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PL-16-3020Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Issue t Perrot NO. PL-11-16-3020 Permit Type: Plumbing - Residential. mark Classification: Addition/Alteration Permit Status: APPROVED. 11/28/2016 Expiration: 05/27/2017 Parcel Number Applicant 135 NE 98 Street Miami Shores, FL 33138- 1132060132310 Block: Lot: FLORIDA MINORITY COMMUNIT Owner Information Address Phone Cell FLORIDA MINORITY COMMUNITY 7210 N MANHATTAN Avenue TAMPA FL 33614- (813)598-6361 7210 N MANHATTAN Avenue TAMPA FL 33614- Contractor(s) Phone Cell Phone M.D.R. PLUMBING & FIRE, LLC (305)484-8509 (305)301-3015 Valuation: Total Sq Feet: $ 3,500.00 1600 Type of Work: RELOCATE WATER LINES AND REPLACE FI Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $2.40 $3.38 $3.38 $0.80 $225.00 $3.00 $3.20 $241.16 Pay Date Pay Type Amt Paid Amt Due Invoice # PL-11-16-61919 11/28/2016 Credit Card $ 241.16 $ 0.00 Available Inspections: Inspection Type: Top Out Final Review Plumbing Underground 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 -named contractor to do the work stated. November 28, 2016 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy November 28, 2016 1 Miami Shores Village BUILDING. PERMIT APPLICATION 0BUILDI EZPLUM BING • 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 r"rs, . .,c,'"grrv•ED. NOV 0 3-2016 FBC,2014 Master Permit No. Sub Permit No.eR-1(0 arD 2A-1 ,• • . ED ELECTRIC ' D ROOFING 0 REVISION ' EXTENSION - 0 RENEWAL - • - O MECHANICAL DPUBLIC WORKS Ei CHANGE OF 0 CANCELLATION 0 SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 136 Ni E City: T -' '11.Miami Shores -••• T LfCounty:.»1 MiamiDade • • Zip: 31 11. - Folio/Pare14: ' -4 ' , the'Building HiStOrically Designated: Yes 5; • k NO 3 d'ectCpitifel2IS . Load" • Constriction'Flood Zone: BFE:i. OWNER: Name (Fee Simple Titleholder): Ficyiolci MY br; CbMritt_A Phone#: f4(.0 a 9 243 Address: 772 10 MOA herikrill A \it/ 31 City: State: l'aVY1PoL, State: r. Tenant/Lessee Name: PhoneM Email: CONTRACTOR: Company Narhe: rAt6i R(C. LL-C-1 Address: IA'D SNJ- City: AOrY State: Qualifier - Qualifier Name: IA/ ,darto Done.( 21 eCt(te Phone#: (3c) 301-• 61 5 StateCertification or Registration #: C FC 142-15 LI-8 Certificate of Competency #: Phone#: (31: • • _. • DESIGNER: Architect/Engineer: Phonett: zip:3 3 I 6 co Address: City: ....... .. , Value of Work for this Permit: $ 6,500- 0 C) Square/Linear Footage of Work: Type of Work: D Addition Et Alteration El New State: ileco Zip: El Repair/Replace El Demolition Description of Work: Re tbrckie wain/ Ines A v-plaue_, Speci Submit .4P CP. tC color of or,thrutile Scanning Fee $ Technology Fee $ wad. P*301!'.; gbIta!:i :WOO tIfilf:‘,4 s v ,0 451 n0 10'4A '1,1'*•V",(7510:1E 01-4 iiTCF.4,?; :=CO/Ce$ ; Radon Fee $ DBPR $ Notary $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 2 Cl I • (Revised02/24/2014) Bonding Company's Name`(if applicable) Bonding Company's Address ' City State - . Mortgage Lender's Name (if applicable) Mortgage Lender's Address a 1 City '1 Fi Zip - • '>- State p ,P. Zip 7:1r';r:ter 4'i' • a , /. Ji .,, •� ; �T.:ft J �, � fw�S.'xi .� � fX Yan� i Application is hereby made to obtain a 1-ire to do the work and installations as indicated. t 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 * w ',1-1 [,-� 4_ '-, L,: �'i f +y t 1 t1i;,; _31�. 1 ,..e ;•`ij Y F-` L 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. • {, ' F - F' C►" •tom. "WARNING TO OWNER: YOUR FAILURE=TO RECORD -A,NOTICE.OF_COMMENCEMENT -MAY RESULT IN YOUR PAYING1TWICE•'FOR1MPROVEMENTS_TO_YOUR_PROPERTY._ IF YOUANTEND TO OBTAIN -FINANCING,. CONSULT WITH YOUR LENDER.OR AN ATTORNEY. BEFORE -RECORDING YOUR NOTICE OF COMMENCEMENT." •l y i; F 3 . • 1) E n F1 �.u� 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 e t 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 appro -; and a reinspection fee will be charged. OWNER or AGENT The foregoing instrument was acknowledged before me this -.5_---_day of '1 •lvQlie,/M %('N"-"-; 20 _I lr ;by 1{� l ✓"(�ry `" . who is personally known to` me Ot who has'produced-----yri irva Ll.u3 Signature 1 _ _._.___ - CONTRACTOR _,_-4_ : _ 1 �� The foregoing instrument was acknowledged before me this , j u {' -day of t3OVe,%i11�Cr '�-►_, 2O1 ' O :'by �" I. i' MYp(Ordti—t); •""I?e'Gat'Vwho s personally,;knowny tos -me-or who has -produced i t 'Di. 4 R 2(. 54* 75 (vie identification and who did take an oath: '" "' identification and who did take an oath:-' NOTARY PUBLIC: .d:•:rs'1 Sign: a }rl vet'r•;+C t*: 4..r�r' ilr 1 K ..ti -t4 _P.-^�� NOTARY PUBLIC:"' Print: -nV Seal: 24, SaIN eeeeeeeteeeee#eeei*ee 44.14 APPROVED BY RUSNKA ORTEGA„ Notary Public - State of Florida Commisslon,# FF 1976911,, My Comm. Expires Feb 9, 2019 !_ 1%►NbMeimiNolmMallbAeei!eeeeeeeeeeeeee s AMIr • 'AEA Sign: Print: Seal: j} VERUSHKA ORTEGA 'IN Notary Public: State of Florida a sJ • ` Commlislun , FF 197698 .1omdMy Comm. Expires Feb 9, 2019 a lesi'keesitonder *eels! yyZoning lin ...- ...y•.A F.7 aim+. Structural Review Clerk Plans Examiner J.7,.,4r c.,i+ _." �' 1 ,r. d y s i 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 withan 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 appro and a reinspection fee will be charged. " Y Signature _ // ` Signature CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing. instrument was acknowledged before me ttiis day of Novk_i.,/1 Y>/:✓ , 20 , by day:of 1JDV6in k/er'_ = .".., 20 I l0 , by NER or AGENT p1 i/\DA , who is personally known to me or who has produced 164/10v as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: ssssss******ss#sss. APPROVED BY RUSIIKK 0RTElA Notary Public - Stab of Fibrilla Commbakdt,N_FF 197 My Comm. Expires Feb 9, 2019 ssass 11 ivy of et1rG4.a b • "' Re LQt` who is personally known to me or who has produced FL- 'DL identification and who did take an oath. NOTARY PUBLIC: Sign: Print: QtAA) Seal: ov ,,,,"VERUSHKA ORTEGA 1 * ,�`4 Notary,.Publlc7 State or !pride `. Commlaaicin•` 4F 1117698 ��OF .1 My Comm. Expires Feb 9, 2019 sssssssssssssss, illt****sti Il Plaris Examiner Structural Review Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 RECARTE, MEDARDO DANIEL M.D.R. PLUMBING & FIRE, LLC 14282 SW 146TH AVENUE MIAMI FL 33186 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 from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your nem'license! RICK SCOTT, GOVERNOR (850) 487-1395 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONALIRGULATION CFC1427548 -: % SUED:" 09/04/2016 CERTIFIED PLUMBING, CONTRACTOR RECARTE, MEDARDdOANIEL-a `.. M.D.R. PLUMBIN(3•4&;FIR ;% IS CERTIFIED under the provisions of Ch.4a9 FS: Expiry+ion date "AUG 3t, 2J18 LIG0y0a00018!5 DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 'LICENSE NUMBER. CFC1427548 The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 RECARTE, MEDARDO DANIEL: M.D.R. PLUMBING & FIRE,LLC 14282 SW 146TH AVENUErt.. -; MIAMI AFL-3318g DISPLAY AS REQUIRED BY LAW ISSUED: 09/04/2016 SEQ # L1609040001815 usir s AT i Receipt x Dade County, State °of Florida' -THIS IS NOT A BILL DO NOT PAY 72'01645 BUSINESS NAME/LOCATION MDR PLUMBING & FIRE LLC 42$2 sw 146 AVE A MIAMI, EL 331$s O :�..' ER MDR PLU CIO ME Workers RECEIP;TNO. RENEWAL 7484365 IEC. TYP 190 NESS -TY PLUMBING RACTOR FPC 12-0 0148. .ptREt 1017 L ptace tv#b isirtss tp County Coe, . ; Chapter &,1g 4 pit/WENT .RE E • BY TI X'CLLE.CT 25: '1 'CREDIT This. Lucai B sines Tex Receipt tiyFcungrnns p s at of the La cal Busin�Tax. The c ,nano, or a c0;inacation of the h� Uder s gaatiiiica ons. to do bt t e s.'Nald r must.cam ,sr,iongoven t t " regulatory tawsald requirements which apply to the business. € don all commeitial vehicles• ' d�pla Tide REC?�'i'�NO ati�►e mu'#��Ye :. �. �, For more if onn_ationi visit ! "'i rr' de.n0 i Y r Jeff Atwater CHIEF FINANCIAL OFFICER Julius Halm DIVISION DIRECTOR Casio Sinco BUREAU CHIEF Keith McCarthy SAFETY PROGRAM MANAGER FLORIDA DEPARTMENT OF FLNANCIAL SERVICES DIVISION OF STATE FIRE MARSHAL 200 East Gaines Street - Tallahassee, Florida 32399-0342 Tel. 850-413-3644 Fax. 850-410-2467 THIS CERTIFIES THAT: CERTIFICATE OF COMPETENCY OFFICIAL COPY Medardo Recarte 14282 SW 146 Ave Miami FL 33186 BUSINESS ORGANIZATION: MDR Plumbing & Fire, LLC Contractor 11 is limited to the execution of contracts requiring the ability to layout, fabricate, install, inspect; alter, repair, and service water sprinkler systems, water spray systems, toam-water sprinkler systems, foam -water spray systems, standpipes, combination standpipes and sprinkler risers, all piping that is an integral part of the system beginning at the point of service, sprinkler tank heaters, air Imes; thermal systems used in connection with sprinklers, and tanks and pumps connected thereto, excluding pre-engineered systems. Issue Date: 07/01/2016 Type: Q7 Class: 12 County: Dade License/Permit #: FPC12-000148 Expiration Date: 06/30/2018 Chief Financial Officer co A 'J CERTIFICATE OF LIABILITY INSURANCE r__ 1 IIV I/ IV 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 Atlantis Insurance 15441 SW 137 Ave, Miami, FL 33177 Phone (305) 969-8776 INSURED MDR PLUMBING & FIRE LLC 14282 SW 146 AVE Miami, FL 33186 _COVERAGES ......e _._-......�.... _.._ _ _ _ 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 ADD UBR L._ �{_,-- TYPE OF INSURANCE POLICY EFF I POLICY EXP .. .-.--..--..-- n---._ INSR. NIQ/A ��,. PO ICY NUMBER _ MM/DD/YYYY) (MM/OD/YYYYJ ,. GENERAL LIABILITY _ Fax (305)969-8744 (305) 484-8509 CONYAt Ralph Ceballos NAME. ,...... PINE 305 969 8776 atlantlsmsurance@att.net INSURERS) AFFORDING COVERAGE. INSURER A ; NAUTILUS INSURANCE INSURER 8 : INSURER C : INSURER D: INSURER E : INSURER F • FAX (AX 140) (305) 969-8744 NAIC # I COMMERCIAL GENERAL LIABILITY ._.( CLAIMS -MADE ❑ OCCUR GE N L AGGREGATE LIMIT APPLIES PER POLICY I;W'r ❑ LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS UMBRELLA LIAB EXCESS LIAR El SCHEDULED AUTOS NON -OWNED AUTOS ri OCCUR 1:...1 CI.AIMS-MADE I...I DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNERJEXECUTiVE OFFtCERJMEMBER ExCLUDED7 (Mandatory in NH) U yof describe under DESRIPTION OF OPERATIONS below N/A NN724442 10/17/2016 [ 10/17/2017 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) PLUMBING CONTRACTOR & FIRE PROTECTION CLASS II CERTIFICATE HOLDER MIAMI SHORES VILLAGE BLDG. DEPARTMENT 10050 N.E. 2ND AVENUE MIAMI SHORES, FL 33138 ACORD 25 (2010/05) QF CANCELLATION LIMITS EAGIHOCCURRENCE .A JIAO PE( rro PRE M ISF E oc,,p,rren e MED EXP (Any one person PERSONAL Li ADV INJURY $ 1,000,000.00 GENERALAGGRECATE PRODUCTS :COMP/OR A 'Ci)v4BRE-tOSI'R LF _!Mrr (Ea acc'Eenij,,,..__ BODILY INJURY (Per person) BODILY INJURY (Per acciden PROPS R? Y tDAVAGE..'—.'v. (Per acndenti EACH OCCURRENCE AGGREGATE WC 57ATi7- . � ���7 _ OTt TQR' UMITs EL EACH ACCIDENT E L. DISEASE - EA EMPLOYE E. t... DSEASE„.:. POI..ICY . IMI? $ 100,000.00 s 5,000,00 s 1,000,000.00 $ 2,000,000.00 2,000,000.00 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 RALPH CEBALLOS ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC L, CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDOIYYYY) 11/01/2016 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 Absolute Choice Insurance 9415 Sunset Drive Suite 151 Miami INSURED MDR Plumbing & Fire, LLC 14282 SW 146th Ave Miami COVERAGES CERTIFICATE NUMBER: 33173 33186 EbNTACT NAME:Carlos A Melich AX PHONE. L JtLp...Wi (305)275m1777 .No(305) 275 1711 AMAREss -nfD©myabsolutechoice.com _ .. INSURERS AFFORDING COVERAGE NAIC # _ INSURERA: ASSOCIATED INDUSTRIES INSURANCE COMPAI I INSURER 8 : INSURER C : INSURER D INSURER E INSURER F • THIS INDICATED: CERTIFICATE EXCLUSIONS LTR IS TO CERTIFY THAT THE POLICIES NOTWITHSTANDING ANY REQUIREMENT, MAY BE ISSUED OR MAY AND CONDITIONS OF SUCH TYPE OF INSURANCE OF PERTAIN. POLICIES, AiSfiL`S`Tis3FE IN II INSURANCE NIVO LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ._,____ POLICY NUMBER ,JMM/DDIYYYY) 1 (MMIDO/YYYY(,; LIMITS cwt. COMMERCIAL GENERAL LIABILITY j CLAIMS -MAD- P.. .. OCCUR .AGGREGATE LIMI APPLIES PER' POLICY 1 dECT LOC OTHER; ` 1 I I E I EACH CCCURREh10E OiSh`.A 10RE/IT 0 ..... fWMISf$, P rSflTKt. MED EX Any one person) PERSONAL & AD4 INJ 1RY „FNFRA( ACGRF ATF PRODUCTS COMP/OP AC C $ $ .... G i $ i $ ..... . 5 AUTOMOBILE '.__......,. .. __ ..., LIABILITY ANY AUTO ALL OWNED AUTOS RED AUTOS ........_... i SCHEDULED AUTOS NON OWNED AUTOS F E ONSNEI5 b11,16L1 Alit „,frEa„aG, Idenfl.,..,, ,, .m _ BODILY INJURY (Per pe€son) __.._._._W__..__..___..._.....,..,_._..__....... BCDILY INJURY (Per accident) PROPERTY DAMAGE „fPdraCthntt--,,,,.— ' $ -...,_. ......... .. $ ..._ _.. ..,.-. ...,_............. $H - .............._.,....._.._. ----- e...,..,. UMBRELLA LIAR EXCESSLIAB .,,, )e ..._.T a......_.d DEL, I 1 RETENT ........ ON $ OCCUR CLAIMS MADE .......:. .. ....... 1 : _ EACH OCCURRENCE '• $ AGGREGATE . _._.. --.. ---..... _.._._ . ....._ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OFOPERATIONSbete Y / N AWC1056524 ? I 01I08/2016 01/08/2017 i ( (SATUE OFH F L. EACH ACCIDENT $ 100,000 E.L, DISEASE - CAEMPLOYEE' $ 100 000 ,.., ............ ............ ... ........... F L, DISEASE - POLICY Y LIMIT. $ 500,000 '- w DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) STATE OF FLORIDA CLASS It FIRE PROTECTION CONTRACTOR.. STATE OF FLORIDA PLUMBING & MECHANICAL CONTRACTOR.. CANCELLATION MIAMI SHORES VILLAGE BUILDING 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 ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD