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PLC-16-984Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 CL t5 -3os2 Inspection Number: INSP-256785 Permit Number: PLC -4-16-984 Scheduled Inspection Date: October 12, 2016 Inspector: Hernandez, Rafael Owner: INC, PUBLIX SUPERMARKETS, Job Address: 9050 BISCAYNE Boulevard Miami Shores, FL 33138 - Project: <NONE> Contractor: JOE COLE PLUMBING Permit Type: Plumbing - Commercial Inspection Type: Final Work Classification: Addition/Alteration Phone Number (863)688-747_ Parcel Number 1132060100010 Phone: (954)472-2242 Building Department Comments PLUMBING WORK FOR INTERIOR REMODEL TO EXISTING PUBLIX. Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. JOECO-1 OP ID: SN A K� CERTIFICATE OF LIABILITY INSURANCE DA06/29DD/YYY1� 06/29/2016 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 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 Brown & Brown of Florida, Inc Suite 400 1401 Forum Way West Palm Beach, FL 33401 Nicholas Heilman CONTACT NA (PHONEC., No, Ext): (A/C, No): 561-686-2313 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Hanover American Ins Co COMMERCIAL GENERAL LIABILITY INSURED Joe Cole Plumbing Corp. 10392W SR 84 Ste 108 Davie, FL 33324 INSURER B: FFVA Mutual Insurance Co 10385 INSURER c : Hanover Insurance Co. 22292 INSURER D : $ 1,000,000 INSURER E : INSURER F : X CERTIFI • 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 A X COMMERCIAL GENERAL LIABILITY ZZJA24005902 03/07/2016 03/07/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE i o 1 PREMISES (Eaa occurrence) ence) $ 100 000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE POLICY OTHER: X LIMIT APPLIES JECT PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X X LIABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS — X SCHEDULED AUTOS NN -OWNED AUTOS AZJA24008802 03/07/2016 03/07/2017 EaaBI EDtSINGLELIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY(Per accident)$ PROPERTY DAMAGE (Per accident) $ $ C X UMBRELLA UAB EXCESS LIAB X OCCUR CLAIMS -MADE UHJA24006202 03/07/2016 03/07/2017 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED X RETENTION$ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under D DESCRIPTION OF OPERATIONS below N N / A WC84000302872016A 03/07/2016 03/07/2017 X PER STATUTE 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 A Leased/Rented Equi ZZJA24005902 03/07/2016 03/07/2017 100,000 Ded $1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Plumbing Contractor CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 2nd Avenue Miami Shores, FL 33138 ACORD 25 (2014/01) MIAMI -9 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 © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ( 57 FLe BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC []PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: 90Y0 Qi5cayne 8Ivo< City: Miami Shores County: ,7R�f 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 J N 2 7 2016 FBC 20 t Master Permit No. CC-12-15"Jo2 Sub Permit No. -RrAb' crg 1 ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL ANGE OF ❑ CANCELLATION ❑ SHOP NTRACTOR DRAWINGS Miami Dade Zip: Folio/Parcel#: 1132 0 COI 000 /0 Occupancy Type: Load: Construction Type: Is the Building Historically Designated: Yes Flood Zone: BFE: OWNER: Name (Fee Simple Titleholder): ` - 6 1 i' S. .t r Address: JJ?bit' PPith0.14P4(44X� 9/i-vk City: L-KC(0-4 State: -Ff' ' NO FFE: Phone#:t 0S. 7S�'l- ZlD Zip: �l( Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Joe Coke ci mh i n9 Address: I0392 /rt/. sl *or Phone#: 9sy %72 '22 VZ City: OGUI C State: 12 Zip: Y132 y Qualifier Name: TO e Code Phone#: State Certification or Registration #: Cr(0192// Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for thislPeermitr 1 /0, 000 , oo Square/Linear Footage o�orJ Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: f q Mbiij reniode/ /U! `uil,_ SrehylOde f' Specify color of color thru tile: C� Submittal Fee $ % Permit Fee $ CCF $ CO/CC $ Scanning Fee $ 1S 'CA Radon Fee $ DBPR $ Notary $ 50 Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) Double Fee $ Bond $ TOTAL FEE NOW DUE $ B -O0 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 1•4c( NER or AGENT, The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this Y day of �,l1'UV , 20 LO , by / 0 day of 144 e , 20 /C , by b' J. no ` a4'Yi-+ , who is personally known to Joe Cole Jr7Ifi'o is personally known to me or who has produced as me or who has produced as Signature CONTRACTOR identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: �i1 NYIF 01(66 4.).04.).0...8e% JODI L. SLOAN Seal, : * * MY COMMISSION # FF 184644 * EXPIRES: February 5, 2019 0JalTFOF coaoP Bonded Thru Budget Notary Services Sig Prin : Sign: 7.14 Notary Public - Stats of Florida C i I I FF 215057 Prin _AM.A - - - ommsson My Comm. Expires Jun 9, 2019 y°i. Sondedth0ud talkie NChryA9994 • APPROVED BY (Revised02/24/2014) Plans Examiner Structural Review Zoning Clerk 11 Codrtud,, (tai 'Ic•a 3350 Burris Road, Suite C Fort Lauderdale, Florida 33314 P: 954-587-2360 F: 954-792-3477 June 24, 2016 Royal Plumbing Corp 3525 NW 79 Street Miami, FL 33147 Re: Publix 0794 Miami Shores FL Thank you for allowing us to use your company for permit submittal on this project. I regret to inform you that your company was not awarded this project. However in order to change the contractor on the permit I need your qualifier to complete where indicated and sign the enclosed Change of Contractor form for Miami Shores Village. Time is of the essence and I have provided you a return envelope and label from UPS. Kindly complete and return the form as quick as you can. Please call me if you have any questions. Sincerely, A'rletta Wood Contract Administrator Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. PLC -4-16-984 Owner's Name (Fee Simple Title Holder): Publix Super Markets Owner's Address: P.O. Box 407 Phone #: 863-688-7407 City: Lakeland State : FL Zip Code: 33802-0407 Job Address (Of where work is being done): 9050 Biscayne Blvd City: Miami Shores State: Florida Zip Code: 33138 Contractor's Company Name: Royal Plumbing Address: 3525 N W 79th Street Phone #: '305-0g40611 City: Miami Qualifier's Name : 3-0,0A ( -717 Zla State: FL Zip Code: 33147 Lic. Number: CiC1 yZ59bD Architect/ Engineer of Record Name: Address: City: Phone #: State: Zip Code: Describe Work: Plumbing work for interior remodel to existing Publix hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless of all legal involvement. Signature Owner or Agent The foregoing instrument was aknowledged before me this ay o Who is r onally know Signature ,20110,by p(`hv,rk.1 'M`t'0 to me or who has produced as indentification. Nota Sign: Seal: ublic: lrav PUd r�,••••.•�% JODIL.SLOAN * , , * MY COMMISSION # FF 184644 #1 -1 EXPIRES: February 5, 2019 "'For now amoger illru AuAgoi N941ry 9lrY!991 Co 40 or or Architect ( The foregoingninstrument was aknowledged before me this ..9.q day of 1LW , 2Of j by 'S'oe ( 'or % who i ersonally know to me or who has produced as indentification. Not//:ar:P;c ign: Seal;,__ stlY : .•' • = VA IS G.as LEZ MY COMMISSION # FF919755 ••',t;lr ,,, EXPIRES September 20, 2019 nartaae.o•aa Fio 4aaNpter SSorvia.corr: BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 954-831-4000 VALID OCTOBER 1, 2015 THROUGH SEPTEMBER 30, 2016 DBA: Business Name: JvE COLE PLU NG CORP Owner Name: JOSEPH L COLE JR Business Location: 10392 W STATE RD 84 108 DAVIE Business Phone: Rooms Scats Employees 12 Receipt#; PL tB11iJG .L�3N sPRNi L; CONPRAC Business Type: (CERT PLUMBING CONTRACTOR) Business Opened:12/ 12/2007 State/Cbunty/Cert/Reg:C FC0192211 Exemption Code: Machines Professionals For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee I NSF Fee I Penalty Prior Years Collection Cos i 54.00] 0.00 0.00 0.00 Total Paid 0.00 0.00 54.00 1 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 County and is non -regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: JOSEPH L COLE JR 10392 W STATE RD 84 STE. 108 DAVIE, 'I, 33324 2015 - 2016 _.. a•.ti.�s<.c:i.wnn. tr►1l sfa1int. +,►iss . CfI..ICIKtCCS RICK SCOTT, GOVERNOR Receipt #52A-14-00005877 Paid 07/16/2015 54.00 KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER The PLUMBING CONTRACTOR Named.below,IS CERTIFIED Under the' provisions of Chapter 489 FS. Expiration date: AUG 31,-2016 COLE,„JOSEPH L.JR" JOE COLE PLUMBING CORP r,a, -3491- SOUTHERN,"ORCHARD_RD_E. #1-2,, DAVIE - FL.33328 , -- icc1 IC n• r1C.H7/9111A r1ISDi AY AS RF('1I IMF(*) RY 1 AW SEo # L1406170000832 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Fax: (305)756-8972 Project Address Parcel No.. Permit NO. PLC -4-16-984 :'_ l Permit Type: Plumbing - Commercial 1 F Work Classification: AdditionfAlteration R..„) Pettit Status: APPROVED Issue Date: 4/25/2016 Expires: 10/22/2016 Tract No. Block No. Lot No. Section Township 9050 BISCAYNE Boulevard Miami Shores, FL 33138- 1132060100010 Owner Information Address Phone Cell Contractor(s) Phone Primary Contractor ROYAL PLUMBING CORP (305)694-1964 Yes Proposed Construction / Details PLUMBING WORK FOR INTERIOR REMODEL TO EXISTING PUBIAX. Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $21.00 $15.42 $15.42 $7.00 $1,028.16 $3.00 $28.00 $1,118.00 t/4)-)2)-' Valuation: $ 34,272.00 Total Sq Feet: 0 Total I Amt Paid I Amt Due $ 2,146.16 $ 1,118.00 $ 1,028.16 Required Inspections: For Inspections call 1(866) 701-3365 Inspection IVR See Permit Record Building Department Copy Monday, /Sril 25, 2016 2 BUILDING PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 (l -t Master Permit No. CC -/2 -1,5- Sub -l5Sub Permit No. 0-1 C l Scf ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL •PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9050 Biscayne Blvd. City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 1 1-3206-010-0010 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Nrthem Trust Bank ETAL % Publix Super Market phone#: 863-688-1188 Address: Post Office Box 32025 City: Lakeland State: FL Zip: 33802 Tenant/Lessee Name: Publix Super Markets Location #0794 Email: Phone#: CONTRACTOR: Company Name: Ktril et. elo �' Address: '559-5 IOW l) `' 1� 1 City: Miosn\ Qualifier Name: cJD6 GYIUtiS State Certification or Registration #: 42. 951 (00 Phone#:,C ) 4 - State: POrlcc.k. Phone#: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 34,q7),- Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New [Repair/Replace ❑ Demolition Description of Work: f LSV K o1-6 Lc? O 1Q A p R /n)1'g-R 09/2 1403)g.I-- CO G; C$r//fig PV B 1iX Zip: 3'2)141 X3052 (,L L((Ql7L( tii Vii., . .;i } , Specify color;of color tliru tle:. .. Submittal Fee $ 6. PermitFee $"•• t &)Zt. CCF $ 21.00 CO/CC $ e Scanning Fee $ Radon Fee $ I S • `r 2- DBPR $5 • (42- Notary $ 9 Technology Fee $ Training/Education Fee $ -a• CO Double Fee $ 0 Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE$ I/a6 8 '03 Bonding Company's Name (if applicable) Bonding Company's Address City Stateaa Zip Mortgage Lender's Name (if applicable) W / A 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 N L.OWNER or AGENT The foregoing instrument was acknowledged before me this day of 0 -Cr Cfnbe4r , 20� , by who is personally known to Signature COjN-(-(cf- ACTOR The foregoing instrumentnwas acknowledged beforeme this ) daay of �-�c.cmf fl , ` 20 1 P , by "SOPA (30117 , who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign Print: Seal: LSi Ocv-, JODI L. SLOAN * MY COMMISSION # FF 184644 �, !! EXPIRES: February 5, 2019 ,SOF F $I' Bonded Thru Budget Notary Services identification and who did take an oath. NOTARY PUB IC: Sign: Pri Sea YAIIRIIS GONZALEZ MY COMMISSION # FF919755 ,`,_ EXPIRES September 20, 2019 (40?) $t $-0' B3 RIOrpaW04'yterviu,car. ****+k*************** kik*************************************************************Mkt********************* * APPROVED BY (Revised02/24/2014) V. q -j3 ��p• Plans Examiner Zoning Structural Review Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 • GONZALEZ, JOEL ROYAL PLUMBING CORP 3525 NW 79 ST MIAMI FL 33147 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and leam more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! RICK SCOTT, GOVERNOR i SCOTT, _ - --_'_ --' <---_ STATE OF:FLORIDA, ON ='--- 7-75-!-------- ..;! --7---71„.„--::;,':;5--___-_- r � � -- ^ .: _ BUSI�`MESS A�tJQ:PftOFESSIONAL'�REGUL1ION �,' _ DEPARTMENT O k�CT.ION-INTI STRl L� salitightt ,t ';i` _,.._�,�,,�....�.,--Y.._s.-._„.ter --' ^, . ..''...`,,.1, '�. [>`"-CP T --- ---- :61.40- '" ' --`' " •`� �, iee �� ^-�`" ..1''-' '-.` .ham- , z+ vn PI , = _ �t �,, .::: \1/4 -.,-::-.N:,-..._:-...:::,„-, `'. �+, �--, —..' " ---.. ,mow —^ �" + —�. ` - . .,... „ \ ,'.*‘.'k\' k%. \''\\\ '\.:\ 0 ,, DETACH HERE KEN LAWSON, SECRETARY AV A c Deni IIQI l RV I AW SEQ# L1407130001240 63 o ROYAL 525 NW EXPIRES SEPTEMBE 40, 2016 Must be ddap isplayetilre of business Puis rant to County Code - Chapter SA _ Art. 9 Si 10 980 Code -Sec 8a-716.. •tea �dotioctor D1628 X Receipt Dace Cotifity, State of Florida —TNS IS NOT A_ BILL - DO NOT PAY ma NAMELOCATION RECEIPT NO. ROY �UMBINQ CORP RENEWAL UNICIPAI[J ESOOC 4960762 X3688 EXPIRES SEPTEMBER 30, 2016 Must be displayed at place of business. Pursuant to County Code Chapter SA -Art. 9& 10 TYPE -OF SUSIiNESS ()MMERCU NDI:USTf0FHICE SPACE PA : 8Y TAX COLLECTOR S75.00 09/03/2015 CREDITCARD—i 5-043980' confirms payment oftheLocal$rsraessTax The Receipt is not a license, sguatifications.to do tininess. 1014k '+, Piywith any governmental aadreguirementswhichapply to` : on ail cwiunermai vehicles -Miami-Dade Code Sec 8a-Z1S. `�` tion, visit www.miamidad itaucellecsgr CERTIFICATE OF LIABILITY INSURANCE ROYAL03 OP ID: AD DATE (MMIDD/YYYY) 04/05/2016 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 poiicy(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 IIeu of such endorsement(s). ' PRODUCER Kahn -Carlin & Company, Inc. 3350 S. Dixie Highway Miami, FL 33133-9984 INSURED Royal Plumbing Corporation 3525 NW 79 Street Miami, FL 33147 CONTACT NAME: AX (A1C PHO.NoNE. Exf: 305-446-2271 (A/C, No): 3054484127 E-MAILss: processin9kahn-carlin.com INSURERS) AFFORDING COVERAGE NAIC a INSURER A:TraVelers Casualty Ins Co Amer INSURER B : FCCI Insurance Company INSURER c : Berkley.Assurance Company INSURER D :Commerce & Industry Ins Co INSURER E : 19046 10178 39462 19410 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 1S 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 POUCY EFF - POUCY EXP (MWDDIYYYYI (MM/DDIYYYY) )NSR LTR C TYPE OF INSURANCE ADDL INSD SUBR WVD POUCY NUMBER X COMMERCIAL GENERAL UABIUTY CLAIMS -MADE X OCCUR X Per Pro) Agg 53M A GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X JE I LOC OTHER: AUTOMOBILE UABIUTY VUMC0023663 12/14/2015 LIMITS 1 211 4/201 6 EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) $ 1,000,000 y 100,000 y 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 X ANY AUTO ALL ONRJED — SCHEDULED AUTOS NON -OWNED HIRED AUTOS AUTOS BA3F746741 12/14/2015 12/14/2016 COMBINED SINGLE LIMIT (Ea accident) S $ 500,000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) s s $ D X UMBRELLA UAB EXCESS UAB X OCCUR CLAIMS -MADE B DED I RETENTION $ EBU012051175 12/14/2015 '12114/2016 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 WORKERS COMPENSATION AND EMPLOYERS' UABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below 001WC14A62982 NIA 12/14/2015 12/14/2016 X I STATUTE I I ERH- E.L. EACH ACCIDENT $ E 1,000,000 E.L. DISEASE - EA EMPLOYEE 1,000,000 E.L DISEASE - POLICY UMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 11 more space Is required) State License No: CFC1425760 CERTIFICATE HOLDER Miami Shores Village Building Department 10050 NE 2 Avenue Miami Shores, FL 33138 MIAMI84 ACORD 25 (2014/01) CANCELLATION 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 m 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD