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ELC-18-190 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-295990 PermitNumber: ELC-1-18-190 Scheduled Inspection Date: February 15, 2018 Permit Type: Electrical Commercial Inspector: Devaney, Michael Inspection Type: Final Owner: MCCARTHY ARCHBISHOP, EDWARD A Work Classification: Generator Job Address:9401 BISCAYNE Boulevard Miami Shores, FL Phone Number Parcel Number 1132060490010 Project: <NONE> Contractor: MOODY ELECTRIC INC Phone: (305)758-2000 Building Department Comments , INSTALL CUSTOMER SUPPLIED 25 KW GENSET AND infractio Passed Comments 100 AMP TRANSFER SWITCH EXCAT CHANGE OUT INSPECTOR COMMENTS False r Inspector Comments Passed n Failed y� I Correction ❑ Needed Re-Inspection ❑ Fee a No Additional Inspections can be scheduled until re-inspection fee is paid. February 14,2018 For Inspections please call: (305)762-4949 Page 12 of 38 Permit No. ELCA-18-190 Miami Shores Village Permit Type:Electrical-Commercial 10050 N.E.2nd Avenue PenWork Classification:Generator -, - Miami Shores,FL 33138-0000 Permit Status:;APPROVED y FNa,r•°` Phone: (305)795-2204 FLORtDp' issue Date:1/3112018 Expiration: 07/30/2018 Project Address Parcel Number Applicant 9401 BISCAYNE Boulevard 1132060490010 Miami Shores, FL Block: Lot: EDWARD A MCCARTHY AjRCHjB Owner Information Address Phone Cell EDWARD A MCCARTHY ARCHBISHOP FL Contractor(s) Phone Cell Phone Valuation: $ 4,600.00 MOODY ELECTRIC INC (305)758-2000 Total Sq Feet: 0 Type of Work:INSTALL CUSTOMER SUPPLIED 25 KW GEN Available Inspections: Additional Info: Inspection Type: Classification:Commercial Final Scanning:3 Rough Review Plumbing Review Planning Review Electrical Review Building Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.00 Invoice# ELC-1-18-66220 DBPR Fee $2.25 01/31/2018 Credit Card $ 115.25 $50.00 DCA Fee $2.00 Education Surcharge $1.00 01/24/2018 Credit Card $50.00 $0.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $4.00 Total: $165.25 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,MECHAN AL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS I VIT: -I th all the foregoing infor ion is accurate and that all work will be done in compliance with all applicable laws regulating construction n onin er e, I authorize the above-nam contractor to do the work stated. January 31, 2018 A horizgnature:Owner / Applicant / Contractor / Agent Date Building epartment Copy January 31, 2018 1 r • Miami Shores Village Buildin&',Department RE,CEIVED�- 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 JAN 2 4 2016' Tel: (305)795.2204 Fax: (305)756.8972 INSPECTION'S PHONE NUMBER: (305)762.4949 BUILDING '��`` Permit No. PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: Electrical / f l/{/) (fi "OWNER. ame(Fee Simple.Titlehold'er): C�Gt-�,©Ge-SG of /�714"W4 rPhone#: 306-`gS�&Z` Tena t/Lessee Nam 1;7, cPho'ne#: Email:- y-aAA0,The_a. o 1M C)y`A JOB ADDRESS: City: Miami Shores County: Miami Dade '" Z1p: Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: �d 6re X-� /NL " Phone#: Address: �9WAC9 v�yw City: 1q`j911VGt/00' _ State: � •tp:_ti.z ;\ _ �' Zip:t j"ge21�- Qualifier Name: V dX/(J 'C/7 � ' °'Phone#: .w > State Certification or Registration#: 'e6_7 certificate of Competency#: Contact Phone#: c�G�s��� Email Address: V���1� � •' �-�°Com+ DESIGNER: Architect/Engineer: /t/l�i� Phone#: Value of Work for this Permit: $Yr�7 � Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: V- lee Y2191 • Submittal Fee$57 00 Permit Fee$ e©� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ �' �` DBPR$12 '�� Bond$'. Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ _ TOTAL FEE NOW DUE$ A Bonding Company:s,Name(if applicable) Bonding Company's'Ad'diess 4i fi ' State Zip City Mortgage Lender's Name(if applicable) 4. Mortgage Lenders 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 fall laws regulating a construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work.will be done incompliance wiih 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 r for the first,inspection,which occurs seven (7) days after,the.building permit is'issued. In the absence of such posted notice, the inspection mill dot'be a45—er— qfv) reinspFction'fee will be'charged.` t 'Signature. Signature � ' �, .• `Contractor The foregoing instrument was acknowlede fore me this * The•foregomg instrument was acknowledged before me this day of J_( 20, by S4 if W kliA)4yl.�`VUf�'lJ , day of � r .�20 1L.,byJ�) ,� who is ersonal�ly known to me r who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARYTUBLIC;---) NOTARY PY LIC• Sign: n� U! 1 1 / ^ Sign: i, Print: ,y 3 Print: "1¢ OS ` , r n Notary Public Stat of brld�. My Commission Expires: My COMMISSION#FF216826 MY Comrriiss s:Rebece Munoi' r, < luy Commission FF 818344 EXPIRES April 02,2019r�nd Expires 09rot1t2019 14071390-0.53 Fioricmowyservice.corr APPROVED BY ��/ ri9'0� Olans Examiner '' Zoning Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) 1/24/2018 Property Search Application-Miami-Dade County "LE OF` THE PROPERT"T" APPRAISER OFF14U Summary Report Generated On: 1/24/2018 Property Information Folio: 11-3206-049-0010 i. Property Address: 9401 BISCAYNE BLVD .. Miami Shores,FL 33138-2970 r Owner EDWARD A MCCARTHY ARCHBISHOP d p r , Mailing Address 9401 BISCAYNE BLVD , MIAMI,FL 33138-2970 PA Primary Zone 1100 SGL FAMILY-2301-2500 SQ s Primary Land Use 7144 RELIGIOUS-EXEMPT: - RELIGIOUS Beds/Baths I Half 0/0/0 Floors 1 r Living Units 0 " Actual Area Sq.Ft r Living Area Sq.Ft Adjusted Area 98,959 Sq.Ft Taxable Value Information Lot Size 167,270 Sq.Ft 2017 2016 2015 Year Built 1982 County Assessment Information Exemption Value $12,183,727 $11,076,116 $10,069,197 Year 2017 2016 2015 Taxable Value $0 $0 $0 School Board Land Value $4,516,290 $3,981,026 $4,336,475 Building Value $8,733,171 $8,439,619 $7,705,739 Exemption Value $13,836,076 $13,015,886 $12,630,480 Taxable Value $0 $0 $0 XF Value $586,615 $595,241 $588,266 City Market Value $13,836,076 $13,015,886 $12,630,480 Exemption Value $12,183,727 $11,076,116 $10,069,197 Assessed Value $12,183,727 $11,076,116 $10,069,197 1 Taxable Value $0 $0 $0 Benefits Information Regional Benefit Type 2017 2016 2015 Exemption Value $12,183,727 $11,076,116 $10,069,197 Non-Homestead Assessment Taxable Value $0 $0 $0 Cap Reduction $1,652,349 $1,939,770 $2,561,283 Sales Information Religious Exemption $12,183,727 $11,076,116 $10,069,197 Previous Sale Price OR Book-Page Qualification Description Note:Not all benefits are applicable to all Taxablelues(i.e.CountySchool Va , Board,City,Regional). Short Legal Description ARCHDIOCESE OF MIAMI SUB PB 116-27 TRA LOT SIZE 167270 SQ FT 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 http://www.miamidade.gov/info/disclaimer.asp Version: POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the most Reverend Thomas Wenski, as Archbishop of the Archdiocese of Miami, his successors in office,a corporation sole,has made,constituted and appointed,and by these presents ' does hereby make,constitute and appoint Sister Elizabeth A. Worley, C.O.O.,his true and lawful attorney for him and in his name,place, and stead. Giving and granting unto Sister Elizabeth A. Worley, C.O.O., his said attorney full power and authority to do and perform all and every act and thing whatsoever requisite and necessary to be done in and about the premises as fully, to all intents and purposes, as he might or could do if personally present,with full power of substitution and revocation,hereby ratifying and confirming all that Sister Elizabeth A. Worley, C.O.O.,his said attorney or his substitute shall lawfully do or cause to be done by virtue hereof. ' In Witness Whereof, I have hereunto set my hand and seal this 20 day of February,A.D.,2015. t Signed,sealed and delivered in the presence of: y 4 Witnes Witness ignature The Most Reverend Thomas Wenski qaAs Archbishop of the Archdiocese of M;k�L i+tU� Miami his successors in office, a Printed Name corporation sole Witness Signature / / r ,�So/a l#?q e Printer amNamN e i STATE OF FLORIDA ) SS: COUNTY OF DADE ) I hereby certify that on this day,before me,an officer duly authorized to administer oaths and take acknowledgements, personally appeared The Most Reverend Thomas'Wcnski, as Archbishop of the Archdiocese of Miami, his successors in office, a corporation sole, known to me to" be the person described in and who executed the forgoing instrument,who acknowledged before'me that he,executed the forgoing ins ment,who acknowledged before me that he executed the same,and an oath was not taken. Said person is personally known to me Said person provided the following type of identification: ; Witness my hand and official seal in the County and State last aforesaid this 20 day of February, A.D.,2015. My Commission Expires: 0r.�y,, Nomryp�swe of Fwrida `F Mays NwNna Posed My Commission FF i9a149 urea QV10 19 Detail by Entity Name Page 1 of 3 Florida Department of State Div;-siov or CorxPotu,r:oras �s®10AM fa4II' •fdJt rat,�d ,se�7 r 1. �'af:++a .,a',t;�:i ;'1Au Department of State / Division of Corporations / Search Records / Detail By Document Number/ i Detail by Entity Name Florida Not For Profit Corporation ARCHDIOCESE OF MIAMI, INC. r Filing Information Document Number N99000001604 FEI/EIN Number 65-0909504 Date Filed 03/15/1999 State FL Status ACTIVE Principal Address 9401 BISCAYNE BOULEVARD MIAMI SHORES,,FL 33138 Changed: 01/14/2008 Mailing Address 9401 BISCAYNE BOULEVARD MIAMI SHORES, FL 33138 Changed:01/14/2008 Registered Agent Name&Address FITZGERALD,J. PATRICK ESQ. 110 MERRICK WAY SUITE 3-B CORAL GABLES, FL 33134 Name Changed: 04/29/2009 Officer/Director Detail Name&Address Title PD a WENSKI,THOMAS GREV 9401 BISCAYNE BOULEVARD i MIAMI SHORES, FL 33138 Title VPD WORLEY, ELIZABETH SISTER http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 1/24/2018 Detail by Entity Name Page 2 of 3 9401 BISCAYNE BOULEVARD MIAMI SHORES, FL 33138 Title T CATANIA,JOSEPH A 9401 BISCAYNE BOULEVARD MIAMI SHORES, FL 33138 Title SD JEANTY,CHANEL REV 9401 BISCAYNE BOULEVARD MIAMI SHORES, FL 33138 Title AT CASCIATO, MICHAEL A 9401 BISCAYNE BOULEVARD MIAMI SHORES, FL 33138 I Title AS FITZGERALD,J. PATRICK ESQ. 110 MERRICK WAY, SUITE 3-B CORAL GABLES, FL 33138 Annual Reports Report Year Filed Date 2016 01/21/2016 2017 01/23/2017 2018 01/16/2018 Document Images 01/16/2018--ANNUM..REPORT View image in PDF format 01.12312017......... UAL._R,E f?RT View image in PDF format 01/2112016--ANNUAL REPORT View image in PDF format 1 9,1/1-142015-.:..,ANNQA.1.REF,Q,RT View image inPDF'format ' 01/1012014--ANNUAL REPORT View image in PDF format 01125/2013--ANNUAL.REPORT View image in PDF format Di"28j2012..........SNNUF L._RE(QRT View image in PDF'format 02/232011--ANNUAL REPOR"IView image in PDF format 9f/1,4/2010,,,.....A NUAf;;_REP RT View image in PDF format 0:?/02/2010--ANNUAL REPORT View image in PDF format 4 0911 6/2009--ANNUAL REPORT View image in PDF format 04i23;2009...,,._,ANNUf L.-EPORT View Image inPDF'format 01/14/2008--ANNUAL REPORT View image in PDF format 04/1,9(2{)07.,.A NU l;;-REPORT, View image in PDF format 04/28/2006--ANNUAL REPORT View image in PDF format 05103/2005--ANNUAL REPORT View image in PDF format http://search.sunbiz.org/Inquiry/Corporati I onSearch/SearchResultDetail?inquirytype=Entity..,. 1/24/2018 Detail by Entity Name Page 3 of 3 t12125/ZQQ4 _f1NN,VF L RFPQRT View image in PDF format 05/0112003--,ANNUAL REPORT View image in PDF format 01'30;2002--ANNUAL REPORT View irnage in PDF format 01?25/2001—,ANNUAL REPORT View image in PDF format ()ilL i%?t3(}5- f1RIN.U...At;;_f?EPORT View image in PD1 format 03115?1999--Domestic Non-Profit View image in PDF format Florid?C'n Jri^ierr.of;i;al f:,Civ:sb:i<:'Cv:;:nr?!if:'IS t d k d' http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 1/24/2018 RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD ��'EC0001il { � The ELECTRICAL CONTRACTOR w- Named below IS CERTIFIED Under.the'provisions of Chapter 489 FS. Expiration date:-AUG 31, 2018 MOODY, JOHN J ° °� �� ■ MOODY ELECTRIC,,INC ' 13700 ROANO_KE STR DAVIE 'A tits ISSUED: 07/27/2016 DISPLAYAS REQUIRED BY LAW SEQ# L1607270001827 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895— 954-831-4000 j VALID OCTOBER 1,2017 THROUGH SEPTEMBER 30,2018 DBA: Receipt#:181-278828 MOODY ELECTRIC INC ELECTRICAL/ALARMS/CONTRAC R Business Name: Business Type: (ELECTRICAL CONTRACTOR) Owner Name:JOHN J MOODY Business Opened:08/17/2016 Business Location:3812 NO 29 AVE State/County/Cert/Reg:EC 0 0 0119 9 HOLLYWOOD Exemption Code: Business Phone: Rooms Seats Employees Machines Professionals 11 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty ,Prior_Years Collection Cost Total Paid 54.00 0.00 0.00 0.00 0.00 0.00 54.00 I i 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: + MOODY ELECTRIC INC Receipt #iCP-16-00013855 3812 NO 29 AVE Paid 07/19/2017 54.00 HOLLYWOOD, FL 33020 07/18/2017 Effective Date 2017 - 2018 MOODELE-01 WENDY .A ® CERTIFICATE OF LIABILITY INSURANCE FDATE 12/28/2017 Y) 12/28/2017 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 r IELOW. 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 CONTACT NAME: Acrisure,LLC d/b/a InSource PHONE FAX 9500 South Dadeland Boulevard (A/C,No,Ext:(305)670-6111 A/c,N,):(305)670-9699 4th Floor ADE-MAIL ,certs@insource-inc.com DR Miami,FL 33156-2867 INSURERS AFFORDING COVERAGE NAIC# INSURER A:Continental Insurance Company 35289 INSURED INSURER B: Moody Electric Inc. INSURER C: 3812A North 29th Avenue INSURER D: Hollywood,FL 33020 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. INSR TYPE OF INSURANCE ALDDL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE F_X]OCCUR 6043563014 12/31/2017 12/31/2018 DAEMGETo RENTED ESIE occurrence) $ 100,000 MED EXP(Any oneperson) $ 15'000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑X SE LOC PRODUCTS-COMP/OP AGG $ 2'000'000 i OTHER: s POLLUTION LIABI 1,000 000 ` A AUTOMOBILE LIABILITY EOMBINED Cident)SINGLE LIMIT $ 1,000,000 X ANY AUTO 6043563028 12/31/2017 12/31/2018 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS yy p BODILY INJURY Per accident) X AUTOS ONLY X AUOTOS ONLY Pe�acadent AMAGE $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE 6043563031 12/31/2017 12/31/2018 AGGREGATE $ 2,000,000 DED I X I RETENTION$ 10,000 I WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE R ANY PROPRIETOR/PARTNER/EXECUTIVE WFICER/M�MgER EXCLUDED? N/A E.L.EACH ACCIDENT $ andatory in BH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Electrical Contractor E I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd.Avenue Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE Pta;p.-1101- ACORD 25(2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MOODY-1 OP ID: NG CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 12/18/2017 FTHIS 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 '91ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED EPRESENTATIVE 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 561-392-3300 NOMEAcr Workers Compensation Group Workers Compensation Group ONE 561-392-3300 FAX 561-361-1132 P O Box 410 A/C,No,Ext): A/C,No Boca Raton,FL 33429-0410 no AIE ,certs@workerscompgroup.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Bridgefield Employers Ins 10701 INSURED Moody Electric,Inc 3812A North 29th Avenue INSURER B Hollywood,FL 33020-1008 INSURER C: 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. INSR TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE [—]OCCUR DAMAGE TO RENTED ' PREMISES occurrence) $ MED EXP(Any one erson $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOSBODILY p BODILY INJURY Per accident $ I AUTOS ONLY AUOTOS ONLY Perr ccitlent AMAGE $ f UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ A AND KERS COMP LIABILITY Y/N �( PER T X ORTH- ANYPROPRIETOR/PARTNER/EXECUTIVE F___1830-29673 01/01/2018 01/01/2019 1,000,000 FFICER/MEMgER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Electrical Contractors I CERTIFICATE HOLDER CANCELLATION MIAMIS3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ATE THEREOF,Village of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS. WILL BE DELIVERED IN Fax:305-756-8972 10050 NE 2nd Ave. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD