INSR SOUR WVD POLICY NUMBER POLICYEFF (NMIDDJYYYY) PODUY 1:X1• (MMVDD/YYYY1 LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL J LIABIUTY OCCUR AGL003117-02 08/05/2015 08/05/2016 EACH OCCURRENCE $ 1,000,000. DAMAGE 10 S (ccencel 100,000.RE S CLAIMS -MADE MED EXP (Any one person) $ 10,000. GEN'L PERSONAL a ADV INJURY $ 1,000,000. GENERAL AGGREGATE S 2,000,000. AGGREGATE Limn- APPLIES PER: POLICY n ECR°`- ELOC PRODUCTS - COM P/OPAGG S 1,000,000. Deductible per Claimant $ 2,500. AUTOMOBILE _ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS ---' SCHEDULED I AUTOS NON -OWNED AUTOS COMBINED tlED� SINGLE LIMIT s BODILY INJURY (Per person) S BODILY INJURY (Per accident) 1 PROPERTY DAMAGE (Per accident) S 1 UMBRELLA LIAR ' EXCESS UAB jl I OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE 5 DED RETENTION $ 1 WORXERS COMPENSATION AND LIABIUTY Yl N ANY PROPRIETORIPPJRTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (MandeteryIn NH) K es, desvihe under DESCRIPTION OF OPERATIONS below N /A WC AIU- OTH- ER TORY LIMTS ER E.L. EACH ACCIDENT $ E.L. DISEASE • EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) GENERAL CONTRACTOR LICENSE NUMBER: CGC1511172. PLUMBING CONTRACTOR LICENCE NUMBER: CFC1427635. ROOFING CONTRACTOR LICENSE NUMBER: CCC1328217. rFRTIFIrATG LJIll IWCD — _____.. VILLAGE OF MIAMI SHORES / BUILDING DEPT. 10050 NE 2nd AVENUE MIAMI SHORES, FL 33138 PH 305 795 2204 FAX 305 756 8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE LUIS DE LA LLERA ACORD 25 (2010/05) ®1988-2010 ACORD CORPORATION. All rihts reserved. The ACORD name and logo are registered marks of ACORD MIAMI-DADE t©t1NTl' 5811063 DBA/BUSINESS NAME: ACA CONSTRUCTION INC BUSINESS LOCATION: 10725 SW 55 TERR MIAMI, FL 33165 OWNER/CORP. ACA CONSTRUCTION INC PHONE # 305-788-8914 10725 SW 55 TERR MIAMI, FL 33165 NAICS CODE: 2389 MIAMI-DADE COUNTY - STATE OF FLORIDA LOCAL BUSINESS TAX RENEWAL 2015 - 2016 APPLICATION RECEIPT: 6059026 STATE # CGC1511172 BUS. COMMENCEMENT DATE:06/01/2006 SEC TYPE OF BUSINESS BLDG1 GENERAL BUILDING CONTRACTOR 1 N/A October 26, 2015 APPLICATION DETAILS FEE AMOUNT Receipt Fee 30.00 UMSA Fee 30.00 Beacon Council Fee 15.00 Bingo Permit Fee 0.00 Nightclub Permit Fee 0.00 Multi -Municipal Contractor Fee 0.00 Restricted Contractor Fee 0.00 Library Fee 0.00 Transfer Fee 0.00 Doing Business without a License Penalty 0.00 Late Penalty 0.00 Collection Cost 0.00 NSF Fee 0.00 Prior Years Due 0.00 Amount Recently Paid - 75.00 TOTAL AMOUNT DUE: 0.00 If no longer in business, please notify us in writing. Review and correct the information shown on this application. A 25% penalty will be assessed to anyone found operating without a paid local business tax, in addition to any other penalty provided by law or ordinance (Sec 8A-176(2)). A Certificate of Use and/or City Business Tax Receipt may also be required. To pay online go to www.miamidade.gov/taxcollector To pay by mail, make check payable to: Miami -Dade County Tax Collector Business Tax 200 NW 2nd Avenue Miami FL 33128 To pay in person go to: 200 NW 2nd Avenue (305) 270-4949, fax (305) 372-6368 A service fee of not less than $25.00 up to a minimum of 5% will be charged for all returned checks. t RETAIN FOR YOUR RECORDS t MIAMI-DADE COUNTY - STATE OF FLORIDA LOCAL BUSINESS TAX 2015 - 2016 APPLICATION 5811063 BUSINESS LOCATION: 10725 SW 55 TERR MIAMI, FL 33165 OWNER/CORP. ACA CONSTRUCTION INC ACA CONSTRUCTION INC ANDRES LEMUS PRES 10725 SW 55 TERR MIAMI, FL 33165 ♦ DETACH HERE AND RETURN THIS PORTION WITH YOUR PAYMENT ' 11 11 11 N/A October 26, 2015 RENEWAL RECEIPT: 6059026 STATE #CGC1511172 BUS. COMMENCEMENT DATE: 06/01/2006 SEC TYPE OF BUSINESS BLDG1 GENERAL BUILDING CONTRACTOR 1 APPLICATION IS HEREBY MADE FOR A LOCAL BUSINESS TAX RECEIPT OR PERMIT FOR THE BUSINESS PROFESSION OR OCCUPATION DESCRIBED HEREON. I HAVE BEEN INFORMED OF ALL ZONING RESTRICTIONS IMPOSED ON THIS RECEIPT. I SWEAR THAT THE INFORMATION IS TRUE AND CORRECT. SIGNATURE REQUIRED SEE INSTRUCTIONS ABOVE Please pay only one amount. The amounts due atter Sept 30th Include penalties per FS 205.053. If Received By Oct 31, 2015 Nov 30, 2015 Dec 31, 2015 Jan 31, 2016 Please Pay $0.00 $0.00 $0.00 $0.00 7000000000000000000000006059026201600000007500000000000006 MIAMI•DADE COUNTY 5811063 DBA/BUSINESS NAME: ACA CONSTRUCTION INC BUSINESS LOCATION: 10725 SW 55 TERR MIAMI, FL 33165 OWNER/CORP. ACA CONSTRUCTION INC PHONE # 305-788-8914 10725 SW 55 TERR MIAMI, FL 33165 NAICS CODE: 238990 MIAMI-DADE COUNTY - STATE OF FLORIDA LOCAL BUSINESS TAX 2015 - 2016 APPLICATION BUS. COMMENCEMENT DATE:06/01/2006 SEC TYPE OF BUSINESS SPECIALTY BUILDING CONTRACTOR BLDGS 1 N/A October 26, 2015 RENEWAL RECEIPT: 6493910 STATE # CCC1328217 APPLICATION DETAILS FEE AMOUNT Receipt Fee 30.00 UMSA Fee 30.00 Beacon Council Fee 15.00 Bingo Permit Fee 0.00 Nightclub Permit Fee 0.00 Multi -Municipal Contractor Fee 0.00 Restricted Contractor Fee 0.00 Library Fee 0.00 Transfer Fee 0.00 Doing Business without a License Penalty 0.00 Late Penalty 0.00 Collection Cost 0.00 NSF Fee 0.00 Prior Years Due 0.00 Amount Recently Paid - 75.00 TOTAL AMOUNT DUE: 0.00 If no longer in business, please notify us in writing. Review and correct the information shown on this application. A 25% penalty will be assessed to anyone found operating without a paid local business tax, in addition to any other penalty provided by law or ordinance (Sec 8A-176(2)). A Certificate of Use and/or City Business Tax Receipt may also be required. To pay online go to www.miamidade.gov/taxcollector To pay by mail, make check payable to: Miami -Dade County Tax Collector Business Tax 200 NW 2nd Avenue Miami FL 33128 To pay in person go to: 200 NW 2nd Avenue (305) 270-4949, fax (305) 372-6368 A service fee of not less than $25.00 up to a minimum of 5% will be charged for all returned checks. t RETAIN FOR YOUR RECORDS t MIAMI-DADE COUNTY - STATE OF FLORIDA LOCAL BUSINESS TAX 2015 - 2016 APPLICATION 5811063 BUSINESS LOCATION: 10725 SW 55 TERR MIAMI, FL 33165 OWNER/CORP. ACA CONSTRUCTION INC ACA CONSTRUCTION INC ANDRES LEMUS PRES 10725 SW 55 TERR MIAMI, FL 33165 1 DETACH HERE AND RETURN THIS PORTION WITH YOUR PAYMENT 11 N/A October 26, 2015 RENEWAL RECEIPT: 6493910 STATE #CCC1328217 BUS. COMMENCEMENT DATE: 06/01/2006 SEC TYPE OF BUSINESS BLDGS SPECIALTY BUILDING CONTRACTOR 1 APPLICATION IS HEREBY MADE FOR A LOCAL BUSINESS TAX RECEIPT OR PERMIT FOR THE BUSINESS PROFESSION OR OCCUPATION DESCRIBED HEREON. I HAVE BEEN INFORMED OF ALL ZONING RESTRICTIONS IMPOSED ON THIS RECEIPT. I SWEAR THAT THE INFORMATION IS TRUE AND CORRECT. SIGNATURE REQUIRED SEE INSTRUCTIONS ABOVE Please pay only one amount. The amounts due after Sept 30th include penalties per FS 205.053. If Received By Oct 31, 2015 Nov 30, 2015 Dec 31, 2015 Jan 31, 2016 Please Pay $0.00 $0.00 $0.00 $0.00 7000000000000000000000006493910201600000007500000000000000 Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address 5 NE 107 Street Miami Shores, FL 33161-7029 Permit Permit NO. PL -4-15-965 Permit Type: Plumbing - Residential Work Classification: Addition/Alteration Pemait Status: APPROVED Issue Date: 9/15/2015 Expiration: 03/13/2016 Parcel Number 1121360070330 Block: Lot: Applicant EAST WEST PROPERTIES HOLE Owner Information Address EAST WEST PROPERTIES HOLDINGS 3900 NW 2 Avenue • • - MIAMI FL 33127- 3900 NW 2 Avenue MIAMI FL 33127- Contractor(s) ACA CONSTRUCTION INC Phone (305)788-8914 CeII Phone Phone Cell Valuation: Total Sq Feet: $ 5,100.00 00 Type of Work: CHANGE VANITY AND SHOWER PAN IN MAS Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $3.60 $3.38 $3.38 $1.20 $225.00 $9.00 $4.80 $250.36 Pay Date Pay Type Invoice # PL -4-15-55301 09/15/2015 Credit Card 04/22/2015 Credit Card Amt Paid Amt Due $ 200.36 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Top Out Final Review Plumbing 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 AFFIDAVIT: I certi ..t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction an. enifig. Futhh•:_ .•=; - . orize the above-named contractor to do the work stated. September 15, 2015 or ture:Owner / Applicant / Contractor / Agent Building Department Copy Date September 15, 2015 1 BUILDING PERMIT APPLICATION ❑BBUILDING ❑ ELECTRIC ('PLUMBING ❑ MECHANICAL 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 RECEIVED APR 12 2015 BY FBC 20 /0 Master Permit No. )2C. /s ' 96 /. Sub Permit No./O/ ❑ ROOFING ❑ REVISION ❑ EXTENSION (RENEWAL 0PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 5 tJ t 0 J -k - City: Miami Shores Folio/Parcel#: Occupancy Type: i,-. Load: County: Miami Dade Zip: Isthe Building Historically Designated: Yes Construction Type: �--4S Flood Zone: BFE: NO FFE: OWNER: Name (Fee Simple Titleholder): Phone#: 3O5 - Address: 3Q cD • City: Tenant/Lessee Name: / Phone#: Email: State: Zip: -3 31 -T CONTRACTOR: Company Name: J�`' S ACS 0 eTh Address: NA/ - City: Phone#: 3cD-C-_ 'g, State: r L_ Qualifier Name: L.A. J . Zip: -;25 Co. Phone#: oS�IG- 3g‘ --i&. State Certification or Registration #: C.- C_. 1 `-} z ) Co Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: Value of Work for this Permit: $ 5 I O0 Type of Work: ❑ Addition ❑ Alteration ❑ City: State: Zip: Square/LinearFo�otage of Work: lrF New �v repair/Replace ❑ Demolition Description of Work: C%►'"�r-SGP ‘f�-� � ��' Q'"cl S l� O V`P� C.� r�/C S-4- I Specify color of color thru tile: Submittal Fee $ 3 Permit Fee $ 4 2 2.C; +Zy CCF $ CO/CC $ Scanning Fee $ Radon Fee $ _ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE$ )-`1 . (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. --''.(6-\1 Signature C,,e/ Signatu OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this m ay of 1 20 (`- by ��� day of pr- I 20 ` _, by sow?�G� �ti cl-efc I9 oo is p sonally knov n to-,i�✓1r � f Q r) (4 who is ersonall�y keno n to me or who has produced as me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: identification and who did take an oath. NOTARY PUBLIC: Sign: (407) 398-0163 FloridallotaryService.com K P int: € MY COMMISSION #FF158014S al: •,„Iro,M1d!A EXPIRES October 1, 2018 I f t MY COMMISSION #FF158014 ' - '•+?cr,n EXPIRES October 1, 2018 (407) 398-0183 Floridallotary8ervice.com ************************************************************************************************************ APPROVED BY 6'f 15 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) A nz.. � CERTIFICATE OF LIABILITY. INSURANCE ,.,,.rte DATE(MM/DDNYYY) 08/28/2014 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(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER DELTA INSURANCE UNDERWRITERS, INC. 777 N.W. 72nd AVENUE, SUITE 3133 MIAMI, FLORIDA 33126 CONTACT LUIS DE LA LLERA NAME: PHONE 305-269-1107 FA 305-269-1108 A/C No, EM): A! ,Noy E-MAIL DELTAINSUND@AOL. COM INSURER(S)AFFORDING COVERAGE NAIC # INSURERA: ARCH SPECIALTY INSURANCE COMPANY 21199 INSURED ACA CONSTRUCTION, INC. dba ACA PLUMBING 10725 SW 55 TERRACE MIAMI, FLORIDA 33165 INSURER B: AGL003117-01 INSURER C: 08/05/2015 INSURER D: $ 1,000,000. INSURER E: $ 100,000. INSURER F: $ 10,000. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMEN T WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSRZWVD POLICY NUMBER POLICY EFF (MM/DDIYYYY) POLICY EXP (MMIDDIYYYY) LIMITS A GENERAL ✓ LIABILITY COMMERCIAL GENERAL LIABILITY JCLAIMS-MADE , /J OCCUR V AGL003117-01 08/05/2014 08/05/2015 EACH OCCURRENCE $ 1,000,000. DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000. MED EXP (Any one person) $ 10,000. PERSONAL 8, ADV INJURY $ 1,000,000. GENERAL AGGREGATE $ 2,000,000. GEN'LAGGREGATE LIMITAPPLIESPER: J POLICY I- 1 ECJ r 1 LOC PRODUCTS-COMP/OPAGG $ 1,000,000. $ AUTOMOBILE __ _ _.. _ _ ___ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS i SCHEDULED J1 AUTOS I NON -OWNED i AUTOS I COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB I OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ WORKERS M P O RSCO LIABILIITTY�N AND Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE r iN OFFICER/MEMBER EXCLUDED? L__, (Mandatory in NH) If yes. describe under DESCRIPTION OF OPERATIONS below / A TORY IMITS I , OEHR E.L. EACH ACCIDENT $ EL. DISEASE • EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, iT more space is'aquirad) GENERAL CONTRACTOR LICENSE NUMBER: CGC1511172. PLUMBING CONTRACTOR LICENCE NUMBER: CFC1427635. ROOFING CONTRACTOR LICENSE NUMBER: CCC1328217. I VILLAGE OF MIAMI SHORES / BUILDING DEPT. 10050 NE 2nd AVENUE MIAMI SHORES, FL 33138 PH 305 795 2204 FAX 305 756 8972 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 LUIS DE LA LLERA �. _ ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD