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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature q&-4i61axt
OWNE r AGENT
The foregoing instrument was acknowledged before me this
2—/ day of -A ) d V 0 A L1/ i� , 20 by
woy known
m r who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
omm-50
Signature !� /�y 79
CON RACTOR
The foregoing instrument was acknowledged before me this
( dayof Ncye kk Ir 20 Ito , by
pwyty who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Prin : c),
— Print:
Seal:.
• :� •�':
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SANDI PENA
Seal::
r*r Not ry Pubk State of Florldu
My COMMISSION #FF163783
� F952774
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EXPIRES September2$,,2Ai8,
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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
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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
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s
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❑ UMBRELLA LIAR OCCUR
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EACH OCCURRENCE
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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
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WVD
POLICY NUMBER
POLICY
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MM/DCONYYY
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COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
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UMBRELLA LIAR OCCUR
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A
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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