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MC-01-22-249Miami Shores Village BUILDING PERMIT APPLICATION ❑BUILDING ❑PLUMBING ❑ ELECTRIC r" MECHANICAL Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 7S6-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 t; 2021 Y_ FBC 20?, Master Permit No. mC-own- Sub Permit No. ZL41 ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: — City: Miami Shores County: Miami Dade Zio�mz4 Folio/Parcel#: 13 ZAD (67 Q oysa Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): '-��/1//I/ T�.4 /� 'Wl/f� Phone#� City: e!A .L�/ State: Tenant/Lessee Name: Email: Gv CONTRACTOR: Company Name: e 7 V20M j60/L .44i Phone#: Address:�%-e c7 c7/ /V Vy / iS Y �A/!/ City: �/, •:i cT .loUlif�j?%(% State: zip;3d3b?�� Qualifier Name: of S?eAkW;> QQI/L1i Phone#: State Certification or Registration #: �Ae �/JZQ2;�Z Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: Square/Linear Footage of Work: Zip: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition /io Description of Work: i O// Specify color of o thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF $ DBPR $ CO/CC $ Notary $ 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 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 excgeding $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. SignatureSl—��' — Signature WNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 5� �day of 20 7iZ , by day of 20 by Jf'ct�b N1 who is personally known to AiJimi 60ekotdd who is personally known to me or who has produced 7FL_� ,1, � I.LC der' me or who hasp e Ll as identification and who did take an oath. NOTJRYUSign:Print Seal: •TFF ######## APPROVED BY (Revised02/24/2014) _. SINDIA ALVAREZ MY CDMMISSIGN # GG 238273 EXPIRES: September 3,2022 identification and who did take an oath. Print: . v \l Plans Examiner Structural Review DANEILVG. FRIAS # Commission#GG 350612 Expires July 1, 2023 Banded thry BudBar Nolery S-'k Zoning Clerk J1�atnq ZonTn gtii1c g�1 StC pe i PREPARED BC •�w-rsceMntl we. Ofnce:d6GI35:91i I M:856>JC 39az Air A SS: 499 NE 102NO STREET, MIAMI SHORES, FLORIDA 33138 SURVEY NUMBER: FL20D/,0274 LD IbRK DAM REVISIONDATE(5):IPNo,vv:mxd BUUNDA74 - RYSU 30.0 n• . a z e 7 t! it rr c o•rer I cw.r. zM ® — _- b I gu�(d'm9 peP y y 0— Date ^e R' CITet pate c_.1 (atl 5Ji I .,: L I �. a�� `o`Wa ong 91- 11 DQeat (1'W�tn I! to comp and leg t� Fa Is.a•f' mM9: anuv�untV ^�^ i• Z laa d. i lI q ,• U ' 1t'� _. P) 39.491NIJ i ' — 1 _ 9057DW. p NriaSs u 53G" 5 44-541I1eW, 55.50u 544.523/e W, 35.5/YMI ED /� rss sTes n 19.6. 1�.3• I .:. . 1 . .. In 9 I I I � 1 nb ID 25.lXi(D) vI w — I I•RG ._ '. 5 74.991 a`520ODW 5 B9.52bT W 74.99' 152.281 5 OOP W 152 2&(((M) 'T. N.R. (PER PLAT) 1 hereby cc c t oundary Survey of the hereon as 0 as been made uncle, my direct Ant the t of my knowledge , and belle i�YisJ-trtfGc,Irz"' , accurate representation of a su )Pict"meets Standards of Practice 30 a Id >o rj-��"w:`, set forth theIT"do rd of Professional jr7 I t� Surveyors pars ' opter 5/-17 of the Roddo Adminl e. GRAPHIC SCALE (In Feet) rr \j Yeyr t�i= 1 y' RONALD W. WALLING 1 inch = 90' ft. SLOG ROrid. Pmlevei 1 Sur o1 Ocd M,,, tiesue xo. "73 uu•IrN: s,•.+ywn•wmmmmminuna�awmenronwLtrauw'•n.lueevd<u.etsmaa.,wwd=nu.mrmw. o..n.. M W YpNxu:Npt!(avIryM104weN1YI1gNLLb Bee1u mdpyge pM MrtmeCndM1[d. FLOOD INFORMATION: BY PERFORMING A SEARCH WITH THE LOCAL GOVERNING MUNICIPALITY OR W W W FEMA.GOV THE PROPERTY APPEARS TO BE` LOCATEp IN 20NE X THIS PROPERLY WAS FOUND IN THE VILLAGE '. _........ ....... ..... lGeornefte Amarn Mustelier _ , . OF MIAMI SHORES. COMMUNITY NUMBER 12065Z DATED W/) I/W. CLIENT NUMBER SUN-3351 DATE: OdAHQO ',� 786.40 -. 8.8770 georgettRSsuncitylive cam '-i\ www.Zncjtyt!Ue.com . S_ - ! UN D•Tvnn.E - ERLE SUYGNNVINCENTDAIDONEANDADALBERLOGIRRERAMARTELL SELLER: HE CORONA AND JEAN CORONA . CERTIFIEDTY}GIFNNMNCEPFCW C EANDADAIHERTOGBRERA MARTEIL -EXACTAA ■ 5UNCoYi .INC O1DREPUBuCunTONALTTUEp COMPA fNNCE yQAU0ERHCMELCANSINC R55UCGES9JRSAND/ ORARKHS; ASTNEW eRERF515MATAIHea1 T. ., T1lizidpage1012 Zlsmtvdlld WlthDutdipaged. PMmerzmil p,�nmlli 156U Ntst3N5Yne1, AR130lCkuMmd OH 11113 --tL 2 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. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. I 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: Cajun BearAc Repair LLC BUSINESS ADDRESS: 1531 NW 7th Ave CITY Fort Lauderdale BUSINESS PHONE: 954 ) CELL PHONE C-) 850-1204 FAX NUMBER (� STATE FL ZIP 33311 QUALIFIER'S NAME: Richard comment (31101 IFIFR'C 11(. NI IMRFR- CAC1820741 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner— Workers' Compensation Insurance Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of 20_ who is personally known to me or has produced as identification. SEAL: �i Ron DeSantis, Governor STATE OF FLORIDA Julie I. Brown, Secretary d bIa pr DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE CLASS A AIR CONDITIONING CONTRACTOR HEREIN IS CERTIFIED UNDER THE CAJUN BEAR AC REPAIR LLC 1531 NW 7TH AVE FORT LAUDERDALE FL 33311 LICENSE NUMBER: CAC1820741 EXPIRATION DATE: AUGUST 31, 2022 Always verify licenses online at MyFioridaLicense.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. BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. AndVALID OCTOBERI , 2021 Lauderdale, THROUGH SEPTEMBER 30, 2022000 DBA: Receipt #:HE TING/AIRCONDITION CONTRACTR Business Name: CAJUN BEAR AC REPAIR LLC Business Type' (CERTIFIED AIR CONDITIONING CONTRACTOR) Owner Name: RICHARD PAUL COMMENT Business Opened:12/31/2020 Business Location: 1531 NW 7TH AVE State/Coup ton COde;CAC1820741 FT LAUDERDALE P Business Phone: 954-850-1204 Rooms Seats Employees Machines Professionals 1 For V¢�Ming Business Only T ax Amount 27.00 Number of Machines: Transfer Fee 0.00 NSF Fee 0.00 Penalty 0.00 "" "'" Prior Years Collectlon Cost Total Paid 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: Receipt k032-20-00003100 CAJUN BEAR AC REPAIR LLC paid 09/29/2021 27.00 1531 NW 7TH AVE FORT LAUDERDALE, FL 33311-5557 2021 - 2022 _ .. �...��.� � v e�r•l�rr�1T .0"-. - -- - - -- - -- - - — - - --- ----- - - -- - - - - - -- - - — 1 UL/Uq/LU'L'L 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 First Choice Insurance Solutions 5812 Stirling Road Hollywood, FL 33021 CONTACT KimberlyJagial PHONE , 954-923-0906 FAAxX No ; 954-775-2882 A `�: Kimftisinc.com INSURERS AFFORDING COVERAGE NAIC# INSURER A: Bass Underwriters INSURED CAJUN BEAR A/C REPAIR LLC 1531 NW 7th Ave Ft Lauderdale, FL 33311 INSURER B INSURER C : INSURER D : INSURER E : INSURER F : r-nVFRArZFS 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. ILTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMMD EFF MMM I °XP LIMITS A x COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR Y 01-C-PK-P20043504-0 01/14/2022 01/14/2023 EACH OCCURRENCE $ 1,000,000 GE TO RENTED PREMISES SES Ea occurrence $ 100,000 MED EXP (Arty one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY PRO � LOC JECT OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident) $ $ UMBRELLA UAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETORfPARTNER/EXECUTIVE r-� OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If es, describe under DESCRIPTION OF OPERATIONS below N / A I PER OTH- STATUTE ER E.L.EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached N more space Is required) Certificate holder is listed as additional insured. f%=DTlcrr-eTt` 41['f1 nFR CANCELLATION MIAMI SHORES VILLAGE BLDG DEPT. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2ND AVE. ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES, FL 33138 AUTHORIZED REPRESENTATIVE KimberlyJagial 0 7988-2Q75 ACORD CORPORATION. All rinhtss rp-gprvpd. 1 02N8y2022 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 be endorsed. If SUBROGATION IS WANED, 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 AP INTEGO INSURANCE GROUP, LLC NAMEACT AP Intego Insurance Group, LLC PHONE Ext). 888-289-2939 nlc No: ADDR6E carts@apintego.com 375 Woodcliff Dr. INSURERIS) AFFORDING COVERAGE NAIC# Suite 103 INSURER A: Technology Insurance Company 42376 Fairport NY 14450 INSURED INSURERS: Cajun Bear AC Repair LLC DBA Cajun Bear AC Repair INSURERC: INSURER D 1531 N W 7th Ave INSURER E: INSURER F: Fort Lauderdale FL 33311 QnVFOA11FR rFRT1FICATF NI IMRFR- REVISION NUMBER] THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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 MATH 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. INTSRR TYPEOFINSURANCE ANNDD B POLICY NUMBER POLICY EFF POLICY EXP 11MIT5 GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY RENT D PREMISES Ea occurrence $ MED EXP (Any one person) $ CLAIMS -MADE ❑ OCCUR I I PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $ $ POLICY PRO- LOC JECT AUTOMOBILE LIABILITY r f COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTYDAMAGE Per aC6dan1 $ UMBRELLA LIAB OCCUR �F EACH OCCURRENCE $ AGGREGATE $ EXCESS UAB CLAIMS -MADE DED I I RETENTION $ $ WORRFRSCOMPENSATION WCSTATU- OTH- TYLA AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE Y OFFICUMEMBER EXCLUDED? (Mandatory In NH) "IA r I TWC4041441 11/06/202 02/08/2022 LEACH ACCIDENT $100000 L. DISEASE - EA EMPLOYEE $100.000 E.L. DISEASE - POLICY LIMIT $500,000 If yes, desalbe under DESCRIPTION OF OPERATIONS �1— DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD fan, Additional RemarNa Schedule, If more space Is required) OF GJ N� �2 02 G-�-(v (R>A Q (� )e s U-C-z--N s- Miami Shores Village Hall Building & Zoning 10050 Northeast 2nd Avenue 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 01nRR-9n1n ArnQn rnROnRATInN Av O CERTIFICATE OF LIABILITY INSURANCE E10412022 03/04/207.7 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 policylies) must be endorsed. If SUBROGATION IS WANED, 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) LNOAMEAcr AP Intego insurance Group. LLC PRODUCER _ AP INTEGO INSURANCE GROUP. LLC PHONE BW289-2939 FA% — 375 Woodcliff Dr. noouL cerls a inte o.wm Suite 103 _ INSURE S) AFFORDM COVERAGE NAICS Fairport NY 14450 INSURER A: Technology Insurance Compa_n 42375 INSURED -- _ INSURERe:- — Cajun Bear AC Repair LLC DRA Cajun Bear AC Repair INSURER c: _ 1531 NW 7th Ave INSURER O: Fort Lauderdale FL 33311 INSURITT F I_ I u,luoco. REVISION NUMBER: COVERAGES ..�,. .. ......�.........�... THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS IS TO CERTIFY ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED. NOTWITHSTANDING ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. CERTIFICATE MAY BE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHONN MAY HAVE BEEN REDUCED BY PAID CLAIMS _ INSN �L POIIDY FFi POLICY EO MWrs LIP TYPE OF INSURANCE POLICYNUMBER GENERAL u1INUITY EACH OCCURRENCE S ET61a amunv PREMISE�xwrwv,_ S _ _ � COMME0.L4LL GENERAL LIABILITY r SIEDONVII.VmeINJURl CtAMSJMDE OCCUR � I s PERSONAL6ADVBUUAY $ GENERALAOGREGATE S___ $ I — GEMAGGREGATELNnAPPLIESPER PRODUCTS-COMPIOPAGG CONIMHED 501 LA11r S POLICY PRO' Loc AUTOMOmLE LIABILITY r 1 L— s 1 BODILY ININ JURY IPa perwnl $ ANY AUTO Nr BODILY INRY IPr ) S AIL OV.NED SCHFDLILED AUTOS AUTOS PROPERTY ONAM1GE $ HIRED AiJT05 ANowUTOS lP?r an denim S UMBRELLA Like OCCUR EACH OCCURRENCE $ AGGREGATE - _. _ i l EXCESS UAB CLAM5�11tDE DEC NETENTIONS X NC BTAIU- 0E 1ORHERSCOMPENSA11ON EL EACH ACCIDENT _ _. SIOOODO ___ AND EMPLOYERS ULABILRY YIN AN, PRDPR;ETORRARTNEREXECUTIVE TWC404140I 11,06/207, 11/06,2022 OFFICEMEVBEP"CLUDED7 ❑ NIA EL DISEASE - EA EMPLOYEE S 100JXX) IManaabr In NH) - E L DISEASE POIICY LAIR S $00,000 , yes, OeavlEe,vtler r r DESCRIPTION OF OPERAYIOIJS I IDCATNNIS I VEHICLES (A call, ACDRD 101, MoNwul Remadis SCMdR . N ni NMce N nquYW1 Miami Shores Village hall RUNdu,q 8 Zoning 10050 Northeir ri 2nd Avenue Miami Shares 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. AUTHORISED PEPRESENTATNE 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Cieal All FrA