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MC-12-20-2812, 70 NW 94th StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 70 NW 94TH ST, Miami Shores, FL 331SO 1131010340210 Contacts KERRY MIKULSKI Owner Navas Multi services Corp Contractor 70 NW 94 ST, MIAMI SHORES, FL 33150 Jose Martell 3050 NW 40th ST, Miami, FL 33142 Business: 3053251077 info@navasmc.com Inspection Requests: Description: EXACT A/C SPLIT SYSTEM CHANGE OUT 4 TON Valuation: $ 4,800.00 r= Total Sq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $3.00 DBPR Fee $2.52 DCA Fee $2.00 Education Surcharge $1.00 Permit Fee $118.00 Scanning Fee $9.00 Technology Fee $4.20 Total: $189.72 Payments Date Paid Amt Paid Total Fees $189.72 Credit Card 12/10/2020 $189.72 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 requj#qd for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. certify that' I the foreRing information is accurate and that all work will be done in compliance with all applicable laws 7nt _ or , atAhorize the above named contractor to do the work stated. Signature:'Owner / Applicant// Contractor / Agent Date December 10, 2020 Page 2 of 2 Miami Shores Village 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 ❑PLUMBING ❑E MECHANICAL ❑PUBLICWORKS JOB ADDRESS:70 NW 94 St. }; p 7 2020 BY, FBC20��` Master Permit No. NA C. a- 20 - 2512 Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: 33150 Folio/Parcel#:11-3101-034-0210 Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):Kerry John Mlkulskl Phone#:305-970-0816 Address:70 NW 94 St. City: Miami Shores state: FL Zip: 33150 Tenant/Lessee Name: Phone#: Email: egarciamikulski@gmail.com CONTRACTOR: Company Name: Navas Multiservices Corp. Phone#: 305-325-1077 Address:3050 NW 40th St. City: Miami State: FL Zip:33142 Qualifier Name: Jose Martell Phone#: 305-325-1077 State Certification or Registration #: CAC1 817859 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State Value of Work for this Permit: $47800.00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Description of Work: Exact A/C Split system Change out 4-ton Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $ Structural Reviews ❑■ Repair/Replace Zip: ❑ Demolition Permit Fee $ CCF $ CO/CC $ Radon Fee $ DBPR $ Notary $ 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 OWNER oKAGENT The foregoing instrument was acknowledged before me this �/ .4 day of Oe�(M�eY 20 21) by k N 14111% KK.V IS�who is personally known to me or who has produced onyef Unef `_-e- as identification and who did take an oath. NOTARY PUBLIC: Signatu CONTRACTOR The foregoing instrument was acknowledged before me this day ofQfQEMhe1 , 20 �, by � �de tAckvyewho is personally known to me or who has produced Per��orra�� U kf)b ' as identification and who did take an oath. NOTARY PUBLIC: Sign: �'���''vnn'� Sign: (sT ��Q� Print: I CI Print: Seal: %► CLAUDUINAVAS Seal: ' CLAWIANAVAS S'An MY COMMISSION # GG 292T05 MY COMMISSION # GG 292705 EXPIRES March 17, 2023 �EXPIRES: March 17, 2023 Bonded Thru MW PublicUrOwol ere"�p ,•'1;? 80ndtad TMu PubOcc Undcrwrkers ©Flan APPROVED BY Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores Florida 33138 ter' . 'moo Tel: (305) 795.2204 Fax:(305) 756.8972 $ AIR CONDITIONING REPLACEMENT DATA �- PERMIT NUMBER: MC fihils f©rm must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): "101At qQW) ►M IQI(y1� lj1(1()Y(°5 City: Miami Shores Village County: Miami Dade Zip Code: S5 50 ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED .... : "qge disoonngctinginepps: YES ❑ NO RrARHI Sheet Attached: YES FrNO ❑ Contract Attached: YES [�J • • .. . 0.0 . ...... ...... ...... .• ...... UMT BE111G.REPLACED DATA NEW UNIT .. • MANUFACTURER • .Q�/ AHU or PKG. UNIT MODEL # I' .' • COND. UNIT MODEL # 9 Pt Ito LAC6 NJ •••• KW HEAT 10 w '• AHUS'�ItU KG NOM TONS 1) M.C.A AHU 15i5CU X15PKG A ){U 46, PKG; 2) M.O.P AHU CU 4OPKG AH01 CU PKG 3) VOLTS AHU U 9*KG PKG T / PKG / EER/SEER 5C'ff YES N REPLACING DUCTS YES YES O REPLACING THERMOSTAT NO YES NO NEW 4"CONCRETE SLAB EEP. NO O YES NO NEW ROOF STAND YES NO NEW RETURN PLENUM BOX NO 1. Minimum Circuit Ampacity (Wire Size): E) 2. Maximum Overcurrent Protection (Fuse/Breaker Size): (5 3. Voltage of Circuit (208/240/480): 24?b 'M0 4. Size Disconnecting Means: 1W. Contractor's Company Name: 46'y&5 tqh `. Phone: _6 Iai-) State Certificate or egi tration No.JI Certificate of Competency No. Signature Date: It V1 1,W—W (Qualifier's signature) 1.­;­Al/'1n/'111 n1 This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service; betweon 1 /1 /2015 and 12i31 /2020. Certificate of Product Ratinas AHRI Certified Reference Number : 20IP94088 Date : 12-07-2020 Model Status : Active Old AHRI Reference Number : 7943535 AHRI Type : RCU-A-CB (Split Systern: Air -Cooled Condensing Unit, Coil with Blower) Outdoor Unit Brand Name : RUUD Outdoor Unit Model Number (Condenser or Single Package) : RA1648AJ1 Indoor Unit Model Number (Evaporator and/or Air Handles) : Ril IT4821STAN Region : All (AK, AL, AR, AZ, CA, CO, CT, DC, DL, FL, GA, HI. ID, IL, IA. IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WV, WI, WY, U.S. Territories) Region Note : Central air conditioners manufactured prior to January 1, 2015 are eligible to be installed in all regions until June 30, 2016. Beginning July 1, 2016 central air conditioners can only be installed in region(s) for which they meet the regional efficiency requirement. • • ric manufjj�turej of this;VUD product is responsible the rating of this syst m combination. • •.. R•ated asjQllows in accor *a* cewith the latest edition of AHRI 210/240 with Addendum 1, Performance Rating of Unitary Air -Conditioning • • • F•Air-Source �ACiiit Ptrm� �F•criirjlrrient and subject to rating accuracy by AHRI-sponsored, independent, third party testing: • Cooling (*RP Vic;*'/ (A2) - Oingre'ry" High Stage (95F), With : 44500 S`E_E:_R : 16.(10 ••••••• Voss •• • •••••• o • EER (A?)o Si4-i or High SUVe (95F) _ 13.00 t"Actives" Model Status arc those that an Al IRI Certification Program Participarrt is cuunrilly producing AND selling or offering for sale; OR new models that are being marketed but are not yet being produced."Production Stopped" Model Status are those that an AHRI Certification Program Participant is no longer producing BUT is still selling or offer ing for sale. Ratinas that a e accomnanied by WAS indicate tin involuntary re -rate, The new Published ratin is shown alone with the orevious (i.e. WAS) rating. DISCI.,AIME R AlMl does, not s.ndol'se tlx: product(;) listed oil this, (,a rtificale ;md rrir')l,r,.s; do wpresnnt.atimis, wnrrcanih tit f;'ts,ir.it°stet :;is to, atyc,i tasaiutnes no responsibility fot'. the product(s) listed on this Ge0ificate. AI.1R1 expressly disr,Irainaes all 1whility for dnmagcs of any kind arising ()tit of the use or perforniance of the;, prodtict(s), or the unatit horwcrl alteration of data listed on this GeOific atc. certifsc.rl valid only for naorlels and configt. m 1pns listed in the directory nt www.ahridlrectory.org. TERMS AND CONDITIONS "'his (,e.rfils,;sitr ,7rica its c.tatitersic: 2iear proprietary prortsiCrtt. of A1tfdL'lhis f: r rttfir xita^':,ln!tli crraly be u:;ed for individual. Personal anti confificntial rcfe�renr.v rimposes.'1'hc contrnis of fhis Certificate tarry not, in whole or in part, he n7proehiced; copied; dsssa*minated; v,Acrad rotes a or ntherwise utilized, in ntiy tcwm or nJmnner or by any means. except far the- t sm's individual, r=er�nn.ii and nonfidenhar rrferancc, AIR-CONDITIONING, HEATING, CSFi;tTiFi(:A"fE VERIFICATION & REFRIGERATION INSTITUTE ,�llo in xrn2al ion for tit nx,dFRl ctft d on Hit cvnlhficoic can ho r a rif,yd ;n www.ahridirectory.org. Oick on "Verify Certificate" rink , i rn,ilw Wk 1r, s^ ,Imf onta;r the Mild ('4,,,0hc d Rete,re,nco Ntnnficr.and the dat?, on which tho certificatc wns issued, u.,f, , i is lisled nYsovi. and t srt Cevtifir,aW,, o., which is rsteci at xitttarii rit;Yit. --- ___ ?!?�QAir-Canctitic>nil�g. Heating, and Refrigeration Instltuto NAVAS Multiservices Corporation Proposal 111620-2 Elizabeth Garcia 70 NW 941h St. Miami Shores, FL 33150 e-mail: eaarciamikulskiCa)amail.com Phone: (305) 510-2166 Dear Mr. Elizabeth, November 16, 2020 Please consider this a proposal/agreement for the following scope of work, all work shall be performed in a professional workman like manner and meet local codes. TERMS THIS AGREEMENT made and entered into this 16 day of November, 2020 by and between •Ne oes Multiservices Corporation (hereinafter "NMC") having its principal address at 3050 N+W40TH 6T•MIAMI, FL 33142, and Elizabeth Garcia, (hereafter ("Customer") having its • ptLngipal address at 70 NW 94"' St., Miami Shores, FL 33150, hereby agree as follows: • •' I. SCOPE*OF WORK: Replacement of a 4 ton air conditioning split system V. NMC sVMI,Mtvide the following labor and materials: •of. ReNV6122nd dispose existing A/C unit • • •0••a. InstNANn of (1) NEW 4 ton air conditioning split system, Brand: RUUD, Seer: 16, Volt: 0.0 208-210, Freon R410A. 0, 3. In�taIAMn of (1) NEW digital non-programable thermostat •• ••4. InjtaTlYion of (1) new overflow float switch �. Instpfl (1� new set of hurricane tie down • • • • •(j. Install (1) new concrete slab • 7. Existing electrical installation will be used to power up the AC unit 8. Existing drain line will be user 9. New unit will be connected to existing air distribution system (ductwork) 10. Start up and check proper operation....................................................... $ 4,800.00 The following items are NOT included with the equipment/installation identified above: • Any item or accessory not specifically listed in the above proposal; • Any type Mild / Dry Wall Work; • Any type of painting job; TOTAL COST $ 4,800.00 Additional Terms: • The above pricing is valid for thirty (30) days from the date provided above. • If additional work is needed, it will be invoiced separately. 3050 NW 40TH STREET • MIAMI, FL 33142 PHONE: (305) 325-1077 • FAX: (305) 325-1087 LICENSE # CAC1817859 & INSURED E-MAIL: INFOQNAVASMC.COM WWW.N_AVASMC.CO,M_ • No architectural fees, no drawings, no heat calculations and/or any type of engineering are included in this proposal. • City Mechanical Permit Processing fees and City Mechanical Permit fees are NOT included in this proposal. Such fees are to be paid separately when permits are processed. • Work will be performed during regular business hours (i.e. Monday through Friday from 8:00 a.m. to 5:00 p.m.) • All areas will be left clean at the end of each working day. II. Payment Terms • Client shall pay a 60% Down Payment • Balance to be paid upon completion of installation III. Lead Time • NMC shall complete installation within1 day IV. Warranty (10) year on compressor and (10) years on parts from manufacturer, with unit • ...: registration. ' • • • • • „� :� 1 year orr installation labor from NMC ...... . .. '. . V. E TO PROCEED: • • • • • .. • DefWtign Notice to proceed is the request from the client to commence Installation on this • • • • • •... prdecC.This request shall be accepted and granted by Navas Multiservices Corporation • • • • • • • • • oncQstlie following conditions have been met: • • 00000 •••• ' •1•414roposal is accepted and signed by client and / or their representative • • 43 4itial payment of "Section II" is received. •...e• .' • --VI. ; JERMS AND CONDITIONS: • • 0 • • 0 •.. • • i Colfbctidh of Fees & Costs from Client. Any changes to project after final approval by the 0 Customer and/or City Building Department will be considered additional services and will be charged at an hourly rate. This proposal is for a total of FOUR THOUSAND EIGHT HUNDRED and 00/100 DOLLARS ($4,800.00) replacement of a 4 ton air conditioning split system and relocation of condenser unit. In the event the client fails to timely pay the invoices, Navas Multiservices Corporation, will be entitled to initiate legal action against Client to collect the amounts owed. If such action is taken, the Client agrees that Navas Multiservices Corporation will be entitled to recover from Client any and all attorney fees incurred, together with costs related to the collection process. The Client further agrees that in the event of any dispute arises from the relationship between the parties, or from this agreement, that the law of the State of Florida shall apply, that venue shall lie exclusively in the Courts of Dade County, Florida, and that the prevailing party waives the right to trial by jury and shall be entitled to recover is reasonable attorney's fees and costs. • Withdrawal of Representation. In the event the Client fails to pay the fees and costs on a timely basis, Client understands and hereby consents to have Navas Multiservices Corporation withdraw as the Client consultant in the matter wherein the Client is represented. • Retaining Lien. Should there be any outstanding sum due to Navas Multiservices Corporation or should Navas Multiservices Corporation deem it necessary to withdraw due to lack of timely payments of Consultant fees and costs, or due to other grounds, then 3050 NW 40TH STREET • MIAMI, FL 33142 E-MAIL: INFO@NAVASMC.COM PHONE: (305) 325-1077 • FAX: (305) 325-1087 WW.W.NAVAS-MC.._C_OM__ LICENSE # CAC1817859 & INSURED 2 Navas Multiservices Corporation shall have a right to a retaining lien against documents or other property, until payment of all sums. Customer agrees to provide NMC with a clear working area. NMC shall not be responsible for any damages caused to person or property while it is providing service/maintenance unless caused by its gross negligence. NMC will not be liable for loss or damage consequential or direct, arising from the operation or failure of the apparatus or its controls, or for work done on the equipment by others. Fires, water contamination, power failure, power surge, or acts of God are not covered by this Agreement. Thank you for the opportunity to provide you with this proposal/agreement and we eagerly look forward to working with you on this and other projects. Each party under this proposal/agreement acknowledge that they have all the authority necessary to execute this proposal/agreement and perform its respective obligations hereunder. If this proposal/agreement is acceptable to you, please sign below and return an original signed copy to us along with the initial 60% Down Payment as soon as possible. Accepted and Agreed to by: Corporate Name: oe wAtAhorized Signer: ' Ptit7t name! •• • •Soso t-)atV : • • .12/4/20 • ew•www ww•••• w• •• •• •'0:09 w Re �pectfulfy§QbMitted, • Vo ny Nawlt' . • • so Navas Multiserv(ces Corporation • . w• . .. ww••w• 3050 NW 40TH STREET • MIAMI, FL 33142 E-MAIL: INFOQNAVASMC.COM PHONE: (305) 325-1077 • FAX: (305) 325-1087 WWWN_A_VASMC.COM LICENSE # CAC1817859 & INSURED 3 AC40REP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1 12/07/2020 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()es) 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 CONTANAME: Adriana L Clavijo Mauri PHONE (305) 220-7447 FAX No): (305) 220 4821 Excellence Insurance, LLC. DBA A&A Underwriters. ADDRESS: CERTIFICATES@AAUNDERWRITERS.COM 3801 SW 107th Ave INSURERS AFFORDING COVERAGE NAIC # INSURER A: Kinsale Insurance Company 38920 Miami FL 33165 INSURED INSURER B : Amguard Insurance Company 42390 INSURER C : BusinessFirst Insurance Company. 11697 Navas Multiservices Corporation INSURER D : Underwriters at Lloyd's, London 15792 INSURER E : 3050 NW 40th Street INSURER F : Miami FL 33142 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 LTR OF INSURANCE ADDLTYPE INSD SUER POLICY NUMBER MM DDPOLICY EFF MMIPOLD/ EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 X MED EXP (Any one person) $ 5,000 Blanket Waiver of Subrogation X Blanket Additional Insured PERSONAL & ADV INJURY $ 1,000,000 A 0100058765-3 11/16/2020 11/16/2021 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICYFI PET LOC X PRODUCTS - COMP/OP AGG $ 2,000,000 X $ OTHER: Primary And Non Contribl. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaccident $ 500,000 BODILY INJURY (Per person) $ ANY AUTO B OWNED X SCHEDULED AUTOS ONLY AUTOS NAAU 192777 03/14/2020 03/14/2021 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY X COMP/COLLISSION $ 1,000 deductible PIP 10,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBEREXCLUDED? Y (Mandatory in NH) N/A 521-14961 11/15/2020 11/15/2021 X STATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 COMMERCIAL PROPERTY Contents Limits $ 100,000 D 994MI100085 11/16/2020 11/16/2021 Cause of Loss Special Coinsurance 90% DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Mechanical contractor CAC1817859 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores FL 33138 ^_ 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD n EXPIRATION DATE AUGUST 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