DOCK-04-22-960Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
ocation Address
1 10 NE 101ST ST, Miami Shores, FL 33138
Contacts
Parcel Number
1132050240030
Expiration: 12/02/2022
George E & Alice P Burch Owner KEARNS CONSTRUCTION COMPANY Contractor
1440 NE 101 ST, Miami Shores, FL 33138-2613 CHARLES SWANSON KEARNS
aliceburch@aol.com 4101 BRAGANZA AVE, MIAMI, FL 33133
Inspection Requests:
Description: repalce broken pilings Valuation: $ 1,800.00
3Qa 7`62�1949 ':
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.40
Permit Fee
$50.00
Planning and Zoning Review Fee
$35.00
Structural Review ($60)
$60.00
ethnology Fee
$2.50
°dock Without Permit Fee
$100.00
Work Without Permit Fee - Plus $100
$100.00
Tota I :
$403.10
Payments
Date Paid Amt Paid
Total Fees
$403.10
Check # 1276
06/02/2022 $353.10
Check # 1254
04/15/2022 $50.00
Amount Due:
$0.00
Building Department Copy
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
1 ertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Ilage. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
rmits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
i)JVNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulatinA construction and zonin Futhermore, I authorize the above named contractor to do the work stated.
Ii -? -zv
Signature: Owner
/ Applicant / Contractor / Agent
Date
November 03, 2022
Page 2 of 2
BUILDING
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
nN'r7MED
FBC 201'�
Master Permit Now"— — 6) 4-3
PERMIT APPLICATION Sub Permit No.
F-IBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL []PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
T � 5� CONTRACTOR DRAWINGS
JOB ADDRESS: ___i ME 191 5 I
Occupancy Type: Load:
OWNER: Name (Fee Simple
City: /V), I K
Tenant/Lessee Name:
Email:
33►3
Building Historically Designated: Yes NO JK
_ Construction Type: Flood Zone: BFE: FFE:
6EO466 + AL-tCC 1�)90f Phone#: ;�05')1$
i
CONTRACTOR: Company Name: KE �y> C4CW-S 1 4`JC Dd Pho^n�e#: 305 `r 0 / 6-31 Q
�
Address: ZD v///6AV-5,lfJv�i, �� `o�o g
City: C 0CW U T-Cqxlk;yjj State: fig Zip:
�J3�1[3 3
Qualifier Name: `- 4..t�J'f+r-rvS iCJ�+kLt C`�5 Phone#: 705 -t G7( 0310
State Certification or Registration M d (po1^�II r1
-1
DESIGNER: Architect/Engineer: 906Aus (ftAI
Address: 7!;'Sb kM 4aI - P, 217
Value of Work for this Permit: $ 1 , 90 0 -00 S1
Type of Work: ❑ Addition ❑j�Alteffrr'a,^,ti''o__n ❑ New
Description of Work: �0- Jm F-Pill Q 111%!/a
Specify color of color thru
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $ _ 16) . LL-' CCF
of Competency #:
Phone#:
State: Zip:
r Footage of Work: _
® Repair/Replace
Urovm Pil
❑ Demolition
CO/cc $
Radon Fee $ DBPR $ ary $
Training/Education Fee$ II3D61€Fee 0-)
Bond $ _
TOTAL FEE NOW DUE $ .3 S 3 V
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable) _
Mortgage Lenders Address
City
9.
State
Zip
Application is hereby made to obtain a permit to do the work and installations as Indicated. 1 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, o 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 CONTRACTOR
The foregoing instrument was acknowledged before me this
I LA— day of _ (AZ2a L_ , 20 Z Z . by
AEU1 GIz {SU26(-i , who is rsonalry no to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal:
MY COMMISSION# OG N"77
EXPIRES: March S, 2024
as
The foregoing instrument was acknowledged before me this
1540 day of IMIZ)6 . 20 2 V by
11ho1-1.ej -P(.I/✓7f who' p'ersonalhy knowJr to
me or who has produced ��� as
Identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: I ��
Seal:
tisss###54###s#i##ii+sii+i#+iii #sif#ii+#F/iii#tiiii#i###fii
APPROVED BY Plans Examiner
Notary Pudic Stab of Florida
Yusleidy, Do La Candad
Vazquez Suarez
My Commp HH 033993
l S�yS�ti� Zoning
Structural Review Clerk
(Revised03/24/2014)
CLASS I PERMIT APPLICATION
EXEMPT PROJECTS
The following is a list of projects that are exempt from a Class I Permit.
(a) Repair and/or replacement of the decking or handrails, on an existing dock or limited to their original
dimensions.
(b) Sealing of cracks and spall repair on a bridge, seawall or bulkhead cap or face.
(c) Repair or sealing of the pilasters of an existing seawall or bulkhead.
(d) Backfilling landward of existing seawalls or bulkheads.
(e) Placement of riprap, gunite-filled tube, or other approved material beneath an undercut seawall or bulkhead
provided that material does not extend more than two (2) feet waterward of the seawall or bulkhead.
(f) Placement of sand -cement riprap bags at the toes of a seawall or bulkhead provided the bags do not extend
more than two (2) feet or the width of two (2) standard sand -cement bags waterward of the seawall or
bulkhead.
(g) The removal of old or unused or rotting piles or the removal of dilapidated docks, boatlifts, davits or piers.
(h) The trimming of a mangrove tree(s) performed in accordance with the permit exemption provisions of Section
403.9326, Florida Statutes, provided that notification is given to the Department as required pursuant to
Section 24-48.17(1) of the Code of Miami -Dade County
(i) Installation, repair, or replacement of marine hardware on docks and piers necessary to secure vessels
including, but not limited to, cleats, mooring whips, chocks and mooring bits
(j) Construction, installation, repair, or replacement of permanent uncovered benches and/or tables on docks and
piers.
(k) Construction, installation, repair, or replacement of fenders, except fender piles, on docks and piers
necessary for the protection of vessels.
(1) Construction, installation, repair, or replacement of storage boxes, not exceeding thirty-six (36) inches in
height, on docks and piers.
(m) Construction, installation, repair, replacement of ladders on docks and piers to provide access to and from
vessels and/or the water.
(n) The placement of concrete jackets or other forms of protection on existing dock, pier or mooring piles.
(o) The replacement of fender piles or mooring piles at the same exact location as they presently exist and
provided that the following criteria are adhered to:
i. The fender piles or mooring piles to be replaced do not protrude into the water more than twenty-
five (25) percent of the width of the waterway.
ii. The work will be done by a contractor holding an applicable certificate of competency.
iii. The contractor shall contact the Director or the Director's designee a minimum of twenty-four (24)
hours prior to performing the fender pile or mooring pile replacement work with information on
the location and the number of fender or mooring piles to be replaced
(p) Repair or replacement of uniform waterway markers or uniform waterway regulatory markers, which markers
conform with Section 327.40 and 327.41, Florida Statutes, respectively, as may be amended from time to time
EXPEDITED ADMINISTRATIVE AUTHORIZATION
The following activities shall be eligible to receive a written expedited administrative authorization, provided the Department
determines the work meets the criteria below and will not result in adverse environmental impacts.
(a) Scientific, water quality or geotechnical sampling or testing in tidal waters or wetlands
(b) Work in tidal waters and wetlands, not to exceed thirty (30) days, associated with motion piPure, television,
photographic or other media production
(c) Treatment or removal of vegetation which is listed as a prohibited species as set forth in Secti�n 24-49.9 of the
Code of Miami -Dade County, Florida, for restoration and enhancement activities
(d) Work within wetlands performed to restrict access to property for the purpose of maintaining the property in its
natural state and protecting the property from trespass, illegal dumping, or damage to wetlands
(e) The placement of natural limerock boulder riprap waterward of an existing seawall, bulkhead or unconsolidated
shoreline provided that the riprap is place on a two (2) horizontal to one (1) vertical slope and the riprap does not
extend more than ten (10) feet waterward of the mean high water line; provided, howev6r, the Department
conducts an inspection prior to the placement of the riprap and determines that said placement will not result in an
adverse environmental impact to benthic communities
(f) Repair and/or replacement of the tieback systems on an existing seawall or bulkhead, provided that the contractor
submits structurally approved plans from the applicably building authority
(g) Repair and/or replacement of the cap of an existing seawall or bulkhead, provided that the contractor submits
structurally approved plans from the applicable building authority
The following is a list of items necessary for RER to process a request for an expedited administrative authorization. If you
have any additional questions, please contact the Coastal Permitting Program at (305) 372-6575.
MIAMI-DADE COUNTY RER (REVISED 02/27/14) PAGE 6
1 4 4 0 N E
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1�
1
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1
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S T R E E T
Im
EXISTING DOCK
TO REMAIN
PROJECT:
BURCH RESIDENCE
--- AFTER -THE -FACT
IMPROVEMENTS
ADDRESS:
_.._..,_l.,...._., . - 1440 NE 101ST STREET
MIAMI SHORES, FLORIDA 33138
i
CLIENT:
MR. GEORGE BURCH
ADDRESS:
1440 NE 101 ST STREET
I 1 MIAMI SHORES, FLORIDA 33138
Ian itaK11.. ,frf%��li/ ENGINEER:
f
+ , L7 / t I � .v—.•e•y.,,":r,•-vm.' ,V Miami I Fat Lauderdale I Jupiter
Tallahassee I St. Pelemburg
I 201 Alharnbm Cirde. Suite 601
I Caal Gables FL 33134
T: +1 305-74"155 F. a1 305-974-1969_ _
www mmmscederberg.wm
� C04 a2p062
I.UMBING
�{ �^
'.` L,j 2ANICAL f O ( O O O<
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(2) EXISTING WOOD •� _ °'
MOORING PILINGS TO Sk"L fi"O
REMAIN
tlyIY2•zz _z
STf1TE OF '
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RASHEED K' MrdU) ANI N77Z09 ,°:, •,
AFTER -THE -FACT (2)
EXISTING TIMBER MOORING
PILINGS REPLACED IN THE
SAME FOOTPRINT WITH 12"
DIA. GREENHEART PILIW3S
�t
lk
B! S C A Y INE B A Y *;.
'S
NOTES
"
1. THIS DRAWING IS NOT A SURVEY AND IS ONLY INTENDED TO
�
SHOW THE APPROXIMATE LOCATION OF THE AFTER -THE -FACT
0 5
_-
t
IMPROVEMENTS WITHIN THE ORIGINAL FOOTPRINT.
_
GRAPHIC SCALE
2. AERIAL IMAGE SOURCE: FDOT 2021. FOR REFERENCE ONLY.
�1lX1�ji°=10'
CC PROJECT NO: 1 111900
DRAWN WT
CHECKED RM
SCALE AS SHOWN
SHEET TITLE
EXISTING SITE
PLAN/AFTER-THE-FACT
IMPROVEMENTS
SHEET 1 OF 1
S-1.0
MPS ° P OF BOUNDARY SURVEY
L®CAT/O/V MAP
SECTION 5, TOWNSHIP 53 SOUTH, RANGE 42 EAST
LYING AND BEING IN MIAMI-DADS COUNTY FLORIDA
(NOT TO SCALE)
SURVEYOR'S NOTES:
1.) THE ABOVE CAPTIONED PROPERTY WAS SURVEYED AND DESCRIBED BASED ON
THE ABOVE LEGAL DESCRIPTION: PROVIDED BY CLIENT.
2.) THIS CERTIFICATION 15 ONLY FOR THE LANDS AS DESCRIBED. IT 15 NOT A
CERTIFICATION OF TITLE, ZONING, EASEMENTS, OR FREEDOM OF ENCUMBRANCES.
ABSTRACT NOT REVIEWED.
3.) THERE MAY BE ADDITIONAL RESTRICTIONS NOT SHOWN ON THIS BOUNDARY
SURVEY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF HIS COUNTY,
EXAMINATION OF ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE
RECORDED INSTRUMENTS, IF ANY AFFECTING THI5 PROPERTY.
4.) ACCURACY: THE EXPECTED USE OF THE LAND, AS CLA551FIED IN FLORIDA
MINIMUM TECHNICAL STANDARDS (5J-1 7.5 1 FAG), 15 "RESIDENTIAL".THE MINIMUM
RELATIVE DISTANCE ACCURACY FOR THIS TYPE OF BOUNDARY SURVEY 15 1 FOOT
IN 7,500 FEET. THE ACCURACY OBTAINED BY MEASUREMENT AND CALCULATION OF
A CLOSED GEOMETRIC FIGURE WAS FOUND TO EXCEED THIS REQUIREMENT.
5.) FOUNDATIONS AND/OR FOOTINGS THAT MAY CP055 BEYOND THE BOUNDARY
LINES OF THE PARCEL HEREIN DESCRIBED ARE NOT SHOWN.
G.) TYPE OF SURVEY: BOUNDARY SURVEY
7.) ELEVATIONS SHOWN HEREON ARE BASED ON TO THE NATIONAL GEODETIC
VERTICAL DATUM OF 1929 (N.G.V.D.29)
8.) ALL MEASUREMENTS ARE IN ACCORDANCE WITH THE UNITED STATES STANDARD
U.S. FOOT
9.) CONTACT THE APPROPRIATE AUTHORITY PRIOR TO ANY DESIGN WORK ON THE
HEREIN DESCRIBED PARCEL FOR BUILDING AND ZONING INFORMATION.
10.) UNDERGROUND UTILITIES ARE NOT DEPICTED HEREON, CONTACT THE
APPROPRIATE AUTHORITY PRIOR TO ANY DE51GN WORK OR CONSTRUCTION ON THE
PROPERTY HEREIN DESCRIBED. SURVEYOR SHALL BE NOTIFIED AS TO ANY
DEVIATION FROM UTILITIES SHOWN HEREON.
1 1.) ENCUMBRANCES NOT SHOWN ON THE PLAT.
12.) THE WRITTEN CONSENT OF LANDMARK SURVEYING $ ASSOCIATES, INC.
UNDERGROUND PORTIONS OF FOOTING, FOUNDATIONS OR OTHER IMPROVEMENTS
WERE NOT LOCATED.
13.) ONLY VISIBLE AND ABOVE GROUND ENCROACHMENTS LOCATED.
14.) WALL TIES ARE TO THE FACE OF THE WALL. .
15.) FENCE OWNERSHIP NOT DETERMINED.
I G.) BEARINGS REFERENCED TO LINE NOTED AS B.R.
17.) BOUNDARY SURVEY MEANS A DRAWING AND/OR GRAPHIC REPRESENTATION OF
THE SURVEY WORK PERFORMED IN THE FIELD.
15.) NO IDENTIFICATION FOUND ON PROPERTY CORNERS UNLE55 NOTED.
19.) THE SOURCES OF DATE USED FOR THE PREPARATION OF THIS BOUNDARY
SURVEY IS "REPLAT OF TRACT "A" OF MIAMI SHORES BAY ESTATES" RECORDED
IN PLAT BOOK 5G, AT PAGE 8G.
20.) THIS MAP OF SURVEY 15 INTENDED TO BE DISPLAYED AT A SCALE OF ONE
INCH EQUALS 20 FEET OR SMALLER.
Y �
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CERT/F/EO TO: y
THI5 BOUNDARY SURVEY HAS BEEN PREPARED FOR THE
EXCLUSIVE USE OF THE ENTITIES NAME HEREON. THE
CERTIFICATIONS DO NOT EXTEND TO ANY UNNAMED
PARTIES.
- GEORGE E. BURCH * ALICE P.
PROPERTY AOORESS:
FOLIO NO. 1 1-3205-024-0030
1 440 NE 101 STREET
MIAMI SHORES, FL 33 138
I HFPE_PY CERTIFY TO THE BEST OF MY
KNOWLEDGE AND BELIEF THAT THIS "MAP OF BOUNDARY SURVEY' I5 A TRUE AND
CORRECT REPRESENTATION QF:A�SURVEY PREFARED UNDER MY DIRECTION. THAT IT
MEETS THE STANDARDS OF FRACTICE AS SET FORTH BY THE STATE OF FLORIDA AREA OF PROPERTY: 12,352 SQUARE FEET AND/OR
BOARD OF PROFESS)OPAL'AND 5UPVEYOF5 IN CHAPTER 5J- 17.050 THROUGH
5J- 17.052 OF THE' FLORIDA ADMINI5AATIVE COCE A'JD ITS IMPLEMENTING LAW, 0.284 ACRES MORE OR LESS.
PURSUANT TO.e} APTEK 421 Oy,FL f JD'A Si
SIGNED " _' 1 FOR THE FIRM
ARTURO MENDIGUTI P. / P.S.M. NG. 5844-STATE OF FLORIDA
NOT VALID WITHOUT T 51GN.ATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA
LICENSED SURVEYOR/ANO MAPPER. ADDITIONS OR DELETIONS TO SURVEY MAPS OR
REPORTS BY OTH THAN THE SIGNING PARTY OR PARTIES IS PROHIBITED WITHOUT
WRITTEN CON T OF THE SIGNING PARTY OR PARTIES IN A DIGITAL FORMAT NOT
VALID WITHOUT AN AUTHENTIC ELECTRONIC SIGNATURE AND AUTHENTICATED
ELECTRONIC SEAL.
LEGAL OE5CRIP7-/ON:
LOT 7, BLOCK 1, OF "REPLAT OF TRACT "A" OF MIAMI
SHORES BAY PARK ESTATES, ACCORDING TO THE PLAT
THEREOF, AS RECORDED IN PLAT BOOK 5G, AT PAGE 8G,
OF THE PUBLIC RECORDS OF MIAMI-DADS COUNTY, PLORIDA.
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GRAPH/C SCALE
20' 10, O 10' 20'
LGLA/L'71�1�/Zl�
( IN FEET) samvc--vu.>G a assoo�-rEs, wc.
I INCH = 20 FT.
LB No. 7633
PROFESSIONAL SURVEYORS AND MAPPERS
1435
S.W. 87th AVENUE: SUITE "201°
MIAMI: FL 331 74
PHONE: (305) 55G-4002 FAX: (305) 55G-4003
W WW. LMSURV EYI NG.COM
EMAIL-LANDMARKSURVEYI NG @HOTMAIL.COM
ABBREVIATIONS ANO LEGEND:
A/C
—DENOTES AIR CONDITIONING UNIT
APPR.
—DENOTES APPROXIMATE
ASPH.
=DENOTES ASPHALT
IE
=DENOTES PROPERTY LINE
B.M.
—DENOTES BENCH MARK
C.B.S.
=DENOTES CONCRETE BLOCK STUCCO
CONC.
DENOTES CONCRETE
L.P
=DENOTES LIGHT POLE
CB
=DENOTES CATCH BASIN
q
=DENOTES CENTERLINE
M
=DENOTES MONUMENT LINE
L.M.E.
=DEN'O,'EirAKE 4 MAINTENANCE
EL SEMENT <
D.E_
=DENO'ES'DRAINAGE CA3EVJ'T
D.H.
=DENOTES DRILL HOLE
(R)
=DENO':ES RECORD
'VaF"
=DCNJ;E9 WOOD POV(u� GEL'
LI-E
DENOTES UTILITY EASEMENT
c P.13
DENOT�S PLAT 1300r1`
Pj��
=DFNOTES�PAGE '
P C.P
=DFROFEScPFRMANENT CONTROL
c c
POINT c ,
P.O.B.
=DENOTES POINT OF BEGI�'NING,
c cR'R r
=DEN7TEfi cTY�ICAL c, c c
FAN HIGH, VY/{TER� I�IE
—
=DENOTES WOOD FENCE
c � =
=DENOTES CHAIN LINK FENCY°
c
c �
=4EtIOTE�-IRON FENGF c c <
®
=D`_NQTES FOUND IRON PIPE (NO ID.)
c
=6EN0T[5` FOUND NA'_ AND DISC
c c
c
=FS�NCS--TES F.SPHALT PAVEMENT
c cc
=DENOTES BRICK
=DENOTES CONCRETE PAD
ALL BEARINGS AND DISTANCES SHOWN
HEREON ARE RECORD AND MEASURED
UNLESS OTHERWISE NOTED.LL
,l
FLOOD ZONE:
AE
W
ELEVATION:
9.0
,�
COMMUNITY:
120G52
PANEL:
1208GC030E
DATE OF FIRM:
09- I I -2009
SUFFIX:
L
ORIGINAL FIELD
WORK SURVEY
09-27-201 7
DATE
Q
BENCH MARK:
N/A
Z
ELEVATION:
N/A
0
DATE
DRAWN BY
SCALE
09-29-201 7
M.G.
I "=20'
O
REVISION /UPDATE OF SURVEY
DATE
DESCRIPTION
N/A
N/A
Q
JOB No.
1709-084 �
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003032
Local Business Tax Receipt
Miami -Dade County, State of Florida
-THISIS NOTA BILL -DO NOT PAY
5342050
431
llUSINESB NANIEILOCATION RECEIPT No. EXPIRES
KEARNS CONSTRUCTION COMPANY RENEWAL SEPTEMBER 30, 2022
2550 SOUTH BAYSHORE DR STE 206 B 4363131 Must be displayed at place of business
MIAMI FL 33133 Pursuant to County Code
Q" Chapter $A - Art 9 & 10
OWNER SEC. TYPE OF BUSW BS PAYNERT RECENEO
KEARNS CONSTRUCTION COMPANY 196 GENERAL BUILDING CONTRACTOR BYTARCOLECToII
C/O 10HN KEARNS CGCO60194 $45.00 07/23/2021
Workers) I CHKY,21 21-062534
This Local Business Tax Receipt Only confirmspaymestOfths Local Business Tax. The Receipt isnot a 110e000,
permit or a certification oftha holder's qualifications, to do business, Holder must comply with any govemmeatal
or nongovernmental regulatory laws and regrdramentswbich apply to the business.
The RECEIPT NO. above must he displayed on ail commercial vehicles- Miami -Dade Code Sac go-E76.
For more information, visit wwwmiammidade ggvkaxcoHecbr
a�i��.�r-r0 1 IAQ11 ITV IAIQIIOAAIt'%C
HC-VKIJ VL11 �� IVP11 L VI LIP%L71L1 1 1 IIVV%JFXMIL
DATE (MMIDD/YYYY)
04/14/2022
F
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Trinity Inv. Inc b/d/a Trinity Insurance
4000 Hollywood Blvd Ste 555-S
Hollywood, FL 33021
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Phone: 305-TRINITY (874-6489), 954-829-5978, 954-613-3601
Fax: 954-206-5978, Email: bgloria@trinityinv.net
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
INSURER A: continental insurance Company
35289
Kearns Construction Company
INSURER B: a"adoa" Longshore Mutual Assn (ALMA) USLH/Great American Ins Co (FL state Act)
2550 South Bayshore Drive, Suite 206-B
Coconut Grove, FL 33133
INSURER C: National Fire Insurance Co of Hartford
20478
INSURER D: Liberty Mutual Insurance Company
FLORIDA DBPR LICENSE #CGC060194
INSURER E:
COVERAGES
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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INbK LTR
INSRD
TYPE OF INSURANCE
POLICY NUMBER
DATE MMIDD
DATE MIDDIMN
LIMITS
A
GENERAL LIABILITY
ML 9780064*
EACH OCCURRENCE
$ 1,000,000
PREM SESOEa occunance
$ 250,000
I/ COMMERCIAL GENERAL LIABILITY
Blanket Additional Insured,
El CLAIMS MADE ❑✓ OCCUR
Waiver of
MED EXP (Any one person)
$ 10,000
*
Y
✓ Blanket Additional Insureds
Subrogation, Primary
03/29/2022
03/29/2023
PERSONAL & ADV INJURY
$ 1,000,000
Non -Contributory,
GENERAL AGGREGATE
$ 2,000,000
✓ Includes xcu
Per Project Aggregate "When
PRODUCTS - COMP/OP AGG
$ 1,000,000
GEN'LAGGREGATE LIMITAPPLIES PER:
required by written contract"
Deductible BIPD ea claim
$2,500
POLICY rl PROJECT M LOC
C
AUTOMOBILE LIABILITY
BUA6023678054
COMBINED SINGLE LIMIT
$ 1
✓ ANYAUTO
*Blanket Additional Insured,
(Ea accident)
+000+���
BODILY INJURY
$
ALLOWNEDAUTOS
Waiver of Subrogation,
SCHEDULEDAUTOS
Primary Non -Contributory
(Per person)
�/ HIRED AUTOS
"When required by written
03/29/2022
03/29/2023
�/ NON -OWNED AUTOS
contract
(Perraccdent)RY
$
PROPERTY DAMAGE
$
*Y
,/ 'Blkt Add[ Insured, Waiver of Subrogation
✓ Primary Non -Contributory
(Per accident)
GARAGE LIABILITY
AUTOONLY- EAACCIDENT
$
OTHER THAN EAACC
$
ANYAUTO
$
AUTO ONLY: AGG
D
EXCESS/UMBRELLA LIABILITY
ATAA1SP8007
EACH OCCURRENCE
$ 5,000 000
AGGREGATE
$ 5,000,000
11 OCCUR ❑ CLAIMS MADE
Follow Form/Drop Down
$ INCL
03/29/2022
03/29/2023
"Scheduled Vessels"
$ ONLY
DEDUCTIBLE
$
RETENTION $
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
FL: Great American Ins Co
✓ TORY LIMITS ✓ ER
USL&H
E. L. EACH ACCIDENT
$ 1,000,000
**
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED?
#WC308605102AND
USL&H: ALMA #ALAM02175-03
03/29/2022
03/29/2023
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
No
**Blanket Waiver of Subrogation
If under
Syes, describe und
SPECIAL PROVISIONS below
"when required b written contract"
Y
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
OTHER
H 0877068 *Blanket Additional Insured,Waiver
P&I $1,000,000 each Occurrence incl Roving
A
Protection & Indemnity Vessel Liability (P&I)
of Subrogation, Primary Non Contributory
03/ /29202 2
03/29/2023
Crew (5 Crew) for Scheduled Vessels ONLY
FOR SCHEDULED VESSELS ONLY
when required by written contract
RE: MARINE CONTRACTOR
MIAMI SHORES VILLAGE BLDG DEPT is included as an Additional Insured - for State or Government Agency or Subdivision or Political
Subdivision — Permits or Authorizations under the Marine General Liability Policy #ML 9780064 SUBJECT TO COVERAGE FORM &
EXCLUSIONARY UNDER AFOREMENTIONED POLICY.
**30 Days Advance Notice of Cancellation EXCEPT for Non -Payment of Premium 10 Days
VCRI IriVmi C nwit- mm VMI\VGLLMI IVI\
MIAMI SHORES VILLAGE BLDG DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
10050 NE 2ND AVE DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
MIAMI SHORES, FL 33138 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Gloria J. Bravo, CIC
ACORD 25 (2001/08)
@ACORD CORPORATION 1988