Loading...
RC-11-23-2712Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Permit NO.: RC-1 1 -23-2712 Permit Type: Building (Residential) Work Classification: Alteration Permit Status: Approved Issue Date: 11/17/2023 1 Expiration:05/17/2024 Parcel Number 987 NE 96TH ST, Miami Shores, FL 33138 1232060143240 Contacts PATRICIA PARRA Owner CSM CONTRACTORS Contractor PABLO CASTRO Home: 3053235330 pat@csmcontrectors.com 987 NE 96 ST, Miami Shores, FL 33138 Business:3053235330 pablo@csmcontractors.com Description: REMOVE EXISTING PORCH TERRACOTA TILE, Valuation: $ 2,450.00 INSTALL MARBLE 36"X 36"i - Total Sq Feet: 144.00 Fees Amount Application Fee - Other $50.00 CCF $1.80 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.90 Permit Fee $50.00 Scanning Fee $9.00 Technology Fee $10.00 Total: $125.70 inspection Requests: p G �- Payments Date Paid Amt Paid Total Fees $125.70 Credit Card 11/17/2023 $75.70 Credit Card 11/01/2023 $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 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 n uction and zoning. Futhermore, I authorize the above named contractor to do the work stated. � + ct, Q�A�Z \,�, IZ3 Authorized ignature: Owner / Applicant / Contractor / Agent Date November 17, 2023 Page 2 of 2 Miami Shores Village NTERED 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 Nov 01 2023 'y-A FBC 2Q::20 BUILDING Master Permit No. IBC' II a-3-9IId- PERMIT APPLICATION Sub Permit No. BUILDING I3 ELECTRIC 0 ROOFING ® REVISION © EXTENSION RENEWAL PLUMBING O MECHANICAL ❑ CHANGE OF I3 CANCELLATION 0 SHOP CONTRACTOR h7:►_ltA11 R01 JOB ADDRESS: q8-+ ME 16� sTzeeT City: Miami Shores County: Miami Dade Zip: 33a8 Folio/Parcel#: 11-320ro -014- 3240 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 1 %\1f'0A PA22A Phone#: 305 - 3Z3 -5 3 3 CO Address: qs-+ KE qbv STP&T City: MiAhi MORES State: f L zip: 33188 Tenant/Lessee Name: Phone#: Email: `410 "McOntr-ay-s-cop" CONTRACTOR: Company Name: 6511 GtOKTPA cryas Phone#: 305-421-5330 Address: ,'ol1 HE 96'0 S1RfkX Email: �wlo Q (_6M Or1frdGfiOY'S • C041 Qualifier Name: '?ARLO 6pSl2o Phone#: 305 323 5330 State Certification or Registration #: U1 c W 151 }54j Certificate of Competency #: DESIGNER: Architect/Engineer: Address: City: State: Zip: Value of Work for this Permit: $ 2/41$lO ,0 0 Square/Linear Footage of Work: SQUARE FPF'l Type of Work: 0 Addition IT Alteration ® New ® Repair/Replace E3Demolition Description of Work: 'fLFrj0VE I i17'Kh %aC}4 r8P4zA(.0r04 I lLg - ItlSNj_ MAMUE, 36" x 361' Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ DCA Fee $ Technology Fee $ Training/Education Fee $ CCF CO/CC $ DBPR $ Notary $ Double Fee $ Structural Reviews (Revised04/05/2022) P&Z Review $ Bond $ TOTAL FEE NOW DUE $ 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 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 or AGENT The foregoing instrument was acknowledged before me this 19-1day of Nova, ,.bLaL 20 a of by poWNCGa Q?AYZ , who is personally known to me or o has produc R-L &YRO c Z t C as identification and who did take an oath. NOTARY PUBLIC: Signature yy CONTRACTOR The foregoing instrument was acknowledged before me this day of NoQ 4wbLa 20 J, by ?AFsLO CA97P-0 who is personally known to me r who has prod d �'L jf,jV1711. I; c as identification and who did take an oath. NOTARY PUBLIC: Sign: ySign: Print:'; Yl Print: Seal: Seal: KRISTINE KEPPLE YAO ,:iii KRISTINE KEPPLE YAO Notary Public -State of Florida Notary Public - State of Florida n Commission if HH 452227' �, Commission p HH 452227 ]]{{ 4*WysGam"ffm**91gt d#3Df# *******»»*»»»»»»**»»»»**ftr +rt+kr?i*omlellmm txm""k 9c440-bust »»»****»*»**** Bonded through National Not, Ass BLn�:%C through National Notary Assn. A 1Z •_ APPROVED BY Plans Examiner Zoning (Revised04/05/2022) Structural Review Clerk OFFICE OF THE PROPERTY APPRAISER Summary Report Folio 11-3206-014-3240 Property 987 NE 96 ST Address MIAMI SHORES, FL 33138-2523 PABLO SEBASTIAN CASTRO FONSECA, Owner PATRICIA ALEJANDRA PARRA Mailing 987 NE 96 ST Address MIAMI SHORES, FL 33138 - Primary Zone 1400 SGL FAMILY - 3001-3250 SO _ Primary Land 0101 RESIDENTIAL- SINGLE FAMILY: 1 UNIT Use Beds / Baths 4 / 2 / 0 /Half Floors 1 Living Units 1 Actual Area Living Area Adjusted Area 2,805 Sq.Ft t� Lot Size 11,500 Sq.Ft Year Built 1938. ,.•� ti,r i,:.. I, Year 2023 2022 2021 Land Value $793.063 $597.862 $367,770. Building Value $339,966 $339.966 $244,035. Extra Feature Value $1,210 $1,210 $1,213. Market Value $1,134,239 $939,038 $613,018 Assessed Value $597,577 $580,172 $563,274. Benefit Type 2023 2D22 2021 Save Our Homes Assessment $536,662 $358.866 $49,744 Cap Reduction Homestead Exemption $25,000 $25.000 $25,000 Second Exemption $25,000 $25,000 $25.000 Homestead Widow Exemption $500 $500 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). 60 MIAMI SHORES SEC 3 PB 10-37 LOTS 13 & 14 BLK 77 LOT SIZE 100.000 X 115 Generated On: 11/01/2023 Year 2023 2022 2021 COUNTY Exemption Value $50,000 $50,500 S50,500 Taxable Value $547,577 $529,672 $512,774 SCHOOLBOARD Exemption Value $25,000 $25,500 $25,500 Taxable Value $572,577 $554,672 $537,774 :CITY Exemption Value $50,000 $50,500 S50,500 Taxable Value $547,577 $529,672 $512,774 REGIONAL Exemption Value $50,000 $50,500 $50,500 Taxable Value $547.577 $529,672 $512.774 t•.. Previous t Price OR Book- Qualification Description Sale Page 09/06/2023 S1,740,000 33882-2521 Qual by exam of deed 07/07/2023 $750,5D0 33797-3501 Qual by exam of deed 02/21/2017 $675,000 30429-0879 Qua] by exam of deed 04/11/2013 $100 28626-0257 Corrective, lax or QCD; min consideration The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at hftp:/Avww.miamidade.gov/info/disclaimer.asp CITY Location of front porch where marble installation will take place LLEY e v 10 00 (R)(M) ,ff N W } ,IW-A fPSI /L)IV SECT i.II ?nl p:,;;n 11-] ' AI IR U.R 1 W A I tf I'm 39.95 Rf1N fttF IAW. PLIC � ., n 0MOliGRGC PAIRASuA.1, 25.A :Ec"fICVAI PYUCF<'NF555hGNR5kf CMPA.:v LEGALDE ,or,13AND -Iv h [-ljrir.%e@reC _lv titcll(`N3.N ACCORD IG C,1 .PLAT ATFA1F,31 Pb RCCORD'0111 RAE 9UU( 10. AT PAGP 31. 1165' o PRUI HII1 All111USA. 5,01 t IlOO)ZONE IM 06Nll1UY 169�F�EGNAT!Q IMF s.15' 'IL L. IVI III O. . G.-11UAIVO III O 'do A5 O d I'IOOU tONP. x h 1= TIES. IQEEjOMP , :0441UHIIY NO I20652 Wn.v`1 JOti dnfP Or R✓M TiEVI V.^.O.Y LOT I) U'Lj Ift II1?O-Vry OOVP NOT ROCK ZI o r: -I tl A CAE fLCCD 14AFD A$A , RE 16,90* J so -. 16.,5f`-I S.100.02(8Md) FlP l/o CBB £o. ✓ii F5RQVED _a-7,4 PWr Julio S Dgital3­20 d byJult ter. date NE 96th STPita._ . yyyy{{}},,jb�(]y i} w 55 ASTOT T PRREMENI I ! 5J990.VV.1�-041QOI BJ' T07R1 H/W N-I ..I:O :'.I!'i. i11KIN1E0 N1IX ENOOSSFJ SIRAY R'S 5EAl .trlary�cY AA S"VS /R0rY1—& NOV 0 l 'tOY3 N v., RVY.Y� IM R VICINITY MAP E£®OQGIIKIfA! S w N �1eJz� ll L R R cil 987 NE 96" ST SCOPE OF WORK IN DETAIL � 0' Ln c6 4.2 5' MftTftRED NOV 01 2023 BY.__ 7.40' Remove existing front porch tile floor. Install new white marble floor 36" x 36" including the two steps between the two handrails and the one little step before front door. Total square footage is 144. FLOOR PLAN CLIENT: PATRICIA PARRA SCALE: 1" = 20' JOB SITE: 987 NE 96`h ST, MIAMI SHORES, FL 33138 PROJECT #: 23-987 REVISION: N/A Construction Solutions Management Corp. PAGE #: 2 OF 2 DBA CSM Contractors CGC 1517544 " 987 NE 96" ST, Miami Shores, FL 33138 Ron DeSantis, Governor Melanie S. Griffin, Secretary Florida STATE OF FLORIDA dr)pr DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CSM CONTRACTORS 900 BISCAYNE BLVD SUITE 1705' MIAMI FL 33132 LICENSE NUMBER: CGC1517544 EXPIRATION DATE: AUGUST 31, 2024 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. 005326 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT BILL -DO NOT PAY 6530340 BUSINESS NAMEADCATION RECEIPT NO. CONSTRUCTION SOLUTIONS MANAGEMENT CIMEWAL 900 BISCAYNE BLVD APT 1705 6800818 MIAMI FL 33132-1563 EXPIRES SEPTEMBER 30, 2024 Must be displayed at place of business Pursuant to County Code D 0 Chapter 6A- An. 9&10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECBNEO CONSTRUCTION SOLUTIONS MCT CORP C/O PAR 196 GENERAL BUILDING CONTRACTOR BYTUMLLECTOR 0 CASTRO PRES CGC1517544 $45,00 07/18/2023 Worker(5) 1 INT-23-407319 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 qualification% to do business. Holdermust comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed an all commercial vehicles - Miami -Dade Code Sac Be-276. For more information, visit www m"it Wfideaovflaxcallector ACORN® A...,� CERTIFICATE OF LIABILITY INSURANCE DATE (MNUDDIYYYY) 09/27/2023 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 Excellence Insurance, a Div of Afore Insurance Services, LLC 5201 Blue Lagoon Drive # 982 Miami FL 33126 NAME: Adriana L Clavijo PH°NE . (305) 226-3900 FA/C No): (305) 226-3997 ADDRESS: clavijoa@afore.insure INSURERS AFFORDING COVERAGE NAIC # INSURER A: BERKLEY ASSURANCE COMPANY 39462 INSURED CONSTRUCTION SOLUTIONS MANAGEMENT CORP. DBA CSM CONTRACTORS. 987 NE 96th ST Miami Shores FL 33138 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : rnV=DAM=c rr-RTIFIr_OTF NIIMRFR- 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. I TR TYPE OF INSURANCE INSD SUER WVD POLICY NUMBER MMrop EFF MMIDD EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX_I OCCUR Blanket Additional Insured VUMA0271381 04/09/2023 04/09/2024 EACH OCCURRENCE $ 1,000,000 DAMAGE TO NTED PREMISES Ea occurrence $ 100,000 X MED EXP (Any oneperson) $ 5,000 X Blanket Waiver of Subrogation PERSONAL & ADV INJURY $ 1,000.000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY PET LOC OTHER: Primary and Non Contribu GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 X $ 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 LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA STAT TE I I 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 H more space is required) License n.° CGC 1517544 License n.° CFC 1429775 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Department AUTHORIZED REPRESENTATIVE 10050 NE 2nd Ave Miami Shores, FL 33138 ``• ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 9/27/2023 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(les) 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 SUNZ Insurance Solutions, LLC. ID: (Cornerstone) c/o Cornerstone Capital Group, Inc. 1 S. Main Street CONTACT Jessi Crumb PHONE FAX E 1:s7o-376-2871 A/c No E-MAIL ADDRESS: coi.requestsC@cornerstonepeo.com INSURERS AFFORDING COVERAGE NAIC# Medford, NJ 08055 INSURER A: SUNZ Insurance Company 34762 INSURED Cornerstone Capital Group, Inc. 1 S. Main Street INSURER B : INSURER C : Medford NJ 08055 INSURER D : INSURER E : INSURER F : .- ....... Af•I�'rlel ►ATC IJIIRAI21C15. -9nrnr-7ae IRPVICInN NIIMRF:R- V V t �■nM4..V � 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. [NSR I LTR TYPE OF INSURANCE ADD SUER POLICY NUMBER MM/RDYEFF /YYYY MM/D/ EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ POLICY PRO LOC JECT OTHER: AUTOMOBILELIABILI Y COMBINED SINGLE LIMIT Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I RETENTION $ WORKERS COMPENSATION �/ PER TH- STATUTE ER $ A WCi044-00001-023 1 /1 /2023 1 /1 /2024 E.L. EACH ACCIDENT $1 0OO 00O AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYEE $1,000,000 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) N / A E.L. DISEASE - POLICY LIMIT $1 000 000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS ! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space Is required) Coverage provided for all leased employees but not subcontractors of: Construction Solutions Management Corp Client Effective: 3/28/2018 license # CGC 1517544 license # CFC 1429775 CATS 1390 Miami Shores Village Building Department 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 i RICK Leonard lGJ 7JiIfZ;�LU ID AVVI'[N a.Vrzrvnr�l IVIr. ion Ilyllt* luaalvau. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 76525715 1 Cornerstone Capital Group PEO 044 MASTER CERT 1 Jessi Crumb 1 9/27/2023 3:27:39 PM (EST) I Page 1 of 1