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MCC-19-1481Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit No.: MCC -06-19-1481 Permit Type: Mechanical - Commercial Work Classification: Kitchen Flood Permit Status Approved Issue Dace07/0`2/20 9 I Expiration: 12/23/2019 Location Address Parcel Number 9801 NE 2ND AVE, Miami Shores, FL 33138 1132060134380 Contacts 9801 PARK LLC Owner AA MASTERS MECHANICAL AIR MOVING Contractor 4141 NE 2 AVE 204 A, MIAMI, FL 33137 AND ENGINEERING SYSTEMS CORP FELIX DE JESUS GUERRA 12333 SW 28 TER, MIAMI, FL 33175 Business: 3052440667 Description: PROVIDE HOOD SYSTEM TO KITCHEN EQUIPMENT Valuation: Inspection Requests: p $ 15,755.00 5-762 -4949 AT NEW CORNER RESTAURANT IN EXISTING SHOPPING CENTER Total Sq Feet: 2,600.00 Fees Amount Application Fee - Other $50.00 CCF $9.60 DBPR Fee $8.27 DCA Fee $5.51 Education Surcharge $3.20 Permit Fee $501.42 Scanning Fee $3.00 Technology Fee $13.79 Work Without Permit 1st Offense $551.42 Work Without Permit 1st Offense $100.00 Total: $1,246.21 Payments Date Paid Amt Paid Total Fees $1,246.21 Credit Card 06/26/2019 $50.00 Credit Card 07/02/2019 $1,196.21 Amount Due: $0.00 Building Department Copy 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 ar�quired for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AMI I that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating cons ti d zo ng. F_ uIjermore, I authorize the above named contractor to do the work stated. Authorized Sig�ture: Qkel / Applicant / Contractor / Agent July 02, 2019 Date Page 2 of 2 BUILDING PERMIT APPLICATION Miami Shores Village Building Department 1i3b50 N.E42nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 ❑BUILDING ❑ ELECTRIC ❑ ROOFING FBC 20 Master Permit No. CC -11-18-3517 Sub Permit No. 0b —1 I0 —118, ❑ REVISION ❑ EXTENSION ❑ RENEWAL F-IPLUMBING Q MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9801 NE 2nd Ave City: Miami Shores County: Miami Dade Zip: ' Folio/Parcel#: 11 -3206-013-4380 Is the Building Historically Designated: Yes NO X Occupancy Type: A-2 Load: 150 Construction Type: III Flood Zone: X BFE: FFE: 10.35' OWNER: Name (Fee Simple Titleholder): 9801 Park LLC Phone#: 305 455 1800 Address: 4141 NE 2nd Ave. Suite #204A City: Miami State: FL Tenant/Lessee Name. AMARANTHINE RESTAURANT Email: yiannikg@gmail.com Zip: 33137 one#: 9543944140 CONTRACTOR: Company Namee:n/�/"1 � / /�/� / /r ��%�� Phone#: Address: 15"40 wp. City: Miami /nn'',, State: FL Zip: ,) �15_0 Qualifier Name: /Y rD •,/ YlS Phone#: State Certification or Registration #: C (O e ificate ompetency #: DESIGNER: Architect/Engineer: The Architects Group Phone#: 305 740 0150 Address: 8000 NW 7 Stree City. Miami State: FL Zip: 33126 Value of Work for this Per it: $ _ uare/Linear Footage of Work: Type of Work: ❑ Additi0 ❑■ Alteration El ❑air/Re lace Re p p El Demolition Description of Work: Provide Ho en equipment at new corner Restaurant in existing Shopping Center. Specify color of color thru tile: /� Submittal Fee $ ` Permit Fee $ 2- CCF $ -" (• CO/CC $ Scanning Fee $ •3 ' Radon Fee $ 5- DBPR $� • �� Notary $ Technology Fee $ (� Training/Education Fee $ Double Fee $�— Structural Reviews $ Bond $ Y ( 40 TOTAL FEE NOW DUE $ 01 6 • �' (Revised02/24/2014) Bonding Company's Name (if applicable) N/A Bonding Company's Address N/A City State Mortgage Lender's Name (if applicable) N/A Mortgage Lender's Address N/A 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 �� v OWNER or AGENT Thefo7clayof ng instrument was acknowledged before me this ' 'J V Y1.4 20 by who ispersonally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print: Seal: r��e . ANAYS'LIGO Notary Public - State of Florida Commission C GG 246553 ov My Comm. Expires Oct 26, 2022 ************ APPROVED BY (Revised02/24/2014) as Signature _ 0 -0j— -r CONT CTOR The foregoing instrument was acknowledged before me this day of Ql0 20, by i ja(9 ri who is personally known to me or who has produced 6fw as identification and who did take an oath. NOTARY PUBLIC: .,�T": ilk. T-0 1 I [.ill {x,lirii 4 C *************************************************************** �,.PI Examiner Zoning Structural Review Clerk Gly ` CONTRACT EQUIPMENT SPECIALIST,LLC 2100 NE DIXIE Hwy JENSEN BEACH FL 34957 PHONE # 772-232-6720 FAX # AMARANTHINE MIAMI SHORES LLC 9801 NE 2ND AvE MIAMI FL 33138 M ARYAN N@CES PECIALIST. COM 56( ^ 3[7-4133 r -M:1 "C'V AMARATHINE 9801 NE 2ND AvE MIAMI, FL 331 38 3/21/2019 2705 Page 1 ei_ tom*►a 10 a I �ro _+ -agil1l 1 HOOD Hood #1- Job #3508338 9,168.88 9,168.88T 5424ND-2-PSP-F - 13ft 1" Long Exhaust -Only Wall Canopy Hood with Front Perforated Supply Plenum with Built-in 3" Back Standoff - 430 SS Where Exposed - FILTER - 20" tall x 16" ( 19.625" by 15.625") wide Stainless Steel Captrate Solo filter with hook, ETL Listed. Particulate capture efficiency: 85% efficient at 9 microns, 76% efficient at 5 microns. Used on hoods shipped AFTER 7/27/17. - L55 Series E26 Canopy Light Fixture - High Temp Assembly, Includes Clear Thermal and Shock Resistant Globe (L55 Fixture), Bulbs By Others - EXHAUST RISER - Factory installed 10" X 32" X 4" - SUPPLY RISER - 12"x 28" Supply Riser with Volume Dampers • • • - 1/2 Pint Grease Cup New Style, Flanged Slotted • • - BACKSPLASH 80.00" High X 158.00" Long 430 SS Vertical (Includes • • • • • • • • End Caps & Divider Bars) • • • -RIGHT END STANDOFF 1" Wide 54" Long Insulated - RIGHT SIDESPLASH 80.00" High X 54.00" Long 430 SS Vertical ""' ' ; •. (Includes End Caps & Divider Bars) -LEFT VERTICAL END PANEL 27" Top Width, 21" Bottom Width, 80" "" ' ' • • •; High Insulated 430 SS • • • • • • • • • • . . • • • • •••• • • •• • • ••• •• Any changes in the equipment or services listed on the attached sales agreement must be made in writing and SUBTOTAL signed by an authorized administrator of the seller and buyer. Receipt of equipment or goods by the buyer without SALES TAX (7.0%) objection will waiver all claims of damage, detention, or loss. Seller will not be liable for the damage, loss, or delay beyond its reasonable control. The equipment specified on the attached agreement is sold with a manufactures warrantee and the seller provides no warrantee. If the buyer refuses for any reason the equipment agreed upon, the buyer will pay the shipping, restocking and storage charges. The buyer agrees not to withhold payment and PAYMENTS/CREDITS pay any storage charges incurred when delays are at the request of the buyer or due to delays not attributed to TOTAL seller. In the event of any legal action with respect to this document we shall be entitled to reasonable attorney's fees, including attorney's fees at the trial level. Page 1 CONTRACT EQUIPMENT SPECIALIST,LLC 2100 NE DIXIE Hwy JENSEN BEACH FL 34957 PHONE # 772-232-6720 FAX # AMARANTHINE MIAMI SHORES LLC 9801 NE 2No AVE MIAMI FL 3313B MARYANN@CESPECIALIST.COM v' mo it 5 AMARATHINE 9801 NE 2ND AVE MIAMI, FL 33138 It 1 ' DO 3/21/2019 2705 Page 2 1 FAN Fan 41 DU180HFA - Exhaust Fan - Job #3508338 0.00 O.00T DUI80HFA High Speed Direct Drive Centrifugal Upblast Exhaust Fan with, disconnect switch and 18-3/4" wheel. Exhaust Fan handles 3336 CFM @ -1.350" we ESP, Fan runs at 1343 RPM. Exhaust Motor: 2.000 HP, 3 Phs, 208 V, 6014z, 8.3 FLA, ODP, Premium (E-Plus3) Eff. x - Grease Cup for kitchen -duty centrifugal exhaust fans, Box Dimensions 17-1/8 L X 5-1/16 W X 3-3/4 H (18 GA.) (Includes Down Spout) xl - Miami Dade Impact and Wind Load Certification +150 / -150 PSF - Miami Dade County Product Control Approved. Florida Building Code approval. Roof & Wall Mount Exhaust Curbs up to 20" high must be 20 gauge Aluminized. • • • • • Roof & Wall Mount Exhaust Curbs above 20" high up to 42" high must be 16 • • • • • • • • Gauge Aluminized. xl • • • - Full Bottom Curb Corner. Base flange corners fully welded or staked by • • : • • • • • • factory. xl ••••• • • .. • - Vented Base for Curb xl ' • • • • • • - Hinged Base for Curb. Standard Hinge attached to curb. Used on Fans with • • • • • • • • • wheels 20 inches or smaller. 12 GA Galvanized. x 1 • • • • • • • • • • - Curb CRB26.5x26E On Fan #1 Flat Curb *** 16 Gauge Construction. x • • • • • • • • Any changes in the equipment or services listed on the attached sales agreement must be made in writing and SUBTOTAL signed by an authorized administrator of the seller and buyer. Receipt of equipment or goods by the buyer without SALES TAX (7.0%) objection will waiver all claims of damage, detention, or loss. Seller will not be liable for the damage, loss, or delay beyond its reasonable control. The equipment specified on the attached agreement is sold with a manufactures warrantee and the seller provides no warrantee. If the buyer refuses for any reason the equipment agreed upon, the buyer will pay the shipping, restocking and storage charges. The buyer agrees not to withhold payment and PAYMENTS/ C R E O ITS pay any storage charges incurred when delays are at the request of the buyer or due to delays not attributed to TOTAL seller. In the event of any legal action with respect to this document we shall be entitled to reasonable attorney's fees, induding attorney's fees at the trial level. Page 2 CONTRACT EQUIPMENT SPECIALIST,LLC 2100 NE DIXIE Hwy JENSEN BEACH FL 34957 PHONE # 772-232-6720 FAX # AMARANTHINE MIAMI SHORES LLC 9801 NE 2ND AVE MIAMI FL 33138 MARYANNQQ CESPECIALIST.COM AMARATHINE 9801 NE 2ND AVE MIAMI, FL 33136 @ 3/21/2019 2705 ftalz 1 FAN #2 Fan #2 A2 -20D - Supply Fan - Job #3508338 0.00 O.00T A2 -20D Untempered Supply Unit with 20" Direct Drive Fan in Size #2 Housing Supply Fan handles 2669 CFM @ 0.650" we ESP, Fan runs at 1098 RPM. Supply Motor: 1.000 HP, 3 Phase, 208 V, 60Hz, 3.8 FLA, ODP, Premium (E-Plus3) Eff. Down Discharge - Air Flow Right -> Left x] - Sloped Filtered Intake for Size #2 Modular Untempered Supply Unit. 26.813" Wide X 53.625' Long X 31.313" High. Includes 2" MV EZ Kleen Metal Mesh Filters. xl - Miami Dade Impact and Wind Load Certification +30 / -130 PSF - Miami Dade County Product Control Approved. Florida Building Code approval. Roof Mount Exhaust Curbs up to 20" high must be 16 gauge Aluminized. x • "`• - Separate 120VAC Wiring Package for Make -Up Air Units. Option must be • `• use "` selected when mounting VFD in prewire panel or with DCV package. Provides 00 ` • `; • separate 120VAC input to supply fan. This 120V signal must be run by • •; • • • • • • • electrician from DCV to mua switch. xl 0000* • • 0 0 - Full Bottom Curb Corner. Base flange corners fully welded or staked by • • • • • `• • factory. xl •••• • • •• ••• - Curb CRB31.OX20H On Fan #2 Flat Curb *** 16 Gauge Construction. xl • • • • • • • 000 • • • • 0• • • • • ••• ••••• • 0 • • • • • • 00• 0000 • ••• 0.• 0 • 00 • • Any changes in the equipment or services listed on the attached sales agreement must be made in writing and SUBTOTAL signed by an authorized administrator of the seller and buyer. Receipt of equipment or goods by the buyer without SALES TAX (7.0%) objection will waiver all claims of damage, detention, or lass. Seller will not be liable for the damage, loss, or delay beyond its reasonable control. The equipment specified on the attached agreement is sold with a manufactures warrantee and the seller provides no warrantee. If the buyer refuses for any reason the equipment agreed upon, the buyer will pay the shipping, restocking and storage charges. The buyer agrees not to withhold payment and PAYMENTS/ C R E D ITS pay any storage charges incurred when delays are at the request of the buyer or due to delays not attributed to TOTAL seller. In the event of any legal action with respect to this document we shall be entitled to reasonable attorney's fees, including attorney's fees at the trial level. Page 3 CONTRACT EQUIPMENT SPECIALIST,LLC 2100 NE DIXIE HWY JENSEN BEACH FL 34957 PHONE # 772-232-6720 FAX AMARANTHINE MIAMI SHORES LLC 9801 NE 2ND AVE MIAMI FL 331 38 MARYANN@CESPECIALIST.COM AMARATHINE 9801 NE 2ND AVE MIAMI, FL 33138 "V �t•F 5yy 3/21/2019 2705 "V �t•F 5yy @a. IRS 1 CONTROLS CONTROLS 0.00 O.00T SC -31 I I I OFP 3 Phase w/ control for 1 Exhaust Fan, 1 Supply Fan, Exhaust on in Fire, Lights out in Fire, Fan(s) On/Off Thermostatically Controlled. Room temperature sensor shipped loose for field installation. INVERTER DUTY 3 PHASE MOTOR REQUIRED FOR USE WITH VFD. Includes I Duct Thermostat kit. xl - Thermistor CABLE - 18/2 AWG GREEN WHITE, plenum rated. USED for thermistor duct stat. Per Foot Price. x150 - Digital Prewire Lighting Relay Kit. Includes hood lighting relay & terminal blocks. Allows for up to 140OW of lighting each. xl - 20 wide X18 tall X8.62 deep SS HINGED ELECTRICAL BOX NEMA 1 - VENTED. Stainless plate instead of filter assembly. xl , "•, - ESV222NO2YXB571 - Variable Frequency Drive - 3 HP Max., 200/240 V, 00 000 ••• Single or Three Phase Input, 9.6 A Max., NEMA 1 Enclosure, with 2RJ-45 FOR • • • *:66 MODBUS xl ••••• • • ••• - ESV75IN02YXB571 - Variable Frequency Drive - 1 HP Max., 200/240 V, • • • • • • • • Single or Three Phase Input, 4.2 A Max., NEMA 1 Enclosure, with 2RJ-45 FOR *000 • • :00 MODBUS xl ••••• 1 FIRE SYSTEM #1 Fire System #1 — INCLUDES PERMIT, HOOK-UP AND TEST • • • • 41,948.56 • , 4,948al ANSUL-3.0/3.0-MANIFOLD Ansul 6 gallon Manifolded Wall Mounted Fire see** ` , •, • ,,, System (includes pre -piped hood(s) and detection). ,.,•, , 1 Inbound Freight Inbound Freight • 650.0p 65pIJ0Q 1 -Deposit Deposit 0-5,230.3 0000 -5,230.35 Any changes in the equipment or services listed on the attached sales agreement must be made in writing and SUBTOTAL $9,537.09 signed by an authorized administrator of the seller and buyer. Receipt of equipment or goods by the buyer without SALES TAX (7.0%) $988.22 objection will waiver all claims of damage, detention, or loss. Seller will not be liable for the damage, loss, or delay beyond its reasonable control. The equipment specified on the attached agreement is sold with a manufactures warrantee and the seller provides no warrantee. If the buyer refuses for any reason the equipment agreed upon, the buyer will pay the shipping, restocking and storage charges. The buyer agrees not to withhold payment and PAYMENTS/CREDITS pay any storage charges incurred when delays are at the request of the buyer or due to delays not attributed to L seller. In the event of any legal action with respect to this document we shall be entitled to reasonable attorney'sFTOTA fees, including attorney's fees at the trial level. $10,525.31 Page 4 PERMIT ADDRESS: 9801 NE 2ND AVE Miami Shores, FL 33138 PARCEL: 1132060134380 APPLICATION DATE: 06/26/2019 SQUARE FEET: 2,600.00 DESCRIPTION: PROVIDE HOOD SYSTEM TO KITCHEN EQUIPMENT EXPIRATION DATE: 12/23/2019 VALUATION: $15,000.00 NEW CORNER RESTAURANT IN EXISTING SHOPPIN CENTER CONTACTS NAME COMPANY ADDRESS Contractor FELIX DE JESUS GUERRA AA MASTERS MECHANICALAIR 12333 SW 28 TER MOVING AND ENGINEERING SYSTEM MIAMI, FL 33175 CORP FELIX DE JESUS GUERRA AA MASTERS MECHANICAL AIR 12333 SW 28 TER MOVING AND ENGINEERING SYSTEM MIAMI, FL 33175 CORP Owner 9801 PARK LLC 4141 NE 2 AVE, 204 A MIAMI, FL 33137 9801 PARK LLC 4141 NE 2 AVE, 204 A MIAMI, FL 33137 9801 PARK LLC 4141 NE 2 AVE, 204 A MIAMI, FL 33137 REVIEW ITEM Mechanical v.1 Comments: NEED COPY OF CONTRACT STATUS REVIEWER Requires Re -submit Jan Pierre Perez email: nu118 June 27, 2019 10050 NE 2 Ave Miami Shores FL 33138 Page 1 of 1 1 O OP PERMIT ADDRESS: 9801 NE 2ND AVE PARCEL: 1132060134380 Miami Shores, FL 33138 APPLICATION DATE: 06/26/2019 SQUARE FEET: 2,600.00 DESCRIPTION: PROVIDE HOOD SYSTEM TO KITCHEN EQUIPMENT EXPIRATION DATE: 12/23/2019 VALUATION: $15,000.00 NEW CORNER RESTAURANT IN EXISTING SHOPPIN CENTER CONTACTS NAME Contractor FELIX DE JESUS GUERRA FELIX DE JESUS GUERRA Owner REVIEW ITEM Mechanical v.1 Comments: NEED COPY OF CONTRACT COMPANY ADDRESS AA MASTERS MECHANICALAIR 12333 SW 28 TER MOVING AND ENGINEERING SYSTEM MIAMI, FL 33175 CORP AA MASTERS MECHANICALAIR 12333 SW 28 TER MOVING AND ENGINEERING SYSTEM MIAMI, FL 33175 CORP 9801 PARK LLC 4141 NE 2 AVE, 204 A MIAMI, FL 33137 9801 PARK LLC 4141 NE 2 AVE, 204 A MIAMI, FL 33137 9801 PARK LLC 4141 NE 2 AVE, 204 A MIAMI, FL 33137 STATUS REVIEWER Requires Re -submit Jan Pierre Perez email: nu118 June 27, 2019 10050 NE 2 Ave Miami Shores FL 33138 Page 1 of 1 11%LX LLIJ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) F06/25/2019 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: I the certificate holder is an ADDITI NAL INSURED, the policy(ies) 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 endorsement(s). PRODUCER Simple Employer Solutions II, Inc 2722 Manatee Ave W Bradenton Florida34205 UUNIAUI NAME: PHONE A/C, No, Ext): 941-761-2882 (A/C, No): 941-896-3178 ADDRESS: rmoore@prodigyresults.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Normandy Insurance Company INSURED PEOProdigy, Inc 3914 SR 64 E Bradenton 34208 INSURER B: INSURER C: INSURER D: 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/OD/YYYY) (MM/DD/YYYY) LIMITS Miami Shores Village FL 33186 COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR EACH OCCURRENCE $ PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 7 JECTPRO ❑ LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OPAGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED$ HIREDAUTOS AUTOS UUMB NtU WNULt LIMI 1 $ (Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Peraccidenl UMBRELLA LAB EXCESS LIAR HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATIONx AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N /A NHFL0053042019 5/23/2019 5/23/2020 - STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 -1T__T DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Policy provides coverage to leased employees in Florida but not subcontractors of: AA MASTERS MECHANICAL AIR MOVING & ENGINEERING SYSTEMS CORP Effective: 4/25/2019 CERTIFICATE HOLDER CANCELLATION © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN iA!9iy►ef Miami Shore Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 Ne 2nd AV, AUTHORIZED REPRESENTATIVE Miami Shores Village FL 33186 liU,�tszPn © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD P� ACORDDate(MW/DD/VYYY � CERTIFICATE OF LIABILITY INSURANCE 06/26/2019 THIS CERTIFICATE IS ISSUE AS A MATTER OF INFORMATION ONLY AD 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 (less)must be endorsed .if SUBROGATION IS WAIVED ,subject to the terms and conditions of the policy .certain policies may required an endorsement .A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement PRODUCER: CONTACT NAME: Gretell Gonzales USA GENERAL INSURANCE PF6—NT-305-386-3305 F A No.Ezt A No. 888 330-1123 ADDRESS: gretell@usageneralinsurance.com 13631 SW 26 ST MIAMI FL 33175 INSURER (S) AFFORDABLE COVERAGE Phone: (305) 386-3305 FAX (305)-330-1123 insurer A WESTERN WORLD INSURANCE COMPANY NAIC # INSURED: insurer B AA MASTERS MECHANICAL AIR MOVING & ENGINEERING SYSTEM CORP. dba AIR 2 AIR LLC. LIC # 1426169 & CAC 057226 MECHANICAL & PLUMBING CONTRACTOR insurer C insurer D insurer E 500 NW 94 ST MIAMI FL 33150 insurer F COVERAGE CERTIFICATE NUMBER REVISION NUMBER THIS IS TO CERTIFIED THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUE TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT.TWERM 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 EXCLUSION AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCE BY PAID CLAIMS LTR TYPE OF INSURANCE ADDLVSBR INSRDate poll Number ry e e PoIIgbpination Dada MM DD Each Occurrence Limit $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY C3 Claim Made ® Occurs X GENL AGGREGATE LIMIT APPLIES PER ❑ POLICY ❑PRO El OTHER fER ❑ LOC X X NPP 8362217 02/06/19 02/06/20 Damage to rented premises (EA Occurrence)$ 1,000,000 Med Exp(Any one person $ 5,000 PERSONAL & ADV I JURY 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCT -COMP/OP/AGG $ 2,000,000 GENLAGGREGATE LIMIT APPLIES PER ❑ Any Auto ❑Schedule Autos ❑ All Owners Autos ❑Non - Owned ❑ Hire Autos ❑ Autos ❑ ❑ COMBINED SINGLE LIMIT $ Each accident BODILY INJURY (Per Person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ ❑ UMBRELLA LAB []OCCURS ❑ EXCESS LIAB ❑CLAIM -MADE EACH OCCURRENCE $ AGGREGATE ❑ DED ❑ RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER/ EXECUTIV OFFICER/MEMBER/EXCLUDED? Mandatory in NH it yes,describe under DESCRIPTION OF OPERATIONS Below WA PER OTH ❑ STATUTE ❑ ER $ E.L EACH ACCIDENT $ E.L DISEASE EA EMPLOYEE E.L DISEASE POLICY LIMITS $ DESCRIPTION OF OPERATION /LOCATION /VEHICLES (Attach ACORD 101 , Additional Remarks Schedule,lf more space is required DESCRIPTION OF OPERATION /LOCATION /VEHICLES (A. Lic # cfc 1426169 cac 057226 CERTIFICATE HOLDER CERTIFICATE HOLDER MIAMI SHORE BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CHANDELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AV. MIAMI SHORES FI. 33186 AUTHORIZED REPRESENTATIVE ACORD 25 (2014 /01) OF @ 1998 -2015 ACORD CORPORATION .All rights reserved. the ACORD name and logo are registered marks of ACORD