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RF-09-23-2344
Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 30 NE 96 ST 11-3206-013-0650, Miami Shores, FL 33138 Contacts Permit NO.: RF-09-23-2344 Permit Type: Roof Work Classification: Repair Roof Permit Status: Approved Issue Date: 10/04/2023 F Expiration: 04/04/2024 Anna Leggett Owner CITY ROOFING AND CONSTRUCTION INC Contractor 30 N.E. 96th Street, Miami Shores, FL 33138 MARIO FAMADA Other: 3057547599 semaj44@aol.com 22700 SW 172nd Ct. SW 172 CT, MIAMI, FL 33170 Business: 3052482994 info@mycityroofing.com Fees Amount Application Fee - Other $50.00 CCF $6.00 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $3,00 Permit Fee (Manual) $80.00 Technology Fee (Manual) $13.00 Total: $156.00 Valuation: $9,072.78 s iw ]t a ter={'. 4 7` a5" Total Sq Feet: 1,311 11 '... J e £ ?..F ��ty m . Payments Date Paid Amt Paid Total Fees $156.00 Credit Card 09/22/2023 $50.00 Credit Card 10/04/2023 $106.00 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 construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. Owner I Applicant I Contractor I Agent October 04, 2023 Page 2 of 2 Miami Shores Village �. LJ Building Department �y 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20, 2 BUILDING Master Permit No. KF-61p-93-ZY4 PERMIT APPLICATION sub Permit No. ®BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL []PLUMBING [:]MECHANICAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS fOBADDRESS: 30 NE 96TH ST MIAMI SHORES FL 33138 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-3206013-0650 IS the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): ANNA LEGGETT Phone#: Address: 30 NE 96TH ST City: MIAMI State: FL zip:33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: CITY ROOFING INC Phone#: Address: 22700 SW 172 CT MIAMI FL 33170 Email: Qualifier Name: RIO FAMADA Phone#: State Certification or Q of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: _Zip: Value of Work for this Permit: $ Square/Linear footage of Work: i-Z�) d C ) Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: ADDING A COATING TO THE FLAT ROOF Specify color of color thru Submittal Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Permit Fee $ DCA Fee $ Training/Education Fee $ DBPR $ CO/CC $ Notary $ Double Fee $ P&Z Review $ Bond $ TOTALFEENOWDUE$ rum'- 04-3 (Re IsedW05/2022) y Dxurr ri ReE.OMA ZKeOU-RRBKAdl4 Pa�"- 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 Zip Application is hereby made to obtain a permit to do the work and installations as indicated. l 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 4NA01046r OWNER or AGENT The foregoing instrument was acknowledged before me this day of 1 by who Is erson�Iykn�own me or who has produced as identification and who did take an oath. NOTARY P Signature CONTRACTOR The foregoing instrument was acknowledged before me this day oit 1Mvv-)bFt/ / 20 _Z , by �g a ersonally kno o me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: iJ Seal: Bonded Through - Cynanotary Florida - Notary Public as APPROVED BY Plans Examiner o Z ntng Structural Review Clerk (Rev1sed04/05/2022) pocument` Ref: DRIA-Zi�BGI-FfRBFA-UQgBI: • wy.M.i.A..J it.i�...i.wi.w. ,... - -..r,..ww...w..r..+tirrwr/.wYwMwrrf art. 45496t� 838 Oct. Return to Name ��d—p- NZCHpLS. ATT01rNEY Address.�.500 f. FI olrr St.�A-107 __i11amL FL 33144 This inxtmment was pmpood by: Name LEON G. NICHOLS Address B300 M. Us wStmtS tSite A 107 IhM4 FL331aa property Appnher's Parcel Idrn1(IkaUon Nw ' ..z2AA-nta_I1i 9 IW529059 1991 SEF IS 16'23 POCSIP-DEE 765.011 SURfA% 0.00 hARSHALL ADER, CLERy. OAOE COUNTY, FL G ranteY JJ91Ya. �� •... •." Grantee S.S. No. �-7.7 +_..�—/- 1SW-r�t,6ove7th�b Rne for tKardinR Jala.l "" WA jjA1`1 1 1 DEED isuT IfORY FORM — SECTION Nr 90L F B This Indenture, made this 17th day of SEPTEMBER 19 91'etwQen ANTHONY PAZIENZA AND SYLVIA PAZIENZA, his wife .. 11604 SUNFISH WAY, COOPER ITY, FLORIDA 33026 grantee, and or the County of DADS FLORIDA JAMES E. LEGGETT AND ANNA CURTIS LEGGETT, his wife whose post office addeas Ls 30 N.E. 96 Street, Miami Shores granln; of the County of Dade •Stale of Florida 33138 W itnesseth that said grant", toe and in cmc+idention of the sum or(S 10.00) Dull m TEN AND 00/100 - aad other good and valuable eunsiJmalir,ns to salt grantor In a hand paid by said helm if,, rcceipi whereof is hereby acknowledged, has granted bargained and sold to The said grantee, and Rmnleeb heirs and assignCounty.rFlodda,lto-wib described land, snuale. lying and being in DADE Lots 8 and 9 Block S of AMENDED PLAT OF MIAMI SHORES SECTION ONE, according to the Plat thereof, as recorded in Plat Book 10 Page 70 of the Public Records of Dade County, Florida. STATE OF FLORIDA, COUNTY OF MIAMI-0ADECCA�*j IIIMBYCSiiIfT ofL r �'m�' WIOIIiiI�iu1ll�tllBrL _r seccAo Mona C euetendCount �{a1 pa t a Ciotti, 6 unty rV Cowi9� DlputyCled( _ BERME SLATER #M7680 and said grantor does hereby fully warrant the Otte to said land. and win defend the same against the lawful claims of all persons whvmsocs'cr. "'Grantor- and "grantee" are used for singular or plural as context requires. In W1tqeS3 {'Yil�granter has hereunto set grantors d an Baal the da and year fist above written. Sign ed and + ed in CUT prnsvlce / . �,•� (Sea)) SCAYEOF FLORIDA COUNTY OF DADE I HERE9y CERTIFY that on this day before me, an officer duty qualified to take acknowledgments. Pei ANTHONY PAZIENZA AND SYLVIA PAZIENZA, his wife, .1 Lome known to be the person(s)described in and who executed the knegoing instrument and acknowledgeq the-r. executed the same. , . WITNESS my hard and official seal in the County and Stale Ltsl1(yhsaid t ' th day of Septemb �-r My eommissionexpiriWNOTARY PUBLIC STATE OF FrOPIDA 447W �_, A/le*V-JNutary Public My COMAISSIAU EXP. APR. IA. I745 DONDED DIRU CTIR:ML Im. U:n. 2I 761L i virnRE,, Florida Building Code 7th Edition (2020) High Velocity Hurricane Zone Uniform Roofing Application Form for Miami -Dade County Master Permit Number: Contractor's Job Address: Section A (General Information) ROOF CATEGORY Process Number: "� Low Slope ❑ Mechanically Fastened Tile ❑ Mortar / Adhesive Set Tile ❑ Asphaltic Shingles ❑ Metal Panel/ Shingles ❑ Wood Shingles / Shakes Section 110.1 Construction or work ROOF TYPE shall remain exposed and provided with access for inspection Lurposes until approved. ❑ New Roof ❑ Repair Maintenance LI Reroofing ❑ Recovering ROOF SYSTEM INFORMATION Low Slope oof Area (ftz} Steep Sloped Roof Area (ft2) Total (ftz) Are there gas vents on the roof? 0 Yes ® No If Yes what type? O Natural 0 LPX Is there an existing roof top Solar System? 0 Yes 0 No If yes will it be reinstalled? ()Yes 0 No Section B (Roof Plan) Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Include dimensions of sections and levels, clearly identify dimensions of elevated pressure zones and location of parapets. Pft Mi® M1AMI-DADS COUNTY PRODUCT CONTROL SECTION DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES (RER) 11805 SW 26 Street, Room 208 ( BOARD AND CODE ADMINISTRATION DIVISION Miami, Florida6) 315-2 T (786)315-2590 F(786)315-2599599 NOTICE OF ACCEPTANCE (NOA) www.nii;imidade.gov/economy GAF 1 Campus Drive Parsippany, NJ 07054 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed and accepted by Miami -Dade County RER - Product Control Section to be used in Miami -Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ). This NOA shall not be valid after the expiration date stated below. The Miami -Dade County Product Control Section (in Miami -Dade County) and/or the AHJ (in areas other than Miami -Dade County) reserve the right to have this product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may immediately revoke, modify, or suspend the use of such product or material within their jurisdiction. RER reserves the right to revoke this acceptance if it is determined by Miami -Dade County Product Control Section that this product or material fails to meet the requirements of the applicable building code. This product is approved as described herein and has been designed to comply with the Florida Building Code including the High Velocity Hurricane Zone of the Florida Building Code. DESCRIPTION: GAF Silicone Roof Coatings LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Miami -Dade County Product Control Approved", unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This new NOA consists of pages I through 5. The submitted documentation was reviewed by Jorge L. Acebo. NOA No.: 23-0125.01 Expiration Date: 04/20/28 Approval Date: 04/20/23 —� Page I of 5 APPROVED APPLICATIONS: (Continued) Trade name: GAF Unisil High Solids Silicone Roof Coating Specifications: ASTM D 6694 Description: A silicone coating membrane applied to EPDM, Concrete, TPO, SBS Granule Surface and Spray applied Polyurethane Foam applied membrane applied at an application rate of • Single Ply EPDM: Apply a Base Coat at a minimum rate of 1 gallon per 100 square feet. Apply a Top Coat at a minimum rate of 1 gallon per 100 square feet. • Concrete: Apply a Base Coat at a minimum rate of 1 gallon per 100 square feet. Apply a Top Coat at a minimum rate of 1 gallon per 100 square feet. • Spray Applied Polyurethane Foam; Apply a Base Coat at a minimum rate of 1 gallon per 100 square feet. Apply a Top Coat at a minimum rate of 1 gallon per 100 square feet. • SBS Mod Bit Granular Surface: o Option 1(with primer): Apply a coat of GAF 2-Part Silicone Primer or PVC Primer for Silicone at a rate of " #gallon per 100 square feet. Within five days apply a Top Coat of GAF Unisil High Solids Silicone Roof Coating at a minimum rate of 1 gallon per 100 square feet. o Option 2 (direct to surface): Apply a Top Coat of GAF Unisil High Solids Silicone Roof Coating at a minimum rate of 1 gallon per 100 square feet. • APP Mod Bit Granular Surface: o Option 1(with primer): Apply a coat of GAF 2-Part Silicone Primer or PVC Primer for Silicone at a rate of " #gallon per 100 square feet. Within five days apply a Top Coat of GAF Unisil High Solids Silicone Roof Coating at a minimum rate of 1 gallon per 100 square feet. o Option 2 (direct to suirface). Apply a Top- Coat of GAF Unisil High. Solids Silicone Roof Coating at a minimum rate of 1 gallon per 100 square feet. • Single -Ply TPO: Apply a coat of TPO Primer for Silicone at a rate of #bnetallon per 800- 1000 square feet. Allow.two hours before applying a Top Coat of GAF Unisil High Solids Silicone Roof Coating at a minimum rate of 1 gallon per 100 square feet. • Single Ply PVC (Aged): Apply a coat of GAF 2-Part Silicone Primer at a rate of v #gallon per .100 square feet. Within five days apply a Top Coat of GAF Unisil High Solids Silicone Roof Coating at a minimum rate of 1 gallon per 100 square feet. • Single Ply PVC: Apply a coat of PVC Primer for Silicone at a rate of " #gallon per 100 square feet. Within five days apply a Top Coat of GAF Unisil High Solids Silicone Roof Coating at a mt*+�rnum rate of 1 gallon per 100 square feet. • Galvanized Metal (Aged): Apply a coat of GAF 2-Part Silicone Primer at a rate of v #gallon per 100 square feet. � Within five days apply a Top Coat of GAF Unisil High Solids Silicone Roof Coating at a minimum rate of 1 gallon per 100 square feet. • BUR Smooth or BUR Granular: Apply a-coat,of GAF 2-Part Silicone Primer at a rate of " # gallon per 100 square feet. Within five days apply a Top. Coat of GAF Unisil High Solids Silicone Roof Coating at a minimum rate of 1 gallon per 100 square feet. Container Sizes: 5 or 55 gallons. Note all cautions on container label. Systems Methods of application and quantities shall comply with the specific Roof Assembly System's Approvals: Product Control Notice of Acceptance where it exceeds standards of this NOA. NOA No.: 23-01.25.01 Expiration Date: 04/20/28 Approval Date: 04/20/23 Page 4 of 5 01 LIMITATIONS. 1 r 7 El.. ti,::,+:r•t; jF i't t14 a. I. Fire classification is not part of this acceptance;, refer tq a�curr. A�pZ roved Roo tg ,Materials Directory for fire rating of this product.i. 2. GAF Silicone Roof Coatings listed here shalltnr.otbe�appiedtinaIement:eaiher conditions. 3. GAF Silicone Roof Coatings listed herein shall not be applied over asphaltic shingles, metal shingles, fiber -cement shingles, quarry slate, cement or clay roofing tile, or wood shingles or shakes. 4. The products listed herein are components of roof assemblies and are approved for use with roof assemblies that list any of the products listed herein as part of their Roof Assembly Notice of Acceptance. S. All approved products listed herein shall be labeled in compliance with TAS 121 and shall bear the imprint or identifiable marking of the manufacturer's name or logo, city and state of manufacturing facility, and the following statement: "Miami Dade County Product Control Approved" or the Miami Dade County Product Control Seal as shown below. M[AMbDA©E CWNTY . APPROVED 6. GAF Silicone Roof Coatings listed herein shall only be applied by a factory trained and certified applicators and in accordance with manufacturer's published application instructions. 7. All products listed herein shall have an unannounced follow-up quality control program from an approved listing agency. Follow up test results shall be made available to Miami Dade Product Control upon request. 8. Change in materials use, or manufacture of any of the products listed herein shall be cause for termination of this Notice of Acceptance. 9. All products listed herein shall have quality assurance audit in accordance with the Florida Building Code and Rule 61 G20-3 of the Florida Administrative Code. END OF THIS ACCEPTANCE C ourrnrAW: NOA No.: 23-0125.01 Expiration Date: 04/20/28 Approval Date: 04/20/23 Page 5 of 5 MIAMI-DADE COUNTY REQUIRED OWNERS NOTIFICATION FOR �I��v� ROOFING CONSIDERATIONS it is the responsibility of the roofing contractor to provide the owner with the required roofing permit, and to ex- plain to the owner the content of this form. The owner's initials in the designated space indicates that the item has been explained. D/ . Aesthetics -workmanship: The workmanship provisions of Chapter 15 (High Velocity Hurricane Zone) are rTm-- for the purpose u of providing that the roofing system meets the wind resistance and water intrusion perfor- mance mance standards. Aesthetics (appearance) are not a consideration with respect to workmanship provisions. Aesthetic issues such as color or architectural appearance, that are not part of a zoning code, should be addressed as part of the agreement between the owner and the contractor. 2. Renailing wood decks: When replacing roofing, the existing wood roof deck may have to be renailed in 461a accordance with the current provisions of Chapter 16 (High Velocity Hurricane Zones) of the Florida Building Code. (The roof deck is usually concealed prior to removing the existing roof system). 141a 3. Common roofs: Common roofs are those which have no visible delineation between neighboring units (i.e. townhouses, condominiums, etc.). In buildings with common roofs, the roofing contractor and/or owner should notify the occupants of adjacent units of roofing work to be performed. 44 4. Exposed ceilings: Exposed, open beam ceilings are where the underside of the roof decking can be viewed from below. The owner may wish to maintain the architectural appearance; therefore, roofing nail penetrations of the underside of the decking may not be acceptable. The owner provides the option of maintaining this appearance. • 5. Ponding water: The current roof system and/or deck of the building may not drain well and may cause wa- ra ter to pond (accumulate) in low-lying areas of the roof. Ponding can be an indication of structural distress and may require the review of a professional structural engineer. Ponding may, shorten the life expectancy and performance of the new roofing system. Ponding conditions may not be evident until the original roofing system is removed. Ponding conditions should be corrected. A.D 6. Overflow scuppers (wall outlets): It is required that rainwater flow off so that the roof is not overloaded from a build up of water. Perimeter/edge walls or other roof extensions may block this discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in accordance with the requirements of: Chapter 15 and 16 herein and the Florida Building Code, Plumbing. 4 � 7. Ventilation: Most roof structures should have some ability to vent natural airflow through the interior of the •`'� structural assembly (the building itself). The existing amount of attic ventilation shall not be reduced. 4Ia 8. Existing Solar Systems: The re -installation of an existing roof mounted photovoltaic system requires a separate permit. Permit must be obtained in order to finalize the roofing permit. CONTRACTOR'S SIGNATURE 30 NE 96TH ST PROPERTY ADDRESS rm"a 123_01-297 4/19 / 1 DATE PERMIT NUMB& I. STATE ZIP QyCurnt Ref.. DR1AX-fCEGIJ=HRBfC1UQQ$ Page'3,af 5 Regulatory and Economic Resources MIAMaDADE BuildingTrade Section 1805 SW 26th Street (Coral Way) Room 137 Miami, Florida 331752474 14, 1 miamidadegov OWNER'S AFFIDAVIT OF EXEMPTION Roof to -Wall Connection Hurricane Mitigation Retrofit for Existing Site -Built Single Family Residential Structures OWNER'S NAME ROOFING PERMIT NUMBER ANNA LEGGETT FATE PROPERTY ADDRESS 30 NE 96TH ST Dear Building Official: CITY STATE i zip I ANNA LEGGETT property owner, certify that I am not required to retrofit the roof -to -wall connections of my building because of one of the following reasons (select one): ❑ The building has an insured value of $300,000 or less. (Provide copy of homeowner's insurance), OR ® Is uninsured or I cannot provide insurance documentation, and the just value of the structure for purposes of ad valorem taxation is less than $300,000. (Provide a copy of the Miami -Dade County Property Appraiser's Assessment), OR ❑ The building was constructed in compliance with the provisions of the Florida Building Code (FBC) or with the rovisions of the 1994 edition of the South Florida Building Code (1994 SFBC). (Provide a copy of the building permit) & (if built before 1994 provide a compliance letter from a Florida Registered Engineer or Architect), OR ❑ The roof -to -wall connections at gables ends or all comers cannot be completed for 15% of the cost of roof replacement (Provide an estimate of costs for retrofit by a General Contractor) p 4AIN4 ZW6vff Aytiv�`;- k rn4n Signature of Property Owner Print Name - STATE OF FLORIDA COUNTY OF MIAMI-DADE Sw rn to and subscribed before me by means of physical presence OR ❑ online notarizations this day of 0 by AVA14 !.E Wr Signature of Notary Public Print Name Personally known or Produced Identification NOTARY (SEAL) Tana Martinez Commission # HH 101638 �a Cammission Expires 03-08.2025 Bonded Through - Cytianotary Florida - Notary Public • � fir•.•. Type of identification Produced •rygodiment'Ref: DRIAX~,�t. :,.:. 123 91.342 6al { ; Page 4 of 5 ,:� 0 Ron DeSantis, Governor Melanie S. Griffin, Secretary Florid STATE OF FLORIDA diolar,a DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION11 CONSTRUCTION INDUSTRY LICENSING BOARD THE ROOFING CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES LICENSE NUMBER: CCC1327381 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 THIS13 NOT A BILL _ 00 NOT PAY 6226138: - 9USINESS KAME/LUCATION T- CITY ROOFING INC RECEmrNp 22700 SW 172ND C7 RENEWAL EXPIRES M1AViIFL33770 5670 6490700 SEPTEM&EN 3612p�;. Must be displayed at place ofbusibess Pursuanttb County Code - . - Chapter. BA—Art::9&10 awxm_ atFRDOFlNGAND CONSIR6LTbNINC 1KTrrEdEsuseM '196 SPECIALTY BUlL1i1NG CONTRACTOR .. Pal CCC1327381 Workers) q . AXCOUMB $'5.00 07/19/2022 Thl"eoal Business Tax Recerptonly confirms 1NT 22_3]001.8 permtEore certificationoftheholder- gaalifi_cahorts t ft L and anion,dthalacal6meness Taz The Receipt is Data license,. or rmegoyammental regulatory laws orremenm which cress. Roldermustcpmply alptiS .The RECEIPT NO. abuse Me" . plytothohusiuess.. Y9ovoMmemal mmi displayed commercial vehicle, -Miami -Bade Code Sep ea-276 . Farmore ibommpon,visitwwwmiamidade v/ds,.oil t r AcoRo® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 08/04/2023 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 INSURANCE LLC DBA SEBANDA INSURANCE #37 CONTACT NAME: Paul Sanchez PHONE , (305) 755-0323 C. No), (305) 755-0349 FAMIVAL E-MAIL DRESS: Paul@sebandainsurance.com 530 SW 1st ST, SUITE 204 INSURERS AFFORDING COVERAGE NAIC # INSURER A: OBSIDIAN SPECIALTY INSURANCE COMPANY 16871 Florida City FL 33034 INSURED INSURER B : INSURER C : City Roofing and Construction Inc dba City Roofing Inc INSURER D : 22700 SW 172nd Court INSURER E : INSURER F : Miami FL 33170 f%f%WCDArrcc rr-RTIFirATF 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. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY X CLAIMS -MADE OCCUR Blanket additional insured Y Y SCB-GL000034641 08/07/2023 08/07/2024 EACH OCCURRENCE $ 1,000,000 DA AGE TO RENTED PREMISES Ea occurrence 5O O00 $ + X MED EXP (Any one person) $ 5,000 X Blanket primary wording PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 X PRODUCTS - COMP/OP AGG $ 2,000,000 A AUTOMOBILE LIABILITYaccident) ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea cadent $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YINANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A STATUTE ER" E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Roofing and General Contractor for Residential and Commercial work. GC license number: CGC1509365 CRC LICENSE NUMBER: CCC1327381 MIAMI SHORES 10050 NE 2nd Ave, Miami Shores, FL 33138 I M L 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 (9)1933-2015 AGOKO cUKPUKA I IUN. All ngnts reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD A< 6R& CERTIFICATE OF LIABILITY INSURANCE il*�' DATE(MM/DD/YYYY) 04/05/2023 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 CONTACT NAME: Automatic Data Processing Insurance Agency, Inc. Automatic Data Processing Insurance Agency, Inc. PHONE E 1-800-524-7024 FAX No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 1 Adp Boulevard INSURER A: SIRIUSPOINT AMERICA INSURANCE COMPANY 38776 Roseland NJ 07068 INSURED City Roofing and Construction Inc INSURER B : INSURER C : INSURER D : DBA: CITY ROOFING AND CONSTRUCTION INC URER E : 22700 SW 172nd Ct [INSURERF : Miami FL 331705610 COVERAGES CERTIFICATE NUMBER: 2948499 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 LTp TYPE OF INSURANCE S D POLICY NUMBER POLICY EFF MMIDD POLICY EXP MM/DD LIMBS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- 7LOC JECT OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBSINGLE Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECU I IVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A N WC9569401 04/08/2023 04/08/2024 PER X1 STATUTE ER - E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Contractor License: CCC1327381 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. 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores FL 33138 O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD