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RC-18-2060— - L / i n ii/v'7s q/zIlY, S — �.uo Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 yF' Phone: (305)795-2204 [OR'lDp' Permit NO. IBC-$-18-2060 Perot Type: Residential Construction enlilWork Classification: Alteration Permit status: APPROVED Issue Date: 8/2/2018 1 Expiration: OV29/2019 Project Address Parcel Number Applicant 289 NE 104 Street 1121360130610 GOODNIGHT MIAMI LLC Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell GOODNIGHT MIAMI LLC 289 NE 104 Street (305)898-9085 MIAMI SHORES FL 33138-2015 289 NE 104 Street MIAMI SHORES FL 33138-2015 Contractor(s) Phone Cell Phone DI OBRA CONSTRUCTION CORP (786)355-7999 In Review Date Approved:: In Review Date Denied: Type of Construction: INTERIOR REMODEL INCLUDING I Occupancy: Single Family Exterior: Front Setback: Left Setback: Bedrooms: Plans Submitted: Yes Certificate Date: Fees Due Amount CCF $0.00 Copies $41.85 DBPR Fee $0.00 DCA Fee $0.00 Education Surcharge $0.00 Lost Plans Fee $225.00 Notary Fee $5.00 P&Z Review Fee $0.00 Permit Fee $450.00 Scanning Fee $0.00 Technology Fee $0.00 Total: $721.85 Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Valuation: $ 15,000.00 Total Sq Feet: 250 Pay Date Pay Type Amt Paid Amt Due Invoice # RC-8-18-68411 08/01/2018 Credit Card $ 50.00 $ 671.85 08/02/2018 Credit Card $ 671.85 $ 0.00 Available Inspections: Inspection Type: Window Door Attachment Framing Insulation Drywall Screw Final PE Certification Window and Door Buck Fill Cells Columns Review Building Review Planning Review Electrical 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: 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. /"V�1 11 August 02, 2018 Audit odied Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy August Miami Shores Village RECEIVED Building Department AUG 2 0 2018 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �) a Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FDA. 20 I -3 BUILDING Master Permit No. kC_ 4- ao6 0 PERMIT APPLICATION Sub Permit No. %BUILDING F_� ELECTRIC ROOFING REVISION E] EXTENSION RENEWAL F-IPLUMBING ❑ MECHANICAL PUBLIC WORKS W_HANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOBADDRESS: S /l / l O S -f-- City: Miami Shores County: Miami Dade zip: 3 13 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): �Q� r 1 C et�tgi Phone#: Address: a c�' cl ��t o Y .S,f " City:t'Ct.Nn. S h s/ e S state: �L zip: 3.3 Tenant/Lessee Name: Email: hone#: CONTRACTOR: Company Name: ��. �T//ui}9.^/r Phone#: 7�"I !�f % �- Address: City: �19C Ti, /'l is c L- —_ a_ G 4 -�-�State: PL Zip: Qualifier Name: Moon cts b � 1 erry, "..? 4 1y Phone#: State Certification or Registration #: CGG l pSa l a y Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State:-7 Zip: Value of Work for this Permit: $ �� �Oa Square/Linear Footage of Work: J �o Zv Type of Work: ❑ Addition ❑ Alteration pp ❑JJ New ❑Repaair/Replace ❑, lDemolition Description of Work: 7i72 el_1rd/ rl e/%10 d��t� ���TGh Pn qvz of T ti`/, Specify color of color thru the: Submittal Fee $ Scanning Fee $ Permit Fee $ CCF $_ Radon Fee $ DBPR $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ _ (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 City State Zip 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 charge Signature OWNER or AGENT The foregoing instrument was acknowledged before me this day of �( 20 by C1 P/s personally known to me or who has producedEd j �lX/► ► as identification and who did take an oath. NOTARY PUBLIC: MAHARAIK.GONZALEZ ISSION # GG 044602 Si MY COMM ~' ters Print: �: ac EePThruNotaryPublicUnderHri Seal: d. Signature CONTRACTOR The foregoing instrument was acknowledged before pe this day of ((20 by ho is p r. aI ry own to me or who has produced J 7 as identification and who did take an oath. NOTARY PUBLIC: Si MAHARAI K. GONZALEZ ?2. = MY COMMISSION # GG 044602 Print: N:FXPIRES7 November 2. 2020 FO v ° ' Bonded Thru Notary Public Underwriters Seal: ********ssssss*r****sssr*:*****s***�.as**s**********�s**s***********r***r**►*******•**s***s*******sssss*s**# APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami shores Village Building Department 1'0050 N.E.2nd Avenue Miami Shores, Florida 33138 Tei: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. W-C 6 is , 2"460 Owner's Name (Fee Owner's; Address: .City: �l �P�t Job Address (Of where work,, is being (tone): - City Miami Shores Contractor's Com{ Address: 1i City:: Qualifier't Name.:, State: 41or°ida Zip Code Phone State: Zip i Uc. Number: Architect/ Engineer of Record Name: Phone'#:. Address: 3 City: State: Zip Code:, Describe Woric hereby certify that, the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores ,harmless of all legal involveme t. Signature - Signature — /�-* Owner crAAgent Contractor or The :foregoing instrument:was aknowle ed before me The for oing instrument was aknowiedged before me tit this bay of�`s1 ,201?,hy ��(i�l� ��ff� this! day of � � 20' 1Nho ispersonally'k to aae or who;has produced who{ni�s.``personaliy known-to� r who has produced A as indentification. LA � icu csC. asindentification. Notary Ptl*,, a U/i D%) J, U LRAMM WCMUNIMM941411 e)T- C 0 k S C 7�ei) s Aic 8ao-l� s�'e 0� Ply c6c,t6 bcae 8� ,a 4,Ttll rye s D wt a 5 I ®vyr�r 4 l y �ePaseS a s 71t,� 4e er s4e- I 1 6, 1 wogktivtl 001 rro ed l 9 e ct ist a, (--eci Swo�h �er-b,(\ MF" /o Y s� SZOVOf 3313E be,�Or-2 '�'� �'S 2 o c� �' `-'i � 2 �v 0� g �rh oOmGS D � l p YYl ���`� iNho P rfJC9�Se ou; MAHARAI K. GONZALEZ MY COMMISSION # GG 044602 N; *: EXPIRES: November 2, 2020 -=.',; F o? Bonded Thru Notary Public Underwriters 4 �r Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner —Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: _aA/2� Owner State of Florida County of Miami -Dade •ir?'v,P e'• MAHARAI K. GONZALEZ MY COMMISSION # GG 044602 O ,0 EXPIRES: November 2, 2020 Bonded Thru Notary Public Underwriters The foregoing was acknowledge before me this _� day of , 20� By �� ,1 D I ( y \ who is personally known to me or has produced as identification. Nota SEAL: 4 BUILDING PERMIT APPLICATION *BUILDING ❑ ELECTRIC 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 FBC 20 Master Permit No. RG 7- Sub f9'� Sub Permit No. ❑ ROOFING ❑ REVISION ❑ EXTENSION *RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION [:]SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 289 N.E. 104th Street City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-2136-013-0610 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Goodnight Miami, L.L.C. Phone#: 305-898-9085 Address: 289 N.E. 104th Street City: Miami Shores State: FL Zip: 33138-2015 Tenant/Lessee Name: Email CONTRACTOR: Company Name: Di Obra Construction, Corp. Address: 9350 Fontainebleau Blvd C-612 City: Miami State: FL Qualifier Name: Rensso Lopez State Certification or Registration #: CGC 1504181 DESIGNER: Architect/Engineer: Add one#: one#: 786-355-7999 _Zip: 33172 ne#: 786-355-7999 Certificate of Competency #: City: Phone#: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑■ Repair/Replace ❑ Demolition Description of Work: Interior Remodeling Kitchen & Bathrooms. _76 7-n— 1'4 - I �( 10 Specify color of color thru tile: c Submittal Fee $.J-0 ' C� Permit Fee $_ �" CCF $ CO/CC $ Scanning Fee $ Technology Fee $ Radon Fee $ Training/Education Fee $ DBPR $ Notary $ 5 c� Double Fee $ Structural Reviews $ Bond $ L-rj- `C F(-0,NS : 22S • w TOTAL FEE NOW DUE $ (Revised02/24/2014) CA-;>C-vz—S -- c-f L S Bonding Company's Name (if applicable) N/A Bonding Company's Address City State Mortgage Lender's Name (if applicable) _ Mortgage Lender's Address City State Zip Zi 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 190TRia�TCI"I The foregoing instrument was acknowledged before me this t> 1 day nnof/�� ,^� AISGU S- 20 , , by W 6 i S day of J�. AU GV � 20 18 by Tjc C �,1(�i1 'vim who i is known to �1� I�S—`fl E z , who is personally known to me or who has produced L— (1°l "pr— as me or who has prod u�e ii Sass identification and who did take an oath. NOTARY Sign Print Seal: S P00 Na Notary Public State of Florida Sindia Alvarez My Commission FF 156750 OF Expires 09/031201 a c"JAPPROVED BY f Plan Signature CONTRACT The foregoing instrument was acknowle,ggged before me this � PP identification and whb did take an oath. NOTARY PUBLIC: Sign: (� Print: t\II-,l eal: y #0 °k* Notary Public State of Florida it ;4 Sindia Alvarez 1 1 My Commission FF 156750 K. } Fa Expires 09/03/20118 s Examiner Zoning (Revised02/24/2014) Structural Review Clerk Property Search Application - Miami -Dade County Page 1 of 1 OFFICE OF THE PROPERTY APPRAISER Summary Report Property Information Folio: 11-2136-013-0610 Property Address: 289 NE 104 ST Miami Shores, FL 33138-2015 Owner ROC ACQUISITIONS LLC Mailing Address ........................................... 4311 SW 16 ST MIAMI, FL 33134 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 2,177 Sq.Ft Living Area 1,433 Sq.Ft Adjusted Area 1,855 Sq.Ft Lot Size 9,225 Sq.Ft Year Built 1938 Assessment Information Year 2018 2017.2016 Land Value $230,638 $230,638 $198,007 Building Value $129,108 $129,1081 $129,108 XF Value $0 $0 $0 Market Value $359,746 $359,746 $327,115 .............................. Assessed Value $343,483 $312,258, $283,871 Benefits Information Benefit Type 2018 2017 2016 Non -Homestead Assessment $16,263 $47,488 $43,244 Cap Reduction Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description MIAMI SHORES SEC 5 PB 10-47 LOT 21 & W1/2 LOT 22 BLK 120 LOT SIZE 75.000 X 123 OR 15601-0790 0792 4 Generated On : 8/1/2018 Taxable Value Information 20181 2017 2016 County Exemption Value $0 $0 $0 Taxable Value $343,483 $312,258 $283,871 School Board Exemption Value $0 $0 $0 Taxable Value $359,746 $359,746 $327,115 City Exemption Value $0 $0 $0 Taxable Value $343,483 $312,258 $283,871 Regional Exemption Value ._..............._... .... Taxable Value $0I $343,483I $0 _._....... _ _ $312,258 l$0 .........-.. $283,871 Sales Information Previous OR Book - Price Qualification Description Sale Page 28417- Corrective, tax or QCD; min 12/17/2012 $0 4472 consideration 28417 12/17/2012 $330,000 Partial interest 4470 ______.... -............... _. _._. ................... ...... 15601- __.................. ......... ..__.......... Sales which are disqualified as a result 07/01/1992 $0 0790 of examination of the deed 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 hftp://www.miamidade.gov/info/disclaimer.asp Version https://www.miamidade.gov/propertysearch/ 8/1/2018 This Instrument was Prepared By and Record and Return To: David A. Messinger, Esq. Steams Weaver Miller Weissler Alhadeff & Sitterson, P.A. 150 West Flagier Street Suite 2200 Miami, Florida 33130 Property Appraiser Identification No: 11-2136-013-0610 CFN 201 BRO448013 OR 8K. 31074 P9s 173-175 QPss) RECORDED 07/25/2018 12:49:58 DEED DOC TAX $2650.00 HARVEY RUVIN, CLERK. OF COURT MIAMI-DADE COUNTYY FLORIDA SPECIAL WARRANTY DE THIS SPECIAL WARRANTY DEED made this day of July, 2018 between DREW M. DILLWORTH, not individually, but solely as the Chapter 7 Bankruptcy Trustee for the Bankruptcy Estate of the Debtor, Peter Cura under Case No.17-24303-LMI, in the U.S. Bankruptcy Court for the Southern District of Florida, Miami Division whose mailing address is c/o Stearns Weaver Miller Weissler Alhadeff & Sitterson, P.A., 150 West Flagier Street, Suite 2200, Miami, FL 33130 (the "Grantor") and GOODNIGHT MIAMI LLC, a Florida limited liability company, whose mailing address is 289 N.E. 1041 Street, Miami Shores, FL 33138 (the "Grantee"). WITNESSETH• That Grantor, for and in consideration of the sum of TEN DOLLARS ($10.00) and other good and valuable consideration, to Grantor in hand paid by Grantee, the receipt and sufficiency whereof is hereby acknowledged, does hereby grant, bargain, sell, alien, remise, transfer, release, convey and confirm unto Grantee and Grantee's successors, heirs and assigns the real property (the "Property") located in Miami -Dade County, Florida, and more particularly as follows: Lot 21 and the West 1/2 of Lot 22, Block 120, An Amended Plat of Section No. 5 of Miami Shores, according to the map or plat thereof, as recorded in Plat Book 10, Page(s) 47, of the Public Records of Miami -Dade County, Florida. SUBJECT TO: 1. All easements, conditions, covenants, restrictions, reservations, limitations, agreements and other matters of record, provided that this instrument shall not reimpose same. 2. Real estate taxes for the year 2018 and all subsequent years. 3. Matters that would appear on a current and accurate survey of the Property. 4. Existing applicable governmental building and zoning ordinances and other governmental regulations. #6655674 v137150-0038 Pi Book31074/Page173 CFN#20180448013 Page 1 of 3 TOGETHER with all the tenements, hereditaments and appurtenances belonging or in any way appertaining to the Property, TO HAVE AND TO HOLD the same in fee simple forever. AND GRANTOR hereby covenants with Grantee that Grantor is lawfully seized of the Property in fee simple; that Grantor has good right and lawful authority to sell and convey the Property; and that Grantor does hereby specially warrant the title to the Property and will defend the same against the lawful claims of all persons claiming by, through or under Grantor, but against none other. The Property is being conveyed free and clear of all liens in accordance with and pursuant to: (a) the Order Granting Trustee Dillworth's Emergency Motion to Approve Proposed Sale of Estate's Right, Title and Interest in Real Property as to the Bankruptcy Estate of Peter Cura under Case No.17-24303- LMI in the U.S. Bankruptcy Court for the Southern District of Florida, Miami Division; (b) the Order Granting Trustee's Emergency Motion: 1) For Order Approving Sale of Estate's Right, Title and Interest In Real Property Free And Clear Of Lines, Interests And Encumbrances (Other Than Those of Miami Shores Village); and, 2) Modify Order Granting Trustee Dillworth's Motion To Approve Sale Of Estate's Right, Title And Interest in Real Property as to the Bankruptcy Estate of Peter Cura under Case No.17- 24303-LMI in the U.S. Bankruptcy Court for the Southern District of Florida, Miami Division; and (c) Amended Agreed Final Judgment for Bankruptcy Estate of Peter Cura, Debtor under Case No. 17-23403- LMI in the U.S. Bankruptcy Court for the Southern District of Florida, Miami Division. [REMAINDER OF PAGE LEFT INTENTIONALLY BLANK] [SIGNATURE AND NOTARY BLOCK ON FOLLOWING PAGE] Book31074/Page174 CFN#20180448013 Page 2 of 3 OR BK 31074 PG 175 LAST PAGE IN WITNESS WHEREOF, Grantor has caused this Special Warranty Deed to be executed on the day and year first above written. WITNESSES: W' ess Signature 40 �AN6 if 14dw2— Print Name of Witness " /—N, Witness Tt ffiture All%, �r 5S Print Name of Witness - STATE OF FLORIDA COUNTY OF MIAMI-DADE DIMW 4. DH LWORTH, not individually, but solely aWthe Chapter 7 Bankruptcy Trustee for the Bankruptcy Estate of the Debtor, Peter Cura under Case No.17-24303-LMI, in the U.S. Bankruptcy Court for the Southern District of Florida, Miami Division ACKNOWLEDGMENT The foregoing instrument was acknowledged before me this _g day of July, 2018, by DREW M. DILLWORTH, not individually, but solely as the Chapter 7 Bankruptcy Trustee for the Bankruptcy Estate of the Debtor, Peter Cum under Case No.17-24303-LMI, in the U.S. Bankruptcy Court for the Southern District of Florida, Miami Division. He is personally known to me or presented a driver's license as identification. Notary Stamp/Seal: PRANCISESI M W COWASNON f Ff 1186141 EMPIRES: Ocftw 24, 2018 Bo�dd7tnNOWyPuMboft b. No Public, State ffFlorida Pil ' t or Stamp Name: :Fmys �a.p My Commission Expires: Oct Z* 2DIk Book31074/Page175 CFN#20180448013 Page 3 of 3 Detail by Entity Name Page 1 of 2 Florida Depaitinent of State Department of State / Dw-sion of Corporations / Search Records / Detail By Document Number / Detail by Entity Name Florida Limited Liability Company GOODNIGHT MIAMI LLC Filing Information Document Number L11000126669 FEI/EIN Number 45-3783863 Date Filed 11/07/2011 Effective Date 11/01/2011 State FL Status ACTIVE Principal Address 1000 Brickell Avenue 1020 MIAMI, FL 33131 Changed: 04/13/2018 Mailing Address 1000 Brickell Avenue 1020 MIAMI. FL 33131 Changed: 04/13/2018 Registered Aaent Name & Address BALOYRA, PATRICIA 1000 Brickell Avenue 1020 MIAMI, FL 33131 Address Changed: 04/13/2018 Authorized Person(s) Detail Name & Address Title MGRM BALOYRA, PATRICIA 1000 Brickell Avenue 1020 MIAMI, FL 33131 Dro.si q oF. CO'YPORPOiONS http://search.sunbiz.org/Inquiry/CorporationSearchISearchResultDetail?inquirytype=Entity... 8/ 1 /2018 Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. x COPY OF QUALIFIER'S STATE LICENCES B. x COPY OF LOCAL BUSINESS TAX RECEIPT C. x COPY OF LIABILITY INSURANCE* D. x COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. ........................................................................................... BUSINESSNAME: Di Obra Construction, Corp. BUSINESS ADDRESS: 9350 Fontainebleau Blvd C-612CITY Miami STATE FL ZIP 33172 BUSINESS PHONE: ( 786 ) 3 5 5- 7 9 9 9 FAX NUMBER ( ) n/ a CELL PHONE ( ) QUALIFIER'S NAME: Rensso Lopez QUALIFIER'S LIC NUMBER: CGC 1504181 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION. INDUSTRY LICENSING BOARD I _ CGC1504181 004469 Loci Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT. A BILL - DO NOT PAY 4795218 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES DI OBRA CONSTRUCTION CORP RENEWAL SEPTEMBER 30, 2018 9350 FONTAINEBLEAU BLVD C612 5005806 Must be displayed at place of business MIAMI FL 33172 Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED DI OBRA CONSTRUCTION CORP 196 GENERAL BUILDING CONTRACTOR BY TAX COLLECTOR C/O LOPEZ'RENSSO... CGC1504181 •. -n •-- Worker(s) t - $7�0D` 07j2I'J2017.c:'_ ': CHECK21-17-070727 This Local Business Tex Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit or a certification of the holders qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0, above must be displayed on all commercial vehicles - Miami -Dade Code Sec 6a-276. For more information, visit www.miamidade.ggyltaxcollector ACORir CERTIFICATE OF LIABILITY INSURANCE `.✓� DATE(MWOD/YYYY) 08/01 /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 CONTACT NAME: Kelly Brown PHONE (772) 559-5334 FAX No): (813) 433-5377 Charlie Brown and Associates Inc. AE-MAILDDRESS6 kelly.walterl@yahoo.com 1827 River Watch Blvd. INSURERS AFFORDING COVERAGE NAIC # Tarpon Springs, FL 34689 INSURER A : United Specialty Insurance Company Phone (772) 559-5334 Fax (813) 433-5377 INSURED INSURER B : INSURER C : Di Obra Construction Corp INSURER D : 9350 Fountainebleu Boulevad #C612 Miami FL 33172 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 I UBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMBS A ❑ COMMERCIAL GENERAL LIABILITY ❑ CLAIMS-MADE OCCUR N N S111008A227481 07/02/2018 07/02/2019 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED PREMISES Ea occurrence $ SO,000.00 MED EXP (Any one person) $ 0 0.00 ❑ PERSONAL $ ADV INJURY 1 $ 1 OO,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: ❑ � POLICY ❑ PRO ❑ LOC JECT ❑ OTHER GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS - COMP/OP AGG $ 1,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO OWNED SCHEDULED ❑ AUTOS ONLY ❑ AUTOS ❑HIRED ❑ NON -OWNED AUTOS ONLY AUTOS ONLY ❑ ❑ COMBINED SINGLE LIMIT Ea accident)$ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ ❑ UMBRELLA LIAB [—]OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A ❑ PERTUTE ❑ OTH- T ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) License# CGC1504181 Rensso Lopez CERTIFICATE HOLDER CANCELLATION Miami Shores Village Bldg Dept. 10050 N.E. 2nd Avenue 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 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) OF The ACORD name and logo are registered marks of ACORD AeO ,Of CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/30/2018 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 terns 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 FrankCrum Insurance Agency, Inc. 100 South Missouri Avenue Clearwater, FL 33756 CONTACT NAME: PHONE A/C, No, Ext : 800 277-1620 X 4800 FAX A/C, No): 727 797-0704 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: Frank Winston Crum Insurance Company 11600 INSURED FrankCrum L/C/F Di Obra Construction Corp. 100 South Missouri Avenue Clearwater, FL 33756 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 492260 REVISION NUMBER: 1 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 INSRD SUER WVD POLICY NUMBER POLICY EFF (MWDD/YYYY) POLICY EXP (MM/DO/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE aOCCUR DAMAGE(Ea occurteRENTED nce) PREMISESS $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ GEN'L PRODUCTS-COMP/OP AGG $ POLICY O PROJECT a LOC OTHER: $ AUTOMOBILE LIABILfTY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Per person) $ ANY AUTO OWNED AUTOS SCHEDULED ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED AUTOS NON -OWNED ONLY AUTOS ONLY UMBRELLA UAB OCCUR EACH OCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N WC201800000 01/01/2018 01/01/2019 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $1 000 000 ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) If yes, describe under E.L. DISEASE -EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Effective 08/31/2015, coverage is for 100% of the employees of FrankCrum leased to Di Obra Construction Corp. (Client) for whom the client is reporting hours to FrankCrum. Coverage is not extended to statutory employees. (Client reference: Carpentry: General Contractor License Number: CGC1504181). Re: Ms. Patricia Baloyra CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village Bldg. Dept. Attn: Rensso Lopez 10050 N.E. 2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1 q - % RECEIVED AUG 13 2018 0'1� dv-� A�q vz . k �? k4p)e" kyWt-'o T4?� T)% oftA t5 m- 2-M tAC - kOA-!w u`\-mCk c�6�s fD\-k -0 (p - (0\ ��o uAt, �e Vafn"-) � qoWrt. A- c�nr,qrc-