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PL-06-21-1570, 304 NE 93rd StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Permit NO.: PL-06-21-1570 Permit Type: Plumbing - Residential Work Classification: Alteration Permit Status: Approved Issue Date: 06/16/2021 Expiration: 05/16/2022 Parcel Number 104 NE 93RD ST, Miami Shores, FL 33138 1132060136350 Contacts ... ....... _..... ._. __ _._._._... ..._... BRADLEY JOHNSON Owner R1 QUALITY PLUMBING CORP Contractor 304 NE 93 ST, MIAMI SHORES, FL 33108 RAYVEL !ACAS 8416 NW 103 ST, HIALEAH GARDENS, FL 33016 Business:9549198382 joaquindupeiron@hotmail.com _.... ......... _ ... ... inspection Requests: Description: PLUMBING FOR BATHROOM & KITCHEN a Valuation: $ 16,000.00 305-762-4949 �,. Total Sq Feet: 2,300.00 Fees Amount Application Fee - Other $50.00 CCF $9.60 Change of Contractor $110.00 DBPR Fee $8.40 DCA Fee $5.60 Education Surcharge $3.20 Permit Fee $510.00 Scanning Fee $15.00 Technology Fee $14.00 Total: $725.80 Building Department Copy Payments Date Paid Amt Paid Total Fees $725.80 Cash 01/12/2022 $110.00 Credit Card 06/16/2021 $615.80 Amount Due: $0.00 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 AFFIDAIVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constrgc i -and zoning. Futhermore, I authorize the above named contractor to do the work stated. Authoriz`ti4'!§_i#A&ure: Owner / Applicant / Contractor / Agent Date i January 12, 2022 Page 2 of 2 Kaml Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 B 7": INSPECTION LINE PHONE NUMBER: (305jr 762-4944 �-I'� FRC 20ZJ "in jI J`r%a=toed ur-'I'l_1'010n aj%.#a .1.beeev vase Pe iii 1dv. _-- _ PERMIT APPLICATION Sub Permit No. PL-06-21-1570 r-1 Iili DING r� ELECTRIC ;U ROOFING -__� REL/IS O%l Lr_i EXTFnICION C]RE� EF MALL PLUMBING MECHANICALPUBLIC WORKS 10jMeHANGE OF CANCELLATION SHOP -CONTRACTOR -DRAWINGS, JOB ADDRESS: 304 NE 93RD ST City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcet#: 1.13206013:6354- Is the Buildirk&Historically Designated:. Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): braoley Johnson Phone#: Address: 304 NE 93 ST, City: Miami Shores State: Fl Zip_ 33108 Tenant/Lessee )Name: Phone#: Email: CONTRACTOR: Company Name: Address: 13203 Sw 252ND Lane City: Homestead State: F1 Zip: Qualifier Name: Kavvei_ iacas Phone#` State Certification or Registration #: CFC1427987 Certificate of Competency #: DESIGNER- `A'rchitart IFrjaineer- Pho'ne#- f ln4tL CG v°,v*\ it ru;.: - Address: j �f & W � V+G G�1. (E�v:-i City: State Value of Work for this Permit: $ 16,000 Square/Linear Footage of Work: 2300 33032 Zip: Type of Work: 0- Addition 40 --Alteration i j'New WRepair/Replace:Demolition Description of Work: Plumbing for bathroom and Kitchen Specify color of color irhru the: Submittal Fee $ Scanning Fee $ _ Permit Fee $ Radon Fee $ I IO.06 CCF $ CO/CC$. DBPR $ Notary $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding- Company's-Ad'd'ress City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zi p 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..... cOWNEA'S AFFIDAVIT-. I certify that ail the foregoing information is accurate and that ail work will be done in compliance with all applicable laws regulating,constructionand 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, FINA`�!":CING, CONSULT IrTK�YOUR L1,1 DER' OR % ATTORNEY BEFORE cicrORDIFN163 YOUR -I'! OTICE-OF-COR4MENCE I=NT:„ -Notice to Applicant. As a condition to the issuance of o'building permit with on 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 incnprtinn Will not hp nnnrnuprl nnA n rp;ncno tine Fo IAIW ; o �i.nrnn.l Signature �TOWNWEor GENT The foregoing instrument was acknowledged before me this 14 day of December 20 21 by Bradley T�hn Jon who is personally known to me or who has produced identification and -who.6d.take. an -oath. NOTARY PUBLIC: NINA Notary Public -State of Florida Commission # GG 328519 My Commission Expires April-29, 2023 as Signature C TRACTOR, The foregoing instrument was acknowledged before me this 14 day of December 20 21 by Ray :gel Jacas who is personally, known to me or who has produced_ identification: anal _who:,did _take an :oath. NOTARY PUBLIC: Sign: c�en• E//X 72 Print: u , _c:1r&JDITH A VILCHEZ Seal: _ C ommission# GG 328519 ivl,, Commission Expires April-29, 2023 as ************************************************************************************************************ APPROVED BY Plans Examiner Zoning `Structural -Review (Revised02/24/2014) -Clerk Miami -Shares Village Building Department 10050 NE 2"d Avenue Miami Shores,'Florida.33131& �w>�=ms?vfl,gow Change oftontract. or/Arch itect or -Engineer A change of contractor, arcKtest or engineer must be done under a permit revision .There is.a 5110.00` char -Re for a chap -Re of contractor. The owner w l submit a Chanize of Contractor Form completed with notarized signatures of both, owner and current contractor. If the signature of the., current contractor cannot be obtained the: owner must send a certified ie?r�freteu-rn-re.ce?�ip t5fj Al t na.—'thel—°_:.:fi'�?'i1% er��tri�r�ee_ad?rt �r'Tfi�%i?{'i tJi�" r�r f d?�r'�iia_ �,+��(i-%i'.%h �.. , _ ,.change _Th,e owner rrru.st :allow =10 business 1days for the coritractor,-zrchiteet or engineer x�t9ti r tizr rY`t iXYr ax rcyry 15 1z Ke-f:l a5 x`e {tx:rr`eu `A�uue.f 5`el:A.AWA b IZ)y410i Ax`Te'--MialU °Oaueiutri y Code. A permit ,applicati.on must ;accompany the change of -contractor form., with the information and signature of the new contractor and owner or owner agent as: req.uiced under FS 713..135. (6)(a) .The new contractor must be, registered with the.V llage. or must. submit, the required documents to register with the Virrage. 1_ Chran:ge of Contractor form co,mpleted,signed anc notarized.. '�' -f- iML-C.11:J1.t114 ati del -I I:f.Y`1'e+.:-,%.v :SL11ll-y�i�;ctfI 3,-Regui-red-fees. 4. `Co_nv -of original -letter sent via certified xmall alonja with the retorn_ed receipt In :addition to ..the requirements .abcve the current .architect :or <engineer of record must -a i it -:aiitK­Y7a..i .rr{u, be inn writi tg, and must be. sigrre_d and sea -led,; an-d shall comply with- Florida,. administrative code �10 1-.1c�.,,2. 11062020 - Change of Contractor Form Page 1 of 2 Permit[utrrriber:- PL-06-21-1570 Owner's Name (Fee Simple Title Holder): Bradley Johnson Phone: Owner's Address: 304 NE 93RD ST. City- Miami Shows, State::, Florida. Zip. Code':: !o Addf--e.ss-f.w•her-e t*As-being done): 304 NE 93RD ST. 331.38. 7in --rip Contractor's Company Name: k 1 M 6'i) Phone ,Add rests - City:. r/,;24Q• flier;ififiPr'c Architect/ Engineer of Record Name: Ad d ress -City: State: State.:- �FL ZiR.Code.:.3301V Describe Work: i-t?CL&3 a&c/ Phone: Zp Code: d,A I hereby cerfifv that the work has -been .abandoned_ and/or the contractor/architect is unable or unwilUng to, complete. the, Eontrac ... I hold -the. BuUdi.ng GfficW and- the Marra Shores. ------------ -- ------.�--- ---------------- Signature Signature ne:r (;Agent ' Contract / A.rchite:ct/: Enine.e.r The f-oregoiogin stxume rit was a�cx�o�raedged aeTore,me._T-iris .iL 20ayDT ,Lu `i a Bradley Johnson Who is personally known to me ,or -who has produced as, inden-tification.. F'Yi ta�Fy PUb_7j14C' T H A V I L. C�H E Z�� otany Public -State of Florida Sign. and Seal: Commission # GG 328519 A ril:'7�, 2023 11062020 ange of Contractor Form The #-or-eg g-,nstrume-nt was a-knowle. ged �DeTore m. e-_,TIMs % day,of -,7;A✓ rtU::Z:2r%-b ' c t'l �iq �✓ Who is personally known to me or who has produced i i-ndentif atiGR_-. Novary Ffl b5c t 17, �' f� IZT H A V I L C H E Z ,t o ary Public -Stair of F+:;rida mmission # GG 328':, 9 Sign and Seal: ;F, �N`-Commission rr,s Page 2 of 2 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: PL-06-21-1570 Permit Type: Plumbing - Residential Work Classification: Alteration Permit Status: Approved Issue Date:06/16/2021 Expiration: 12/16/2021 Location Address Parcel Number 304 NE 93RD ST, Miami Shores, FL 33138 1132060136350 Contacts �_.......... .... -_..... Contractor BRADLEY JOHNSON Owner A.B. & K PLUMBING CORP 304 NE 93 ST, MIAMI SHORES, FL 33108 JAMES ZEIGLER 13920 CYPRESS CT, MIAMI LAKES, FL 33014 Business: 3052167280 _ Inspection Requests: Description: PLUMBING FOR BATHROOM & KITCHEN p Valuation: $ 16,000.00 A 305-762-4949 Total Sq Feet 2,300.00 Fees Amount Application Fee - Other $50.00 CCF $9.60 DBPR Fee $8.40 DCA Fee $5.60 Education Surcharge $3.20 Permit Fee $510.00 Scanning Fee $15.00 Technology Fee $14.00 Total: $615.80 Payments Date Paid Amt Paid Total Fees $615.80 Credit Card 06/16/2021 $615.80 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 AFFID IT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating cons i ion and 7dng. Futhermore, I authorize the above named contractor to do the work stated. Authorized gnal:4: 0�wgr / Applicant / Contractor / Agent June 16, 2021 Date Page 2 of 2 Miami Shores Village RP-cFzvEi:) Building Department JUN 16 202' 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 2-0 BUILDING Master Permit No.'-P,0. - 12 w2n 4,5 PERMIT APPLICATION Sub Permit NO.PL 0(P - 21 - 1 S--i 0 BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION []RENEWAL [PLUMBING ❑ MECHANICAL [-]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zia: OQ, Folio/Parcel#: 1 1-3 Z 0 6 0 I.3 (,3 5 d Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): -P Rn Phone#: 2n5 990 5OL15 Address: ?50H to t Q3 ' S t If Ck City: K% G a n % ' La r e S State: i o r•% A a Zip: '� '-'� I OR Tenant/lessee Name: Phone#: Email: CONTRACTOR: Company Name: !�-3 �.K -V>1t ) coL -op CL�� Phone#: Address: 13 U c'27 S'( 1) .2S4Lj +h' -';TRi-i = l J City: VA mr S-'c=_Fln State: Zip: 2i':3; 03� Qualifier Name: ern ,S 'x. �= T 1, LE2 Phone#: State Certification or Registration M O _V- C. 1 L4 2 .q O R q Certificate of Competency #: DESIGNER. Architect/Engineer. Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 1 �,, �f>�� Square/linear Footage of Work: Type of Work: ❑ Addition Description of Work: Cz Alteration r. ❑ New ❑ Repair/Replace ❑ Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Technology Fee $ Structural Reviews $ Training/Education Fee $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ (Revis,d 2/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address city State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 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 opprove4and a reinspection fee will be charged. ER or AGENT The foregoing insttdm5R1was acknowledged before me this 0 day of v 20 2% , by QJA who is personally known to me or whq h produced t/0—b &%`S~was identification and who did take an oath. NOTARY P B C: Sign: (aG CNotary Public • State of Florida Seal: .,tdrT Commission N GG 951096 "�`' My Comm. Expires Feb 11, 2024 Signature _21�= CONTRACTOR The foregoing instrument was acknowledged before me this kLA day of «n C. . 20 2l= by mCSiCi�2r who is personally known to me or who has produced as identification and who did take an oath. NOTARY PU Print: My Comm. Expires Jur 14, 2024 ed through National Notary Assn. •ssssssssssssssssssssssssssssssssssssssssssssasssassssssssssssssssssssssssssssssssssssssss�sssssssssssssssss APPROVED BY Plans Examiner Zoning Structural Review Clerk (RevMM2/24/2024) 'Ron-DeSantis; Governor Halsey-Bes[Tears-,*SareW� STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER: CFC1429084 EXPIRATION DATE: AUGUST 31,2022 THE PLUMBING CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES ZEIGLER, JAMES PATRICK A.B. & K. PLUMBING CORP. 13920 CYPRESS COURT MIAMI LAKES FL 33014 ISSUED: 08/26/2020 Always verify licenses online at MyFloridaLicense.com Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. L/ COPY OF LOCAL BUSINESS TAX RECEIPT C. U; COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affdavit) IF CONTRACTOR 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 Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. ........................................................................................... BUSINESS NAME: RF �1� rn�nnf �'r7 P r BUSINESS ADDRESS: 1 '30 �;n SWIRL) +Y'5 1 CITY orncqT--fa STATE. � I_ ZIP BUSINESS PHONE: (3L f t "7 l- ')Q ; FAX NUMBER ( ) CELL PHONE (365 ) Q -70 QUALIFIER'S NAME: 1 a Zi:- QUALIFIER'S LIC NUMBER: 0-YE-C 14 2 CIQ S L� Ron DeSantis, Governor Halsey Beshears, Secretary Florida STATE OF FLORIDA LJ1 r- FAK I IVIUM I OF DUZINIC-aa AND rK0rC.'=01VNAL REGULATION. IVN CONSTRUCTION.,I-N�DUS,,-TRY:L�ICENSING BOARD THE PLUMBING CONTRACTQR�",HEkEl�N,-I.S:CER-TIFIED UNDER THE PROVISIONS ,"Of:CHAPTER 489-RO.RIQA,,,'STATUTES PATRICK "A ZEIGLE.�, BING 2ily "PRESSIt Al LICENSE .-NUMBER: ,"CFC, 1429084 EXPIRATIONAUGUST 31,2022 Always verify licenses online at MyFloridaLicense.com Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. ■ 11 Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 3816205 BUSINESS NAME&OCATION A B & K PLUMBING CORP 13427 SW 284TH ST HOMESTEAD, FL 33033 OWNER A B & K PLUMBING CORP CIO JAMES PATRICK ZEIGLER (31 IAI IFIFR Worker(s) 2 RECEIPT NO. RENEWAL 3984516 SEC. TYPE OF BUSINESS 196 PLUMBING CONTRACTOR CFC1429084 LBT EXPIRES SEPTEMBER 30, 2021 Must be displayed at place of business Pursuant to County Code Chapter SA - Art. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR 45.00 09/17/2020 CREDITCARD-20-077770 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit of a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec Se-276. M®2 For more information, visit www.miamidade.aov/texcollector l ® A CERTIFICATE OF LIABILITY INSURANCE DATE (MM/1) 2o21 os/oz,2021 VORV 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 endorsements . PRODUCER Marsan Financial Dba Orange Group I 4261 SW 72ND AVE CONTACT Melissa Sanchez NAME: PNONE . (305) 740-9938 FAX No): (305) 740 9948 ADDRESS: msanchez@orangeins.com INSURERS AFFORDING COVERAGE NAIC 0 INSURER A: Evanston Insurance Company MIAMI FL 33155 INSURED A.B. & K. Plumbing Corp INSURER S : Ascendant Isurance Company _ INSURER c : Allstate Insurance Company INSURER D : 13427 SW 284 St INSURER E : INSURER F : ....... .,. union. Homestead FL 33033 COVERAGES VtKIiriw%i=numor-m; -------- 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. MSR LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF M D 08/02/2020 08/27/2020 POLICY EXP MM/DD 08/02/2021 08/27/2021 LIMITS EACH OCCURRENCE $ 1,000,000 A C COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FXOCCUR 3AA415878 648189941 PREMSES Eaocwrrence $ 100,000 MED EXP (Arty one person $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO_ LOC OTHER: AUTOMOBILE LIABILITY ANY AUTO XOWNED SCHEDULED AUTOS ONLY AUTOS HIRED V NON -OWNED AUTOS ONLY AUTOS ONLY PRODUCTS - COMP/OP AGG $$ 1,000,000 COMBINED SINGLE LIMB Ea accident)$ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per cadent) $ PROPERTY DAMAGE Per accident $ is UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE N / A WC-76992-0 05/07/2021 05/007/2022 EACH OCCURRENCE $ AGGREGATE $ [PERT OTH- STAUTE I ER $ DIED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICEWMEMBEREXCLUDED? Y (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below B E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Plumbing- Residential & Commercial #CFC 1429084 Miami Shores Village Building Department 10050 N.E. 2nd Avenue Miami Shores SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE FI 33138 ` ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD