RC-16-3474Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Permit NO. RC -12-16-3474
Permit Type: Residential Construction
Work Classification: Addition/Alteration
Permit Status: APPROVED
Issue Date: 3/31/2017
Expiration: 09/27/2017
Parcel Number
Applicant
142 NW 103 Street
Miami Shores, FL 33150-
1131010220010
Block: Lot:
US BANK TRUST NA TRS CIO Cl
Owner Information
Address
Phone
Cell
US BANK TRUST NA TRS CIO CALIBER 13801 WIRELESS Way
--- -- - -•- - ---- - - ---- OKLAHOMA CITY OK 73134-
142 NW 103 Street
OKLAHOMA CITY FL
Contractor(s) Phone
A & J GENERAL CONSTRUCTION COI (305)599-2782
CeII Phone
Valuation:
Total Sq Feet:
$ 15,300.00
69
Approved: In Review
Comments:
Date Approved: : In Review
Date Denied:
Type of Construction: REPLACE
Stories:
Front Setback:
Left Setback:
Bedrooms:
Plans Submitted: Yes
Certificate Date:
Bond Return :
GARAGE DOOR 8X7 RE
Occupancy: Single Family
Exterior:
Rear Setback:
Right Setback:
Bathrooms:
Certificate Status:
Additional Info: REPLACE GARAGE DOOR 8X7 REF
Classification: Residential
Fees Due
CCF
CO/CC Fee
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$9.60
$50.00
$6.89
$6.89
$3.20
$459.00
$9.00
$12.80
$557.38
Pay Date Pay Type
Invoice # RC -12-16-62474
12/27/2016 Credit Card
03/31/2017 Check #: 2202
Amt Paid Amt Due
$ 50.00 $ 507.38
$ 507.38 $ 0.00
Available Inspections:
Inspection Type:
Final PE Certification
Drywall
Miscellaneous
Window Door Attachment
Tie Beam
Final
Framing
Insulation
Truss lnsp
Columns
Foundation
Window and Door Buck
Fill Cells Columns
Wire Lathe
Review Electrical
Review Electrical
Review Electrical
Review Electrical
Review Building
F. Termite Letter
F. Elevation Certificate
Review Planning
Review Mechanical
Review Plumbing
Declaration of Use
Review Structural
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
construction and zoning. Futhermore1 au • . ize the above-named contractor to do the work stated.
Auth• -d S re ." - / Applicant / Contractor / Agent
Building Department Copy
March 31, 2017
Date
March 31, 2017
1
Miami Shores Village
- Building Department
QAA
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
L Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
FBC201-///
Master Permit No. 121C (2`1D -3474-
4-
Sub Permit No.
*BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS [] CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 142 NW 103 ST Miami Shores, FL 33150
City: Miami Shores
County:
Miami Dade Zip:
Folio/Parcel#:11-3101-022-0010 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): U S Bank Trust c/o Caliber Homes Phone#:
Address:13801 Wireless Way
City:
Oklahoma City State: OK Zip: 73134
Tenant/Lessee Name:
Email:
Phone#:
CONTRACTOR: Company Name:
A & J General Contractors Phone#: 305-599-2782
Address: 4337 E 11 Ave
City: Hialeah State:
Florida Zip: 33013
Qualifier Name: Miguel Guerrero Phone#:
State Certification or Registration #: CGC 1519495 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: /-� City:
Value of Work for this Permit: $ %� 200. GO
Type of Work: ❑ Addition ❑ Alteration ❑ New epair/Replace ❑ Demolition
State:e(Zip:
Square/Linear FootagVI Work: 1 6f
Description of Work: A!!-:,.2 - j boto)
I
�_� ;%/./� 1 /� �� I ;i Z WIC 4VId.„ -
i
Specify color of colloor..thru tile: T�'Q
Submittal Fee $ re tb - Permit Fee $ C/54:1
Scanning Fee $ Radon Fee $ Gis • 61
Technology Fee $ 12 •80 Training/Education Fee $ • ZIf7 Double Fee $
Bond $ ..
TOTAL FEE NOW DUE $ `,V
CCF $ 67• (4242 co,cc $ 5C)
DBPR $ - 3 1 Notary $
Structural Reviews $
(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 app y• ved and o reinspection fee will be charged.
Signatur Y
- — •w -
c Tv ER or AGENT
The foregoing instrument was acknowledged before me this
0 -41 -1'‘ -day of ', �, t DIK- , 20 1 (e , by
eLn
A k11 12j2 , who is ersonally know to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
*******
Heath 17 ayabouasy
APPROVED BY
(Revised02/24/2014)
HEATHER SAYABOUASY
Notary Public, State of Texas
My Commission Expires
October 03, 2018
n
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
t�-.(e day of , 20 l , by
0\k A `(4 , who is personally known to
me or who has produced as
identification anwho did take an oath.
NOTARY PUBL
Sign:
Seal:
*******************************
Plans Examiner
Structural Review
:� :" ;•• / ARACELYS M. HERNANDEZ
MY COMMISSION OFF 984511
[WIRES: AprlI27, 2020
,e,gf i c•• Bonded TM; Notary Public Underwrltere
************
*****************
Zoning
Clerk
RECF
DEC 27 2016
BY
H'
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Re stucco exterior wing. •• •
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Primer and paint exterior. • •• •• • • • • • • :.
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place Garage door 8' X 7'
A 15-0505.05
arr Garage Doors
4.4/-62
QNT ELEV • TYONCT 10 CCMIPL1f NCE W!'Hi ALL FEDERAL
• STATE ANu CC IN �j, 7 i1_,L -S 1D/RREEGULLATTIIONS
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Replace rear garage dogr. , wide X 6S8":: • ••
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Out swing +76.00/-76.Q•
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FL4904-R7 Masonite International
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REAR ELEVATION
1
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Replace Vanity 30 inch.
Replace bathroom floor tile.
itiLa
Replace kitchen cabinets
per existing layout
it $ i
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Fridge on dedicated circui
dedicated circuit IL- y ,,
cab Microwave on
dedicated circuit/
Paint Interior.
Install Smoke Detectors hard wired.
SD to me hard wired and connected to master bedroom circuit
cab
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water heater.
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MOUNTING
POLES:
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M IAM I•DADE
COUNTY
DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES (RER)
BOARD AND CODE ADMINISTRATION DIVISION
MIAMI-DADE COUNTY
PRODUCT CONTROL SECTION
11805 SW 26 Street, Room 208
Miami, Florida 33175-2474
T (786) 315-2590 F (786) 315-2599
NOTICE OF ACCEPTANCE (NOA) www.miamidade.eov/economy
�Amarr Garage Doors
165 Carriage Court
Winston-Salem, NC 27105
SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction
materials. The documentation submitted has been reviewed and accepted by Miami -Dade County RER-Product Control
Section to be used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ).
This NOA shall not be valid after the expiration date stated below. The Miami -Dade County Product Control Section (In
Miami Dade County) and/or the AHJ (in areas other than Miami Dade County) reserve the right to have this product or
material tested for quality assurance purposes. If this product or material fails to perform in the accepted manner, the
manufacturer will incur the expense of such testing and the AHJ may immediately revoke, modify, or suspend the use of
such product or material within their jurisdiction. RER reserves the right to revoke this acceptance, if it is determined
by Miami -Dade County Product Control Section that this product or material fails to meet the requirements of the
applicable building code.
This product is approved as described herein, and has been designed to comply with the Florida Building Code,
including the High Velocity Hurricane Zone.
DESCRIPTION: Model 950 Heritage & 655 Oak Summit 1000, 2000 Steel Sectional Garage Door up
to 9'-O" Wide
APPROVAL DOCUMENT: Drawing No. IRC -9509-185-15-I, titled "Model 950 Heritage and Model 655
Oak Summit (24ga) 1000, 2000 Short, Long, Flush and Oak Summit Panels", Sheets 1 through 3 of 3, dated
04/06/2007, with revision D dated 12/02/2011, prepared by Amarr Garage Doors, signed and sealed by
Thomas L. Shelrner•dine, P.E., bearing the Miami -Dade County Product Control revision stamp with the
Notice of Acceptance number and e • • • . - - . i - iami-Dade County Product Control Section.
MISSILE IMPACT RATIN Large and'Sma11 Missile ImpactResista tt..)
LABELING: A permanent label with the manufacturer's name or logo, 3800 -Greenway Circle, Lawrence,
Kansas, model number, the positive and negative design pressure rating, indicate impact rated if applicable,
installation instruction drawing reference number, approval number (NOA), the applicable test standards, and
the statement reading `Miami -Dade County Product, Control Approved' is to be located on the dcgor's s ide
track, bottom angle, or inner surface of a panel, •••
RENEWAL of this NOA shall be considered after a renewal application has been filed andthereras bele* nh
ocange . •
in the applicable building code negatively affecting the performance of this product. • • • •
•
TERMINATION of this NOA will occur after the expiration date or if there has been a revfsion or chane in the •
materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endoriir rgat of any proarrct, for
sales, advertising or any other purposes shall automatically terminate this NOA. Failure to carlpjx }vith arty •ection of • •
this NOA shall be cause for termination and removal of NOA.• •• •• ••
.. .. .. ......
ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, floriell and followed by the •
expiration date inay be displayed in advertising literature. If any portion of the NOA is displayed; then be done
in its entirety.• • •
• . .
.
INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distaibutcis.and •
shall be available for inspection at the job site at the request of the Building Official.
This NOA revises NOA # 12-0228.07 and consists of this page 1 and evidence page E-1, as well as approval
document mentioned above.
The submitted documentation was reviewed by Carlos M. Utrera, P.E.
MIAMI.DADE COUNTY
APPROVED
NOA No. 15-0505.05
Expiration Date: September 6, 2017
Approval Date: July 16, 2015
Page 1
.
Amarr Garage Doors
NOTICE OF ACCEPTANCE: EVIDENCE SUBMITTED
A. DRAWINGS "Submitted under NOA # 12-0228.07"
1.. Drawing No. IRC -9509-185-15-I, titled "Model 950 Heritage and Model 655 Oak
Summit (24ga) 1000, 2000 Short, Long, Flush and Oak Summit Panels", Sheets 1
through 3 of 3, dated 04/06/2007, with revision D dated 12/02/2011, prepared by
Amarr Garage Doors, signed and sealed by Thomas L. Shelmerdine, P.E.
B. TESTS "Submitted under NOA # 12-0228.07"
1. Test report on Evaluation of Painted or Coated Specimens Subjected to Corrosive
Environments per ASTM D1654 & ASTM B117, prepared by Architectural Testing,
Inc., Test Report # A7420.01-106-18, dated 04/12/2011, signed and sealed by Joseph
A. Reed, P.E.
2. Test report on Forced Entry Test per FBC, TAS 202-94, prepared by American Test
Lab, Inc., Test Report # ATLNC 0912.01-11, dated 10/13/2011, signed and sealed by
David W. Johnson, P.E. "Submitted under NOA # 12-0228.09"
"Submitted under NOA # 07-0928.11"
3. Test report on Large Missile Impact Test per FBC TAS 201, Uniform Static Air
Pressure Test per FBC TAS 202 and Cyclic Wind Pressure Test per FBC TAS 203 for
a 9' x 7' Sectional Steel Garage Door, prepared by American Test Lab, Inc., Report #
ATLNC 0312.02-07, dated 05/04/07, signed and sealed by David W. Johnson, P.E.
4. Test report on Tensile Test for 3 Samples per ASTM E 8, prepared by
Hurricane Engineering & Testing Inc., Report # HETI-07-T684, dated 04/19/2007,
signed and sealed by Candido F. Font, P.E.
C. CALCULATIONS "Submitted under NOA # 12-0228.07"
1. Anchor calculations prepared by Structural Solutions, P.A., dated 01/25/2012, signed
and sealed by Thomas L. Shelmerdine, P.E. • .
D. QUALITY ASSURANCE
1. Miami -Dade Department of Regulatory and Economic Resources m3R) '
• .. .
.. . ..
. .
. • . . .
E. MATERIAL CERTIFICATIONS
1. None.
F. STATEMENTS
.... •.. . • .
. •. .
••••• . •
•.
. .
.. ..
. . .
... .
• •
••
•
1. Statement letter of code conformance to the 5th edition (2014) TBC and noifislacial
interest issued by Structural Solutions, PA., dated 04/08/2015, ignet1 and spgle.d by
•
Tomas L. Shelmerdine, P.E.• '
E -1
•/,
pr? /015
C rlos . Utrera, P.E.
Product Control Examiner
NOA No. 15-0505.05
Expiration Date: September 6, 2017
Approval Date; July 16, 2015
•• •
.'
•
•
•
13 DA GALV. COMMERCIAL
TIP ROLLER 22RACKET
ATTACHED 0/44) 1/4' x
3/4' HEX HEAD MRCVS
PER IRAnIET
TYPICAL TOP FIXTURES
N.T.S.
•
SCE (TAILE 2) OR PAGE 3 FOR
RECOMMENDED SECTION CINFIGORATNW
4
•
AD.LSTASLE ROLLER CARRIER
ATTACHED V/ (2) 1/4' x 1/e'
DOLT 4 NUT PER BRACKET
••
3' FOGA STRUTS ATTACHED
V/ (2) 1/4' x 3/4'
MX HEAD SCREWS AT
EACH CENTER STILE
2' 10 'ALL STEEL WITH
5• STEN ROLLER Id/RETAINER
USED EN THREADED SHAFTS
1486., DURASAFE
CENTER HINGE ATTACHED
V/ (4) 1/4' x 3/4'
HO( HEAD MRCVS
r
24 GA MIN EXTERIOR SKIN
W/ BAKED ON POLYESTER FINISH
A TYPICAL DURASAFE CENTER HINGED
R70.
STILE STIFFENERS (3)
LOCATED IN HINGE MV(0)
ON TDP SECTION ONLY
3' 2006. STRUT
ATTACHED V/ (2)
1/4' x 3/4' HEX
HEAD SCREWS
Y 2024. STRUT
ATTACHED V/ 43)
0/4' x 3/4' HEX
HEAD SCREWS
INSIDE ELEVATION
N.T.S.
14 CM. AAPASAFE
END HINGE ATTACHED
V/ (2) 1/4' x 3/4'
HEX HEAD SCREWS
40A. WRASAFE
ROLLER CARRIERS ATTAINED
TO END STILE V/ C3) 1/4' x 3/4'
HEX FE011 SCREWS PER CARRIER
2' 10 HALL STEEL VITA
S. STEN ROLLER IP/RETAINER
USED FOR THREADED SHRIFTS
E T ILE ) ON PACE 3
FOR STRUT SPACING
HOLES FIR STRUT
ATTACHMENT
(STRUT NOT SNOVN
FOR CLARITY)
3' 2013L STRUTS ATTACHED
V/ (2) 1/4' x 3/4'
HEX HEAD SCREWS AT
EACH CENTER STILE
TYPICAL STILE STIFFE>ER�
ILLS
SLIDE LOCK ENGAGES INTO VERTICAL
TRACK EN awe S10ES 5/6' MIN
(SNAP LATCH. IR LOCK 140 OPTIONAL)
ATTACH
2/42)1/4* N 3/4'NEX HEAD SCREWS
TYPICAL DURASAFE END
MTS. 3
(T)11/12" DIA. X 1-5//0
LAS DOLT ATTACHED .TO JAMS
AT TA, 4AVB BRACKET
(3) 20 OA CENTER STILES
ATTACIE1 VITD (0)
102 -L -LOC AT ME TOP AND
1HOIi0N Rla INTERIAND MFACE
HINGE
M 66. CALV. STEEL END STILE
ATTACHED 9110 (7) TOGv1-LOC
Ioe-EL inT aALO
• • ••
• • • • •
• • •
3 3/4' MIN.
SIDEMEN
•
RETAINERPM RROLLER. � � MACS WO.
N STEEL • •
1/4-20 x SOPTRACK • • • • •
MACE MLT AND NUT CONT. WATMJVaMMB 2
OR (2) RIVETS TRACK M081iT'Q4C ➢:TAIL• • .sry GB
NEI. • • • • 010' &OR g
Y 2066. STRUT
ATTACHED V/
CA) 2/4' X 3/4'
HEX HEAD SCREWS
AT et MO CENTER
STILES
•
••
•
• •
;10 SALE STEEL WITH
5' STEN ROLLER V/RETAINER
USED FOR 1/TREADED SHAFTS
••• •••
• •
• •
• •
• • • •
Rf
3 GA COMMERCIAL
TOP FIXTURE ATTACHED W/
<4) 1/4' x 3/4' HEX HEAD SCREWS
ADJUSTABLE SLIDE BRACKET ATTACHED
V/<2> 1/4' x 1/2' BOLT AHD NUTS
END HINGE
44 GA.
3' x 20 GA. STRUTS
(2) PER SECTION.
C�1T. STEELRETAINER
W/ CONT. BM SEAL
SECTION A—A (SIDE VIEW)
N.T.S.
IDTTON BRACKET
13 ATT )THIC4. K 3% ACNE5
NEX NEAP SCREWS
TYPICAL BOTTON BRACKET O
N.T.S.
INTDRLR OF GARAGE
IMAX. MOTH V0 -.—
DESIGN LOADS®
+244.0 IJS/FT 811E HOTS 2
-270.0 N3/Ff
3PFCIFICATIONS AND NOTES
1. ALL THE LOAD FROM THE DOOR IS TRANSFERRED TO 1110 VERTICAL TRACK.
FROM THE TRACK THE LOAD 13 TRANSFERRED TO THE VERTICAL JAMBS.
THE HORIZONTAL JAMB OR HEADER RECEIVES NO PORTION OF THE LOAD
TRANSFERRED FROM THE DOOR.
2. EACH VERTICAL JAMBS RECEIVES MAXSAUM DESIGN LOADS OF.
+244.8 LBS/FT & -279.0 LBS/FT
3. DOOR AND HARDWARE VLI. BE DESIGNED, MANUFACTURED
AND INSTALLED WITH STANDARDS AS SET FORTH BY DASD&
4, SECTICNS SHALL BE 24 GA. DOOR
0/ BAKED ON POLYESTER ) EXTERIOR SKIN
TER F1NISH.
011(
5. DOORS UP TO 7'0' HIGH CONSIST OF (4) SECTIONS AS SHOWN.
USE (2) 3' 20 GA STRUTS PER SECTION
0. DOORS OVER (4) SECTIONS REFER TO TABLES 1 AND 2
ON PAGE 3
7. SUPPORTING STRUCTURAL ELEMENTS SHALL BE DESIGNED
BY A REGISIRED PROFESSIONAL ENGINEER FOR WIND LOADS
INDICATED ON THIS DRAMNO IN ADDITION TO OTHER LOADINGS.
8. THIS APPROVAL REQUIRES THE MANUFACTURER TO DO TESTING
OF ALL COILS USED TO FABRICATE 0008 PANELS UNDER THIS
NOTICE OF ACCEPTANCE. A MINIMUM OF 2 SPECIMENS SHALL BE
CUT FROM EACH COIL AND TENSILE TESTED ACCORDING TO ASTM
0-8 BY A DADE COUNTY APPROVED LAB SELECTED AND PAID BY
THE MANUFACTURER. EVERY 3 MONTHS, 4 TIMES A YEAR, THE
MANUFACTURER SHALL MAIL TO THIS -OFFICE: A COPY OF THE TEST
REPORTS WITH CONFIRMATION THAT THE SPECIMENS WERE SELECTED
FROM COILS AT THE MANUFACTURER PRODUCTION FACILITIES. AND
A NOTARIZED STATEMENT FROM THE MANUFACTURER THAT ONLY
COILS WITH YIELD STRENGTH OF 34,600 PSI OR MORE SHALL BE
USED TO MAKE 000R PANELS FOR DADE COUNTY UNDER THIS
NOTICE OF ACCEPTANCE.
PMODUCiREVIS0U
4M =004 w011 Ile PI•INS
Building Coda
A4011/M 00 No
6)4 NSCAPmT a MEM
A MO BOE ROOT 10 PAGE 2
S O0RECU IFIKK 10351ESS NOL
C 0010 6 0201
0 WPM 10 7010
SAE BY
7-3-01 ENG
5.13-07 011
1.2-15-06 CBT
MAX SIZE
9' x14'
PRODUCTREVLSH) DESIGN LOADS
el cavil** whit Ow Florida +54.4 PSF
BalMi0jCO4e ,0 —92.0 PSF
No a" l2' 07
H. 4.6-""
LARGE MISSILE
IMPACT
RESISTANCE
LARGE MISSILE
IMPACT
RESISTANCE
�a��T�•�pE NgF �90�Aii
No 0048570 .4.1• 1▪ ."1..
I STof . Yi
I45 CARRGSE COURT VINSION-SALES. NC. 27105 WV.ANARRC0M
MODEL 950 HERITAGE 1000 & 2000
MODEL 055 OAK SDMMIT(24ga 1000 & 2000
Short, Long, Flush & Oak Summit Panels
910 NANO ND MR 00/1/07 CRANK MARI
B 0100 2 93I DAT OW07 IRC -9509-185-15-I
ROM BMW L SWORE PL It HA MOD 9413 1 G 3
• • 0
•
••• • • • • ••• • •
• • • • • • • •
• • • ••• • • •
• • • • • • • • • •
• •• •• • • • •• ••
••• • • • ••• • •
%Ivl
ISPLICE TRACKS AT THIS LOCATION
E= W/ (4) 1/4"-20 TRACK SPLICE BOLTS & NUTS
SECURE TO JAMB WITH (3) 5/16" DIA. x 1-5/8"
LAG BOLTS
s
<SPLICE)
3 GA. FLAG BRACKET ATTACHED TO WOOD
JAMB
W/ (3) 5/16 DIA. X 1-5/8' LAG BOLTS AND TO
TRACK W/ (4) 1/4'-20 x 5/8 TRACK SPLICE
BOLTS AND NUTS
0000 IGH )
il
r
(tlj
**WWI' I' SLIVISED
samegayir *PA
, Hu fl sidR • P14RO" O,,.UCT&B•
.VLSEA
11::
• •• •• •• •
•• •,:'. •1%1V'
A.
•
•
• ••• ••••e• Iiii.: AoRmA
Product Qr/
•d7/o1
7 ue8•N• r aeHptylq with the Moe*e
dMpro*
•• ••• •• • • •
(1) 5/16" DIA. x 1-5/8"
LAG BOLT ATTACHED TO JAMB
AT EA. JAMB BRACKET
12 GA. GALV. STEEL
JAMB BRACKETS
ATTACHED W/ (1) 1/4"-20
TRACK SPLICE BOLT & NUT
SEE (TABLE 3) ON PAGE 3
FOR JAMB BRACKET SPACING
• •
TRACK CONFIGUIR'ATItN FOR :6'6'; UP `r ?$'• TALL DOORS
• • • • • • •
•• • • • • • • •
• •• • • • • • ••
WOOD JAMB ATTACHMENT TO STRUCTURE
2 X 8 VFRRCALJAMB ATTACHMENT 70 1600141 FRAME STRUf:111RF
8/16' X 3' IAD SCREWS MONO 6' FROM ENDS THEN 20' O.C. (1 1/2' EMBEDMENT)
2 X 6 VERTICAL .W® A1TAL IMFRT 10 2000 PSI FANCRFTP
HLT Ka1K BOLT 3/8• X 4' WARM 6• (ROA ENO8 THEN 24" O.C. (2 1/2' EMBEDMENT)
HLT SLEEVE ANCHOR 3/15• X 2-3/4' STMIPIO 8• MOM ENDS THEN 18' O.C. S1 1/4' E 66011661)
MY/RAMSET REDHEAD (7RU-6OL1) 3/6" X 4' STARTING 6' FROM 61405 THEN 24 0.C. (2 l/ " EMBEDMENT)
2 X 6 VFRIN'AL JAMB ATTACHMENT TO HOLLOW 0-90 RLQC,I(
SIMPSON 1/4' X 3' MEN SCREWS STARTING 8' FROM ENDS, USE PARS Of FASTENERS (3" APART) AT 8' 0.0
(1 1/2' EMBEOAENTl
HETI 1/4' X 2-3/4 IOMN-CON II+ SCREWS STARING 8' FROM ENDS. USE PAIRS OF 605TOI R5 (3" MART)
AT 8' 0.0. (1 1/4" EMBE0M0IT)
2 X 6 VERTICAL JAMB ATTACHMENT W GROUTED C-00 BLOCK (2000 PS1 CBQUIl
HL1I SLEEVE ANCHOR 3/13' K 2-3/4" STARTING 0' FROM ENDS THEN 20' 0.0. (1 1/4' EASEMENT)
(OR USE FASTENERS FOR HOLLOW C-60 BLOCK)
•4165 AND BOLTS CAN BE COUNTERSUNK 70 P '. . A FLUSH MOUNTING SURFACE.
*PREPARATION OF WOOD JAMBS BY 0111605
HOLLOW BLOCK
STRUCTURE
CROMER
STRUCTURE LOCH
}<1
6-7/14' RN
3' HN
REV DXSIP108 Q K119045
A Axa BRE 8000 ID PAGE 2
B MEMO IRO MOOS NW
C NDA 6 HENSED
D
BMW 10280 RC
u7xx 14' SIZE
9'
DESIGN LOADS
+54.4 PSF
-620 PSF
LARGE MISSILE
IMPACT
RESISTANCE
DAT 6T
7-3-97 RW
0.41-07 DNA
12-1S-06 (81
12-2-11 6111
01lf11 1q,p
„i• v. SUPT OOO
.`$41 AGENSF••i4:4.•
4 e No 50485761
Y fT
s
4.4 Vdikii1t•i%
rr
166 CARRIAGE C•RT VINS770-SALDI4 N.C. 07102 WVANARILMIN
MODEL 950 HER1TA00 1000 k 2000
MODEL 055 OAK SUMMIT(24ge 1000 & 200D
Short, Long, F1ueh k Oak Summit Panels
017E WAR BT 801 MT 03/7/97 CRAM NAM
B aim or SII 1A16 04/9/97 IRC -9509-185-15—I
010BNDC REWAS L SOMME FL I1L 1A 004671 SW 2 OF 3
••• • • • • ••• • •
• • • • • • • •
• • • ••• • • •
• • • • • • • • • •
• •• •• • • • •• ••
••• • • • ••• • •
TABLE 1
DOOR
HEIGHT
STRUT SPACING (BASED ON RECOMMENDED
SECTION CONFIGURATION)
TOP
A
BCDE
#5
#6
#7
#8
F
GN
21"
21"
I
J
18"
K
L
MN
0
T
pp
AWMI
Est.
Mil
EW
21"
18"
qM��
T
18"1
187"J
18"
21"
X
11' 6"
21"u
p�p
21"
��18g
211""p
_1�8g"gip
18"
7' 5 1/2"
18"
25
3/8"
39"
46 3/8"
60"
67 3/8"
q�3"�
8'
7
d
7
1100' 6q"
46"
21"
21"
�---_&_t-�
78"
82 1/4"
ILPILI
8' 5 1/2"
3
18"
25
3/8"
36"
a_ lEIlRM
43 3/8"
54"
61 3/8"
72"
79
3/8"�-
SEr
:12
E
E
--g_
8'6"
EE
E
94 1/4"
-
hymn•
9'
5 1/2"
15"
22
3/8"
33"
40 3/8"
51"
58 3/8"
7' 6"
�7-¢j_-'j
18"
87"
t
94
3/8"
-_-_
21"
18"
Viginaal
1061/4"
69"
76
3/8"
46"
10'
5**1/2"
78"
25
3/8"
46 3/8"�
60"
67 3/8"
78"
8y5
3/8"tl
3/8"
��-ty-_
1181/4'
Varo
ENTE
��1gg8"yy
p�39"
MIIMME
�
54"
M
61 3/8°
_
72"
:d:.
79
irL"•�f.��a,OL^n'
3/8"
,9^6"
90"
�1g03
° <
97
3/8"
^L. ' fu#TaV?•. 3RMIP,I
108" 115 3/8"
-_
y
1 ' ...J k,
130 1/4"
11'
5 1/2"
18"
25
3/8"
36"
43 3/8"
EMEOITWOOMMIKMIESIEMMILIMMAIMPMEARIAlriMaNEM
38"
46"
56'
68"
78'
88"
100"
110"
122
136"
WaiZMNERMBERIECNIMEEMEMIROMALMMETEM
12'
5 1/2"18"
25 3/8"
39"
46 3/8"60"
67 3/8"
81"
88 3/8"102"
I
109 3/8"
t• /8nO
120" 127 3/8"-.142
04
8
1/4"
ert
E'A
38' ""
E
66
MER
Mi1
100"
° U
122"a
13'
5 1/2"
18"
25
3/8"
39"
48 3/8"
60"
67 3/8"
78"
85
3/8"
96"
103
3/8"
114' 121 3/8"
132"
139 3/8"
1541/4"
mom
14"
27"
38"
46"
56"
68"
78"
88"
100"
114"
122"
134'
146"
160"
14'
5 1/2"
18"
25
3/8"
39"
46 3/8"
60"
67 3/8"
81"
88
3/8"
102"
109
3/8"
123" 130 3/8"
144"
151 3/8"
166 1/4"
TABLE 2
DOOR
HEIGHT
SECTION HEIGHTS
Btm
#2
#3
#4
#5
#6
#7
#8
WillaWariffirdantliMPAMENA
13' 6"
21"
21"
21"
21"
21"
18"
18"
21"
Maitrt-olenIPEIMBEraW,
g�D����IE-�.��'1
"'rkTEA'xr.I
AWMI
Est.
Mil
12 66"
21"
18"
qM��
18"1
187"J
18"
21"
X
11' 6"
21"u
p�p
21"
��18g
211""p
_1�8g"gip
18"
18"8"
18"
21"0
MREAPT
76"MD,TiMU
q�3"�
8'
7
d
7
1100' 6q"
46"
21"
21"
�---_&_t-�
78"
2�1 "
-MOM
9 6
[ +21"5
Tt
21"18"
PMalrif
18"
p721"
Mili
E#2�1p"j�
aliEna
a 7EM3✓IXGAa
MMEAM
:12
rt•
... •
• • •
8'6"
21"
21"
21"
hymn•
?e9'
EE 3"
14"
27"
38"
4p6'y""�
�g/
56"
q
F68"
• •••
7' 6"
�7-¢j_-'j
18"
18"
18"
18"
�� �,.,��i;[yiy��
21"
18"
maim
$y ti
•
• 6"
•
TABLE 3
DOOR
HEIGHT
TRACK ATTACHMENT
SPLICE
A
B
C
F
G
H�
I
J
N
SME
g�D����IE-�.��'1
"'rkTEA'xr.I
AWMI
EMMMEw.-x
�Ka�.�
�^--_L�. �y�
D6::41L?dMLKe
qM��
��S EI
7'
14"
38"
46'I
68"
76"MD,TiMU
q�3"�
8'
3"
14"27
��2�7/"�
gal
38"
46"
E566"
56"
68"
�---_&_t-�
78"
88"
T
wEMP
MMEAM
h!E
DI
s
?e9'
EE 3"
14"
27"
38"
4p6'y""�
�g/
56"
q
F68"
78"
88"
�7-¢j_-'j
-ky-
100'
ANIM
10'
3
14"
27"
38".
46"
56"
68"
78"
88"
100"
112"
11'
3"
14"
27"
38"
46"
56"
68"
78"
88"
100"
110"
NEM
ghim
3"
14"
27"
38"
46"
56'
68"
78'
88"
100"
110"
122
136"
WaiZMNERMBERIECNIMEEMEMIROMALMMETEM
3",N
14"M
27"
38' ""
46"est
66
68"
78"
100"
114"d
122"a
i
1480"�
3M
lgargESA
X88"
mom
14"
27"
38"
46"
56"
68"
78"
88"
100"
114"
122"
134'
146"
160"
• • • • • •
• • • 8 • •
•• • • • • w •
• •• • • • • •
•• • ••• • •
ALL TRACK ATTACHMENT SPACING +/-2' ALLOWED WITH SYP OR SPF NO. 2 OR SETTER ONLY
•
••
•
PRODUC'4 R&VLSFD PRODUCT A8Vi3CD
..za lyilg •itthe Floel0a a/ asaplyasuilthe Fl"24yt
mamma* t& / "0, 174 i', `
�Acceppmeettio
Egkarlak 7 End
REV DESCRP110{ OF E.YENNS OAR 87
A AEDED DRE 8.00 TO PM 7 7-3-07 DIG
8 mDICORD 1805E TH508SS 8011 8-13-07 •G
C 801E 0 008011 12-15-01 GDT
D DRAB 20 7010 8770 12-2-11 0.18
%
MSIZE .�0P;CEINC
AO E90°'
DESIGN LOADS
•�"ti��'••NO =au48570).'2R`z
+54.4 PSF .
-82.0 PSF ;; *• � V ?>t
,Elly
LARGE MISSILE T•. 4 OF'.•�C��,
RESISTANCE ••AOciSSjpNALS%%%% ,
A%%%%%% tRItt`
WS CARMAN CUNT VINSTON-SALEM NC. 87107 WVAWVte.CON
MODEL 000 HERITAGE 1000 & 2000
1100E1. 855 OAR SUMIIIT(240a) 1000 & 2000
Short, Long, Flush & Oak Summit Panels
SR CRAW DT ECC DA11 03/7/01 CRAW MAW
B 51EC01D If S51 DAR 04/1/07 IRC -9509-185-15-I
MGM 1M7RIS L 58180 E88 RE I71 Na DORM 08E1 3 OF 3
••• • • • • ••• • •
• • • • • • • •
• • • ••• • • •
• • • • • • • • • •
• •• •• • • • •• ••
••• • • • ••• • •
, 12/27/2016.. Florida Building Code Online
B rsiness
P ofessiona
egu atm
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4904
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Masonite International
Category: Exterior Doors
Subcategory: Swinging Exterior Door
Assemblies
National Accreditation & Management
Institute
(804) 684-5124
Approved
R7
History
*Approved by DBPR. Approvals by DBPR shall be reviewed and ratified by the POC and/or the Commission if necessary.
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FL4904-R7
Affirmation
2014
Approved
Product Manufacturer Masonite International
Address/Phone/Email 1955 Powis Road
West Chicago, IL 60185
(615) 441-4258
sschreiber@masonite.com
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TAS 201 • •1994 • •
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Page 2 of 4
mammary of Products
FL #
Model, Number or Name
Description
4904.1
Wood -edge Steel Side -Hinged
Door Units
6'-8" Opaque I/S and 0/S Single Door
Limits of Use
Approved for use In HVHZ: Yes
Approved for use outside HVHZ: Yes
Impact Resistant: Yes
Design Pressure: +76.0/-76.0
Other: Evaluated for use in locations adhering to the
Florida Building Code including the High Velocity
Hurricane Zone, and where pressure requirements as
determined by ASCE 7, Minimum Design Loads for
Buildings and Other Structures, does not exceed the
design pressures listed. 3'-0" x 6'-8" max nominal size.
When large missile impact resistance is required,
hurricane protective system is NOT required. See DWG-
.Ji&EL 128-05 for details.
Certification Agency Certificate '
FL4904 R7 C CAC NI006110.01.pdf
Quality Assurance Contract Expiration Date
12/31/2020
Installation Instructions
FL4904 R7 II FL0128.odf
Verified By: National Accreditation & Management
Institute
Created by Independent Third Party:
Evaluation Reports
FL4904 R7 AE 504A.pdf
Created by Independent Third Party: Yes
4904.2
Wood -edge Steel Side -Hinged
Door Units
8'-0" Opaque I/5 and 0/5 Single Door
Limits of Use
Approved for use in HVHZ: Yes
Approved for use outside HVHZ: Yes
Impact Resistant: Yes
Design Pressure: +70.0/-70.0
Other: Evaluated for use in locations adhering to the
Florida Building Code including the High Velocity
(Hurricane Zone, and where pressure requirements as
determined by ASCE 7, Minimum Design Loads for
Buildings and Other Structures, does not exceed the
design pressures listed. 3'-0" x 8'-0" max nominal size.
When large missile impact resistance is required,
hurricane protective system is NOT required. See DWG-
MA-FL0129-05 for details.
Certification Agency Certificate
FL4904 R7 C CAC NI006110.02.pdf
Quality Assurance Contract Expiration Date
12/31/2020
Installation Instructions
FL4904 R7 II FL0129.pdf
Verified By: National Accreditation & Management
Institute
Created by Independent Third Party:
Evaluation Reports
FL4904 R7 AE 503A.pdf
Created by Independent Third Party: Yes
4904.3
Wood -edge Steel Side -Hinged
Door Units
6'-8" Opaque I/S and 0/S Door w/ or w/o Sidelites •
• :•••)
Limits of Use
Approved for use in HVHZ: Yes
Approved for use outside HVHZ: Yes
Impact Resistant: Yes
Design Pressure: +55.0/-55.0
Other: Evaluated for use in locations adhering to the
Florida Building Code including the High Velocity
Hurricane Zone, and where pressure requirements as
determined by ASCE 7, Minimum Design Loads for
Buildings and Other Structures, does not exceed the
design pressures listed. 12'-0" x 6'-8" max nominal size.
When large missile impact resistance is required,
hurricane protective system Is NOT required on opaque
panels, but is required on glazed panels. See DWG -MA-
FL0128 O5.
_••
gr
Certification Agency Certificate• • •
FL4904 R7 C CAC NI006110.01.pa.• ; •• ••
•
Quality Assurance Contract Expiration Date • • •
12/31/2020 • • •
Installation Instructions • • • • • • • •
FL4904 R7 II FLO12B.pdf ••• • ••
•
Verified By: National Accreditation & Management • • -
Institute • •; • • • • • • •
Created by Independent Third Iertw• • • •
Evaluation Reports • • • • • • •
FL4904 R7 AE 502A.pdf • • • •
Created by Independent Third Party: 'fes • •
• • •••••
•s • • ••
•
••••
•
4904.4
Wood -edge Steel Side -Hinged
Door Units
• •
8'-0" Opaque I/S Door w/ or w/o Sidelites • • •
Limits of Use
Approved for use in HVHZ: Yes
Approved for use outside HVHZ: Yes
Impact Resistant: Yes
Design Pressure: +45.0/-50.0
Other: Evaluated for use in locations adhering to the
Florida Building Code including the High Velocity
Hurricane Zone, and where pressure requirements as
determined by ASCE 7, Minimum Design Loads for
Buildings and Other Structures, does not exceed the
design pressures listed. 12'-0" x 8'-0" max nominal size.
When large missile impact resistance is required,
hurricane protective system is NOT required on opaque
Certification Agency Certificate
FL4904 R7 C CAC NI006110.02.pdf
Quality Assurance Contract Expiration Date
12/31/2020
Installation Instructions
FL4904 R7 II FL0129.pdf
Verified By: National Accreditation & Management
Institute
Created by Independent Third Party:
Evaluation Reports
FL4904 R7 AE 501A.pdf
Created by Independent Third Party: Yes
https://www.floridabuilding. org/pr/pr_app_dtl. aspx?param=wGEVXQwtDgteluIwHNbblSc... 5/5/2015
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Florida Building Code Online
Page 3 of 4
panels, but is required on glazed panels. See DWG-MA-
FL0129-05.
4904.5
Wood -edge Steel Side -Hinged
Door Units
8'-0" Opaque 0/S w/ or w/o Sidelites
I
Limits of Use
Approved for use in HVHZ: Yes
Approved for use outside HVHZ: Yes
Impact Resistant: Yes
Design Pressure: +50.0/-45.0
Other: Evaluated for use in locations adhering to the
Florida Building Code including the High Velocity
Hurricane Zone, and where pressure requirements as
determined by ASCE 7, Minimum Design Loads for
Buildings and Other Structures, does not exceed the
design pressures listed. 12'-0" x 8'-0" max nominal size.
When large missile impact resistance is required,
hurricane protective system is NOT required on opaque
panels, but is required on glazed panels. See DWG-MA-
FL0129-05.
Certification Agency Certificate
FL4904 R7 C CAC NI006110.02.pdf
Quality Assurance Contract Expiration Date
12/31/2020
Installation Instructions
FL4904 R7 II FL0129.pdf
Verified By: National Accreditation & Management
Institute
Created by Independent Third Party:
Evaluation Reports
FL4904 R7 AE 501A.pdf
Created by Independent Third Party: Yes
4904.6
Wood -edge Steel Side -Hinged
Door Units
6'-8" Glazed I/5 and 0/5 Door w/ or w/o Sidelites
Limits of Use
Approved for use In HVHZ: Yes
Approved for use outside HVHZ: Yes
Impact Resistant: No
Design Pressure: +50.5/-50.5
Other: Evaluated for use In locations adhering to the
Florida Building Code including the High Velocity
Hurricane Zone, and where pressure requirements as
determined by ASCE 7, Minimum Design Loads for
Buildings and Other Structures, does not exceed the
design pressures listed. 12'-0" x 6'-8" max nominal size.
When large missile impact resistance Is required,
hurricane protective system Is required. See DWG-MA-
FLO130-05 for details.
Certification Agency Certificate
FL4904 R7 C CAC NI006110.03.pdf
Quality Assurance Contract Expiration Date
12/31/2020
Installation Instructions
FL4904 R7 II FL0130.pdf
Verified By: National Accreditation & Management
Institute
Created by Independent Third Party:
Evaluation Reports
FL4904 R7 AE 502A.pdf
Created by Independent Third Party: Yes
4904.7
Wood -edge Steel Side -Hinged
Door Units
8'-0" Glazed I/S Door w/ or w/o Sidelites
Limits of Use
Approved for use in HVHZ: Yes
Approved for use outside HVHZ: Yes
Impact Resistant: No
Design Pressure: +40.0/-45.0
Other: Evaluated for use in locations adhering to the
Florida Building Code including the High Velocity
Hurricane Zone, and where pressure requirements as
determined by ASCE 7, Minimum Design Loads for
Buildings and Other Structures, does not exceed the
design pressures listed. 12'-0" x 8'-0" max nominal size.
When large missile Impact resistance is required,
hurricane protective system is required. See DWG -MA-
FLO131-05 for details.
Certification Agency Certificate
FL4904 R7 C CAC NI006110.04.pdf
Quality Assurance Contract Expiration Date
12/31/2020
Installation Instructions
FL4904 R7 II FLO131.pdf
Verified By: National Accreditation & Management
Institute
Created by Independent Third Party: • •
Evaluation Reports• . •• • • • • • •
FL4904 R7 AE 501A.pdf • • .
• •
Created by Independent Third Rainy; 41 s • • •
• • • • •
• • •
4904.8
Wood -edge Steel Side -Hinged
Door Units
8'-0" Glazed 0/5 Door w/ or w,b SicTeTites • • .
•••• • • •
• -�
Limits of Use
Approved for use in HVHZ: Yes
Approved for use outside HVHZ: Yes
Resistant: No
Design Pressure: +45.0/-40.0
Other: Evaluated for use in locations adhering to the
Florida Building Code including the High Velocity
Hurricane Zone, and where pressure requirements as
determined by ASCE 7, Minimum Design Loads for
Buildings and Other Structures, does not exceed the
design pressures listed. 12'-0" x 8'-0" max nominal size.
When large missile impact resistance is required,
hurricane protective system is required. See DWG-MA-
FLO131-05 for details.
Certification Agency Certifiedte • • • •• •
FL4904 R7 C CAC NI006114.614.44f. •
Quality Assurance ContraciaE�x��ra:ion Date ••
Impact
12/31/2020 • . . •
Installation Instructions • • •
FL4904 R7 II FLO131.odf • • •...•
Verified By: National Accredltito IA B.Managctnent
Institute • 04,00
Created by Independent Third Party: •• • • •
Evaluation Reports •
FL4904 R7 AE 501A.pdf
Created by Independent Third Party: Yes
Back
Next
Contact Us :: 1940 North Monroe Street. Tallahassee FI. 32399 phone: 850-487-1824
The State of Florida is an AA/EEO employer. Copyright 2007-2013 State of Florida :: Privacy Statement :: Accessibility Statement :: Refund statement
Under Florida law, email addresses are public records. If you do not want your e-mail address released In response to a public -records request, do not
https://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDqteluIwHNbblSc... 5/5/2015
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, ,Florida Building Code Online Page 4 of 4
send electronic mall to this entity. Instead, contact the office by phone or by traditional mail. If you have arty questions, please contact 850.487.1395.
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with an email address If they have one. The emails provided may be used for official communication with the licensee. However email addresses are public
record. If you do not wish to supply a personal address, please provide the Department with an email address which can be made available to the public.
To determine if you are a licensee under Chapter 455, F.S., please click jlgrg.
Product Approval Accepts:
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https://www. floridabuilding. org/pr/pr_app_dtl.aspx?param=wGEVXQwtDqteluIwHNbblSc... 5/5/2015
INSTRUMENT#: 2016181720, BK: 24073 PG: 1746 PGS: 1746 - 1750 05/11/2016 at
11:22:12 AM, DEPUTY CLERK:MTERRELL Pat Frank,Clerk of the Circuit Court
Hillsborough County
Document drafted by and
RECORDING REQUESTED BY:
Caliber Horne i,oans. inc.
13801 Wireless Way
Oklahoma City, OK 73134
SPACE ABOVE THIS LINE FOR RECORDER'S USE
LIMITED POWER OF ATTORNEY
The trusts identified on the attached Schedule A (the "Trusts"), by and through
U.S. Bank Trust National Association, a national banking association organized and existing
under the laws of the United States and having an office at 190 S. La Salle Street, MK-IL-SL7R,
Chicago, IL 60603, not in its individual capacity but solely as Trustee ("Trustee"). hereby
constitutes and appoints Caliber Home Loans. inc. (fka Vericrest Financial. Inc. as of April 8,
2013) and its wholly-owned subsidiary, Caliber Real Estate Services, LLC ("ORES"),
(collectively referred hereafter as ("Servicer"), and in its name, aforesaid Attorney -In -Fact, by
and through any officer appointed by the Board of Directors of Servicer. to execute and
acknowledge in writing or by facsimile statnp all documents customarily and reasonably
necessary and appropriate for the tasks described in the items (1) through (12) below; provided
however. that (a) the documents described below may oily he executed and delivered by such
Attorneys -In -Fact if such documents are required or permitted under the terms of the related
servicing agreements. (h) all actions taken by Servicer pursuant to this Limited Power of
Attorney must be in accordance with Federal, State and local taws and procedures, as applicable
and (c) no power is granted hereunder to take any action that would be either adverse to the
interests of or be in the name of U.S. Bank Trust National Association in its individual capacity.
This Limited Power of Attorney is being issued in connection with Servicer's responsibilities to
service certain mortgage. loans (the "Loans") held by the Trustee. These Loans are secured by
collateral comprised of mortgages, deeds of trust. deeds to secure debt and other forms of
security instruments (collectively the "Security Instruments") encumbering any and all real and
personal property delineated therein (the "Property") and the Notes secured thereby. Please refer
to Schedule A attached hereto.
1. Demand, sue for, recover, collect and receive each and every sum of money, debt, account
and interest (which now is, or hereafter shall become due and payable) belonging to or
claimed by the Trustee, and to use or take any lawful means for recovery by legal process
or otherwise, including but not limited to the substitution of trustee serving under a Deed of
Trust, the preparation and issuance of statements of breach, notices of default, and/or
notices of sale, accepting deeds in lieu of foreclosure, evicting (to the extent allowed by
federal, state or local laws) foreclosing on the properties under the Security Instruments by
judicial or non judicial foreclosure. actions for temporary restraining orders, injunctions,
appointments of receiver, suits for waste, fraud and any and all other tort, contractual or
verifications in support thereof, as may he necessary or advisable in any bankruptcy action,
state or federal suit or any other action.
Document drafted by and
RECORDING REQUESTED BY:
Caliber Home Loans, Inc.
13801 Wireless Way
Oklahoma City, OK 73134
SPACE ABOVE THIS LINE FOR RECORDER'S USE
LIMITED POWER OF ATTORNEY
The trusts identified on the attached Schedule A (the "Trusts"), by and through
U.S. Bank Trust National Association, a national banking association organized and existing
under the laws of the United States and having an office at 190 S. La Salle Street, MK-IL-SL7R,
Chicago, IL 60603, not in its individual capacity but solely as Trustee ("Trustee"), hereby
constitutes and appoints Caliber Home Loans, Inc. (tka Vericrest Financial, Inc. as of April 8.
2013) and its wholly-owned subsidiary, Caliber Real Estate Services; LLC ('`CRSS"),
(collectively referred hereafter as ("Servicer"), and in its name, aforesaid Attorney -In -Fact, by
and through any officer appointed by the Board of Directors of Servicer, to execute and
acknowledge in writing or by facsimile stamp all documents customarily and reasonably
necessary and appropriate for the tasks described in the items (1) through (12) below; provided
however, that (a) the documents described below may only be executed and delivered by such
Attorneys -In -Fact if such documents are required or permitted under the terms of the related
servicing agreements, (b) all actions taken by Servicer pursuant to this Limited Power of
Attorney must be in accordance with Federal, State and local laws and procedures, as applicable
and (c) no power is granted hereunder to take any action that would be either adverse to the
interests of or be in the name of U.S. Bank Trust National Association in its individual capacity.
This Limited Power of Attorney is being issued in connection with Servicer's responsibilities to
service certain mortgage loans (the "Loans") held by the Trustee. These Loans are secured by
collateral comprised of mortgages, deeds of trust, deeds to secure debt and other forms of
security instruments (collectively the ''Security Instruments") encumbering any and all real and
personal property delineated therein (the "Property") and the Notes secured thereby. Please refer
to Schedule A attached hereto.
1. Demand, sue for, recover, collect and receive each and every sum of money, debt, account
and interest (which now is, or hereafter shall become due and payable) belonging to or
claimed by the Trustee. and to use or take any lawful means for recovery by legal process
or otherwise, including but not limited to the substitution of trustee serving under a Deed of
Trust. the preparation and issuance of statements of breach, notices of default, and/or
notices of sale, accepting deeds in lieu of foreclosure, evicting (to the extent allowed by
federal, state or local laws) foreclosing on the properties under the Security Instruments by
judicial or non judicial foreclosure, actions for temporary restraining orders, injunctions,
appointments of receiver, suits for waste. fraud and any and all other tort, contractual or
verifications in support thereof, as may be necessary or advisable in any bankruptcy action,
state or federal suit or any other action.
2 Execute and/or file such documents and take such other action as is proper and necessary to
defend the Trustee in litigation and to resolve any litigation where the Servicer has an
obligation to defend the Trustee, including but not limited to dismissal, termination,
cancellation, rescission and settlement.
3. Transact business of any kind regarding the Loans, as the Trustee's act and deed, to
contract for, purchase. receive and take possession and evidence of title in and to the
Property and/or to secure payment of a promissory note or performance of any obligation or
agreement relating thereto.
4. Execute, complete, indorse or file bonds, notes, mortgages, deeds of trust and other
contracts, agreements and instruments regarding the borrowers and/or the Property,
including but not limited to the execution of' estoppel certificates, financing statements.
continuation statements. releases. satisfactions. reconveyances, assignments, loan
modification agreements, payment plans. waivers. consents, amendments, forbearance
agreements, loan assumption agreements, subordination agreements. property adjustment
agreements, management agreements, listing agreements, purchase and sale agreements,
short sale transactions and other instruments pertaining to mortgages or deeds of trust, and
execution of deeds and associated instruments. if any, conveying the Property. in the
interest of the Trustee.
5. Endorse on behalf of the undersigned all checks, drafts and/or other negotiable instruments
made payable to the undersigned.
6. Execute any document or perform any act in connection with the administration of any PMI
policy or LPMI policy, hazard or other insurance claim relative to the Loans or related
Property.
7. Execute any document or perform any act described in items (3), (4), and (5) in connection
with the termination of any Trust as necessary to transfer ownership of the affected Loans
to the entity (or its designee or assignee) possessing the right to obtain ownership of the
Loans.
8. Subordinate the lien of a mortgage, deed of trust, or deed or other security instrument to
secure debt (1) for the purpose of refinancing Loans, where applicable, or (ii) to an
easement in favor of a public utility company or a government agency or unit with powers
of eminent domain, including but not limited to the execution of partial satisfactions and
releases and partial reconveyances reasonably required for such purpose, and the execution
or requests to the trustees to accomplish the same.
9. Convey the Property to the mortgage insurer, or close the title to the Property to be acquired
as real estate owned, or convey title to real estate owned property ("REO Property").
10. Execute and deliver any documentation with respect to the sale, maintenance, preservation,
renovation, repair, demolition or other disposition, of REO Property acquired through a
foreclosure or deed -in -lieu of foreclosure, including, without limitation: permits,
remediation plans or agreements, certifications, compliance certificates, health and safety
certifications, listing agreements; purchase and sale agreements; grant / limited or special
warranty / quit claim deeds or any other deed, but not general warranty deeds, causing the
transfer of title of the property to a party contracted to purchase same; escrow instructions;
and any and all documents necessary to effect the transfer of REO Property.
11. Servicer has the power to execute additional limited powers of attorney and delegate the
authority given to it by U.S. Bank Trust National Association, as Trustee, under the
applicable servicing agreements for the Trusts listed on Schedule A, attached.
12. To execute, record, file and/or deliver any and all documents of any kind for the purpose of
fulfilling any servicing duties, including but not limited to those listed in subparagraphs (1)
through (1 1), above, where Trustee's interest is designated, stated, characterized as or
includes any reference to one or more of the following: "Indenture Trustee". "Owner
Trustee", "Successor Trustee", "Successor in Interest", "Successor to" "Successor by
Mere>er "Trustee/Custodian", "Custodian/Trustee" or other similar designation.
Trustee also grants unto Servicer the full power and authority to correct ambiguities and errors in
documents necessary to effect or undertake any of the items or powers set forth in items (I) to
(12), above.
In addition to the indemnification provisions set forth in the applicable servicing agreements for
the Trusts listed on Schedule A, attached, Servicer hereby agrees to indemnify and hold the
Trustee, and its directors, officers, employees and agents harmless from and against any and all
liabilities, obligations, losses, damages, penalties. actions, judgments, suits, costs, expenses or
disbursements of any kind or nature whatsoever incurred by reason or result of the misuse of this
Limited Power of Attorney by the Servicer. The foregoing indemnity shall survive the
termination of this Limited Power of Attorney and the related servicing agreements or the earlier
resignation or removal of the Trustee for the Trusts listed on Schedule A.
Witness my hand and seal this 14t1 day of March, 2016.
NO CORPORATE SEAL
Witness: Angela Lee
Witness: Saba Debes •
Attest: Richard rupske, Trust Officer
On Behalf of the Trusts, by
U.S. Bank Trust National Association, as Trustee
By:
Russell D. Mosley, Vice President
By:
Brian Giel, Assistant Vice President
CORPORATE ACKNOWLEDGMENT
State of Minnesota
County of Ramsey
On this 14th day of March, 2016, before me, the undersigned, a Notary Public in and for said
County and State, personally appeared Rusell D. Mosley, Brian Giel and Richard Krupske,
personally known to me (or proved to me on the basis of satisfactory evidence) to be the persons
who executed the within instrument as Vice President, Assistant Vice President, and
Trust Officer, respectively of U.S. Bank Trust National Association, a national banking
association, and acknowledged to me that such national banking association executed the within
instrument pursuant to its by-laws or a resolution of its Board of Directors.
WITNESS my hand and official seal.
Signature:
1'
Kristy K. Le
My commission expires: 1/31/2019
. KREreK.!E
NOTARY PUB! iC - Air;N:SoTA
My Comstis:ion t::.paes jCn. 31, 2019
EXHIBIT A
LSF6 BERMUDA INVESTMENTS 2011-1 TRUST
LSF6 BERMUDA MRA TRUST
LSF6 WLI TRUST
LSF7 BERMUDA NPL I TRUST
LSF7 BERMUDA NPL II TRUST
LSF7 BERMUDA NPL III TRUST
LSF7 BERMUDA NPL IV TRUST
LSF7 BERMUDA NPL V TRUST
LSF7 BERMUDA NPL VI TRUST
LSF7 BERMUDA NPL VII TRUST
REVOLVING MORTGAGE INVESTMENT TRUST 2014-3Q7R
VERICREST OPPORTUNITY LOAN TRUST 2011-NPL2
VOLT PARTICIPATION TRUST 2011-NPL2
VOLT ASSET HOLDINGS NPL3
VOLT ASSET HOLDINGS TRUST XVI
VOLT NPL IX ASSET HOLDINGS TRUST
VOLT RPL XI ASSET HOLDINGS TRUST
VOLT RLF XII TRUST
VOLT XIV ASSET HOLDINGS TRUST
VOLT 2012-RPL1 ASSET HOLDINGS TRUST
VOLT 2012-NPL1 ASSET HOLDINGS TRUST
VOLT 2012 RPL2 ASSET HOLDINGS TRUST
VOLT 2012-NPL2 ASSET HOLDINGS TRUST
VOLT RLP ASSET HOLDINGS TRUST
LSF8 MASTER PARTICIPATION TRUST
LSF9 MASTER PARTICIPATION TRUST
LSRMF MASTER PARTICIPATION TRUST
LSF6 INVESTMENTS 2011-1 TRUST
LSF6 MRA REO TRUST
LSF7 NPL I TRUST
LSF7 NPL II TRUST
LSF7 NPL III TRUST
LSF7 NPL IV TRUST
LSF7 NPL V TRUST
LSF7 NPL VI TRUST
LSF7 NPL VII TRUST
bocuSign Envelope ID: CO1 DF966-0919-4330-98CE-87063981 DE69
CALIBER REAL ESTATE SERVICES, LLC
CERTIFICATE OF INCUMBENCY
Marion McDougall, Steven Scribner and Rod Wylie (the "Board of Managers") hereby
certify that each of them are the duly qualified and elected Board of Managers of Caliber Real
Estate Services, LLC (the "Company").
The Board of Managers hereby certify that the following named persons (i) have been duly
appointed to the office set forth opposite their name, and (ii) continue to hold said office at the
present time:
Alonzo, Patricia
Aslam, Shabana
Barfield, Leah
Boyd, Justin
Byrd, Jon
Carter, Tanya
Chance, Karen
Chaney, Wendy
Cooper, Angela
Crossman, Jaqua
Dao, Kevin
Dowling, Kelly
Fischer, Randall
Foley, Dane
Freeman, Tahonie
Gardner, Kenneth
Griffin, Shantay
Grimes, Dena
Haub, Christopher
Hawkins, Heather
Hinerman, Kelly
Hodges, Odette
Holdren, Judi
Horton, Linda
Lightfoot, James Timothy "Tim"
Longsworth, Alma (Suzie)
Maddox, Beverly
r. Maher,, Erin
Mahler, Lynnette
Manzato, Diana
Mayes, Sheila
Meyers, Aubrey
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Assistant Secretary
Vice President
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
FA uthorized`Signatory,
Authorized Signatory"
Authorized Signatory
Treasurer
Secretary
bocuSidn Envelope ID: CO1 DF966-0919-4330-98CE-870639B1 DE69
Mirasola, Kevin
Nelson, Eric
Niemann, Charles
Pegler, Sheryl
Roberts, Paula
Rosales, Hope
Santos, Ronald
Sayabouasy, Heather
Shorkey, Shawn
Snethen, Angela
Stark, Scott
Teer, Debbie
Varghese, Philip
Walker, Sally
Wall, Roy
Walter, Timothy
Watson, Pamela
Wells, Lynn
White, Connie
White, John (Jack)
Wylie, Rod
Yeldell, Brent
Vice President
Assistant Vice President & Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Vice President
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Authorized Signatory
Senior Vice President
Authorized Signatory
[Remainder of this page intentionally left blank]
`DocuSign Envelope ID: CO1DF966-0919-4330-98CE-670639B1DE69
IN WITNESS WHEREOF, the Board of Managers have hereunto subscribed their name
this 14th day of June, 2016.
CALIBER REAL ESTATE SERVICES, LLC
DocuSIgned by:
ka bk, kr,Vovirtf,
arcesIDlaugall, Manager
DocuSigned by:
SfUM, Sonl4tA r
Vern cher, Manager
LDocuSIgned by:
Pa 1. witie.
div; (Manager
DocuSign Envelope ID: CO1DF966-0919-4330-98CE-870639B1DE69
CALIBER REAL ESTATE SERVICES, LLC
CERTIFICATE OF INCUMBENCY
Marion McDougall, Steven Scribner and Rod Wylie (the "Board of Managers") hereby
certify that each of them are the duly qualified and elected Board of Managers of Caliber Real
Estate Services, LLC (the "Company").
The Board of Managers hereby certify that the following named persons (i) have been duly
appointed to the office set forth opposite their name, and (ii) continue to" hold said office at the
present time:
Alonzo, Patricia
Aslam, Shabana
Barfield, Leah
Boyd, Justin
Byrd, Jon
Carter, Tanya
Chance, Karen
Chaney, Wendy
Cooper, Angela
Crossman, Jaqua
Dao, Kevin
Dowling, Kelly
Fischer, Randall
Foley, Dane
Freeman, Tahonie
Gardner, Kenneth
Griffin, Shantay
Grimes, Dena
Haub, Christopher
Hawkins, Heather
Hinerman, Kelly
Hodges, Odette
Holdren, Judi
Horton, Linda
Lightfoot, James Timothy "Tim"
Longsworth, Alma (Suzie)
Maddox, Beverly
Maher, Erin
Mahler, Lynnette
Manzato, Diana
Mayes, Sheila
Meyers, Aubrey
Authorized Signatory
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Assistant Secretary
Vice President
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Treasurer
Secretary
DocuSign Envelope ID: CO1DF966-0919-4330-98CE-870639B1DE69
Mirasola, Kevin
Nelson, Eric
Niemann, Charles
Pegler, Sheryl
Roberts, Paula
Rosales, Hope
Santos, Ronald
Sayabouasy, Heather
Shorkey, Shawn
Snethen, Angela
Stark, Scott
Teer, Debbie
Varghese, Philip
Walker, Sally
Wall, Roy
Walter, Timothy
Watson, Pamela
Wells, Lynn
White, Connie
White, John (Jack)
Wylie, Rod
Yeldell, Brent
Vice President
Assistant Vice President & Authorized Signatory
Authorized Signatory
Authorized Signatory
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Vice President
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Authorized Signatory
Senior Vice President
Authorized Signatory
[Remainder of this page intentionally left blank]
DocuSign Envelope ID: CO1DF966-0919-4330-98CE-870639B1DE69
IN WITNESS WHEREOF, the Board of Managers have hereunto subscribed their name
this 14th day of June, 2016.
CALIBER REAL ESTATE SERVICES, LLC
DocuSigned by:
114 A 1i6tit Md,V bu at t
ariheiaugall, Manager
DocuSigned by:
L
Vum. Su ileva,r
PfFStSimier, Manager
LP-O
cuSigned by:
Wyle
ice; FManager
Certificate Of Completion
Envelope Id: C01 DF9660919433098CE870639B1 DE69
Subject: Caliber Real Estate Services, LLC - Certificate of Incumbency
Source Envelope:
Document Pages: 3 Signatures: 3
Certificate Pages: 5 Initials: 0
AutoNav: Enabled
Envelopeld Stamping: Enabled
Time Zone: (UTC -06:00) Central Time (US & Canada)
Record Tracking
Status: Original
6/14/2016 10:54:14 AM
Signer Events
Marion McDougall
Marion.McDougall@caliberhomeloans.com
EVP
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 9/15/2015 3:02:34 PM
ID:1eld76bd-7aab-4fca-bcac-628d0a5945d9
Rod Wylie
Rod.Wylie@caliberhomeloans.com
SVP, REO
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 9/16/2015 4:57:02 PM
ID:9f1bc6d0-2d4e-468e-b4e2-6affdd9bfc9c
Steve Scribner
steve.w.scribner@gmail.com
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 4/5/2016 12:08:01 PM
ID:951ed8c9-dabd-4e8d-beb7-aaelfa8blb60
In Person Signer Events
Editor Delivery Events
Agent Delivery Events
Intermediary Delivery Events
Certified Delivery Events
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Holder: Shantay Griffin
shantay.griffi n@cal i berhomeloans. com
Signature
--DocuSigned by: el a
s.--19FDADBB610E4DF..
Using IP Address: 66.210.82.162
—Doeu8lgnod by:
CdA l4/
`--281962C48AE04FF..
Using IP Address: 208.185.23.250
—DoouSlgned by:
�ttatil cnl tUr
`—E7AD8FF39F8E4F8_.
Using IP Address: 108.77.4.100
Signature
Status
Status
Status
Status
Status
Docu
Status: Completed
Envelope Originator:
Shantay Griffin
603 N Wilmot Rd
Tucson, AZ 85711
shantay.griffin@caliberhomeloans.com
IP Address: 199.204.116.30
Location: DocuSign
Timestamp
Sent: 6/14/2016 10:59:45 AM
Resent: 6/16/2016 9:09:44 AM
Viewed: 6/16/2016 2:12:13 PM
Signed: 6/16/2016 2:12:32 PM
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U tEt ti
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Dena Grimes
dena.grimes@caliberhomeloans.com
Security Level: Email, Account Authentication
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Electronic Record and Signature Disclosure:
Not Offered via DocuSign
ID:
Rod Wylie
Rod.Wylie@caliberhomeloans.com
SVP, REO
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 9/16/2015 4:57:02 PM
ID:9f1bc6d0-2d4e-468e-b4e2-6affdd9bfc9c
Shawn Shorkey
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Timestamp
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Sent: 6/20/2016 8:57:59 AM
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Viewed: 6/20/2016 9:08:22 AM
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6/20/2016 8:57:59 AM
Electronic Record and Signature Disclosure created on: 9/8/2015 5:12:15 PM
Parties agreed to: Marion McDougall, Rod Wylie , Steve Scribner, Rod Wylie
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008873
Local Business Tax Receipt
Miami -Dade 'County, State of Florida
-THIS ISNOT A BILL. - D0 NOT PAY
6256200
, BUSINESS NAME/LOCATION
A & J GENERAL CONTRACTORS CORP
4337E 11 AVE
HIALEAH FL 33013
RECEIPT NO.
RENEWAL
6520770
LBT
EXPIRES
SEPTEMBER 30, 2017
Must be displayed at place of business
Pursuant to County Code
Chapter 8A - Art: 9 & 10
OWNER SEC. TYPE,OF BUSINESS
A 8,1 GENERAL CONTRACtORS CORP 196 SUB -BUILDING CONTRACTOR
C/0 MIGUEL GUERRERO CRC1329763
Worker(s) 1
PAYMENT RECEIVED
BY TAX COLLECTOR
$45.00 07/21/2016
CHECK21-16-099269
This Local Business Tex Receipt only confimu payment of the Local Business Tax. The Receipt is not a license,
permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental
or nongovernmental regulatory laws and requirements which apply to the business.
The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-278.
For more information, visit www.miemidade;govttexaollectot
DETACH HERE
RICK SCOTT, GOVERNOR
KEN LAWSON, SECRETARY
LICENSE NUMBER
45
ATE" OE FLORIDA`'
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION`
-- a __CONSTRUCTION INDUSTRY LICENSING BOARD`--
CG(6151
-The 'GENERAL CONTRACTOR'`.N .�; ` "' :'�, `~*,'`. `'•'1� ,
Naffed=below IS CERTIFIED .. ," r
.,:Urra4ii a prdvlslo`ns"ot.Chapter 489 FS`. »�.
'"Eipiratron'date:.AUG 31; 213f$ -
.
O.GERREROIIIGUELAN I
tA & J GENERAL CONT -
437.<E,i 1 TH=AVE .
•
ISSUED: 06/23/2016
DISPLAY AS REQUIRED BY LAW
\MAI
SEQ # L1606230000821
CERTIFICATE OF LIABILITY INSURANCE
Date
12/19/2016
Producer: Plymouth Insurance Agency
2739 U.S. Highway 19 N.
Holiday, FL 34691
(727) 938-5562
This Certificate is issued as a matter of information only and confers no
rights upon the Certificate Holder. This Certificate does not amend, extend
or alter the coverage afforded by the policies below.
Insurers Affording Coverage
NAIC #
Insured: South East Personnel Leasing, Inc. & Subsidiaries
2739 U.S. Highway 19 N.
Holiday, FL 34691
Insurer A: Lion Insurance Company
11075
Insurer B:
Insurer C:
Insurer D:
Insurer E:
Coverages
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. Aggregate
limits shown may have been reduced by paid claims.
INSR
LTR
ADDL
INSRD
Type of Insurance
Policy Number
Policy Effective
Date
(MM/DD/YY)
Policy Expiration
Date
(MM/DD/YY)
Limits
GENERAL LIABILITY
Commercial General Liability
Each Occurrence
$
Damage to rented premises (EA
Claims Made Occur
occurrence)
$
d3
Med Exp
$
General
3
Personal Adv Injury
$
aggregate limit applies per:
Policy ❑ Project ❑ LOC
General Aggregate
$
Products - Comp/Op Agg
$
AUTOMOBILE
Imi
11
11
LIABILITY
Any Auto
All Owned Autos
Scheduled Autos
Hired Autos
Non -Owned Autos
Combined Single Limit
(EA Accident)
$
Bodily Injury
(Per Person)
$
Bodily Injury
(Per Accident)
$
Property Damage
(Per Accident)
$
EXCESS/UMBRELLA
LIABILITY
Occur ❑ Claims Made
Deductible
Each Occurrence
Aggregate
A
Workers Compensation and
Employers' Liability
Any proprietor/partner/executive officer/member
excluded? NO
If Yes, describe under special provisions below.
WC 71949
01/01/2017
01/01/2018
X
I WC Statu-
tory Limits
I OTH-
ER
E.L. Each Accident
$1,000,000
E.L. Disease - Ea Employee
$1.000,000
E.L. Disease - Policy Limits
$1,000,000
Other
Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616
Descriptions of Operations/LocationsNehicles/Exclusions added by Endorsement/Special Provisions: Client ID: 91-67-412
Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following "Client Company":
A & 3 General Contractors, CO
Coverage only applies to injuries incurred by South East Personnel Leasing, Inc. & Subsidiaries active employee(s), while working in: FL.
Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity.
A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937-2138 or by calling (727) 938-5562.
Project Name:
ISSUE 01-09-15 (EP)
Begin Date: 8/15/2013
CERTIFICATE HOLDER CANCELLATION
VILLAGE OF MIAMI SHORES
BUILDING DEPT.
10050 N. E. 2ND AVENUE
MIAMI SHORES, FL 33138
Should any of the above described policies be cancelled before the expiration date thereof, the issuing
insurer will endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to
do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives.
1 .,„a./4":.,
CERTIFICATE OF LIABILITY INSURANCE
Date .
1 1/8/2016
Producer: Plymouth Insurance Agency
2739 U.S. Highway 19 N.
Holiday, FL 34691
(727) 938-5562
This Certificate is issued as a matter of information only and confers no
rights upon the Certificate Holder. This Certificate does not amend, extend
or alter the coverage afforded by the policies below.
Insurers Affording Coverage
NAIC #
Insured: South East Personnel Leasing, Inc. & Subsidiaries
2739 U.S. Highway 19 N.
Holiday, FL 34691
Insurer A: Lion Insurance Company
11075
Insurer B:
Insurer C:
Insurer D:
Insurer E:
Coverages
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. Aggregate
limits shown may have been reduced by paid claims.
INSR
LTR
ADDL
INSRD
Type of Insurance
Policy Number
Policy Effective
Date
(MM/DD/YY)
Policy Expiration
Date
(MM/DD/YY)
Limits
GENERAL LIABILITY
General Liability
Each Occurrence
$
Damage to rented premises (EA
Claims Made Occur
occurrence)
$
TCommercial
Med Exp
$
General
3
Personal Adv Injury
$
aggregate limit applies per:
Policy ❑ Project ❑ LOC
General Aggregate
$
Products - Comp/Op Agg
$
AUTOMOBILE
_
LIABILITY
Any Auto
All Owned Autos
Scheduled Autos
Hired Autos
Non-Owned Autos
Combined Single Limit
(EA Accident)
$
Bodily Injury
(Per Person)
$
Bodily Injury
(Per Accident)
$
Property Damage
(Per Accident)
$
EXCESS/UMBRELLA
LIABILITY
Occur Claims Made
Deductible
Each Occurrence
Aggregate
A
Workers Compensation and
Employers' Liability
Any proprietor/partner/executive officer/member
excluded? NO
If Yes, describe under special provisions below.
WC 71949
01/01/2016
01/01/2017
X
I WC Statu-
tory Limits
I OTH-
ER
E.L. Each Accident
$1,000,000
E.L. Disease - Ea Employee
$1,000,000
E.L. Disease - Policy Limits
$1.000,000
Other
Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616
Descriptions of Operations/LocationsNehicles/Exclusions added by Endorsement/Special Provisions: Client ID: 91-67-412
Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following "Client Company':
A & 3 General Contractors, CO
Coverage only applies to injuries incurred by South East Personnel Leasing, Inc. & Subsidiaries active employee(s), while working in: FL.
Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity.
A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937-2138 or by calling (727) 938-5562.
Project Name:
ISSUE 01-08-16 (PH)
Begin Date 8/15/2013
CERTIFICATE HOLDER CANCELLATION
VILLAGE OF MIAMI SHORES
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, the issuing
insurer will endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to
do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives.
x,aerC•s+wv
'4R I® CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DDIVYYY)
12/27/2016
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(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
Casualty Systems Inc.
3331 SW 107 Ave
Miami FL 33165
CONTACT Juan Hernandez
NAME:
PHONE F:D• (305) 551-0590 FAX
No): (305)551-0857
E-MAIL
admin@casualtysystems . com
INSURER(S) AFFORDING COVERAGE
NAIC #
INsuRERA:CovingtOn Specialty Insurance
LIABILITY
COMMERCIAL GENERAL LIABILITY
INSURED
A & J General Contractor Corp.
4337 E 11 Ave.
Hialeah FL 33010
INSURER B :
VBA386629
INSURER C :
07/01/2017
INSURERD:
$ 1,000,000
INSURER E :
$ 100,000
INSURERF:
$ 5,000
L1362803082
REVISION NUMBER:
vTHIS 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.
INSRT
LTR
TYPE OF INSURANCE
ADDL
INSR
SUBR
WVD
POLICY NUMBER
POLICY EFF
(MMIDDIYYYY)
POLICY EXP
(MMIDD/YYYY)
LIMITS
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
10050 NE 2nd Avenue
VBA386629
07/01/2016
07/01/2017
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 100,000
MED EXP (Any one person)
$ 5,000
CLAIMS -MADE
X
OCCUR
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
71 POLICY n jECOT I I LOC
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
_AUTOS
SCHEDULED
AUTOS
NON -OWNED
CMBND
Ea acccident)SINGLE LIMIT
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
$
DED RETENTION$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITYYIN
ANY PROPRIETOR/PARTNER/EXECUTIVE I I
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N 1 A
WC STATU- OTH-
TORY LIMITS ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
IM, rIO LNCL
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Miami Shores Village
Building Dept
AUTHORIZED REPRESENTATIVE
10050 NE 2nd Avenue
Miami Shores, FL 33138
Juan Hernandez/YOYI
ACORD 25 (2010/05)
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