Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
PL-17-1391
NOTICE: In addition to the requirements of this additional restrictions applicable to this property the public records of this county. Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 _ ermrt N0 � Perm ' x y . Classficarron• Dram • � s_ Sr tus *AF'PRt? IED Parcel Number } PL 5 17� 1391.E it*Type Plumbing ResiderifiaI #'' field" errnft a ssue Date t6151201T Expiration: 12/02/2017 40d M..t. Applicant 150 NE 108 Street Miami Shores, FL 33161- 1121360100040 Block: Lot: Phone JEFFREY KOLOFOFF Ceti Owner Information Emily Bradfute Address 150 NE 108th Street Miami Shores FL 33161 Contractor(s) Phone CeII Phone _._. _ .. _. _... ALLSTATE DIVERSIFIED ENGINEERIP (305)256-0306 (305)258-7797 ^4 Type of Work: SEPTIC TANK AND DRAINFIELD. Type of Piping: Additional Info: Bond Return : Classification: Residential Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Amount $1.20 $4.50 $4.50 $0.40 $300.00 $3.00 $1.60 Total: $315.20 305 679-9744 Tilis I$IUST BE ON JOBNPECTMOOF Pay Date Pa Tvpe Invoice # PL-5-17-64091 06/05/2017 Check #: 6692 05/23/2017 Credit Card Amt Paid Amt Due $ 265.20 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: HRS Approval Final Review Plumbing Applicant Copy For Inspections, a Call (306) 762-4949 or Log on at https://bldg.miamishoresvillage.com/ca Requests must be received by 3 pm for following day inspections. permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER that may be found in GOVER MANAGEMENT TS, STATE AGENCIES, OR FEDERAL AGENCIES. D STRI �..�e nn 91117 2 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL APPLICANT: Jeffrey Kolokoff AGENT : Allstate Diversified 150 NE 108 St PROPERTY ADDRESS: LOT: 4 SUBDIVISION: Miami, FL 33161 BLOCK: 209 ID# : 11.2136-009.004 CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. SETBACKS APPLICATION #:AP1�$41 PERMIT # :13-SC-1725875 DOCUMENT # : F 11124369 DATE PAID :07/17/2017 FEE PAID :100.00 RECEIPT # :1 3-P I D-3300866 TANK INSTALLATION [ ] [01] TANK SIZE [1] [ ] [02] TANK MATERIAL [ ] [03] OUTLET DEVICE [ ] [04] MULTI -CHAMBERED [ ] [05] OUTLET FILTER [ ] [06] LEGEND 1. 13-07Q 8DC3 [ ] [07] WATERTIGHT [ ] [08] LEVEL [ ] [09] DEPTH TO LID DRAINFIELD INSTALLATION [ ] [10] AREA [13 510 [2] [ ] [11] DISTRIBUTION BOX [ ] [12] NUMBER OF DRAINLINES [ ] [13] DRAINLINE SEPARATION [ ] [14] DRAINLINE SLOPE [ ] [15] DEPTH OF COVER [ ] [16] ELEVATION [ ABOVE [ ] [17] SYSTEM LOCATION [ ] [18] DOSING PUMPS [ ] [19] AGGREGATE SIZE [ ] [20] AGGREGATE EXCESSIVE FINES [ ] [21] AGGREGATE DEPTH FILL / EXCAVATION MATERIAL [ ] [22] FILL AMOUNT [ ] [23] FILL TEXTURE [ ] [24] EXCAVATION DEPTH [ ] [25] AREA REPLACED [ ] [26] REPLACEMENT MATERIAL Comments: Comments are on page 2. CONSTRUCTION FINAL SYSTEM [ APPROVED APPROVED DISAPPROVED / DISAPPROVED (Explanation of violations on following page) DH 4016, 08/09 (Obsoletes all previous Incorporated: 64E-6.003, FAC EH Database v 1.0.1 1050.00 [2] Concrete ( Y Tuf-Tite EF-4 2. HEADER 1. .5.22 2. BELOW ]: ]: SQFT X ] BM 27.96 [27] SURFACE WATER [28] DITCHES [29] PRIVATE WELLS [30] PUBLIC WELLS [31] IRRIGATION WELLS [32] POTABLE WATER [33] BUILDING FOUNDATIONS [34] PROPERTY LINES [35] OTHER FILLED / MOUND SYSTEM [36] DRAINFIELD COVER [37] SHOULDERS [38] SLOPES [39] STABILIZATION ADDITIONAL INFORMATION UNOBSTRUCTED AREA STORMWATER RUNOFF ALARMS MAINTENANCE AGREEMENT BUILDING AREA LOCATION CONFORMS WITH SITE PLAN FINAL SITE GRADING CONTRACTOR OTHER INFILTRATOR ARC 24 46 5 FT FT FT FT FT FT 19 FT FT FT ABANDONMENT [49] TANK PUMPED [50] TANK CRUSHED & FILLED Dade CHD Environmental Specialist 11 Jermaine D CrittendenShaw (Florida Depart Dade CHD Environmental Specialist 11 Jermaine D CrittendenShaw (Florida l o d Dew er editions which may not be used) l EID1725875 �.S. D 5 �' �` Prograrn DATE: 07/18/2017 DATE: 07/18/2017 AP1266841 Florida Health i_`.? rrsiy;gi;l 2Cge1'Ity f STATE.OFFLORIDA DEPARTMENT OF HEALTH DISPOSAL SYSTEM ONSITE SEWAGE TREATMENT AND DISPOSAL ALPSYSTE CONSTRUCTION INSPECTION AND APPLICATION $: AP41 PERMIT # :13-SC-1725875 DOCUMENT it : F11124369 DATE PAID :07/17/2017 FEE PAID :100.00 RECEIPT. * :13-PID-3300866 s sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of 400 Comments The system i gpd. -34 chambers with trench configuration -42in sand 08/09 (Obsoletes all previous editions which may not be used) DH 4016, EID1725875 Incorporated: 64E-6.003, FAC . Apti2Bgga1 EH Database V 1.0.1 Page 2 of 3 Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address it ssue Date; 61 Permit NO. PL,5-17-1391 Permit Type: Plumbing -Residential Work Classification: ©rainfieid Permit Status: APPROVED 2017 Expiration: 12/02/2017 Parcel Number Applicant 150 NE 108 Street Miami Shores, FL 33161- 1121360100040 Block: Lot: JEFFREY KOLOFOFF Owner Information Emily Bradfute Address 150 NE 108th Street Miami Shores FL 33161 Phone 305 679-9744 Contractor(s) Phone CeII Phone ALLSTATE DIVERSIFIED ENGINEERII• (305)256-0306 (305)258-7797 Valuation: Cell $ 2,000.00 Total Sq Feet: 500 Type of Work: SEPTIC TANK AND DRAINFIELD. 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 $1.20 $4.50 $4.50 $0.40 $300.00 $3.00 $1.60 $315.20 Pay Date Pay Type Invoice # PL-5-17-64091 06/05/2017 Check #: 6692 05/23/2017 Credit Card Amt Paid Amt Due $ 265.20 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: HRS Approval Final 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 AFFI construction a /Aut AVIT: zonin that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating . Futhermore, I authorize the above -named contractor to do the work stated. ��- June 05, 2017 rized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy June 05, 2017 1 067'1 u Miami Shores Village k g Building Department BUILDING PERMIT APPLICATION 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 (`-I Master Permit No. eL. -1(Q o2-Ci4 Sub Permit No.'L-11-- 139 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL Ni1PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 150 NE 108th Street City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:1121-3601-00040 Is the Building Historically Designated: Yes Occupancy Type: Load: Construction Type: Flood Zone: BFE: NO X FFE: OWNER: Name (Fee Simple Titleholder): Emily M. Bradfute and Jeffrey M. Kolokoff Phone#: 786.837.3333 Address:150 NE 108th Street city: Miami Shores State: FL Zip: 33161 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: 79�L/' 0,�U , L..�l (11..Q! p1L,(y e/j Phone#: a 0a-2- Address: `dZ� J I A1! USU U City: State: -- Zip: oxaa Qualifier Name: 67L/ 1 Q6 �(' S6 Phone#: SG LI b j State Certification or Registration #: C FC /``t 'f 7 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: 7 ....... ..� ��y� Value of Work forthis Permit $ :OraA ) M ifs., Type of Work '❑ Addition ..❑ Alteration ❑ New :; Repair/Replace ;,,❑ ,demolition 4t i 5 t� L 4. Mirk _ es n t..I ill—ILJ 4 . .._fv .._- .. >C .:D'esc'ription'of VVork:'x"" , --�j� 46,111 ! zee. ,.., ,. : , r., :..;• , Squa(e/t#n ritotage:tJfiworie y d Specify color of color thru tile: Submittal Fee $150 ' CADJ Permit Fee $ 160 — CCF $ CO/CC $ 0 Scanning Fee $ Radon Fee $ DBPR $ _ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ 50 Structural Reviews $ V) Bond $ 129 Y6 TOTAL FEE NOW DUE$ 2—G5 ' 20 (Revised02/24/2014) r \. tA Bonding, Company',s,Narre~(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 .e posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absen of su'h posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature The fo WA- day o Signature OWNER or AGE CONTRACTOR instrument was acknowledged before me this The foregoing instrument was acknowledged before me this Pei , 20 1/ , by -Ea;ki M. i3 v)gift .--..krr-re. K614rvho is personally known -to- me or who has produced identification and.rIt,Au.,llG, NOTARY PSIBLIC: 'I - day of 1JQ� gii- as me or who has produced DIUANE CYRIAOUE MY COMMISSION / FF 988521 EXPIRES: May 7, 2020 Bonded Thru Notary Public Underwriters Print Print: Seal: identification and w 'did'take .: NOTARY PUBLIC/ Sign: Print: Seal: SARIMA BATISTA • la. ▪ ' 14 MY COMMISSION # GG 078885 .�411:,..47 EXPIRES: May 11, 2021 ',gaga." Bonded 'Rau Notary Pubic Underwriters r• ****************************************Plc *************************************s***************************** APPROVED BY Plans Examiner Zoning r t (Revised02/24/2014) Structural Review Clerk J STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Jeffrey Kolokoff PROPERTY ADDRESS: 150 NE 108 St Miami, FL 33161 LOT: 4 BLOCK: 209 PROPERTY ID #: 11-2136-009-0040 SUBDIVISION: PERMIT #: 13-SC-1725875 APPLICATION #: AP1266841 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR1047373 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT PI+IN THIST ERKIT BEING MADE FROM COMPLIANCE WITH ULLER L ANDVOID. D. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE STATE, OR LOrAt, PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 1,050 1 GALLONS / GPD Septic CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS 81 ]DOSES PER 24 HRS #Pumps [ ] D [ 500 ] SQUARE FEET Trench confiauratio drainfie SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [1 MOUND [ ] I CONFIGURATION: [x] TRENCH [ ] BED I ] N F LOCATION OF BENCHMARK: CL NE 108 St., 11.01' NGVD FT ] [ABOVE /�� BENCHMARK/REFERENCE POINT 1 ELEVATION OF PROPOSED SYSTEM SITE [ 3.72 1 / [ 33.72 1 [I INCHES f FT l [ ABOVE A BELOW j BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: 0 T H E R U INCHES [ 0.001 INCHES EXCAVATION REQUIRED: [ 72.00 1 INCHES 'Invert elevation of drainfield to be no less than 8.70' NGVD. *Bottom of drainfield elevation to be no Tess than 8.20' NGVD. *Install 42" of slightly limited soil under the bottom of drainfield. -Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed absorption bed or drain trench The system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of 400 gpd. The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with s. 64E-6.013(3)(f), FAC. SPECIFICATIONS BY: GUILLERMO SUAREZ APPROVED BY: Carlos !i Icasa DATE ISSUED: 01/30/2017 TITLE: TITLE: Dade CHD EXPIRATION DATE: 07/30/2018 DE 4016, 08/04 (Obsoletes all previous editions which may not be used) Incorporated: 648-6.003, FAC SE1021106 v 1.1.4 AP1266841 Page 1 ACORLI CERTIFICATE OF LIABILITY INSURANCE L.------ DATE(MM/DD/YYYY) 5/19/2017 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 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 Eastern Insurance Group, Inc. 9570 SW 107 Avenue Suite 104 Miami FL 33176 CONTACT NAME: Amanda Nogues NCNN ). (305) 595-3323 FAX ( No): (305)595-7135 AD REs:amanda@easterninsurance.net INSURER(S) AFFORDING COVERAGE NAIC # INsuRERA:Colony Insurance Company INSURED Allstate Diversified Engineering, Inc. 25525 SW 141 Ave Homestead FL 33032 INSURER B:Starstone National Insurance Co. INSURERC: INSURER 0: INSURER E : INSURER F : CERTIFICATE NUMBER Mastar 17-18 • 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 MD POLICY NUMBER POUCY EFF (MM/DD/YYYY) POUCY EXP (MM/DD/YYYY) LIMBS A X COMMERCIAL GENERAL LIABILITY 103G1,0007204-02 11/13/2016 11/13/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO urr PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES JECT PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGO $ 2,000,000 $ AUTOMOBILE — _ LIABILITY ANY AUTO U. OOS OWNED AAUT HIRED AUTOS AUTOESDULED NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B x UMBRELLA LIAB EXCESSLIAB ` OCCUR CLAIMS -MADE 89000N172AL2 4/20/2017 4/20/2018 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED RETENTIONS - $ WORKERS COMPENSATION AND EMPLOYERS' LIABIU Y ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y IN N / A PER OTH- STATUTE 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 apace Is required) Septic tank systems, installation servicing or repair CERTIFICATE HOLDER CANCELLATION Miami Shores Village 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 David Lopez/ANA ACORD 25 (2014/01) INS025 r�nlan» ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORIIY CERTIFICATE OF LIABILITY INSURANCE �..----- DATE(MM,DD"YYY) 5/19/2017 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). PRODUCER SUNZ Insurance Solutions, LLC. ID:(Amer. Emp Grp) c/o American Employer Group III, Inc. 800 Oak Ridge Turnpike Suite A-702 Oak Ridge , TN 37830 NAMEACT Cora Rutherford PHONE FAX tic. No. Ex* 865-481-0910 tac, No): 877-299-9849 ADDRESS: cora.rutherford@aegpeo.com INSURER(S) AFFORDING COVERAGE NAIC 11 INSURERA: SUNZ Insurance Company 34762 INSURED Invo PEO of Florida, Inc. Madison PEO of Florida Inc. 1 225 West Seminole Blvd, Suite 103 Sanford FL 32771 INSURER B : INSURERC: INSURER D: INSURER E ; INSURER F : COVERAGES CERTIFICATE 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 OF INSURANCE AL AWL MISD_yND SUBR POLICY NUMBER POLICY EFF IMM/OD/YYYY) POLICY EXP (MMIDD/YYYY) LIMITS COMMERCIAL GENERAL UABILITY EACH OCCURRENCE $ CLAIMS MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES Ra PER: LOC GENERAL AGGREGATE $ PRODUCTS-COMP/OPAGG $ $ AUTOMOBILE _ LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY — SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident)$ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB— EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/E)(ECUTIVE OFFICER/MEMBEREXCLUDED? u (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WCPE0000008906 WCPE0000008905 10/1/2016 10/1/2015 10/1/2017 10/1/2016 �/ STATUTE EAR E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 $ 1,000,000 E.L. DISEASE - POLICY LIMIT 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: ALLSTATE DIVERSIFIED ENGINEERING, INC. Location coverage effective: 11/20/2016 CERTIFICATE HOLDER CANCELLATION 010495 Miami Shores Village 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 REPRESENTATNE Glen J Distefano 4-fter. ACORD 25 (2016/03) 01988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 35732311 I Invo PEO of Florida, Inc. (Master Certificate) I Donna Steele 15/19/2017 1:59:08 PM (EDT) I Page 1 of 1