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EL-01-19-33, 716 NE 92nd St 2MMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Expiration: 07/08/2019 Location Address Parcel Number 716 NE 92ND ST 2M, Miami Shores, FL 33138 1132060440520 s Contacts EDUARDO ARAOZ Owner CITYWIDE ELECTRICAL SERVICE LLC Contractor 1026 NE LITTLE RIVER DR, EL PORTAL, FL 33138 RAY ROQUE Business: 7863677733 s � � on Description: REPLACE OUTLETS INSTALL APPLIANCE TO REPLACE ' Valuation: $ 250.00 Inspect62-4 Requests: PERMIT#EL18-1678 305 762 4949. TotalSq Feet: 0.00 Fees Amount Application Fee - Other $50.00 Permit Fee $25.00 Tota I : $75.00 Payments Date Paid Amt Paid Total Fees $75.00 Credit Card 01/07/2019 $50.00 Credit Card 02/06/2019 $25.00 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 regulating construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. Owner /.Applicant / Contractor / Agent Date February 06, 2019 Page 2 of 2 `SHdRES yr` Miami Shores Village r 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 &� Phone: (305)795-2204 �toriI Project Address 716 NE 92 Street Number: 2-M Miami Shores, FL Owner Information EDUARDO ARAOZ Parcel Number 1132060440520 Block: Lot: Address 1026 NE LITTLE RIVER Driveway EL PORTAL FL 33138- 1026 NE LITTLE RIVER Driveway EL PORTAL FL 33138- Contractor(s) Phone Cell Phone CITYWIDE ELECTRICAL SERVICE LL( (786)367-7733 e of Work: REPLACE OUTLETS INSTALL APPLIANCE itional Info: ;sification: Residential nning: 1 Fees Due Amount CC F $0.60 DBPR Fee $2.25 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee - Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $158.85 Applicant EDUARDO ARAOZ Phone Valuation: $ 250.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # EL-6-18-67975 06/19/2018 Credit Card $ 50.00 $ 108.85 07/05/2018 Credit Card $ 108.85 $ 0.00 Available Inspections: Inspection Type: Review Electrical L) 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 ill be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractgyto 09 the work stab. j July 05, 2018 Authorized Signature: Owner / Applicant / Contractor / Building Department Copy July 05, 2018 1 RECEIVED Miami Shores Village JV 07 2019 Building Department BY 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 20 4 BUILDING Master Permit No. ?30— 30 PERMIT APPLICATION Sub Permit No. LL(q - 33 ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION [:]SHOP CONTRACTOR DRAWINGS JOB ADDRESS: • ( W Folio/Parcel#: r 20(d)gL Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: OWNER: Name Fee Simple Titleholder): % A® Address: Dz � c_ t e— City: C 92 State: Tenant/Lessee Name: Email: CONTRACTOR: Company Name: Address: E cc City: Qualifier Name: I'm Flood Zone: BFE: FFE: Z Phone#: Phone#: ne#: J ' State Certification or Registration #: i i> > l Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Zip: 550) ­7-&(e) -, 33 Address: City: State Value of Work for this Permit: $ �- 5� ' Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Description of Work: —( C; Zip: ❑ Demolition Specify color of color thru tile: Submittal Fee $ ), 0�) Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee Structural Reviews $ Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTO The foregoing instrument was acknowledged before methisthis - � day of 10fV � � 20 11 by C C0006 J l 0a2,who is personally known to me or who has produced identification and who did take an oath. as The foregoing instrument was acknowledged before me this Iday of Yis 20 by personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: A Sign: Print: /�`� Print: (i[iIL , �Pa �, Blanca L. Moreno Sea l,_�P1 �!��d Blanca L. Moreno seal;? ,• Commasion # i3G129380 Commission # GG129380 , Expires: July 30. 2021 Expires: July 30, 2021 '„11, J Bonded thru Aaron No orf . t „��i„���� tart 1 APPROVED BY Plans Examiner Structural Review Zoning Clerk (Revised02/24/2014) Miami Shores Village RECF-IVF-Q Building Department JUN 19 2ole 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 1 972 Te . (305) 795-2204 Fax. (305) 756-8 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 1-1-j �3 BUILDING Master Permit No. aC 1 `� PERMIT APP ICAT' ON Sub Permit No. � � n - (Cps K ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF [—]CANCELLATION ❑ SHOP ^ • :0 ` J CONTRACTOR DRAWINGS JOB ADDRESS: 7 � '`o OE C12- 5- 2 - City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO - Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): f&0(dy A rQ 0Z Phone#: Address: i oZME E I1 H le ri" Dr. City: �,�_ 46I State: ( Zip: Tenant/Lessee Name: Phone#:_ Email: '' ,,� CONTRACTOR: Company Name: i'►t"l(AP 1 1A1cq WUa) UC Phone#: _ Address: City: I Qualifier Name: State Certification or Registration #: �( Zip:: J 3�0^Q--�. Phone#:-j O(U" — g733. V0 / Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Z SO Square/Linear Footage of Work: Type of Work: ❑ Addition Description of Work: ❑ Alteration ❑ New ❑ Repair/Replace t-T. F o „0 6 1 1& f 2"? 411— Specify color of color thru tile: ❑ Demolition Submittal Fee $ Permit Fee $ 46-0 / ® d CCF $ CO/CC $ Scanning Fee $ Radon Fee $ c " « DBPR $ oZ " oZ S Notary $ Technology Fee $ Structural Reviews $ Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ � (08 - 0S (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 Zi 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 musfbe posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence ch posted notice, the inspection will not be approved and a reinspection fee will be charged. 11:,�FSignature OWNER r AGENT The foregoing instrument was acknowledged beforei2v this day of1&� . 20 by -&4(4trd0 fqCOo2. who is p rsonally kno me or who has produced as identification and who did take an oath. NOTARY PUBLIC: /1 Sign: Print: "C "O O Signat The foregoing instrument was acknowledged beA e this day of 20 by who i ersonally kno me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: Seal: P�;�.,,� Blanca L. Moreno ;.QSP.••.J/q'�,, Blanca L. Moreno `�'= Commission # GG129380 Commission # GG129380 =#` '= Expires: July 30, 2021 :******* �;«..�szoa«.*..****.*******.*.********.�`��**»&�nde��tllarop�ALo�ar�►.:**:*.*:*** ed thru Aaron Notary APPROVED BPlans Examiner Zoning Structural Review Clerk (Revised02/24/2014) IVlldl l ll JI IUI CJ V IIId6C Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION ❑BUILDING ELECTRIC ❑ ROOFING "MC (2�0, 14" Master Permit No. rx�G "' �� 1-5 Sub Permit No. C—LA(vo- ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: ` Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 1EbvDr6o Phone#: � • 2S-7- l3`5a ' Address: 10 aca 1jia'- City: 1 vA ( P� i-� ( State: (:�4_ Zip: Tenant/Lessee Name: Phone#: Email: rj CONTRACTOR: Company Name: CTIA W (6f'- C,` .! V Phone#: _99(0 - --3V) —7733. Address: 3ZO2_ G�, �6N: ' City:ffi2 State: .9, • Zip: d:?� D 13 •-�-72-� Qualifier Name: Phone#: -1�3 D • (0-7' l ! ✓✓ State Certification or Registration #: Certificate of Competency #: IS (0 DESIGNER: Architect/Engineer: Phone#: Address: City: State Value of Work for this Permit: $ X,460, O'Q Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace Description of Work: N (PQja049_ b UAAeA--:; � j n.S Jgtj a -VQ 110yl Zip: ❑ Demolition Specify color of color thru tile: Submittal Fee $ t Permit Fee $ CCF $ 0 ' ��J CO/CC $ Scanning Fee $ Radon Fee $ O9n • P DBPR $ Notary $ Technology Fee $ Training/Education Fee $ o Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE S Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) _ Mortgage Lender's Address City State Zip Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. e "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 inspect' which occurs seven (7) days after the building permit is issued. In the abse c of such posted notice, the inspection will not e proved and^einspection fee will be charged. M OWNER cNAGENT / CONT The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this —6 day of 20 l V , by day of ^ , 20 l (oo by e-ck who is person u� M 0. (LO �� , who is personally known ttoo/�,2 me or who has produced as me or who has produced. 9209 -920"1M``�5"✓ identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: ()&A- Sign: �-u--- Sign: �t- �i�-�'�(� Print: Print: A�`-�� Seal: GARY RIVERON Seal: P�, �:;°�k * * MY COMMISSION 1 FF 92M EXPIRES: Oc6pber * t MY COMMISSION #RIVE� 1852 EXPIRES: Oct Wr i, 2019 6, 2019 a +'ea Bonded Thru Buyet Nopry Senim n a,de Boned Thru 8WW NeprySeeeioe nye� ************************************************************************************************************ r APPROVED BY Plans Examiner Zoning Structural Review Clerk Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel. (305) 795.2204 Fax; (305) 756.8972 CONTRACTORS' REGISTRATION CTORIS A FLORIDASTATE CERTIFIED CONTRACTOR: A. COPY- l ALIFIER'S STATE LICENCES B. COPY OF LOCAL 'SS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D; COPY OF WORKERS COMPENSATION INSURANCE* - (Workers Compensation EXEMPTION must have NOTICE TO Ot #rainand' Contractor Affidavit) IF CON TRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A, _ COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. - COPY OF LOCAL BUSINESS TAX RECEIPT C. �/_ COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL / CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Voider; MIAMI SNORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. •esrrrra-srrrrsrrrp rrsarrrrr.■rsr.■:r:N r•rr rs BUSINESS NAME: wi d,= El; •issrrrrrrrrrsr�rrsrr�srrrrrsrrrrar�rrrrrrrrrrr� 4co-Q Cam, - BUSINESS ADDRESS::: 2- %CMI CITY jht&AkSTATE Ft, ZIP ' 1 BUSINESS PHONE: FAX NUMBED ( CELL PHONE (3 _MP1 -) 0-11 QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: CTQB Construction T Quaiiiybtg Board 8U::» ,4f..S;", CERTIFICATE OF COMPETENCY Et 00622 CI tYWIDE� ELECTRICAL SERVICE LLC ROQUE RAY is certified t2rid q tt* vtvvtwns of 2 IQ Qf h laT!-D*unty STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 ROQUE. RAY CITYWIDE ELECTRICAL SERVICE. LLC 3362 E 6TH AVE HIALEAH FL 33013 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers, from boxers to barbeque DEPARTMENT OF BUSINESS AND restaurants, and they keep Florida's economy strong. PROFESSIONAL REGULA:riON ' Everyday we work to improve the way we do business in order ER13015189 ISUEO� 06/15f2016 to serve you better. For information about our services, please fog onto www.myfforidalicense.com. 'There you can find more REG ELECTRICAL, CONTRACTOR information about our divisions and the regulations that impact ROQUE, RAY you, subscribe to department newsletters and learn more about CITYWOE EL,EcTmcAL SERVICE, LLC the Department's initiatives, (IND11\41DUAL MUST MEET AL1,0CAL. Our mission at the Department is: License Efficiently, Regulate LICENSING REQUIREMENTS'PRIOR TO CONTRACTING IN ANY AREA) Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, HAS REGISIERED under the Provisions of Ch 469 FS and congratulations an your new license! Expiratianda% ALIG31 M,18 L 160615000173i RICK SCOTT, GOVERNOR DEPARTMENT OF Bt ELECTRICAL MuCr4apm Ilumac DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA 51NESS AND PROFESSIONAL REGULATION 'ONT- RACTORS LICENSING BOARD The ELECTRICAL CONTRACTOR Narned below HAS REGISTERED Under the provisions of Chapter 489 FS, Expiration date. AUG 31, 2018 (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO C90TRAQTING IN Ah AREA) LAW SEQ# L1606150001737 0161177 Local Business Tax Receipt Miami -Dade County, State of Florida 199711 --THIS IS NOT A GILL - DO NOT PAY BUSINESS NAME/LOCATION RECEIPT NO, EXPIRES CITYWIDE ELECTRICAL SERVICE LLC RENEWAL SEPTEMBER 30, 2017 3362 E 6 AVE 7482266 Must be displayed at place of business HIALEAH FL 33013 Pursuant w County Code Chapter SA -- Ay t: 9 & 10 OWNER SEC. TYPE OF BUSINESS 'TYWIDE ELECTRICAL SERVICE LLC 196 SPEC ELECTRICAL CONTRACTOR PAYMENT RECEIVED 1) RAY ROQUE 15F000622 BY TAX COLLECTOR Worker(s) 2 S45M 07/14/12016 FPPU 10-- 16--014644 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply in the business. The RECEIPT NO, above must be displayed (in all commercial vehicles., Miami -Dude Code See tie-276, For more information, Asil W CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYIY) 12/05/16 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 pollcy()es) 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 CONTACT NAME: FAfX First Class Insurance Market PHCN o Ext : (305)441-2997 AC No): (305)441-6443 4101 NW 9th Street E'MAtL S. fcimc@aol.com Miami, FL 33126 INSURERS AFFORDING COVERAGE NAIC # Phone (305)441-2997 Fax (305)441-6443 INSURER A: ARCH SPECIALTY INS i INSURED INSURER B : PROGRESSIVE EXPRESS INS COMP CITYWIDE ELECTRICAL SERVICES LLC INSURERC: NORMANDY INSURANCE COMPANY 3362 E 6TH AVENUE INSURERD: 1 HIALEAH, FL 33013 INSURER E I 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. INSR; LT TYPE TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY Q COMMERCIAL GENERAL LIABILITY r ❑ ❑ CLAIMS -MADE u OCCUR ❑ I 0123016 12l05/2016 i 12/05/2017 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED ccurrence PREMISES (Ea occurrence) $ 100,000.00 MED EXP (Any one arson) $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GENT AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ PRO ❑ LOC PRODUCTS - COMP/OP AGG $ 1,000,000.00 $ B AUTOMOBILE LIABILITY ❑ ANY AUTO ALL OWNED SCHEDULED ❑ AUTOS AUTOS NOWOWNED ❑ HIRED AUTOS ❑ AUTOS ❑ ❑ 02953872-0033016 ( i :, 03/30/2016 03/30/2017 COMBINED SINGLE LIMIT Ea acc de t 10,000.00 BODILY INJURY (Per person) $ 20,000.00 !BODILY INJURY Per accident ( ) $ 10,000.00 PROPERdY DAMAGE Peracci ant)$ $ ❑ UMBRELLA LIAB OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DIED ❑ RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) If yes, descnba under DESCRIPTION OF OPERATIONS below N / A I NHFL0051392016 I 04/01/2016 04/01 /2017 a WC STLITU- ❑ OTH E.L. EACH ACCIDENT $ 1,000,000.00 E.L. DISEASE -FA EMPLOYEE $ 1,000,000.00 E.L. DISEASE- POLICY LIMIT $ 1,000,000.00 { I � i i DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER MIAMI SHORES VILLAGE HALL 10050 NE 2 AVENUE MIAMI SHORES, FL 33138 CANCELLATION SHOULD THE EXP ABOVE DESCRIBED' POLICIES BE CANCELLED BEFORE E,THEREOF, NOTICE WILL BE DELIVERED IN 'HE POLICY PROVISIONS. ACORD 25 (2010106) QF ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD