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RC-18-1777Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 nspection Number: INSP-309806 Permit Number: RC-6-18-1777 Inspection Date: August 06, 2018 Inspector: Kendall, Travis Owner: RODRIGUEZ, CLAUDIO Job Address: 1263 NE 101 Street Miami Shores, FL Project: <NONE> Contractor: MIAMI SKYLINE CONSTRUCTION CORP Permit Type: Residential Construction Inspection Type: Survey Final Work Classification: Addition/Alteration Phone Number Parcel Number 1132050250040 Phone: (305)899-9696 Building Department Comments INTERIOR REMODEL TO EXISTING BUILDING AND ADDITION OF NEW KITCHEN, MASTER BEDROOM AND FAMILY ROOM 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. For Inspections please call: (305)762-4949 August 06, 2018 Page 1 of 1 COUSINS SURVEYORS & ASSOCIATES, INC. 3921 SW 47TH AVENUE, SUITE 1011 DAVIE, FLORIDA 33314 CERTIFICATE OF AUTHORIZATION : LB # 6448 PHONE (954) 689-7766 FAX (954) 689-7799 PROJECT NUMBER : 6688-11 CLIENT : CLAUDIO RODRIGUEZ SKETCH OF SURVEY LEGEND: CKD CHECKED BY CONC CONCRETE DWN DRAWN BY FB/PG FIELD BOOK AND PAGE SIR SET 5/8" IRON ROD Sc CAP #6448 SNC SET NAIL AND CAP #6448 FIR FOUND IRON ROD FIP FOUND IRON PIPE FNC FOUND NAIL AND CAP A/C AIR CONDITIONER SLAB P.B. PLAT BOOK M/D.C.R. MIAMI/DADE COUNTY RECORDS —X— CHAIN LINK/ WOOD FENCE WM WATER METER 9•A ELEVATION R RADIUS A ARC DISTANCE DELTA ANGLE LAND DESCRIPTION: •.•• • • •••• • • • • •. • •• • • • .• • • .• • 4.0001. .••. • • .. •• • . • • LOT 5, BLOCK 185 OF "BAY BREEZE SECTION MIAMI SHORES",• •• ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOIf. i, PAGE 25, OF THE PUBLIC RECORDS OF MIAMI/DADE COUNTY, FLORIDA. NOTES : 1. NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. 2. LANDS SHOWN HEREON WERE NOT ABSTRACTED FOR RIGHTS —OF —WAY, EASEMENTS, OWNERSHIP, OR OTHER INSTRUMENTS OF RECORD. 3. THIS SURVEY WAS DONE SOLELY FOR BOUNDARY PURPOSES AND DOES NOT DEPICT THE JURISDICTION OF ANY MUNICIPAL, STATE, FEDERAL OR OTHER ENTITIES. 4. THE LAND DESCRIPTION SHOWN HEREON WAS PROVIDED BY THE CLIENT. • • • .... • • • • .... • • • • • •• • .• • • .• • • •• . • • . .. . 5. UNDERGROUND IMPROVEMENTS NOT SHOWN. 6. ELEVATIONS SHOWN HEREON ARE BASED ON THE NATIONAL GEODETIC VERTICAL DATUM OF 1929. 7. BENCHMARK DESCRIPTION : MIAMI/DADE COUNTY BENCHMARK # B-26—RA ELEVATION = 17.23' I HEREBY CERTIFY THAT THE "SKETCH OF SURVEY" OF THE HEREON DESCRIBED PROPERTY IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF AS SURVEYED IN THE FIELD UNDER MY DIRECTION IN AUGUST, 2018. I FURTHER CERTIFY THAT THIS SURVEY MEETS THE STANDARDS OF PRACTICE FOR SURVEYING IN THE STATE OF FLORIDA ACCORDING TO CHAPTER 5J-17 OF THE FLORIDA ADMINISTRATIVE CODE. PURSUANT TO SECTION 472.027, FLORIDA STATUTES. THERE ARE NO ABOVE GROUND ENCROACHMENTS OTHER THAN THOSE SHOWN HEREON, SUBJECT TO THE QUALIFICATIONS NOTED HEREON. FOR THE FIRM, BY: SURVEY DATE : 08/01/18 RICHARD E. COUSINS PROFESSIONAL SURVEYOR AND MAPPER FLORIDA REGISTRATION NO. 4188 REVISIONS DATE FB/PG DWN CKD BOUNDARY & IMPROVEMENTS SURVEY 10/05/11 SKETCH REC REC UPDATE SURVEY 04/05/12 REC REC FOUNDATION SURVEY 06/03/14 SKETCH REC REC FINAL SURVEY 08/01/18 SKETCH AM REC FLOOD ZONE INFORMATION COMMUNITY NUMBER 120652 PANEL NUMBER 0306 L ZONE AE BASE FLOOD ELEVATION 8 EFFECTIVE DATE 09/11/09 PROPERTY ADDRESS : 1263 NE 101ST STREET \ SCALE: 1 "= 20' SHEET 1 OF 2 COUSINS SURVEYORS & ASSOCIATES, INC. 3921 SW 47TH AVENUE, SUITE 1011 DAVIE, FLORIDA 333 CERTIFICATE OF AUT PHONE (954) 689-13: X�y'�:�'-79 PROJECT NUMBER : 6688-11 CLIENT : CLAUDIO RODRIGUEZ LOT 3 BLOCK 185 SIR 0 x RECEIVED AUG 032018 BLOCK 185 5' PUBLIC UTILITY EASEMENT x x x x x SKETCH OF SURVEY N 0 03 (0— OO ti 0.2' z 0 7 1' CHAT LINK FENCE POOL PUMP ON CONC M STEP 44.5' CORAL POOL DECK STEP 100.00" CO STEP J M LEAN OUT 1. LOT 5 BLOCK 185 CORAL WALK t� PLANTER IJ 43.2' (TYP) COVERED N PATIO 10 37 0///////////� / 1.3' 10.0 0 I®I 7. COLUMN 0 FY- STEP 2 STORY CBS RESIDENCE FLOOR ELEVATION = 9.90' SECOND FL ELEV =19.70' 11.0' 10.0' . ///////////,/ , co i.^ / / / PLANTER ''/; o PLANTER �' , 13/3 N. //% / . "; a% PORCH 7J ; °^ / 25.4' /// z /3 -✓,?////////////////////// STEPS / / <t i• 1� M / BRICK 90 FIP (3/4") BRICK DRIVE LANTE SIR 10' OFF5ET SOUTH -J -J 1.6' ;W 1- Ncc W %U f— w ;Z •••• CC ,0 • • A •;• • 0 • • )• •• • • 0 • • • • • • • • i(• • •11 • II •••• ip • • • •. 0.1' •••• • • • :-- • • 1�• •• •••• / •••• He- , • • • • • / • • mw • 0 •,� To •d:' • • i Y•IS itit i•t°• • • • • r N CO --�w .* U /-- Z m 0 0 v / / / 0 20.5' % 10.0' /////////////// /i-+ r , • • (V `Po. 00. 0. 1C) DROPPED CURB 100.00' 14.5' CONCRETE WALK DROPPED CURB FIR, _5/Er)LIp 6I448 O cn 0 to BRICK DRIVE 1.8' CONCRETE CURB Sc GUTTER 0 WATER METER 1 BRICK DRIVE O L. o j L o LIJ i CD G ` {{ c 7 Ui - )—� Q N CO i NE 101ST STREET 19' ASPHALT PAVEMENT cn QJ z cc 0 o g O- D W ri = o QI w W 1 E z D < ccI o tI 0 0 0 J .- t- 0 i m REVISIONS DATE FB/PG DWN CKD BOUNDARY & IMPROVEMENTS SURVEY 10/05/11 SKETCH JD REC UPDATE SURVEY 04/05/12 REC REC FOUNDATION SURVEY 06/03/14 SKETCH REC REC FINAL SURVEY 08/01/18 SKETCH AM REC FLOOD ZONE INFORMATION 1 COMMUNITY NUMBER 120652 PANEL NUMBER 0306 L ZONE AE BASE FLOOD ELEVATION 8 EFFECTIVE DATE 09/11/09 'PROPERTY ADDRESS : 1263 NE 101ST STREET • / SCALE: 1 "= 20' a 1 SHEET 2 OF 2 POST ON SITE INSPECTION RECORD Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Fax: (305)756-8972 Permit NO. RC -6-18-1777 Permit Type: Residential Construction Work Classification: Addition/Alteration Issue Date: 6/28/2018 INSPECTION REQUESTS: (305)762-4949 or Log on at https:/Ibldg.miamishoresvillage.comlcap REQUESTS ARE ACCEPTED DURING 8:30AM - 3:30PM FOR THE FOLLOWING BUSINESS DAY. Requests must be received by 3 pm for following day inspections. Expires: 12/25/2018 Residential Construction Parcel #:1132050250040 Owner's Name: CLAUDIO RODRIGUEZ Job Address: 1263 NE 101 Street Bond Number: Miami Shores. FL Contractor(s) Phone Primary Contractor MIAMI SKYLINE CONSTRUCTION C (305)899-9696 Yes Owner's Phone: Total Square Feet: Total Job Valuation: 2964.79 $ 110, 000.00 WORK IS ALLOWED: MONDAY THROUGH FRIDAY„'8.00AM - 7:OOPM. SATURDAY 8:00AM- 6:00PM.:_" NO WORK IS ALLOWED ON SUNDAY OR HOLIDAYS. BUILDING AND ROOFING INSPECTIONS ARE DONE MONDAY THROUGH FRIDAY. NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED. PLANS ARE READLY AVAILABLE, IT IS THE PERMIT APPLICANT'S RESPONSIBILITY TO ENSURE THAT WORK IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES. NEITHER THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL REQUIRED TO ALLOW INSPECTION. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN" ATTORNEY BEFORE COMMENCING WOR _ OR RE �, �,ING YOUR NOTICE OF COMMENCEMENT. INSPECTION RECORD STRUCTURAL INSPECTION DATE INSP Foundation MEM_ Stemwall Mill Slab Columns (2st Lift) Columns (2nd Lift) Tie Beam == Truss/Rafters Roof Sheathing Bucks Interior Framing Insulation Ceiling Grid Drywall Firewall Wire Lath Pool Steel Pool Deck Final Pool Final Fanro Screen Enclosure Driveway Driveway Base Tin Cap Roof in Progress Mop in Progress Final Roof Shutters Attachment Final Shutters Rails and Guardrails ADA compliance 1. 14 FINAL /30 2117� DOCUMENTS ` Soil Bearing Cert Soil Treatment Cert = Floor Elevation Survey Reinf Unit Mas Cert Insulation Certificate Spot Survey Final Survey Truss Certification STRUCTURAL COMMENTS WINDOWS &DOORS INSPECTION DATE INSP Attachment FINAL PUBLIC WORKS INSPECTION DATE INSP Excavation FINAL ELECTRICAL INSPECTION DATE INSP Temporary Pole 30 Day Temporary Pool Bonding Pool Deck Bonding Pool Wet Niche Underground Footer Ground el-L. Jiau Wall Rough Ceiling Rough Rough Telephone Rough Telephone Final TV Roug TV Final Cable Rough Cable Final Intercom Rough Intercom Final Alarm Rough Alarm Final Fire Alarm Rough Fire Alarm Final Service Work With 616111111111111111 FINAL L i ELECTRICAL COJruv,Lir a 1 INSPECTION Final Sprinkler Final Alarm FINAL FIRE DATE INSP boy INSPECTION PLUMBING DATE INSv Rough Water Service 2nd Rough Top Out Fire Sprinklers Septic Tank Sewer Hook-up Roof Drains Gas LP Tank vv/.JI Lawn Sprinklers Main Drain Pool Piping Backflow Preventorl Interceptor Catch Basins Condensate Drains Underground Pipe Ventilation Rough noon Kougn Pressure Test Final Hood Final Ventilation Final Pool Heater Final Vacuum MECHANICAL COMMENTS ' 14,/ Al -Flex Exterminators, Inc. 4035 S.W. 98 Avenue, Miami Florida 33165 P.O. Box 650213 Miami, FL 33165-0213 Tel. (305)552-0141 / 1-800 782-9284 FAX (305) 227-1797 Web Page: www.alflexexterminators.com / Email: alflex@bellsouth.net CONFIRMATION OF COMPLETION OF NATIVE SUBTERRANEAN TERMITE PRETREATMENT AND CERTIFICATE OF COMPLIANCE Purchaser : Address of Treated Premises : MIAMI SKYLINE CONSTRUCTION SERVICE CC RESIDENTIAL Address 12864 B!SCYNE BLVD #176/NORTH MIAMI, FL Lot- 0 Block- 0 Phone (305) 899-9696 1263 N.E. 101 STREET/ MIAMI SHORES, FL Number of Structure(s) to be treated : ONE Product Used : Square Footage : 2,650 Gallons Used : 265 DOMINION 2L Linear Footage : 204 Gallons Used : 81 IMIDACLOPRID Permit #: ( 0.05 Date Initial Treatment : 10/25/2013 12:00 PM Date of Completion : 7/27/2018 12:00 PM Technician : ALEXIS Al -Flex Exterminators hereby confirms that the structures described above have received a complete treatment for the prevention of NATIVE SUBTERRANEAN TERMITE infestation. Treatment has been made in accordance with the rules and laws as establishedby the Florida Department of Agriculture and Consumer Services. Exterior perimeter treatment was completed upon final grade. Al-Fiex's limited warranty is presently in full force and effect. (WARRANTY EXCLUDES FORMOSAN & ASIAN TERMITES) Al -Flex Exterminators, Inc. by President Dated: 7/27/2018 This is not valid without a Company Seal Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Parcel Number Permit No. RC-6-18-1777 Permit Type: Residential Construction Work Classification: Addition/Alteration Permit Status: APPROVED Expiration: 12/25/2018 Applicant 1263 NE 101 Street Miami Shores, FL 1132050250040 Block: Lot: CLAUDIO RODRIGUEZ Owner Information Address Phone Cell CLAUDIO RODRIGUEZ 1263 101 Street MIAMI SHORES FL 33138- 1263 101 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone MIAMI SKYLINE CONSTRUCTION COI (305)899-9696 (305)216-2224 Valuation: $ 110,000.00 Total Sq Feet: 2964.79 Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Construction: INTERIOR REMODEL & ADDITION Stories: 2 Front Setback: 39.11 Left Setback: 14 Bedrooms: 5 Plans Submitted: Yes Certificate Date: Bond Return : Occupancy: Single Family Exterior: Rear Setback: Right Setback: 19.11 Bathrooms: 3.5 Certificate Status: Additional Info: KITCHEN FAMILY ROOM & MASTEF Classification: Residential Fees Due Permit Fee Total: Amount $3,300.00 $3,300.00 Pay Date Pay Type Invoice # RC-6-18-68082 06/28/2018 Check #: 1519 Amt Paid Amt Due $ 3,300.00 $ 0.00 Available Inspections: Inspection Type: Drywall Miscellaneous Window Door Attachment Tie Beam Final Framing Insulation Final PE Certification Truss Insp Foundation Window and Door Buck Columns Fill Cells Columns Wire Lathe Review Mechanical Declaration of Use F. Termite Letter F. Elevation Certificate Review Planning Review Structural Review Electrical Review Building Review Plumbing 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 zoning. Futhermore, I authorize the above-nad con ctor to do the work stated. Authorized Signature: Owner / Applicant Contra / Agent June 28, 2018 Date Building Department Copy June 28, 2018 1 MIANII SKYLIN CONSTRUCTION CORP. STATE CERTIFIED BUILDING CONTRACTOR G C f+ .1i 3 Q 5_ L I (' - Z Z Z 'ti Claudio Rodriguez CBC 057075 PHONE: (305) 899-9696 609 N.E. 127th St. FAX: (305) 899-8840 North Miami, FL 33161 caudio@miamiskylineconstruction.com BUILDING PERMIT APPLICATION 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 Master Permit No.-L C (e Sub Permit No. t UILDIN ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION rprRENEWA177 ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I Dlp NC IDI cS' ee--\ City: Miami Shores C ` County: Miami Dade Zip: 33 i 3 C' Folio/Parcel#: 1132C) 5(� `,( Y4O Is the Building Historically Designated: Yes NO Y Occupancy Type: Load: Construction Typ e: Flood Zone: BFE: CyFFE: OWNER: Name (Fee Simple Titleholder): C.OUX \0 Phone#: 3 - 8 991-9 '9 Address: , NG Ic>\ ee A City: 1" \ 1 Ci!-A t 5 '-oce State: Zip: J� 3 Tenant/Lessee Name: Phone#: Email: Cyseent C❑ (c-., M; 0.v---; S k-1-1e l t`)r)s-A4u- .-'7io!v CO & CONTRACTOR:nnCompany Name:Nat ►1Qi--U •SIC 4 (f' QQ l,�y i�7�IUCs' tC)1_X Ed • Ph O /9—%9(O Address: 1 d C�Lo� T):_\Cc (-' UC'X . (n City: C),1-1'; QM t State: �I Oc i 8 0.. Zip: 5��� I I V Qualifier Name: C1t u-c-L'C c_` '-kor� cke Phone#: 30c 099"9ia`7 (' State Certification or Registration #: RCS 0 c 71 Certificate of Competency #: DESIGNER: Architect/Engineer:12? r-- t1,04 r F -Q-, Phone#: 7 g b- 5 C% 3- - S S Address: 1 0 1 I J tZ.- 11 zi S. City: s �^State: t` ( Zip: � Value of Work for this Permit: $ (lO i CG - 03 Square/Linear Footage of Work: 7 'cr./Cc, L4 • 41 Type of Work: Addition ^❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: � e Mo O11 e `� v 1 Q1-) 6 Specify color of color thru tile: Submittal Fee $ 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 $ 3l 300 - (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 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 of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before memethis Q 2Ck- day of wryy�. , 20[ ,\PCB , by 2.5 day of p�JU(\_Q.__ (Y) , 20t , Iwo) , by Cif 0 U 6} O 12�-Gvh s perso iiy krro to ()audio V o Is per riail owwnn to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Signature CONTRACTOR me or who has produced Lt..A 1 identification and who did take an oath. NOTARY PUBLIC: Sign� Print: MY COMMISSION # GG 044602 Seal: ************************ APPROVED BY The foregoing instrument was acknowledged before me this Si Print: Seal: MAHARAI K. GONZALEZ MY COMMISSION # GG 044602 EXPIRES: November 2, 2020 unaea i hru Notary Pubhc Underwriters ************************************* *************************** Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) �1 AC'ORLO" MIAMI37 INSURANCE OP ID: FL DATE(MM/DDIYYYY) 03/28/2018 `..�.►/ CERTIFICATE OF LIABILITY 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 954-776-2222 Brown & Brown of Florida, Inc. 1201 W Cypress Creek Rd # 130 P.O. Box 5727 Ft. Lauderdale, FL 33310-5727 Commercial Lines House NAMEACT Commercial Lines House PHONE 954-776-2222 I FAX 954-776-4446 (A/C, No, Ext): (A/C, No): ADDARESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :*FCCI Insurance Company+ 10178 INSURED Miami Skyline Construction Attn: Claudio Rodriguez 12864 Biscayne Blvd #176 Miami, FL 33181 INSURER B : Evanston Insurance Company+ 35378 INSURER C : INSURER D: INSURER E : INSURER F : • 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 INSD SUBR W VD POLICY NUMBER EFF IMM/DD/YYYYI POLICY EXP MIPOLICY (MDD/YYYYI LIMITS B X COMMERCIAL GENERAL LIABILITY 3AA147750 09/22/2017 09/22/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) 100,000 $ CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 • PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS - COMP/OP AGG $ 1,000,000 $ AUTOMOBILE — _ LIABILITY ANY AUTO OWNED AUTOSE�ONLY AUTOS ONLY _ ^ SCHEDULED AUTOS AUUTO ONEDY (Ea accidentSINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Peraccident)$ $ _ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ A ANDEMPLO EMPLOYERS' COMPENSATION ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 001WC18A66406 03/23/2018 03/23/2019 STATUTE R ER H E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE 1 �000�Q00 $ E.L. DISEASE - POLICY LIMIT 1,000,000 $ LDi ense°N QFgE�2y�B/egOCATIONs / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) r[ r rr'V'sr C rIVC✓Cr\ MIAMISH Miami Shores Village Building Dept. 10050 NE 2nd Avenue Miami Shores, FL 33138 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 TI� - ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and foga are registered marks of ACORD