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PW-10-23-2610Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Issue Date: 10/30/2023 Parcel Number 190 NW 93RD ST, Miami Shores, FL 33150 1131010330970 contacts Permit NO.: PW-10-23-2610 Permit Type: Public Works Work Classification: Public Works Permit Status: Approved Expiration: 04/30/2024 1 COBB INVESTMENTS LLC Owner Jacobo Aguia 650 NE 32 ST 3103, Miami, FL 33137 Mobile: 3057812146 JACOBO.AGUTA@GMAIL.COM AGO NORTH MERICA LLC Contractor LUIS SANCHEZ ABARCA GORNALS Mobile: 7865463080 LSANCHEZ@AGONORTHAMERICA.COM Description: REPLACE SIDEWALKS Fees Amount Education Surcharge $0.90 Public Works Permit Fee $100.00 scanning Fee (Manual) $6.00 Technology Fee $10.00 Total: $126.90 Valuation: $ 3,000.00 Ins ection Requests: 305-762-4949 Total Sq Feet: 250.00 Payments Date Paid Amt Paid Total Fees $116.90 Credit Card 10/30/2023 $116.90 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 all the foregoing information is accurate and that all work will be done in compliance with all applicable laws hennore. I authorize the above named contractor to do the work stated. I Applicant / Contractor / Agent Date 30, 2023 Page 2 of 2 RECEIVED OCT 2 4 _ 2023 . err Miami Shores Village Public Works Department (30S)795-2210 Public works forms are available from the building department,10050 NE 2ndAve., Miami Shores, FL33138 PUBLIC WORKS PERMIT APPLICATION Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property Permit#:r-C k2z\ 3 ZOCU Name of Applicant (if utility see below): � C-CAO� Owner off the following described property: Legal Description: Lot Block Subdivision Folio#;�1 3\CD\ c-:->33 0 Address: Ac1h \JW UTILITY NAME: I"- L-- Qualifier/Authorized Agent: aC City: A -A UY-� '-3V-*V(Z• Telephone: -4r-�-7i� 2\ State Certification or Registration #: ry MM State: Ra Certificate of Competency # CONTRACTOR NAME: N-6C) �f3C7J��c,JN, ,iouy\c Qualifier/AuthorizedAgent: i—J GANG+1r� c-A Address. \y `� 1 Sts� 7 O S City: A State: F ZIP:7� 1 U S Telephone: 40 4Ema11: 1.Son-1E © aaO 'OV41AQMV%0rIcC� , COY'11 State Certification or Registration #: Certificate o Competency #: Requests permiss.on to attach sseep�rate pagre if necessary) in the adjoining right of Type of Work: ❑ Paving ❑ Utility Sidewalk ❑ Electric ❑ Irrigation ❑ Landscape ❑ Antenna ❑ Other: DESIGNER: Architect/Engineer: Address: City: State: Telephone: Email: Registration #: ZIP: Value of Work for this Permit: $ •� ��� Square/Lineal Footage of Work: Z SO .,.*****Fees***** Permit Fee $ 100.00 Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $ Bond $ (if required) . Total Fee New Due $ 1 1 V • i b .. . 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 afterthe public works permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection will be charged. Signature X The fore o' me thi / / cantor uthor Agent strum�nt`w.a_aknowledgedb fore day of ` 20by Signature ompany tilityAgent The foregoing instrument was acknowledged before me this L� day of �U✓ 2023 is Jglrsgn a or who has produced is personally known to me or who has produced as as identification. identification. NOTARY PUBLIC:- Sign: L Sign: Print:coAC, Print: Q V- SEAL: Notary Public State of Florida SEAL: Marla del Filar Moreno Notary Public State of Florida My Commission HH 355060 Maria del Filer Moreno Illt Expires 317I2027 III My Commission HH 355080 Expires 3ni2027 2� APPROVED BY: i Public Works Director, or Designee 2017-04-15 I II�lII ��Ill III �Illiili�� III�� i!I!1 III! 1111 ' Miami Shores Village Public Works Department (305)795-2210 Public works forms are available from the building department, 10050 NE 2n1 Ave., Miami Shores, FL 33138 COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY GFN it B'23RO762336 OR BK 33938 Fs 1025 (1PSS) RECORDED 10;`24/2023 07:36942 JUAN FERNANDEZ-BAROUIN CLERK OF THE COURT & COMPTROLLER MIAMI-DADE COUNTYr FL ,r Whereas, (hereby referred to as the owner)��� Of the following described property: S SCG Cp 3� Legal Description: Lot 12 Block 13 `t Subdivision L51015, 11 Address: lq-o Nw g3r6 5k VAi ct, t "5A45>.r-eS iFL 3?15c�—> Rgquests permission to,install (describe work, attacH separate page if necessary) in the adjoining right of way: IN C00DERATION of the approvaIV this permit by the village, the owner agrees as follows: - 1. To maintain and repair, when necessary, the above -mentioned item(s) installed within the dedicated right of way. If it . becomes necessary for Miami Shores Village or Miami -Dade County to make repairs or maintain said items within the public right of way including restoration of the street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does herby agree to indemnify and hold Miami Shores Village or Miami -Dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 14 days' notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the .._ item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be bin . on the under,,* ned, their heirs and assigns until such time as this obligation has been cancelled by an affidavi ' ed in th Publi cord f Miami -Dade County, Florida by the Village Manager of Miami Shores Village (or his fullyvAhorized rep ese ayive) t Signature ruwner or State of a County of STATE OF FLORIDA, COUNTY OF MIAIVII-DADE t HEREBY CERTIFY that this is a true copy of the odaloauled ir►elisa110:e on day of 20 and Official Seal. prrkzpf Circuit and County Courts The foregoing strum/-e+-ntw�as�acknnoowledged before me this Q21 day of 20 ii7; by who is personally known to me or who has produced :`?''•'• HEBERTMARTINEZ MY COMMISSION # HH 323276 <; `••'.?o;;;o?' EXPIRES: October 16, 2026 Kion. Documents are recorded at the Clerk SEAL: of the Courts, MIAMI-DADE COUNTY RECORDER, COURTHOURSE EAST, 22 N.W. First Street, 1st Floor, Miami, FL 33128. 2017-04-11 1355 NW 97 AV SUITE 200 _ SURVEY NO. 21-0000251-1 MIAMI, TELEP ONE:(A33172 �� rUP1JIIi8 Jnr. TELEPHONE: (305) 264-2660 '� FAX: (305) 264-0229 DRAWN BY: LAND SURVEYORS SHEET No. 2 OF 2 BOUNDARY SURVEY RECEIVED SCALE=1"=20' j \ OCT 2 4 2023 93 11.63 N.W. 93rd. ST. -- - - - --- 11.16 x.0 11.20 20' ASPHALT _ n PVMT. O R=25.00' F L=39.37'. - —" Tan=25.10' 10.85 D=90'13'55" ASPH:._ CH=35.43' RETURN CHB=224°55'5 n F.I. 3l4" 11.37 NO CAP 10.30 23' PWY 10.27 B.C. 10.43�— F.I.P34" TCONCSWK � NO C ! 75.00'. .. .... j-NO—CAP .. 9 '5" 90-13-55" 10.30 j 10.94 jl 10.25 U 11.48 10.51 10.62 35.00' STEPS PL.r 111.26'. + 6 13.60' F.LP3 " C.P ' ON PL NO CA 14.91' �'o 35.30' _ LOT - 12 LOT 11 en BLOCK-134 F.F.E =12. 9' BLOC -134 ONE ST0�2Y W RES. # 1 0 m 0 10.90' Q 1 .ar 11.10' 0.20'ENC .S CONC. R 9.90 STEPS m 6.80' 1�• a" 10.72 <v. �1021 UTILITY 20 d REMAINDER LOT - 11 BLOCK -134 Z N MIA I SHORES VIG (N.A.P.) x 'Z 4'C.L.F. PU LICRKS REIEW N .'.O 11.. 5' C.L.F. 4 APP EDx �'�DATL 477 J e 9.57 1.69' ce m I a I d 9.70 r hl. &355 0 ..' 040' 1 3 4' .L.F. 89'4531� 1 T:10 F.hP-8/4=U,P J _- - 15.AL�EY75_00'-10'ASPH PVMT ` . -P1P3r4 W"-- .V, NO CAP U . '..� rN0 CAP, 1 o.5J—moo j11 Pj v s.78 10.47 C.S. — 70 UO' TOT L R/W LOT - 13 BLOCK-134 G ■ ■ Y SURVEYOR'S NOTE: COPY -'1'here may be Easements recorded in the Public Records not shown on this Survey. 1355 NW 97TH AVE, SUITE 200 MIAMI, FL 33172 Nova Surveyors Inc. SURVEYNO 21-0000251-1 TELEPHONE: (306) 439-0004 FAX: (305) 264-0229 DRAWN BY: LAND SURVEYORS SHEETNO 1 OF 2 SURVEY OF THE WEST 112 OF LOT 11 AND ALL OF LOT 12, BLOCK 134, OF MIAMI SHORES SECTION NO.6, ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 10, PAGE 39, OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA. PROPERTY ADDRESS: 190 NW 93 ST, MIAMI SHORES, FL 33150 FOR: SOFLO FLIPPERS LLC LOCATION SKETCH Scale 1" = NT.S. J /! • ! zJA/ V 1i !M 1 t31 to el ?z ABBREVIATION AND MEANING A = ARC MC = AIR CONDITIONER PAD AE. = ANCHOR EASEMENT AIR = ALUMINIUM ROOF NS - ALUMINIUM SHED ASPH. = ASPHALT B.C. = BLOCK CORNER B.C.R. = BROWARD COUNTY RECORDS B.M. = BENCH MARK B.O.B. = BASIS OF BEARINGS C - CALCULATED C.B. - CATCH BASIN C.B.W. = CONCRETE BLOCK WALL CH - CHORD CH.B. - CHORD BEARING CL = CLEAR C.L.F. = CHAIN LINK FENCE C.M.E. = CANAL MAINTENANCE EASEMENTS CONIC. .CONCRETE C.P. = CONCRETE PORCH C.S. = CONCRETE SLAB D.E. = DRAINAGE EASEMENT D.M.E. - DRAINAGE MAINTENANCE EASEMENTS DRIVE = DRIVEWAY ENCR =ENCROACHMENT E.T.P. = ELECTRIC TRANSFORMER PAD F.F.E. = FINISHED FLOOR ELEVATION F.H. = FIRE HYDRANT F.I.P. = FOUND IRON PIPE F.I.R. - FOUND IRON ROD F.N. = FOUND NAIL F.N.O. = FOUND NAIL 6 DISK FNIP. - FEDERAL NATIONAL INSURANCE PROGRAM IN.SEG. = INGRESS AND EGRESS EASEMENT L.F.E. = LOWEST FLOOR ELEVATION L.M.E. = LAKE MAINTENANCE EASEMENT L.P. = LIGHT POLE M. = MEASURED DISTANCE M/H = MANHOLE N.AP. - NOT A PART OF NGVD = NATIONAL GEODETIC VERTICAL DATUM N.T.S. = NOT TO SCALE O.H.L = OVERHEAD UTILITY LINES O.RB. = OFFICIAL RECORD BOOK O/S = OFFSET OVH. = OVERHANG P.B. = PLAT BOOK P.C. = POINT OF CURVE P.C.C. = POINT OF COMPOUND CURVE PL. = PLANTER P.LS. = PROFESSIONAL LAND SURVEYOR P.O.B.. = POINT OF BEGINNING P.O.C.. = POINT OF COMMENCEMENT P.P. = POWER POLE P.P.S.. = POOL PUMP SLAB P.RC. = POINT OF REVERSE CURVE PRM= PERMANENT REFERENCE MONUMENT PT. = POINT OF TANGENCY PVMT. = PAVEMENT PWY=PARKWAY R. = RECORD DISTANCE ,. 4 „ L . L . I •4 l7.91t1 93rd. ST. STREE 1 IQ 9 8 7 a a A4. - i ""- SUB CT PROP RTY HAD. = RADIUS OF RADIAL RGE. = RANGE R.P. = RADIUS POINT R.O.E. = ROOF OVERHANG EASEMENT RAN = RIGHT-OF-WAY SEC. = SECTION S.I.P. = SET IRON PIPE L.B. 96044 SWK = SIDEWALK T=TANGENT TWP =TOWNSHIP U.E. = UTILITY EASEMENT U.P. = UTILITY POLE W.M. = WATER METER W.R. = WOOD ROOF W.S. = WOOD SHED � = ANGLE 0 = CENTRAL ANGLE 4 = CENTER LINE V =MONUMENT LINE LEGAL NOTES TO ACCOC V - THERE MAY BE EASEMENTS RECORDED IN THE PUBLIC RECORDS NOT SHOWN ON THIS SURVFY - EXAMINATIONS OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IF ANY, AFFECTING THE PROPERTY. THIS SURVEY IS SUBJECT TO DEDICATIONS, LIMITATIONS, RESTRICTIONS, RESERVATIONS OR EASEMENTS OF RECORD, AND LEGAL DESCRIPTIONS PROVIDED BY CLIENT OR ATTESTING TITLE COMPANY. BOUNDARY SURVEY MEANS A DRAWING AND / OR A GRAPHIC REPRESENTATION OF THE SURVEY WORK PERFORMED IN - THE FIELD, COULD BE DRAWN AT A SHOWN SCALE AND / OR NOT TO SCALE. EASEMENTS AS SHOWN ARE PER PLAT BOOK UNLESS OTHERWISE SHOWN. - THE TERM "ENCROACHMENT' MEANS VISIBLE AND ABOVE GROUND ENCROACHMENTS. - ARCHITECTS SHALL VERIFY ZONING REGULATIONS, RESTRICTIONS AND SETBACKS, AND THEY WILL BE RESPONSIBLE - FOR SUBMITTING PLOT PLANS WITH THE CORRECT INFORMATION FOR THEIR APPROVAL FOR AUTHORIZATION TO AUTHORITIES IN NEW CONSTRUCTIONS, UNLESS OTHERWISE NOTED. THIS FIRM HAS NOT ATTEMPTED TO LOCATE FOOTING AND/OR FOUNDATIONS. FENCE OWNERSHIP NOT DETERMINED. - THIS PLAN OF SURVEY HAS BEEN PREPARED FOR THE EXCLUSIVE USE OF THE ENTITIES NAMED. - HEREON, THE CERTIFICATE DOES NOT EXTEND TO ANY UNNAMED PARTY. - THE SURVEYOR MAKES NO GUARANTEES AS TO THE ACCURACY OF THE INFORMATION BELOW. THE LOCAL F.E.M.A - AGENT SHOULD BE CONTACTED FOR VERIFICATION. THE FNIP FLOOD MAPS HAVE DESIGNATED THE HEREIN DESCRIBED LAND TO BE SITUATED IN ZONE: X COMMUNITY/PANEUSUFFIX: 120635 0302 L DATE OF FIRM: 09111/2009 BASE FLOOD ELEVATION: NA CERTIFIED TO: SOFLO FLIPPERS LLC 17 IS 19 1 '0 i � I I � LEGEND TYPICAL �H- OVERHEAD UTILITY LINES 2� C.B.S.=WALL (CBWI C.L.F.-CHAIN LINK FENCE I.F. - IRON FENCE W.F. = WOOD FENCE • 0.00 = EXISTING ELEVATIONS SURVEYOR'S NOTES 1) IF SHOWN, BEARINGS ARE REFERRED TO AN ASSUMED MERIDIAN, BY SAID PLAT IN THE DESCRIPTION OF THE PROPERTY. IF NOT, THEN BEARINGS ARE REFERRED TO COUNTY, TOWNSHIP MAPS. 2) THIS IS A SPECIFIC PURPOSE SURVEY. 3) THE CLOSURE IN THE BOUNDARY SURVEY IS ABOVE 1:7500 FT. 4) IF SHOWN, ELEVATIONS ARE REFERRED TO MLAM9-DADE COUNTY. ALL ELEVATIONS SHOWN ARE REFERRED TO NATIONAL GEODETIC VERTICAL DATUM N.G.V.D. 1929 MIAMI DADE COUNTY BENCH MARK NO.N569 LOCATOR NO. 3100 SW ELEVATION 9.65 FEET OF N.G.V.D. OF 1929 SURVEYOR'S CERTIFICATION I HEREBY CERTIFY: THAT THIS "BOUNDARY SURVEY" OF THE PROPERTY DESCRIBED HEREON, AS RECENTLY SURVEYED AND DRAWN UNDER MY SUPERVISION, COMPLIES WITH THE MINIMUM TECHNICAL STANDARDS AS SET FORTH BY THE FLORIDA BOARD OF PROFESSIONAL LAND SURVEYORS IN CHAPTER 61G175, FLORIDA ADMINISTRATIVE CODE PURSUANT TO 472.027, FLORIDA STATUTES. BY'. Atr 0FIELD 3-�S-2I ) PROFESSIONAL LAND SURVEYOR NO. 2534 STATE OF FLORIDA (VALID COPIES OF THIS SURVEY WILL BEAR THE EMBOSSED SEAL OF THE ATTESTING LAND SURVEYOR). REVISED REVISED N pGE... 18', �$ryp lFjFy I e ii * io � WI/ 0$ 4L, STATE OF S R10�': \ �JG" A A'INY BUP4f O SURVEYOR'S SEAL 5 Ron DeSantis, Governor Melanie S. Griffin, Secretary a STATE OF FLORIDA dbpr DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE GENERAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE i ,, r • � i i 0 7' SANCHEZ ABARCA GORNALS, LUIS AGO NORTH AMERICA LLC 1431 SW 20 ST }� MIAMI FL 33145 .0,e : = A . LICENSE NUMBER: CGC1528536 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. Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 7297703 BUSINESS NAME&OCATION AGO NORTH AMERICA LLC 1431 SW 20TH ST MIAMI, FL 33145 OWNER AGO NORTH AMERICA LLC CIO LUIS SANCHEZ ABARCA 01 IAI IFIFR Worker(s) 1 RECEIPT NO. RENEWAL 7587425 LIBIr EXPIRES SEPTEMBER 30, 2024 Must be displayed at place of business Pursuant to County Code Chapter 8A — Art. 9 & 10 SEC. TYPE OF BUSINESS PAYMENT RECEIVED 196 GENERAL BUILDING BY TAX COLLECTOR CONTRACTOR 45.00 07/06/2023 CGC1528536 INT-23-389192 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 holders 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 se-276. ®a For more information, visit seas w.miamidade.govhexcollectcr ACORDr CERTIFICATE OF LIABILITY INSURANCE `, DAM(MMfDO/YYYY) 07/20/2023 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 pollcy(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 endorsements . PRODUCER ALL CITY INSURANCE INC. 1400 NW 107th AVE SUITE 210 DORAL FL 33172- CONTACT INGRID HERRERA PHONE 01C No . (305)463-9431 FAX No1.(305)436-6797 E-MAIL GMAIL@ALLCITYINS.COM AFFORDINGGE INSURER .US SPECIALTY INSURANCE COMPANY 29599 INSURED AGO NORTH AMERICA LLC 1431 SW 20TH ST Miami FL 33145- INSURER B: INSURER C: INSURER D COVERAGES 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXPLTR LIMBS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE M OCCUR U23AC137742-02 7/16/2023 7/16/2024 EACH OCCURRENCE 1,000,000 DAMAGEq ( RENTED 100,000 MED EXP (Anv oneperson) 5,000 PERSONAL & ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY JECTT LOC 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(pa ef�Lqrlpnt) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? u (Mandatory In NH) If es, describe under OF OPERATIO below N / A PER OTH- E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L.,RIPTION DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Addlttonal Remarks Schedule, may be attached if more space is required) CGC15281536 CERTIFICATE HOLDER CANCELLATION Al 008496 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village $ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami Shores FL 33138- AUTHORIZED REPRESENTATIVE O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 0 JIMMY PATRONIS CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 8/2/2022 PERSON: LUIS SANCHEZABARCA FEIN: 844732903 BUSINESS NAME AND ADDRESS: AGO NORTH AMERICA LLC 1431 SW 20 ST MIAMI, FL 33145 SCOPE OF BUSINESS OR TRADE: Contractor -Project Manager, Construction Executive, Construction Manager or Construction superintendent EXPIRATION DATE: 8/1/2024 EMAIL: LSANCHEZ@AGONORTHAMERICA.COM IMPORTANT: Pursuant to subsection 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to subsection 440.05(12), F.S., Certificates of election to be exempt issued under subsection (3) shall apply only to the corporate officer named on the notice of election to be exempt and apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to subsection 440.05(13), F.S., notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 E01573292 QUESTIONS? (850) 413-1609