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PW-11-19-2818Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 issue Date:11/26/2019 Location Address Parcel Number 10050 NE 2ND AVE, Miami Shores, FL 33138 1132060131960 Contacts Permit NO.: PW-1 1 -19-2818 Permit Type: Public Works Work Classification: Public Works Permit Status: Approved Expiration: 05/26/2020 MIAMI SHORES VILLAGE Owner STAR PAVING CORPORATION Contractor MIAMI SHORES VILLAGE ABEL MENDEZ 10050 NE 2 AVE, MIAMI SHORES, FL 331382304 9312 NW 13 ST #7, DORAL, FL 33172 Other:3057511271 Business:3054639030 STARPAVING@AOL.COM Description: PAVING, ASPHALT, DRAINAGE, TRAFFIC CIRCLE AT Valuation: $ 0.00 Inspection Requests: NW 115 STAND NORTH MIAMI AVE 305 762 4949' Total S Feet: 0.00 CONTRACT #20170025, WO# 11 q NORTH END OF BARRY U. Fees Amount Copies Fee (Manual) $7.05 Public Works Permit Fee $100.00 Scanning Fee $12.00 Technology Fee $2.50 Total: $121.55 Building Department Copy Payments Date Paid Amt Paid Total Fees $121.55 Check # 2742 11/26/2019 $121.55 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 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 authogze the above named contractor to do the work stated. k Authorized Signature: Owner / Applicant / bontractor / Agent Date November 26, 2019 Page 2 of 2 EX7RUED 6 �-�../ Miami Shores Village NOV 2 6 WO melon Public Works Department,, (305)795-2210 Public works forms are available from the building department, 10050 NE 2nd Ave., Miami Shores, FL 33138 PUBLIC WORKS PERMIT APPLICATION Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property Permit#: Name of Applicant (if utility see below): ("Q (C(✓ 1 ( OG de (OS/"/)+ Owner off the following described property: Legal Description: Lot ^ Block Subdivision Folio #; Address: Nv1J 115 S+ 0V-4-► Mwrr 2-01700r­-� UTILITY NAME: Qualifier/Authorized Agent: Address: City: Telephone: State Certification or Registration #: State: CONTRACTOR NAME: _ � (-J��/ 7 Ulf/ (a Qualifier/All, horized Agent: It Address: �_� d City: _ _�l.A ( State: Telephone: M-Lfto6-r1020 Email:�'(�Q Jf State Certification or Registration #: P;. `r ZIP: Certificate of Competency # Requests ermission to install (des ribe work, attach eparate page if necesf ry) in the adjoining might way: �1.(� �A C9i %l/i -' PsHA_-&Q,P . /.� AOUL—fti4r, �/ !N 0 4 - l l) Type of Work: Paving ❑ Utility Sidewalk ❑ Electric ❑ Irrigation ❑ Landscape ❑ Antenna ❑ Other: � , 5 DESIGNER: Architect/Engineer: _�jIIPTAddress: City: City: State: ZIP: Telephone: Email: Registration #: TW01 Value of Work for this Permit: $ V C y'�-e Square/Lineal Footage of Work:Siai �' i 00 ®'�4 Fees f� 000 f ********** Permit Fee $ 100.00 Notary $ Training/Education $ 0,20 Technology Fee $ 0.80 Scanning $ Bond $ (if required) Total Fee Now Due $ I r Bonding Company's Name (if applicable): Bonding Company's Address: City: - State: ZIP: Application is hereby made to obtain a public works permit to do the work in the right of way 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, regulation construction in this jurisdiction. I understand that separate permits must be secured for APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with applicable laws regulating construction and specifically construction in the right-of-way. "WARNING TO APPLICANT: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO THE RIGHT-OF-WAY. 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 public works permit with an estimated value exceeding $2,500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to the attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the public works permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection will be charged. nature p r Au orized Agent The foregoing in rument was acknowledged before me this 7104 day of J40Jt& OM_, 20T by _ Qi41G1 �i who i ersonally knowr�j to me or who has produced as identification. NOTARY PUBLIC: Sign: Print: �t1�d P o M , G45[jZo SEAL: Signature 'Company/Utility Agent The foregoing instrument was acknowledged before me this4"day of MiTeMP& 20 H by _be( —who is personally known to me or who has produced as identification NOTARY PUBLIC: Sign: —M- — r� Print: SEAL: � ^ ..e o v pro;'•; LUCY M BATISTA Notary Public-5tateof Florida Commission # GG 078034 °9FoFF�' MY Comm. Expires May30,2021 APPROVED BY: _ L �y i� , Public Works Director, or Designee Castro ��?����;f %Olt AlvaroCorr^�iss M # FF342576 •" Expirt,,,. Ci.^ember 9, 2019 Bondea thru Aaron Notary n�rran" 2017-04-15 Address Omer Name Subdivision Name Folio Property Address 11300 NE 2 AVE Owner BARRY COLLEGE Mail® Address 11300 CIE 2 AVE. LA 011E BLDG 2ND FL RM 204 MIAMI SHORES, FL 33161-6828 PA Primary Zone 2200 SC14 0OLS & CHURCHES Prianary Lard Use 7241 Edt1C4TIQt tSCiEN`IT FIC - EX EDUCATIONAL - PR3VATE Beds d Baths l Half 01010 Floors 2 Actual Area Living Area Adjusted Area 82.3##2 Sq.Ft Lot Size 1,740,40D SJ.Ft Year Built Multiple (See Saslding Info-) Featured Online Toots OwWwable Sales GI sary PA Additional Online Toals Fropedy Record Cards RepDiscrepancies Report i- wie-ste l Fraud Special Taxing ncts- and Other Tax Comparison T; t�bn-Ad valorem Assessments value Adj usfff ter t Bo wd NOIS30 YON €$ bo LMULS M AN 233a1S Ytt 3N _ ., e �f`, !''�. . •- "i W a,. a. � ��w..c`. szW a+ \1 �' --�/90 °j� q_. 1 FIX o riSSi (�doW N�aii $>ic<ic�i aoNNvxi $fix r r, „1 _ T ayyspwc $ -a uZrf-<`,gm RF Wm m mw .rc r For•V ,,, -iz V S7xO o =l�o c o��Uw �1 o prc�Rtt+ vNi yyi0_FOsFN r yOmO F F WF \ H3�,W �owrc�� a d d ..]..:c7 din ��q4 �y=ly �0 old !,Ontol "-- x,'i zs �,� �*P' x 3 '�rV1 �• p� �i �I N Y Cf 3 O 30 W �w� Wyi wa Vk =W zU�IYn 'd'F iYIm�,;OSSi�W _. 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(7 z Q O_ NE 1 AVE a3SOl0 l avoa W Z 03SO10 avoa U-1 ROAD Lo CLOSED Zf----- I NW1AVE ° ~ �, of I m •, _ Imo' l � ILiQ ry�t1'hi � ; a Z h.a uE LULU s r� �41i iw� I a � m �E Pill W Ic �Q� y a cin NW 2 AVE o -�Fit v W U C aN76 m m m y �r to Z y Y WrL 0, J m Z U 0 IL m m O F w i o rn LLJ U ~ �Z Q ¢0 z J z O J cl) W � U W W0 Z O V 908 K � � z zz¢ O O NE 2 AVE NE 1 AVE ii if wwr E 0 0 Construction Trades ua+i lyBoard BUSINE55 CERTIFICATE OF COng MPETENCN E 1982 BAR PAVING CORP MD .B.A.: 'y'tNL7EZ ABEL T Is certified under the provisions of Chap�loiami-gads Countyht._ QUALIFYING T— R ,S) 0007 PAVING ENGINEERING Jaime D. G.sc,,, P.E. i�\: .� Seeretary c/lhe Board '"i_" Mlq MFambDaae COwdy retains allproperiy his w.rx.miantiaaaegoyleennamy 001324 Local Business Tax Receipt Miami -Dade County, State ofiiliFlorida -THIS IS NOT A BILL - DO NOT PAY 1143254 LBTI BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES STAR PAVING CORPORATION RENEWAL SEPTEMBER 30, 2020 9312 NW 13TH ST BAY 7 1143254 Must be displayed at place of business DORAL FL 33172 Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS STAR PAVING CORPORATION 196 SPECIALTY ENGINEERING CONTRACT PAYMENT RECEIVED C/oABELTOMASMENDEZPRES- El982 BYTAX coulcroR _. _. $45.00 07/22/2019 Worker(s) 10 FPPU06-19-017995 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 to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276. For more information, visit www.miamidade.gov/taxcollector 014655 -Municipal Contractor'"eceip Miami Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 1143254 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES STAR PAVING CORPORATION NEW SEPTEMBER 30, 2020 9312 NVV 13TH ST BAY 7 7575510 Must be displayed at place of business DORAL FL 33172 Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER STAR PAVING CORPORATION SEC. TYPE OF BUSINESS MMC SPECIALTY ENGINEERING CONTRA,�p#NTRECEIVED _ `sytAItCOLLECTOIL C/O ABEL TOMAS MENDEZ PRES El982' $200.00' 07/22/20`19 Category(s) 1 FPPU06-19-017995 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 to the business. Tfie RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276. For more information, visit wl w pinmidade.govhaxcollector R CERTIFICATE --� OF LIAB LI TY THIS I NS U RA N C E DATE (MM/DD/YYYY) CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 11 /25/2019 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 be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions _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 Poky,, certain ). PRODUCER CNTACT Acentria Insurance - Insurance Marketers NAME: Evarist Milian Jr. 2600 S Douglas Road Suite 712 PHONE Coral Gables FL 33134 A/C No Ext: 305-442-9507 FAx E:MAIL__ A/C No : 305-447-8527 INSURED I INSURER A : Tokio Marine S ecialt NAIC # Star Paving Corp STARPAV-01 INsuRER a :Allied Insurance Com an of America 23850 9312 NW 13th St, Bay #7 INSURER National Union Fire Ins. Co. Pittchiir�l, on 10127 Doral FL 33172 777:CERTIFICATE NUMBER: 769612829 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD REVISION NUMBER: 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. ISR TR TYPE OF INSURANCE ADDL SUBR A GENERAL LIABILITY POLICY NUMBER POLICY EFF POLICY EXP MM/DD/YYYY PPK2037357 X MM/DD/YYYy LIMITS COMMERCIAL GENERAL LIABILITY 9/12/2019 9/12/2020 EACH OCCURRENCE CLAIMS -MADE a DAMAGE TO RENTED $ 1 OCCUR PREMISES Ea occurrence $ 1 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 1 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE X POLICY PRO LOC PRODUCTS - COMP/OP AGG $ 2 $ 2, B AUTOMOBILE LIABILITY ACPBAL3008854949 X ANY AUTO 4/27/201g 4/27/2020 COMBINED SINGLE LIMIT $(Ea ALL OWNED SCHEDULED accident) AUTOS AUTOS BODILY INJURY (Per person) $ X HIRED AUTOS X AUTOS NON-OWNED BODILY INJURY (Per accident) $ PRO AMAGE C UMBRELLA LIAB X Per cc dent $ OCCUR BE080703402 $ EXCESS LIAB .. 9/12/2019 9/12/2020 ❑Al--,,,,,______ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY $ ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N WC STATU- OTH- OFFICER/MEMBER EXCLUDED? T RY LI T ER (Mandatory in NH) NIA A E.L. EACH ACCIDENT $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPI nvF c DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Driveway, Parking Area or Sidewalk -Paving or Repaving. policy. Coverages are subject to terms conditions deductibles and exclusions as shown on the Contractor License Number: E1982 TE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami FL 33138 AUTHORIZED REPRESENTATIVE c A,, ACORD 25 (2010/05) The ACORD name and logo are registered marks o ACORD ORD CORPORATION. All rights reserved. AC 0 DATE (MMIDD/YYYY) � CERTIFICATE OF LIABILITY INSURANCE 11/25/2019 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 endorsement(s). PRODUCER CONTACT NAME: _ __ _ _ Bouchard Insurance for WBS PHONE _ _ FAX PO Box 6090 LA/C No, Exit: (866) 293-3600 ex . 623 ! (A/C, No): E-MAIL Clearwater, FL 33758-6090 ADDRESS: ____- . 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 ADDL SUBR ___- - _- ' POLICYEFF POLICYEXP -- LTR TYPE OF INSURANCE POLICY NUMBER MM/DDIYYYY MM/DDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $_ .... ......... DAMAGE TO RENTED _ ..... CLAIMS -MADE --_l OCCUR __PREMISES.(Ea occurrence) $ !.', ....... ........ ........_.... ---- MED EXP (Any one person) .._ ......... ......... $ ____.__. ......... ........._.__._.. PERSONAL & ADV INJURY .. ......... ......... $ ______.- ......... ._.................____ GEN'L AGGREGATE LIMIT APPLIES PER: ....... ...... AGGREGATE $ PRO- _GENERAL _ ....._.... ............................................ ___ _..__ __ ..._.... _........._..__. POLICY _ I JECT LOC PRODUCTS COMP/OP AGG _. $ OTHER: $.. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO OWNED ! SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident) $ HIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY _AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION X PER OTH- STATUTE ER AND EMPLOYERS' LIABILITY Y / N E.L. EACH ACCIDENT $ 1,000,000 A ANYPROPRIETOWPARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? ❑ N/A WC 90-00-818-08 12/31/2018 12/31/2019 E.L. DISEASE - EA EMPLOYEE. $ 1,000,000 (Mandatory in NH) If yes, describe under --- ___-- ___-- --- DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 Qualifier: Able Mendez Location Coverage Period: 12/31/2018 12/31/2019 Client# 000674 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Star Paving Corporation E1982 Coverage is provided for 9312 NW 13th St, Bay 7 only those co -employees of, but not subcontractors Doral, FL 33172 to: t.cm I lriym I C rIVLtJCR t.AINL rLLA I IVIV Miami Shores Village Bldg Dept 10050 NE 2nd Ave Miami SHores, FL 33138 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/031 The ACORD name and Joao are registered marks of ACORD