Loading...
EL-04-21-931 i '� �0����\ �iF\�>t� `�t�� �1�kD11 ` ��� ���1 CS��`'�� n ��.;,���� i{S"� �? t \ i� �? �\��,\l\�� � � \\���:. li��Z� \ ��\�'� .�\`� �.��i`��`� e���� Z���.Q�� \ .��� �., i�\'Z�\4�\t s 1�, \\��� �;:\�'�'�\i\�}��,2�\ �l��� \ ����ti�� .����� ,�,;, �� S � ,�� �+���,$ ���Z�ti��`�j��a ���'t\ ���s� ;k ������t1`��4�`��1�`�����`� � � �, �u �'i� '��5. �f' t.�' \\ ��\�\\\ti\ .� �\ '�, �Stti��;2�`zS �� �\���� �i a��� 1t��t���j�\x $� ,4���� � � ��� �� �r ��� ��' Mt�i71I S�1Ar�S Vi�E3�G � ; �� �� ����3���.� � '�ol�}��\����t���ti��\�� "� �� �� �� � °� �\ ` � � , . ` " a�\� s�����t � , � � � � �' 7Q050 NE 2 Av� 1 i � ` � �� l��`�����i 5�`�\����.z��k�\�e���� 4�` '�����{�� �ia x 1 � � ���\� `�1\ \ �,�4.a �. 4� LS�Z ��... �� Miami Shores F�33238 �\� � � � �� � � \�\���� � �� �\ \ ;t� �� �� 11��11tt�1���ti,4�� 1 ��.`� � �.t �� �..�� � �;,t� ��„,..,�„�, , .��,.. 3Q5-745-2204 � 1l�t�7ti,ti�i �Q��.t��� ��� ��i '`�.�t ����� zl.l\\"��\�\?�� � ��c��t>;'\�\ �1��,.\\\��,5:�;'ti�� .�: x `!t� �� �'�\� �� \1 � �\t ti l� �. �\ ��o � ' i���� � . �`�7 4 irs�L)� ��\�� �t \� �Z', �. A �i V �A t ic i��\t �� � � AA � 1 l�.t V �\ 4\Z � d� �\Z�1�� ��� �Zi� ��r� �,.>>� �41 �t�. ��.' '.';o-��.���� 'i � A�`�y,��1� ..�s�:�i a\n�'�`„?�;�": �C3��"��" ���\����\�\\�� t � �V�»� tit�; ��1»��\�\�41�`� �y����`��+������,� � E?t�3II'�'�QC1. ��,��.�.��Q�1 `1` .»������\,���»\. � .�,.. �...,.���t �,.;,,,: Eoeation Addr�ss Parc�f N�mb�r ,,>a..U.�.,.�...�..r..,,,..,...�..,..�.�..,��,���.N...._..____..,..,.....��_,,......._._._........�......_.,..�...._,.......�....,._�...,......,.�..,w,��.,._......_..�_..........�..................�..._..._...n.an....._,..._.��..u........_,....,....�...,..,.v,.r.......,.,._.....,...�,_....._...�.....�...,....�_m_..n._..._....�_...._._...._....._....�n_..__..._._..._..,__...n._........n.........wm.......__�.�.........., i 9200 NE 12T`H R1VE, t�iami Shores,FL 33138 1T3205025Q260 �� :� � Crant��ts � ftobert Cohen������ � ��urner 1D�LfCTREC ENC ���.�_�.�������� �.��Cor�trac�or� 9�00 N� 12TN AV�,Miami Shares,FL 33238 lUSTO�SC?SA � robca75�«�maiLcom 887T iVIN 168 lN,MI�MI IAKES,E13301$ � � �usiness:30529�24£32 �._._��a��,.�..�.�.,_m.�,...,�........�__.r_.�_.��____�.mm...�,w.�_�_�.�,�.�...�_._w,_......._�.�...�__.�_._._, �.._.._...._.�.__..�__.�.�._..,._.�..._.__.�. _..M�.n��_r_,.,.. i � Iq5 8C1,10R R@CiU�� I [}escription:TlCE FCO�RS,BATHROG€VI REMUC?E�ING � Valuation: $ 2,O�Q.00 � , �; ,���t^�--� �;°• �� ` BATHROQM 2 REMO[?EL{NG,P�UMBENG,REPLACE KITCHEN i ������������� ;��" �� �����`�� � i��� � �ota I S Fe��: 2 6Q0.t10 �� � � eA�PI�F��F S�3tV1�C(��tEIGI}I�ATE�(�!,BA�I-EROOMS WEL�E�lTAIk s� � q , �.�,��� �����.�.,.��...,:,.�,�,,,�.,,�..,�, �� , � NEW SNOWER P�N NEW TU�.TILINf�AND�IXTURES. �• � �� �,� ��������� Fees Amount Payments �ate Paid Arrst Paid Applicatian Fee-Other $SQ.00 Total FBeS $311.90 CCF $2.8Q Credit Card Q4J12/2Q21 �3g?.gp DBPR Fee $2,0� DCA Fee $2,44 �mount Due: $�.bQ Ed�cation Surcharge $Q.60 Feemit Fee $SQ.O� Scanning Fee $3.QQ Techno4agy Fee $2.5Q Work Wi4haut Fermi4 Fee S1Q0.00 Work Withaut Permit Fee-Plus$100 $200.OQ 'Fotal; $311.3p ull tn e er�t O y In c�nsider�tion of the i�suar�ce to me of this �ermit, I agree fo p�rfarm tha work covered her�und�r in compliance with ai1 aedinanc�s �nci r��ulati�ns pertaining thareto and in strict c�nformity wi�t� th� plar��, d�awings, statements ar spe�ificaii�an� submitted fc� tt�e proper authoriti�;s of fl�iami Shores Village. In �ccepting this permit f assum� r�sponsibility f�r a!I woek dQne by either myself, my agent, servants, or employes. E understand 4hat sep�rate permits ar�r�quired far E�EGT�I�AL, PLEJ(vtE3lNG,MECHANl�A�,WINDQWS, DC3t?R8, ROO�ING and SYVENkNfING POOL work. OWN�RS AFFfC?AVIT: E certify that all the foregoing informatic�n is accura4e and Chat a!I work will be d�ane in eompli�nce with aIl applica�le laws regulating e�nstre�ctian and zc�ning F rmore, (auEhorize th�above named corrtractor tc�da the work stated. ,-��,a A � orized ig��#ur�_Own�r l Applicant! C�ntractor / Agent Date Apri(12,2021 Pa�e 2�f 2 � � � , d ��.���� �����������.� I I :;: >� 1Q050 N.E.2€�d Aver�u�, Miarni Shar�s, FEarida 3313� , Tel: (305}795-2204 F�x� (305)756-8972 � � ��s�Ec:rrio� Len�E P�ta���uma��: (so��7sa���� ����:u, _� ��...� �����. �� � i F��� � �� ����.����ii i�East�r P�rr�it �1�. ��' - �° Ty � � �� � Sc�b P���Et �.��' �.. ��,`'` `�� � `� �.�� ��uE�.���� ��Ec-r��c � �c�a���� � ��v�s�a� � �x-r��s�c�� ����EwaL ❑P��n��i�� � ��e�s��6c�� ��u��oc�nroRKs � c�,���E o� � c,���E��a-rac�� � s�c�� �� Cf�(�TRACTC}R DR�W I�1f�S J��A��RESS� `'" � City: Mi�mi Shores CountY: Nliami C�ade Zip. ����C� Fc�lioj�ar�cel#: Is tE����aildir�g Hi���ric�lly[3�§igr�at�d:Yes N(3 C3ecupancy Type: Load: Canstruction Type: Flood Zone: �FE: FFE: C?l�it�ER. �lam�(Fee Simple Titleh�ald�r�: � `� Phan�#�:� '�������"�`°� �` "� Address: �ity� State: Zip: � Tenantfl.essee�iame: Phone#: �E���`���� � ,;�� EmaiP: � � ` �'� � � cc�n�����r��: corn��ny��m�: °� ������, �,�� �no�,�:���������� Address: ��`7 �f ����-� .� City: f � � dC�� Statea �� Zip; �� v� Qualifi�r Name: � "�'t� ,� , . Phone#. St�t�Certi�c�tiQn�r Registratiea�#: Certifie�t�o�Competency#: /� �� �ES6��1ER;�rchitect/En�ineer: Phon�#: Adedress: City: St�t�: Zip: �w� Va1u��f lPVark for this Permit:$ �� � � �quare�tin��r Fac�t��e o,f W�rk: �'y��of VUork: ❑ Addition �It�ration ❑ New ❑ RepairJR�place ❑ Demalitior� D��cri tian e�f Wetrk: � � �� � �� � S��c�ifjo�c���r c�f ccttca�thru til�; s��r���t�i ����. � ���m������ ��F� c�/c�� S�ar�r�in�F��$ Radar�Fee$ C?�PR� �1�tar�a$ T�chnoEagy Fee$ �'ra�ningJEducat�on F�e$ ��ukal�F�e$ Structural��views$ �t�r�d$ 1°t�TAC FEE�i��(tf�11E$ .� 1 �"�� ����.��.� (�ev�$eao2/2�/za14) �or�din�Cort�pany's tUarne(if applicabf�� � , ��ndin��carnpany's�ddress City Stat� Zip �,1o�t�age�ender's[�arne(if applicabl�) Mortgage l.end�r's Address ' City Stafie Zip Rppiication is hereby made to c�bt�in a permit to do the �re�rk �nd sns�ail�tions as indica�ed. I certifij that na w�rk or instali�tio� h�s eomrn�r�c�d pri�r to the iss�aance of a permit and that all work will be p�rformed t� mee# the standards of all lav�s r��ul�tin� construefican ira this jurisdictian. I und�rst�nd that a separate p�rmit m€ast be secur�d fe�r E€.ECI'RfC, PLUMBING, Slt�NS, PC�t7�.S, FURN�CES, �OItERS, NEATERS,T,4iVKS,RtlR COiVQlT#�RIERS, ETC..... �1�f�lER°S �4F�i�At61�': ! certify �hat all th� foregoing inform�tic�n is �ce�rate and th�t al1 work wil! be dane in campli�nce �rith a(I applieabl�lav�s re�ul�tir�g c�r�s�ruction ar�d zoning. " 1 T : Y F IL E 1' C T! F C C E T Y E LT I Y Yi T I� F 1 E 1'S T Y . IF Y I 1"E `T T 1 FI �1 , LT IT Y U � EY EF E� t Y TI F C E T." fVotic� te+�4p,vfieant. Rs a cc�nditian tQ the i.ssusnee o�a bur`ldrng p�rmit with an�stimated v�lu�exce�drng$25�0, the appficant musfi pramise irt gaod faifh that c�er�py vf th� rrotie�of�ommencemen2 ane�eonstr�eeti�n (Pen law brQchure wrll be �efivered tQ th�person w�hcase pro�ert�r is subject t�attaedarrrent. Alsa, a certi�r'ed eopy af the recard�d ne�tice�f comrrr�ncerta�nt must be post�d at t�r�ja�site f��r t'h�firsi� ins�aecEian which e�ecurs s�v�n (7) ciay.� aj-t�r the buildin� �a�rmit r.s issued. /n the absence of sueh p�.sfed rrr�t�ice, th� rnsp�ctr`�n �il!not b��pqrov�d and a reinspecti�n fee wit!be eh�rg�d. �� �- g�.�� �.�� Si�na�ur� Si�nature OVVNER car AGENT CC��ITRACTC}R The fc�r����r��instrument we�s acke�e�vf�d�ed b�for�me this The fore�c�in�i�strumer���ras ackne�wl�d��d b�f�r�rrte�t�is � day e�f � � . 2� rt`1�� by �� day c�f � � 20 c� � by `` C����'�' �'�'���.�-� . � � . i � � v�rho is personaEly kn��e�tct � ,whc�is personaCEy knowr�tc� �., .-- r�e or who h�s produc�d �� � ��� ����,�=',� �s m�c�r who h�s produced as idenSifie�tion arad who di;c�take an oath, identificatiean and vvho did t�ke an oath, [��°T�RY PU ;�� ,`` �" � NC3TA�Y RU�tIC: } r� � � ; z � r'` � F�``€ �.�-�--° , �I�Ct: f '"ry 'y �I�61. r � � ,- � , �� �,�+ s Print;� ��.% �-� . Prin�� �i°�L� ����� 5��1: Seal: ����� �aa�ry��,�t�e���q�����rrc�a _ _.�. � C�t�(�(�,����AE . _ �'_ � FAy Cc�mmt�5i�aet C,Ca 151375 �'��,� E�e�lt�31C}t951�Q�i ��a�x��a��:€�����:+������x�:��x������*��:�s�����������:�������s*���*�***�:����:�*�:���������������*��� ���� �:a�������������� �1FPftt?�fED��' Pl�ns Ex�rr�iner Zear�in� Structear�(Review Clerk {Revisedozfza/za��) ���� � � �� � � '�' �����~. r �� �� �s,,w �. .. , , , � „ ,� �. '�"�/'""'��!"� /� ✓,u ::.j�/'% � � ..: � ��F�u...ri � er��,r/o//�r.��,. �J.F-'✓,.v ':`r,,� „�,�� r�c,r� i ��,. ���%�f� � ,.>= .�/' . � i . ✓., . �.!M.. , f`�'` � "'��' - �/�'; ��.✓o-'i� �i � ,� � ,/i j� ��� i��;� e �;°�, �' i✓,•� �%��a� �rr i�f�'��F'`� � ��,. l� � ��f/ j`� r.%��,i Cr' /; J�yfi���a��✓ ,,,, ��G���i` .0 �. ����� � � �� ��� ,�� ��'� Y�r./��/'���� ����j, �. ��'�,;,, cr �-�:�',,f�'�r �_ �",�'"a,��,':," . �� ����� c����/����'��„v�`^�''rc�/�r'�`'�`��.� v.,N .,�. . � �4a"✓r'` � �': '''„% . � ���`!� r���`r��� ��ii'A � l ��". » ��Z���'>,;U � ��"s,� rr .. s����"., �� �� � �N��e �s�� � �e�/l!w/'/ i i^"� ��� ��c��fi k � ' '����//�u�������x,,'/� .� ,�� < J, e ����< lv „- �",�'y .c����F�,l�^���'��,z,� �. �����"";,� " �`� `���� � ��"� . .. '�ry:" �.�. ,�. ,:'`a �`� . "� �e��ti - r �^ ; . � �w��.,��7 i � .-w '�: r"' . ., �� , .,�' � ::r �� G,�� �✓r �,r. ��'�'r'/�`��',v���� �R`�.��6"'���/.. _ ��� . ��. . . ... . � .• "'" /G/, " �G��'���/' �H � -'l.��5�,� f k. � yF„�� �G'�� �'� G. ..�,»��d.. ✓,�fj./�/'� ^"-� �. . ,�..r, .✓,'.`, ' : ",../' '.: ����F�EY�"v '.."f���'"' /� m wi������ �"�,% G`�.,.��/���€.�. . �,��'' ���,n�, �/�;..y' t .i t�'� ?' � �r`'� ��...i" ^'�"'zr`� ig�``���r,�`��� �`�� � �a ��� ��0,;� ��;����s�.�`� ��.f'',.�;�.�, � � ��� '`������� "� �� ``�' � '.�^%� e � � � o��-. ,.- r r � � ��c� �, �� `Oi.- �. .. /`.r �.,� � .. ��'j�'��'-'�'���'�.�`�"-� ��ij���;��:.."i"/ y�.� /' � ��.,:..v� ,'�� �/ �`1r �� ��.� �� .F �N � G��� ��� �i� � / ��� 5� ����� � � �� �� a � � � /FU� �✓ � ���,�cy�!c��'.?"'�-�s'�„.,^�' �. ,�`"'�"� . ,��,%�'1�������''��✓`������� ��`��� � � �`��'���� ��i�� � �, �.�. �,,„s �.'�.t,�'o,it�r„�y� �,�i�,r/ �d �� �• . '�'r r`i��'�-�Z��i�l-�� �'�r"�Y � iH `�,� Y'w� '�-�'` �:G/� ...�.;' �������,�x'� "' `�� � i i G:..,.f P /� / /� F� �' ��y��2 ���1����'���/ ,lz,,;P /� y �.:� %tw'r�'%��/l/ `��/������✓j'�`",�'`9" '�ll`� l�'� ' Z ;��c��,'"ys�������U�i����,�`�����.� '� ��U� �� �� � '�� �i�;� r o;���✓✓ a���' � ���/� ��� �y��r,� ����" /��/r'�,,��1 i!',�'�/� -��r �i J ;es�y� �' �`. �f����lr� �i������i/I.�y�w.�ri`� .fa`� '� �', wz� �� ✓% /�il� ., �� .wS'��'a"^�' ���/�?` ,� `�?� �a'��,���`'���`�"�������� ,�� ' i r�!�������,i������/ �"iY, -e , d��� ;� � �x` �, � $ � �� , �z , D�iPT�- ���A, JUST(� I.,: Doin� �3usin�ss f�s: �L} �;LEGTRIC�, INC., Re�;�st�:red Electric... Pa�c; 1 of 2 s;�a���nr�r,2��2� �,1��1���� ������ 1����r���� T�f�r��ti�r� N�t�t�; � �A� Jll�� t� (��-a �r�� t�a �} � ����"T�I�, I �a {��� �� �� �I�in �ldcfre�s: �� i�� [� � I� I t�Al��� ���s�i�� ����� �c�unty: A � Li�ense ��ilinc�: �.icenseLc�ca�ican: ���� i�� E� �� I I L fC�� FL ���1.� �ounty: �� � �.i��r��� Ir�f�r �ti�r� �ic�r��e Type: ��i�t�r� ����t�i��l �c�r��r���t�� €��nk: �� �I��tr°���1 Licen�� IVumber: � i� 1 1�� >tatu�: ���r���fA��i�� Licensure C�ate; ��1��/��1� Expire�: � j�1(���� ����6a1 ���i�f����i�r�� C���[ffi��ti�r� �ff���i�r� �r°� �r�� i�J1�J�.�1� ��� �/��/'��1� I��ra���� [�� �� ��� ����t���.���r���_I�� r� ����s� �'��L����� � ��`sr�� � ���33 �[air� et�����€ �����L��� :: Er�aii: ca���ara��r�ca�efi�b�.���g i: C�;st���er Cc�t�t:���.�3�?e��: 8S(}.��?.i3�� �'���t��e�c��F;c k±�is.��-�A- �4��em�iaye�. t' €�t 2t�(ba-�¢?€����saf�€c�rit4�.t'e-'s�� � m�r� Elrqde���(crztl:� i���;,�rraai!�dt�resscs e�r� ��.t�isz rUecrk��. I�;�c�u�1i�rtt�P.uat�t 7`ca�r GE,�t�zz,tetJ���s�r�tvr�_etl i[*resq;�tr�sti�c a p�.,t�k�U�€uct�fc�s r�y�a��t,c.c�rt�,[se�7;1 cle.ct.c?��i,.��»(�Cv t(�is��:t€ty.£,�4t:c�ci,ct�:�ta�t[.;es t�f`�ice up��-�:�,1�r�= �y 6.�tlriior,�.�]���aii. ii;�cu ha'�����iY c�uesEi�n�,�I��<e cn��tY:act f3�zU.��7.1�95. *AcFes��nt[u`_;ec:iur,�'r��,2i5{i�,,`ic�€`�;��tz�t�,�;s,�.fi�ccLlve i�etUbe��I;��i2, i[ce�rtse*€�s uccr�se;1�ir��!er i:i�af3C�.r 4:�5,!.4.n��isi p,ovf��e t�e Je�aus�en�>r�t 4�iti'P3���f,�n.i(ac7dr�ssv i�ti��y h�<� u�r,c. .�4=ern�iis;�r�vEcEc c'r���Y hz, https./!ww-w.myflar�cialicens�.�om/LicenseDet�il.a�p?SII�=8�ic�1=D7�D�F'EB4I�A23EEC.,. 4112/2(}21 � � � 1 I � ILI I ����'��„'�", a��i�r�o�� TNIS G�RTIFIC�T� IS I��U�D �t� � �flA�TT�R�� 1NF�R�IATtAN t)NLY�ND CE)N��RS t�t� RI�HT� UPCiN THE CEF��'IFIG�ft'C� H�L.DEFi.THI� �����F�c��r� ��a�s �o�r��€r��a�r�v��.v �� ���aTtvE�� ����€�, �x°r�N� c�� �L����r�� c�v�e���� ���a���� eY Tr�� P�Laci�s ��CpLCp7W�n.. �T¢'�Mq^µl��ry�;gERryTp'1�ryIGry,S/yT�yEyp�AR,FrytP1pa�Ugg^�R�Apg�NCp�a�^Dp�gC�►gE�rySpaNpQ+�T u�p��gNry�cTpITUTE�4 CONTR�4�T �� EEN fiF1� I��UIN� IN�UREF!{S}p dUTHORIZEQ Ri.C'R�a7�I1BMi9Y�LJ6'!f'ilbtVV4�F"!9 HAYP.R /f9�Le6:&'1/!['tLMt�1FW`&iL('6. IRRPQRT�NT; If#h�c�rt9fi��t�h�id�r I�an AGlC?iT1C?RIAL iN�URE[�,the poticy{a��)rnu�t hav���D1TE�RI�L IN�I���[�prrcavi�ions or b� d�rs�. tf St1BR ,ATIQtd iS 1��IV�C►,subJ�ct to th�t�rm�and�andit�on�of the p�licy, ce En p�lic���m�y r,�qu�re ar�sndors�m�nt. A�t�tem�nt�n eht���rtit€c�te do��n�t�onf�r right�co th���rtifi��t�hoider€n l€eu�f suah�+��rs 4{�}. pAo�uc�R ����: Autam�tic C�ata Froeessing insuran Agency, Inc. — -- -_ — — --- ___ __. Autom�tic C�ta Pr��ssing fn�uean A��ncy, Ine. ���� �c} 1-8i34-�24-7C�24 _ — _������ e-�a�� � __ .....----- ADQR€SS: � 1 Rdp�ouleuard r�tsuR�r���a�Faere�l��ccsv� ��_ _ � ���� _ �QSE�e�€1d �� �7��$ tNSEtRERA: NorGUARD€nauranceGom��np _ .____. ___ - - ��4�Q _ __.______. _-- _----- ---- -- - ----- tNSURE� Jd EI�tP'tC IqC lNSttF#�R B: _.._�._ ___ _ _ fNSURER G: -- - - -.___ .._____ --- --.__ . - -- ,-__ ---- $A77 NW 768th Ln tNStSRFR R: ENSUR�R E: -__ ..�.__ �� FIiaE2ah FL 33Qt8 fNSURERF: Cf3V�F�Af��� ��R"CE�1�AT�NU��EFi: �921712 R�t�I�lAh!NFJ�I��E�: TF!!S IS TC7 CERTIFY TNAT TME Pt?LtCfES OF INSURANCE LISTED�ELf?W HAVE BEEN ISSU��TC�THE INSUR�(�NAM�C}A�OVE�C�Fi THE PC�LlGY P�RIOD IN�lG,4TEE}. NE3TWlTNSTANDIN�S�NY REQUfREMENT,TERf�fl QR CC3NDETIQM1I C}F ANW GONTRACT Of�Q7MEFi C?C7CU�tiENT UJiTH RESR�CT TQ WH(GH THtS GERTIFtGATE PtAAY E3E CSSU�D C1R MAY PERTAIN. TNE INSURANC�AFFOt��ED BY Thi� PQIiClES QESG�iI��C� H�REIM1I IS SUBJECT TO ALI.THE TERMS, EXCLUSIdNS AhIC?Gt�NQITIt}NS QF SUGH PCtLIGfES.LIMITS SMC3WN�Y HAVE BEEN Fi��UCEd BY PAI�GLAIMS. INBR� �� - ---� L1$�� i POL.�Y EPF i P4lIC�Y EXP � � ___._____ _ lTR'i TYP�(5F IN�URAPVG� 4NSR:t�1Y0 PQLICY NUh�BER I R�t�DfYYYY : MMA)D t�IF�(f�a i GOMM�RC4AIe GENER�L CWBiLP�Y � I � EACH C?GGUFiR�NGE �� { r --- — � 1 CLAfMS-MADE ��OCCUR � � � ' _� -- . Ff���Y1���S�OCClfYf9R1CQ} ,� ..�... .. .�.—. � � ; MED EXP(Any one pee�n} � � ,__.._ � _.__._..___.----- f _.___M _�� ( PERSQNAL&ADV(NJURY I 5 � ,—� � ( i GEN'L AGGFiEGATE L IMIT AFPUES REF� GENEFiA�.AG�xREGATE � $ j •-� ' ( : 1 _._ ' -- - P(?L(CY i ��� + �QC i PROCTUCTS CQMRX�P AGG � $ � � � �� �___> � _, T_ � _� : OTH�R�. ( ' ( � � At1TQ BIE��LF�6IL�1`Y 1 � $ I � �a a�ident� _� —�_ . .— — '_ -- i ANYAUTQ � ' � i � � _ BtJQtLY iNJURY(Perparsron} � � �' O�NED `�-;SGHEQULEO __ _- —t-.. - . ---- ��;AUTOS ONGY �� �UTOS ( � I � �t?ptLY I(uJURY(Par�e�tc€�nc;i $ ; HIFiED � � N(?NaOWNEQ � , i � PROFER7Y-5( AMiA�E � — - _, AUTQ.�ONLY �_� ,4UTtJS ON�\ ; � F(Peraecide�rrt� �� � j � -- _ -- � � �ttR�t���t.t.�LN1� (oGCu�i � I EACN oCcuRRENGE � --' r- � i _-- --t - _ ----- EXGE��14� i i G�AtMS-MAQEt I AGGREGAT� � '__ ,_f.� _ _i. . .L--- � : ! ( ' . oEo ' ��T��Tior�� � ; _ _ ___� --I Vdf}RK�RS C4PAP�NSATlOPI i ; I - ANR�MPE.�YER�'LiA�ll.il"Y � STATUTE ER Y F N � - �- �-- - �� -- - — ANY FRQRRIETL?FitPAftTNEFilEXEGUTtVE i E L EACN�CCIC}ENT ,� 1 Q{'j(�QQQ � a�Ffc�R�,r��a��Exe��o�c�� ��N Ir�r�a N �tC�WC139322 ;I051�9F�0�0 05�}9t20�1 -- _----- _ __ ------ Er��n�zo��n�v�} � � 1 , ��_o�s�as� ����P�av� s ��4t}4,flQ0 If yes,des-criba�doc � ------ . _____._ ___�,��Q QQ� _ QESGREPTIQN C?F OPERATI4hlS b�low � E 4.QfSEASE Pt?LICY t�IMIT , $ ' � i i � i DESCREFYt4N QF OF�R4TR4N$t LOCATtQN�f Y�N�E.E3{�GORD 141,Additionai Rer�rks 5ch�fule,�y he att�hed i#rrxsee space ie r�quir�d) LICENSE NUM6ER 16EQOC�056 CERTtF1�AT�1-I�L.t)E� CAPIC�t�LATI�t� SN€}UE��ANY f?F TH�ABQV����G�6��� G,1Ct�5 BE CANCELI�ED 6E�OR� TH� EXPIRAi'I�N t}.QTE THER���, NC}TlC� aViLL �E DE�IVERED IN P�iami�hcar�s Village�uilding Departm�nt ACG�R�ANC�VdiTH TME Pt3EIGY PROVISiC3NS. 1fH}5C}N�2nd Ave AUTHORC2�D REPRESENTATEYE � �. �iami Sh�r�;s F� 3313� ���s«-., "�. ��,_ tc�1�f3€#-2Q1S ACC'�RD CC}�iPC?RA"['IC}N. AEI ritahts rP.senr�d. � � � � � ��� � � �a�{tat�t��tvYvr} 1 � I _ _ ___' -______— _.._ -- --__ ._---- -- -----_ ----_ Z ---0410512021 _I ' TH15 C�F2TIFI�ATE iS i�SU�[�AS A MA7TEi2 C}F INFORf�IATION C}RE�Y AND G{3NFER�NO RtCHTS UPON TN��ERTIFIGATE H�L��R.THIS � GERTIFICA`tE�Q��NOT,4FFIRNEATIVE�.Y 4R N�GATEVELY Af1��N�,�XT�ND OR AL`F�R'TH�Gf3VE G�AFFOE2DED�Y T'H�PC}�ICIEa � �eLc�w. °r��s c�RT€�tc,�T�c����su �c���a���c�T co�s�riTu���cor�T�ac°r���rvv��r�THe issuw��wNsuRER(s�,auT���iz�a , REPR�S� ATiY�QR PRQDUC��,�4ND TH�C�f2TIFIGAT�Hl'}I�D�R. _I �----- ___-- -- -- __-- - -— - -- - __ - -_ . - ------- if�PORT T; (f the certlf�cate halder is art DITIQNAL fNSUR�D,the polEcy(ie�)must have ADRiT1�NAF.INSURED provis[ons�r be endors�d. ( {E St�BROGAfiIC3N I�VYAIVED,subj�ct to the term�and conditions of the policy,certain policies may requie�an endor�emsnt. A sfiatement Qn � 4hI�cerflf�eat�daes not canfer righi�to the certif�cate hold�r In(ieu of sueh endorsement(s�}. i _ ---- ._. _ _......_. _._..j } PRODUCER . __'._CC?NTACT DAVID AJO I '� i_hIAME: - ' ---._ ..._..._. _____ ... ., ' Interassurance pw��e - (305}75$-8322 F'� 305 75$-4456 ,t_�e,.�4,�tRk� �.t�1JQ,No}: _� ) E-MAIL - -- — - � 9190 Bisc� �Blvd.,Suite#201 dawd interassurane com Y� �_��a�; _ �-- - _ ______I � �Aiami Shar�s,FL 3313� � �Nsu����s���o�zo€ra�cov��zac� , N�c� � --..._.... _ _ - ----- ___ i Phone ._(305)75II-8322 Fax (345)758-4A56 �r�suR��a: FiUD�ON SPECEAITY INS CC} .i - _..--- _ ... . -- _- — _ _ . ir�su�Eo ' ; ( ; [NSURER�f: ... ..... � - -- — -�— - �JD E�ctri�, Inc ;�r��uR��c: ; - — -- -- — i � HHTT NW Sfi$tI1 La(12 ;_lNSURER_D: ___ .. r__----- � -- I 6NSURER�: � I ; r����� ���5 F� ��a�� ----. - _._ ....--- _. �--- _ - --- _-------- - __ __' ir�suRe�z�: j ._. ___ —__ GOVEk2A��S C�RTIFIGAT�NU��ER: I��ti/ISION NUR��Et2: - -- � �--- --- - - - — - --- - ---- -- �-- - THES IS TC}CERTIFY THP,T THE POLIGl�S dF INSt1RRNCE LISTED BELt?W NAVE BEEN ISSUED TO TFiE fNSURED RIAMED RROVE FOR THE PC?LICY PERIflD � INDiCATED. N4TWITHSTANDING ANY REQUIREfv9ENT,7ER�1 OR CONQITIC?N OF ANY CONTRACT OR 07HER DC?GUMEfVT WETH RESPECT TQ WHIGH TNIS CERTIFIGATE�AY BE tSSUED QR NtAY PERTAIC�,TN�(hlSU62ANCE AFFORDED�Y TNE POl.ICIES DESCRIBED H�REIN IS SUBJECT TO AL�TNE TERMS, ( EXGLUSIOPISAND GC}NDfTIQNS aF SUGH POLICIES LIMITS SHQWN MAY HAVE BEEN REDUCEQ BY FAID CLA(M8 ' - --- -- INSR �---- �ADDL U�R �------ -_ __--- ..._- . PO�ICY EFF (� POIICY EXP �.._. ........_ ._ ._.. .__---i tTR� _ 7YP�O�INSURANCE _IlN�R�4'�'�� _ POLIGYNUPR�ER-- I7j�qMtDDtYYYV);_(MM@DlYYYY��_ �[MIT� -- _ _ ���/I CQMMERCIAL GENERAL LUa61LiTY - _ - -- --.._--- ' � ; i � i_�.acM_occuRReNce s 1,404,aao aa �a': c�a�r�s-nn,�o� C�' occuR j = °�°��`����E��° �- 100,000 OQ � , , i PR�MISES Ea aecc��ance� � � -- .._ � � i MEO EXP{Any one person) ( $ �,�Q.�Q � A -- --- -- - Y Y H�D10Q39863 ;0612�12020 ;4&12�/2021 - - t-- --- ----i ' ; i FERSONA(�&AOV INJURY � $ 1,OQQ,C}OO QO i - - - ---- -; _... _._._. - : i , ��r��R�c Ac�Ree,aT� � � 2 400,000.oa ' GEN`L AGGR�GATE LIMETAPPLIES PER: __._.._.- ----.._ . � - - _ ' ��� POt1�Y i-�� JECT � -- LOC ( ' -' (�PRQQUCTS-CQMPtQPAGG $ �,OOQ,QOO.QO ... .� ; QTM�R 1 PRO- � i I ,- ----- _- - -- -' 1 I { I---4-�:-' _ -------- - }.__ _�---- __ , --- --___ --... _. .- ,_- t�RBtNEQ SlNGLE LlfthiT AUT0090�EE.�LIA�ILITY �� , � ; (�a aco�dent � _ _ . . � -� -�- i� ANY AUTfl � ' � 60[�tl.l`INJElRY(Par pa�snn) $ { � !.__' SCNEDULED ' - - --- -.. -- � `-i 0���� �-� AU1�}3 �QDILY tNSURY{Per aecid�nt) � � r l AUT06 QNGY J NC?P!-C}WNED ; Pt2QPERTY�MAGE �_ __ ___ B � . AUTC?S QNEY j L . AUTOS pNLY �Per accidenF - -- -.- - j � �-t {-- ---.......__�. '_ � � .. - - . _..--.�_.... ---{�- i_ � l � � � UM�R�LGA LIA� � j QCC1162 � - - --,- � ( . ' � - EAGH OCCURRENCE �- --__ , _ _ � � EXG�SS LfA� � )C�AIRhS MADE ; i AGGREGATE $ --- --- - ; -- -- , - {; � ,_.D�D L1 RETENTION$ i � �---* -- -_... _- - -- t---- - � - � WQk2KER8 CQh4PENSATiCIN ; � PER - OTH � , . 7AT�TE �R � AND EMPt�QYERS`L1�BiLiTY Y!N i � — _ --- � � j ANY PRQPRI�TORIPARTN�RIEXEGUTNE, � i E L EACH AGG@ENT I$ i � ' OFFIC�RThAEMBER EXCLUDED? � ��N t A� i I !- - -_ ..- -- ----' I (Mandatory in NH� -�i � i � E L OISEASE-EA EMPlOYE $ � If yes,describe under � � i — - - � � DESGRIPTIQN OF OPERATIONS below i { � E L DISEASE POUGY LIMIT � � _ � _ -- ---_- - _�__ � - _ � ___ �-- .._- ---- - -----j � � , � ; , � ; � r_..___7______....._..__.__ ____.. ..___.__.___ ... � � �___ ._______ __...__. .._._.__. : _______ v___.__ j......_..__— _ ___._!___ .________ ___.______.1 i DESCRtPT14N 4F pPERA'fiQP1S t LOCATICIPIS t VENlCLES {Attach,4Gt?RD 1Q1,Addifianal R�marks Schedule,if rtwre�pac�is requir�d) ( 'L�cENs��unn��R�s�aooa� i I , � ; ---- ------ -- - --- _ --- ___ c��°rr�e�A°r��oLQE� caNCE�t�TEc�� ------------ ------ --—- _. _------ __. --_ __ - -- ----- _ ----i � � SHOUI�D 0.MY 9F T HE ABQVE�ES�RI��D PQLICIES B��ANC�LLE���FO�� � iYi[Al�I SHORES V(LLAG� � THE EXPIRATI�N DATE THEREOFa NCIT�CE WILL B��ELIY�RED IN , ACG€}RQANCE WITH TH�POIIGY PRQVI�IQNS. ; �UI�C3ING DEP��7M�NT ; i � i + 1Q050 NE 2ND AV� F ----- ___..- - - -- -- - -- _ � AUTNORIZED R�P(2�u�h11'�T1V� -'-^�y MIf1Ml SF1C}RES,FI�3313� --v�"""x..��~"'._... , � (, � ---- -- -- ----._ _ --- _ -- -_-- -----' O 1988-2015 A�C}RE}C;ORPORATI�N. All rights r���rved. ACC}F2E3 25(2Q16fU3)QF Th�AGf3RD name and logo are r�gfst�r�d marks a��0.CQ��