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PL-16-1794 (2)
RENOPLU-01 MNORTON .4CORO" `,� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DCINYYY) 11/1/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE• DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Plastridge Insurance Agency 2100 N. Dixie Highway Boca Raton, FL 33431 I CONTACT NAME: PHONE FAX Palo, Ext): (561) 395-1433 (ac, No(561) 3954755 MoaEss: bocadocs@piastridge.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Arch Specialty Ins. Com COMMERCIAL GENERAL LIABILITY INSURED ' Reno's Plumbing & Pool, Inc. 1057 NW 6th Drive Boca Raton, FL 33486 i - INSURER B : AGL00472503 fi r INSURER C : 09/26/2017 INSURER D : $ 1,000,000 INSURER E : INSURER F : X COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. 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 POLIC ES 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 I TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DDIYYYYI POLICY EXP (MM/DD/YYYYI LIMITS ' A X COMMERCIAL GENERAL LIABILITY AGL00472503 fi r 09/26/2016 09/26/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TOEREoNaTuErDence) $ 100,000 MED EXP (Any one_person) $ 10,000 $ 1,000,000 PERSONAL & ADV INJURY GEN'L AGGREGATE POLICY OTHER: LIMIT APPLIES fl a PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000 $ AUTOMOBILE , LIABIUTY ANY AUTO OWNED AUTOS ONLY HIREDTS ONLY SCHEDULED AUTOS p AUTO ONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Peri axRdentDAMAGE $ $ UMBRELLA UAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' UABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N ] N / A j STATUTE TUTE OTH- ER E.L. EACH ACCIDENT I $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $' I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 11 more space is required) Contractor License: CFC056782 I CERTIFICATE HOLDER CANCELLATION Miami Shores Building Department 10050 NE 2nd Ave Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax': (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION 0BUILDING ❑ ELECTRIC ❑ ROOFING PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: £ .53 /tie s ,ire City: Miami Shores County: JUN 2.8 201 BY. - FBC 2014 M Master Permit No. BPP (6 -. Sub Permit No. PL t6 —17 q7' ❑ REVISION ❑ EXTENSION RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS Miami Dade Zip: 3'313 NO Folio/Parcel#: 1 1 3a OCo Or/ 0 35 '0 Is the Building Historically Designated: Yes Occupancy Type: Load: Construction Type:. Flood Zone: BFE: FFE: Sart Cruz lee: Episcc�cy j",ChurC , c-�..51 J �1, OWNER: Name (Fee Simple Titleholder): -7, 1, -p (� Y }-cej'Z Phone#:1 o ) V I9q Address: `I Oe- 1COU1[ f_ City: M moil/ . 6"e, 5 State: Zip: Tenant/Lessee Name: Phone#: Email: *l \\ _ \ r,.w, ti, CONTRACTOR: Company Name: `Cin-o'S•- �(1\f�i/h y 4 ?oc� ln� Phone#: �jr — 2 — ZS' t-2. Address: �VC7I LI. (b /',d.e )-- / IA) y ( 7 City: ((Cl Tom' 1 State: L Zip: `-WS 1 Qualifier Name: kenct4-6 V 0 I I: Phone#: SC71 '54 L '2,SZS 2 State Certification or Registration #: Cr L sL--K Certificate of Competency #: DESIGNER: Architect/Engineer: . Phone#: Address: City: State: + Zip: Value of Work for this Permit: $ k S 0 O • o-'' Square/Linear Footage of Work: Type of Work: ❑ Addition 0 Alteration ❑ New ❑ Repair/Replace • Description of Work: IJ2k..J Pool CPMS-i If Qlumb ►115 ❑ Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ � Radon Fee $ 2—> . 58 Technology Fee $ I • (0 ° Training/Education Fee $ Structural Reviews $ �1(/ (Revised02/24/20141 CCF $ ( . 2.0 CO/CC $ DBPR $ 3 • 36 Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 0-5 • 9(0 Bonding Company's Name (if applicable) Bonding Company's Address City - State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address ri 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: 1 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." it Notice to Applicant: As o 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 The foregoing instrument was acknowledged before me this 30" day of me or who has produced identification and who did take an oath. NOTARY PUBLIC: ,20 d6 ,by , who is personally known to as Sigy /X.P.. ,,pp Print: 4LI KC'M,kw,c t� i*i!'44i4i.KYLE C HAMBRICK = ;,r MY COMMISSION # EE867056 ~?'osri EXPIRES January 22, 2017 FIOidaNQ 'vSar,14. n' Seal: Signat CONTRACTOR The foregoing instrument was acknowledged before me this no jA Z P day of ,20 1(0 ,by ��Y)C1�0 UCi1lt , who is personally known to me or who has produced as identification aFld who did takc an oath` :"• KYLE C HAMBRICK NOTARY PUBO' ,,,• '= MY COMMISSION # EE867056 .1 . EXPIRES January 22, 2017 Sig Print: k(e J/ow Jv� (5,‹ Seal: FiondallotaryServIce com APPROVED BY (Revised02/24/2014) �r(!_ v l Plans Examiner Zoning Structural Review Clerk Reno's Plumbing and Pool Inc. 3601 N. Dixie Hwy #17 reno@renoplumbing.com CFC056782 Boca Raton, FL 5615422582 Date: State of Pi by ► coca County of NItrtoll pod -e. Before me this day personally appeared being duly sworn, deposes and says: who That he or she will be the only person working on the project located at L//C ,AJP /Glom S'+ -r ee /44 (um/ Si1CYe S Sworn to (or affirmed) and subscribed before me this /6 day of Jurist , 2016 by on i-1 o "°` KYLE C HAMBRICK '= MY COMMISSION # EE867056 -?q' o, EXPIRES January 22, 2017 (4 7) 399-0153 Fioridallotar Se /...mite com Personally Known Or Produced.Identification I/ Type of Identification R p,►r,P,s use Print, Type of Stamp Name of Notary RENOPLU-01 LDEZIC AC ,RO' `,,;.� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 6/13/2016 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). i PRODUCER Plastridge Insurance Agency 2100 N. Dixie Highway Boca Raton, FL 33431 CONTACT NAME: PHONE 561 395-1433 FAX 561 395-4755 (AIc, No. Ext): ( ) (ac, No): ( ) ADDRESS: bocadocs@plastridge.com INSURER(8) AFFORDING COVERAGE NAIL A INSURER A : Arch Specialty Ins. Com COMMERCIAL GENERAL LIABILITY INSURED Reno's Plumbing & Pool, Inc. 1057 NW 6th Drive Boca Raton, FL 33486 INSURER B: AGL00472502 INSURER C : 09/26/2016 • INSURER D : $ 1,000,000 INSURER E : 100 000 $ r INSURER F : 1 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE ADDLSUBR INSD WVD POLICY NUMBER POUCY EFF (MDDIYYYY) POUCY EXPMI (MM/DD/YYYY) imamimamLTR A X COMMERCIAL GENERAL LIABILITY AGL00472502 09/26/2015 09/26/2016 • EACH OCCURRENCE $ 1,000,000 DAMAGE To RENTED PREMISES (Ea occurrence) 100 000 $ r CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE 1 $ 2,000,000 GEN_ AGGREGATE POLICY OTHER: LIMIT APPLIES JET PER: LOC PRODUCTS - COMP/OP AGG $ 1,000,000 $ AUTOMOBILE UABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON-OWNED AUUTOSTOS COMBINED SINGLE LIMIT ffla accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS UAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N 1 A PER STATUTE OTH- ER E.L EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ EL DISEASE - POLICY UMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached M more space is required) I ERTIFICATE HOLDER CANCELLATION 1 VILLAGE OF MIAMI SHORES Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHOR¢EDREPRESENTATIVE ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD cam$ ,t.....•VL/ CERTIFICATE OF LIABILITY INSURANCE DATE(MMAIDNYYY) 06/13/216 THIS CERTIFICATE 1S 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: It the certificate holder Is an ADDITIONAL INSURED, the pollcy(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 8eu of such endorsement(s). PRODUCER Automatic Data Processing Insurance Agency, Inc. 1 Adp Boulevard Roseland, NJ 07068 CONTACT NAME: 1 PHONE FAX MI, EKG: INC, Nok ADDRESS: DISURER(S) AFFORDING COVERAGE NAIL I INSURER A: Moral ksuranca Cenpany 38970 INSURED RENOS PLUMBING & POOL INC DBA: Renes Plumbing & Pool Inc 3601 N. Dixie HWY Unit 17 Boca Raton, FL 33431 INSURER B: 1 T INSURER C INSURER D: $ INSURER E: S NSUtER F : 1 COVERAGES CERTIFICATE NUMBER: 472739 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS N LTRIIYYYY) TYPE OF INSURANCE INNSD MDSTE POUCY NUMBER (MINPOLICY t dvwY) LIMITS COMMERCIAL GENERAL LIABILITY 1 T EACH OCCURRENCE $ i ELI PREMISES (Eat"occunence) S CLAIMS -MADE 1 1 OCCUR MED EXP (My oos pmson) $ -, PERSONAL & ADV INJURY S GENERAL AGGREGATE $ ,,. GENL AGGREGATE LIMIT APPLIES PER: PRO - POLICY ❑ JT LOC OTHER: PRODUCTS- COMP/OP AGG $ $ AUTOMOBILE _ UABILITY ANY AUTO ALL OWNED HIRED AUTOS — SCHEDULED AUTOS NON-OWNEDOS(Par COMttINPD SINGLe LIMIT (Ea eminent) $ BODILY INJURY (Par person) $ BODILY INJURY (Per accident) $AUTOS I PROacaccident) RTY DAM $ S UMBRELLA LAB_ EXCESS UAB OCCUR CLAIMS -MADE , A EACH OCCURRENCE $ AGGREGATE $ S DED 1 RETENTIONS A WORKERS COMPENSATION AND EMPLOYERS' LIABLTTY OFFICER/ EMTBER EXCL DEE �� (Mandatary In NH) R describe under DESCRIPTION OF OPERATIONS below YNN NIA N MWC0078776-01 05/30/2015 05/30/2016 X STATUTE f I ERH- El. EACH ACCIDENT S 100,000 E.L. DISEASE - EA EMPLOYEE S 100,000 E.L. DISEASE - POUCY OMIT $ 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be atbched M mora epee b requked) CERTIFICATE HOLDER CANCELLATION I Village of Miami Shores Attn: Building Dept. 10050 N.E. 2 nd Ave Miami Shores, FL 33138 I 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 ) -, A- ACORD 25 (2014/01) 1988.2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD