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MC-16-2795 (4)Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. Owner's Name (Fee Simple Title Holder): Owner's Address: 7,6q ) r -A City: A-v+ _� a LA — fob Address (Of where work is being done): City: Miami Shores Contractor's Company Name: Address: j/��/ `S� City: Qualifier's Name: do Architect/ Engineer of Record Name: Address: City: Describe Work: 0 �k State: —Florida Zip Code; Phone State:_ Zip Code: Lic. Number: C l� State: Phone #: Zip Code: 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 iami Shores harmless of all legal involvement. Signature Signature � ' j C�e I c f )Q or Age t Contractor or Architect The foregoing instrument was aknowledged before me The foregoing instrument was aknowledged before me this e day of ,2V7,by this jn�� day of _ 20/ y Wh is personally known to me or jo has plyd�uced whp ispersonally knoyT Q e or vhgrhas proAuced /_r — _ _. _ - n_ / indentification. / der Notary ES Notary Public: ;t _Z 1 #FF101662 ....u,, .Vk Sign: o, ALOESSi$n: ••. f• Seal: :+� d`D EXPIRES March 13, 2018 t. �. i i Seal: . ni 862 March 13, 2018 (407) 3ggAt 53 FlorldallotarySeNlOe•Com a'.. ti� EXPIRES °Om �a071 398.0153 FlorldaNOterySeNice Miami Shores Village Building Department 10050 N.E. 2No Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Change of Contractor/Architect or Engineer A change of contractor, architect or engineer must be done under a permit number. There is a $75.00 charge for a change of contractor. The owner will submit a Change of Contractor Form completed with notarized signatures. If the signature of the previous contractor cannot be obtained the owner must send a certified letter/return receipt notifying the previous contractor, architect or engineer the reason for the change. The owner must allow 10 business days for the contractor, architect or engineer to respond. A permit application must accompany the change of contractor form, with the information and signature of the new contractor. The new contractor must be registered with the Village or must submit the required documents to register with the Village. I. Change of Contractor form completed, signed and notarized. 2. Permit application by new contractor. 3. Required fees. 4. Copy of original letter sent via certified mail along with the returned receipt. In addition to the requirements above the architect or engineer of record must authorized the new architect or engineer to reproduce his documents. The authorization must be in writing and must be signed and sealed. RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY ` STATE OF FLORIDA ' 41 DEPARTMENT OF`BUSINESS AND:PROFESSIONALREGULATION' CONSTRUCTION-INDUSTRY.'LICENSING'BOARD; •.. y ne :,L/iOS;ts HIKyL;UNUIJ1UNINU,L;UN I KAL: lame'd�below,is-QERTIFIED--"----.,—'- --1 �► Iride-rtlie�p or visions_of Chapter 489,F.S.�`- :xpitation date'�AUG-31;,'2018µ.. :Z- .; IU%NGoING— �3012 - -"- "` -"w.. ^�"--- �'. '^,4�a •, `h 'd -' _-.y ram. •f. "tea... °'r.~1, "",,..� `*.," �" \�`'+. 4 `'''•.... "`w.� "'�.. ' �b",, rr "..�-NX . ''• ❑T ISSUED: 07/19/2016 DISPLAY AS REQUIRED BY LAW SEQ # L1607190000798 Local Business Tax Receipt Miami —Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY 2878123 L*BT BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES HAVANA AIR CONDITIONING RENEWAL SEPTEMBER 30, 2017 INC 3011129 887 W 34 ST Must be displayed at place of business HIALEAH, FL 33012 Pursuant to County Code Chapter 8A — Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS HAVANA AIR CONDITIONING INC 196 SPEC MECHANICAL PAYMENT RECEIVED BY TAX COLLECTOR CONTRACTOR 49.50 10/20/2016 Worker(s) 1 CAC056638 0222-17-000124 Als Local Business Tax Recelpt only confirms payrrierrtof the Local Business Tax. The Receipt is note 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 NO. above must be displayed on all commercial vehicles— Miami —Dade Code Sec Sa-276. MIAM For more information, visit www.miamidade,govkaxcollector Job#1201 DLi SERVICES LLC This Agreement, Made as of May 23, In the Year of 2017, Between the Contractor: DLF Services LLC PO Box 138904 Hialeah, Florida 33013 United States CGC1515978 3054208135 And the Subcontractor: Company Name 14Rt/RtV4 Q./%L CvnldiTionli,J ��Jc. Address rl 0J-eA�- 3 -57— City State Zip IWA /e Q Ji /= L —'F Tel: 01050 .S-Sf—q/3( Email Address 4V4WA A/i�.I� 1,4 0A40q Contact Person QZZ License # For the Project: 1201 - 2nd Floor Addition 1201 NE 96 Street Miami Shores, Florida Article 1. SCOPE OF WORK Article 1.1. Subcontractor has heretofore entered into a contract with said Contractor to furnish all labor, materials and equipment to perform all work described below according to the construction documents. 15700 - Heating, Venting and Air Conditioning - HVAC shall be a fully operational engineered system as specified in the construction documents. All permits and inspections shall be obtained by contractor as required by applicable building codes. 15720 — Air-conditioning Unit - HVAC unit(s) shall total a high efficiency as specified in the construction documents. The system will contain a concrete pad for the condenser (provided and installed by others), power disconnects, condensate drains, air distribution ducts, diffusers and thermostats. Each floor level shall have a separate system. Coordinate location of return air unit with contractor. Ducts and Diffusers - Layouts for vents and diffusers shall be based per construction documents. Exhaust Fans - Supply, install and hook-up all required exhaust fans as per buildiing code requirements. Initialed by: Contractor Subcontractor - Page 1 of 5 ACCW01" CERTIFICATE OF LIABILITY INSURANCE `� DATE (MM/DDIYYYY) 1 07/28/2017 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: Sara1 Medina Emmanuel Insurance & Associates, Inc. AICNIJ Ell: (305) 693-0003 Fac No): (305) 691-4381 E-MAIL sarai@emmanuelinsurance.com ADDRESS: 2370 E 8TH AVE INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: United Speciality Insurance company 12537 HIALEAH FL 33013-4236 INSURED INSURERB: Associated Industries Insurance Company, Inc. 23140 INSURER C : Wesco Insurance Company HAVANA AIR CONDITIONING INC INSURERD: COMMERCE & INDUSTRY INS CO OSVALDO BORRELLHIALEAH INSURER E 887 W 34TH ST HIALEAH, FL 33012 INSURER F License Number: CAC056638 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 SUBR POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 CLAIMS -MADE ® OCCUR PREMISES Ea occurrence $ 50,000.000 MED EXP (Any one person) $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 A S111005B215226 07/20/2017 07/20/2018 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 POLICY Ix PRO ❑ LOC JECT PRODUCTS - COMP/OP AGG $ 2,000,000.00 $ OTHER: I AUTOMOBILE LIABILITY CEa OMacBINED SINGLE LIMITcident $ 1,000,000.00 BODILY INJURY (Per person) $ ANY AUTO C OWNED SCHEDULED AUTOS ONLY AUTOS WPP1403087 01 09/08/2016 09/08/2016 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000.00 X HCLAIMS-MADE AGGREGATE $ 2,000,000.00 D EXCESS LIAB EBU 014744687 07/21/2017 07/21/2018 DED RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑ (Mandatoryin NH) N/A AWC1071087 09/10/2016 09/10/2017 PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000.00 E.L. DISEASE - EA EMPLOYEE $ 1,000,000.00 E.L. DISEASE - POLICY LIMIT $ 1,000,000.00 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Mechanical Contractor A/C License Number: CAC056638 Village of Miami Shores 10050 NE 2ND AVE Miami Shores FL 33138-2304 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 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 REC1F;�rvFD r 1,4 2016 BY: A " FBC 201 Master Permit No. Tzo K// - 1 � 'f Sub Permit Now 1 b-' 2-�-CjJ ❑ REVISION ❑ EXTENSION [:]RENEWAL ❑PLUMBING,MECHANICAL! ❑PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 0- D I N 9(0 5- Q City: Miami Shores County: Miami Dade Zip: 33 of Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: k o P��3 5 gog)ZOr •OWNERName (Fee Simple Titleholder) Rk Address: 2n �3 &scayn.e �d#W City: P� State: �� Zip: Tenant/Lessee Name: Phone#: Email: all hotik /anti . CMA"- ' � J "1 f CONTRACTOR: Company Name: Al Al L y1� Phone#: :;r9?(Q�.3 �E�y Address: 11j i 5 a l 6 U) d b i eZ City: 1`��1 Qy,(\ \ State: }- Zip: Qualifier Name: Phone#: 3051485 4T 4 State Certification or Registration #: CA C015 & G O o Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: Add �� ,�� State: Zip: Value of Work for this Permit: $ . I'� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ A tion §0 New ❑ Repair/Replace Description of Work: IDn ()I(\ ❑ Demolition Specify color Eof�color thru tile: ( Submittal Fee $ �1 ' W Permit Fee $ CCF $ - w CO/CC $ 7" Scanning Fee $ 1 • CX1 Radon Fee $ (S' zt2 DBPR $ Notary $ Technology Fee $ - 1 (3. Training/Education Fee $ Double Fee $ Structural Reviews $ Bond,$ " 0 TOTAL FEE N011<lf�; • 2 (Revised02/24/2014) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax:(305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): I a_0 1 tj &_ C1 (0 6T City: Miami Shores Village County: Miami Dade Zip Code: 33 13 e ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED Change disconnecting means: YES ❑ NO M ARHI Sheet Attached: YES ® NO ❑ Contract Attached: YES UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER Ca¢ i ee AHU or PKG. UNIT MODEL # COND. UNIT MODEL # OA 3 KW HEAT NOM TONS 3 i AHU CU PKG 1) M.C.A o AHU CU PKG AHU CU PKG 2) M.O.P AHU CU PKG AHU CU PKG 3) VOLTS ;L 0A AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER j & S NO REPLACING DUCTS NO eW NO REPLACING THERMOSTAT NO E NO NEW 4"CONCRETE SLAB NO ES NO NEW ROOF STAND NO ES 1NO NEW RETURN PLENUM BOX ES NO 1. Minimum Circuit Ampacity (Wire Size): (� 2. Maximum Overcurrent Protection (Fuse/Breaker Size): �D 3. Voltage of Circuit (208/240/480): qog 4. Size Disconnecting Means: Contractor's Company Name: C L 1 V_ JC� A/ t� [. Phone: �I:_ lip4_31je_ L` State Certificate or Registration No. Certificate of Competency No. Signature MI IA� �?C'yw �- \G1 Date:- �l- a - (Qualifier's signature) (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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job -site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. [ Signature C/ OWNER or AGENT Signature 1 C e ` �Q YtQ ifZ ( Q CONTRACTOR The`foregoin instrument was acknowledged before me this The foregoing instrume t was acknowledged before /m' a this �� day of 20 % by -^ I day of 20 l b by who is personally known to ' who is personally known to me or who has produced �.�ti j�"x-o-v�� as e or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign identification and who did take an oath. NOTARY PUBLIC: Sign: C iL Print: Print: z ELOISECUEiO Seal: �`- '•?SSECUETO Seal: '' +; + My C,,-W !1 SION # FF 113684 My COMMISSION 113684 ` ES: June 14, 201 EXPIRES ON # FF a 3F E' F r c 8 June 14, 2018 or Bonded Thru Notary Public Underwriters hl „ry. Bonded Thru Notary Public Underwriters APPROVED BY �P nskaminer Zoning Structural Review Clerk (Revised02/24/2014) A '" - • _ , ..�.c�•'"""•""'t'! • � • . ��r. _ '.'��..w. ., �' -'� ..� -```sue �` , . -*. 'wc"� ` .�. 'DEPARTMENT:I:BUSINESSANDPROFESSIONAL REGUL:A ION''►` 'C�NST1ICENSING".BQARD``, Lf BRI . M C L'g.®.�Y►.' r t� a r ` tkTH�.-E t �z r� s l . .e. +•� J " as MUM- 08/28J2016 DISPLAYAS:REQUIRED- BYLAW 1838 Local Business- Tax Receipt * Miami-DadeCoCounty,State of"Florlda -THIS IS NOT A BILL,-- DO NOT PAY, 3153525 BU81NESS-NAMEiLocATioN AIRMET A C INC 3,61"1 SW,- 8,7 AA MIAMI FL,33165 op RECEIPT NO. EXPIRE'S RENEWAL SEPTEMBER 301 201i 3291069 Must, be displayed4 at place of business Pursuant .to County Code Chapter BA � Art., 9 & 10 Or-V. -1vvr M tsv;015M=4�$ i OWNER ENt PAYM �AECEIV90 AC INC.� C MECHANICAL. CONTRACTOR AIRMET .'�11-96 SPE 8Y'TAX COLLECTOR C/ .0-MICHAEL SANABRIX QUALIFIER,CACO5f90Q. $75.00' 08/09/2016 W6rke �(i ) 'Thi1Local 00% a 'A or nongarli rDr IVI-A r% I &-nAr-AAQ r,t- � ' Business Tex ReGe'pt ohy.0'aaft" PtVM*qt of ;he LocalBuslaess Tex., The Receipi is nova Ileense, certification of eholdeftauollficifidns, to do business. Holder mustcomplmith, any governmentalnMintalfigUlaibrVlawg an roq*emefits Whiapply to6ibu$16 EcEIP mmere" I ibbJes' Miami;..' T No'. above,inuitbedisp eye on all C6 IL& to Dale Code'tec-Ba--276. NF-tL Mrajohmati.0", visit mipjUldAde',go4jtaxC1GIIeGtor �1 ® ,4� o CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 09/27/16 PRODUCER A-1 Stop Insurance 3629 S.W. 8th St. Miami, FL 33135 Phone (305)441-7100 Fax (888)908-0449 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED AIRMET A/C, INC. 11521 SW 40 TERR Miami, FL 33165 INSURER A: FEDERATED NATIONAL INS.CO. 10790 INSURER B: NORMANDY INSURANCE COMPANY INSURER C: INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION DATE MWDD/YY LIMITS A ❑ GENERAL LIABILITY Q COMMERCIAL GENERAL LIABILITYDAMA ❑ ❑ CLAIMS MADE OCCUR d❑ $500 DED PDL GL0504010150-03 01/08/16 01/08/17 EACH OCCURRENCE 1,000,000 E TO RENTED PREMISES (Ea occcureence) 100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY 1,000,000 ❑ GENERAL AGGREGATE 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ❑d POLICY ❑ PROJECT ❑ LOC PRODUCTS - COMP/OP AGG 2,000,000 B ❑ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS ❑ COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) ❑ GARAGE LIABILITY ❑ ANY AUTO ❑ AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG El EXCESS/UMBRELLA LIABILITY ❑ OCCUR ❑ CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION $ EACH OCCURRENCE AGGREGATE B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? YES If yes, describe under SPECIAL PROVISIONS below NHFL0042122015 10/28/15 10/28/16 Q WC STATU- ❑ OTH- TRY IMITS ER E.L. EACH ACCIDENT 100,000 E.L. DISEASE - EA EMPLOYEE 100,000 E.L. DISEASE - POLICY LIMIT 500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS AIR CONDITIONING REPAIRS, SERVICE AND INSTALLATION CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Dept 10050 NE 2nd Avenue Miami Shores, FL 33138 Fax: 305-756-8972 ACORD 25 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE © ACORD CORPORATION 1988