Loading...
MC-10-2132Inspection Number: INSP- 153869 Permit Number: MC -12 -10 -2132 Scheduled Inspection Date: December 21, 2010 Inspector: Perez, JanPierre Owner: CHARLES, MARILYN & JOSEPH Job Address: 1248 NE 99 Street Project <NONE> Miami Shores, FL 33138- Contractor: REEVE AIR CONDITIONING CONTRACTOR Building Department Comments INSTALL NEW AH & COND UNIT 2.5 TON T-47 I /D Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments December 20, 2010 For Inspections please call: (305)762 -4949 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number (305)751 -4669 Parcel Number 1132050090170 Phone: (954)764-4481 Page 17 of 28 BUILDING PERMIT APPLICATION FBC 20 • Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): TO6 G4 f RLE •S Phone#: 3OS 761" 17/66 9 Address: i 2. ? ill E (j y S 'T City: h - ► 14' s h 61z E5 State: L-R . Zip: 3 3 /3? Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: l L 1 -1 £ ° < 3 T City: S cA Miami Shores County: Folio/Parcel #: Is the Building Historically Designated: Yes CONTRACTOR: Company Name: R( irC 2 . 5 - 0 1 s, pol-rat ,a Address: City: Qualifier Name: Type of Work: Address Description of Work: Fee $ 11- 3205 (7,, HA, D State: ? L_. 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Miami Shores Village Building Department State Certification or Registration #: C ' b 2C 3 7 Certificate of Competency #: Contact Phone#: 3G C ° 7)57?— Li/ 73 1 Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 39it Square/Linear Footage of Work: DAlteration 5 % -LL /lir�r 2- - 70 ** ************ * *******: tax ************** / * ees ** ** *********************************** 1 ) V CCF $ CO /CC $ Scanning Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ Permit Fee $ Radon Fee $ Leo Miami Dade l� Permit No. 1`� IDA- Master Permit No. NO ° Flood Zone: Phone #: 3 Phone #: New la ir/Re P P lace Zip: 3 3 13 8 C o &. D. U'u t7 Zip 3 3 G 6 (-757-t7p UDemolition TOTAL FEE NOW DUE $ t Bonding Company's Name (if applicable) Bonding Company's Address City State Zip 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 FT.F,CTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S A)HFLDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this 3D day of Alai) , 20 J, by JOSE/Oil G?. 06I -RLE S who is personally known to me or who has produced C —' P 37,-6 As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Co ******** APPROVED BY 1' 0 A // /7Cr ex % . OBERT O. WHITE MY COMMISSION # DD661833 +4 EXPIRES: Apn120, 2011 (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) ** ******************************* to Plans Examiner Structural Review Signature Sign: Print: Contractor The foregoing instrument was acknowledged before me this 30 day of NOV , 20 p D , by STE j p140( E. RAVE who is n y known to or who has produced as identification and who did take an oath. NOTARY PUBLIC: My Commis * . reROBERT 0. WHITE MY COMMISSION # DD661833 EXPIRES: April 20, 2011 I$0044NOTARY FL Nanry Discount Assoc. Co. Zoning Clerk UNIT BEING REPLACED DATA NEW UNIT li Fe. i-ta MANUFACTURER WC-C.6- RBEA -173 7 s Li £,4 2 AHU or PKG. UNIT MODEL # / HH 2 tom RA-In A a C.0 , olz COND. UNIT MODEL # RI M 30/i0/ 75 KW HEAT °7.•5 2 / /2L NOM TONS 2- I X AHU j CU 2S PKG 1) M.C.A AHUy® CUaS PKG AHU 45 CU 30 PKG 2) M.O.P AHUIK CU 30 PKG AHU 23A CU t3 PKG 3) VOLTS AHUi36CUZ3® PKG PKG UNIT / / PKG UNI / / /b EERISEER 9 1 to YES NO v' REPLACING DUCTS YES / /// NO YES r/ NO REPLACING THERMOSTAT YES V NO YES NO NEW 4 "CONCRETE SLAB YES NO YES NO NEW : STAND W RALCe Warr YES 7 NO YES NO NEW RETURN PLENUM BOX YES NO V This form must accompany ALL air conditioning replacement permit applications. Each unit change - out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): 1 214 E _ 9 '9 ST - City: City: Miami Shores Village County: Miami Dade Zip Code: 33 13? ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO F9 ARHI Sheet Attached: YES ❑ Contract Attached: YES V 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3 3. Voltage of Circuit (208/240/480): '2- 1 4. Size Disconnecting Means: 1 °' Contractor's Company Name: REeVE /} /e° C© ,Ji). Phone: 3 73 State Certificate or Registration N. £14C 0 Z� ( 7' 3? Certificate of Competency N. Signature (Qualifier's signa a only) AIR CONDITIONING REPLACEMENT DATA ZS Miami Shores Village Building Department 10050 N. E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 PERMIT NUMBER: MC Date: 11/30/f 0 UNIT BEING REPLACED DATA NEW UNIT K4 fits;v. MANUFACTURER � CrH RUA- /7707sv£A2 AHU or PKG. UNIT MODEL# $/¢p2/5075 RA-MA - 03D .7"11z COND.UNITMODEL# /41 4i M 30 /9O/ T � , > KW HEAT 2 A. NOM TONS 7- 4 AHU lip CU 2S PKG 1) M.C.A AHUym CU .:IS PKG AHU gig CU 30 PKG 2) M.O.P AHU CU 30 PKG AHU 23b CU 7.3a PKG 3) VOLT S AHU23pCU23d PKG PKG UNIT / / PKG UNIT / / /D _ EERISEER 13 1 / (.o YES NO REPLACING DUCTS YES NO i/' YES ✓ NO REPLACING THERMOSTAT YES V/' NO YES NO _ NEW4"CONCRETE SLAB NEW : STAND 're_ EMSe (44),r YES NO ✓ YES NO YES r/ NO YES NO NEW RETURN PLENUM BOX YES NO ✓ 1 Signature (Quaiiner s signs only) AIR CONDITIONING REPLACEMENT DATA Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): 12. if c' /LIE, 9' 9 Sr City: Miami Shores Village County: Miami Dade Zip Code: 33 /3? ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO ERHI Sheet Attached: YES Ell<lir Contract Attached: YES jE 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3 D 3. Voltage of Circuit (208/240/480): 2. 4. Size Disconnecting Means: 3 Contractor's Company Name: R EVE ft l e, CON .D. Phone: State Certificate or Registration N. (24C 07f Y3 7 Certificate of Competency N. Date: ///3p/ 6 REEVE AIR CONDITIONING, INC SINCE 1957 State Licensed CACO25438 & Insured 2501 S. Park Road, Hallandale, Florida 33009 a Broward 954- 764 -4481 Fax 954- 962 -9600 Dade 305- 758 -4731 STREET: d `�..�1 . N E. 99 S?: NAME: CITY: i l ( 01-67( 5iftiNE S PHONE: 305 -751- % lam: E ' 30 1 90 ( g6'I1 2- /7'0 New Thermostat - [� Digital Condensation Drain Piping [ ] New Indoor A/H Stand [ ] New Aluminum Roof Stand cL New Hurricane Straps Proposed R I-1EE'/✓1 System Brand Limited Warranty: 1 Yrs. Labor, Authorized Signature: Date: 11 °- I6 Signature: PROPOSAL 500, 00 FPI- DAT LOCATION: 11,57 -401 S Si' .5 rF/v, s STATE: 'r L / ZIP: 33 kg FAX: ALTERNATE: 7 - fp 22? „IN O V 4 . 9// o We Hereby Submit Specifications and Estimates to Furnish and Install: 4 R410A 0. Condensing Unit IA—Air Handler / Fan Coil with P24-1, 5 K.W. Electric Heat $4_Reconnect to Existing Adequate Electric, wiring, fusing, etc OR [ ] Customer and / or an Electrician is Responsible for Providing Electric to the Equipment Materials and Labor Include: , 3- C{f' m. FA'5h' Refrig Lines — [ ] w/ Wall Chase - Install New Float Switch [ ] New Cement Slab [ ] New Outdoor Wall Bracket [ ] Other: Proposed System Equipment Cost $ 39 /0 , 0 BTU Capacity 7 . - ' ' , & 0 @ 1(, SEER Total Labor & Materials $ ,' C /- • Yrs. Parts, 1 Yrs. Compressor WTY NET TOTAL PRICE $ 3 WO, 0 0 4LsO Qv&L.( pie S Fog. F--FQ 7itiA C Reof r - 30 Any Building Permit Fee, and the costs of obtaining one will become an additional charge over and above the Net Total Price. Terms: 10% Deposit upon Acceptance of this Proposal, Balance in Full upon Completion / Start-up All material is guaranteed to be as specified. Any alteration from the above specifications involving extra costs, will be executed only upon written orders, and will become an extra charge over and above this proposal. Suitable space and access for this installation must be provided by the customer. All agreements contingent upon strikes, accidents or delays beyond our control. This Proposal subject to acceptance within _3_ days an is void thereafter at the option of the undersigned. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. It is agreed that title to the above specified equipment and materials, remain titled to seller, until fully paid for. In the event it shall become necessary to collect the money described herein or any part thereof, I agree to pay any cost thereof, including reasonable attorney's fees. I further acknowledge and agree that a service charge of 1.5% per month will be applied to all amounts which are delin, uent 30 days past due. Print name: V 0, 1 . 6 19 c9/'74' S Certificate of roduct ratings AHRI Certified Reference Number: 3412342 Date: 11/30/2010 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 14AJM30 Indoor Unit Model Number: RBHP -21 +RCHL -36A1 Manufacturer: RHEEM MANUFACTURING COMPANY Trade /Brand name: RHEEM 14AJM SERIES Manufacturer responsible for the rating of this system combination is RHEEM MANUFACTURING COMPANY Rated as follows in accordance with AHRI Standard 210/240 -2006 for Unitary Air - Conditioning and Air - Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI- sponsored, independent, third party testing: Cooling Capacity (Btuh): EER.Rating (Cooling): SEER Rating (Cooling): 28800 13.00 16.00 This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2010. * Ratings followed by an asterisk (') indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disclaims ad liability for damages of any kind arising out of the use or performance of the product(s), or the unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed In the directory at www.ahridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRL This Certificate shall only be used for individual, personal and confidential reference purposes. The contents of this Certificate may not, in whole or in part, be reproduced; copied; disseminated; entered into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's individual, personal and confidential reference. CERTIFICATE VERIFICATION The Information for the model cited on this certificate can be verified at www.ahridirectory org, click on "Verify Certificate" link and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above, and the Certificate No., which Is listed below. ©2010 Air - Conditioning, Heating, and Refrigeration Institute $t ' I Air- Conditioning, Heating, * • and Refrigeration Institute CERTIFICATE NO.: 129356097208248878 t CUMULATIVE SUBSTANTIAL IMPROVEMENT VERIFICATION WORK SHEET In accordance with FEMA regulation and Miami Shores Village Flood Damage Prevention Ordinance the costs of all improvements must be monitored. The costs of any improvements in the past 12 months and the costs of any proposed improvements must be shown on the worksheet. The cost of improvements must include demolition, raw and finished materials (include those donated), labor (including volunteer and self - performed), construction supervision and management, and overhead and profit. A list of items the costs of which are to be included as well as those excluded is attached for your reference. �(A Copy of the Contract must be attached) PROPERTY OWNER: 1 rI aCC 1►111 j a %S ep H Chfa (tte S PERMIT # M C - /a - /0 - . ADDRESS: ( aq i NE 99 S #lEE o M! i t SU©(ZES I FL 3313? FOLIO NUMBER: /1 - 39.0 5 009-0170 FLOOD ZONE: A 6 BASE FLOOD ELEVATION: g FREEBOARD: EAST OF FL.CCCL: COST OF PAST IMPROVEMENTS (12 MONTHS): COST OF PROPOSED IMPROVEMENTS: (ATTACH COPY OF CONTRACT) OWNERS SIGNATURE: PLANREVIEWER: PLAN REVIEWER SIGNATURE: Created on June 2009 TOTAL CUMULATIVE COST OF IMPROVEMENTS (past and proposed): / (77f4 r d GI V O l x VALUE OF PRINCIPAL STRUCTURE (attach appraisal): G-> '17/. DATE:__ SUBSTANTIAL IMPROVEMENT / DAMAGE LIST (NOTE: THIS LIST IS INTENDED FOR GUIDANCE ONLY, AND IS NOT ALL INCLUSIVE) ITEMS TO BE INCLUDED ALL STRUCTUAL ELEMENTS, INCLUDING Foundations including; Spread footing, Continuous footing, isolated footing, piles and pile caps Slabs including; Monolithic, floating, elevated Walls including; Exterior walls, Bearing walls, Shear walls Beams, Tie Beams, Columns and Posts Wood decking, Floor and Roof Sheathing Trusses, Joist Windows /Doors ALL BUILDING ELEMENTS, INCLUDING Interior Partitions, Walls, Columns Drywall, Ceilings, Built in Furniture, Cabinets, Vanities All Fixtures Flooring, Tile, Carpet, Stone, Linoleum, ect. All Finishes including Drywall, Paint, Stucco Plaster, Paneling, Tile, Marble, and Moldings Roofing Material ALL HARDWARE ALL UTILITY and SERVICE EQUIPMENT HVAC Electrical System and Equipment Plumbing System and Equipment Security System and Equipment Central Vacuum System Plumbing Fixtures Lighting Fixtures and Ceiling Fans Water Systems including Softeners /Filtration Created on June 2009 ALSO: All Labor and other Costs associated with Demolition, Removing, Replacing, Installing Building or Altering Building Components Construction Management / Supervision Overhead and Profit Equivalent cost for: Donated Materials Volunteer Labor (including owners and friends) Any Improvements Beyond Pre - damaged Condition, including; Utility Upgrades Code Upgrades ITEMS TO BE EXCLUDED Plans and Specifications Survey Costs Elevation Certificate Costs Permit fees Debris Removal Items not considered to be REAL Property Rugs, Furniture, Refrigerator, Appliances not Built -in Outside Improvements, Including; Landscaping Sidewalks Patios Fences Yard lights Sheds Gazebos Irrigation Pool I J i Primary Zone: 1400 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds /Baths: 3/3 Floors: 2 Living Units: 1 Adj Sq Footage: 2,906 Lot Size: 10,900 SQ FT Year Built: 1949 Legal Description: EARLETON SHORES PB 43 -80 LOT 5 & W25FT LOT 4 BLK 2 LOT SIZE IRREGULAR OR 10073 1973 74 0678 4 Year: 2010 2009 Taxing Authority: Applied Exemption/ Taxable Value: Applied Exemption/ Taxable Value: Regional: $50,000/ $199,638 $50,000/ $193,075 County: $50,000/ $199,638 $50,000/ $193,075 City: $50,000/ $199,638 $50,000/ $193,075 School Board: $25,000/ $224,638 $25,000/ $218,075 Folio No.: 11- 3205 -009 -0170 Property: 1248 NE 99 ST Mailing Address: JOSEPH G CHARLES &W MARILYN 1248 NE 99 ST MIAMI SHORES FL 33138 -2643 Year: 2010 2009 Land Value: $131,515 $192,284 Building Value: $244,504 $262,491 Market Value: $376,019 $454,775 Assessed Value: $249,638 $243,075 Property Information Map { Property Information Map Aerial Photography - 2009 This map was created on 12/2/2010 1:06:52 PM for reference purposes only. Web Site © 2002 Miami -Dade County. All rights reserved. My Home Miami -Dade County, Florida 0112ft Summary Details: Property Information: Assessment Information: Page 1 of 1 Exemption Information: Taxable Value Information: http: / /gisims2.miamidade. gov /myhome /printmap. asp? mapurl = http: / /gisims2.miamidade. go... 12/2/2010 2010 2009 Homestead: $25,000 $25,000 2nd Homestead: YES YES Property Information Map { Property Information Map Aerial Photography - 2009 This map was created on 12/2/2010 1:06:52 PM for reference purposes only. Web Site © 2002 Miami -Dade County. All rights reserved. My Home Miami -Dade County, Florida 0112ft Summary Details: Property Information: Assessment Information: Page 1 of 1 Exemption Information: Taxable Value Information: http: / /gisims2.miamidade. gov /myhome /printmap. asp? mapurl = http: / /gisims2.miamidade. go... 12/2/2010 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I LTR I TYPE OF INSURANCE POLICY NUMBER E 1VE DA ER Eli L N (M LIMITS A GENERAL LIABILITY NZ COMMERCIAL GENERAL LIABILITY CLAIMS MADE V OCCUR CFM 90524673 12/14/09 12/14/10 /DAMAGE EACH OCCURRENCE $ 500,000 TO RENTED PREMISES (Ea occurence) $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 500,000 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY n PROJECT n LOC PRODUCTS - COMP /OP AGG $ 1,000,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS II SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN • EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY OCCUR fl CLAIMS MADE DEDUCTIBLE 7 RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ $ B WORKERERS' EMPLOY ANY OFFICER/MEMBER If yes, SPECIAL BILITY S CO MPENSATION AND LIA PROPRIETOR/PARTNER/EXECUTIVE EXCLUDED? 2700008288 12/14/09 12/14/10 11 // - TO RY LIMI n ER E. L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 describe under PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLE$ /OCCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS PRODUCER McTaggart Insurance Agency, Inc 9900 Stirling Road Cooper City, FL 30024 INSURED Reeve Air Conditioning Inc. 2501 South Park Rd.. Pembroke Park.FI 33009 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A Zurich INSURER B: Everest INSURER C: INSURER D: INSURER E: DATE (MM /DD/YYYY) 12/08/2009 NAIC # COVERAGES CERTIFICATE HOLDER ACORD 25 (2001/08) City of Miami Shores 10050 NE 2ND Ave. Miami Shores, FI. 3 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE f10 9BUGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIIVAS. r AUTHORIZED REP ftESE b © ACORD CORPORATION 1988