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CC-10-23-2577Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 1700 NE 1O5TH ST 111, Miami Shores, FL 33138 Contacts PermitNO.: CC-10-23-2577 Permit Type: Building (Commercial) Work Classification: Alteration Permit Status: Approved issue Date:11/14/2023 Expiration: 05/14/2024 Parcel Number 1122300500110 PEDRO PINHEIRO SARAIVA Owner RETOS SERVICE PLUS LLC Contractor 1700 NE 105 ST 111 HILDA BALBI 15970 STREET ROAD 84 244, SUNRISE, FL 33326 Business:9545888468 sales@awningsallawnings.com --- Description: PORCELAIN TILES INSTALATION Valuation: $ 5,500.00 Ins action Re nests: Total Sq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $3.60 DBPR Fee $2.48 DCA Fee $2.00 Education Surcharge $1.80 Permit Fee $115.00 Scanning Fee $12.00 Technology Fee $16.50 Total: $203.38 Payments Date Paid Amt Paid Total Fees $203.38 Credit Card 10/20/2023 $50.00 Credit Card 11/14/2023 $153.38 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 construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. Authorized Signature: Owner ! Applicant / Contractor f Agent November 14, 2023 Page 2 of 2 Miami Shores Village 0 T@ T 0 T T Building Department OCT 202023 D 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 13 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 44 FBC 202(� �—"7�1] BUILDING Master Permit NoM 4D Z3 20 t 1 PERMIT APPLICATION sub Permit No. BUILDING 13 ELECTRIC ® ROOFING I3 REVISION [3 EXTENSION RENEWAL PLUMBING ® MECHANICAL CHANGE OF []CANCELLATION 17 SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1700 NE 105th St Apt 111 City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel#:11-2230-050-0110 Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Condo Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Fabiola Novella Saraiva & Pedro Miguel Pinheiro Saraiva Phone#: 9177547715 Address: 1700 NE 105th St Apt 111 City: Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: PM )7SARAiy;0_D0VT1rx)K. GoM CONTRACTOR: Company Name: RETOS SERVICE PLUS LLC Phone#: 9545888468 Address: 15970 W STATE RD 84 #244 SUNRISE, FL 33326 Email: retosseryicepluS@gmaii.com Qualifier Name: HILDA BALBI State Certification or Registration #: CGC1508959 DESIGNER: Architect/Engineer: Value of work for this Permit: S 5500 of Competency _City: State: _Zip: Square/Linear Footage of Work: 1100 SF Type of Work: 0 Addition 0 Alteration ® New ® Repair/Replace [3 Demolition Description of work: porcelain tiles instalation Specify color of color thru tile: Submittal Fee $ gJ-6D Permit Fee $ (v ' CCF $ S 10O CO/CC $ r Scanning Fee $ (9-1tY DCA Fee $ Q 'CO DBPR $ 2 •—C?l Notary $ Technology Fee $ (`V -S(-i Training/Education Fee $ -"Z!)D Double Fee $ Structural Reviews $ P&Z Review $- Bond $ 1— 22��•• TOTAL FEE NOW DUE$ �SJ. BX5 (Revised04/05/2022) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State gr 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. OWNER or The foregoing instrument was acknowledged before me this I C�k day of O C:-,� . 20 2 '3 by O f QdYD 40411CA QI )h it D fal-a who is personally known to �4bolq t�lF..tlgfQY�i��i, me or who has produced i'L NT V LI (-C nse as identification and who did take an oath. NOTARY PUBLIC: Print: MC-"D 1IZ-' ,yAs' ""�� Seal:�i'4 BETSY RESTFEPO Notary Public • State of Florida Commission Y HH 189185 ' p[.t.`% My comm. Expires Oct 20. 2025 APPROVED BY The foregoing instrument was acknowledged before me this % day of n,/J 20 23 by 16 /Acc J6 who is personally known to me or who has produced identification and who did NOTARY PUBLIC: Plans Examiner as ANTONIO MARIA-tOORIGUEZ MY COMMISSION I HH 320911 EXPIRES: Jwuq 13.2027 Zoning (Revised04/05/2022) Structural Review Clerk Return to: FEDERATED TITLE & TRUST 2630 SW 281h Street, Suite 61 Coconut Grove, FL 33133 Instrument Prepared by: Christopher R Kelley, Esq, CHRISTOPHER R KELLEY, P.A. 11098 Biscayne Boulevard, Suite 205 Miami, FL 33161-7486 Folio No. 11-2230-050-0110 OCT 2 0 2023 Warranty Deed CFN: 20230670880 BOOK 33892 PAGE 4147 DATE:09/21/2023 10:24:57 AM DEED DOC 1,560.00 JUAN FERNANDEZ-BARQUIN CLERK OF THE COURT & COMPTROLLER MIAMI-DADE COUNTY. FL THIS INDENTURE, Made this 254h day of k4q0 2023, Between ROBERTA C. SWAN, a single woman, herein called the GRANTOR, and FABIOLA NOVELLA SARAIVA and PEDRO MIGUEL PINHEIRO SARAIVA wife and husband, whose post office address is 1700 NE 10511 Steet, Unit 111 Miami Shores FL 33138, GRANTEES: (Wherever used herein the terms "grantor" and "grantee" include all the parties to this instrument and the heirs, legal representatives and assigns of individuals and the successors and assigns of corporations) WITNESSETH, That said GRANTOR, for and in consideration of the sum of TEN AND 00/100 ($10.00) DOLLARS, and other good and valuable considerations to said GRANTOR in hand paid by said GRANTEES, the receipt whereof is hereby acknowledged, has granted, bargained and sold to the said GRANTEES, and GRANTEES' heirs and assigns forever, the following described land, situate, lying and being in Miami -Dade County, Florida to -wit:. UNIT NO. 111, THE SHORES CONDOMINIUM, A CONDOMINIUM, ALL AS SET FORTH IN THE DECLARATION OF CONDOMINIUM AND THE EXHBITIS ATTACHED THERETO AND FORMING A PART THEREOF, AS RECORDED IN OFFICIAL RECORDS BOOK 4247, PAGE 707, AND ALL AMENDMENTS THERETO, OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA. THE ABOVE DESCRIPTION INCLUDES BUT IS NOT LIMITED TO, ALL APPURTENANCES TO THE CONDOMINIUM UNIT ABOVE DESCRIBED, INCLUDING THE UNDIVIDED INTEREST IN THE COMMON ELEMENTS OF SAID CONDOMINIUM. Commonly known as: 1700 Northeast 1051 Street, Miami Shores, FL 33138 SUBJECT TO: (1) Taxes for 2023 and subsequent years; (2) Conditions, restrictions, easements, and limitation of record, if any, but not meant to reimpose same; (3) Applicable zoning ordinances and governmental regulations; (4) Declaration of Condominium, Articles of Incorporation, Rules and Regulations of THE SHORES CONDOMINIUM, and all Amendments thereto, if any. Pagel of 2 CFN: 20230670880 BOOK 33892 PAGE 4148 Warranty Deed Swan s/t Saravia TOGETHER, with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining. TO HAVE AND TO HOLD, the same in fee simple forever. AND the GRANTOR hereby covenants with said GRANTEES that the GRANTOR is lawfully seized of said land in fee simple; that the GRANTOR has good right and lawful authority to sell and convey said land; that the GRANTOR hereby fully warrants the title to said land and will defend the same against the lawful claims of all persons whomsoever; and that said land is free of all encumbrances, except taxes accruing subsequent to December 31, 2022. IN WITNESS WHEREOF, GRANTOR has hereunto set GRANTOR'S hand and seal the day and year first above written. Signed, sealed and delivered in our presence: 'Witness 6i nature c Vj J� L Print Na OcA Print Addre s 1 Print Address Witn ss nature C Print Name Print Address Print Address STATE OF FLORIDA COUNTY OF MIAMI-DADE } e,,a j -, .. -2ts C.�Yv 931 OBERTA C. SWIM Grantor 741 NE 112t" Street Biscayne Park, FL 33161-7325 I HEREBY CERTIFY that the foregoing instrument was acknowledged, subscribed and sworn to before me by means of [ X ] physical presence or U online notarization, this ��f'lday of A2023 by ROBERTA C. SWAN, who produced a Florida Driver License as identification. CHRISTOPHER P. KELLEY Commission#GG9507q% ARY PUBLIC, St to LORIDA at Large My commission expires: ' oFFLOP` 13ortaedmryB dSol&I ,ss Q0yptla CHRlS7 0 _ ..*_•.,��, PHERP.KELLEy * Commission # GG 950755 ' °� Expires May 21, 2024 Page 2 of 2 OFF10 ` BondedTttntautetNotWlyset ON CFN: 2023067088.0 BOOK 33892 PAGE 4149 THE 4j;p�+t►t1414,ttME. 17ilti R T:1A m�a t T M#AMt.*tCR 6�'P�:+CiRIOA.33438 FWiQN��(M6}88 8T41 > ' . .. FRX ('3�#8gi•E3� .:E�l1dAEtr if�tt�A�9�� . • . CERTIFICATE OF APPROVAL WAIVER OF RIGHT OF FIRST REFUSAL & STATEMENT OF ASSESSMENT In reference to: Unit 111 of THE SHORES CONDOMINIUM, a: -condominium according to the Declaration thereof;. recorded at Official, Records Book 4247 Page 707, et seq. of the Public Records of Miami - Dade County, Florida, and any amendments thereto, together with. its undivided share in the common elements. a/k/a 1700 NE 1051" Street, Unit a.q Miami -Shores, Florida 33138.ParceIIdentification Number: folio.number 11-2230-050-0.1.10 At the request.of the present owner, the undersigned officers. of THE -SHORES CONDOMINIUM, INC. :(the Association),, operating 1-he above -described condominium, 'hereby certify gas. follows: That Pedro Miguel Pinheiro Saralva & Fabiola. -N ..11a Saralva. as; purchasers, .have been duly approved by the. undersigned Condominiunn Association; .pursuant to the: provisions of the above - described Declaration -of -Condominium, and the Association waives. its right of first refuisal, DATED September 12023 THE SHORES CONDOMINIUM, INC. DATED this September 1,. 2023- Elir Director Attes ane Grable, Director - Page 1 of 1 CFN: 20230670880 BOOK 33892 PAGE 4149 OCT 2 0 2023 By if 1700 NORTHEAST 105m STREET • MWAi SHORES, FLORIDA 33138 , PHONE(305)80 67At rAX(301)801.0580 • EfitAll: Ui0ih0r80Land0�ea�rot CERTIFICATE OF APPROVAL WAIVER OF RIGHT OF FIRST REFUSAL & STATEMENT OF ASSESSM) NT In reference to: Unit 111 of THE SHORES CONDOMINIUM, a condominium according to the Declaration thereof, recorded at Official Records Book 4247 Page 707, et seq. of the Public Records of Miami - Dade County, Florida, and any amendments thereto, together with its undivided shore in the common elements. a/k/a 1700 NE 10511 Street, Unit .& I i Miami Shores, Florida 33138 Parcel Identification Number: folio number 11-2230-050-0110 At the request of the present owner, the undersigned officers of THE SHORES CONDOMINIUM, INC. (the Association); operating the above -described condominium, hereby certify as follows: That Pedro Miguel Pinheiro Saralva & Fabiola Novella Saraiva. as purchasers,.have been duly approved by the undersigned Condominium Association, pursuant to the provisions of the above - described Declaration of Condominium, and the Association waives its right of first refusal. DATED September 1, 2023 THE SHORES CONDOMINIUM, INC. DATED this September 1,. 2023 By: Director Attes an,e Grable, Director Page 1 of 1 Pn T 0 T Er OCT 2 0 2023 WORK REQUEST APPLICATION Owner's Name C-DRO 6)q S'vfl % Ftlgu�L N'oVeLLA Unit I hereby request approval from the Board of Directors for the following modification or alteration to my unit that will be performed by a licensed contractor: Electrical work Carpet installation Tile installation Description of the work Plumbing work Window shutters Other work Before you decide to upgrade your apartment (other than paint or carpet) you must obtain permission from the Board of Directors and/or Miami Shores Village. A copy of the plans, specifications, and permits, and a description of the licensed work to be performed must be submitted for consideration and approval by the Miami Shores Village Building Department (305-795-2204). It is the owner's responsibility to ensue that the contractor removes all excess construction material or building debris. It cannot be placed in our dumpsters. I, as the unit owner, acknowledge responsibility for any damage to the building or personal injuries that may occur during the project. The Shores Condominium, Inc., its officers and employees are in no way responsible for damage or theft to my apartment or my belongings. (A $200 deposit is required and will be refunded if no damage to the property is reported.) I fully understand and ague to the statements made above. 0y L --� �s 1010? 1 a70%3 Unit owner's signature U Date Note: Work hours are from 9:00 a.m. to 5:00 p.m. Monday through Saturday. Approved bycL Date ��3 10/19/23, 8:46 AM PHOTO.2023-10-18-17-11-25.j pg FLOORPLAN SKETCH Boa"m Fawn Novella swaiva and Pedro r) File Na.: 0822232 . ............. Rupnfty Addmss.1200 N.E. 105M Fdrefd Gne No.. City Miend s m State FL DP. 33138 LQMW Urfod wnolowtc ------f4 ----- —Patio 27.0' o 12 A' / in B rod 92 as r m�B 100 1fd }�C. Ct / �� N Hallway D Ing itcty�n I / Ro TI Master ' 00m R - AC #2 Bathroom 39.0' �UILDit�:G R'- ' ARW CILLCVIATlONR BLMl/ARY Cca• pvanyplep nMfv NN MZb taNMe�' Nat le4b MEiGtCYMT3PM9 aNUNDOWd namro !we a e. xafplt v - WNfii 4er 6l<: Rrt:. nn, 1(1 )nfio !.nLO u160 r3, r.mir t49 X.r� f01aC. c �...aun..usl4r-aatraibus. LLI OCT 2 0 2023 Td\ CITY COPY https:/lmail.google.comlmaillu/llqinbox/FMfcgzGwHLgVnvBpjSwmbFbRcwfFRrXq?projector-1RmessagePartld=0.4 1/1 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. 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: 7�z_f 0 S � �� n n K BUSINESS ADDRESS: I S6% LU j� CITY STATE I%L zip_3332,6 BUSINESS PHONE:i 5`�) �W�� f FAX NUMBER () CELL PHONE � O � ��SG e QUALIFIER'S NAME: � QUALIFIER'S LIC NUMBER: C&C �� S —1 no 0 Ron Desantis, Governor Melanie S. Griffin, Secretary STATE OF FLORIDA I I0 b: pr -:i DEPARTMENT nC BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE GENERAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES BALBI, HILDA MARIA RETOS SERVICE PLUS LLC 15970 W ST RD 84 STE 244 SUNRISE FL 33326 LICENSE NUMBER: CGC1508959 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. BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-357-4829 VALID OCTOBER 1, 2023 THROUGH SEPTEMBER 30, 2024 D: Business Name: RETOS SERVICE PLUS LLC Owner Name: HILDA MARIA BALBI Business Location: 15970 W STATE RD 84 #244 SUNRISE Business Phone: 954-588-8468 Receipt #: 180-245458 Business Type: GENERAL CONTRACTOR Business Opened:12 / 01 / 2 011 State/County/Cert/Reg:CGC 15 0 8 9 5 9 Exemption Code: Rooms Seats Employees Machines Professionals 3 For Vending Business Only Ni mhor of Machines' Vendina Tvoe: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost I Total Paid 27.00 0.00 0.00 0.00 0.00 0.001 27.00 Receipt Fee 27.00 Packing/Processing/Canning Employees 0.00 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: RETOS SERVICE PLUS LLC 15970 W STATE RD 84 #244 SUNRISE, FL 33326 2023 - 2024 Receipt #WWW-22-00259381 Paid 07/24/2023 27.00 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-357-4829 VALID OCTOBER 1, 2023 THROUGH SEPTEMBER 30, 2024 DBA:RETOS SERVICE PLUS LLC Business Name: Owner Name: HILDA MARIA BALBI Business Location: 15970 W STATE RD 84 #244 SUNRISE Business Phone: 954-588-8468 Receipt#: 180-245458 Business Type: GENERAL CONTRACTOR Business Opened: 12 / 01 / 2 011 State/County/Cert/Reg: CGC 15 0 8 9 5 9 Exemption Code: Rooms Seats Employees Machines Professionals 3 Signature For Vending Business Only u..�a._.. _t u__�e.._... \/nnrlinn Tenn• Tax Amount Transfer Fee^ NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.001 0.001 0.00 0.00 0.00 27.00 Receipt ffwww-zA-uuZsysei Paid 07/24/2023 27.00 A� V CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 10/19/2023 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 endorsement(s). PRODUCER CONTACT NAME: PHONE (855) 222-5919 FAX (A/C,No): Next First Insurance Agency, Inc. PO Box 60787 Palo Alto, CA 94306 E-MAIL support@nextinsurance.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: State National Insurance Company, Inc. 12831 INSURED INSURER B : Retos Service plus LLC 15970 W State Road 84 # 244 INSURER C INSURER D : Sunrise, FL 33326 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 631037183 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. LT R LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMIDDIIYYW MMfDCD EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000.00 CLAIMS -MADE � OCCUR GE TO RENTED PREMISES Ea occurrence S 100,000.00 MED EXP (Any one person) S 15,000.00 PERSONAL & ADV INJURY S 1,000,000.00 A X NXTK0L1 L7Z-02-GL 06/23/2023 06/23/2024 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S2,000,000.00 PRO - %( POLICY1:1 JEcT PRO- ❑ LOC PRODUCTS - COMP/OP AGG S2,000,000.00 S OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S BODILY INJURY (Per person) S ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) S PROPERTY DAMAGE Per accident S S UMBRELLA LIAB OCCUR EACH OCCURRENCE S AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION S $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDED? (Mandatory In NH) NIA NXT03C1 XDU-02-WC 01 /29/2023 01 /29/2024 OTH- X STAT UTE ER E.L. EACH ACCIDENT S 1,000,000.00 E.L. DISEASE - EA EMPLOYEE $1,000,000.00 E.L. DISEASE - POLICY LIMIT S 1,000,000.00 If es, describe under DESCRIPTION OF OPERATIONS below Each Occurrence: $25,000.00 A Contractors Errors and Omissions X NXTKOL1 L7Z-02-GL 06/23/2023 06/23/2024 Aggregate: $50,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Certificate Holder is Miami Shores Village Building Department. This Certificate Holder is an Additional Insured on the General Liability policy per the Additional Insured Automatic Status Endorsement. All Certificate Holder privileges apply only if required by written agreement between the Certificate Holder and the insured, and are subject to policy terms and conditions. CGC 1508959 4iami Shores Village Building Department LIVE CERTIFICATE 0050 NE 2nd Ave liami Shores, FL 33138 0@agoml 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 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD