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RC-16-32121.4 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Pe •mit Permit NO. RC -11-16-3212 Permit Type: Residential Construction Work Classification: Addition/Alteration Permit Status: APPROVED tete Date: 1219/2016 Expiration: 06/07/2017 Parcel Number Applicant 541 NE 105 Street Miami Shores, FL 1122310140260 Block: Lot: TARIK & CATHERINE GUETARN Owner Information Address Phone Cell TARIK & CATHERINE GUETARNI 541 NE 105 Street MIAMI SHORES FL 33138- (404)395-7245 541 NE 105 Street MIAMI SHORES FL 33138- Contractor(s) BUILD & FIX INC Phone (786)312-4880 Cell Phone Valuation: Total Sq Feet: $ 18,000.00 650 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: NEW Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Yes Certificate Date: Bond Return : KITCHEN CABINETS OPEN K Occupancy: Single Family Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $10.80 $8.10 $8.10 $3.60 $540.00 $18.00 $14.40 $603.00 Pay Date Invoice # 12/09/2016 11/28/2016 Pay Type RC -11-16-62173 Check #: 01094 Credit Card Amt Paid Amt Due $ 553.00 $ 50.00 $ 50.00 $ 0.00 Available Inspections: , Inspection Type: Final PE Certification Drywall Miscellaneous Window Door Attachment Tie Beam Final Framing Insulation Truss Insp Columns Foundation Window and Door Buck Fill Cells Columns Wire Lathe Review Electrical Review Mechanical Review Plumbing Review Building F. Termite Letter F. Elevation Certificate Review Planning Review Structural Declaration of Use 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 re -all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRIC; L, P - • ICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFID construction a Authorize foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating uthorize the above-named contractor to do the work stated. e: Owner / Applicant / Contractor / Agent Building epartment Copy December 09, 2016 Date December 09, 2016 1 ,y\.‘ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: 541 NE 105 ST RECEIVED NOV 28 2016 BY. FBC 201 Master Permit No. C 1 (© - 3 2 1 Z. Sub Permit No. ❑ REVISION ❑ EXTENSION El RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-2231-014-0260 Occupancy Type: RES Load: Is the Building Historically Designated: Yes Construction Type: Flood Zone: OWNER: Name (Fee Simple Titleholder): TARIK GUETARNI CATHERINE GUETARNI Address: 541 NE 105 ST NO X BFE: FFE: Phone#: 404-395-7245 City: MIAMI SHORES State: FL Tenant/Lessee Name: N/A Phone#: Email: tguetarni@aol.com Zip: 33138-2044 CONTRACTOR: Company Name: BUILD & FIX Phone#: 786-3124880 Address: 9076 HARDING AVENUE City: SURFSIDE State: FL Qualifier Name: PEDRO FURTADO Zip: 33154 Phone#: 786-312-4880 State Certification or Registration #: C rc1 C-1 Si 361.3 Certificate of Competency #: DESIGNER: Architect/Engineer: OSCAR POSADA ARCHITECT Phone#: 305-554-1195 Address: 9231 SW 12 ST City: MIAMIState: FL Zip: 33174 Value of Work for this Permit: $ / 8/ WO Square/Linear Footage of Work: 6620 SF Type of Work: ❑ Addition n Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of work: NEW KITCHEN CABINETS, OPEN KITCHEN AREA, REMODEL 02 BATHROOMS, WOOD FLOOR AT KITCHEN, ADD ONE POCKET DOOR, NEW LIGHT FIXTURES.....-..--- .,...k / } J' 1.4 1 t Specify color -of color thru-tile: ,. . ,.. _ Submittal Fee $ ( Permit Fee.$ �,, Li 0 CCF $ �0. 80 CO/CC $ y T Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ _5 } r •• i• • I (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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature �' OWNER or AGENT The foregoing instrument was acknowledged before me this 1,1A+" day of 1"4.0 , 20 Ica , by C }kp /NE.- ¶ ( U I, whois personally known to me or who has produced 365-137-.81-ffi`3O-O as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: re__ MY COMMISSION 9 FF91114i) • • EXPIRES August 19. 2019 I 1401 308.0153 F INori$rr c cqn Signature CONTRACTOR - The foregoing instrument was ack owledged before me this by wn to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: ************************ ************************************* APPROVED BY Plans Examiner Zoning My C NMotary Pub; State of Florida y Commission Pent Y ommission FF 957875 a n Expires 02/07/2020 ********** Structural Review Clerk (Revised02/24/2014) Property Search Application - Miami -Dade County Page 1 of 3 IMPORTANT MESSAGE SEARCH: When buying real estate property, you should not assume that properly taxes will remain the same. Whenever there is a change in ownership, the assessed value of the property may reset to full market value, which could result in higher property taxes. Please use our Tax Estimator to approximate your new property taxes. The Property Appraiser does not send tax bills and does not set or collect taxes. Please visit the Tax Collector's website directly for additional information. Address Owner Name Subdivision Name Folio 541 ne 105 st 00 Or, PROPERTY INFORMATION 0 Folio: 11-2231-014-0260 Sub -Division: MIAMI SHORES SEC 5 AMD Property Address 541 NE 105 ST Miami Shores, FL 33138-2044 Owner TARIK GUETARNI CATHERINE GUETARNI Mailing Address 541 NE 105 ST MIAMI SHORES, FL 33138 Primary Zone 1000 SGL FAMILY - 2101-2300 SO Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY : 1 UNIT Beds/Baths/Half 3/2/0 Floors 2 Living Units Actual Area 2,337 Sq.Ft Living Area 2,337 Sq.Ft Adjusted Area 2,098 Sq.Ft Lot Size 9,150 Sq.Ft Year Built 1948 Featured Online Tools Comparable Sales Glossary Non -Ad Valorem PA Additional Online Tools Property Record Cards Assessments Property Taxes Report Discrepandes Tax Comparison Tax Estimator TRIM Notice Value Adjustment Board ASSESSMENT INFORMATION 0 BENEFITS INFORMATION 0 Year 2016 2016 2014 Land Value $172,556 $138,044 $98,888 Building Value $131,419 $131,419 $128,020 Extra Feature Value 514,823 $10,553 $10,562 Market Value $318,798 $280,018 $237,470 Assessed Value $318,798 $239,369 $237,470 Properly Search Help Report Homestead Fraud 'Benefit Type 2016 2015 2014 Save Our Homes Cap Assessment Reduction $40.647 Homestead Exemption 025,000 $25,000 $25,000 Second Homestead Exemption $25,000 $25,000 $25,000 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). FULL LEGAL DESCRIPTION 0 http://www.miamidade.gov/propertysearch/ 11/28/2016 Property Search Application - Miami -Dade County Page 2 of 3 E TAXABLE VALUE INFORMATION 0 1 COUNTY Exemption Value Taxable Value SCHOOL BOARD 1 - Exemption Value Taxable Value r CITY 2016 2015 $50,000 $50,000 $268,798 $189,369 $187,470 2014; 550,000 ; i Exemption Value 1 Taxable Value h ---- S REGIONAL Exemption Value Taxable Value $25,000 $25,000 $25,000 $293,798 $214,369 $212,470 SALES INFORMATION 0 $50,000 $50,000 $268,798 $189,369 550,000 $50,000 $268,798 $189,369 $187,470 $50,000 $187,470 $50,000 + AMD PL MIAMI SHORES SEC 5 PB 10-47 LOT 168 W1/2 LOT 17 BLK 110 r LOT SIZE 75.000 X 122 OR 19103-2245 05 2000 1 Previous Sale Price OR Book -Page Qualification Description 06/26/2015 $514,000 29678-1391 Qua! by exam of deed i 05/01/2000 5222.500 .19103-2245 Sales which are qualified 10/01/1998 $178,500 18340-0839 Sales which are qualified 08/01/1988 $0 00000-00000 Sales which are disqualified as a result of examination of the deed 03/01/1980 $85,000 10693-2257 Sales which are qualified € 11/01/1972 $38,000 00000-00000 Sales which are qualified For more information about the Department of Revenue's Sales Qualification Codes. 2016 2015 2014 LAND INFORMATION Land Use 1 GENERAL Muni Zone R-17.5, R-18.5 1 BUILDING INFORMATION 1 0 ( Building Number Sub Area :41 Building Sketches Available! EXTRA FEATURES 6 1 Description Chain -fink Fence 4-5 8 high s Pool 6' res AVG 3-8' dpth, plain feat 250-649 sf Patio - Concrete Slab f Chain -fink Fence 4-5 8 high Patio - Concrete Slab PA Zone 1000 - SGL FAMILY - 2101-2300 SO Year Built 1948 Actual Sq.Ft. 2,337 Previous Owner 1 Previous Owner 2 CHARMAINE DEFRANCESCO 8 REGINA M PAVONE Unit Type Front Ft. Living Sq.Ft. 2,337 Year Built 1972 1957 1957 1948 1948 Units 75.00 Adj Sq.Ft. 2,098 Units 137 1 554 110 327 ADDITIONAL INFORMATION ' The information listed below is not derived from the Property Appraiser's Office records. 0 is provided for convenience and is derived from other government agencies. Calc Value $172,556 Calc Value $131,419 Calc Value $647 $12,000 $1,064 $484 $628 http://www.miamidade.gov/propertysearch/ 11/28/2016 Property Search Application - Miami -Dade County LAND USE AND RESTRICTIONS Community Development District: NONE Empowerment Zone: Urban Development: NONE INSIDE URBAN DEVELOPMENT BOUNDARY Government Agencies and Community Services I OTHER GOVERNMENTAL JURISDICTIONS Business Incentives lFlorida Department Of Revenue School Board Community Redevelopment Area: NONE Enterprise Zone: NONE Zoning Code: R17.5 - Existing Land Use: 10 - SINGLE-FAMILY, MED. -DENSITY (2-5 DU/GROSS ACRE). Page 3 of 3 Chiklrens Trust Flonda Inland Navigation District South Florida Water Mgmt District City of Miami Shores PA Bulletin Board Tax Collector Environmental Considerations Non -Ad Valorem Assessments 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. 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All rights reserved. http://www.miamidade.gov/propertysearch/ 11/28/2016 RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 FURTADO, PEDRO BUILD & FIX INC 9076 HARDING AVENUE SURFSIDE FL 33154 ISSUED: 0727/2016 DISPLAY AS REQUIRED BY LAW SEQ # L1607270001398 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOTA BILL -DO NOT PAY 7162081 BUSINESS NAMFJLOCATION BUILD & FIX INC 9076 HARDING AVE MIAMI, FL 33154 OWNER BUILD & FIX INC CIO ENRIQUE LUJAN Workers) RECEIPT NO. RENEWAL 7440042 LBT EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter BA - Art. 9 dr 10 SEC. TYPE OF BUSINESS 196 GENERAL BUIDING CONTRACTOR 1 CGC1513513 PAYMENT RECEIVED BY TAX COLLECTOR 45.00 091212016 0202-16-002424 This Local Badness Tax Receipt tidy coin= payment alike lid Business Tee_ The Nit is Eats iceman;., pemek ara certiceiee of tire bis qua tams, w de basins. Raeder ase comply wide any grvenamotal wmagenenunenui myrdatery pa Md requirements wiici apply *tie iasiaass. Tie REC6lr NO. alum mast be displayed as all eeeeereial vehicles- Dade Cade Sec ta-IJS. Fur nee nkrmv6em visit wmwnia+Iidlade-S Necter .1►r— c ori ,,..,,a:- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 11/14/16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poiicy(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 Florida Bankers Insurance 7278 SW 8 Street Miami, FL 33144 Phone (305)266-6493 Fax (305)262-0679 CONTACT MARTA ALONSO NAME: _ PHONE 305 266-6493 Fax 305 262-0679 (AIC. No. Ext): ( ) (AIC, No): ( ) ADDRESS: maria@floridabankersinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: FEDERATED NATIONAL INSURANCE CO Ni INSURED BUILD & FIX INC 9076 HARDING AVE SURFSIDE , FLORIDA 33154 INSURER B: 12/17/2015 INSURER C: EACH OCCURRENCE INSURER D: DAMAGE TO RENTED PREMISES (Ea occurrence) INSURER E : EXP (Any one person) INSURER F: 0 mu CLAIMS -MADE 0 OCCUR • SO 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. LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY Ni N GL-00504014075-00MED 12/17/2015 12/17/2016 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED PREMISES (Ea occurrence) 100,00a00Q EXP (Any one person) $ 5,000.00 0 mu CLAIMS -MADE 0 OCCUR PERSONAL & ADV INJURY $ 1,000,000.00 . GENERAL AGGREGATE $ 2,000,000.00 ■ GENII AGGREGATE LIMIT APPLIES PER: PRODUCTS • COMP/OP AGG $ 2,000,000.00 n POLICY 0 JECT PRO II LOC $ AUTOMOBILE LIABILITY CO aBINEeD1SINGLE LIMIT(E $ BODILY INJURY (Per person) $ II ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED • AUTOS AUTOS PROPERTY DAMAGE (Per accident) $ NON -OWNED II HIRED AUTOS • AUTOS $ II II EACH OCCURRENCE $ II UMBRELLA LIAB ❑ OCCUR AGGREGATE $ II EXCESS LIAB II CLAIMS -MADE $ • DED II RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N ANY PROPRIETOR/PARTNER/EXECUT1VENIA OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below ■ WC STATU- ■ OTH- TORY LIMITS •ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CGC1513513 CERTIFICATE HOLDER C VILLAGE OF MIAMI SHORES 10050 NE 2ND AVE 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 MARTA M. ALONSO ACORD 25 (2010/05) QF © 1988-2010 AC RD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A9ftb® ACO/C U �� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 11/14/2016 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 endorsernent(s). PRODUCER SUNZ Insurance Solutions, LLC. ID: (TLR) c/o TLR of Bonita, Inc 700 Central Ave Suite 500 St. Petersburg, F L 33701 CONTACT Workers' Comp Department PHONE FAX Ext):727-520-7676 x 3 (A/C, No): 727-525-3862 IL E-MAIL ADDRESS: certs@encorehr.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: SUNZ Insurance Company 34762 INSURED TLR of Bonita, Inc EnterpriseHR 700 Central Avenue Suite 500 St. Petersburg FL 33701 INSURER B : INSURER C : INSURER D: DAMAGE TO RENTED PREMISES (Ea occurrence) INSURERE: INSURER F : CLAIMS -MADE COVERAGES CERTIFICATE NUMBER: 32820440 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS COMMERCIAL GENERALLIABILITY EACN OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GE 'L AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ A WOR KERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N/A WCPE00000001 12 6/1/2016 6/1/2017 ,/ STATUTE OTH- ER E.L. EACH ACCIDENT $ 1,000,000.00 E.L. DISEASE - EA EMPLOYEE $ 1,000,000.00 E.L. DISEASE - POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Coverage Provided for all leased employees but not subcontractors of: BUILD & FIX INC Client Effective: 7/12/2016 CGC1513513 CERTIFICATE HOLDER CANCELLATION 1529 Village of Miami Shores 10050 NE 2nd Ave 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 Glen J Distefano —7 dzie ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 32820440 1 Master Certificate 1 Jillian Mally 1 11/14/2016 10:54:03 AM (CDT) 1 Page 1 of 1