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ELC-19-1538Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date: Location Address Parcel Number 11300 NE 2ND AVE, Miami Shores, FL 33161 1121360000050 Contacts Permit No.. ELC-07-18-1,= Permit Type: Electrical - Commercial Work Ciassiffcatfot Service Change Permit Status, AWoved- Expi raft on : 02/17/2020 Inspection Requests: Description: LIBRARY - INSTALL 800AMP 480V 3PHASE SERIVCE Valuation: $ 19,670.00 1��62-4949 FEEDERS AND CONDUIT FROM FPL TO EXISTING SERVICE Total 5q Feet: 0.00 Fees BARRY UNIVERSITY INC Owner R & R ELECTRIC OF BROWARD INC Contractor BARRY UNIVERSITY ERIN RICHARDSON 11300 NE 2 AVE, MIAMI SHORES, FL 331616628 DBPR Fee $10.33 Business: 9543195630 rrelectricofbroward@gmail.com Inspection Requests: Description: LIBRARY - INSTALL 800AMP 480V 3PHASE SERIVCE Valuation: $ 19,670.00 1��62-4949 FEEDERS AND CONDUIT FROM FPL TO EXISTING SERVICE Total 5q Feet: 0.00 Fees Amount Application Fee - Other $200.00 CCF $12.00 DBPR Fee $10.33 DCA Fee $6.88 Education Surcharge $4.00 Notary Fee $5.00 Permit Fee $488.45 Scanning Fee $9.00 Technology Fee $17.21 Total: $752.87 Payments Date Paid Amt Paid Total Fees $752.87 Check # 3059 07/03/2019 $200.00 Credit Card 08/20/2019 $552.87 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 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 regulati onstruction and z-onnii g. Futhermore, I authorize the above named contractor to do the work stated. Authorized Signature: Owhef % Applicant / / Agent Date August 20, 2019 Page 2 of 2 srk : 86' -f -i OF/S r --J,- �0. �orcft(14 :' }r":ivAF.S, VGRVIir tr;ee.bel' Primus 1 ,a 1 �2 x 6G► c w G/1 �'UU:f�i �J�1 �GfJ�✓��J' f E�: t �SAf3OIM rl ••• • • • • ••• • • • • • • • • • • • • • •• •• • • • •• •• ••• • • • ••• • • BUILDING RECt- o JET . Miami Shores Village JUL 0320►9 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 �- FBC 20n � Master Permit No. E�L_01 'Ili -1 1 5 J o PERMIT APPLICATION ❑BUILDING 0 ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Barry University - Library 11300 NE 2ND AVE. City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-2136-000-0050 Is the Building Historically Designated: Yes NO Occupancy Type: N/A Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Barry University-r)hone#: Address: 11300 NE 2nd Avenue City: Miami Shores State: FL Tenant/Lessee Name: Phone#: Email: zip: 33161-6628 CONTRACTOR: Company Name: R & R Electric of Broward, Inc. Phone#: 954-319-5630 Address: 7958 Pines Blvd., Suite 238 City: Pembroke Pines State: FL Zip: 33024 Qualifier Name: Erin Richardson Phone#: 954-319-5630 State Certification or Registration #: EC 13006319 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 19,670.00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑■ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 1. INSTALL 800 AMP 480V 3-PHASE SERVICE FEEDERS AND CONDUIT FROM FPL TRANSFORMER TO EXISTING SERVICE Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ O (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 WE 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 suck posted notice, the inspection will not be approved and a reinspection fee will be charged. /f .17 Signature%C/,//-- Signature \y/� OWNER or AGENT CONTRACTOR T,� folegoing instrumgjn�t was acknowledged before me this I//'111, day of Cw 20 _ by SUSAN Nt6�Al., who is personally kno 0 T.�-orwho has produced identification and who did take an oath. NOTARY as The foregoing instrument was acknowledged before me this 3 day of ��--�,� '20 by ERIN RICHARDSON who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign v N--, Sign:_ Print: Print: Seal: ;* ;= Commis"8GG24WIS Seal: �''.,��,,°•`•''TmvT 'M Nr 1 40.7019 APPROVED BY Plans Examiner Structural Review (Revised02/24/2014) C • d 'Wo �� c' mr:✓_ Zoning Clerk BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2018 THROUGH SEPTEMBER 30, 2019 DBA: Business Name: R & R ELECTRIC OF BROWARD INC Owner Name: ERIN RICHARDSON Business Location: 7958 PINES BLVD 238 PEMBROKE PINES Business Phone: 9543195630 Receipt#:ELECTIaCA RL/ALARMS/CG Business Type: (MASTER ELECTRICIAN) Business Opened:02/27/2008 State/County/Cert/Reg:EC13 006319 Exemption Code: Rooms Seats Employees Machines Professionals 3 For Vending Business Only Numbar of Machines: Vandina Tvoa- Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 1 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: R & R ELECTRIC OF BROWARD INC 7958 PINES BLVD 238 PEMBROKE PINES, FL 33024 2018 -2019 Receipt #04B-17-00005821 Paid 08/27/2018 27.00 11 70 ACOREP CERTIFICATE OF LIABILITY INSURANCE 16.� DATE (MM/DDIYYYY) 1 07/03/2019 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: 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: Rosa Aguilar PHO"ICN o 954-966-5533 ac No: 954-989-8208 Finney Insurance Corporation 5601 Sheridan Street Hollywood, FL 33021 E-MAIL rosa inns insurancecor com ADDRESS: Y p• INSURERS AFFORDING COVERAGE NAIC # INSURERA: Colony Insurance Company 39993 EACH OCCURRENCE $ 1.000 000 INSURED INSURER B: INSURER C: R & R Electric of Broward Inc. 7958 Pines Blvd Suite #238 INSURER D: Pembroke Pines, FL 33024 INSURER E: INSURER F: AUTOMOBILE COVERAGES CERTIFICATE NUMBER: 00000000-302996 REVISION NUMBER: 68 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 MM/D POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FIOCCUR 101 GL 0072009-01 03/10/2019 03/10/2020 EACH OCCURRENCE $ 1.000 000 DAMAGE TO REITEI PREM SES E. occurrence $ 100 000 MED EXP (Any one person) $ 51000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT F7] LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per acddent UMBRELLA LIAB EXCESS LIAB HOCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ R/ OFFICEMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYE $ E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ELECTRICAL CONTRACTOR, LIC # EC13006319 Miami Shores Village Building Department 10050 N.E. 2nd Ave Miami, FL 33338 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE r _ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by RBA on July 03, 2019 at 01:14PM 91Er RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY a dbpr STATE OF FLORIDA DEPARTMENT OF BUSINESS*AN©-PROFESSIONAL REGULATION ELECTRICAL•CONTRACkTORS,LICENSING BOARD .[r' `�m�.�1�'"""':r It r�; :i-• :_": s'�Cw l�'�,. —. THE ELECTRIC�AgONTRACT4R HEREIWIS CERTIFIED UNDER THE ,ir< .r�r ,�,F�Y..- �r'�•M - ��d ��h-J . ��'�,.- PROVISsIONS OF•�CHAPTER'489, FLORIDgA�STATUTES RICHARD:SON ERIN= §Lf1 R-& R ELECT=RIC OF `BROV1%A-RD � INC �-�.. �'fr - "it.rJ11.?at .`,. i':- t^dr�. %i l",r '=' J � 158,PINESrBLVD.,-SUITE�23-8 4 PEMBROKE:RINES', FL,3aO2'4 4y LICENSt44UNIBER:'EC1b006319 EXPIRATION,�D*TE:'�AU�UST 31;2020 z...� Always verify licenses online at MyFloridaLicense.com i r Do not alter this document in any form. pF 1 This is your license. It is unlawful for anyone other than the licensee to use this document. ® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 7/3/2019 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: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 KHAIR DISLA NAME: PNONE . (877) 613-5042 (FAX No SAFEGUARDCASUALTY.COM, INC ADDRESS: DISLA68@YAHOO.COM 9996 PINES BLVD INSURERS AFFORDING COVERAGE NAIC # EACH OCCURRENCE $ INSURERA: FWCJUA PEMBROKE PINES FL 33024 INSURED INSURER B: R & R ELECTRIC OF BROWARD INC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ INSURER C 7958 PINES BLVD, SUITE 238 INSURER D INSURER E: PEMBROKE PINES FL 33024 INSURER F: FEIN:562365958 COVERAGES CERTIFICATE NUMBER: 1907030006 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 POLICY EXP M D LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F1 OCCUR EACH OCCURRENCE $ DAMAGETO S(R NTED PREMISES Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT ❑ LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLYAUTOS HIRED NON -OWNED AUTOS ONLY qAUTOS ONLY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident UMBRELLA LIAR EXCESS LIAB —d OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / NE.L. OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 6G439871 10/7/2018 10/7/2019 X STATUTE ETH EACH ACCIDENT $ 1,000,000.00 E.L. DISEASE - EA EMPLOYE $ 1,000,000.00 E.L. DISEASE - POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) MIAMI SHORES VILLAGE I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE MIAMI FL 33338 AUTHORIZED REPRESENTATIVE Phone Number: (305) 795-2204 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD PERMIT ADDRESS: 11300 NE 2ND AVE Miami Shores, FL 33161 APPLICATION DATE: 07/03/2019 SQUARE FEET: EXPIRATION DATE: 12/30/2019 VALUATION: CONTACTS NAME Contractor ERIN RICHARDSON ERIN RICHARDSON Owner BARRY UNIVERSITY REVIEW ITEM Electrical v.1 PARCEL: 1121360000050 0.00 DESCRIPTION: LIBRARY - INSTALL 800AMP 480V 3PHASE SERIVCE $19,670.00 FEEDERS AND CONDUIT FROM FPL TO EXISTING SERVICE COMPANY R & R ELECTRIC OF BROWARD INC R & R ELECTRIC OF BROWARD INC BARRY UNIVERSITY INC STATUS REVIEWER ADDRESS , FL 7958 PINES BLVD PEMBROKE PINES, FL 33024 11300 NE 2 AVE MIAMI SHORES, FL 33161 Requires Re -submit Michael DeVaney email: null9 Comments: SHOW THE FOLLOWING: SITE LOCATION WITH DISCONNECTS. GROUNDING. SIZE OF TRSNSFORMER IN K. V. A. PROVIDE A COPY OF SIGNED CONTRACT. DRAWING TO BE MADE BY ELECTRICAL ENGINEER FL STATUE 471.003(2)(h)(2.a) ... , m,.. ,,,,. ........r _ ,. .. ....,m w,..... ., July 08, 2019 10050 NE 2 Ave Miami Shores FL 33138 Page 1 of 1 PERMIT ADDRESS: 11300 NE 2ND AVE PARCEL: 1121360000050 Miami Shores, FL 33161 APPLICATION DATE: 07/03/2019 SQUARE FEET: 0.00 DESCRIPTION: LIBRARY - INSTALL 800AMP 480V 3PHASE SERIVCE EXPIRATION DATE: 12/30/2019 VALUATION: $19,670.00 FEEDERS AND CONDUIT FROM FPL TO EXISTING SERVICE CONTACTS NAME COMPANY ADDRESS Contractor ERIN RICHARDSON R & R ELECTRIC OF BROWARD INC , FL ERIN RICHARDSON R & R ELECTRIC OF BROWARD INC 7958 PINES BLVD PEMBROKE PINES, FL 33024 Owner BARRY UNIVERSITY BARRY UNIVERSITY INC 11300 NE 2 AVE MIAMI SHORES, FL 33161 REVIEW ITEM Electrical v.1 STATUS REVIEWER Requires Re -submit Michael Devaney email: nu119 Comments: SHOW THE FOLLOWING: SITE LOCATION WITH DISCONNECTS. GROUNDING. SIZE OF TRSNSFORMER IN K. V. A. PROVIDE A COPY OF SIGNED CONTRACT. DRAWING TO BE MADE BY ELECTRICAL ENGINEER FL STATUE 471.003(2)(h)(2.a) July 08, 2019 10050 NE 2 Ave Miami Shores FL 33138 Page 1 of 1 A C f I V �. CERTIFICATE OF LIABILITY INSURANCE DATE (MM1DDtYYYY) 71312019 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 KHAIR DISLA NAME: PHONE (877) 613-5042AX AIC No): SAFEGUARDCASUALTY_COM, INC ADDRESS: DISLA68@YAHOO_COM 9996 PINES BLVD HMR AFFORDING COVERAGE NAiC it EACH OCCURRENCE S INSURER A: FWCJUA PEMBROKE PINES FL 33024 INSURED INSURER 0: R & R ELECTRIC OF BROWARD INC GENERAL AGGREGATE S PRODUCTS - COMPIOP AGG $ INSURER C 7958 PINES BLVD, SUITE 238 INSURER D: 1NSURERE: PEMBROKE PINES FL 33024 INSURER F: FEIN: 562365958 COVERAGES CERTIFICATE NUMBER: 1907030006 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 MMIDDIYYYY POLICY EXP M1DOIYYYY LIMITS COMMERCIAL GENERAL LIABILITY ❑ flcCuR EACH OCCURRENCE S Ea $ MED EXP ane S PERSONAL & ADV INJURY $ GENL AGGREGATE LIMIT APPLIES PER: POLICY ❑ i ❑ LOG OTHER: GENERAL AGGREGATE S PRODUCTS - COMPIOP AGG $ S AUTOMOBILE LIABILITY ANY AUTO OWNED � AUTOS Y A WNED OS ONLY AUTOS ONLY COMBINED SINGLE LIMIT$ Ea acrid BODILY IMAM (Per Person) S BODY INJURY (Per accident) $ PROPERTY DAMAGE ai aaccider� $ UMBRELLA LIAB EXCESS LIAH OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DIED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN OFFWE MRMB�XXCLUDEEDD�UT El (ManAworyinNH) IIyes, descr�e under DESCR�TIDN OF OPERATIONS below NIA BG439871 101712018 10!7/2019 �/ PER OTK X 9VTK E.L.EACHIACCI�NT g 1,000,000.00 E.L. DISEASE -EAEMPi $ 1,000,000-00 E.L. DISEASE - POLICY LIMIT S 1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES JACORD 101, Additional Remarks Schedule, maybe attached if more space is required) MIAMI SHORES VILLAGE I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE MIAMI FL 33338 AUTHORIZED REPRESENTATIVE Phone Number: (305) 795-2204 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD FLOM N0wRS mmpr Fm Jw uaX 'rl c AmikTim. NC. WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY EXTENSION OF INFO PAGE—SCHEDULE WC 00 00 01 ( A) POLICY NUMBER: (6FR13UB-6G43987-1-18) INSURER. FLORIDA W.G. 3UA INSURED'S NAME: R & R ELECTRIC OF BROWARD INC DATE OFISSUE:10-26-18 GM ST ASSIGN: FL Page 1 of RATE BUREAU ID: 913658604 EXP. MOD. EFFECTIVE DATE: 05-20-18 PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER $100 OF ANNUAL CLASSIFICATION CODE REMUNERATION REMUNERATION PREMIUM LOCATION 001 01 FEIN 562365958 ENTITY CD 001 R & R ELECTRIC OF BROWARD INC 7958 PINES BLVD, SUITE 238 PEMBROKE PINES, FL 33024 SIC CODE: 1731 NAICS: 238990 ELECTRICAL WIRING -WITHIN BUILDINGS & DRIVERS 5190 88000 5.51 4849 CABLE LAYING -BY SPECIALIST CONTRACTORS EMPLOYING AUTOMATIC EQUIPMENT WHICH, IN ONE OPERATION, OPENS THE TRENCH, LAYS THE CABLE AND BACKFILLS-& DRIVERS 6325 22000 7.85 1727 CLERICAL OFFICE EMPLOYEES NOC. 8810 IF ANY .23 DATE OFISSUE:10-26-18 GM ST ASSIGN: FL Page 1 of