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PW-18-3428Permit NO.: PW-11-18-3428 Miami Shores Village "� r 1 '>' ._,•_.,�-, ti Permit Type: Public Works 10050 re 2 Ave ' '` I (" Miami Shores FL 33138 � �� IVI � ` � �� Work Classification: Public Works 305-795-2204 Permit Status: Approved Issue Date:12/11/2018 Expiration: 06/10/2019 Location Address Parcel Number 274 NW 92ND ST, Miami Shores, FL 33150 1131010331280 Contacts DANIEL MAFRA Owner AP WELDING AND STEEL Contractor 274 NW 92 ST, MIAMI SHORES, FL 33150 MANUFACTURER CORP JOSE ALONSO 4150 W 19 AVE, HIALEAH, FL 33012 Business: 3058254511 rcapwelding@gmail.com Description: REPLACE APPROACH SIDE WALK 6" THICK Valuation: $ Inspection Requests: 800.00 1305-762-4949 Total Scl Feet: 400.00 Fees Amount Education Surcharge $0.20 Public Works Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $105.70 Payments Date Paid Amt Paid Total Fees $105.70 Credit Card 12/11/2018 $105.70 Amount Due: $0.00 Building Department Copy 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 AFFID IT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating co stj tion and zoning. Futhermore, I authorize the above named contractor to do the work stated. Auth rid Signature: Owner / Applicant / Contractor / Agent Date December 11, 2018 Page 2 of 2 RtCEI VED Miami Shores Village NOV 13 1018 Public Works Department (3m221D n Public works are available from the building department, 10050 NE Z"d Ave., Miami Shorts, EL 3338 PUBLIC WORKS PERMIT APPLICATION Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property Permim Ste - 3 Z' Name of Applicant (if utility see belcaw); '^ •-� .. Owner off the foliowin _d s rid id Legal Descri do X/Block ubdivislon Folio #; Address: UTILITYNAME; Qualifier/Authorized Agent: Address: City: State: ZIP: Telephone: Email: State Certification or Registration #: Certificate of Competency CONTRACTOR NAME: tha` L In Le A ld- S`i i=F-t, Qualifier/Authorized Agent: :SO5SS r icy AL o,vSo Address:.A' 3 30 €3 c f '-A.A--f _ city: a 14 L-` A t-t State: � ZIP � Telephone: .�)o'S `r 5D-H i (, b Email: State Certification or Registration #: C %�5j G� 2 S Certificate of Competency #:_ ,way: Lam — Type of Work: D Paving (l Utility Landscape E] Antenna DESIGNER: Architect/Engineer: Address, City: Telephone: _ Registration #: Value of Work for this Permit: $ attach State: Email: N Sidewalk El Electric D Irrigation Q Other: ZIP: �� r right of Square/LinealFootage of Work: _ ^ e• o**I�« fees *4***' Permit Fee $;100.00 Notary $ Training[Educati sn $ 0.20 Technology Fee $ 0.80 Scan I Bonn 5 (if required) Total Fee Now Due $ I Bonding Company Name (if applicable), Bonding Company's Address; 0 City: State: Nis Application is hereby made to obtain a public works permit to do the work in the right of way 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, regulation construction in this jurisdiction. I understand that separate permits must be secured for APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with applicable laws regulating construction and specifically construction in the right-of-way. "'WARNING TO APPLICANT: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO THE RIGHT-OF-WAY. 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 public works permit with an estimated value exceeding $2,500, 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 the attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job sit,- for the first inspection which occurs seven (7) days after the public works permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection will be charged. Signature piica t or Authorized Agent The fon,,,o, was acknowledged before s s s me this day of _ __, 2Q!.S, by _V_Jn�,F —C-11- who is personally known to me or who has produced as identification. 3 is P40TARY OUBLIC: Sign: Print: SEAL, Signature 69 Conl6any/Utility Agent The foregoing instrument was acknowledged before me this 4-4- 20_, c;-, day of IfL_,L t -,, k, , , - L' bY ;6 t"A "s 0 ----,—Who is personally known to me or who has produced identification. NOTARY PUBLIC: Sign: Print: SEAL: 8-atriz Sardinas .l." % � . — _t01 " t�tyCcr3lts�ionGGt327iG SIKDIA ALVAREZ ExpitesVJ1712020 FAY COMMISSION# GG 238273 EXPRM September 3,2022 APPROVED BY: 1A 13�� Public Works Director, or Designee 2017-04-15 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY Whereas, (owner) -,-2 � 2,,-22� d� hereinafter referred to as the owner of the following des_pribed property (address): � Legal Description: Lo r lock ubdivis!pn Requests permission o install dees ibe work the public right of way of (address) 13R 2.9, 11164 F3 2196 (1F'gs i il':' "' ;.i. UJURT IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows: 1. To maintain and repair, when necessary, the above -mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized representative). Signature Agent State of Florida County of Miami Dade The foregoing instrument was acknowledged before me this day of �Cl= , 20 t'�'. r "- who is personally known to me or who has produced 1 �,; , by SINDIA ALVAR�EZ R MY COMMISSION # GG 238273 EXPIRES: September 3, 2022 Babed lhru Notary PuWk Uedenvrlten RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY Flonbb r I dko/ 1104"lk 0�- STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE GENERAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES ALONSO, JOSE FELIPE, AP WELDING AND STEEL MANUFACTURER, CORP. 2330 WEST 80TH STREET, BAY #7 HIALEAH FL 3,3016 LICENSE NUMBER: CGC.1516255 EXPIRATION DATE: AUGU51 31, 7-UZU Always verify licenses online at MyFloridaLicense.com Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. �fl 002962 Local Business Tall Recei t c Miami -Dade County, Stag o Fbrid R Pp -TH!S Is NOT A BILL - 00 NOT PAY 6400774 _ -D BUSINESS NAME/LOCATION RECEIPT NO. AP WELDING AND STEEL MANUFACTURER. Co1ENEIIAL EXPIRES 2330 w 80TH ST7 6668868 SERTEM$ER 30, 2019 HIALEAH FL. 33016 Must be displayed at place of business Pursucntto County Code Chapter 8A — Art. 9 & it) OWNER 'SEC. TYPE OF BUSINESS AP WELDING AND STEEL MANUFACTURER TARP 196 GENERAL BUILDING CONTRACTOR PAYMENT RECEIVED C/O LOSE FELIPE ALONSO QUALIFIER CGC1516255 13v TAX COLLECTOR Worker(s) 1 $45.00 08/30/2018 ECHECK-18-207724 This Local Business Tax Receipt only confirms payment of the Local Business Tax, The Redeiptis not a license, Permit, or a certificatior of the holders qua:ifications, to do business. Holder must comply wish any or nongovernmentalregulatory lawsardrequird*dd Rpvhichapplytoihebusiness. govertlmerttaf The RECEIPT NO; above must be displayed on a;l commercial vehicles_ Miant 1)Ede Cod, S,c 8e-276. For more information, visit www rniamidade oovttsx gl ect2r 58938 ACCO �® CERTIFICATE OF LIABILITY INSURANCE DA12/7/TE DD/Y8 12/7/2018 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 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 Heritage Insurance Services LLC PO Box 1508 Palmetto, FL 34220 CONTACT NAME:ME: Gabe A. Clements PHONENo, / g417231400 FAX(AIC AC No 9417231440 ADDRESS:certificates@heritagefla.com INSURERS AFFORDING COVERAGE NAIC r INSURER A: Kinsale Insurance Co 38920 INSURED AP Welding and Steel Manufact Corp 4150 West 19th Ave Hialeah, FL 33012 INSURER B : INSURERC: INSURERD: 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 LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM POLICY EFF MPS Y EXP LIMITS A GENERAL LIABILITY X X 2297355A 11/17/2018 11/17/2019 EACH OCCURRENCE $ 1000000 x COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES E.occurrence $ 100000 CLAIMS -MADE XIOCCUR X MED EXP (Any one person) $ 5000 PERSONAL & ADV INJURY $1000000 GENERAL AGGREGATE $2000000 GENI AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2000000 $ X I POLICY 7 PRO LOC AUTOMOBILE LIABILITY COBINED SINGLE LIMIT Ea Maccident BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS A UMBRELLALIAB X OCCUR 2304616A 11/17/2018 11/17/2019 EACH OCCURRENCE $ 1000000 X AGGREGATE $ 1000000 EXCESS LIAB CLAIMS -MADE X DEDT I RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is included as an additional insured on a blanket basis as required by written contract (CAS50100717). A waiver of subrogation applies in favor of certificate holder on a blanket basis as required by written contract (CAS4002 0110). CGC1516255 Village of Miami Shores 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 ©1983-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Delivered By EzCOI.com A� V CERTIFICATE OF LIABILITY INSURANCE MMID DATE(YY1^O s/81201/2o1$ 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) Go TLR of Bonita, Inc 700 Central Ave Suite 500 St. Petersburg, �L 33701 CONTACT NAME workers' Comp Department PHONE 727-520-7676 X 3 FAX No): 727-525-3862 E-MAIL AODRE certs�encorehr.com, __ INSURE S AFFORDINGCOVERAGE I NAIC# INSURERA: SUNZ Insurance Com an 34762 INSURED TLR of Bonita, Inc 700 Central Avenue Suite 500 Petersburg FL 33701 INSURER B : _ :St. LINSURER:EnterpriseHR : : GUVCKAIat, ai�n�,rwnr� nvroai�...-,c-rcu�.rr 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.SU POLICY EFF POLICY EXP LIMITS TR TYPE OF INSURANCE 1 POLICY NUMBER MMIDDIYYYY ' M DNYYY I tt 1 COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE s -- EDAM E t } CLAIMS -MADE _ OCCUR i PREMISES (Ea acarrence) 15 f � MED EXP (Any one persos 4 , PERSONAL & ADV INJURY s it— GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s I�i} PRO- �� PRODUCTS-COMP/OP AGG . s POLICY 1 ': JECT LOC s OTHER: I COMBINED SINGLE LIMIT Is 1 AUTOMOBILE LIABILITY SEa 4�.2t) E ANY AUTO BODILY INJURY fer person) is — ? OWNED T SCHEDULED I BODILY INJURY (Per accident)! s r AUTOS ONLY AUTOS ! I PROPERTY DAMAGE 1 s ! HIRED ~� NON -OWNED Per accident AUTOS ONLY AUTOS ONLY Is UMBRELLA IOCCURI .EACH OCCURRENCE s f-.--a i # 1 EXCESS LIAR I CLAIMS -MADE? AGGREGATE $ 4 I S DED RETENTION 5 a A +WORKERSCOMPENSA71ON I } WC016-00001-018 `. 6/1/2018 6/1/2019 L/ STATVTE , ERH I AND EMPLOYERS' LIABILITY YIN `: WCPE0000000113 1 611 /2017 6/1/2018 E L EACH ACCIDENT $1,000 000.00 'ANYPROPRIETORIPARTNERIEXECUTIVE NIA I ?OFFICERIMEMBEREXCLUDED? E.L. DISEASE -EA EMPLOYE s ((Mandatory In NH) ; jj If yes. describe under , E.L. DISEASE - POLICY LkMIT $1 000 000.00 DESCRIPTION OF OPERATIONS belw+ 1 } DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Coverage Provided for all leased employees but not subcontractors of: AP Welding and Steel Manufacturer, Corp. Client Effective: 5/2/2014 CGC1516255 7679 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Villaga of Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 N.E. 2nd Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores FL 33138 AUTHORIZED REPRESENTATIVE d Glen J Distefano ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 42428237 1 TLR Of Bonita, :nc PEO 016 Ys1STER CERT I Andrea Iteluccti 1 6/9/2018 11:47:30 A`! (GTt I Page 1 of 1 45625 Aco v" CERTIFICATE OF LIABILITY INSURANCE ° 66/27' 20 8'' 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 endorsements . PRODUCER Heritage Insurance Services LLC PO Box 1508 Palmetto, FL 34220 NAMEACT Gabe A. Clements PHONE ,9417231400 fAX Nac 9417231440 E-MAIL,,.certificatesgheritagefla.com AODRE INSURE S AFFORDINGCOVERAGE ( NAICtf tNSURERA: Maxum,, Indemnity Ins Co ;26743 INSURED AP Welding and Steel Manufact Corp 4150 West 19th Ave Hialeah, FL 33012 INSURERS: Commerce and Industry Ins Co 119410 INSURERC: ; i INSURERD: INSURERE: ? INSURER F : I COVERAGES carellrlCAIMIYVmccrc: •---•-•-•-- - --- 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 i IADDL SUBR. POLICY EFF POLICY EXP I LIMITS LTR TYPE OF INSURANCE 7 f POLICY NUMBER MM/DDMfYY MMI A [GENERALLU\BIUTY j X 1 X BDG0091003-03 j 11/17/2017 il/17/20.8! EACHOCCURRENCE S 1000000 �— MA TO RE NT E D `$100000 1X COMMERCIAL GENERAL LIABILITY E { 's PREMISES (Ea occurrence) i CLAIMS -MADE IV. OCCUR 1 MED EXP (Any one person) { $5000 i t 1 PERSONAL&ADV INJURY S 1000000 -- GENERAL AGGREGATE52000000 z PRODUCTS- COMP/OP AGG $2000000 I GEN'L AGGREGATE LIMIT APPLIES PER. r— S 1-- `] 7 PRO- } � POLICY : I LOC 4 -COMBINED SINGLE LIMIT 1 AUTOMOBILE LIABILITY # { ((_Ea acddenfl S ! ' , BODILY INJURY (Per Person) ANY AUTO S ALL OWNED SCHEDULED ; 1 BODILY INJURY (Per accident) ( S I AUTOS AUTOS 1 S NON -OWNED PROPERTY DAMAGE I HIRED AUTOS AUTOS 3 (per accident).,- i S i B 1 # UMBRELLAUAB OCCUR EBU 028257562-02 11/17/2017 11/17/20181 EACH OCCURRENCE j $ 1000000 IX ' EXCESS LIAB CLAIMS -MADE X X ; AGGREGATE S 1000000 I AND EMPLOYERS' LIABILITY YIN 1 ANY PROPRIETORMARTNERIEXECUTIVE i OFFICERIMEMBER EXCLUDED? El N I A f (Mandatory In NH) ( If yes. describe under_ __ _ __ TORY LIMI 11 E.L. EACH ACC i ( E.L.DISEASE- I } E.L. DISEASE - I DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Certificate holder is included as an additional insured on a blanket basis as required by written contract (CG 2033 0413). A waiver of subrogation applies in favor of certificate holder on a blanket basis as required by written contract (E919 0211) CGC 15i6255 ;ERTIFICATE HOLDER village of Miami Shores 10050 NE 2nd Ave Miami Shores, FL 33138 ACORD 25 (2010105) 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 01988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Delivered By &COI COO 11 City of City of Hialeah H L E A Business Tax Receipt 2018-19 Mayor Carlos Hernandez No: 236115-48 (OLD-1521-546) mount: $ 200.00 The person, firm or corp. listed here has paid the business tax required to engage in or operate the business specified subject to the regulations and restrictions of the City of Hialeah. Florida Owner: JOSE FELIPE ALONSO TipeofBusiness: New Single -Family Housing Construction (except Operative Builders) AP WELDING AND STEEL MANUFACTURER CORP. Business Location, 2330 W 80 ST #7 HIALEAH, FL 33016 2330 W 80 ST 7 Validating No. 457382 Expires September 30, 2019 THIS IS NO T A BILL