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RC-18-1121Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit NO. RC-4-18-1121 Permit Type: Residential 'Construction Work Classification: Alteration Permit Status: APPROVED Issue Date: $123/2018 Expiration: 11/19/2018 Parcel Number Applicant 10 NW 100 Street Miami Shores, FL 33150- 1131010180400 Block: Lot: YNC INVESTMENT GROUP LLC Owner Information Address Phone Cell YNC INVESTMENT GROUP LLC 1170 SEAGULL Terrace HOLLYWOOD FL 33019- (305)951-6724 1170 SEAGULL Terrace HOLLYWOOD FL 33019- Contractor(s) TREO CONSTRUCTION LLC Phone (305)851-2130 Cell Phone Valuation: Total Sq Feet: $ 20,000.00 1587 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: INTERIOR Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Certificate Date: Bond Return : REMODELING , FLOOR Occupancy: Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: INTERIOR REMODELING , FLOOR 1 Classification: Residential Fees Due Bond Type - Owners Bond CCF DBPR Fee DCA Fee Education Surcharge P&Z Review Fee Penalty Fee Permit Fee Scanning Fee Technology Fee Work without Permit Fee Total: Amount $500.00 $12.00 $9.00 $6.00 $4.00 $0.00 $100.00 $600.00 $24.00 $16.00 $600.00 $1,871.00 Pay Date Invoice # 05/23/2018 04/27/2018 Bond #: 3772 Pay Type RC-4-18-67331 Check #: 134 Check #: 125 Amt Paid Amt Due $ 1,671.00 $ 200.00 $ 200.00 $ 0.00 Available Inspections: Inspection Type: Final PE Certification Window Door Attachment Framing Insulation Drywall Screw Fill Cells Columns Window and Door Buck Review Planning Review Electrical Review Electrical Review Building Review Plumbing Review Structural Review Mechanical 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: 1 certi that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructio'anOoning tithe i ore, I authorize the above -named contractor to do the work stated. ALQ OIJ L,EQ Authorized Signature: Owner fj / Applicant / Contractor / Agent May 23, 2018 Date Building Department Copy May 23, 2018 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-310071 Permit Number: RC-4-18-1121 Scheduled Inspection Date: August 10, 2018 Inspector: Naranjo, Ismael Owner: Job Address: 10 NW 100 Street Miami Shores, FL 33150- Project: <NONE> Contractor: TREO CONSTRUCTION LLC Permit Type: Residential Construction inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1131010180400 Phone: (305)851-2130 Building Departnnent Comments INTERIOR REMODELING , FLOOR TILES REPLACEMENT , NEW LIGHT BULBS , NEW KITCHEN ON SAME LOCATION , MASTER BATHROOM REMODELING . Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. August 09, 2018 For Inspections please call: (305)762-4949 Page 26 of 27 BUILDING PERMIT APPLICATION BUILDING INSLECTRIC Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 ❑ ROOFING LUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: FBC 20 n11 Master Permit No. 9)C.-1 a - I12I Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP 10 Ma k0Q-0A- S� CONTRACTOR DRAWINGS City: Miami Shores`Q `p /�/� County: Miami Dade Folio/Parcel#: `—SkOk'0 -Q1cQO Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: 3g& BFE: FFE: OWNER: Name (Fee Simple Titleholder):1N C'TA) jJVitV (O,Iw L L Phone#: JV•C CiKk 2\ Address: ``� Q JFi u/ 01/40 2 City: V�Q 1�Q ��QQ/�� State: Zip 1 1 V ^^ Q Tenant/Lessee Name: Phone#:,'�O..< ciA (el-M Email: S)*(LQt,Q `t A Qj`'� rUck CONTRACTOR: Company ,Name: n___ Address: � igg2 Q,Q �NMC�% `'�1-vm City Off•\ ,1T \—w �AA... �� 0(2'CcA.t" State: tiQualifier Name: 3,,\_ l.J6'�.+!) L Q C-M-i-L0c--- . State Certification or Registration,#: (� G Zip: Phone#: •30 Certificate of Competency #: DESIGNER: Architect/Engineer:.A L' QS Q., G c G NM, Phone#: Address:`io1,.0o tv& tA4w pc./ `QS City:OAV( State: Zip: Value of Work for this Permit: $ 21'000 Square/Linear Footage of Work: Type of Work: ❑ Addition •� Alteration nn lt❑New ❑ Repair//RReplace Demolition Descri tion of Work: `Q QY� 4e clf2 Q V� L / (%)=04 ldketil-135 ,J ZW.. Owl Sp,11r7 L.Qc c"C .9�, Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ Permit Fee $ (Revised02/24/2014) Pa CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ \J[ * 100 Bond 00 O TOTAL FEE NOW DUE $ tOt � • ram..• • r.. Bonding Company's Name (if applicable) a, Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) ; xu Mortgage Lender's Address City 0, ., 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 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. •'` ` a , '' ( ' •i "WARNING;&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.' '' . ; -- ,�r,. 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 brochurewill 'be delivered to the person -rt 6 whose property is subfject'to attachment. Also, a certified copy of the recorded notice of commencement"m'u5t be posted at the job site for the'first inspection whichoccurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection wilinot be approved and a reinspection fee will be charged. Signature, • -_�� , x k`; sT • 14' Signature • .. .1*"v, P. . - j ; .✓ =M'i y t.'�.w. ;.. --- i OWNER or AGENT. t f CONTRACTOR , 7 r . regoing instrumenttwas acknowledged before a this The foregoing instrument was acknowledged before a this it L;. ,/�.(� 1 by + s "day off (•>iC,��� `� , b day of y��V ,`20 y SALMOiks LoN)i , who is personally known to a �s 'y+`'AWN ,•�+l 1Ct , lwir ,3 ,��i atl •- -`,f . . tF me or whohas produced, as identification'and who did take an oath. NOTARY, PUBLIC., Sign: �/.//!ill Print: IOW it �. -.-.v. Ti' Seal: - t -APPROVED BY, f °' �•. (Revised02/24/2014)• i i { r 2#~ LIGIA D. MALDONADO Notary Public - State of Florida Commission Y GG 120388 My Comm. Expires Oct 6, 2021 ho is personally known to me or who has p produced' F ., d. ,( y`°.., ; , .7 ' identification and who did take an'oath. F n _ i 1 NOTARY PUBLIC: Sign: , Print:•. Seal' ' '�t'R�Pba ; LIGIA D.-MALDONADO - Notary Public - State of Florida Commission 8 GG 120388 My Comm, Expires Oct 6, 2021-, Bonded hro : Plans Examiner Structural Review .4f1 ISO AVM'r • ~ .1. ‘,.,1 as Zoning Clerk Property Search Application - Miami -Dade County Page 1 of 2 Summary Report Property Information Folio: 11-3101-018-0400 Property Address: 10 NW 100 ST Miami Shores, FL 33150-1200 Owner YNC INVESTMENT GROUP LLC Mailing Address 1170 SEAGULL TER HOLLYWOOD, FL 33019 USA PA Primary Zone 1000 SGL FAMILY - 2101-2300 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY : 1 UNIT Beds / Baths / Half 3/2/0 Floors 1 Living Units 1 Actual Area 2,097 Sq.Ft Living Area 1,587 Sq.Ft Adjusted Area 1,725 Sq.Ft Lot Size 6,095 Sq.Ft Year Built 1965 Assessment Information Year 2017 2016 2015 Land Value $133,928 $133,928 $99,168 Building Value $107,640 $107,640 $121,060 XF Value $485 $493 $401 Market Value $242,053 $242,061 $220,629 Assessed Value $98,461 $96,436 $95,766 Benefits Information Benefit Type 2017 2016 2015 Save Our Homes Cap Assessment Reduction $143,592 $145,625 $124,863 Homestead Exemption $25,000 $25,000 $25,000 Second Homestead Exemption $25,000 $25,000 $20,266 Senior Homestead Exemption $47,961 $45,936 $50,000 Long -Term Resident Senior Exemption $0 $0 $0 Widow Exemption $500 $500 $500 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description NAVARRO SUB PB 12-59 LOTS 1 & 2 BLK 5 LOT SIZE 57.500 X 106 Generated On : 4/25/2018 Taxable Value Information 2017 2016 2015 County Exemption Value $98,461 $96,436 $95,766 Taxable Value $0 $0 $0 School Board Exemption Value $25,500 $25,500 $25,500 Taxable Value $72,961 $70,936 $70,266 City Exemption Value $50,500 $50,500 $50,500 Taxable Value $47,961 $45,936 $45,266 Regional Exemption Value $50,500 $50,500 $50,500 Taxable Value $47,961 $45,936 $45,266 Sales Information Previous Sale price OR Fa Booe k 9 Qualification Description 01/29/2018 $319,000 30851-1402 Qual by exam of deed 11/15/2016 $100 30347-2878 Corrective, tax or QCD; min consideration The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp https://www.miamidade.gov/propertysearch/ 4/25/2018 Detail by Entity Name Page 1 of 2 Florida Department of State or Department of State / Division of Corporations / Search Records / Detail By Document Number / DIVISION Or CoaPORA! OrjS Detail by Entity Name Florida Limited Liability Company YNC INVESTMENT GROUP, LLC Filing Information Document Number L17000139855 FEI/EIN Number 82-2112547 Date Filed 06/28/2017 State FL Status ACTIVE Principal Address 1170 SEAGULL TER HOLLYWOOD, FL 33019 Mailing Address 1170 SEAGULL TER HOLLYWOOD, FL 33019 Registered Agent Name & Address LEVY, SALOMON 1170 SEAGULL TER HOLLYWOOD, FL 33019 Authorized Person(s) Detail Name & Address Title MGR LEVY, SALOMON 1170 SEAGULL TER HOLLYWOOD, FL 33019 Annual Reports Report Year Filed Date 2018 04/04/2018 Document Images 04/04/2018--ANNUAL REPORT 0612812017 -- Florida Limited Liability View image in PDF format View image in PDF format http://search. sunbiz. org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 4/25/2018 -0' ,aft..'S't}...•-; ~. .•�ph�..�: al :!,qp+:.,; 1�`aW```^t�mq.}' • i rTATE DUI -QM PAR MEN1'OF ESSIONAL cR EG T ISSUED:.:$" /( 5/ {cEtiTfri O NE CON.�itAC i Ott.-- $R OtO S RUCTtO£�"LLC•' TEO- t;fwietibe,proy4tOns7trf.C41*.:A 3 t:CS: .7..: j 1'4 �..1• . Np...�.• NY S aM. ii"l. V it s A ` ! a . • a SSAND PRESSO AL REGU Jr *Itay "a /�y��u vy.j qp,► y�p�r �j — ''ef'�`'�- +., `•^�,.� r�,"�;.. CONS i R 1JL'+1,..INOUSTI./MUSING AiS o-�',.y..ra., :rti +.,;, '. y'+.'�:°G-. ; - •.. �. - -ah,,, 3p4 s'.'.. ti,. • '.r'^. aye!. .• 1 a , ACTOR •tea.-,_: 4ti, ;;�,;w, •4 i -'' �;""!"."" •- 'Yy. '/w ' 4.+ �'- "-L- `• .! "L .'°\}• ,* � s4'89 # 'w•r wait' t ►' `- a.- '.Y`.yy + � "'ti •- +<�` r��ilc�• _ ,-• .-•" •y k!'" ' l�h V'i;,r + T • NORTH-M A E. H a FL' 1 ,,•,¢,.;r.�y'1 YI'_ .'.T '_j'v tr{L .. 54�. ..ni . Atel ,,i. r :•.� . ' 4 �' -�: � �• �� ^,; 101 yam'. D SY LAW >--- I 8200 NE 19TH MvE SFE f1'^`""' • 005316 Local Business Tax Receipt' Miami —Dade County, State of Florida -THIS IS NOT A BILL - 00 NOT PAY ittiiINESS,NAME/LOCATION T.TREO CONSTRUCTION LLC i 18200 NE'19 AVESTE 101 I NJORTKMIAMI,BEACH FL 33162 v RECEIPT NO RENEWAL 744E457 0 EXPIRES SEPTEMBER'30' 2018 'Must be displayed at place of business Pursuant to County Code Chapter8A - Art. 9 & 10 '' ,-.N. ,,,,..- ,,,,i 1 i --- OWNER r ‘ -,: ,' , ,. , SEC, TYrE OF itLiStorES8 i =7- - CONSTRUCTION LLC IL. 196 GENERAL BUILDING CONTRACTOR1 PAYMENTRECEIVED 0 RICARDO HALFEN MGR, L CGC1622146 -BY TAX COLLECrOR l'02/ 261 .;!' Workers} (S) :t 4 I', "i•.‘ ''' ' - i- ... , 1 ;., • :. ..:, '11 4 CREDITCARD-z-17-051875-1/4. 4 This Loco( Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not site' permit ar a codification of the holder's qualifications, to do business. Holder must comply with any gtwernmental or nongovernmental regulatttry laws add requirements which apply to the business. Vie NECEIPT NO. above must be displayed on all commercial vebicles - Miami-Oade Code Sec 8a.216. 4 For‘triore infoiMation,vhdt wwi'crajjamihie.golligsgikete r • City of North Miami Beach Community Development Division &1sine. Tax Receipt 1 7050 NE 19 Avenue North Miami Beach, FL 33162 MAIL TO : TREO CONSTRUCTION LLC 18200 NE 19 AVE 101 NORTH MIAMI BEACH,FL 33162 Thank you for choosing the City of North Miami Beach! You can now visit us on-line at www°.citynmb.com or you can e-mail us at NMBBTRa citynmb.com T7m its, 01 \orth MLA! n Rr.kit \"I .L'S) Now More 'Beautiful! THIS IS YOUR 2017-2018 BUSINESS TAX RECEIPT. Important Reminders: Business fax Receipts expire September 30t" of each year You must submit all fees and documents Of applicable) prior to that date or you may be subject to delinquency fees, an additional Cost Collection Fee of $250.00, placement of a lien on the property, and/or involuntary shutdown of this business by the Police Department You are required to notify the City in writingif there have been any changes in ownership. location nature of business any contact information. and/or when this business ceases operations This is in order to ensure that you are not billed in error. Failure to notify this office of such changes may result in the assessment of penalty fees and collection activities. Have any more questions? Our friendly staff is here to assist you by phone, (305) 948-2917. Monday -Friday from 8.30 a m - 5 00 p m or at our office Monday -Friday from 9:00 a m.- 4:00 p rn. We would love to hear from you! *** THIS IS NOT A BILL — DO NOT PAY *** Please detach the Below receipt and display in a conspicuous place. 2017-2018 Cite Of North Miami Beach BUSINESS TAX RECEIPT No.: 176544 RENEWAL AcctNo: 795903 DBA: TREO CONSTRUCTION LLC Location: 18200 NE 1.9 AVE 101 NORTH MIAMI BEACH, FLORIDA Activity: OFFICE ONLY: CONTRACTOR Rcnl:i;rks: .,tits 2017 09/30/2018 Taxes: 177.0c Penalty Fee: 0.00 Credit: 0.00 TOTAL PAID: S 177.05 This receipt is non-transterabie without City approval and is only valid at the locations listed herein \c v ltq �l at.itiliit ----"'' TREOD-1 AC-OR/Cr CERTIFICATE OF LIABILITY INSURANCE OP ID: GOR DA04/26/2018TE Y) 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). PRODUCER 305-899-5125 Golden Global Insurance 19950 W. Country Club Dr # 902 Aventura, FL 33'f80 MARC HAIME CONTACT MARC HAIME PHONE FAX 305-899-5125 305-899-5135 (NC, No, Ext): (A/C, No): EIL MARC@GOGLO.NET AD RESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Kinsale Insurance Company INSURED TREO CONSTRUCTION LLC 18901 NE 29TH AVE STE 101 MIAMI, FL 33180 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : • REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL IN D SUBR WVD POLICY NUMBER POLICY EFF IMM/DD/YYYY) POLICY EXP (MMIDD/YYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY 010005058902 04/28/2018 04/28/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) 100,000 $ CLAIMS -MADE X OCCUR MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES JECT PER: LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ AU A LIABILITY .. SCHEDULED AUTOS SSWN AUTOS ONLYY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY accidentDAMAGE $ $ U UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? ECUTIVE (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CONTRACTORS LICENSE # CGC1522146 . MIAMSHO MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33185 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORtF CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/10/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the 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 SUNZ Insurance Solutions, LLC. ID: (TLR) do TLR of Bonita, Inc 700 Central Ave, Suite 500 St. Petersburg, FL 33701 CONTACT NAME: Workers' Comp Department PHONE FAX (Ala No. Ext): 727-520-7676 x 3 (A/C, No): 727 525-3862 ADDRESS: certs@encorehr.com INSURER(S)AFFORDING COVERAGE NAIC # INSURERA: SUNZ Insurance Company 34762 INSURED TLR of Bonita, Inc EnterpriseHR 700 Central Avenue Suite 500 St. Petersburg FL 33701 INSURER B : INSURER C : INSURERD: INSURERS: 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 LTRINSD TYPE OF INSURANCE ADDL SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MMIDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES JECOT- PER: LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Perident accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB O OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANYPROPRIETOR/PARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N NIA WCPE0000000113 6/1/2017 6/1/2018 i STATUTE OTH- ER E.L. EACH ACCIDENT $1,000,000.00 E.L. DISEASE - EA EMPLOYEE $ 1,000,000.00 E.L. DISEASE - POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS / 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: Treo Construction LLC Client Effective: 11/17/2015 CERTIFICATE HOLDER CANCELLATION 9368 Miami Shores Village Bldg Dept. 10050 NE 2nd Ave. Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Glen J Distefano 4-4cre ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 41283580 I TLR of Bonita, Inc PEO 001 MASTER CERT I Aimee Gray 14/10/2018 4:42:32 PM (CDT) I Page 1 of 1