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MC-16-3177t `S�aOREt �� Miami Shores Village 10050 N.E. 2nd Avenue NE " Miami Shores, FL 33138-0000 Phone: (305)795-2204 �oRtnA Permit NO. MC-11-16-3177 tPermit Type: Mechanical - Residential er v4t rkCtassification: Addition/Alteration Permit Status: APPROVED Issue Date:1218120'16 1 Expiration: 06/06/2017 Project Address Parcel Number Applicant 1037 NE 91 Terrace 1132050010050 Miami Shores, FL Block: Lot: ALISON HARKE Owner Information Address Phone Cell ALISON HARKE 1037 NE 91 TERR MIAMI SHORES FL 33138-3401 Contractor(s) Phone Cell Phone RAA SERVICE CORP (305)554-4482 Info: VENTILATION, REPLACEMENT REF LINE ion: Residential oved: In Review ments: Denied: ning: 1 Fees Due Amount CCF $13.80 DBPR Fee $12.08 DCA Fee $12.08 Education Surcharge $4.60 Permit Fee $805.00 Scanning Fee $3.00 Technology Fee $18.40 Total: $868.96 Valuation: $ 23,000.00 Total Sq Feet: 0 Date Approved:: In Review Type of Work: VENTILATION, REPLACEMENT REF Pay Date Pay Type Amt Paid Amt Due I Invoice # MC-11-16-62132 12/08/2016 Check #: 1605 11/21/2016 Credit Card $ 818.96 $ 50.00 $ 50.00 $ 0.00 Avauame Inspection Type: Final 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. December 08, 2016 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy December 08, 2016 1 0 N 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 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING ECEIVE:D NOV 21 2016 � � 1 FBC 20 14 Master Permit No. P, C Sub Permit No. Mc -3137' ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING Z"MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 103-7 4)o !2I S/ — City: Miami Shores County: Miami Dade Zip: -.3 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Address: City: Tenant/Lessee Name: Email: CONTRACTOR: Company Name: /L- Address: 12 &0 5U) /--' n City: li1F- QualifierName: State Certification or Registration #: DESIGNER: Architect/Engineer: State: sal Phone#: Zip: Phone#: hone#: is -232—(� Zp/ State: 1/Z Zip: 'fj9 Phone#: Certificate of Competency #: Address: City: State: Value of Work for this Permit: $ 2 3,151 o O Square/Linear Footage of Work: Type of Work: ❑ Addition 0 Alteration ❑ New ❑ Repair/Replace Description of Work: Specify color of color thru tile: Zip: ❑ Demolition ram, Submittal Fee $ oa1 C Permit Fee $ V, 11 ..,- CCF $ 1 3. ab CO/CC $ Scanning Fee $ Radon Fee $ di ppD��BPR $( `,,1 �- - � K Notary $ Technology Fee $ _ Training/Education Fee $ L? Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ < q (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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature q&-4i61axt OWNE r AGENT The foregoing instrument was acknowledged before me this 2—/ day of -A ) d V 0 A L1/ i� , 20 by woy known m r who has produced as identification and who did take an oath. NOTARY PUBLIC: omm-50 Signature !� /�y 79 CON RACTOR The foregoing instrument was acknowledged before me this ( dayof Ncye kk Ir 20 Ito , by pwyty who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Prin : c), — Print: Seal:. • :� •�': �; SANDI PENA Seal:: r*r Not ry Pubk State of Florldu My COMMISSION #FF163783 � F952774 .� c9, ar, EXPIRES September2$,,2Ai8, .` d� ati Expine02J07/2020 (407)398-0153 Fo[+dallotaryService.comTM� APPROVED BY I Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT, GOVERNOR STATE OF FLORIDA KEN LAWSON, SECRETARY ALFONSO,.,ROBERTO°ANDqEf',' R.A,A.'SERVICE`C0RP,,.-' 12160SW 132N6-CTiS'TEJ03 lie- 4m. I I MIAMF- FL 331W 1 ISSUED: 08/0212016 DISPLAY AS REQUIRED BY LAW SEQ # L1608020000891 =-WGW9W,`S CRE-TAKY RICK SCOTT, GOVERNOR STATE OF FLORIDA OF BUSINESS AND PROFESSIONAL REGULATION roi irTinm iNnUSTRY'LICENSING BOARD qMC125bl2g The MECHANICAL CONTRACTOR Named below IS CERTIFIED IFIED ...... Und6r the provisions of -Chapter 489 FS. Expiratibn'date: AUG -31C2018 dw u ALFON ,0;,f:tflBERTOAliDR"E-�S""�" Rlk.A7SERVICE,'CORP.a1.-l', 12360'SW 1321415-d-T;ST 163' -- N11 MIAMI- -ft,3ai861' xc X ISSUED: 08102/2016 DISPLAY AS REQUIRED BY LAW SEQ # L1608020001584 KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF mjqJhl=QQ AMIN b0f%Cr-0&lf%&lAl 620216 - Under the PMvisiohs of Chapter 489,FS. Expiratl6n date:- AUG',31-,,'2018 ff ALFON8b.-.ROBERT0 -DR' AN P.Kk SERVICE-,tORP 12360SW,j D 32N-CT,STE-103' _ I Ml- `Ft 86,1 % 941 ISSUED, 08/0212016 DISPLAY AS REQUIRED BY LAW SEQ # L1608020001302 005419 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 7122773 BUSINESS NAME/LOCATION RECEIPT NO. R A A SERVICE CORP RENEWAL 12360 SW 132 CT STE 103 7400120 MIAMI FL 33186 LBT EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter 8A -Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS R A A SERVICE CORP 196 GENERAL MECHANICAL CONTRACTOCAYMENT RECEIVED CMC1250129 Y TAX COLLECTOR Worker(s) 1 $75.00 08/03/2016 ECHECK-16-172471 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 6a-276. Formore information, visit AMWIniamidade noyaaxcollector 004206 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6394043 LBT BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES R A A SERVICE CORPORATION RENEWAL SEPTEMBER 30, 2017 12360 SW 132 CT STE 103 6661954 Must be displayed at place of business MIAMI FL 33186 Pursuant to County Code Chapter 8A -Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS R A A SERVICE CORPORATION 196 SPEC MECHANICAL CONTRACTOR PAYMENT RECEIVED CAC1816116 BY TAX COLLECTOR Worker(s) 1 $75.00 08/03/2016 ECHECK-16-172469 This local Business Tax Receipt only confirms payment of the local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed an all commercial vehicles - Miami -Dade Code Sec as-276. For more information, visit wowwow miam collector 005231 Local Business Tax Receipt Miami —Dade County, State of Florida —THIS IS NOT A BILL —DO NOT PAY 7035348 LBT- BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES VA SERVICE CORP RENEWAL SEPTEMBER 30, 2017 12360 SW 132 CT STE 103 7311475 Must be displayed at place of business MIAMI FL 33186 Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS RAA SERVICE CORP 196 GENERAL BUILDING CONTRACTOR PAYMENT RECEIVED CGC1520236 BY TAX COLLECTOR Worker(s) 1 $75.00 08/03/2016 ECHECK-16-172468 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must he displayed on all commercial vehicles- Miami -Dade Code Sec Ba-276. For more information, visit www.miamidade.aovRexcollector ® ACORV CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 11/03/2016 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 pollcy(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 AUTOMATIC DATA PROCESSING INSURANCE AGENCY, INC. 1 ADP BOULEVARD Roseland, NJ 07068 CONTACT NAME PHONE FAX Ne: MAIL INSURER S AFFORDING COVERAGE NAIC i INSURER A: INSURED R. A. A. Service Corp 12360 SW 132 Court Ste 103 Miami, FL 33186 INSURERB: NorGUARD Insurance Company _ 1470 INSURER C INSURER0: INSURERE: INSURER F : 1_nVF0Ar%;:8 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 POUCIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS COMMERCIALOENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR ED a occ rrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG POLICY PECT LOC $ $ OTHER: AUTOMOBILE LIABILITY CO(EaaccideDSINGLE LIMIT $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per socide t) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE (Per accident E __ E UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LLAB CLAIMS -MADE DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANYPROPRIETORIPARTNERIEXECUTIVE Y I N OFFICERIMEMBEREXCLUDED? ❑Y (Mandatory in NH) NIA RAWC778322 08/20/2016 08/20/2017 X STTAATUT OTH- E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ 500.000 M yes describe under DESCRIPTION OF OPERATIONS belTnL_-T I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Exclusions: Roberto -Alfonso; c MIAMI SHORES VILLAGE, BUILDING DEPARTMENT 10050 NE 2nd Ave TEL: 305-795-2204 Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE lip►✓ �C/ �-�.------� w Iwoe -2Vl l gMVrtl/ a.Vrtrvrv+ nvr�. ran r aynaa .a:��.. ��. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AC"RD CERTIFICATE OF LIABILITY INSURANCE �TEI1110S120 g 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 holier Is an ADDITIONAL INSURED, the pollcy((es) must be endorsed. N SUBROGATION IS WAIVED, subject to the tams and conditions of the policy, certain policies may require an endorsement. A statemeu on this certificate does not confer rights to the certifcate holder In lieu of such endorsemengs). PRODUCER Accurate 8300 West Flagler Suite 114 Miami, FL 33144 Phone (305)226-8727 Fax (305)226-8767 Lucia Estrella PHONE(305)226-8727 0; (305)226 8767 Man Iuciaeoslia®beffsoulhnet AFFORDING COVERAGE NAIC / -INSUREIRiSl INSURER A: United Specialty Insurance Co. INSURED R.AA. Service Corp. 12360 SW 132 Ct Suite 103 Miami FL 33166 INSURER B : Mg R R C : INSURER 0: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. INSLTR R TYPE OF INSURANCE W UBR POLICY RUMBER Iakm PO LIMITS A 0 COMMERCIAL GENERAL LIABIL" ❑ cEJdM3 MADE RI OCCURPREMISES ❑ ❑ GEWL AGGREGATE LIMIT APPLIES PER: ® POLICY El JPE ❑ LOC ❑ OTHER AVGKO4587878 01/25/2016 01/25/2017 EACH CCURRENC f 1,000,000.00 f 100,000.00 MEO EXP am s 5.000.00 PERSONAL aADV INJURY s 1,000.0W•0 GENERAL. AGGREGATE $ 1,000,000.00 PRODUCTS -COMP/OPAM S 1,000,000.00 f AUTOMOBILE LABILITY ❑ ANY AUTO ALL OWNED ❑ AUTOS ❑ SCHEDULED AUTOS WL� HONO❑- HIRED AUTOS ❑ AUTSV/NED .WanilLE LIMIT BODILY INJURY (Per parson) s BODILY INJURY (Per f pERTY eor�da s i ❑ UMBRELLA LIAR OCCUR ❑ EXCESS LIAR ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE f DED ❑ RETENTIONS f WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIET RIPARTNERIEXECUT OFFICERIMEMB EXCLUDED? (Mandatory in NH) If yes, desedbs under DESCRIPTION OF OPERATIONS Wow R I A FITTH- E.L. EACH ACCIDENT f E.L. DISEASE - EA EMPLOYEI S EL DISEASE - POLICY LIMIT f DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 141, Additbnal Remarks Saboduts, N men space is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 1 D050 NE 2nd Avenue Miami Shores, Florida 33138 Tel: 305-795-2204 Fax: 305-756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF E WILL BE DELIVERED IN ACCORDANCE WITH THE POLIO VI AUTHORIZED REPRESENTATIVE Lusia Estrella 01288-2014 AD riohts reserved. ACORD 25 (2014/01) OF The ACORD name and logo are registered marks of ACORD A� o" CERTIFICATE OF LIABILITY INSURANCE °"� 1/2 r o 6 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. fi 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 endomement(s). PRODUCER NAWRIACT ME. Automatic Data Processing Insurance Agency, Inc. iu N Ext : AAICC, No): ADDRESS: 1 Adp Boulevard Roseland, NJ 07068 INSURER(S) AFFORDING COVERAGE NAIC N INSURER A: NorGUARD Insurance Company 31470 _ INSURED R.A.A. SERVICE CORP 12360 SW 132 CT STE 103 INSURER e INSURER c : Miami, FL 33186 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 554795 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 INSO 3UB" WVD POLICY NUMBER POLICY MMIDD F Y EXP MM/DCONYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE f CLAIMS -MADE OCCUR PREMISES Ea occurrence f MED EXP (Any one person) f PERSONAL S ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY n PRO-- LOC PRODUCTS-COMP/OPAGGOTHER: L$��- AUTOMOBILE LIABILITY EaM'eccldent If BODILY INJURY (Per person) f ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) f Perac dan�AGE f NON,OWNED HREDAUTOS AUTOS s UMBRELLA LIAR OCCUR EACH OCCURRENCE f AGGREGATE f EXCESS LIAR _ CLAIMS -MADE f DED RETENTION s A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY IN ANY OFFICERIMEM EREXCLUDED �TIVE Y� (Mandatory In NH) NIA N RAWC778322 08/20/2016 08/20/2017 X OTH STATUTE ER E.LEACH ACCIDENT f 1,000,000 E.L. DISEASE - EA EMPLOYEE f 1,000,000 It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addltimal Remarks Schedule, may be attached I more space Is required) Contractor License: License # CMC1250129/CAC1816116 Exclusions: Roberto Alfonso 6CKIIrIGAIr: MVLUtK GANGELLATIUN Building Deparment 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 CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD