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CC-17-1651 � ,. r ��<�. #s� is ��' +4r ;kL. �. � .�-r `,'r`..:Y a.. y � 4-i.s=: •� r .r F• _ ^, `�/Ll,�[',�' �.E. 147✓r.Gs''/},- ��l�_ � 1'''� -� - � e. ,� .'�.. W, r 10 .. y• � �a+-, - .. .q � �x, _. '�;;P n a� � yw,..,.. � bra� y .. r5 i.'.. J �� � r � ;1 e. . _ a�yy s .. • — ti, .—,• - r.._ �. � .•_ �' � -`•s• "': w �' ,� t ~ � `� ria :� _P'"'." - t -•ks ... • ati. .,,�....,. _,,, � .�,.....,� ar�_.w� .. .__ �. ..,~a:"� J.... ^n�.�adML.tf.P-_ ... � .'aw . �"�", ..:�.^.'.�: :! Permit No. CC-6-17-1651 �swO1 s L,� Miami Shores Village Pennif Type:Commercial Construction 10050 N.E.2nd Avenue NE Per� � I work Classifrca#ion:Alteration Miami Shores,FL 33138-0000 Patmit'Status:APPROVE Phone: (305)795-2204 N �LORIOP' - - issue Date- 10/3, 112017 Expiration: 04/29/2018 Project Address Parcel Number Applicant 9705 NE 2 Avenue 1132060134230 COCHRAN MIAMI SHORES LLC Miami Shores, FL Block: Lot: Owner Information Address Phone Cell COCHRAN MIAMI SHORES LLC 1800 ELLER Drive FT. LAUDERDALE FL 33316- 1800 ELLER Drive FT. LAUDERDALE FL 33316- Contractor(s) Phone Cell Phone Valuation: $ 25,000.00 D.TORR GENERAL CONTRACTORS, 1 (305)301-9913 Total Sq Feet: 1105 Approved: In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final PE Certification Date Denied: Window Door Attachment Type of Construction:AND INTERIOR RENOVATION FOR Occupancy Load: Tie Beam Stories: Exterior: Slab Front Setback: Rear Setback: Termite Letter Left Setback: Right Setback: Framing Plans Submitted:Yes Certification'Status: Store Front Attachment Certification Date: Additional Info: Insulation Bond Return: Classification-Commercial Drywall Screw Scannin :8 Window and Door Buck Gelling Grid Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Fill Cells Columns CCF $15.00 Review Electrical CO/CC Fee Invoice# CC-6-17-64393 Review Electrical $200.00 10/26/2017 Credit Card $952.75 $200.00 DBPR Fee $11.25 Review Planning DCA Fee $7.50 10/19/2017 Credit Card $200.00- $0.00 Review Building Education Surcharge $5.00 Review Structural Permit Fee $750.00 Review Mechanical Plan Review Fee(Engineer) $120.00 Review Plumbing Scanning Fee $24.00 Technology Fee $20.00 Total: $1,152.75 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 AFFIDAVIT: I certify that all the foregoing information is accurate and that all workill be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above-named contractor do the rk st ed. October 31, 2017 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy October 31,2017 1 Miami Shores VillageCET i JUN-2 3 2017 Building Department 10050 N.E.2nd Avenue,Miami Shores,.Florida 3313E BY: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 i FBC 20 (q BUILDING Master Permit No. CC "t (dOJ PERMIT APPLICATION Sub Permit No. OBUILDING ❑ELECTRIC ❑ ROOFING E REVISION ❑ EXTENSION RENEWAL .❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION SHOP CONTRACTOR D INGS ;JOB ADDRESS: 9711. NE 2nd Ave. M CL, City: Miami Shores County Miami Dade Zip: Folio/Parcel# 11-3206013-4230 is the Building Historically Designated:Yes'. NO X Occupancy Type: B Load: 37 Construction Type: IIIA Flood Zone: X. BFE FFE: 9.80' OWNER:Name(Fee Simple Titleholder):Cochran Miami Shores, LLC Phone#:954-760-4360 Address:1800 Eller Drive#212 City: Ft. Lauderdale state: FL Zip: 33316 Tenant/Lessee Name: Flight Wine Lounge, Inc. Phone#:305-778-1019 Email: kirn@flightwinelounge-.com E a CONTRACTOR:Company Name: Phone#:_2' ! _q( 13 Address: City: Ml � State: Zip:631Sb Qualifier Name: Phone#: State Certification or Registration M. � C� SZ� 23 Certificate of Competency#: DESIGNER:Architect/Engineer: Kimberley Flower FL AR#94059 Phone#: 305-778-1019 Address:301 NE 98th St City. Miami Shores State: FI Zlp; 33138 Value of Work for this Permit: rjl��y Square/unear Footage of Work: t.o Type'of Work: ❑ Addition 6�7Atteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work.. an interior renovation for a wine cafe including a new storefront, updating existing ` restrooms to ADA compliant and electrical, mechanical &plumbing updates as per plans , Specify color oftfald color—t7hru tile:: _-Z)' t— ` $ t 15 Z . 1 S Permit Fee$: �y G,7 CCF$ I`�' � CO/Cc$_2aJ• C� Scanning Fee$ -2 —1 Radon.Fee$ DBPR$_ 1 Notary$ Technology Fee$ 20. Op Training/Education Fee$ 5 - C-7-Q) Double Fee$ Structural Reviews$ f,2jo_ • Bond$ / TOTAL FEE Now DUE$ (I `G 2z• -'5 V (Revised02J24/2014) _��� i Y 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.. 1 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 ail;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'acturate;and that all work will be done in compliance with all applicable laws regulating construction and toning. 'WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR`PAYING,TWICE FOR IMPROVEMENTS TO.YOUR PROPERTY. IF'YOUINTEND TO OBTAIN'FINANCING, CONSULT WITH'YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuanceof 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 ottochment. Also,:a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occu seven (7)days after the building permit is issued. 1n the absence of such posted:notice,.the F inspection will not be app d reinspection fee will be charged. Signature Signatu OWNER or AGENT CONTRACTOR The foregoing strument was acknowledged before me this The foregoing instrument was acknowledged before me this 23 day of 20 by 1 day of 0 CkDVer ,`20 by rfey who s poay kno to me or who has produced as me or who has produced as; identification a tApwt SCHWESTER identification and whm a an oath. A PabOD MY COMMISSIOt4 0 FF08Z W9 �Q*�% NOTARY.PUBLI ';,, NOTARY PUBLIC: m F'= „a• ,,•• EXPIRES April 30,2020 _ Cd` Rlssion#GG082163 Exp lies: March 13, 2021 ''-,;,, ;•�� Bonded lbru Aaron Notary ign: Sign Print: Print: G Seal: Seal:. I APPROVED BY Plans Examiner Zoning /f T Structural.Review Clerk (RexAsed02n4/2014) Property Search Application - Miami-Dade County Page 1 of 1 OFFICNI PROPERTY", Summary Report Generated On:6/22/2017 Property Information - Folio: 11-3206-013-4230 9705 NE 2 AVE �. Property Address: � +'"�'r! :t,. _"�� , • Miami Shores,FL 33138-2403 Owner COCHRAN MIAMI SHORES LLC . Mailing Address 1800 ELLER DR STE 212 FT LAUDERDALE,FL 33316 ti.. . PA Primary Zone 6400 COMMERCIAL-CENTRAL f t 1209 MIXED USE- ' Primary Land Use STORE/RESIDENTIAL:MIXED USE -RESIDENTIAL k • Beds/Baths/Half 0/0/0 Floors 1 ' Living Units 0 Actual Area Sq.Ft ` 2f Living Area Sq.Ft Adjusted Area 15,885 Sq.Ft Taxable Value Information Lot Size 13,000 Sq.Ft 2017 2016 2015 Year Built 1926 County Exemption Value $0 $0 $0 Assessment Information Taxable Value 1 $915,0181 $831,835 $756,214 Year 2017 2016 2015 School Board Land Value $338,000 $338,000 $234,000 Exemption Value $0 $0 $0 Building Value $596,368 $567,970 $511,173 Taxable Value $945,157 $916,885 $756,214 XF Value $10,789 $10,915 $11,041 City Market Value $945,157 $916,885 $756,214 Exemption Value $0 $0 $0 Assessed Value $915,018 $831,835 $756,214 Taxable Value $915,018 $831,835 $756,214 Regional Benefits Information Exemption Value $0 $0 $0 Benefit Type 2017 2016 2015 Taxable Value 1 $915,018 $831,835 $756,214 Non-Homestead Cap Assessment Reduction $30,139 $85,050 Note:Not all benefits are applicable to all Taxable Values(i.e.County, Sales Information School Board,City,Regional). Previous OR Book- Sale Price Page Qualification Description Short Legal Description 03/01/2008 $0 26354- Sales which are disqualified as a result of 1 53 41 6 53 42 0686 examination of the deed MIAMI SHORES SEC 1 AMD PB 10-70 12/01/1995 $0 00000- Sales which are disqualified as a result of LOTS 13&14 BLK 31 1 100000 lexamination of the deed LOT SIZE 100.000 X 130 i OR 17224-2398 1295 5 i 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 hftp://www.miamidade.gov/info/disclaimer.asp Version: http://www.miamidade.gov/propertysearch/ 6/22/2017 Detail by Entity Name Page 1 of 2 Florida Department of State Dri;siou or CoRnorar<-ONs } 1 ?Y., Jt' tis Department of State / Division of Corporations / Search Records I Detail By Document Number I p Detail by Entity Name Florida Limited Liability Company COCHRAN MIAMI SHORES, LLC t Filing Information Document Number L08000034368 FEI/EIN Number N/A Date Filed 04/03/2008 Effective Date 04/03/2008 State FL Status ACTIVE Last Event REINSTATEMENT Event Date Filed 01/24/2014 Principal Address 1800 ELLER DRIVE, SUITE 212 FT. LAUDERDALE, FL 33316 Changed: 01/24/2014 Mailing Address 1800 ELLER DRIVE, SUITE 212 FT. LAUDERDALE, FL 33316 1 Changed:01/24/2014 Registered Agent Name&Address ,FITZGERALD PROPERTY MANAGEMENT 1800 ELLER DRIVE, SUITE 212 FT. LAUDERDALE, FL 33316 a Name Changed: 02/16/2011 Address Changed:01/24/2014 Authorized Person(s)Detail Name&Address Title MGRM COCHRAN,JOHN B 43 LOOKOUT POINT ROAD HULLS COVE, ME 04644 I http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 6/22/2017 t Detail by Entity Name Page 2 of 2 F Title MGRM COCHRAN,"SHELIA S,TRUSTEE- 8205 KERRY ROAD CHEVY CHASE, MD 20815 Annual Reports ' Report Year Filed Date 2015 02/06/2015 2016 02/09/2016 2017 02/22/2017 Document Images 02122/2017--ANNUAI..REPORT View image in PDF format 02.:00,2016 -ANNUAL REPORT View image in PDF forrnaE 02,0612015--ANNUAL REPORT View image it)PDF format Oz/212.012_.....ANNUAL REF t7PT View image in PDP format 02116/2011--ANNUAL REPORT View image in PDF format 04,,011201D--tNNNUAI..REPORT View image in FDF format 02119,12009--ANNUAL REPORT View image in PDF format 04,103.2008--F:lorida Lit nited Liability View image in PDF format floriaa DecarCnzrt of Sate,Divil-n._ 1 i http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 6/22/2017 Y 06/17/2011 11:05 3019518819 aXHRAN PAGE 01 COCHRAN MIMAI SHORES, LLC 1800 Eller Drive.Suite 222 Fort Lauderdale.FL 33316 951-760--13b0 September 13,2011 City of Miami Shores.- Please hores:Please utilize this letter as authority for Shelby G,Smith to execute documents related to our property located tit 9701-9711 NE 7'r`Avenue and 211-217 NE 97'h Street, Miami Shores.Such documents shall be limited to Permit Applications and related documents: Violation Corrective Actions.and other city documents required within the normal duy'to day operation orre al estate. This document shall not be used to commit the property or Its owner/s under an mortgage and/or loan. Should there be arty questions,please feel free to contact the corporate reprtsentativi:at Cochran Miami Shores,LLC Shella Cochran,as Trustee �� � E I certify under penalty of pedury that this document has been executed by the individual referenced above. u kK &'LtS ,1 � i PORROFATTORNEY KNOW ALL MEN BY.THESE PRESENTS that 1, 5&1 n S; ferArryl.have made,constituted and$ppointed, and by these presents do make,constitute and appoint Shelby G. Smith true and lawful ` attorney for me and in my name, place and stead, to execute any and all documents incident to the Properly,ggly as it relates to permitting for improvementsdirectly related to the-properly-or any portion thereof, and to do and perform all and every act and thing whatsoever requisite and necessary for this appaitt6rtent;to all intents and purposes that I might or could do if personally present,with full power of substitution and revocation,hereby ratifying and confirming all that said attorney shall do or cause to,be done by virtue hereof. The powers granted herein shall remain in full force and effect until termination of tient certain Management Agreement dated Jmuwv 1.. 2003. by and between Carlyle, V.D. Cochratl Trust and FITZGERALD PROPERTY MANAGEMENT.INC.,a Florida corporation,or until otherwise revoked in writing by me or upon my death.. ]iN WITNESS WHERCOF, I have hereunto set our my hand and seal this. 2-8,+ day of 1.D0 66 Signer!,sealed and delhwmd in life pre3099.Of s'�.: Mke [Print name of witness] tPrint name of witness] STATE OFF IDA "4"Q COUNTY DF � The foregoing.insh_vnumt aelofow'ledead before me this day 6f o?Zg6 ..by,%E1 5•: of ,who is personally knc0n to me or who rodiced At ftfi& &Wj".3dV q' as identification. T NQTARY PU$L1C A D wli art ELE [print_narrtej^ My Commission Expires: 711 (Notary Seal} waw{�lttl }clsauo4stu4rt3 I ILL-IbL fW1.14 tuaws6xir~r_1N#essV-pUb fDaH< W,Bu.04stu v ma,Pub< Apub< Z3o Z aftd Y M r' A. t E-TT :GERALD PROPERTY AL4,NAGEMENT April 11,2017 City of Miami Shores 477," Building Department NbV 0 U11 r 13 Dear Sir/Madam / Please utilize this letter as approval for Flight Wine Lounge, Inc., Kimberley Flower, its President to make alterations to 9711 NE 2nd Ave, Miami Shores, Florida per the'plans , by RE Design, project number 17-002, having no revision date/s. Should'there be any questions or concerns, please-feel free to contact me. Sincerely, Fitzgerald property A/Ianagement, Inc. 'Yncreasing andRFptecting Value through Professional Management Shelby t Smith III CPM, RPA Di-18ion, President Fitzgerald Property Management, Inc''. By and For Cochran Miami Shores, LLC' Per the letter dated September 23, 2011 shefby@fitzgera ldgrbUp.com 1800 Eller Drive, Suite.212, Fort Lauderdale, F1 3331 6 Telephone(954)-760-4360 FaXC.(954)760793.10 Website: www.fitzgeraidgroup.com Document 1 7 t _ � ,t 0611712011 11:05 3019sleei9 COCHRAN PAGE 01 , i COCHMN, MINIA1 SHORES, LLC 1 Soo Eller Drive.Suite 22 F ort Lauderdale;FL 3331.0 954-760-4360 I S�ptCtllbcr?3 ,,7{jl.l City Ormiuilli Sho es° i'lense utillfe this letter as author=ity for Shelby G,:Smitli tri execute documents reh ed to our property located al 9701.9711 NE 7'"'Avenue and 211-217 NE 97"'Street, Miami Shores. Such doctiments shall be limited to Permit Applications and related docuniems: Violation Corrective Aciions;'and Tither city documerits-required within the no final day to day operation orrt4111 estutc, This document sttrtll no# be used we ITION9490 And/or 1661j. onxtiit the propert}'or tiv Its gnrrls oondcr nn)' � Should'thm be:nty questions,please /eel free to enntacl Ilse corporate represenatove:rt Cochran Miami S/h�oret,LLC Shella Cochran,as Trustee l certify undsr'periaity of perjury that this document has been egeculad by thei indivtduat . refereneed above: l."-t-tMw t t { i HOLD HARMLESS PROPERTY LOCATED AT: 9711 NE 2 Ave I Kimberly Flower owner of the subject property, Permit number M 1I—I6 6 L would like to request an early start permit as allowed under section 105.12 of the 2014 Florida Building Code for the scope of work delineated in the building permit application and plan prior to the final approval and issuance of the permit, provided the work does not proceed past the first required inspection. I agree to hold Miami Shores Village, its agents and authorized personnel harmless and relieve them from any responsibility or liability for any legal action or damage, cost or expense (including attorney's fee) resulting from missed inspection of the above mention permit. I furthermore assume responsibility for the correction, if required, of work performed under the above permit. _Sergio D Torres (Print Name) (Prime Contractor-qualifier) State of Florida County of Dade: The undersigned, being the first duly sworn, deposes and says that he/she is the contractor for the above property mentioned. Sworn to and subscribed before me this `23 day of 60ob-C r 201 Who has PrOdUCrd br►ver c ns as d-e'-},F;cuor► . Notary Public, State of Florida at Large a A" YANADY PRIETO r. k: MY COMMISSION N FF 214031 EXPIRES:March 25 2019 p6 q Q Bonded Thru Notary Public Underwrlters i 3os-30i—Clcl 1 lz� j It A,, A. t CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395 we 2601 BLAIR STONE ROAD ' TALLAHASSEE FL.32399-0783 TORRES, SERGIO DARIEN D.TORR GENERAL CONTRACTORS, INC 218 NW 92 STREET MIAMI SHORES FL 33150 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 STATE OF FLORIDA ; from architects to yacht brokers;from boxers'to barbeque 's DEPARTMENT`OFBUSINESSAND restaurants,and they keep Florida's economy strong. PROFESSIONAL REGULATION ' CGC1521423 �I SUL6%08/10/2016 - Every day we work to improve the way we do business in order .- ir to serve you better. For information about our services,please tog onto www.myfloridalicense.com. There you can find more .'CERTIFIED GEIfo' L CONTRACTOR information about our divisions and the regulations that impact 1 TORRES•SERGID"'•DARIEN �» ' you, subscribe to department newsletters and learn more about D TORR GENERAL CO . INC INC, k the Department's initiatives. �x + Our mission at the Department is:License Efficiently, Regulate s w" s' ��V 9;•,p: Fairly.We constantly strive to serve you better so that you can `{ IS CERTIFIED under the provisions"of Ch.489,FS. serve your customers. Thank you for doing business in Florida, } � -. 1 _ , € r Expvahondate,:AUG31;2018 '''* L1&08100001770 and congratulations on your new license! - - - HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION - „CONSTRUCTION INDUSTRY LICENSING BOARD The GEN ERAL•CONTRACTOR , „:• Named below ISCERTIFIED Under`the provisions of:Chapter 489 FS. IZ ' Expiration°date AUG'31;'2018 ` 41 ,. a"r ,w'� „_,. °,so.,y. .w.,.+er ...4r,,,,;•s, .`'`y�'S '�'�.^w 4 k, JORRES;SERGIO:DARIEN D TORR-GENERAL-CONTRACTORS 'INC ��� •-218'NW,92;STREET...�. � 5, d MIAMI SHORES*AFL 3 50 V' „P I ./ �". • sM!M�a gy!"y" .5{` q' }y. iL. }{ F `- `�1 +i '''4 .. ��,.•.�.,:---''�, "f.r..^^sr..'`f- :.� "+.,.� - y �4� '44 � lie '4! 4� t 4 -`" �kP .„w.ac'+......w:.,.�'»..,a.'.�..a..^'' a"�`�� ,-w,#1 d"�s� �7G"��..-� - ,�c.'3.`......� �5.i.�b.-,'L 5...�s�..�...'a�l..�;, �• ; •,� issuED: 08/10/2016 DISPLAYAS REQUIRED BY LAW SEQ# L1608100001770 r r , 009934 'Local Business Tax Receipt Miami—Dade County, State of Florida THIS IS NOT A BILL—DO NOT PAY t ' 7202848 \ILBT �)k BUSINESS NAME/LOCATION RECEIPTN"O. EXPIRES - 218 TORR GENERAL CONTRACTORS INC RENEWAL SEPTEMBER S- 2018 MIAMI 218 92 ST 74$5656 Must be displayed at place of business • F FL 33150 Pursuant to County Code Chapter 8A—Art.9&10 m..� l y OWNER f L I SEC.TYPE'OWBUSINESS � D TORR GENERAL CONTRACTORS + 196 GENERAL BUILDING CONTRACTOR PAYMENT RECEIVED y RGIO:TORRES PRES N � � �''rCGC1521423 ,,?BY TAX COLLECTOR , Worker(s) 1 4 $45.00 07/18/2017 CREDITCARD-1:7-048.463'.....,— This Local Business Tax Receipt only conf s payment of the cal Busin Tax.The ce eiptiis not a license, I 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. t 1� The RECEIPT N0.above must be displayed on all commercial vehicles—Miami—Dade Code Sec 8a=27.6. �— For more information,visit www mismidade govhaxcoilector— ,,,,E L M� ,�►co v® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 10/18/2017 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 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). CONTACT PRODUCER SUNZ Insurance Solutions, LLC. ID: (TLR) NAME: Workers'Comp Department c/o TLR of Bonita, Inc PHONE 727.520 7676 x 3 FAX No: 727-525-3862 700 Central Ave Suite 500 E-MAIL St. Petersburg, �L 33701 ADDRESS: certencorehr.com INSURERS AFFORDING COVERAGE NAIC k INSURERA: SUNZ Insurance Company 34762 INSURED INSURER B: TLR of Bonita, Inc EnterpriseHR INSURERC: 700 Central Avenue Suite 500 INSURER D: St. Petersburg FL 33701 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 38411928 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 VOTH 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. ILTR TYPE OF INSURANCE ADDL UBR im POLICY NUMBER MM/IDDI EFF POLICYMMIDDI EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE F OCCUR DAMAGE TO PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE $ POLICY❑PRO ❑ LOC JECT PRODUCTS-COMP/OP AGG $ OTHER: 1 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEC) RETENTION$ $ A WORKERS COMPENSATION WCPEO000000113 6/1/2017 6/1/2018 / STATUTE ERH AND EMPLOYERS LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000.00 OFFICERIMEMBEREXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1 U yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Coverage Provided for all leased employees but not subcontractors of:D.Torr General Contractor Inc. Client Effective:8/14/2017 CERTIFICATE HOLDER CANCELLATION 2470 Miami Shores Village Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 N.E. 2nd Ave. g P THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores FL 33138 AUTHORIZED REPRESENTATIVE Glen J Distefano ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 38411928 1 TLR of Bonita, Inc PEO 001 MASTER CERT I Andrea Delucchi 1 10/18/2017 11:28:33 AM (CDT) I Page 1 of 1 ij ACORO® DATE(MM/DDIYYYY) f CERTIFICATE OF LIABILITY INSURANCE 12/18/2017 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 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(les)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). CONPRODUCER SUNZ Insurance Solutions, LLC. ID: (TLR) NAME Workers'Comp Department c/o TLR of Bonita, Inc PHONE 727-520-7676 x 3 Fn/C No): 727-525-3862 700 Central Ave Suite 500 EMAIL St. Petersburg, �L 33701 ADDRESS: Certs encorehr.com INSURER(S)AFFORDING COVERAGE NAICN INSURERA: SUNZ Insurance Company 34762 INSURED INSURER B: TLR of Bonita, Inc EnterpriseHR INSURER C: 700 Central Avenue Suite 500 INSURER D: St. Petersburg FL-33701 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 39298354 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. ILTR TYPE OF INSURANCE ADDL SUER J=WVD POLICY NUMBER MMIDDY� MAOAIIDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE. $ CLAIMSDAMAGE TO RENTED -MADE ❑OCCUR 7� }a ■ 7■Q PREMISES Ea occurrence) $ at wiL i®Yl�l1b-3 MED EXP(Any one person) $ PERSONAL&ADV INJURY $_ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ _ PPOLICY JECT ❑ LOC DEC 0 4 011 r PRODUCTS-COMP/OP AGG $ _ OTHER: I I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Pi .4, fp! !a Ea accident ANY AUTO ;' ` 3 e� �Fi BODILY INJURY(Per person). $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION N WCPEOOOOOOU113 6/1/2017 6/1/2018 �/ STATUTE ETH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $1,000,000.00 OFFICER/MEMBEREXCLUDED? F NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached U more space Is required) Coverage Provided for all leased employees but not subcontractors of:D Torr.GeneraLContractor Inc. Client Effective:8/14/2017 CERTIFICATE HOLDER CANCELLATION 2470 Miami Shores Village Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 N.E. 2nd g p THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores FL Ave.e. ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE r'J�K/Ji. a M Glen J Distefano ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 39298354 1 TLR of Bonita, Inc PEO 001 MASTER CHET I Andrea Delucchi 12/18/2017 11:01:02 AM (CST) I Page 1 of 1 I