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MC-17-2171Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. MC -8-17-2171 Permit Type: Mechanical - Residential Worts Classification: A/C Replacement Permit Status: APPROVED Issue Date: 8/30/2017 Expiration: 02/26/2018 Parcel Number Applicant 101 NE 104 Street Miami Shores, FL 33138- 1121360130700 Block: Lot: RMGM PROPERTIES LLC Owner Information Address 4764 NW 120 Drive CORAL SPRINGS FL 33076- 4764 NW 120 Drive CORAL SPRINGS FL 33076- Phone Cell Contractor(s) SMC AIR CONDITIONING Phone Cell Phone (954)562-8161 Valuation: Total Sq Feet: $ 3,150.00 0 Tons: 5 Additional Info: A/C CHANGE OUT REPLACEMENT 5 TONS Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 3 Date Approved:: In Review Type of Work: NC CHANGE OUT REPLACEMENT 5 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Amount $2.40 $2.00 $2.00 $0.80 $110.25 $9,00 $3.20 Total: $129.65 Pay Date Pay Type Amt Paid Amt Due Invoice # MC -8-17-65007 08/28/2017 Check #: 003293 $ 50.00 $ 79.65 08/30/2017 Check #: 3307 $ 79.65 $ 0.00 Available Inspections: Inspection Type: Final Review Mechanical 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 construction and zoning. t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating I authorize the above-named contractor to do the work stated. Authoriz • igna T e: Owner / Applicant / Contractor / Agent Building Department Copy August 30, 2017 Date August 30, 2017 1 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑PLUMBING MECHANICAL JOB ADDRESS: Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Horida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 Master Permit No. Sub Permit No. RECEIVED ,G 28201 sh SBC 20 �� I Mc f 21� ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS / 0! N3 /o4 S+ 33138 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: /1 !3lsc130 boa Is the Building Historically Designated: Yes NO X Occupancy Type: L Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Tom- &T -VII\ C (1 ,ypspAr.0 S L ''Shone#: Address: kk-4KQN t V3 \2–A c �( City: Co__ M s Q� \ (�C S State: Y . Zip (3 3 oS -3-32y Tenant/Lessee Name: Email: 0 r\i'S`r\ ,',10 uJ glrwin. e cnvN CONTRACTOR: Company Name: Address: 6"031 S'/4C Air (,Q,ndii+'oninq Phone#: S. 6+41e road 7- .0 ,7.04 Phone#: g34SGZ a i ; City: I .4e. State: Qualifier Name: 4 '' 40,eais i�. Phone#: Zip: 335/V QJYSGZ8/4/ State Certification or Registration #: CHS / 2444 34 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 3I50 . oo Square/Linear Footage of Work: Type of Work: ❑ Addition Description of Work: '4(c. ❑ Alteration chance cc.,+ El New 5 Aons 0 Repair/Replace ❑ Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ \ 'p % II'S CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ c7f` 6v (RevisedO2/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signatu OWNER or AGENT The foregoing instrument was acknowledged before me this 2.64 day of Ct , 20 11 , by r� ('€5O t , who is personally known to me or who has produced "FL /DL as identification and who did take an oath. NOTARY PUBLIC: Sign: -Print: ) iTYf Seal: : ►"�:' KEIT s` TNCMP$ON sI, ` MY C�'.' v:iS•;34 u GG030924 #.********, APPROVED BY (Revised02/24/2014) *Irr Signature The foregoing instrument was acknowledged before me this 2c Lday of'J LA—L'1 , 20 t1 , by �ik.ezo o A C , who is personally known to me or who has produced F C 1 T� L as identification and who did take an oath. NOTARY PUBLIC: Sign:S^--- Print: 2 . `T vvL {!S o -►•u Seal: 4F KEITH R THOMPSON A * MY COMMISSION # GG03O 24 *WAWA SM*9111M 442010, Plans Examiner Zoning Structural Review Clerk 8/28/2017 Detail by Entity Name oloyi of � T an !Scull .111h QJfLorLds Department of State / Division of Corporations / Search Records / Detail By Document Number / Detail by Entity Name Florida Limited Liability Company RMGM PROPERTIES LLC Filing Information Document Number L17000006385 FEI/EIN Number NONE Date Filed 01/09/2017 Effective Date 01/09/2017 State FL Status ACTIVE Principal Address 4764 NW 120TH DRIVE CORAL SPRINGS 33076 Mailing Address 4764 NW 120TH DRIVE CORAL SPRINGS 33076 Registered Agent Name & Address MASS, GREGORY M 4764 NW 120TH DRIVE CORAL SPRINGS, FL 33076 Authorized Person(s) Detail Name & Address Title MGR MASS, GREGORY M 4764 NW 120TH DRIVE CORAL SPRINGS, FL 33076 Annual Reports No Annual Reports Filed Document Images 01109/2017 — Florida Limited Liability View image in PDF format http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetai I?i nqui rytype=EntityN ame&directionType= Initial&searchN ameOrder= RM GM PROPERT... 1/2 RICK SCOTT, GOVERNOR ;C14.4C7249636 r'The MECHANICAL,CONTRACTOR Nariied•below=IS CERTIFIED.. Onder the'.provisions°of Chapter 489 FS. - 4 .fExplratiOrrdate•-AUG 31.2018 KEN LAWSON, SECRETARY ' _ STATE OF`FLORIDA DEPARTMENT: OF BUSINESSAND PROFESSIONAL REGULATION \, CONSTRUCTION INDUSTRY LICENSING BOARD- ,�.' �_ ..••••4.X 1j ala ti 1 GA C ArEDGARDO-A==.--.. /SMC;AIR'CONDITIONING '"_ �� *5071.5 STATE RD7JSTE=704— ✓~ DAV,tEr ,,FL 33 • r ISSUED: 08/23/2016 DISPLAY AS REQUIRED BY LAW 1 SEQ # L1608230003089 1 '., BROW 115 Business Name: Owner Name: Business Location: Business Phone: Rooms r RDCCOUNTYT CAT-B'US1NESS"TAX RECEIPT S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2017 THROUGH SEPTEMBER 30, 2018 DBA: SMC AIR CONDITIONING Receipt #:189-6145A OTHER TYPES Business Type: (CERT MECHANICAL EDGARDO A GARCLA Business Opened:09/06/2006 5071 S STATE RD 7 STE 704 State/County/Cert/Reg:CMC1249636 DAVIE Exemption Code: 954-562-8161 Seats Employees Machines Professionals 1 CONTRACT CONTRAC i For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward non -regulatory in nature. You must meet all County and/or Municipality WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred the business is sold, business name has changed or you have business location. This receipt does not indicate that the business it is in compliance with State or local laws and regulations. Mailing Address: SMC AIR CONDITIONING Receipt #05C-16-00005707 5071 S STATE RD 7 STE 704 Paid 07/13/2017 27.00 DAVIE, FL 33314 ._. . ___. - 2017_- 2018 • County and is planning when moved the is legal or that rJ ACO Ue CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 8/28/2017 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(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 Ileu of such endorsement(s). PRODUCER PTL INSURANCE ASSOC., INC. 7201 CORAL WAY MIAMI, FL. 33155 CONTA(,1 NAME: PHONE 305-262-7094 (NC No, Ext): E -Mbit. ADDRESS: / C,No):305-262-4907 INSURERS) AFFORDING COVERAGE NMCN INSURER A : INSURED SUMMA MECHANICAL CONTRACTORS LLC DBA SMC AIR CONDITIONING 5071 S STATE RD 7 STE 704 DAVIE, FL 33314 954-562-8161 INSURER B : FUBA INSURER C : INSURER D : INSURER E : INSURER F : 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 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 LTRmix TYPE OF INSURANCE AWOL sum wvo POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MMIDD/YYYY) LIMITS GENERAL — LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ PRTU o Iuo PREEMM ISS ES (Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ ' GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY El CT n LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE _ _ 4IABILITY ANYAUTO ALL OWNED AUTOS i HIRED AUTOS — — SCHEDULED AUTOS NON -OWNED AUTOS (Ea accident) INULE LIMI 1 $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS IAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED 1 RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYk`RS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE r�Y-�I�N�� OFFICER/MEMBER EXCLUDED? fin I (Mandatory In NH) If yes, describe ander DESCRIPTION OF OPERATIONS below NIA 10651285 01/04/17 01/04/18 WC STATU- TORY LIMITS X OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1 , 000 , 000 E.L. DISEASE - POLICY LIMIT $ 1 , 000 , 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES Attach ACORD 101, Additional Remarks Schedule if more space is required) AIR CONDITIONING INSTALLATION, SERVICE AND REPAIR , CANCELLATION 1 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABS, E DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE ' OLICY PROVISIONS. r` AUTHORIZED REPRE IV: f4 ACORD 25 (2010)05) © 8820CORD C 0 TION. All rights reserved. The ACORD name and logo are registered marks of ACORb OtCEIVCD rAUO 8 2017 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 Th s or 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): /01 NE rat si- City: Miami Shores Village County: Miami Dade Zip Code: 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 Q NO ❑ CdMtratt Attac?i f!YES [ . •. •• • • UNIT BEING REPLACED DATA . .tIgW UNIg • • ►e-^7 MANUFACTURER •.ilro•,,n4 : •••• U1304G'1 A =C--rr AHU or PKG. UNIT MODEL# h.s:r..4coiv.4 •_ /1 ti./A-1 040 COND. UNIT MODEL # S?5!R1f044L• • 10 KW HEAT • • •-70 • S NOM TONS • • - AHU >;Z CU l3 PKG 1) M.C.A AHU 5''`•V.1 }3 PKg•• • AHU Go CU t0 PKG 2) M.O.P AHU Ga CU lio PKG '•: AHU 205 CU 43,5 PKG 3) VOLTS AHU 20$CU 206 PKG PKG UNIT / / PKG UNIT / / 64 EER/SEER JG.. YESi1/O� REPLACING DUCTS YES N`�' YES CO) REPLACING THERMOSTAT tE_,S1 NO YES NEW 4"CONCRETE SLABYES6-4YES g NEW ROOF STAND YES YES (NO) NEW RETURN PLENUM BOX YES 60) I /G 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): /' 3. Voltage of Circuit (208/240/480): 20 $ 4. Size Disconnecting Means: /TV Contractor's Company Name: s' 4it C"'�`�'s"' Phone: 9S�rSG ZS R., State Certificate or Registration No. 'L 6,36' Certificate of Competency No. Signature (Revised02/24/2014) (Qualifier's sign ""re Date: 8/2''',3* • • • • • •• • • Licensed & Insured CMC 1249636 SMC Air Conditioning 5071 S. State Rd 7 # 704 Davie, FL 33314 Phone: (954) 562-8161 I Fax: (954) 434-0188 E-mail: infosmcac.com www.smcairconditioninq.com DATE Og/lt// 177 CHANGE ORDER NUMBER 0 CONTRACTOR: Summa Mechanical Contractors. LLC. D.B.A SMC Air Conditioning OWNER: 'QE -G© 1ZY MASS JOB ADDRESS: 10 1 I1EE to CITY, STATE, ZIP: KA i AAA(, ?L `33 \3 8' Pursuant to that agreement between G-12 £ G 0 e_y i(V\ A S , described herein as OWNER and Summa Mechanical Contractors, LLC. D.B.A SMC Air Conditioning described herein as CONTRACTOR, dated 4g/ /(' / / `7 . •• • The following change is made in the specifications and scope of work to be performed! .,•,.• • PLACE 4 (L ,k LL ---i2 AA. op .P T •; 2.1‘,64(44 • . 'i 1 ? W ' 41 )-}-,� h(D L Ne AV f - -FcLi 91) c •.... • moi•••••• .. .. . . . . .. . . .. . . . . All payment agreements and contract conditions will remain the same as contained.vithi; the alcove mentig1 t : contract dated &1 / 2 0 / / r/ . .. . ••• • .• Not Valid Until Signed By Owner And Contractor/Manager The original contract sum was Net change by previous authorized change orders The contract sum prior to this change order was The contract sum will be '❑ increased o decreased by this change order in the amount of The new contract sum including this change order is The contract time will be o increased o decreased changed by C days The Substantial Completion as of the date of this change order is / / $ ©.00 $ ,o. m o $3i 0 *Si /�-- Contractor/Manager Signature Date Owner Signature Date /40625 60.4k, G Y714S S Print Name Print Nam4 "ESL CERTIFIED° www.ahridirectory.org This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2016. Certificate of Product Ratings AHRI Certified Reference Number: 8996159 Date: 8/14/2017 Product: Split System: Air -Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: GSX160421F* Indoor Unit Model Number: AVPTC49D14A* Manufacturer: GOODMAN MANUFACTURING CO., LP. Trade/Brand name: GOODMAN; JANITROL; AMANA DISTINCTIONS; EVERREST; ONE HOUR AIR CONDITIONING AND HEATING; ENERGI AIR; FRANKLIN Region: All (AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, ID, IL, IA, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, 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 conditipner* can only be installed in region(s) for which they meet the regional efficiency requirerr jt. Series name: GSX16 • .... • . •••• ..•• 111.. • • . . .. . •.••� r 1••• Manufacturer, responsible for the rating of this system combination is GOODMAN MANbJFACTUANb CO., LP.*:. •• • •.•.. Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air -Condit pgfng anti atrfSource... Heat Pump,Equipment and subject to verification of rating accuracy by AHRI-sponsonclsindependept, third .' party testing: ••• ' Cooling Capacity (Btuh): 41500• . .. . .•• . • 1 • • EER Rating (Cooling): 13.00 • • SEER Rating (Cooling): 16.00 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.ahridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and confidential reference purposes. The contents of this Certificate may not, in whole or in part, be reproduced; copied; disseminated; entered into a computer database; or otherwise utilized, In any form or manner or by any means, except for the user's individual, personal and confidential reference. CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified at www.ahridirectory.org, click on "Verify Certificate" link and enter the AHRI Certified Reference Number and the date on which the certificate was issued, AIR-CONDITIONING, HEATING, & REFRIGERATION INSTITUTE we make life better"' which is listed above, and the Certificate No., which is listed at bottom right. ©2014 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 131472029638694015 Date: August 17, 2017 REF: Majorca Towers Condominium, Inc. 11930 N. Bayshore Drive Unit 809 N. Miami, FL 33181 To Whom It May Concern: This is to acknowledge that SUMMA MECHANICAL CONTRACTOR LLC is approved to get all the approvals as part of the documentation requirements for the condominium association in order to grant permission and approval to replace the air conditioning in the apartment:•• Sincerely, 0- GrchaP iro, LCAM M dORCA TOWERS CONDOMINIUM, INC. • . . • .. . ... . . . . • ..• . . . • . .... .. . • .• • .. . •••• . • .. . . .. . . . . . . .. .. ..• . . . . • .. . • . •• . • . •• • ••• • • • •• •• Majorca Towers Condominium, Inc. - 11930 N. Bayshore Drive N. Miami, Florida 33181 P: (305) 893-5851 F: (305) 893-6728 ENGINEERING 'EXPRESS® E.x.P.E.R.T. (Engineering Express Product Evaluation Report) 160 SW 1 2TH AVE SUITE 106, DEERFIELD BEACH, FL 33442 (954) 354-06601 ENGINEERINGEXPRESS.COM Technical Evaluation Report DIVISION: 23 08 D0—COMMISSIONING OF HVAC THIS DOCUMENT CONTAINS (5) PAGES: THE FIRST PAGE MUST BEAR AN ORIGINAL SIGNATURE & SEAL OF THE CERTIFYING PE TO BE VALID FOR USE (Issued March 6, 2017 Subject to Renew January 1, 2019) EVALUATION SUBJECT: AMANA SPLIT UNITS TER -16-3146.3a REPORT HOLDER: GOODMAN COMPANY, L.P. 5151 SAN FELIPE STREET HOUSTON, TX 77056, USA 877-254-4729 1 AMANA-HAC.COM SCOPE OF EVALUATION (compliance with the following codes): THIS IS A STRUCTURAL (WIND) PERFORMANCE EVALUATION ONLY. NO ELECTRICAL OR TEMPERATURE PERFORMANCE RATINGS OR CERTIFICATIONS ARE OFFERED OR IMPLIED HEREIN. This Product Evaluation Report is being issued in accordance with the requirements of the 5th Edition Florida Building Code (2014) with 2016 supplements, per FBC Section 104.11, FMC 301.15, FBC Building Ch. 16, ASCE-7-10, FBC Existing Building sections 701.1, 706.6.1, FBC Building 1522.2, and FBC Residential M1202.1, M1301.1, FS 471.025, including Broward County Administrative Provisions 107.3.4. The product noted on this report has been tested and/or evaluated as summarized herein. IN ACCORDANCE WITH THESE CODES EACH OF THESE REPORTS MUST BEAR THE ORIGINAL SIGNATURE & RAISED SEAL OF THE EVALUATING ENGINEER. SUBSTANTIATING DATA: • Product Evaluation Documents Substantiating documentation has been submitted to provide this TER and is summarized in the sections below. • Structural Engineering Calculations Structural engineering calculations have been prepared which evaluate the product based on comparative and/or rational analysis to qualify the following design criteria: • Maximum allowable unit panel wind pressure connection integrity • Maximum allowable uplift, sliding, & overturning moment for ground and roof applications Calculation summary is included in this TER and appears below. NOTE: No 33% increase in allowable stress has been used in the design of this product. Microsoft Excel was used to carry out the calculations present in this report. INSTALLATION: The product(s) listed above shall be installed in strict compliance with this TER & manufacturer -provided model specifications. The product components shall be of the material specified in the manufacturer -provided product specifications. All screws must be installed in accordance with the applicable provisions & anchor manufacturer's published installation instructions. LIMITATIONS & CONDITIONS OF USE: Use of this product shall be in strict accordance with this TER as noted herein. See final page for complete limitations and conditions of use. OPTIONS: This evaluation is valid for all AMANA models present in the table located on the final page. FINISH: Baked enamel. NOTE: GRAPHICAL DEPICTIONS IN THIS REPORT ARE FOR ILLUSTRATIVE PURPOSES ONLY AND MAY DIFFER IN APPEARANCE UNIT CASING MATERIAL: 26ga galvanized sheet steel ASTM A653 CS corlotled steels for side covers. 22ga galvanized sheet steel ASTM A653. cal+ rolled steel, tar bottom base pan. 20ga galvanized sheerstoel ASTM,46513 cold rolled V2el for top panel. Removable top & siiie.cgyers secerrji•vyith #10-12 sset metal screws. • • • • Knockouts provided for utility & cont of connections. . • • • • • INSTALLATION: •••• • • • Shall follow manufacturer specificaNar�st�s�vell as theeinf•rmation+a of/xied herein. • • • • • • • • • • STRUCTURAL PERFORMANCE:* • .•• • Models referenced herein are subject to.the follo►vireg.ksign limiia4bh�: ASCE-710 Exposure Categories C. ••th• • • • Up to and including 175mph (Vult) fdrup tb 200' MRPI* . NVHZ**I • Up to and including 170mph (Vult) for up to 260' MRH**!HVHZ*** Up to and including 200mph (Vult) for up to 200' MRH**. Non-HVHZ*** Ground or Roof Application per installation instructions **Mean Roof Height ***High Velocity Hurricane Zone ••• Maximum Rated Wind Pressure: 193psf Lateral 93psf Uplift (less Dead Load) Site specific wind analysis may produce alternate limitations provided maximum rated wind pressure is not exceeded. ORIGINAL SIGNATURE AND RAISED SEAL REQUIRED TO BE VALID PER CODE: March 6, 2017 Frank L. Bennardo, P.E., SECB ENGINEERING EXPRESS PE #0046549 CA #9885 The FBC 14 defines APPROVED SOURCE (Section 2.2) as: "An independent person, firm or corporation, approved by the building official, who is competent and experienced in the application of engineering principles to materials, methods or systems analyses.' Engineering Express® professionals meet the competency requirements as defined in the FBC and can seal their work. Engineering Express® is regularly engaged in conducting and providing engineering evaluations of single -element and full-scale building systems tests. AMANA SPLIT SYSTEMS Engineering Express® 1 TER -16-3146.3a SECTION 2 PRODUCT INSTALLATION Condenser Unit Roof or ground structure / substrate (concrete, steel, see schedule below) TIE -DOWN STRAP & CLIP SCHEDULE Tie -down clips. See tables below for specifications Cabinet Roof Might* 71e -down Straps Strap WLL (lbs) Tie -down dips per Side Al Ground 0 NA 1 Upto60'(80') 2 300 1 Up to 120'(150') 2 300 1 Up to 200' (250') 2 400 1 Bl, 82 Ground 0 NA 1 Up to 60' (80') 2 400 1 Up to 120' (150') 2 400 2 Up to 200' (250') 2 400 2 C1, Q, C3, C4, C5 Ground 0 NA 1 Upto 60' (80') 2 400 2 Up to 120' (150') 2 500 2 Up to 200' (250') 2 600 2 01, D2,133, D4, D5, D6 Ground 0 NA 1 Upto60'(80') 2 800 2 Up to 120' (150') 2 1000 2 Up to 200' (250') 2 1000 3 TIE -DOWN CLIP (GROUND APPLICATION) ASTM A653 G60 galvanized cold rolled steel 0.072" thick for all cabinets tied down at ground (Goodman Bracket); fasten cabinet using (2) anchors per clip from Anchor to Host Structure Schedule Table. Clip integrates into base pan slot. TIE -DOWN CLIP (GROUND AND ROOF APPLICATION) Miami Tech CUTD 1" wide and any length ASTM A653 galvanized steel 0.07" thick for all cabinets tied down to a roof structure; fasten clip to structure using anchor from Anchor Schedule to Host Structure Table and (2) #10 x 3/8" SS 410 self -drilling screw to fasten clip to unit base pan. See Tie -down Strap & Clip Schedule Table for clip amount. For ground applicationse tie -down clip schedule corresponding to 60' height. • • •••- • • • •• • •• • Tie -down Strap & Clip Type: (for roof applicatipga). • • • • • • - • Working Load Limit (WLL) is strap's manufacturer - specified per strap. A minirbyrg•.: strap width of 1" and minimum length of 15 ft.ertItliwd for alb tlpin!V• • Clips heights shall be adequate to fit SMS within base pan height. uesi(y heightrpoeitti Clips shall be placed at center on each side aori Onleny spaced.. • • • Cross member shall be added and fixed to rogf stapiltee detallo • • • •• • • • • ANCHOR TO HOST STRUCTURE SCHEDULE Cabinet Ground or Roof Height* Height Anchor Type Concrete 3,000 Psi 1/8" Min A36Steel 1/8" Min 6061-T6 Aluminu m Al Ground A NjA N(A Up to60' 180'1 N/A Up to 120'11501 N/A B B Up to 200' (250') N/A B B B3, B2 Ground A tJ/A N/A B N/A 8 Up to 60' (80'1 Up to 120' (150') N[A 8 B Upto200'1250') N/A B B C1, Q C3 C4, C5 Ground A NIA IA to 60' 80' N A B 8 Up to 12011501 - Up to 200'12501 N/A B 13 D1, 02, D3, D4, 05, 06 Ground A NWA N/A UD to 60' (80') N/AA 8 159 toUp ((o200' Nife) @B R i350) N/A B • • • • • • • • • • • • • *The value shown in •parentheses• Indicates the• allowable roof height in 170mph conditions. Ler ri0' (80') indicates an allowable roof height of 60' for 175mph or 80' for 170mph Vult. Note: (Horizontal and Vertical Straoaino 1. Tie -down straps shall be wrapped around unit and roof stand rail, and shall be tightened using the buckle. Provide two straps per unit. 2. Strap material shall be high strength webbing and shall be compliant for exterior grade use if they contain plastic components, per FBC chapter 26. Select strap from table based on WLL requirements. 3. For Non-HVHZ, use (2) straps with minimum WLL of 500Ibs each, up to 200' MRH. Anchor Types to Host Structure: A. — 1/4" ELCO ULTRACON SS4 Anchor embedded 3" in 3,000 psi concrete. 2 1/2' from edge minimum. NOA No. 15-0226.11 B. — 1/4" -20 UNC SAE Grade 5 screw min. 1/2" from edges with nut and washer OD 0.75" NA. - No anchors apply. • IN ALL CONDITIONS IT IS THE RESPONSIBILITY OF THE PERMIT HOLDER TO ENSURE THE HOST STRUCTURE IS CAPABLE OF WITHSTANDING THE RATED GRAVITY, LATERAL, AND UPLIFT FORCES BY SITE-SPECIFIC DESIGN. NO WARRANTY OF ANY KIND, EXPRESSED OR IMPLIED, IS OFFERED BY ENGINEERING EXPRESS AS TO THE INTEGRITY OF THE HOST STRUCTURE TO CARRY DESIGN FORCE LOADS INCURRED BY THIS UNIT. ENGINEERING EXPRESS® 160 SW 12TH AVE. SUITE 106 DEERFIELD BEACH, FL 33442 (954) 354-0660 ENGINEERINGEXPRESS.COM Page 2 • AMANA SPLIT SYSTEMS Engineering Express® TER -T6 -3146.3a STRAP AND CLIP LAYOUT YPICAL 3 -CLIP CONFIGURATION OR SEE DETAIL A TM MI MUM 0111111111.1011111111 SEE ANCHOR TO HOST STRUCTURE SCHEDULE — STRAPS SEE TIE -DOWN STRAP & CLP SCHEDULE MIAMI TECH CUTD SEE TIE -DOWN STRAP & CLIP SCHEDULE CROSS MEMBER 6061-T6 ALUMINUM 2" X 2" Y4" 0STRAP AND CLIP LAYOUT SCALE: N.T.S. ROOF STAND RAIL . PER SEPARATE ENGINEERING PLAN VIEW UNIT ROOF STAND RAIL PER SEPARATE ENGINEERING UNIT ROOF STAND RAIL PER SEPARATE ENGINEERING 011 AND 2 CLIP CONFIGURATIONS SCALE: N.T.S. DETAIL VIEW j MIAMI TECH CUTD SEE MIAMI TECH CUTD SEE TIE -DOWN STRAP & CLIP SCHEDULE 0CROSS MEMBER FRONT VIEW SCALE: N.T.S. SECTION VIEW BASE PAN (2) #10 x343" SS 410 SMS (2) #14-18 SS 410 SMS %" SS 410 WITH WASHER & NUT CROSS MEMBER 6061-T6 ALUMINUM TX2"XYe" Z STRAP AND CUP LAYOUT SCALE N.T.S. ELEVATION VIEW STRAPS SEE TIE -DOWN STRAP & CUP SCHEDULE HORIZONTAL STRAP SEE PANEL INTEGRITY FOR STRAP SPECIFICATION MIAMI TECH CUTD SEE TIE -DOWN STRAP & CUP SCHEDULE ROOF STAND RAIL PER SEPARATE ENGINEERING •••• • CgQnS•MEMBEgt 6061-T6 ALUMINUM • • • • • • UNI1 • • y 421#111-•18 STAINLESS • •SThGL410SHEEL••• shigT4J SCREW • • • • • •• •• Mc)?STAND Rini-••:• PER SEPARATE • • �• • • ENGINEERING • C/ SCREWS AT CROS$'MeMBEP • • • SCALE: N.T.S. DETAIL VIEW • • • • BASE PAN (2) #10x3/8' SS 410 SMS (2) #14-18 SS 410 SMS • • • • '" SS 410 WITH WASHER & NUT may— CROSS MEMBER f/ 6081-T8 ALUMINUM 2'X2'XY." 0CROS�, S MEMBER SIDE VIEW SCALE: N.T.S. SECOON VIEW ROOF STAND RAIL PER SEPARATE ENGINEERING Note: Installers must ensure that screws used to fasten the tie -down clips with the unit base pan do not touch the coil preventing any damage. ENGINEERING EXPRESS® 160 SW 12T" AVE. SUITE 106 DEERFIELD BEACH, FL 33442 (954) 354-0660 ENGINEERINGEXPRESS.COM Page 3 AMANA SPLIT SYSTEMS Engineering Express® 1 TER -16-3146.3a SECTION 4 SUPPORTING CALCULATIONS & SUMMARY FORCES SUMMARY Cabinet Outside Dimensions Weight Range (Ibs) Ground or Roof* Height Lateral Pressure (Psf) Uplift Pressure (Psf) Max Force (lbs) Max Overturn (lbs -in) Max Tension (lbs) Uplift Force (lbs) D (in) W (in) H (in) Al 23.0 23.0 25.7 102 Ground 42.7 0 175.6 2261.5 83 0 23.0 23.0 ® 60' (80') 151.0 73 621.2 7998.0 503.2 268.5 23.0 23.0 ® 120' (150') 173.7 84.0 714.4 9197.8 585.6 308.8 23.0 23.0 25.7 200' (250') 192.9 93.4 793.5 10216.4 655.5 343.0 Bl, B2 26.0 26.0 325 103 131 Ground 42.7 0 250.6 4072.4 137 0 26.0 26.0 60' (80') 60' (80') 151.0 73 886.3 14402.6 752.3 343.1 26.0 26.0 ® 120' (150') 173.7 84.0 1019.3 16563.2 874.0 394.6 26.0 26.0 32.5 200' (250') 192.9 93.4 1132.2 18397.5 9773 438.3 Cl, C2, C3, C4, C5 29.0 29.0 40.0 142-184 Ground 42.7 0 344.0 6880.7 209.7 0.0 29.0 29.0 40.0 60' (80') 151.0 73 1216.7 24334.3 1076.4 426.8 29.0 29.0 40.0 120' (150') 173.7 84.0 1399.2 27984.8 1250.3 490.9 29.0 29.0 40.0 200' (250') 192.9 93.4 1554.2 31083.9 1398.0 545.2 120' (150') 355 35.5 41.8 Yes Ground 42.7 0 439.6 9176.0 218.3 0.0 131, 1)2, 133, 3®�® 206-306 60' (80') 151.0 73 1554.6 32452.0 1273.3482 639.6 D4, D5, D6 41.8 120' (150') 173.7 84.0 1787.8 37320.3 1482.3 735.6 35.5 35.5 200' (250') 192.9 93.4 1985.8 414533 16599• .• • $17.0 • Note: • • + • • Calculations performed according to the information provided by the client. Cabinets were assumed solid (0% porosity) for shear apif • tension calculation purposes. • • PANEL INTEGRITY SUMMARY • • • • • •••• •• • • • • • • • • •••• • •• Cabinet Roof Height* Horizontal Strapping Required Strap WLL (Ibs) Chassis Roof Height Horizontal Strapping pp g Required .. • • • • %+yap �: LL ; (its! Al 60' (80') No - Bl 60' (80') No y • • •- • 120' (150') No - 120' (150') No •• • - 200' (250') No- 200' (250') No - 82 60' (80') No- C1 60' (80') No - 120' (150') No - 120' (150') No - 200' (250') No - 200' (250') No - C2 60' (80') No- C3 60' (80') No - 120' (150') No - 120' (150') No - 200' (250') No- 200' (250') No - C4 60' (80') Yes 700 C5 60' (80') No - 120' (150') Yes 700 120' (150') No - 200' (250') Yes 700 200' (250') No - Di 60'(80') Yes 700 D2 60'(80') Yes 700 120' (150') Yes 700 120' (150') Yes 700 200' (250') Yes 700 200' (250') Yes 700 D3 60' (80') Yes 700 D4 60' (80') Yes 700 120' (150') Yes 700 120' (150') Yes 700 200' (250') Yes 700 200' (250') Yes 700 D5 60'(80') Yes 700 D6 60'(80') Yes 700 120' (150') Yes 700 120' (150') Yes 700 200' (250') Yes 800 200' (250') Yes 800 Note: Cabinets consisting of grilles as a side covers instead of louvers are not required to have horizontal strapping at any height. ENGINEERING EXPRESS® 160 SW 12Th AVE. SUITE 106 DEERFIELD BEACH, FL 33442 (954) 354-0660 ENGINEERINGEXPRESS.COM •• • • • • •. • • • • • ••• • • • • • �• • • • • Page 4 • S • AMANA SPLIT SYSTEMS Engineering Express®I TER -16-3146.3a CABINETS & DIMENSIONS Amana Model No. W / D (in.) H (in) Cabinet A(S,N)X130181 23.00 25.75 Al A(S,N)X130241 26.00 27.50 BI A(S,N)X130301 26.00 27.50 B1 A(S,N)X130361 26.00 27.50 B1 A(S,N)X130421 29.00 36.25 C3 A(S,N)X130481 29.00 36.25 C3 A(S,N)X130601 29.00 40.00 C6 A(S,N)X130611 35.50 38.25 D5 A(S,N)X140181 26.00 27.50 B1 A(S,N)X140191 26.00 27.50 B1 A(S,N)X140241 26.00 27.50 81 A(S,N)X140251 26.00 32.50 B2 A(S,N)X140301 29.00 32.50 C2 A(S,N)X140311 29.00 32.50 C2 A(S,N)X140361 29.00 32.50 C2 A(S,N)X140371 29.00 32.50 C2 A(S,N)X140421 29.00 36.25 C3 A(S,N)X140431 29.00 36.25 C3 A(S,N)X140481 35.50 36.25 01 A(S,N)X140601 35.50 38.25 D5 ASXC160241 29.00 32.25 C2 ASXC160361 29.00 38.25 C2 ASXC160481 35.50 36.25 D1 ASXC160601 35.50 38.25 D3 ASX160181 29.00 32.25 C2 Note: Illustration selected for dimensional purposes Amana Model No. W / D (in.) H (in) Cabinet ASX160241 29.00 32.25 C2 ASX160301 29.00 36.25 C3 ASX160361 29.00 38.25 C6 ASX160421 35.50 36.25 01 ASX160481 35.50 36.25 D5 ASX160601 35.50 38.25 D3 ASX160611 35.50 38.25 D5 ASX160311A 29.00 38.25 C3 ASX160371A 35.50 36.25 D1 ASXC180361 35.50 38.25 D3 ASXC180481 35.50 38.25 D3 ASXC180601 35.50 38.25 D3 AVXC200241 35.50 38.25 D4 AVXC200361 35.50 38.25 D4 AVXC200481 35.50 41.75 D6 AVXC200601 35.50 41.75 D6 A(S,N)Z140181 29.00 34.50 C1 A(S,N)Z140241 29.00 34.50 C1 A(S,N)Z140301 29.00 36.25 C5 A(S,N)Z140361 29.00 36.25 C5 A(S,N)Z140421 35.50 39.75 D6 A(S,N)Z140481 29.00 36.25 C5 A(S,N)Z140491 35.50 34.50 D2 A(S,N)Z140601 35.50 34.50 D2 ASZ160181 29.00 36.38 C5 Amana Model No. W / D (in.) H (in) Cabinet ASZ160241 35.50 34.63 D2 ASZ160301 35.50 34.63 D2 ASZ160361 35.50 40.00 D6 ASZ160421 29.00 36.38 C5 ASZ160481 35.50 34.63 D2 ASZ160601 35.50 40.00 D6 ASZC160241 29.00 38.25 C4 ASZC160361 35.50 38.25 D3 ASZC160481 35.50 38.25 D3 ASZC160601 35.50 38.25 D3 ASZC180361 35.50 38.25 D3 ASZC180481 35.50 38.25 03 ASZC180601 35.50 38.25 D3 AVZC200241 35.50 38.25 D4 AVZC200361 35.50 65.60 41 • •••• 41.25 • • • D6 4 D6 4--+ AVZC200481 AVZC20060.•9..4•50 411.7.,4•••D6 4 A(S,N)Z1401100 • QpJO 34.50 • C1 • A(S,N)Z14025•••21po 34+90• ••C1 4 • A(S,N)Z14031• • 43%.50 34%3 • • D2 1 A(S,N)Z140.7 • 35450 40,00 • • • D6 4 •• AVZC1802441 •• at9 j10 2910 •• 38.25 38.25 . 4 • C5 • C5 • AVZC18036:A AVZC 18048.A ••0 38!25 • • • D2 : AVZC180601A' 31.5 38!29 • : D2 • • Note: The model numbers on this page may be followed by up to two (2) alphanumeric characters. Those characters will not affect the structural performance, since they refer to minor/major changes not related to the cabinet structure. LIMITATIONS & CONDITIONS OF USE: Use of this product shall be in strict accordance with this TER as noted herein. The supporting host structure shall be designed to resist all superimposed loads as determined by others on a site specific basis as may be required by the Authority Having Jurisdiction. Host structure conditions which are not accounted for in this product's respective anchor schedule shall be designed for on a site-specific basis by a registered professional engineer. No evaluation is offered for the host supporting structure by use of this document; Adjustment factors noted herein and the applicable codes must be considered, where applicable. At supporting components which are permanently installed shall be protected against corrosion, contamination, and other such damage at all times. Fasteners must penetrate the supporting members such that the full length of the threaded portion is embedded within the main member. This evaluation does not offer any evaluation to meet large missile impact debris requirements which typically are not required for this type of product. All of the wind resisting exterior panels, individually meet or exceed their capacity to resist the design wind loads as stated in the calculations as required by the Florida Building Code Fifth Edition (2014). Due to the indeterminate nature of these units, distortion and deflection cannot be accurately evaluated, but with diaphragm acticn of external components and internal stiffeners, the base unit has the capacity to withstand these forces with individual extemal parts being contained. Yearly inspections, during equipment maintenance or after a named storm; all screws, cabinet components, clips, anchor, bolts, straps and cables are to be verified by the AIC contractor. All damaged cabinet components, loose, corroded, broken screws or anchor bolts shall be replaced to ensure structural integrity for Page 5 hurricane wind forces. ENGINEERING EXPRESS® 160 SW 12T" AVE. SUITE 106 DEERFIELD BEACH, FL 33442 (954) 354-0660 ENGINEERINGEXPRESS.COM • • • • • •••• • • •••• • • • • • CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/28/2017 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(ies) must have ADDITIONAL INSURED provisions or 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 Russo Insurance Group 11011 Sheridan St., Suite 201 Cooper City FL 33026 NAME: RALPH RUSSO (A/CNNn FA). E (954) 345 1904 FAX Nel; (954) 827- 2355 E-MAIL l i rah russo ADDRESS: P � 9•com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : WESTERN WORLD INS CO 13196 INSURED SUMMA MECHANICAL CONTRACTORS LLC DBA SMC AIR CONDITIONING 5071 S. STATE RD 7, SUITE #704 DAVIE FL 33314 INSURER B : NAUTILUS INS CO 17370 INSURER C : COVINGTON SPECIALTY INS CO. 01/05/2018 INSURER D : $ 1,000,000 INSURER E : INSURER F : X 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. 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INSR LTR TYPE OF INSURANCE JMAD SU POLICY NUMBER EFF IMM/DY/YYYYI LICY EXP IMMI DIIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY X X NPP8394298 01/05/2017 01/05/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGETO RENTED PREMMISES (Fa occur -r ncel $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY JE LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY — SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Fa accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE _(Per accident) $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE AN034658 01/05/2017 01/05/2018 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER OTH- STATUTE FR E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ C COMMERCIAL PROPERTY VBA511851 02/03/2017 02/03/2018 BPP $45,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) MECHANICAL CONTRACTOR - A/C INSTALLATION, SERVICE & REPAIR CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED IN REGARD TO GENERAL LIABILITY POLICY. CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE Building Department 10050 N.E. 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 REPRESENTATIVE <DA> ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD