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EL-10-20-2471
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THE Q�IVlNE�ROUP HQtVlES LLC Owner AE,I ABt}UT CONSTRUCTIQN INC. Contractar � _.u . �w_..�w.__r...�.�._.�..M_.b�� R�.���_��w.��.�.w��.w._��.�„m___mw�.�._��.�� ��.��,.�,������..�,��.w_� �,,�,�_�.4.�..�.�,n,m�� E 293 N�61 ST,Ml�MI,Fl 33137 RRNAt�DO ANTONlO TEXIDOR � Busi�2ess:3Q53QQ5174 13375 NE 4 CT,M1lC�RTH R�IAMI,FL 33161 � � � ��asiness:7�6�1�76233 � � € A!L ABf3E1T CQNSTRUCT'i0N kNC �lgent � anief toledo 455 s biscayne river dr,miami,F�33169 � 6usiness:305-3Q0-5774 aaeelectricalc@�maii.com � MobiEe:305-3Q0-517A . . ..nm.��,P,a,.,.�.�...-..�n, �.�....�.....�.,..,,......�....................:...............M..............m...�............,.n. p �.y p } 9�r'J �f+4�Q�Re u��4� � ��scription:TEMP FQR CONSTRUCTI�N NEW SINGLE STf�RY 4. € �aluatican, $ 1,500.Q0 � � r,�J����,���^'�;������� ,� s< .., � BEDROONIS,3 BATNR(?t�MS,SING�E FXlMILY NOPViE 3600 € ��_�{����������'�����c�������';��c������`����� `� SQFT OF TOTAL CC�NSTRUCTRCIN �TotalSq Feet; 3 600.QQ ���'�������`��l�\�`��������������,���'` r 1`�,��� 1���.��\���:����,;\�<�\..�,,.si'��i: � 123 NE 99 ST f 11-32E�6-013-21$1 � DRY RUN Fe�s Amount p�y�ents Date Paid Amt Paid Application Fee-Other $54.QQ Total Fe�s �19.1.10 Cc� �1.zo cn���#�oos 11/0���o�Q ��z.g� DBPR Fee $2.04 Credit Card 1QJ27j2020 $50.UQ ac��ee ��.00 Educatie�n Surcharge $0.4d �mount�u�: $0.00 Permit Fee $SQ.00 Scanning Fee $3.00 TechnolqgyFee $2.50 Tot�l: $111.10 I�t� 1�1 ��+�t'� e11� �Q �f In ca�sideration of the issuance to me of this psrmit, 1 agree to perform the work covered h�reund�r in complian��with ail ardinances �nd reguEations pertaining tMereto �nd in sErict eonformity with �he pians, drawings, statement� ae specifi�atians submitted to t1�e propee authorities of �lliami Shares Vill�g�. fn accep#ing this parmit i assume re�ponsibility for all wark done by ei4h�r myself, my�g�nt, servants, �r employ�s. I und�r�t�nd that separ�te permits are required for EI�ECTRICAL, PLUM�ING,IV(EGNRNIGA�,WINDOWS, E}C?C�RS,F2C}CJFING and SWINIMING PQC}L work. C?WNEF2S AFFIDAVIT: I eertEfy that �If the faregoing information is accurat� and that aEl w�rk will be done in c�mpiiance with afl applicable Iaw+s regul�Eing canstruetian and zaning. F€athermore,i au�harize t�e above nar�ed eontractor ta do the work stated. ����f� / f� � �„ °` � �� Authorized Signature:4wner 1 Applicant 1 ��'f �ontracYo�� 1 Ag�nE DaEe r' j (Vtsuember Q5,2020 Pa��2 Af 2 \ � � l\ l � 1 l �) i \� 1 `. \ � \`��4 l�\\�� � 1�1 i 3 \ � t\ l� 1 t . � 1,\ ; �: � ��iV��i�� '�.t� 1:4 � �� � �� � � �a�����,,s�,� ����$ � � \��Z\��\A\�i '��� � s�," � t �ti � �� � ���. A� �� � �� z�. i 1 � �* �\ � t t � t� � �� � � 3 ��{ 8 � �� � � >>A� ��� � �p ��A � i��` � � ^ � �t ti ��\t \\ � ; � � � � ti� x� . � .� E���������������� � � � � l��'�� � � �S \ � � " ii � � � � l\ 1 1 \ �� � ` �L 1 �`2�,2 , ,� 3 �j^ iooso�E a av� , � � � � 1 ��� ��� �, t � il � � \ i � l �. t \x.�� � � �� i ��� ` `�, . ��� Miami Shores FL 3323$ ,` n � ��"�����������������` � ���� ' �;������o\\�i ��i��. ��� �. � ���` �l . \iL �`�\z{ r�t�\}ti111 \�\5��� �\O\� l��`����.:. fa 3Q5-745-2204 ������ ��\\�\O�o��� Z� �� �� ; � � ������;��` ` �� � � ��L��« � �� � `�' \�7C°����;��� t� '\�v�st� � ` z t ������ `^i�.4T ay�` \\���•� t� 1�\�\1 � ����\l i »lt \\�� D`ii�����.� � � �yEgSgqiN�@� �t \\ �\"��r���`i��\ ����ti�yt l �ak ` �..�4.U�\� . ..i.<�.��'�.�}\��,.,s,.1..�., ..���:: ��iRHi55+�'.:� ������\\Z�� £����\\�2\1�l\\ �l�i\ S\ ..\.a.\..� ,......�u1�y,L,��..�\ ,,,, �l� �3\��Z.1 s z V . � . �� � � �� E�f�l�'e�'�'(Qt1: �}��{����Q�� ������Z�'��}��``�,\�z., ��' �� .���:�,��;<�,,:; C��at��n Address Parcel Number � �,�.,��� ���. � �����m..M.a�.�.�� �_.��,��.v__��.�.�.��.m��,.u_�,�w.���� �.�.�.._,.��.u��u.��a�,� � � 123 EVE 99 S`� 1132060132181 � Cont�cEs . . ... ........ .. ���....,,�A�_� �.�.��_.�,�.aee,,�������r.�,e.x��.�.�.��w��._m_.w.,��_���.��_._�_�.._____,,._.�.,�....�����.w._,_�e evv„__v.ff.r�_...__� ��_.m.__-__�._�_. � TNE f3LlViNE�ROUP HOMES lLC t?w�ser ALl ABQUT CC�NSTRUCTkON IM1IC. �c�r�#r�ctor ' 293 NE 62 ST,MIAMI,fL 3313T ARNAlDO d�NTONIO TEXIDQR � t � �usiness:3053�05174 13375 NE 4 CT,NORTH MIIAMl,Fl 33161 � � Business:?864�76233 , � AL�ABOUT CC?NSTRl7CTIQ(V INC Ag�nf� � i oniel toledo � 455 s biscayne river dr,miami,FL 33169 t � Business:305-3Q0-S174 aacelectricalc@gmaiLcam � Mobile:305-3Q0-5174 E �.�m...n���.��_..__�....�_.�_._.�... �,���. ��.�_, .__.,.�...._._..,.._.�.._._._.__a......_.a..m�.�--� �m �_.. fi a ins ect�on R� u�sis ; Descript°son:TEMP FOR CONSTRUCTION NEW SINGl�E STt�RY, 4 ( Valuatic�n. $ 2,504.Q0 ����� � ��z ,� �� t � ���1� �� ` B�BROOMS,3�ATHROOIVIS,SINGIE�AMI�Y HOME 3600 � ������\����`���`�����z�`��,��� ��`��'� j � `� �������\� Z� ��� ``��� ti� Z�� i SQFT OF TQTA�CC7NSTRUCTION ( Total Sq Feet: 3,60Q,00 . ��\�� � �; �� o � � o� � �; ���,�,a �<..v� . �.� ._ .....��..,.�>° � 123 NE 99 5T 21-3206-013-2282 � E�RY RlJN F�es Amount payments Da�e Paid Amt Paid Application Fee-Qther $Sd.00 Total Fees $111.10 CC� 51,20 Check#20Q6 1S105/202Q $61.14 DBPR Fee $2.OQ Credit�ard 10/27/2020 $5f}.QO DCA Fee S2.Ofl Edueat�on Surcharge $p.40 ��Qun#�ue: $O.Q� Permit Fee $Sd.QO Scanning�ee S�.OQ TeehnQlogy Fee $2,50 T�ta1: $111.1Q �IG � d y For lr�spections, �a�l �30�) 762-494�9 or �og or� at https;l/bldg.miamishoresvillage.comfc��/. Req�e�ts must be r�ceived by 3pm for foll�wing day insp�cfi�ans. NQT(CE: In addition to th� requir�:ments of this permit, ihere may be ANE� TH�RE MAY BE ADdITIf�hIA� PERMITS ��QU6FtEC} FROM C�TN�R additia��l r�stricFians�pplicable to this property that ma�be found in th� GOVERNMENTAL�NT1TtES SUCH AS WATER IUTANAGEPAENT DOSTRICTS, publie records of this county. STA7E AGENGI��,OR FEDE k.AG�NCiES. t��uarnb�r Q5.2Q2� �a�e 1 0€2 � � � � � �'�_�`���n��"?'.�. �t` ,�.�,��.� p ����psq� }� B 1. t:�`��1 G+ , �� �I � � � rfi r�� • �F, � . _ �`,�,��,�„-�� 2QQ50 N.�.2nd Av€�nue, �tliami Shores, Flc�rid�3313� ���f t, ���� �, � HN��� �� ,�-� `��1:{305}7�S 2204 F��:{3Q5}756-8972 ��s�e�����������c��€r������;{����a�2���� � ��� F 2Q �� ��t�r P�ro��fi �I�.`��, �� ,� ��� �_ ��;�m � � � Sc�b R�rrr�i� PV�, �.= ��� �C� "� � � ��������� � ���c-r�Ec � �c�c��R�� � R�v��Ec�� � �x�r�r�s�a� �����w�� ���ur����� � ��c����c�� ��u���cwca�x� � c����� e�� � ���c��l��r��� � s�c�P e�������r�� �������s �c�a�����ss: �23 N� 99th �tr��t �it� : (�flfliami Shc�res Cc�unfiy. R�1i�mi I?ade Zi : F�6a�/P�r�el#: 11-3206-0`I 3-2181 Is th�6c�iidir�g��st�ri���6y�����rt�t�d:Yes ___�� �.. C?ccupancy Type: Lo�d: Constructic�n Type: Flc�t���one: �FE: FFE: c��t���:r�a�n�{��e sEr�,�ie r�����,n�c�eG��:Th� �Bivin� �roup �iome� LI�� ��,o���; 3053Q05174���.�a.� �ddress:293 N� 61 sfi Stre�t cE�y: Miarni s��t�. FL �;�,. 33137 _a... TenantJl.essee hlame:_�.. _.n_e_____..__n .�_�m_... __.. _.____�.m__Phc�ne#:� �ma��; a�celectri��lc(�gm�il.com �tarv�������:cc���,p�n��a�,�: �11 Ab�ut C�ar��tructi�n Inc �n��,�,� �053Q05174 �dar�s�: �55 � �i���yn� Riv�r �r ciry: Mi�r�t€ state: �� _ � ._�.. __� M��� 3316� Q�a�if�er€�an�e: �rtl�id� T�xideG' Phc�r�e�: .._ State C�rtificatic�r�o��R��istratie�n#: ��13Q�5547 C�rlificate af Campe�eney#: �ESl�h1E�.Archftect/Engineer:.mm _Phc�ne#: __ ___ ___��.___._�� �ddress: City: �State: _Zip: 66�Q�� � � �:"�� t i.�� ll�lu����rte�rk f�r�his Perrs�i�.$�� Sqc�ar��l.ir�e�r Fc�c�t��e caf�ork,____ '�+�pe c�f 1A��r�: � �ddiiiprt [� I�Iter�ticn [� t�le�v � Re�air�/Re�ala�e �� E��rr�cliti�r� ������p�,���,��v���: �ingl� F�rr�i[y Resid�nc� a Electric�l �-� �"��„,��-:��,�� �=���., � ,� .� �{�.;��d�.� :�C ��t`«�� �--�7 �'..,._..� � _.. _ .. __�__.... � ��ify��l���f c°���r�h��r �il�� S�brv�itt�l F����.�. _�_P�rr�if F��$ ��F$� � ������ . �..� Sc�r�rrir��F�e� R�de�r�Fe�$ ��PR$�. , #����r�$ T��hr��9��y F��$ _ Tr���s's��f£d�a���ic�r� F��$ __�.�._�cacable��e� S�rtactc�ral�e�i��s����_____ .� _� ��_� �����.. �� lb.dek`46�&..�t#4+�A" {.6V�y� �� 4 €� (R@Vi$E'ciC�2(L�4j2Csi4} �onding Cc�mpany's t�ame(if applfcable}__ �_ • �c�ndin�Cornpany's Addr�ss _._ ._�._ ���__� __.__ __. �..� _�_.__.� _ _ City _ St�te Zi� t�ortgage�ender's(�ame(if appiicable}__�._ �vl�artg��e Lender's�ddr�ss�__� _.. _._._.�.� __�._�. .__ .. �_ . __._�_._ City � State� � ZiP ____ �pplicaticrn is hereby made ta c�btain a permit to do the work �nd installaticans as it�dicated. 1 certify that nca l�c�rk or install�tic�n has cor�nrnenced pric�r to the issuar�ce c�f a �a�rrr�it anci that all �rork will be per-fcarmed to meet th� star�dar�ds c�f a11 lav�rs re�ul�ting cc�nsCructaan in this jurisdictiran. f understand that a sepa��te perrnit m�ast be seeured fc�r �l.EC:TRI�, P�Ut�BI(�G, SIGNS, PC�C�IS, FURt����S, E�QILERS, k-IERTER�,T��l�S.A(R CC}�1�17IC�i�ERS, �T�..... t��ff�E�'S �FF�[3��1�; ! eerti�y that �If the �oregQing infarmation is aceurate and Chat al1 wor� will be dc�ne in c�mplianee v�ith a(! applicable laws r��u�ating cdnstructio��and zoning. �$ ' � � : � � ��,� � � �� �� � � � � � �' � ����� � � � �� ��� � � �� � �� � � � �� a �� � � �� � � � �� �� � � � �� ��� � �� � �� �� � �� � � � �� � � � � �� � �a�, IVc�tice te�,�p�alicar�t; �ts a cor�ditie�n tc� the issue�nce caf a buildr`ng permlt wrrth ar� estirrmated value exeeedirtg.�2�11t?, th�a�pliepnt rrtust �arcrrraise ir� gcaad f�ith that c€ cc�py of the nc�tice af cc�mmer�c�rs�rent t�nd ceanstructic�n (ien Iaw brc�chc�r� will be c�elrv�red to the person whose pr�op�rty is su6j�et tc�crttachnaer�t. Atsc�, a certified ecapy o�`the r�ccrrded natr`c�of comme�aeerraent must be pc�sted crt the jcab site fc�r the�irst inspeetion which c�ccur�s s�verr j7) days af[er thP building pern7lt fs ssued. !n the crbsence of such pns�e� nt�Cice, th� irrsp�ctr`on wi�l n�t be a�proved a d a reins eetion f�e wifl be charg��, �� � k� r � r` .�° '"� � � j--- ,� � R.�'' �� w�. � .� S��r��ture �~ ______ S��n�t��rc_ , __.__. � � {��p� �R� (^� p,�-y- € ,e�p�p�^�pn/^�^�^f {^� �YY FY�tl OC�IJ�EY I 4 I,IJIY[FlP1i..,f 4�R Th�fc�re�oing instrurt�ent was�cxkrrya�l�clg�d b��are n�e this The fc�re��in�instrurnet��wras acknc�wled�ed befc�ee�1�e this p f . � ���#.�t���ay��__E�`'� �t� �j �� ,2f? �'--� by � day of���"� ���� � �� ��� ,�Y � _ __-___ , _ �� �m � „ t � ��,� __.w _._ �L�-- �t �` '•�_ �. � � �e�� '�ersonall knou�n � � t�nc��is persvnalfy knca �o ��� .� ��___�__._ ,� {� Y �� � � �. _.,� �._ �. _._,._�..��-M- _, me or v�rhe�has produced __�.__._�__ �s m�c�r who has praduced as ici���tifi�atic�c�a«c�who did tak�a«t��th. id�n�ificafiicsn anc�+n�ho did take���o�tl�. hICDTA�Y P�t�CI�: RVC�T��°PE��E.��: " � ' � �� �2C}�r�:�3EL��JILL,EN � �� � � � ���� ;���� '� �r�, � �� �3Y CC�?b9�SS�ON#G�r3E�7�,4 Si�,n:.�,..� �-. ..a.. Si�ft:� n�.e..� t. _,_,„�P ^3:�tarcPt 2` 2Q�3 > � � Print:��.�� . � _ Pein�: � ���� .,�.�.� �.. �`�.�.�._..'`� �� ��� � � N df dE � t,9F"1 t9 F�b,. �Pt t Sd td€l � �e��: ��`"�� �¢`*g E��t�ry PubiicP�tat��t F4�rid� Se�I: «* �� ��tTtrr�i��(or�# F#M 22743 �� �'� ��� �y��r�rr�i��ion Expir�� `'ffP����°`°° S�pt�mb�r 2B, 202� ��������������� �:��»��m�x������:���������*������z�����:�����:���������������s���� „..� � �*� ^f l�P6�RC?lt�p�Y ���r � ���,•'�����-� �-� �,E�-� Plans Ex��-€�ii�er Zc,nln� Structu���(Revi�v�= Cler� (Revi�ed�zJ2�f zC�aaj �y1����'S � � ..�. .f,.�� iami hore� illag� ````��r������'�� 1� 1 '����r��` �aa�a N.�.��,a �Venu� Miami �h�res, Florida 3313$ T+�1: (305} �95.22C}4 F�xe (305} 756.8972 T ' I � EF CONT CT4�!S A FLQRlDA STATE GERTIFIED CdNT CT4R: A. C�PY OF 4UALIFIER'S STATE �iCENCES B. CQPY�F �OCA� BUSINESS TAX RECEIPT C. COPY QF LIA�ILITY INSURANGE* D. CQPY aF W�RKERS CONIPENSATIO�I I�ISURANC�* (Warkers Gompensation EXENiPTIQN must have NQTICE TQ OWNER f�rm and �ontractor Affidavit� 1F CaNT CTOR FlAS A MIAMI DADE CQUNTY CERTIFICATE QF GQ PETENGY: A. GQPY�F CERTIFIGATE QF C(�MPETENCY QF QUALIFIER �. C�PY UF L�GAL BUSINESS TAX RECEIPT C. CaPY QF STATE REGISTERED GE�NTR�CTOR LIGENSE C�R MIAMI DADE Ct�UNTY MUNICIPA�. CQNTRACTQR'S TAX R�CEIPT. D. C(�PY OF I�lA�ILITY INSU CE* E. CC}PY OF WaRKERS CC3MPENSATI�N lNSURANCE* (UV�rkers C�mpensation EXEMPTIQN mus�have NQTfCE TQ C}WNE�farm and Con�ract�r Affidavit} *Yt�UR ECdStJ NCE C�MP�NY Ml1ST ISSUE A GERfiIFIGATE AS FOLL� : Cer�ificate Hold�r: C�IAMI SHORES VI�t�AGE BLD�DEPT 10050 NE 2NQ AVE NIIAM!SHQRES,FL 3313� Gertificate must specify the descrwpti�n af�psrati�ns or contractoe lic�n��number. .......................................��................�....�..�.�........�.............. �usi��ss �a��: ��� ����� �������:��"��.`�..�` :��� -_ � �;,� ausiN�ss a��R�ss: ��� ,�����.� �;� ��� ' ��i�����:�,� _�� �;�,��� � � �� . � � s�r��r�_ � zi� ��-� � � � gus��ESS PHo��: � ���' � �'� �-� ��� �� F�c�u���� � } CELL PHONE ��`� } �`�� __ � � ���-.QUA�IFIER'S NAMIE� �`��'����` �` � ��'�_ �ua�����R}s ��c �u����: ����.`_�.1��� �,--Y�_�:��°� ��Q��,"� . � ��as�� E�mi hores illage ao�� �aeer� . . � A � ``�"� "��� ����� �.�.�tl� f�V@(lU@ ������� Mi�mi Shores, Fl�rid� 3313� 1'�I: (305) 795.2204 Fax: (305) 756.�972 tl � t' � C i" ' �I ' 1" C tl Fiorida Law requires Warkers' Compensa�ian uisurar�ce coverage under C'h�pter 440 of ttie Florida Statutes. Fla. Stat. § 440.Q5 allaws cc�zporate offieers in tlze construction industry tc�exetnpt th�mselves frc�m El�is r�quirement fUr any eanstractiori project priar to obtaining a building permit. Pursu�nt to the Flarida Divisian af Workers'Coznpens�tion Empioyer Facts Brochiu�e: An emplayer in the constructiozl industry who �mploys one or more part-time ar full-time employees,includzn�the owner,must obtain workers' cc�m�er�satiazz coverage, Corporate offieers or m�mbers of a limited tiabil'rty company (LLC'} in the constnzctian industry may eiect to be exempt if: � 1. The c�fficer owns at le�st 2�per�er�t af the stack of the corporation, or in the case of an LLC,a stateinet�t attesting to the minimu�n 1 Q perc;ent ownershi�; 2. The af�c:er is iis�ed as an oftzce�• af the eor�aration in the recore�s of the FiQrida Department of State,�ivisian of Co��porattorzs;and 3� Th� corparation is i�e�ist�red and Iisted as active with the �'lorida Deg�artment of Stat�,I}ivision of Corparatic�ns. No n�or� than three �orpt�rate ogficers ��z• carpc�ratian or limieed lia6ility coinpany members are allowed ta be exempt. Construction exemptians ar� vaiid for a period of two years or untii a votuntary revocatic�n is filed or the ex�m��tiorz is reuoked by t���I�'rvisic�n. Your contractar is z-eq�zestin�a permi�under this wc�z•kers' cQrnpensation ex�mption and has aeknawied��that he ar she wiil not use day Iabor,part-tirz7e emplc�yees or subcontz�aetc�rs for vc�ur project.Th�cantraetor has prc�victed�n affidavit statin�that he c�r she will b�th�only�ersQzi alloufed tc�wc�rk or�yotfr pi�oject. Is�these circuznstanees,Miamz Shores Villa�e does n�t rec�c�ire verification of �uarkers' compensatian iusurac�ce covera�e from the cot�tractor's company far�ay labc�r,part-time eznployees aa•subcantractors. BY SIGNING B�LQW YQt.� ACKN(�WLEDGE TH�T YOU HAVE iZAD `I`HIS NQ'FICE Ai�ID UNI�ERSTAND FTS CQNTENTS. Szgyzattu•�: C}��ner State of Florida County of Miarni-L)ade The faregoing was acknowiec3�e before me this� day af ,2(� By whc� is p�rsonally knawn to m�or has produe.ed �s identif�cation. Natary: SEAL: � §; ��f,R �can���ar����.C�c�w��v�szr �; 6���Is�g���sh���,� s����r}� � � � � �`I�'�E��.. c � �;. � r � �t.' � t '�`' � � � n . �z � �� �� t.ts �' ` � �� � ��� � , ,h:�` ���� �` ��T� F ��� ���� � ��5�1 �, `TI � � ; �� ������ ������� �� ���� °� �� �'���� �.��������� ��� � ���� � �������������������������� ����������c��������� � � �����������������'������ �������s°��r�r��s � � �� �4����s�r��1'�������������i�i�����r� � � I ; � �� � � � �� �; ��� �� �� 3 g } .�w (�ra�p� {,�w y i �� �Rrobw������tud`��w?4 Feba*iue..���&Y ff!��a .�... . 1 g ytn i , : ������# .�.'"'€.������fa.r �.. . :.. ; �.:. . . ����� �8��3�. �&ut�Ma��d�+ .. � i � �y�.v ,:agt�an 'Y.:k�a�ewexM p»� �u. `tt5;..'a�V.+:ki, .Y. � ��bPbu �M` 'eab. 4 ia��� ���� ".. � �� � ������ ���c�����,���� z ���� ' " �t�v�����r�f�B���ras��c��ali��,��t�����ri�L���rrs�.�e�r� � ��� � � �� ' �1c�����1�������dc���rr��r����s���f�r�a j �' ` � �' 7"f����s���r�i���t��.��i��r�6��ft,�E��s��r��s���c��l��r�h��a����'s��������ts��hi�d��t�r����, I � � � � � � �i��������������;����� �� �1�r��� �r���r��u�'�����t �� �s����� 6���� ' ����� �c�. ������� � �a���������������a� 6�� �E.a��t�J`����I� Ll�"TMf��# � ���'������ ��� �$��"� �' ��� ���S�g��1�? ����#�1������� �c�s���c�`tsp����c��c'�����a�b�s�a�� ���Yr&"..� ����� �,ei.' � �tf4'�i.L�€1'��{)�biSt'���£'�f�E$ � ���£s.f,7t�t'��^;�i:k'R,�3�t�S� �p��t � C«tr".�.� . . ��A���. � ���.`f'Y���i^���El�lN��� ��G�A�t913"��C��9�T�t�GT1C3iV 1�1� ���5 ��.��"C}�E��E� �,�����'��a����rr�� "" : ���`�C���?�,� �E��hl��?��C� �r�r�� �.��� �� �������� ?5.t?� 6�91fl�2fl�43 ��ter(�� 9 ����t���7 �� ��t-�t�-2����7 `th� .�6���a 7� �p�ant��ca�efi p�yan�ae���#�� �t� aaa' T��,"6�t�����pt s��r��ti� , � St��ar���rti���i�ar��hr�1d��'s�um�a t� s,�+a dca�a��n�ss�F��rPd�r �t��w�p1���#h�ny gov� cai�! sc un� ! e�i ry�� ��d �s�m� �#h�p�3y i�Ma�� 3s��s, ; A�EtPT�0.�ov�nau�b�dis�t�}��t��!c �i��v�hi�t��'�»A�" i���d�C+s�S�� �, h�ara F�r €r� t �i��6 : � 1 � �i�^ �' �a&FEf��t��tvvYY� `��,,. I I °T L� I�.� � 1 �ar�s��o�o �T�91� ���`�IFI�AT� IS I��tl�[? A� A �AT"T�� t�F IP1F��t�A"ftt��i C?�JE�( �t�C} �C3NF��5 i�� �@C#�T� t���� T�9� ���"f�Fi���°� E�t3����. °��60� ��F2°fIFl�AT'E �f�E� �d�T' ��F1f2�AT"I�f���° C?� h���A�TB�d��Y �4����, ��3'�Fl� �� ��T"�� 1'Bi� �����A�� P,FF����� �Y 't�f� 6��L.I�1�� ��I���. °fF6I� C���'6F1��1"� �F Ifd�E1�At��� �t)�� �9C3T ��€V�T'�T11`�� � ��t�1"�2���' ��T"W��� TF�� I��tJ6�C`a IEV��7���{�), �t1�F4��[��� F2������6���TE49�C?R��C7�l���R,�[�t�1`9����RT9Fi���"�4-6C}t���62. i�F`��'TA�1'F: 1f th���t�if'scate hold�r i��e����}Il"E���L @NSlB��t�, �6�� pcali�y{i��� rr�ta�� h���;�4�[3!1'IC3E�R�E� �t��tt��� pr�vi�`s�r�� �r����dcar��d, If�19�F2��AT'O�tV 1��'��V��, �uEaj��t�cs th���r�ro� �rsc! ��r�e�ktic��� c�f th� }acal6�y, ��r��sr� p�ldc��� r�tay r�q�ir� �s� er�dc�r��re��rtY. A �t���raa�rs� �� thi�c�rfifi�a�e d���r�c�f c�r�f�r r� hts t�th�ce�'t'sfi����hc�fd�r ir�Ei�a��f��s�P��rtt��r��rn�r�t�}. a�a�ucE� c���'�c� €�EQUIE�EC�Is�bel �nn��: - -- �U�w Law In�uranc�R ene -- _-- -- 9 Y t���� (305}$�7-0711 ��c �o� (305)884-2411 . _...._ -- 1Q�0�4th Ave ������ r�e�(auvinsur�nc� maiP.com ������s: �9 IPdSUR�R�A�FORDlNG Cf)VE �',E iV�iC# ......._------- . ._.--- ----. ..._._ ------ . ......... _.....------- Flial�ah, Fk 33410 FL 33Q10 o�su�a���: GEC UPVDERVt1F�l�'�R -- � -- - - --- _ ---._. --- _- ---- �r��u��t� - -_._ - - wsuR�€��: -- _ __....... __-- AII Rbout Con�4ruc2ion Irac E��u���a c: _-- __.... . - ....._.... -- _ ---— 455 S. �,iscayn�River Dr �r�su����: ���u�E��: _ _._....._. �IRR�iI FL 33169- t�suta���: ��V������ ���T"1FE��'��CJ41���E2e �E�1�9�t��ll���R. THIS iS TQ C�RTIFI° THAT l'NE FC3LICIES �F INSURANCE LES�EQ B��dW HRVE BEEN ISSUED 1"Q THE INSURED (�AMGD ABOVE FOR THE PC�LICY P�F210D INDIC�TED. NOTWITHSTRNDENG ANY REQUIREMEt�7, TER� t?R GC7NDITIC}(� O� ANY CONTRACT C?R EaTNER DC}CU�ENT V�TM R�SPECT Td iCN THIS CERTIFICATE MA`� �E ISSUEQ QR MAY F'E6�TAERl, TFIE E�SURl�NGE AFFC)RDEi� BY THE POLIGIES C��SCRI��D HER�I� �S SUBJEC"f' TC} �LL TH� TER�S, �XGLUSION5,4f�D CC}�l�ITIC3NS OF SUCH POLiCIES �I(vi€TS BHdW��AY NAV����N REDUGED BY PAID Gl_Al�riS. -- IPd�R i &�4L'3U��_ ___._. .___. ._....._ ��LkCY EFF ' F'94.iCY��P -__. .._....... ......._. ._--- ----- --.........__._. .. L�`F2: TYP�OF ENSU NGE P()LICY hUF��ER ''..... �ht/RDIYYYY . FdftAtDD1YYYY ..... LINlt75 )C; cc��r���e�nL�er�� €.�fA6lLI7Y EAGN C7CCURRENCE � 1,OUQ,4(}tl -- , aa�ac�ro���r�a --- ! G�AlAfiS-MADE OCGUR PREfthfSES Ea oecurrence I � 1 Q4.(�f�Q _�__ , i _._ � __ _.__ � . ......... '....... ...... �iED EXF(Any ona persan} '.., S �,��?� . , ____---------...__._._ __ .._._..----- _...... .__._._._ _____---.._ R Q185FL0005d4�3-7 Ct6i251202Q 0612512Q21 : aE�saNn�..�;aov iN�u�� � 1,OQO,Q00 --� __ _ _... --- ------.._ � - _ -- GEN`l AGGREGATE�IM1hIT APP[IES PER GENERA�AGGREGATE � �,aoo,aoo . _ ' -' PRQ- ; ,, ' --....._ ------. ,— ___---- .....____-- �: PQLICY`---' ,�ECT � _J lQC . ....... ........ .., ......... PRODUCTS CQMPtQP AGC : $ �Q��},QQ� . ..---- __._. �---- ___-._ ..._.._......... QFHER: � .�AU'TQnA��ILE LiA�ILITY ...... ...... i . ' Ct?MElNEd S(NG€.E L(A�ili : � __.._, ...... ........ .. ''..... iEa aeciden4; : � -- '--- ._...._..... _____. _. :RNY AUTO . ..,... ........ ........ '; �t}DELY lhdJURY(Per p�rsor} ; �w . ._.._. ----- _____ ;..-- ---.......... ;OWNED '-SCNEOl7LED �Bf�DILY lNJUftY(P�.;accade�itj'$ —-.._ �AUTQS ON�Y ;AUTQS . '...... '....... ..... � r . � .__ ..._....... ; HIRED PlC7P!-C7WNEQ PROPER'fY DAP�IAGE ' $ ;AUTQS 6NLY ; RUTQS QIVLY :__(Per aecident4 - - ' $ -.. ' UM�RE�Er0.€�tA6 OGCUR EACH C}GGtJRftENCE � � �%C���LERH _ i CIAi�S-MAQE ,AGGREGRTE � QED ftETENT40(�w ' ' $ RK�Ft�s C�ti§RENSATION �.. ...... �. � PEf2 : OTN �ANCt EM�LQY���'LIa\�tUTY Y J fd ! ......... �!_STATUTE _ ..;.ER ......... _. RNY PftORftI�TQWPARTNERtEXECUTlVG ; E� EAGH AGGIDENT $ ;�FrICERIMEME3Eft EXCLUDED? �!,i*1 t� ......... ...... ' ----_ _....._. ,,(t�anda4ory in NH} ......... ,� � ' E.�.DMSEASE-EA EMf��OYEE; $ v- ____- -......._---- ----� ._........_.---- ;Ef yes.describe under ......... '..... ____. DESCRIPTION OF QPERATiONS bei�w E� DPSEASE-PC}�iCY�IMI7 I $ D��G�tF'TFf.TN OF QP�[2R7IC7NS i L ATi4N�t V�NfClES (AC4��9Qi,Addifian�!Remarks S�€�e�tuls,at�y b�a4fached�€mora sp�ee is requiredj Et;':30055�47 ���T"IFI�AI"��6�1���� �AP���F� "�I�P� �I�catJL���Y CIF'fFi�A��t+����C�t���s F�E3Lt�������,�RdCEE.L���EFCaR� TH� ��f�I�,0.'fIC?�7 C3A7"� 1"h9����F, �CkI'IC� �lC.L �� ���.f1t���C? !RE �i�mi Shdr�Uiliag� ���O�C��,€���VN6TM T�E�F'��I�Y PRf}VI�I���. ��silding D�partm�nt 10050 NE 2nd�v�t�iami �urr��a�iz�o ta��r��s��ear�v� Shores,FL 33138 - " rJ 19��-2t3'95������C7������f6��. kl6 r6gh� r��� �c�. ��C���25(20�96103� T'h�A���C�c��rr���a�d I�g����r�gi���r�d r�€�s°k��sf����� � '�,; � � Jlfv��Y€'AT�C}hllS �HIEF�ItVANGI�L C�FFICER �T�A�E �� FLORI�A ���A�1`���`T�F F1�1���I�L��R�IIG�� �E�1�1�� Q� �RK�R�& G� ����A°TI�� �����`T1�I�AT"� �F �L���'E�� T°� �E ��� �1` �R�� FC.�R��A ������g �O �����1'I�t� [�A �� �QF��1"Rt1�7'1�� IN�tJ�T'R� ��E��1���N Thi� certi��s th�t th� ir�d�v6d��l li�ted b�lo�r ha��(��t�d fo b� ���rnpt�re�m ��orid� V1�ork�r�' Gearrr�p�r�s��ic�n 6�v�. ���E�TI�� �Al��a 4/1412(72Q ��PER�TI�N �AT�. 4/1412022 �����EV: �Rh�,�L�D� T��16��R ���i�a ����t��GTF�����C c���v1�I�.G�� F�1�: 611615Q59 El�IN��� M1�A E AN����R���F �LL�,�C)l1T GCJI��1"F2CJG�EC}E� IfV� �55 � �I��Al°I�E �Ilf�� �R t�EAf�I, FL 33169 ����E �� �1�[td��� ��1" ��e Electrieal Wiring Within Buildings snd Drivers IMPQR�"ARIT:Pursuant fo subsection 440.05(14),F.S.,an officer of a carpor�iion wha elects exerr�ptie�n feam ihis chapter by filing a certificate of eiectian under this sectie�n may not recaver k�enefits or compansation under this chapfer.Pursuant to subsaction 440.Q5(12},F.S.,Gertificates of ekecEion ta be exempt issued under subsection(3)shall appfy anly tc�4he corporafe afficer named or�the notsce af electian to be exempt and apply only ti�ithin the scope of the business or trade iisted an Th�notiee of efection 4es k�e exempt.�ursuant to subsectian 440.05{13},F.S.,notices af electi�n ta be exempt and certificatas of election to b� exempt shall be subject to revaeation if,at any time after the filing of the notice or tF�e issuar�ce af the certiPicate,the persan named on the c�otice or cerEificate no Eongsr meets the requirements of this secTion for issuance of a certificate.The dep�eYmenE shali revoke a certifieate at any time fe�r fai€ure of tha person named on the c�rtificate to meet the requirements af this section. C�F�aF2m�VVC-252 CER�lFI�AT�C)F ELECTI��!TC}�� �X��VIPT REViSEL1 08�13 EQ1150621 C�UESTIG��?(85Q}Q13-16Q9