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MC-18-346 Inspection Worksheet Miami Shores Village vx�' 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: I NSP-2971 11 Permit Number: MC-2-18-346 Scheduled Inspection Date: March 01, 2018 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: SHEA, SEAN Work Classification: A/C Replacement Job Address:1053 NE 95 Street Miami Shores, FL Phone Number , Project: <NONE> Parcel Number 1132060143600 r Contractor: ULTRA WEATHER CORP Phone: (786)615-4559 Building Department Comments , EXACT A/C CHANGE OUT(2 UNIT) Infractio Passed Comments INSPECTOR COMMENTS False 02/27/2018 AS PER OWNER HE KNOWLEDGES THAT BOTH SIGNATURES DO NOT LOOK THE SAME BUT HE DID ; SIGN IN BOTH PAPERWORK, APPLICATION AND AFFIDAVIT. I Y Y l Inspector Comments Passed Failed , Y Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled until reinspection fee is paid. _. r , a a February 28,2018 For Inspections please call: (305)762-4949 Page 16 of 26 x , Permitwo. MC-2-18-346 sHO1 s L,� Miami Shores VillagePermit Type.Mechanical-Residential 10050 N.E.2nd Avenue NE ,w'"t WNorkClassif cation AIC Replacement Miami Shores,FL 33138-0000 Per, Phone: (305)795-2204 Permit Status:=APPROVED FCORlDp' issue Date:2/27/2018 Expiration: 08/26/2018 Project Address Parcel Number Applicant 1053 NE 95 Street 1132060143600 Miami Shores, FL Block: Lot: SEAN SHEA Owner Information Address Phone Cell SEAN SHEA 1053 NE 95 ST MIAMI FL 33138-2547 Contractor(s) Phone Cell Phone Valuation: $ 6,000.00 ULTRA WEATHER CORP (786)615-4559 Total Sq Feet: Tons: Available Inspections: Additional Info:EXACT A/C CHANGE OUT(2 UNIT) Inspection Type: Classification:Residential Final Approved:In Review Review Mechanical Comments: Date Approved: : In Review Date Denied: Type of Work:EXACT A/C CHANGE OUT(2 UNIT) Scanning:2 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.60 DBPR Fee Invoice# MC-2-18-66408 $3.15 02/09/2018 Check#: 1650 $50.00 $180.85 DCA Fee $2.10 Education Surcharge $1.20 02/27/2018 Credit Card $ 180.85 $0.00 Permit Fee $210.00 Scanning Fee $6.00 Technology Fee $4.80 Total: $230.85 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 my t, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOOR ,ROOFING an SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing inform on is accu ate and that all wo k will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above a acont for to do the work tated. February 27, 2018 Authorized Signature:Owner / Applicant / ontrac r / Agent Date Building Department Copy February 27, 2018 1 f Miami Shores Village g.,r.-_. Building Department 2o�s \/ 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 [7FER'0 ��,(,4 T''I �� Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 Erb (J FBC 2019 BUILDING Master Permit No. CI ,—'3 1 PERMIT APPLICATION Sub Permit No. E ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING Q MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1053 NE 95th St I City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-3206-014-3600 Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BF�E: FFE: OWNER:Name(Fee Simple Titleholder): Sean Shea & Rosalie Phone#: l78(v, Address: 1053 NE 95th St City: Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Ultra Weather Corp Phone#: 786-229-4364 Address: 17851 SW 152nd Ct City. Miami State: FL Zip: 33187' 4ualifier Name: Lazaro Alberto Phone#: 786-229-4364 State Certification or Registration t CAC1816585 Certificate of Competency#: DESIGNER:Architect/Engineer: N/A Phone#: Address: —tan I / City: State: Zip: Value of Work for this Permit:$ V Square/Linear Footage of Work: E Type of Work: ❑ Addition ❑ Alteration ❑ New ❑W Repair/Replace ❑ Demolition Description of Work: Exact A/C Change Out. 2 UnS Specify color of color thru tile: �Q Submittal Fee$� '1 Permit Fee$ % CCF$ CO/CC$ Scanning Fee$ Radon Fee$ d• 1b DBPR$ 3• is Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$J. (Revised02/24/2014) 4S r Bonding Company's Name(if applicable) N/A Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) l Mortgage Lender's Address City State Zip I 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 f 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 1 for the first inspection which occurs seven (7) days after the building permit is issued. In the abse f such`posted notice, the inspection will not be approved and a reinspection fee will be charged. 1 4 Signature CQJYI tag, Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 8th day of February 20 18 by 8th day of February 20 18 by Sean Shea who is personally'known to Lazaro Alberto who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: U IAOSEFINA RUBIO Print: CIS •= MY.COMMISSION#FF937023 EXP" Print: 19,.2T Seal: ';. EXPIRE 19,.2019 Seal: �• ' f,,p;S•• (407)398.0153 FloridallotaryService.com (407)398-0153 Floni a'kotaryService.com 4 APPROVED BY I sEiner Zoning 4 } Structural Review Clerk (Revised02/24/2014) I { "Olga Miami Shores Village Building Department Eggs 10050 N.E.2nd Avenue e Miami Shores, Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC " This form must accompany ALL air conditioning replacement permit applications. Each unit change-out must be on its own data sheet. Multiple units on single sheets are not acceptable. r Job Address(where the work is being done): 1053 NE 95th St City: Miami Shores Village County: Miami Dade Zip Code: 33138 ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB " ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION , A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED Change disconnecting means:YES❑ NO❑ ARHI Sheet Attached:YES Co NO❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER6 11'131 AHU or PKG. UNIT MODEL# µ T T 3AB ©J-. COND.UNIT MODEL# aAS�Ik,•LsA V ►Cj,J KW HEAT NOM TONS .ov'r ►.4 AHU CU 2-5>PKG 1)M.C.A AHU RU :5�¢jPKG AHU(4C CU PKG 2)M.O.P AHU _5 U%4t)PKG AHU CU PKG 3)VOLTS AHU CU PKG PKG UNIT / / PKG UNIT ( EER/SEER YES NO REPLACING DUCTS S NO YES NO REPLACING THERMOSTAT S NO YES NO NEW 4"CONCRETE SLAB 6E-9NO YES NO NEW ROOF STAND YES i YES NO NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity(Wire Size): O 2. Maximum Overcurrent Protection (Fuse/Breaker Size): G 3. Voltage of Circuit(208/240/480): 0�0?kd 4. Size Disconnecting Means: Contractor's Company Name: Ultra Weather Corp Phone: 786-2294364 State Certificate or Registration 0. AC1816585 Certificate of Competency No. Signature Date: February 8th 2018 aiifler's %nat5 (Revised02/24/2014) 15NOR,Es Miami Shores Village Building Department Eggs ,.,,. 10050 N.E.2nd Avenue ...., Miami Shores, Florida 33138 �°N�` Tel:(305)795.2204 <oRtvp' Fax:(305)756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC + This form must accompany ALL air conditioning replacement permit applications. Each unit change-out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address(where the work is being done): City: Miami Shores Village County: Miami Dade Zip Code: ALL CONDENSING UNITS MUST BE ON A 4-INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED Change disconnecting means:YES❑ NO❑ ARHI Sheet Attached:YES ❑ NO❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER }fit C_,7157 M A q 17 AHU or PKG.UNIT MODEL# . _'�T-� S)Q D CON D.UNIT MODEL# Kt-1-)&�Lq14_5-TA/\1TA KW HEAT ,'G IA2 NOM TONS °,�7 p r AHU)q cu a0 PKG 1)M.C.A AHU I4}CU,,(0PKG AHU'j&CU ?50PKG 2)M.O.P AHU 0'7 ,^CU---30 PKG AHU CU PKG 3)VOLTS AHU CU PKG PKG UNIT / / PKG UNIT f EER/SEER j YES NO REPLACING DUCTS NO YES NO REPLACING THERMOSTAT S NO YES NO NEW 4"CONCRETE SLAB1( S NO YES NO NEW ROOF STAND YES YES NO NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity(Wire Size): y 2. Maximum Overcurrent Protection (Fuse/Breaker Size): t 3. Voltage of Circuit(208/240/480): d? 1 ►"3C� �' 4. Size Disconnecting Means: ' 2e ) wee.. xr C'o Contractor's Company Name: //rr Phone: State Certificate or tion N G /�jMIKCertificate of Competency No. Signature Date: (Qualifier's signature) r (Revised02/24/2014) t i This combination qualifies for a Federal Energy Efficiency tax Credit when placed in service between Feb 17,2009 and Dec 31, 2016. sual CERTIFIED Certificate of Product R AHRI Certified Reference Number:201278739 Date:02-09-2018 Model Status :Active r Old AHRI Reference Number :7940891 AHRI Type RCU-A-CB Series : Outdoor Unit Brand Name :RHEEM Outdoor Unit Model Number (Condenser or Single Package) :RA1624AJ1 Indoor Unit Brand Name Indoor Unit Model Number(Evaporator and/or Air Handler) :RH1T2417STAN Furnace Model Number: Region :All(AK,AL,AR,AZ,CA,CO,CT,DC,DE;FL,GA,HI,ID,IL,IA,IN,KS,KY,LA,MA,MD,ME,MI,MN,MO,MS,MT,NC,ND,NE,NH, NJ,NM,NV,NY,OH,OK,OR,PA,RI,SC,SD,TN,TX,UT,VA,VT,WA,WV,WI,WY,U.S.Territories) Region Note :Central air conditioners manufactured prior to January 1,2015 are eligible to be installed in all regions until June 30,2016. Beginning July 1,2016 central air conditioners can only be installed in region(s)for which they meet the regional efficiency requirement. The manufacturer of this RHEEM product Is responsible for the rating of this system combination. l [--t r—>• r—l--- '1� Rated as follows in accordance with the latest edition of ANSI/AHRI 210/240 with Addenda 1 and 2,Performance Rating of Unitary Air-Conditioning &Air-Source Heat Pump Equipmdnt and subject toIndaccuracy by;AH 1=spons(red,•indepZndent,'thirb party testing: Cooling Capacity(rA2)� floor rHigh Sta`ge'(95F),btuh 240100 I I I \--N— U I � � j 1� 1 SEER.16.00 EER(A2)-Single or High Stage(95F) :13.00 � x IEER I t'Active'Model Status are those that an AHRI Certification Program Participant is currently producing AND selling or offering for sale;OR new models that are being marketed but are not yet being produced."Production Stopped"Model Status are those that an AHRI Certification Program Participant is no longer producing BUT is still selling or offering for sale. Ratings that are accompanied by WAS indicate an involuntary re rate. The new pudished rating is shown alma with the previous(i.e.WAS)ratino. DISCLAIMER AHRI does not endorse the product(s)listed on this Certificate and makes no representations,warranties or guarantees as to,and assumes no responsibility for, the product(s)listed on this Certificate.AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s),or the unauthorized alteration of data listed on this Certificate.Certified ratings are valid only for models and configurations listed in the directory at www.ahrldirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI.This Certificate shall only be used for individual,personal and confidential reference purposes.The contents of this Certificate may not,in whole or in part,be reproduced;copied;disseminated; entered into a computer database;or otherwise utilized,in any form or manner or by any means,except for the user's individual, personal and confidential reference. AIR-CONDITIONING,HEATING, CERTIFICATE VERIFICATION BREFRIGERATION INSITIUM The information for the model cited on this certificate can be verified at www.ahridirectory.org,click on'Verify Certificate"link we make life better- and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above,and the Certificate No.,which is listed at bottom right. ©2018Air-Conditioning, Heating,and Refrigeration Institute CERTIFICATE NO.: 131626640012066502 i 1 f FFThis combination qualifies for a Federal Energy Efficiency tax Credit when W , placed in service between Feb 17,2009 and Dec 31, 2016. Certificate of Product Ratings AHRI Certified Reference Number:201290216 Date:02-09-2018 Model Status :Active Old AHRI Reference Number :7942888 AHRI Type :RCU-A-CB Series : Outdoor Unit Brand Name :RHEEM I Outdoor Unit Model Number (Condenser or Single Package) :RA1642AJ1 Indoor Unit Brand Name : Indoor Unit Model Number(Evaporator and/or Air Handler) :RH1T4821STAN Furnace Model Number Region :All(AK,AL,AR,AZ,CA,CO,CT,DC,DE,FL,GA,HI,ID,IL,IA,IN,KS,KY,LA,MA,MD,ME,MI,MN,MO,MS,MT,NC,ND,NE,NH, NJ,NM,NV,NY,OH,OK,OR,PA,RI,SC,SD,TN,TX,UT,VA,VT,WA,WV,WI,WY,U.S.Territories) Region Note :Central air conditioners manufactured prior to January 1,2015 are eligible to be installed in all regions until June 30,2016. Beginning July 1,2016 central air conditioners can only be installed in region(s)for whicbthey meet the regional efficiency requirement. The manufacturer of this RHEEM product is responsible for the rating of this system combination. Rated as follows in accordance with the latest edition of NSI/AHRI 2101240 with Addenda 1 and 2,Performance Rating of Unitary Air-Conditioning &Air-Source Heat Pump.Equipment'and subject to rating accuracy by:AHRI=sponsored,`Independent,-third party"testi Cooling Capacityng: } l le roHigh Stage(95F);biuh�500 SEER :16.001 �—F �� �--�—� f vvv EER(A2)-Single or High Stage(95F) 13.00i j �� mf �0� $1 JEER ti t'Active'Model Status are those that an AHRI Certification Program Participant is currently producing AND selling or offering for sale;OR new models that are being marketed but are not yet being produced."Production Stopped"Madel Status are those that an AHRI Certification Program Participant is no longer producing BUT is still selling or offering for sale. Ratings that are accompanied by WAS indicate an invduntary re rate. The new published rating is d own along with the orev (i a WAS)rating. DISCLAIMER AHRI does not endorse the product(s)listed on this Certificate and makes no representations,warranties or guarantees as to,and assumes no responsibility for, the product(s)listed on this Certificate.AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s),or the unauthorized alteration of data fisted on this Certificate.Certified ratings are valid only for models and configurations listed in the directory at www.ahridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI.This Certificate shall only be used for individual,personal and confidential reference purposes.The contents of this Certificate may not,in whole or in part,be reproduced;copied;disseminated; e entered into a computer database;or otherwise utilized,in any form or manner or by any means,except for the user's individual, personal and confidential reference. AIR-CONDMONIN0,HEATINO, CERTIFICATE VERIFICATION &REFRIOERA110MINSTITUrE The information for the model cited on this certificate can be verified at www.ahridirectory.org,click on"Verify Certificate'link we make life bettef- and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above,and the Certificate No.,which is listed at bottom right. ©2018Air-Conditioning, Heating,and Refrigeration Institute CERTIFICATE NO.: 131626637915658246 k :::rte.•-- AA r Ultra Weather Corp 17851 SW 152"d Ct Miami , FL 33187 786-615-4559 CAC1816585 Miamiiceac@gmaii.com Date: 2-26-2018 State of Florida County of Dade Before me this day personally appeared Larazo K. Alberto who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 1053 NE 951'�St Miami Shores FL 33138 �-�'A` _ Contractor Signature Sworn to (or affirmed) and subscribed before me this 26 day of February. 2018 By Lazaro K. Alberto Personally Known X Or Produced Identification Type of dentification P1�4ed osefina Rubio Print, T e or Stamptary �'"""'• JOSEFINA RUBIO. MY COMMISSION#FF937623 EXPIRES November 19,2019 P,:. .• (407)398-0153 Floridallotaryservice com 5�ORES' '1pC't9g2 Gr� s� Miami shores Village sell . BuildingDe 'artment y ,ES to "a p 10050 N.E.2nd Avenue �ORIDp' Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: I. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County of Miami-Dade / d The foregoing was acknowledge before me this a( ,4 day of Fe b ru ac y ,20 �0 By SeCx_yn who is personally known to me or has produced as identification. Notary: � �tn"' JOSE FINA RUBIO i MY COMMISSION#FF937623 t SEAL: EXPIRES'November 19,2ai9 (40n 39&0153 FloridAotaryService.com 011662 ne enc Recet t I } . ..-Dade County, t of Florida =THISIS NOT A BILL -DO NOT PAY 7e_- 677,5549, m E.X1171PM SEPTEM-I*P-A 30 2018 llZr _ m Must'be di4ptayec at place of business 'MIA— t1,87-1� ,33 4 I u-runt to County Code Chapter SA — Ari. 4 & 10 x r R r '; R� �,�..`. y r" SEC. TYPE._Q1 g�.._S1NESS � � .� PAYMENT RECEIVEL? `'U LTRA�1ltlEATHERICORPr: 196 'SPEC MECH�►Ni.Ci4L Cai 1TRACTQF 1 1 CAC181685x �f TAX cLI.EcrQR 1 worker({ ) _ �. a. 41 ., CRED Tt� T7,�05 Th s.l.ocal Business Tax Receipt only confirms payment of they Local Bgsmess Ta'. 1 e Ili cei #is ria ,a b ase. f permit,or'a certifieat Qn;t►f the hepar s giuslif catio4,to du business. Flolder mast comply with any govern■*s I . /or g±opgpvernmental.regutatory laws and rb qu remelts which apply to the hi hitt I T s The[RECEIPThItI.above mit be-riieplayed on all commercial vehiclee Nlp�e� For more information,visit AN m ,mac" DATE(MMODNYYY) s�CO d CERTIFICATE OF LIABILITY INSURANCE 2/8/2018 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: H the certificate holder Is an ADDITIONAL INSURED,the poliey(ies)must be endorsed. B SUBROGATION IS WANED,subject to the terms and conditions of the Policy,certain policies may require an endorsemerrt A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER NAME: 12 25 WSIJOkeechobee Road aHOic"N;Ett: (305)221-8099 ,,0:(305)221-8049 Hialeah Gardens, FL 33018 ADDRESS:ca=en@cjginsurance.com RVAIRER(S)AFFORONG COVERAGE NAIL. INSURER A:Ascendant Commercial Insurance INSURED Ultra Weather Corp. INSURER B: Lazaro INSURER C: 17851 SW 152nd Ct INSURER D: Miami, FL 33187- INSURER E: (786)229-4364 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. ureR AWL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE OM WVD POLICY NUMBER LIMITS X COMMERCIAL GENERAL LIABISMY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE ®OCCUR PREMISES o $ 100,000 GL 48859-1 07/26/17 07/26/18 MED EXP( Wamperson) $ 5,000 A 8 DED: 500 PERSONAL a ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 } PouCY❑� ❑LDC PRODUCTS-coMPioP AGG s 1,000,000 OTHER $ AUTOMOBILE LIABILITY (Ea ec*WM S ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SC ��HIE AUTOS AUTOS BODILY INJURY(Per aaideM) $ MON-OHIRED AUTOS AUTOSNMED s $ UMBRELLA LIAR OCCUR EACH OCCURRENCE S EX ��LU16 CLAIMS-MADE AGGREGATE $ DED I RETENTION$ = WORKERS COMPENSATION AND EMPLOYERS'LLABILITY YrN STATUTE I ER ANY PROPRET00PART ERIDECUfNE OFFCER/YEMBER EXCLIMED7 ❑NIA E.L.EACH ACCIDENT s I m MI) EL DISEASE-EA EMPL = D Tres,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POUCY LIMIT+ s i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Shcedule,may be attached it more apace is regCired) AC SERVICE INSTALLATIONS AND" REPAIR r CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2nd Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores FL 33138 AUTHORIZED REPRESENTATIVE 01988-2014 ACORD CORPORATION. All rights reserved. ACORD25(2014/01) The ACORD name and logo are registered marks of ACORD fi r