WS-08-23-2134Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Permit No.: WS-08-23-2134
Permit Type: Windows/Shutters
Work classification: Window/Door Replacement
Permit Status: Approved
issue Date: 09/11/2023 I Expiration: 03/11/2024
85 NW 102ND ST, Miami Shores, FL 33150 -�
Contacts
RICHARD BOULLON Owner FHIA LLC Contractor
85 NW 102 ST, MIAMI SHORES, FL 33150 WAYNE BURNETT
Home: 7863970291 3044 sw 42, HOLLYWOOD, 33312
Business: 9547924415210 PERMITS@FHAPRODUCTS.COM
Description: REPLACING 2 DOORS WITH IMPACT SIZE FOR SIZE Valuation: $ 13,800.00 Ins ection Requests:
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$8.40
DBPR Fee
$2.25
DCA Fee
$2.00
Education Surcharge
$4.20
Scanning Fee
$19.00
Technology Fee
$15.00
Windows/Shutters Fee
5100.00
Total:
$199.85
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$199.85
Credit Card
08/29/2023 $50.00
Credit Card
09/11/2023 $149.85
Amount Due:
$0.00
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 'n strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting i permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits ar4AFFlu,v
ECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERScertify that all the foregoing information is accurate and that all work will be done in cempliance with all applicable laws
regulating zonin Father more, I authorize the above named contractor to do the work stated. I
L01t (�<) LZ 4I.r 23
Authorized Signatu e: Owner / Applicant / Contractor / Agent Date
September 11, 2023 Page 2 of 2
Miami Shores Village
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
BUILDING
PERMIT APPLICATION
UILDING ❑ ELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS:
AUG 2 9 2023
—f4)•
FBC 202(7
Master Permit No. QS ^D; 223-21�-
Sub Permit
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
City: Miami Shores County: Miami Dade Zip: rid 1 C'o
Folio/Parcel#: It - 3101- oil - w v-) Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type:
Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 1 II(�'kjPAr(j 6011 ()jj Phone#{.7 SG-1 bt1 7 - 096)
Address:
. 9- 1N1_ `o) '
City: MlC'1Y�11 �VIOr'rR State: T-L Zip: 331 T� j
Tenant/Lp4see Name: Phone#:
Email:
CONTRACTOR: Company Name:
i'h
Email:
Qualifier Name:�he,
l.1��OrW,a?�
Phone
State Certification or Registration #: l /�07( 13101206
Certificate of Competency #:
DESIGNER: Architect/Engineer:
Phone
9
Address: City: State: Zip:
Value of Work for this Permit: $ /,2 1 71y Square/Linear Footage of Work: C36
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $ �,f�6, CD Permit Fee $ IUD. � CCF $ ( ."4Q CO/Cc $
Scanning Fee $ P3, °0 DCA Fee $ 2,t>�) DBPR $ 2'4 Notary $ Y�
Technology Fee $ I �• CID Training/Education Fee $ • 2 o Double Fee $ �rYC
Structural Reviews $ P&Z Review $ Bond $
TOTAL FEE NOW DU
(Revised04/05/2022)
Bonding Company's Name (if applicable)
Bonding Company's
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. A n A
Signature / Signature \,U A X /
OWNER or AGENT
The foregoing instrument was acknowledged before me this
�?11 day of 6t*4- .20 13 . by
f' who i ersonally know
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: V qnwrr
, F; Notary PUh -State of Florida
Seal: LA • <i Comrm;sian q HH 331606
My Comm. Expires Nov 14, 202 t
Banded through National Notary Assn. b
CONTRACTOR
The foregoing instrument was acknowledged before me this
AS dayof
420 23 . by
Ubfit,r,_ [. i'firsail¢.whoi ersonallyknown o
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
ittt4t4ttttttt4it4ttt4F4tt44ttt 4/tytitt�tjt7+4tt4i4tt4444t44tttittt4t444t##t44ttttt44tt#444ttt4ttt44t4#44itttt4t
APPROVED BY-) Plans Examiner Zoning
Structural Review Clerk
(Revised04/05/2022)
-�;OFFICE OF THE PROPERTY
II11 APPRAISER
ReportSummary
PROPERTY INFORMATION
Folio
11-3101-018-0080
Property Address
85 NW 102 ST
MIAMI SHORES, FL 33150-1229
Owner
RICHARD BOULLON
Mailing Address
85 NW 102 ST
MIAMI SHORES, FL 33138
Primary Zone
0800 SGL FAMILY- 1701-1900 SQ
Primary Land Use
0101 RESIDENTIAL- SINGLE FAMILY: I UNIT
Beds / Baths /Half
2 / 2 / 0
Floors
1
Living Units
1
Actual Area
1,125 Sq.Ft
Living Area
1,125 Sq.Ft
Adjusted Area
1,125 Sq.Ft
Lot Size
7,560 Sq. Ft
Year Built
1979
Year
2023 2022
2021
Land Value
$355,084 $280,031
$219,484
Building Value
$118,755 $119,700
$86,175
Extra Feature Value
$868 $882
$896
Market Value
$474,707 $400,613
$306,555
Assessed Value
$192,029 $186,436
$181,006
BENEFITS INFORMATION
Benefit Type
2023 2022
2021
Save Our Homes Assessment
$282,678 $214,177
$125,549
Cap Reduction
Homestead Exemption
$25,000 $25,000
$25,000
Second Exemption
$25,000 $25,000
$25,000
Homestead
Note: Not all benefits are applicable to all Taxable Values (i.e. County,
School Board, City, Regional).
NAVARRO SUB PB 12-59
LOT 17 &W15FT LOT 18 BLK 1
LOT SIZE 70.000 X 108
OR 16553-2687 0994 4
Generated On: 08/21/2023
TAXABLE VALUE INFORMATION
Year
2023
2022
2021
COUNTY
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
$142,029
$136,436
$131,006
SCHOOLBOARD
Exemption Value
$25,000
$25,000
$25,000
Taxable Value
$167,029
$161,436
$156,006
CITY
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
$142,029
$136,436
$131,006
REGIONAL
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
$142,029
$136,436
$131,006
Previous
OR
Sale
Price
Book-
Qualification Description
Page
04/29/2013
$200,000
28612
Qua] by exam of deed
3480
11/13/2009
$17,600
27120-
Religious, charitable or
2817
benevolent organization
10/31/2009
$17,500
27120-
Religious, charitable or
2816
benevolent organization
09/01/1994
$0
16553-
Sales which are disqualified as a
2687
result of examination of the deed
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://www.miamidad
e.gov/info/disclaimer.asp
Miami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138 F-IMWJ\
305-795-2204 www.msvfl.gov9 2023
Inspection requirements for:
Windows, Doors, Skylights or Fixed Glass (cladding) Permits
Upon issuance of permits for the scope of work involving the removal, changing and/or replacement of
any type of windows, doors, sidelites, skylights or fixed glass (cladding) the permit holder or qualifier
bearing his signature on the permit application shall abide by the requirements of this department and
comply with the following statement:
Upon obtaining window and/or door permits for the installation of same, it is the responsibility of the
permit holder to request window/door framing in -progress inspection, prior to concealment of any
horizontal or vertical clip mullion, bucks, shims, etc. Inspector will also verify anchor type, edge distance,
embedment and spacing. The purpose for this inspection is for the verification of conformance with
Product Approval (NOA).
Acknowledgement:
ier/Owner Signature Date
For Forms and Applications click here:
Print Name
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Rev01282021 Windows Doors Shutter Checklist Page 2 of 2
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FHIA - DIAGRAM SHEET
�wnDa
ASSRCV 1 MIATFES 3
S
MEASURE TECH
DATE
TONY
08 21 2023
CUSTOMER'S NAME
FHIA LEAD NUMBER
TYPE OF PROPERTY
ROOF HEIGHT
FLOOR NUMBER
TOTAL FLOORS
BOULLON
108889937
HOUSE
12
1
1
34 1/4 X 81 3/4
(+75/-85)
NOA 20-1216.19
(a-
85 NW 102 ST
SFD
BED
1
BATH
BATH
KIT
BED
LIVING
SFD O
DINING
ENTRY
34 114 X 81 1/2
(+75/-85)
NOA 20-1216.19
PRODUCT APPROVAL NUMBER:
20=1216.19
OPENING IDENTIFICATIONS:
1-2.SFD
COUNTY
DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES (RER)
BOARD AND CODE ADMINISTRATION DIVISION
NOTICE OF ACCEPTANCE (NOA)
Eurotech Industries, Inc.
4201 NE 12 Terrace
Oakland Park, FL 33334
SCOPE:
MIAMI-DAME COUNTY
PRODUCT CONTROL SECTION
11805 SW 26 Street, Room 208
Miami, Florida 33175-2474
T (786) 315-2590 F (786) 315-2599
www.miamid adeyov/economv
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
(hi 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 ormaterial fails to perform in the accepted
manner, themanufacturer will incurthe expense of such testing and the AHJmayimmediately 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.
DESCRIPTION: Aluminum Outswing Entrance Door-LNII
APPROVAL DOCUMENT: Drawing No. W04-01 Rev G, titled "Aluminum Outswing Entrance Door", sheets 1,
1. 1, 2 through 5 of 5, dated 01 / 15/04 and last revised on DEC 11, 2020, prepared by AL-Farooq Corporation, signed
and sealed by Jalal Farooq, P.E., bearing the Miami -Dade County Product Control Revision stamp with the Notice of
Acceptance number and expiration date by the Miami -Dade County Product Control Section.
MISSILE IMPACT BATING: Large and Small Missile Impact
Limitations:
1. See Design Pressure (DP) capacity Single doors & Double doors VS locks +bolts, glazing types and water ratings
in sheet 2. Higher DP Single/Double Doors at active leaf require 3-point lock and manual Flush bolts at top/bottom.
2. Single or double doors maybe mulled with approved clipped mullion or sidelites or transom (under separate
approvals), lower design rating shall apply and such installation to be reviewed & approved by AHJ.
LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and series and
following statement: "Miami -Dade County Product Control Approved", 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 otherpurposes shall automatically terminate this NOA. Failure to comply with any section
of this NOA shall be cause fortermination 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 NOA revises NOA # 19-0318.01 and consists of this page 1 and evidence pages E-1, E-2 & E-3, as well as
approval document mentioned above.
The submitted documentation was reviewed by Ishaq I. Chanda,P.E.
5 �_ L �a n NOA No. 20-1216.19
Expiration Date: June 10, 2024
(Approval Date: January 21, 2020
Page 1
Eurotech Industries, Inc.
NOTICE OF ACCEPTANCE: EVIDENCE SUBMITTED
1. Evidence submitted under previous approvals
A. DRAWINGS
1. Manufacturer's die drawings and sections (Submitted under files below)
2. Drawing No. W04-01 Rev C, titled "Aluminum Outswing Entrance Door", sheets 1 through 5 of 5,
dated 01 /15/04 and last revised on FEB 01, 2012, prepared by AL-Farooq Corporation, signed and
sealed by Javad Ahmad, P.E.
B. TESTS (Submitted under files # 14-0303.09/#12-0208.03/#09-0310.05)
1. Test reports on 1) Air Infiltration Test, per FBC, TAS 202-94
2) Uniform Static Air Pressure Test, Loading per FBC, TAS 202-94
3) Water Resistance Test per FBC, TAS 202-94
4) Forced Entry Test, per FBC 24113.2.1 and TAS 202-94
5) Large Missile Impact Test perFBC, TAS 201-94
6) Cyclic Wind Pressure Loading perFBC, TAS 203-94
along with installation diagram of aluminum outswing door, prepared by Hurricane Engineering Testing
Inc., Test Report No(s). HETI- 08-2021, 08-2022, 08-2023 and 08-2024, all dated 03/15/08, signed and
sealed by Candido Font, P.E.
2. Test reports on 1) Air Infiltration Test, per FBC, TAS 202-94
2) Uniform Static Air Pressure Test, Loading per FBC, TAS 202 94
3) Water Resistance Test per FBC, TAS 202-94
4) Forced Entry Test, per FBC 24113.2.1 and TAS 202-94
5) Large Missile Impact Test perFBC, TAS 201-94
6) Cyclic Wind Pressure Loading perFBC, TAS 203-94
along with installation diagram of aluminum outswing door, prepared by Hurricane Engineering Testing
Inc., Test Report No(s). HETI- 03-1882, 08-1889, 08-18890 and 08-2024, dated 01/15/04 thru 02/09/2004,
all signed and sealed by Rafael E. Droz-Seda, P.E. (transferred from file # 08-0507.10)
3. Tensile Test prepared by Hurricane Engineering & Testing, Test No. HETI-04-T100, dtd
01 /29/04, tested per ASTM E8-01, signed & sealed by Rafael E. Droz-Seda, P.E.
C. CALCULATIONS
1. Anchor Calculations and structural analysis, dated 07/23/15, prepared by Al-Farooq Corp., signed and
sealed by Javad Ahmad, P.E.
2. Glazing complies w/ ASTME-1300-04 & -09.
D. QUALITY ASSURANCE
1. Miami Dade Department of Regulatory and Economic Resources (RER).
E. MATERIAL CERTIFICATIONS
1. Notice of Acceptance No.14-0916.11 issued to Kuraray America., Inc. for their "Sentry Glas
® (Clear and White) Glass Interlayer", expiring on 07/04/18.
2. Notice of Acceptance No.14-0916.10 issued to Kuraray America., Inc. for their "Butacite
PVB Interlayer', expiring on 12/11/16.
F. STATEMENTS
1. Statement letter of conformance to FBC 2014 & no financial interests, prepared by Al Farooq
Corporation, dated 07/23/15, signed and sealed by Javad Ahmad, P.E.
2. Lab compliance as part of the above referenced test report.
G. OTHER
1. This NOA renews NOA # 14-0303.09, expiring on June 10, 2019.
2. Test proposal #* 07-3527 approved by BCCO.
Ishaq I. Chanda, P.E.
Product Control Unit Supervisor
NOA No. 20-1216.19
Expiration Date: June 10, 2024
Approval Date: January 21, 2021
E-1
Eurotech Industries, Inc.
NOTICE OF ACCEPTANCE: EVIDENCE SUBMITTED
2. Evidence submitted under #18-0116.03
A. DRAWINGS
1. Drawing No. W04-01 Rev F, titled "Aluminum Outswing Entrance Door", sheets 1, 1. 1, 2
through 5 of 5, dated 01/15/04 and last revised on MAY 08, 2018, prepared by AL-Farooq
Corporation, signed and sealed by Javad Ahmad, P. E.
B. TESTS
1. None.
C. CALCULATIONS
1. None.
D. QUALITY ASSURANCE
1. Miami Dade Department of Regulatory and Economic Resources (RER).
E. MATERIAL CERTIFICATIONS
1. Notice of Acceptance No.16-1116.01 issued to Kuraray America., Inc. for their "Trofosil ultra
clear, clear & color PVB Interlayer", expiring on 07/08/19.
F. STATEMENTS
1. Statement letter of conformance to FBC 6tb Edition (2017) and of no financial interest,
prepared by Al Farooq Corporation, dated 12/10/17, signed and sealed by Javad Ahmad, P.E.
G. OTHER
1. This NOA revises NOA # 18-0116.03, expiring 06/10/2019.
3. Evidence submitted under previous submittal
A. DRAWINGS
1. Drawing No. W04-01 Rev F, titled "Aluminum Outswing Entrance Door", sheets 1, 1. 1, 2
through 5 of 5, dated 01/15/04 and last revised on MAY 08, 2018, prepared by AL-Farooq
Corporation, signed and sealed by Javad Ahmad, P. E.
B. TESTS (Reference current test submitted under files #15-0707.02)
1. Test reports on 1) Air Infiltration Test, per FBC, TAS 202-94
2) Uniform Static Air Pressure Test, Loading per FBC, TAS 202-94
3) Water Resistance Test per FBC, TAS 202-94
4) Forced Entry Test, per FBC 2411 3.2.1 and TAS 202-94
5) Large Missile Impact Test per FBC, TAS 201-94
6) Cyclic Wind Pressure Loading per FBC, TAS 203-94
along with installation diagram of aluminum outswing door, prepared by American Test Lab
of South Florida, Test Report No(s). ATLSF 0304.01-15, dated 05/26/15, signed and sealed
by Stephen Warter, P.E.
I. «.m..).
Ishaq I. Chanda, P.E.
Product Control Unit Supervisor
NOA No. 20-1216.19
Expiration Date: June 10, 2024
Approval Date: January 21, 2021
E-2
Eurotech Industries, Inc.
NOTICE OF ACCEPTANCE: EVIDENCE SUBMITTED
C. CALCULATIONS
1. None.
D. QUALITY ASSURANCE
1. Miami Dade -Department of Regulatory and Economic Resources (RER).
E. MATERIAL CERTIFICATIONS
1. Notice of Acceptance No.' 16-1116.01.issued to Kuraray America., Inc. for their "Trofosil ultra
clear, clear & color PVB Interlayer", expiring on 07/08/19.
F. STATEMENTS
1. Statement letter of conformance to FBC 6th Edition (2017) and of no financial interest,
. prepared by Al Farooq Corporation, dated 02/28/19, signed and sealed by Javad Ahmad, P.E.
G. OTHER
1. This NOA renews NOA # 18-0116.03, expiring 06/10/2024, subjected to verification in next
renewal cycle.
4. New Evidence submitted
A. DRAWINGS
1. Drawing No. W04-01 Rev G. titled "Aluminum Outswing Entrance Door", sheets 1, 1. 1, 2
through 5 of 5, dated 01/15/04 and last revised on DEC 11, 2020, prepared by AL-Farooq
Corporation, signed and sealed by Jalal Farooq, P. E.
B. TESTS
1. None.
C. CALCULATIONS
1. Anchor verification calculations and structural analysis, complying with FBC 01 Edition
(2020), dated 12/11/20, prepared by Al-Farooq Corporation, signed and sealed by Jalal
Farooq, P.E.
D. QUALITY ASSURANCE
1. Miami -Dade Department of Regulatory and Economic Resources (RER).
E. MATERIAL CERTIFICATIONS
1. Notice of Acceptance No.19-0305.02 issued to Kuraray America, Inc. for their
"Trosifol® Ultraclear, Clear and Color PVB Glass Interlayers" dated 05/09/19,
expiring on 07/08/24.
D. STATEMENTS
1. Statement letter of conformance, complying with FBC 7th Edition (2020), dated 11/12/20,
issued by Al-Farooq Corporation, signed and sealed by Jalal Farooq, P.E.
G. OTHER
1. This NOA revises NOA No.19-0318.01, expiring 06/10/24.
Ishaq I. Chanda, P.E.
Product Control Unit Supervisor
NOA No. 20-1216.19
Expiration Date: June 10, 2024
Approval Date: January 21, 2021
E-3
SEE SEPARATE NOA FOR TRANSOM RATING AND DETAILS
LOWER DESIGN PRESSURE OF TRANSOM. DOOR OR
TRANSOM MULLION SHALL CONTROL DESIGN PRESSURE
FOR ENTIRE ASSEMBLY
ALUMINUM OUTSW NG ENTRANCE DOOR
APPROVAL APPLIES TO SINGLE (X) AND DOUBLE (XX) LEAF DOORS.
ALSO SINGLE AND DOUBLE DOORS IN COMBINATION WITH SIDELITES
USING MIAMI-DADE COUNTY APPROVED MULLIONS IN BETWEEN.
ALSO SINGLE AND DOUBLE DOORS WITH OR WITHOUT SIDELITES IN
COMBINATION WITH TRANSOMS USING MIAMI-DADE COUNTY APPROVED
MULLION IN BETWEEN.
LOWER DESIGN PRESSURES FROM DOOR. SIDELITE OR MULLION
APPROVAL WILL APPLY TO ENTIRE SYSTEM.
THIS PRODUCT HAS BEEN DESIGNED AND TESTED TO COMPLY WITH THE
REQUIREMENTS OF THE 2017 (6TH EDITION)/2020 (7TH EDITION) FLORIDA
BUILDING CODE INCLUDING HIGH VELOCITY HURRICANE ZONE (HVHZ).
1BY OR 2BY WOOD BUCKS & BUCK FASTENERS BY OTHERS, MUST BE
DESIGNED AND INSTALLED ADEQUATELY TO TRANSFER APPLIED PRODUCT LOADS
TO THE BUILDING STRUCTURE.
ANCHORS SHALL BE CORROSION RESISTANT, SPACED AS SHOWN ON DETAILS
AND INSTALLED PER MANUF'S INSTRUCTIONS. SPECIFIED EMBEDMENT TO BASE
MATERIAL SHALL BE BEYOND WALL DRESSING OR STUCCO.
A LOAD DURATION INCREASE IS USED IN DESIGN OF ANCHORS INTO WOOD ONLY.
ALL SHIMS TO BE HIGH IMPACT, NON-METALLIC AND NON -COMPRESSIBLE.
MATERIALS INCLUDING BUT NOT LIMITED TO STEEL/METAL SCREWS, THAT
COME INTO CONTACT WITH OTHER DISSIMILAR MATERIALS SHALL MEET THE
REQUIREMENTS OF THE 2017/2020 FLORIDA BLDG. CODE & ADOPTED STANDARDS,
THIS PRODUCT APPROVAL IS GENERIC AND DOES NOT PROVIDE INFORMATION
FOR A SITE SPECIFIC PROJECT, i.e. LIFE SAFETY OF THIS PRODUCT, ADEQUACY
OF STRUCTURE RECEIVING THIS PRODUCT AND SEALING AROUND OPENING FOR
WATER INFILTRATION RESISTANCE ETC.
CONDITIONS NOT SHOWN IN THIS DRAWING ARE TO BE ANALYZED SEPARATELY,
AND TO BE REVIEWED BY BUILDING OFFICIAL.
DESIGN LOADS SHOWN ARE BASED ON 'ALLOWABLE STRESS DESIGN (ASO)'.
42-
TRIBUTARY END LOAD FRAME WIDTH
V
��
o
AND ANCHORS TO BE
a
REVIEWED BY AHJ 13- MAX.
Z "
o
#
HEAD/SILL
5- MAX.
SURFACE APPLIED
FALSE MUNTINS
O
Q
A
MAY BE USED
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a
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SINGLE DOOR W/ 3 POINT LOCK + FLUSH BOLTS
C
-=
LEAF WIDTH
SEE DP CHART ON SHEET 2
m-j
-T—n
-----------------------
LOCK OPTION -1'
SINGLE DOOR W/ 3 POINT LOCK
SEE Op CHART ON SHEET 2
PRODUCT REVISED TYPICAL ELEVATIONS
as complying with the Florlds
Building Com
ROA-Ho. 20-1216.18
Expiration Date 0611012024
By I
111111mml-D&IM Product n
THESE DOORS ARE RATED FOR LARGE & SMALL MISSILE IMPACT.
SHUTTERS ARE NOT REOUIREO.
DEC 11 2020
I
OGEN
No.61223 o ~
fit•' STATfc (drawing no.
%��S�:�ODt��� I W04-01
(4) ANCHORS
AT MTG. STILE ENDS 75 3/4'
AT 3' O.C. FRAME WIDTH
DOOR HINGES 1
SEE SHEET 2 13" MAX. 5' MAX. Z e FOR QUANTITIES HEAD/SILL HEAD SILL M
do CAPACITY A CORNERS O
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u W
APPROVED MULLION . m w +�' z C n
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SEE SEPARATE NOA 2g' N t �-
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D.L. OPG. = 7 N o O.L. OPG. wJ � W O
d
TRIBUTARY END LOAD 36 3/8" 36 3/8" n---
AND ANCHORS TO BE REVIEWED BY AHJ LEAF WIDTH LEAF WIDTH
AT ANCHORS s
AT MTG. STILE ENDS
AT 3' O.C. INTO CONC. 4
U
N
LOCK OPTION '2' °
PRODUCT REI/ESEO
DOUBLE DOOR W/ 3 POINT LOCK +FLUSH BOLTS as cone eettgg with the Florida u w
SEE Dp CHART ON SHEET 2 Beellding�oda d a
NO"o. 20-1216.19
TYPICAL ELEVATION Expirstlon Date 0611012024 Ja
By Is+.� r, L�,.1 t
2
Klan1 O a-0 n 'a' O
�. t0
� '� •' VCENBF'• '�� I � � a
1 gn4n i CZa
DEC 1 i LULU _ No.81223 t
=1VY
0 STATE ly,� drawing no.
/�. ONAI. ..i
DESIGN LOAD CAPACITY - PSF
SINGLE (X) DOORS
DOOR SIZE
GLASS TYPE
WIDTH HEIGHT
EXT. (+)
INT. (-)
2/6
3/0 6/8
3/6
75.0
85.0
75.0
85.0
75.0
85.0
2/6 !
3/0 7/0
3/6
75.0
85.0
7s.o
85.0
75.0
85.0
2/6
3/0
g/0
75.0
85.0
75.0
85.0
DOORS APPROVED FOR INSTALLATIONS
WHERE WATER INFILTRATION RESISTANCE
IS REO"'R"^
3 POINT LOCK SYSTEM AT ACTIVE LOCK S
36' FROM BOTTOM, KEY OPERATED ON
EXTERIOR AND THUMB TURN ON INTERIOR.
STRIKE PLATE
1-1/4' X 1/4" X 16-1/4" LONG
`ATTACHED WITH (2) 18 X 3/4' SMS /
TWO-HANDED COMB HING
EXTRUDED ALUMINUM BRIDGE 2
BY 'GIESSE'
(5) PER LEAF
AT 6", 12", 35'. 63-1/2" AND
92-1/2" FROM TOP OF DOOR
DESIGN LOAD CAPACITY - PSF
SINGLE (X) DOORS
DOOR SIZE
I GLASS TYPE 'B'
WIDTH
HEIGHT
EXT. (+)
TNT. (-)
2/6
3/0
3/3
6/8
100.0
140.0
140.0
100.0
100.0
140.0
2/6
3/0
3/3
7/0
100.0
140.0
100.0
140.0
100.0
140.0
2/6
3/0
3/3
g/0
100.0
140.0
140.0 _
100.0
100.0
140.0
DOORS APPROVED FOR INSTALLATIONS
WHERE WATER INFILTRATION RESISTANCE
IS REQUIRED,
LOCKS SINGLE.DOORS: (OPTION 12)
MANUALLY OPERATED FLUSH DOLTS AT
TOP AND BOTTOM OF ACTIVE LEAF PART 102181
ATTACHED WITH (4) #10 X 1-1/2" SMS.
3 POINT LOCK SYSTEM AT ACTNE LOCK STILE
36" FROM BOTTOM, KEY OPERATED ON EXTERIOR
AND THUMB TURN ON INTERIOR.
STRIKE PLATE
1-1/4" X 1/4" X 16-1/4" LONG
ATTACHED WITH (2) #8 X 3/4" SMS
BINGES SINGLE DOORS:
TWO-HANDED COMB HING
EXTRUDED ALUMINUM BRIDGE 2
BY 'GIESSE'
(7) PER LEAF AT 7/0 AND 8/0 DOORS
AT 3". 9' AND 26-3/8" FROM
TOP AND BOTTOM, ONE AT MIDSPAN
(6) PER LEAF AT 6/8 DOORS
AT 3". 9" AND 26-3/8" FROM
TOP AND BOTTOM
/
I
\
/
I
\
/
I
\
/
I
\
I
/
A
/
\
I
/
DESIGN LOAD CAPACITY - PSF
DOUBLE (XX) DOORS
DOOR SIZE
IGIASS TYPE 'A' OR 'B'
MOTH
HEIGHT
EXT. (+)
INT. (-)
5/0
6/8
75.0
75.0
75.0
75.0
6/4
5/0
7/0
75.0
75.0
75.0
75.0
6/4
5/0
8/1
75.0
v 75.0
75.0
614
75.0
LOADS SHOWN ABOVE ARE FOR
INSTALLATIONS WHERE WATER INFILTRATION
RESISTANCE IS NOT REQUIRED.
LIMIT EXTERIOR(+) LOADS TO 48 PSF
FOR INSTALLATIONS WRERE WATER
INFILTRATION RESISTANCE IS REQUIRED.
LOCKS DOUBLE DOORS: (OPTION 12)
ACTIVE LEAF:
MANUALLY OPERATED FLUSH BOLTS AT
TOP AND BOTTOM OF ACTIVE LEAF PART #02181
ATTACHED WITH (4) 18 X 1-1/2" SMS.
3 POINT LOCK SYSTEM AT ACTIVE LOCK STILE
36" FROM BOTTOM, KEY OPERATED ON EXTERIOR
AND THUMB TURN ON INTERIOR.
INACTIVE LEAS
MANUALLY OPERATED CONCEALED FLUSH BOLTS AT
TOP AND BOTTOM OF INACTIVE LEAF PART 102168
ATTACHED WITH (4) 08 X 1-1/2' SMS.
HINGES DOUBLE DQORS:
TWO-HANDED COMB HING
EXTRUDED ALUMINUM BRIDGE 2
BY 'GIESSE' PRODUCT REVISED
(5) PER LEAF as campg with the Florida
AT 6". 12'. 35'. 63-1/2' AND BalldIng bode
92-1/2" FROM TOP OF DOOR NOA-Ho. 20-1216.19
NOTE: TOP AND BOTTOM FLUSH BOLTS MUST BE
ENGAGED DURING PERIODS OF HURRICANE WARNING.
Expiration Date 06/10/2024
By I„ t'.? ; . e*�"1-
MiamPOude rou n
ITEM 1
PART /
REQD.
DESCRIPTION
MATERIAL
MANF./SUPPLIER/REMARKS
1
ER006
AS REOD.
DOOR FRAME
6063-T6
-
2
ER012
AS REGD.
DOOR LEAF
6063-T6
-
3
VZ1566
1/ LEAF
DOOR BASE BOARD
6063-T6
-
-
4
VZ-1483
1/ DOOR
FRAME SILL
6063-T6
5
-
1/ DOOR
SILL BASE
6063-T6
- --
6
VZ-1481
AS REDD.
ASTRAGAL STILE
6063-T6
7
VZ-1535
4/ LEAF
GLAZING BEAD
6063-T6
-
8
2801
AS REOD.
GLAZING GASKET
EPOM
DUROMETER 75l5 SHORE A
9
-
I
SHEAR CLIP
6063-T6
10
1001/50
1/ CORNER
CORNER KEY
ALUMINUM
MONTICELLO �-
1I
00600X
4/ LEAF
HINGES
ALUMINUM
GIESSE _
12
110 X 3/8'
4/ HINGE
HINGE INSTALLATION SCREWS
-
PH MACHINE SCREWS
13
-
AS REDD.
BULB WSTRIPPING
14
#10 ■ 2'
AS REOD.
ASSEMBLY SCREWS
-
HH SELF DRILLING
15
112 X 1-1/4
-
FRAME ASSEMBLY SCREWS I
- I
SMS
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.�
100' Interfoyer
o
TrosifolnlPVByei
SentryGlos
By 'kurorcy Americo. Inc.' By 'Kuraroy America, Inc.'Ofe
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c
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GLASS TYPE 'A' GLASS TYPE
GLAZING OPTIONS
CIn
n n
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a
NOTE:
GLASS CAPACITIES ON THIS SHEET ARE
^ b
BASED ON ASTM E1300-09 (3 SEC. GUSTS)
0
o e n.'
�
%e - 1
AND FLORIDA BUILDING COMMISSION
b
S n
DECLARATORY STATEMENT DCA05-DEC-219
c "
oI W
00
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DEC 1 s ION
I
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No. 81223
1
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drawl no.
TYPICAL ANCHORS
SEE ELEVATIONS -
FOR SPACING �\
n EDGE Dih
6-1
I B)
I
9
13
ERCE
TYPICAL ANCHORS
SEE ELEV. FOR SPACING
ley
WOOD BUCK
ACCESS HOLES
WITH PLUGS
TYPICAL ANCHORS
SEE ELEVATIONS
FOR SPACING
TYPICAL ANCHORS
SEE ELEVATIONS
FOR SPACING
SEE SEPARATE NOA
FOR TRANSO
RATING AND PErAILS
1
II
GoI
II
II
I`------
II
II
II
II
----------'I
13
MIAMI-DADS COUNTY
APPROVED MULLION
SEE SEPARATE NOA
(SEE Op UMR NOTE IN SHEET 1)
d8 X 1/2" S'
-- 3' FROM ENDS
AND 10' O.C. MAX.
(4) #12 X I" SMS
AT 2' O.C. MAX.
AT CENTER OF SILL
REOD. AT
DOUBLE (XX) DOORS
ONLY
TYPICAL ANCHORS
SEE ELEV. FOR SPACING
PRODUCT REVISED
as camptlling with tho Florida
Building ode
NOA-No. 20-1216.19
Expiration Date 06110/2024
By 1 sl—; I
MlamPfllade r uc OR
SEALANT
ALL FRAME AND LEAF CORNERS AND JOINTS SEALED WITH
ADSEL OR TEKNA 50729 SEALANTS.
Le
TYPICAL ANCHORSMETAL o
SEE ELEVATIONS - STRUCTURE Z w h
FOR SPACING
G n °'
J
EDGE DIST. c9v I
a
/MIL
n 7{
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cn
cn a V p y r- ,
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LLzln 'U.
M'
WOOD BUCKS AND METAL STRUCTURE NOT BY 'EUROTECH' Q w 0
MUST SUSTAIN LOADS IMPOSED BY GLAZING SYSTEM AND
TRANSFER THEM TO THE BUILDING STRUCTURE.
li p
v' 1I
ICAL _ ANCHORS: SEE ELEV. TFORPACINGULTRACON+ BY 'QEWAL7'64 KSI, fy=14p KSI) a C M rn III
INTO 2BY WOOD BUCKS OR WOOD STRUCTURES -
1- t /2" MIN. PENETRATION INTO WOOD (HEAD/JAMBS) z m "� 4
THRU 1BY BUCKS INTO CONC. OR BLOCKS ITj
1-1/4" MIN. EMBED INTO CONCRETE (HEAD/JAMBS) I? I o► v
1-1/4" MIN. EMBED INTO BLOCKS (JAMBS)CL
z cV ` rn
IRECTLY INTO CONCRETE OR BLOCKS v o
1- MIN. EMBED INTO CONCRETE (HEAD/SI BS) �j u
1- t /4" NTO BLOCK jz� 1) Z 'D ; j
ZE
O - o m
A14 SMS OR SELF-QRE LIN • SCREWS (GRADE 2 CRS) j oNoINTO MIAMI-DADS COUNTY APPROVED MULLIONS W It 0
OR
INTO METAL STRUCTURES (HEAD/JAMBS)
(3) THREADS MIN. TO EXTEND BEYOND METAL THICKNESS IL,
ALUMINUM: 1 /8" THK. MIN. (6063-T5 MIN.) i3 m m w w
STEEL: 1/8" THK. MIN. (Fy = 36 KSI MIN.)
(STEEL IN CONTACT WITH ALUMINUM TO BE PLATED OR PAINTED) c
o
a
�o n CRMC-e1 EDGE DISTANCE b o
INTO CONCRETE AND BLOCKS = 2-1/2" MIN. H 3 d faW P
n a a It,
INTO WOOD STRUCTURE = i" MIN. D > > a
INTO METAL STRUCTURE = 3/4" MIN.
WOOD AT HEAD OR JAMBS SG a 0.55 MIN.
0
CONCRETE AT HEAD SILL OR JAMBS PC a 3000 PSI MIN. a o 0 3 r
C-90 HOLLOW/FILLED BLOCK AT JAMBS t'm - 2000 PSI MIN.
0tA
u o w u
No. 8t223 r
DEC
usal'
`�••Cdrowing v no.
TYPICAL ANCHOI
SEE ELE
FOR SPACII
MIAMI-DADS COUNTY O
APPROVED MULLION E
SEE SEPARATE NQA-\
�I
---------
SEE SEPARATE NOA 4 i�
FOR SIDELITE
RATING AND DETAILS jj p j
I
1 /4' MAX.
AL
UCTURE
AL ANCHORS
ELEV.
SPACING
1 /4' MAX.
EXTERIOR
PRODUCT REVISED DOUBLE
as comp ngg with tho Florida D 9QB
Building Godo
KOA-No. 20-1216.19
acp[ratlon Date 0611012024
By 1:"-7 ( �h•n:
Mina[ a e uc n ro
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TYPICAL ANCHORS
SEE ELEV.
FOR SPACING
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DEC 1 1 2020 nlo. Z3 o n
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MIN
ALUM OUTSWING ENTRANCE DOOR (L.M.I.) ,� AL-FAROOQ CORPORATIONFa
Eurotech industries Inc. ENGINEERS & PRODUCT DEVELOPMENT
4201 N.E. 12th Terrace MIA SUNSET DRIVE, SUITE 220
IAMI. FLORIDA 33173 (C.A.N. 3S38) I /�
Oakland Park. Florida 33334 ' TEL (305) 26"100 FAX. (305) 262-6978 �r
I
Tct. (-- , 630-9967 Far. (954) 630-0217 1`
IS
FHIA, LLC
License No. CCC1331144/CGC
061890 / CAC1815985
3801 SW 30th Ave.
Hollywood, FL 33312
AUG 2 9 2023
WA
FHIA
REMODELING
Window & Door Contract
Page 1 of 11
Broward: 954-792-4415
www.fhiaremodeling.com
info@fhiaremodeling.com
Richard Bolton 786-397-0291 Date:0811812023
85 Nw 102st Boullonr@gmail.com Rep: Christyan Calero
Miami FL 33150
This Contract is made and entered into this date of 08/18/2023 by and between FHIA LLC, a Delaware Limited
Liability Company known as ("Contractor" or "FHIA, LLC") Florida LIC: CCC1331144; CGC061890; CAM 815985,
and Richard Bolton ("Owner") for certain Work on the property located at 85 Nw 102st
Miami FL 33150 ("Property").
Pursuant to Florida Statutes § 713.015, the notice required to be printed in no less than 12-point capitalized, bold
face print is contained on Exhibit "A" of this Agreement, on the page immediately following the signature page.
Scope of Work: The Contractor agrees to perform the work described on Exhibit "B" at the Property ("Work").
Contract Sum: Owner shall pay Contractor the sum of $13,800 for the Work, subject to changes as set forth
herein, as follows:
Richard Bolton(Customer's Initials)
Owner hereby agrees that, pursuant to §489.126(2)(a), Florida Statutes, Contractor shall not be liable, nor required
to return any Deposit paid, should the acquisition of permits exceed Thirty (30) days or the commencement of
construction exceed Ninety (90) days.
This space intentionally left blank
e'UlJdgOal_r:' �'. I j'
Page 8 of 11
FHIA One Year Total Investment
$21,589
FHIA Monthly Marketing Promotion
$4,589
Initial Visit Reward
$2,000
Neighborhood Referral Program
$1,000
Manufacturer Instant Rebate
$200
Total Contract Price (including all discounts)
$1%800
Deposit
0.00
Balance Due
$13,800
Balance Form of Payment
Finance
Lender
Aqua
Application ID
3338279
***All discounts are final. No additional promotions apply.***
t-rencn
Door Style
ETI Single Door
Door Brand
ETI Single Door
Glass Type
Clear
Quantity
1
a Location
Living Room
White
Size
36 X 80
Interior Color
Exterior Color
White
_ Door Style
ETI Single Door
Door Brand
ETI Single Door
Glass Type
White Inner -Layer
Quantity
1
Location
Bedroom 1
White
b Size
36 X 80
Interior Color
Exterior Color
White
This space intentionally left blank
leapludigilal.00m 2.15.2
Ron DeSantis, Governor STATE OF FLORIDA Melanie S. Griffin, Secretary
db
'
pr
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
THE GENERAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE
PROVISIONS OF CHAPTER 489, FLORIDA STATUTES
BURNETT, WAYNE THOMAS
FHIA, LLC
3801 SW 30TH AVE
FORT LAUDERDALE FL 33312
LICENSE NUMBER:'CGC061890
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 — 954-831-4000
VALID OCTOBER 19 2022 THROUGH SEPTEMBER 309 2023
DBA:
Business Name. FHIA LLC
Owner Name: WAYNE T BURNETT
Business Location: 3801 SW 30 AVE
HOLLYWOOD
Business Phone: 954-792-4415
Receipt O
#: GENERAL CONTRACTOR ( GENERAL
Business Type: CONTRACTOR (HOME IMPRV) )
Business Opened: 01 / 01 / 2 0 0 6
State/County/CerdReg:CGC 0 618 9 0
Exemption Code:
Rooms Seats Employees Machines Professionals
2
For Vending Business Only
Number of Machines: For
Type:
Tax Amount
Transfer Fee
NSF Fee
Penalty
Prior Years
1
Collection Cost
1
Total Paid
27.00
0.00
0.00
0.00
0.00
0.00
27.00
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is
non -regulatory in nature. You must meet all County and/or Municipality planning
WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location. This receipt does not indicate that the business is legal or that
it is in compliance with State or local laws and regulations.
Mailing Address:
WAYNE T BURNETT
3801 SW 30 AVE
HOLLYWOOD, FL 33312-6809
2022 -2023
Receipt #02B-21-00003369
Paid 08/04/2022 27.00
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000
VALID OCTOBER 1, 2022 THROUGH SEPTEMBER 30, 2023
DBA: FHIA LLC
Business Name:
Owner Name: WAYNE T BURNETT
Business Location: 3801 SW 30 AVE
HOLLYWOOD
Business Phone: 954-792-4415
Rooms Seats
Receipt #: 180-7204
Business Type: GENERAL CONTRACTOR (GENERAL
CONTRACTOR(HOME IMPRV))
Business Opened: 01 / 0112 0 0 6
State/County/Cert/Reg: CGC 0 618 9 0
Exemption Code:
Employees Machines Professionals
2
Signature For Vending Business Only
AL■.a.Mnr of Mae•i�innc• Vending Tvne:
Tax Amount
Transfer Fee
NSF Fee
Penalty
Prior Years
Collection Cost
Total Paid
27.00
0.00
0.00
0.001
0.001
0.00
27.00
Receipt #02B-21-00003369
Paid 08/04/2022 27.00
aI C01U>
`r.� CERTIFICATE OF LIABILITY INSURANCE
DATE 12023 YYYY)
oa/o3no23
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 endorsement(s).
PRODUCER
MARSH USA, U.C.
1221 Brickell Avenue, Suite 1550
Miami, FL 33131
CONTACT
NAME'
PHONE C No):
E-MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC 0
INSURER A: United Specialty Insurance Company
12537
CN142132459--23-24
INSURED HIA, LLC
INSURER B : Crum & Forster SpeclOy Insurance Co
44520
INSURER C : Hudson Insurance Co
25054
3801 SW 30th Avenue
Fort Lauderdale, FL 33312
INSURER D : Clear Spring Property & Casualty Company
INSURER E : Fortegra Specialty Insurance Company
INSURER F :
COVERAGES CERTIFICATE NUMBER: ATL-005578099-02 REVISION NUMBER: 0
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTR
TYPE OF INSURANCE
ADDL
SUER
POLICY NUMBER
MM/DD/ EFF
MM/DD EXP
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE F TIOCCUR
Deductible: $50,000
ATN2356026
04/01/2023
04/01/2024
EACH OCCURRENCE
$ 1,000.000
DAMAGE TO RENTED
PREMISES (Ea occurrence
$ 50,000
X
MED EXP (Any oneperson)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L
X
AGGREGATE LIMIT APPLIES PER:
POLICY PRO- JECT LOC
OTHER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
C
AUTOMOBILE LIABILITY
ANY AUTO
OWNED X SCHEDULED
AUTOS ONLY AUTOS
X HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
HST-000471-00
Comp./Coll.: $2500
0401/2023
04/01/2024
COMBINED SINGLE LIMIT
Ea accrden
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per acclder
$
UMBRELLA LIAB
EXCESS LIAR
X
OCCUR
CLAIMS -MADE
SEO-123279
04101/2023
04/01/2024
EACH OCCURRENCE
$ 2,000,000
X
AGGREGATE
$ 2,000,000
DED T7 RETENTION $
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBEREXCLUDED? FRI
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
CS -WC- 013633-01
PA,MDNJLA
( FL SCTNNC TXOKVA j
AL,MS,OR,NV,AZ,IA,IL,MN,WI,KS )
04100023
041OW024
X PE STATUTE OTH
ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
E
Excess Liability
AUR-XS-01-000165.00
040112023
04/0112024
Each Occurrence
Aggregate
3,000,000
3,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space Is recurred)
License #CGC061890 #CGC1519922 #CCC1331144
Miami Shores Village
10050 NE 2nd Avenue
Miami Shores, FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
i�izls-044 ZtS�0 ..Je_ed!5!
O 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD