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MC-17-637 Permit No. C-3-17-637 �sµO%'s oMiami Shores Village Permit Type:Mechanical-Residential 10050 N.E.2nd Avenue NW rd,r ' L Work Classification:A/C Replacement Miami Shores,FL 33138-0000 PelmitStatus:APPROVED '�. V1 Phone: (305)795-2204 FtoRYVA Issue Date:5!5120"17 Expiration: 11/01/2017 Project Address Parcel Number Applicant LMiarrd W 100 Street 1131010220300 NOMADE REALTY LLC Shores, FL 33150- Block: Lot: Owner Information Address Phone Cell NOMADE REALTY LLC 230 NE 107 Street (786)458-7799 (786)251-0138 MIAMI SHORES FL 33161- Lj Contractor(s) Phone Cell Phone Valuation: L$ 6,OL00.00 RAMS AIR CONDITIONING INC Total Sq Feet: Tons: Available Inspections: Additional Info:PUTTING A 5T UNIT,NEW AND SAME DU Inspection Type: Classification:Residential Final Approved: In Review Review Mechanical Comments: Date Approved::In Review Date Denied: Type of Work: PUTTING A 5T UNIT,NEW AND SAM f Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.60 Invoice# MC-3-17-63248 DBPR Fee $3.15 DCA Fee $3.15 03/09/2017 Check#:0011 $50.00 $ 178.90 Education Surcharge $1.20 05/05/2017 Check#:0014 $ 178.90 $0.00 Permit Fee $210.00 Scanning Fee $3.00 Technology Fee $4.80 Total: $228.90 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 work will be done in compliance with all applicable laws regulating construction and zo ' g. Futhermore, I authorize the above-named contractor to do the work stated. May 05, 2017 , uthorized Signature:Owner / Applicant / Contractor / Agent Date i Building Department Copy May 05, 2017 1 Miami Shores Village MAR o9zo,� L Building Department [By: 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 F BC20 GG,, BUILDING Master Permit No. R C 1-1 " _J PERMIT APPLICATION Sub Permit No.M C I .7" 'b 3_7 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL ❑PLUMBING [%MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP I I ` CONTRACTOR DRAWINGS JOB ADDRESS: �D 1 Nw ���Cke-tut City: Miami Shores County: Miami Dade zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: /Flood Zone: BFE: qFFE: OWNER: Name(Fee Simple Titleholder): �Ur1ttil.�.J�� JIC �C_Phone#: '716 2-'S-I O 1 Address: ?-?,o / 07 S�t City: n( 1.2 '�l.�rM State: Zip: Tenant/Lessee Name: 14-ck Sf eatA 19:9 tA —A f�o'j H/ Phone#: Email: J CONTRACTOR:Company Name: 1 V` l (--K / Phone#: Address: City: if Gl C te: Zip: G S r r Qualifier Name: / �V / /� Phone#: U1 State Certification or Registration#: 0 C 9130 Q Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$&460 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: Submittal Fee$ 50 1 Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ I -c1-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..... { f 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 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 such posted noti , e inspection will not be approved and a reinspection fee will be charged. V4Signature Signature N or AGENT CONTRA OR k The foregoing ins rument was acknowledged before me this The forgoing instrument was acknowledged before me this day of MPry ,20 1'3 by �� dayof M�vr�h 20 i- by -IASSA- &Vi'Ce 11DQWk,who is personallynow .to" ����.a �� .` `������ ,who is personally known to 41 me or ho has produced as me or who has produced r� �� as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: �,A V,n A rJ list/Seal: +R 'y!�e: PATRICIA FEBLES Seal: David A. Peters MY COMMISSION#GG009157 ^* *= Commission#EE881877 ; .�,.• . EXPIRES July 06,2020 ; ., ,: - Expires: March 7, 2017 rY �qn�ed thru Aaron Nota APPROVED BY PI ns Examiner Zoning j Structural Review Clerk , (Revised02/24/2014) , } CERTIFICATE OF LIABILITY INSURANCE DATE D/YYYY) o22/2a/24/17 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to, the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Jessica Perez IPC Insurance of Florida LLC P"CNE . (305)273-4530 ac No): (305)273-4409 10481 SW 88TH ST STE D204 -MAIL jesssica@ipcfl.com MIAMI,FL 33176-1528 INSURER(S) AFFORDING COVERAGE NAIC# Phone (305)2734530 Fax (305)273-4409 INSURERA: GRANADA INSURANCE COMPANY INSURED INSURER B: MERCURY INSURANCE COMPANY Rams Airconditioning,Inc. INSURER C: 826 eudid Avenue#14 INSURER D: ASCENDANT COMMERCIAL INSURANCE MIAMI Beach,FL 33139 (305)861-7267 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 ADDL UBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR POLICY NUMBER MM/DD/YMF MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 3E TO COMMERCIAL GENERAL LIABILITY PAMAI REM SES Ea oNccurrence $ 100,000.00 A ❑ ❑ CLAIMS-MADE 0 OCCUR 0185FL00029409-2 MED EXP(Any one person) t $ 5,000.00 F-1PERSONALy 09/23/2016 09/23/2017 PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000.00 ❑ POLICY ❑ JECTPRO- ❑ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I Ea accident ❑ ANY AUTO BODILY INJURY(Per person) $ 100,000.00 ALL OWNED SCHEDULED FLC7018712-2 BODILY INJURY(Per accident $ B ❑ AUTOS © AUTOS 04/20/2016 04/20/2017 ) 300,000.00 ❑ HIRED AUTOS PROPER DAMAGE $ 50,000.00 ❑ AUTOS NON-OWNED PROPer accident ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ©WC STATU- __J OTH- TORY EMPLOYERS'LIABILITY Y/NL'MIS ER ANY PROPRIETOR/PARTNER/EXECUTIVE NHFL0037112015 E.L.EACH ACCIDENT $ 100,000.00 D OFFICER/MEMBER EXCLUDED? N/A 05/02/2016 05/02/2017 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 500,000.00 If as,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 100,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION o SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE G1 F MIAMI SHORES THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2ND AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI3 33138 AUTHORIZED REPRESENTATIVEFAX, FAX 3055 7568972 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)QF The ACORD name and logo are registered marks of ACORD � r _._____....... RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY _STATE OF FLORIDA 4 " DEPARTMENT:OF BUSINESS`AND PROFESSIONALREGULATION,-: w.; _CONSTRUCTION:INDUSTRY LICENSING BOARD `CAC1813270 The CLASS B AIR CONDITIONING CONTRACTOR-.,`+�-"-,- Named below IS CERTIFIED , Under the:provl3lofls of.Chapter 489 FS4a»' Ezpiratlo'n•date:AUG`31`2018 y rr` w v %., ��� �.����'� ��� �� ��� »_:�t�*ti,�.. ....,,,5.` ",....,",,,,� '",�r.<f,.,��'��•�,+�„�$� e +py mss, "'+ 4•Svt'� ,L• ki' }r. �„✓' �'�_.�,_„�.,r �., w.- ,..«e - --s�`n...,o- '�.�y�w '� '. ti'. is Q � } -t�MIRAN D`A SILVIO:RAFAEL �-'---,',,RAMS AIR'C,ONDITIONING INC. :ti , ' "` . �4'` T�,` G'' -�826�EUCLID AVE APaT-*4 w` *� FL`33139��`"`° -� - ' ��`�a+-�,."'"� O ,.r'�'�p. :rf��...: '.�.1����.o, •h„+.� .: .���4�'C - �y«y �``,'�'.i y..:,°i Th i�S i4 i, ��'.�''..0�...�.�+'r..._..,1.!:.F�.�:«.»,..r!"r±�.:•rti' :.<wA..+ zA..7�w.�AC���''i1 ..... �.'s..� y..'«..�i-4..'�a.�'�_�'t.�.�.�1k� �ty�. A.� ISSUED: 08/14/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1608140002808 002655 local Business Tax Receipt Miami—Dade County, State of FloridaLBT —THISI,$NOTA BILL-DO NOT PAY 4828795 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES RAMS AIR CONDITIONING INC RENEWAL SEPTEMBER 30, 2017 i 826 EUCLID AVE#14 5040407 Must be displayed at place of business MIAMI BEACH R 33139 Pursuant to County Code Chapter 8A—Art.9&10 • OWNER k r I SEC.TYPE OF BUSINESS— I PAYMENT RECEIVED" RAMS AIRCONDITIONING INC ' .196 SPEC MECHANICAL CONTRACTOR I., BY TAY-COLLECTOR a i I CAC1813270 $45.00-08/03/2016 Worker(s) I, CHECK21-16-108067 1 } 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 ND:above must be displayed on all commercial vehicles?Miami—Dade Code Sec go-276- For more information,visit www miamidede go`v/texcollector I ACCM& DATE(MM/DD/YYYY) ,�. CERTIFICATE OF LIABILITY INSURANCE 03/02/17 i THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER COMNTACT NAE: Jessica Perez IPC Insurance of Florida LLC WN (305)273-4530 FAX No): (305)273-4409 10481 SW 88TH ST STE D204 E-MAIL jesssica@ipcfl.com MIAMI,FL 33176-1528 INSURERS AFFORDING COVERAGE NAIC# Phone (305)273-4530 Fax (305)273-4409 INSURER A: GRANADA INSURANCE COMPANY INSURED INSURER B: MERCURY INSURANCE COMPANY Rams Airconditioning,Inc. INSURER C: 826 euclid Avenue#14 INSURER D: ASCENDANT COMMERCIAL INSURANCE MIAMI Beach,FL 33139 (305)861-7267 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 CONTRACTOR 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 rypE OF INSURANCE ADD UBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM D MM D LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 © COMMERCIAL GENERAL LIABILITY PREM SMAGE TO ES Ea occu ante $ 100,000.00 ❑ ❑ A CLAIMS-MADE © y y 09/23/2016 09/23/2017 OCCUR 0185FL00029409-2 MED EXP(Any one person) $ 5,000.00 ❑ PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000.00 ❑ POLICY ❑ PRO- JECT ❑ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ❑ ANY AUTO BODILY INJURY(Per person) $ 100,000.00 ALL OWNED SCHEDULED FLC7018712-2 BODILY INJURY(Per accident) $ 800,000.00 B E] AUTOS © AUTOS 04/20/2016 04/20/2017 NON-OWNED PROPERTY DAMAGE F-1HIRED AUTOS ❑ AUTOS Per accident $ 50000.00 ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION WC STATU- 11OTH- AND EMPLOYERS'LIABILITY Y/N TORYLMIS ANY PROPRIETOR/PARTNER/EXECUTIVE NHFL0037112015 E.L.EACH ACCIDENT $ 100,000.00 D OFFICER/MEMBER EXCLUDED? N/A 05/02/2016 05/02/2017 (Mandatory in NH) El E.L.DISEASE-EA EMPLOYE $ 500,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 100,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,it more space is required) MECHANICAL CONTRACTOR 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 10050 NE 2ND AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI,FL 33138 AUTHORIZED REPRESENTATIVE FAX:3057568972 @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)OF The ACORD name and logo are registered marks of ACORD t ACCM0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) -� J— 05/05/2017 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 I BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT,CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED i REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: It the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). OLGA CHAVEZ _ PRODUCER �NAME: -� rPHONE FAX (305_)228-1525 Citinsurance Agency Corp L(A/C,No.Extl:_(305)228-1533___--_ - (ac,No);.— _ _ i E-MAIL citins@citi-ins.com — — 8390 W.Flagler Street,Suite#213 ADDRESS: -- Miami,FL 33144 _ ._,_INSURER(S)AFFORDING COVERAGE NAIC p Phone (305)228-1533 Fax (305)228-1525 INSURERA_ ASSOCIATES INDUSTRIES INSURANCE CO -- J- -- --- _.�...�_.-_._�..._..-----` -- --- _- INSURED INSURER_B;— 9 RAMS AIR CONDITIONING,INC INSURER C:__. _ G INSURER D: 826 Euclid Ave INSURER E: Miami Beach FL 33139_ i Ii NSURER F - - ------ COVERAGES _CERTIFICA_TE 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 — I 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. _ -- tFtINSR---_" - �ADDLSUBR' ~_-• v �rPOLICYEFF f POLICY EXP ��-��--•--"^_- LIMITS --- i LTR�. -_ TYPE OF INSURANCE �_-INSR.rWVDf-__ _POLICY NUMBER--__—f{MM/DD/YYYY)I(MM/DD(YHYY)y4 - i GENERAL LIABILITY I _ EACH OCCURRENCE ;_$ , ❑ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY i PREMISES.(Ea occurrence) $ r -_ - --1 ❑ ❑ CLAIMS-MADE OCCUR❑ MED EXP(Any one person)-1 $ ❑ I l) i PERSONAL&ADV INJURY _ $ �. I❑ i I PRODUCTS-COMPIOP AGG f_$ ; GENERAL AGGREGATE i1 _._.._..__ - - --- GEN•L AGGREGATELIMIT APPLIES PER. f._ $ _❑ POLICY ❑ PRO- _ ❑ LOC ~� AUTOMOBILE LIABILITY i I COMBINdeD SINGLE LIMIT { ! (Ea aqc�nl) BODILY INJURY(Per person) ANYALITO I I ❑ ALL OWNED NON OWNED SCHEDULEDBODILYINJURY DRAMAGEPer accident� $__--- - _� _ AUTOS ❑ AUTOS � i ( - 1 $ �, er -i I❑ HIRED AUTOS ❑ AUTOS (P--aaident) $--- --- '❑ UMBRELLA LIAB ❑OCCUR I EACH OCCURRENCE __ __$ ❑ EXCESS LIAR ❑CLAIMS_MADE � '� I ` AGGREGATE_ _ $ I 1❑ DED ❑ RETENTION$-___ -----� $ - -- 1 WORKERS COMPENSATION ? I J PER STATUTE-L=4 0 ER OTHH- AND EMPLOYERS'LIABILITY Y I N E.L.EACH ACCIDENT I $.-_100_,000.00 ANY PROPRIETOR/PARTNERIEXECUTFv1 i A. OFFICER/MEMBER EXCLUDED? N I A (AWC1079708 02/03/2017 i 02/03/2018 r ---- - - -� (Mandatory in NH) -�j t E L DISEASE•EA EMPLOYEE$ 500,000.00 If yes,describe under ! ( + E L DISEASE-POLICY LIMIT $ 100,000.00 j DESCRIPTION OF OPERATIONS below ' i DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) i CONTRACTOR 4 I I i i CERTIFICATE HOLDER CANCELLATION 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE j VILLAGE OF MIAMI SHORES THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN I ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NORTHEAST 2ND AVENUE I MIAMI SHORES,FL 33138 AUT R RES ATIVE ---.__-- -—© 8 - �ACORD CORPORATION.LL All rights reserved. ACORD 25(2014/01)QF The ACO name and logo are registered marks of ACORD