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PL-18-1237 (4)Miami Shores Village N. 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 t�Ar o s 2018 FBC 20 «' Master Permit No. Q.0 - 1—,�- LJZ Li Sub Permit No. e 1 16- 1 2 ,�;—q ❑ REVISION ❑ EXTENSION ❑ RENEWAL MN PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 128 NE 94 ST City: Miami Shores County: Miami Dade ZiD: Folio/Parcel#: 11-3206-013-2980 Is the Building Historically Designated: Yes NO X Occupancy Type: residential Load: Construction Type: CBS Flood Zone: X BFE: FFE: OWNER: Name (Fee Simple Titleholder): SALVATORE INVESTMENTS INC Phone#: 305-778-5961 Address: 6130 NE 4th Ct City: Miami State: FL Zip. 33137 a Tenant/Lessee Name: Phone#: Email: alsba@bellsouth.net CONTRACTOR: Company Name: SUPREME PLUMBING CORP Phone#: 305-790-9169 Address: 840 E 5 ST City: HIALEAH State: FL Zip: 33010 Qualifier Name: HECTOR CUE Phone#: 305-790-3769 State Certification or Registration #: CFC1428027 Certificate of Competency #: DESIGNER: Architect/Engineer: CARMEN T. DIAZ Phone#: 786-312-6060 Address: 5001 S.W. 74th CT # 100 City: MIAMI State: FL zip:33155 Value of Work for this Permit: $ 32,700.00 Square/Linear Footage of Work: 5,329 Type of Work: ❑ Addition ❑ Alteration Q New ❑ Repair/Replace ❑ Demolition Description of Work: NEW RESIDENTIAL HOME Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ 1� _ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ !. `9 Structural Reviews $ Bond $ �, j .•-) TOTAL FEE NOW DUE $ / 1 G 3 ' 4 2— (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 commen ment must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In t absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. OWNER dr AGENT The foregoing instrument was acknowledged before me this The foregoing instrument wars acknowledged before me this day of WV �� — \ 20 Q, by 2)-- day of 20 by � who is personally known to �Q �i3a C tq J who is personally known to me or who has produced as me or who has produced as identification and who did takd an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Print:-ay�'` "�- Print: Seal: Seal: KARINAALEJANQRALUNA ,���•...;�., KARINA ALEJANQRA LUNA 'A i•" c'- Commission 8 FF 950062 '• Commission N FF 950062 a• •= = . ; My Commission Expires My Commission Expires -' January 12, 2020 January 12. 2020 �''%�°;�t��� APPROVED BY 5--T--,l&Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) gc (8 , 4Z4- Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number:INSP-311647 Permit Number: PL-5-18-1237 Scheduled Inspection Date: September 06, 2018 Permit Type: Plumbing - Residential Inspector: Massanet, Maykel Inspection Type: Rough Owner: SBARRA, .LOSE Work Classification: New Job Address:128 NE 94 Street Miami Shores, FL 33138- Project: <NONE> Phone Number (305)758-1169 Parcel Number 1132060132980 Contractor: SUPREME PLUMBING, CORP Phone: (305)316-1164 rtment tomments NEW RESIDENTIAL HOME Passed El Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. INSPECTOR COMMENTS False l Inspector Comments CREATED AS REINSPECTION FOR INSP-311591. provided letter from ing. - water piping on PEX September 05, 2018 For Inspections please call: (305)762-4949 Page 23 of 37 Engineering Design, Inc. C.A. W 29235 September 4, 2018 To: City of Miami Shores Ref: plumbing rough inspection on master permit RC-18-424 Address: 128 NE 94 st, New Residence This letter is to let the plumbing inspector know that PEX tubing (Cross -linked polyethylene (PEX) plastic tubing ) (ASTM F876; ASTM F877; CSA B137.5) has been used in replacement of the PVC pipes at the referenced project all according with the 2017 Florida Building Code - Plumbing, Sixth Edition, chapter 3 and it has been installed according with the manufacturer specs and with the approved tools to furnish the installation. `0`II1111111//Il'I E N O07 Best Regards <*o t Antonio Rodriguez �.• STATE OF : J 0'�`�•'c< �p.; •�'••••••O R %•0 PE #70746 �i S ���` 5890 SW 76 Ave �irS�10NA� 'e% Davie. FI 33328 Date: 7/3/ 2018 State of FLORIDA County of MIAMI DADE SUPREME PLUMBING CORP 840 E 5 ST, HIALEA, FL 33010 Before me this day personally appeared HECTOR CUE says: Regarding the plum bing work at 128 NE 94 st, Miami Shores Village, I will be the only person to perform work on the jo bsite - 7/3/ 2018, by HECTOR CUE •;":::o;o" KARINAALEJANOR L NA Commission A FF 9 2 f: My Commission E s I%;'„",►,;;,;' .tonuory 12, 2 Whom I Personally know L j,� Print, Type or Stamp Name of Notary Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 rmouce ro uwner - vvorKers- c;ompensavon Insurance Exem 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: State of Fl( County of Miami -Dade The foregoing was acknowledge before me this �3 day of `� , 20 1� . By `-,� 6� who is personally known to me or has produced �I?•% a�`^' Cor[i//�is ion i ff 950ti 062 Not, ,y{�► M.11/�F mission Expires SEAL: STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 CUE, HECTOR EDUARDO SUPREME PLUMBIING,CORP 840 EAST 5 STREET HIALEAH FL 33010 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For Information about our services, please tog onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIrtt,NAL REGULATION CFC1428027 1P TIiED 08/10/2016 CERTIFIED PLUf lawil'C.ON-R"A�TOR CUE, HECTOR, ARDtt x - - SUPREME PLUMPIING•t�O� Ri ,r� 1 IS CERTIFIED under the Provisions of Ch.489 FS, ExPlmemdine: AUG31,2018 LISM100001468 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY, STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD --------------- CFC1428027 a The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 _ 4 ❑Nw v ❑ CUE, HECTOR EDUARDO ��• ti • SUPREME PLUMBIING,�� i 840 EAST 5 STREET 1 HIALEAH r• to Issul=o: os/ta2016 DISPLAYAS REQUIRED BY LAW SEQ# L1608100001468 JIMMY PATRONIS CHIEF FINANICAL OF KX R STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW • CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Flofida Wolters' Compensation low. EFFECTIVE DATE: &28=17 PERSON: CUE FEIN: 275301441 BUSINESS NAME AND ADDRESS: SUPREME PLUMBIING CORD 840 EAST HIALEAH FL SCOPE OF BUSINESS OR TRADE: uceresd Pkmfty canaamr 33010 EXPIRATION DATE: W8(2(119 HECTOR E IMPORTANT: Praarsnt to ChOPtsr 440JW14), F.S., an otscer of a corporation who elect exempdoo �> r� recover berrefQa or caMWertsa6ai touter 911e chePMr P�xsuairt to ctre�er from riffs o U�y under aP�y within tim scope d9re echobu*to be bade pefsd on the Thence de vocgl b be Pcammra b Ct0VIer 440.05(13L F_S.. NoBcee of aWcdon to be POMM and cd an thenotice m ti election b be exempt gr mshal et the r@ to IevocelEn iF, at any tirrre alEer the f8aV of fie notice or the issuance d the cer96cete. 018 cartillrzte et snY time 16r fatirasQ�rtllfcafe rc burger meets the requ@anrranb of this secdar for issuance of a cerdocefe. ThO deParbnent shall revoke a of Me Peram named an the oa96cafe to mast to requirements of tNs section. DFS-F24 UYVC 252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850){13-1809 004350 Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS 140T A BILL - DO NOT PAY 6857628 BUSINESS NAME/LOCATION RECEIPT NO. SUPREME PLUMBING CORP RENEWAL 840 E 5 ST 7132251 HIALEAH FL 33010 le - EXPIRES SEPTEMBER 30, 2018 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 k 10 OWNER SEC. TYPE OF BUSINESS SUPREME PLUMBING CORP 196 PLUMBING CONTRACTOR PAYMENT RECEIVED CEC1428027— BY TAX COI.I.eCTOR Worker(s) i $45.00- 08/24/2Q17 . ; CREDITCARD-17-055811 The Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a learns, Permit. or a oertiRoation of the holder's gnallRoations, to de buaiML Holder must comply wkb mY governmental Of aorppseramsmal Fa9Matory lees and requirements which only to the buslnass. The Al N0, above most be displayed on ail cesmwclal whlcles - Mleml-Dade Code Soo Be-M For more information, cisk :e . ^9-"KAA CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYYI 06/01/2018 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: B the certificate holder Is an ADDITIONAL INSURED, the policy(Ms) 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 endorsemen s). PRODUCER NAME: Elizabeth Diaz Blanco Insurance Assoc., Inc. PNONE 305) 888-0524 Me.No): (786 272-0044 1462E 4 Ave E'DDR . maria@blancoinsurance.00m INSURERS AFFORDING COVERAGE NAIL e Hialeah INSURER A : AMTRUST NORTH AMERICA FL 33010 INSURED INSURERS: SUPREME PLUMBING CORP INSURER C : 840 E 5TH ST INSURER D : INSURER E Hialeah FL 33010 INSURER F : -� - - -- Ktv131UN NUM01:K: 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. LTTR X TYPE OF INSURANCE COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR POLICY NUMBER PO FF MMfLD Y EXP LIMITS EACH OCCURRENCE S 1,000,000 p ,� gETiSIIERTEtr— $ 100,000 MED EXP (An one Person) $ 5,000 A Y WPP1520793 OB/25/2017 08/25/2018 PERSONAL&ADVINJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY 0JEC LOC OEM GENERAL AGGREGATE S 2,000,000 PRODUCTS -COMPIOPAGG s 2,000,000 OTHER: $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS AUTO ED V1 COMBINED SINGLE _*Arr a S BODILY INJURY (Per person) $ BODILY INJURY (Per occident) $ PROPERTY DAMAGE r accident) $ S UMBRELLA L AS EXCESS LIAB OCCUR CLANriS MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTIONS WORKERS COMPENSATIDN PER $ AND EMPLOYER$' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? RMmuMM yyeess. M Ide«xbeunder DESCRIPTION OF OPERATIONS bebw NIA I IsTATUTE I I ER E.L.EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VENKXES (ACORD 101, Additional Remarks Schedule, may be attached If non spsce Is requhad) COMMERCIAL & RESIDENTIAL PLUMBING.WORK LICENCE # CFC1428027 VILLAGE OF MIAMI SHORES IS ALSO AN ADDITIONAL INSURED WHEN REQUIRED BY WRITTEN CONTRACT. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN VILLAGE OF MIAMI SHORES ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE AUTHORIZED REPRESENTATIVE MIAMI SHORES FL 33108-� - 01988-2014 ACORD CORPORATION. All riehta mearvad ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD ACOR1 0 CERTIFICATE OF LIABILITY INSURANCE lllo./ DATE(MM/DD/YYYY) 5/7/2018 THIS CUTIFICATE 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:(Lightsource PEO C/O Lightsource Holdings LLC 707 Mendham Blvd, Suite 250 Orlando, FL 32825 CONTACT NAME: Amanda Santiago PHONE FAX 877-257-6662 ext 114 A/c No): 877-758-6522 E-MAIL ADDRESS: CertS count idehr.com INSURERS AFFORDING COVERAGE NAIC# INSURER A: SUNZ Insurance Company 34762 INSURED Torch USA, LLC 1034 S. Brentwood Blvd INSURER B : INSURERC: INSURER D : Suite 310 St. Louis MO 63117 INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: 41729692 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 TR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICDY EFF nPOLILICDY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $-DAMAGE TO RENTED CLAIMS -MADE OCCUR PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PE O- LOC PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y WCPE00000306 04 7/2/2017 7/2/2018 STATUTE ER E.L. EACH ACCIDENT $ 1 00O 000 OFFICER/MEMBEREXCLUDED7 N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $ 1 00U 000 H yes, describe under DESCRIPTION OF OPERATIONS below 7. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Workers' Compensation coverage applies only to those temporary employees assigned by Torch USA, LLC but does not extend any other rights or endorsements, unless explicitly requested. Staffing For: Ireti Inc Client: Supreme Plumbing Corp. Lic# CFC1428027 A list of the assigned employees can be obtained by faxing request to 954-251-0326 or email to iretiwc@gmail.com Village of Miami Shores 10050 NE 2nd Avenue Miami Shores FL 33138 L:ANt;tLLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORUEDREPRESENTATIVE J4' ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 41729692 1 Torch USA, LLC MASTER CERT I Arturo Cardenas 1 5/7/2018 10:33:51 AM (EDT) I Page 1 of 1