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EL-18-207 Inspection Worksheet i Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL i Phone: (305)795-2204 Fax: (305)756-8972 { Inspection Number: INSP-297948 Permit{Number: EL-1-18-207 Scheduled Inspection Date: February 26,2018 Permit Type: Electrical -'Residential Inspector: Devaney, Michael Inspection Type: Final Owner: D PUMA, LAWRENCE Work Classification: Service Change Job Address:10210 N MIAMI Avenue Miami Shores, FL Phone Number (786)251-9834 Parcel Number 1131010210030 Project: <NONE> I Contractor: ELECTRIC SOLUTIONS SERVICES CORP Phone: (786)339-0938 Building Department Comments REPLACE THE METER BOX. UPDATE THE GROUNDING Infractio Passed Comments ELECTRODE SYSTEM INSPECTOR COMMENTS False I F t i Inspector Comments Passed I r Failed I i:�:> Correction ❑ Needed 1 Re-Inspection Fee I I No Additional Inspections can be scheduled until re-inspection fee is paid. i i I February 23,2018 For Inspections please call: (305)762-4949 i Page 22 of 27 Permit NO. EL-148.207 Miami Shores Village t Permit Type:Electrical -Residential 10050 N.E.2nd Avenue N PerillWork Classiffcation:Service CChange_ - Miami Shores,FL 33138-0000 Permit Status:APPROVED Phone: (305)795 2204 �oR1oA Issue Date: 1126/2018 Expiration: 07/25/2018 Project Address Parcel Number Applicant 10210 N MIAMI Avenue 1131010210030 LAWRENCE D PUMA Miami Shores, FL Block: Lot: Owner Information Address Phone Cell LAWRENCE D PUMA 46 NE 101 Street (786)251-9834 MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 850.00 ELECTRIC SOLUTIONS SERVICES CC (786)339-0938 Total Sq Feet: Type of Work:REPLACE THE METER BOX.UPDATE THE G Available Inspections: Additional Info: Inspection Type: Classification:Residential Scanning:3 Review Electrical , Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee Invoice# EL-1-18-66246 $2.25 01/26/2018 Credit Card $50.00 $ 119.85 DCA Fee $2.00 Education Surcharge $0.20 01/26/2018 Credit Card $ 119.85 $0.00 Notary Fee $5.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $169.85 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 AFF Vin ify that the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction anerm9r , I authorize the above-named contractor to do the work stated. January 26, 2018 Auth i ed ' nature:Owner / Applicant / Con a r / Agent Date Building Department Copy January 26, 2018 1 l ,�- f �� . , f Miami Shores Village \\7-6>V-1 Building Department REcETVRD' 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 AN 2 q 2018 Tel:(305)795-2204 Fax:(305)756-8972 Mj\'� INSPECTION LINE PHONE NUMBER:(305)762-4949 B FBC 20 [-q BUILDING Master Permit N.-,a I C? -20'4 PERMIT APPLICATION Sub Permit No. ❑BUILDING 0 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL F7]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 10210 N MIAMI AVE I City: Miami Shores County: Miami Dade Zip: 33150-1252 Folio/Parcel#: 11-3101-021-0030 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):LAWRENCE D PUMA Phone#:��I Address: 10210 N MIAMI AVE City: Miami Shores state: FI Zip: 33150 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: ELECTRIC SOLUTIONS SERVICES, CORP Phone#: 786-339-0938 Address. 3646 SW 112 AVE City: MIAMI State: FL Zip: 33165 Qualifier Name: Alfredo M. Abrahantes-Vazquez Phone#: 7863390938 State Certification or Registration#: ER13014931 Certificate of Competency#: 13E000469 DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$$ 850.00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑■ Repair/Replace ❑ Demolition Description of Work: Replace the meter box. Update the Grounding Electrode System. Specify color of color thru tile: Submittal Fee$ Permit Fee CCF$ CO/CC$ Scanning Fee$ Radon Fee$ 2. W DBPR$ 2 Z S Notary$ .S. Co Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ q TOTAL FEE NOW DUE$ 11 / • &S, (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..... t OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all I pplicable laws regulating construction and zoning. I 4 "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 f will be charged. Signature Signature OWNER or AGENT CONTRACTOR E The foregoing instrument was acknowledged before me this The foregoing instru nt was acknowledged before me this c day of c�^v�r�r ,20 ,by 2<�day of io�� d ,by � <>t,xJferCc PUrnnG who is personally known to Is personPale 1yl—down two me or`who has produced i—(Gr,Vic, 'Dr"JyS as me or who has produced t�b� � ��"�;s identification and who did take an oath. identification and who did take an oath. F NOTARY PUBLIC: NOTARY P B C: Sign: Sign: Print: c Print: SI N�1A Seal: Seal: ISAAC LOPEZ-ZAMORA Notary Public-State of Florida a�a�YPu�o Notary Public State of Florida * Sindia Alvarez ' commission B FF 918397 oar ca My Commission FF 156750 "r My pmm.Ex Ires Se 15,2019 v `ea F 'sssssss*sss sir,�l �RSk' J%mm.ss�ssssss*sssss ***s***ssssssssssssssssssssi#'# +esss�k` '9e*Ot�t� yr€#isssssssss *ssss i APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Property Search Application - Miami-Dade County Page 1 of 1 `* PROPERT"Y"" �.� Summary Report Generated On: 1/26/2018 Property Information v, Folio: 11-3101-021-0030 . �t�,,,,�,„,„ ' --Rte.=*,--t,. �. � W., ,� •�-�, 10210N MIAMI AVE Property Address: " f ' Miami Shores,FL 33150-1252 , t K Owner LAWRENCE D PUMA Mailing Address 10210 N MIAMI AVE MIAMI SHORES, FL 33150 PA Primary Zone 1000 SGL FAMILY-2101-2300 SQ , Primary Land Use 0101 RESIDENTIAL-SINGLE � FAMILY: 1 UNIT Beds/Baths/Half 3/2/0 Floors 1 »' Living Units 1 b Actual Area Sq.Ft Liv to amp y - Living Area Sq.Ft ft Adjusted Area 3,370 Sq.Ft Taxable Value Information Lot Size 14,400 Sq.Ft 2017 2016 2015 Year Built 1938 County Assessment Information Exemption Value $50,000 $50,000 $50,000 Year 2017 2016 2015 Taxable Value $275,051 $268,366 $266,153 Land Value $301,446 $301,446 $222,118 School Board Building Value $195,150 $195,150 $195,150 Exemption Value $25,000 1$25,0001 $25,000 XF Value $33,828 $34,222 $22,855 Taxable Value $300,051 $293,366 $291,153 Market Value $530,424 $530,818 $440,123 City Assessed Value 1 $325,0511 $318,366 j $316,153 Exemption Value $50,000 $50,000 $50,000 Taxable Value $275,051 $268,366 $266,153 Benefits Information Regional Benefit Type 2017 2016 2015 Exemption Value $50,000 $50,0001 $50,000 Save Our Homes Assessment Taxable Value $275,051 $268,366 $266,153 Cap Reduction $205,373 $212,452 $123,970 Homestead Exemption $25,000 $25,000 $25,000 Sales Information Second Previous Sale Price OR Book-Page Qualification Description Homestead Exemption $25,000 $25,000 $25,000 04/16/2009 $100 26840-0323 Affiliated parties Note:Not all benefits are applicable to all Taxable Values(i.e.County, 06/01/1987 $95,000 13311-1731 Sales which are qualified School Board,City, Regional). Short Legal Description HAMILTON TER A SUBDIV PB 15-75 LOTS 3&4BLK1 LOT SIZE 100.000 X 144 OR 13311-1731-30-29 0687 1 The Office of the Property Appraiser is continually editing and updating the tax roll.This website may not reflect the most current information on record.The Property Appraiser and Miami-Dade County assumes no liability,see full disclaimer and User Agreement at hfp://www.miamidade.gov/info/disclaimer.asp Version: http://www.miamidade.gov/propertysearch/ 1/26/2018 i OR h i eggs Miami shores Village Building Department ALRIDp' 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: a A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: ELECTRIC SOLUTIONS SERVICES CORP. BUSINESS ADDRESS: 3646 SW 112 th AVE CITY MIAMI STATE FL ZIP 33165 BUSINESS PHONE: (_� FAX NUMBER(_� CELL PHONE 786 339-0938 QUALIFIER'S NAME: ALFREDO M. ABRAHANTES QUALIFIER'S LIC NUMBER: 13E000469 a CTOB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCI 13E000469 ELECTRIC SOLUTIONS SERVICES CORP D.B.A.: AB NTES-VAZQUEZ ALFREDO M Is certified under the provisions of Chapter 10 of Miami-Dade County QUALIFYING TRADE(S) 0001 ELECTRICAL 0002 BURGLAR ALARM 0004 FIRE ALARM SPECLT Jaime D.Gascon.RE. Scuetary of the Board www miamidadeyov7eco " .Aatiti.Dade Co retains aB op erty figtits herein. y 009655 E Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT ABILL-DO NOT PAY L B T 7165939 BUSINESS NAME&OCATION RECEIPT NO. EXPIRES ELECTRIC SOLUTIONS SERVICES CORP. RENEWAL SEPTEMBER 30, 2018 3646 SW 1 i 2 AVE 7444365 Must be displayed at place of business MIAMI FL 33165 Pursuant to County Code Chapter 8A-Art.9& 10 OWNER SEC.TYPE OF BUSINESS ELECTRIC SOLUTIONS SERVICES CORP. 196 ELECTRICAL CONTRACTOR PAYMENT RECEIVED C/O ALFREDO M ABRAHANTES 13E000469- BY .00 07/01/201 Worke (s) 1 $75.00 07/01/2017 CREDITCARD-17-041354 This Local Business Tax Receipt only confirms 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 N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sec Ba-276. For more information,visit www;miamidade. ov axcollecMT 1 F G i .t , RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY } r STATE OF FLORIDA -- {- DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 's.; W - ELECTRICAL CONTRACTORS LICENSING BOARD _ i t r"ER13014931' r t .' f The ELECTRICAL CONTRACTOR m - +-Naed below HAS,REGISTERED— *`� ' a ' Wt� a Under the provisions'6f Chapter 489'FS., �' " •��,_ � - Expiration.date' AUG 31, 2018 _' •`` �+i; -*•, ` #� (INDIVIDUAL MUST MEET ALL,LOCAULICENSING 4k 'REQUIREMENTS'PRIOR TO;,CON fRACTING IN ANY AREA) ��.".. ' ABRAHANTES VAZQUEZ AL•FREDO M -ELECTRIC SOLUTION&SERVICES, CORP 13646 SW 112TH AVE, ` fi _MIAMI ' ,,rFL 33165. �" . --- . A, ♦' �J ',f+'' .,nr Y'.r•"� �.. W"�.� �NX� ..'"R;= a�'�# .�,,,}� i s k. ;` � Yy '� ❑ . ISSUED: 07/25/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1607250001318 f t r r ELECTRC OP ID:JB CERTIFICATE OF LIABILITY INSURANCE �"'�"MIDDIMY ' 01ro8/2018 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 MOLDER. 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 endoraemenL A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME Angel Bichara Tropical Insurance Agency PE 8700 West.Flagler St Ste 230 N :305-221-2400 No:305-552-5360 Miami,FL 33174 AM&m:an el icalinsurance-com Nestor G.Rivero,CIC INSURER(S) AFFORDING COVERAGE MAIC a! INSURED Electric Solutions Services, INSURER e:PrOgr98SIV0 EX rens Ins Co , 10193 Corp 3646 SW 112 Avenue INSURER c Miami, FL 33165 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRI ADDL SUBS POLICY EFF POLICY EXPLIMITS I. TYPE OF INSURANCE POLICY NUMBER X X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000+ DAMAGE To RERTED CLAIMS-MADE T OCCUR 19$-8707 05/08/2017 0510812018 PREMISES Ea occurrence S 100,00 MED EXP(Any one person) S 5,00 PERSONAL 8 ADV INJURY S 2+000,0 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2+000+00 POLICY❑JECT F-]LOC PRODUCTS-COMPIOP AGG S 2+000+0 OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident B ANY AUTO 03978560-1 11/0812017 11108/2018 BODILY INJURY(Per person) $ 10,00 ALL OWNED116nissan SCHEDULED BODILY INJURY(Per accident) $ 20,00 AUTOS AUTOS NON-OWNED DAMA WNED Peraoddent $ 10,00 HIRED AUTOSAUTOS X com/coll- comp/coll $ 1,00 UMBRELLA LIAB d OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION S $ WORKERS COMPENSATION ST TUTE ERT AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN NIA E.L.EACH ACCIDENT $ OFFICERMIEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S Ryes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S i DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD IOI,Additional Remarks Schedtde,maybe attached ff oars space b mgrdrod) Electrician CERTIFICATE HOLDER CANCELLATION MIAMISH 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 AUTHORIZEDREPRESENTAIIVE 10050 N.E 2nd Avenue t Miami Shores,FL 33138 I'AY� � 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD { . { ® DATE AC Ro CERTIFICATE OF LIABILITY INSURANCE 01r23/2018 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 poilcy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terns 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 endomement(s). PRODUCER CONTACT NAME: PHONE F Automatic Data Processing Insurance Agency,Inc. AC No): E-MA1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSUREWS)AFFORDING COVERAGE NAIC t INSURER A: NmGUARD brsuranoa Company 31470 INSURED INSURER B: ELECTRIC SOLUTIONS SERVICE CORP INSURER C: 3646 SW 112TH AVE Miami,FL 33165 INSURER D INSURER E• I INSURER F: COVERAGES CERTIFICATE NUMBER: 820668 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY LIMBS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMSIUADE D OCCUR PREMISES Ea occurrence) E MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEWL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ I POLICY❑PERCT F]LOC PRODUCTS-COMP/OPAGG E OTHER 1 $ COK48INED SINGLE 0917— AUTOMOBILE LIABILITY accident $ ANY AUTO BODILY IWURY(Per parson) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED y HIRED AUTOS AUTOS aoddem i UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-- ADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION �( STATUTE OR _ AND EMPLOYERS'LIABILITY 100,000 A► O�F'FICREWMREM OBERIPARTNDED�UT� YIN NIA N ELWC875242 04/22/2017 0412=018 F- EACH ACCIDENT S 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes desalt under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES(ACORD 101.Additional Remarks Schedule,may be anached N more space Is required) Electrician CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES VILLAGE BLDG DEPT ACCORDANCE WITH THE POLICY PROVISIONS. 10050 No 2nd Ave Miami Shores,FL 33138 AUTHORED REPRESENTATIVE �I1k A@ 1988-2014 ACORD CORPORATION.All rights reserved. f i I