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ELC-10-50Inspection Number: INSP - 133242 Permit Number: ELC- 1 -10 -50 1 Inspection Date: January 22, 2010 Inspector: Devaney, Michael Owner: CHURCH, ST ROSE OF LIMA CATHOLIC Job Address: 418 NE 105 Street Miami Shores, FL Project: <NONE> Contractor: SUN POWER ELECTRIC CO Building Department Comments TEMPORARY CHURCH CARNIVAL Passed Failed Correction Needed Re- Inspection Fee January 22, 2010 No Additional Inspections can be scheduled until re- inspection fee is paid. insoection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspector Comments For inspections please call: (305)762 -4949 Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)758 -0539 Parcel Number 1122310150060 Phone: (305)297 -6678 Page 1 of 1 Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Underground W. W. Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795 -2204 418 105 Street Miami Shores, FL Owner Information ST ROSE OF LIMA CATHOLIC CHURCH 9401 BISC BLVD MIAMI FL 33138 -2970 Contractor(s) SUN POWER ELECTRIC CO Phone Cell Phone (305)297 -6678 Type of Work: ELECTRICAL Additional Info: CARNIVAL Classification: Commercial Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $0.60 $0.20 $1,000.00 $3.00 $0.80 $1,004.60 Building Department Copy January 22, 2010 Address Authorized Signature: Owner / Applicant / Parcel Number 1122310150060 Block: Lot: Phone Invoice # Total Amt Paid Amt Due ELC -1 -10 -36808 $ 1,004.60 $ 1,004.60 $ 0.00 Check #: 1145 Contractor / Agent Expiration: 07121!2010 Applicant Date ST ROSE OF LIMA CATHOLIC CI Cell For Inspections please call: (305)762 -4949 Available Inspections: 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, iNINDOWS, 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. January 22, 2010 1 BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Electrical Owner's Address 9401 Biscayne Blvd. City Miami Shores Tenant/Lessee Name E -MAIL: State Job Address (where the work is being done) 41 8 NE 105th S t r e e t City Miami Shores Village FOLIO / PARCEL # Is Building Historically Designated YES Contractor's Address 1363 NE 182 Street Value of Work For this Permit $ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Bond $ Code Enforcement $ Double Fee $ JAN 11 2010 t BY: / Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. I 10 Master Permit No. Owner's Name (Fee Simple Titleholder) Archdiocese of Miami Phone# (3 09)757-6241 FL • - • - 11 _ County NO Zip 33138 one# (305)758 -0539 Miami -Dade Zip 33138 Contractor's Company Name Sun Power Electric Co . , Tnekone# (305)297 -6678 City North Miami Beach State FL Zip 33162 Qualifier Name Si lvio Medi xa Phone# (305) 297 - 6678 State Certificate or Registration No. Certificate of Competency No. CC /300 q-, E-MAIL: Si iv; nMPdi na @aol _ corn Architect/Engineer's Name (if applicable) Phone # Square / Linear Footage Of Work: Type of Work: ['Addition ['Alteration ['New ❑ Repair/Replace ❑ Demolition Describe Work: Temporary Church Carni va Submittal Fee $ Permit Fee $ C���� 6 CCF $ 0•C / CEO //CSC Notary $ Training/Education Fee $ �' J • Technology Fee $ O . OV Scanning $ � C7l J Radon $ DPBR $ Zoning $ Structural Review. $ Total Fee Now Due $ See Reverse side —> 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 Fr F.CTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 F6R 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 qfter the building permit is issued In the absence of such posted notice, the inspection will not be « «j' roved and a reinspection fee will be charged NOTARY PUBLIC: The foregoing instrument was acknowledged before me this 1 1 day of. n , 201 , by S E/t,t S s 1€ wharsonalty kno me or who has produced A P FtY A, <, Dell Marie Springer * Commission # DD566868 N , ^ Expires August 25, 2010 T • Ran - Insurance, Inc 800. 385.7019 Sign: _ Print 'Dieu_ tv1 /�I-�.ItG Pi211Ue1Q.. My Commission Expires: APPLICATION APPROVED BY: (Revised 02/08106) BRIAN MORRISSEY President Signature Contractor The foregoing instrument was acknowledged before me this 0 day of her- ,2007by fr A who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC • STATE OF FLORIDA NOT �" �: .,, "' , Marino Pasache iCOmmission •►,,,,,�• Expires: MAR. 22, 2011 nONtiRia TNttt1 C BONDING COs, INC. 1 4 4: 4 A /0 ASSOCIATES,INC. Main Office: 10420 SW 115 Street • Miami, R 33176 -4045 Phone: (305) 234 -7776 Fox: (305) 252 -2650 Toll Free: (800) 851 -7643 Winterquarters: (305) 232 -9995 Cellular: (786) 586 -9568 Email: bmorri9495 @aol.com www.leisuretimeassociotes.com My Commission Expires: **. *** ***** r***** ter *** ****** **,> ***art** * *,t ***** *** * ** r**** * **** ** Fir* **** * ************ar****** ** u*,>t *>ti**** *, *** Plans Examiner Engineer Zoning 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. INSR r . ADD'L i , F i TYPE OFDISURANCE POUCY NUMBER POLICY EFFECTIVE , . r ,.,.. n r AAA POUCY EXPIRATION _ I 1, i,„ vr.a LIMITS A INSURER k Aspen Insurance UK Ltd GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY A882790 04/03/2009 04/03/2010 EACHOCCURRENCE $ 1,000,000 X DAMAGE TO RENTED P� I. r ) $ CLAIMS MADE X OCCUR XP (Arty one perso (Any one person) $ X $500 Deductible PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L — I AGGREGATE LIMIT APPLIES PER: POLICY I-I jE n LOC PRODUCTS - COMP /OP AGG $ 1,000,000 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 01CB4509013 03/27/2009 03/27/2010 COMBINED SINGLE UNIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) X BODILY INJURY (Per acddent) $ X PROPERTY DAMAGE (Per acddent) GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ 7 OTHER THAN EA ACC $ AUTO ONLY: AGG $ C EXCESS/UMBRELLA LIABILITY 000372390 04/03/2009 04/03/2010 EACH OCCURRENCE $ 4,000,000 " I OCCUR CLAIMS MADE AGGREGATE $ 4,000 000 DEDUCTIBLE RETENTION $ $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, d esaf bo under SPECIAL PROVISIONS below I TfIRY 1 MINT-, I I'M EL EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY UMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS St. Rose of Lima Catholic Church & School, The Archdiocese of Miami, Archbishop John C. Favalora, D.D.S.T.L., M.L.D., Village of Miami Shores, FL are included as additional insureds but only as respects the operation of the named insured per policy terms and conditions. ACORE CERTIFICATE OF LIABILITY INSURANCE DATE(M/DDNYYY) 08/24/2009 AUTHORIZED REPRESENTATIVE Dave Harman/JOANNE a_' , C ''"" .eg-- ' , " --e PRODUCER (425) 454 -3386 FAX (425) 451 -3716 Arthur .7. Gallagher Risk Management Services, Inc. P .0. Box 367 Bellevue, WA 98009 -0367 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 NAIC # INSURED Briggs Transport, Inc . DBA: Modern Midways, Inc. 22901 Sherman Road Steger, IL 60475 INSURER k Aspen Insurance UK Ltd INSURER B: American States Insurance Co INSURER C: James River Insurance Co INSURER D: INSURER E: Village of Miami Shores C/O Mr. Larry 2igmont St. Rose of Lima Catholic Church & School 415 NE 105th Street Miami Shores, FL 33138 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 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Dave Harman/JOANNE a_' , C ''"" .eg-- ' , " --e VER ACORD 25 (2001/08) ©ACORD CORPORATION 1988 CO LTR A ACORD R TIF1CAT E _ .. 203 - 931 -7095 Specialty Insurance, LTD -Tom Plouffe P.O. Box 16901 West Haven, CT 06516 PRODUCER INSURED COVERAGES MODERN MIDWAYS, INC. 879 JOLIET STREET DYER, IN 46377 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE E 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. TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR OWNER'S & CONTRACTOR'S PROT AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY ANY AUTO THE PROPRIETOR/ PARTNERS/EXECUTIVE OFFICERS ARE OTHER CERTIFICATE HOLDE ACORD 2 EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY n INCL EXCL POLICY NUMBER 13- 10804-09035- 8264821N DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES ISPECULL ITEMS St. Rose of Lima Catholic Church & School 415 NE 105th Street Miami Shores, FL 33138 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. COMPANY TRAVELERS INDEMNITY COMPANY A COMPANY B COMPANY C COMPANY D POLICY EFFECTIVE DATE (MMIDD/YY) 2/3/09 CANCELLA COMPANIES AFFORDING COVERAGE POLICY EXPIRATION DATE (MM/DDIYY) 2/3/10 GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGO $ PERSONAL & ADV INJURY $ EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ MED EXP (Any one person) $ COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: AGGREGATE EACH ACCIDENT AGGREGATE EACH OCCURRENCE TORY LIMITS LIIMITS I X I ER EL EACH ACCIDENT EL DISEASE - POLICY LIMIT LIMITS EL DISEASE - EA EMPLOYEE $ DATE (MMIDDIYY) 9 -24-09 1,000,000 $ 1,000,000 $ 1,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Thomas A. Plouffe %AC } t dRRPORATION 1 12/08/2009 17:44 850 -488 -9023 • I. Tag Cf?h' E' s: YOt ?. QI7E,ST'P`D A.' NSPBCTION CAIi MPINgpCTION OP: ' :. oft,. AMT)SBM T RIDES`(`) ON --arr k AzT %-z. . • • Bureau ofFair:Rfdes= ,spectioF frj,spection:Regscett Confirmation DA.' iT .: \ - . cASS is� O • FDA /FAIR RIDES PAGE 03 • • l O M L Th SPBCTTONfP I! CBS AS .A?P7. C I. '• • B, r.. i 'r : $100. c: . PA .0 .B' TO CANCEL S: $I00 EID$ j = , • D. B$ BCTIO,x ,s: • $ ' . g. • 'B '.D QLLDAY : $ 75. X . • :RIDB(S) � 4 c30 AR D ikt$PBCTTOIN PBBS : $ 7. X. _ T(S): • 3; X0 REeginKrE I$• s . S[ DITI:E13 F DATE RBQUESTAD. - �] .\ -, ° L ` 6 \ '4 .V .. ` •• B NOT SCFIBD.ULED FOR DATE RBQLT.SST D. S CECED17..3 1 • ir,OUR.BQUEST IS SCIISDULBD BOR. • ' . CALL; , ' 050)48$ -9790 IF NE DB] , • ' C. ' NCQ LBTB AND NOT SCHBDUL , PL E Tom • FOLLOWENG:IN ORDER_ TO SCEBIYOL.E: . • D. NOTEC1BDULED D.UB TO DN?A]D P. BS ORNSP. CALL • {85.©)488 -9790 TO DISCUSS: • MIAhIT -DADE COUNTY TAX COLLECTOR LOCAL BUSINESS TAX SECTION 140 W. Flagler St. - 1st Floor Miami, Florida 33130 TEMPORARY RECEIPT 2009 -2010 LOCAL BUSINESS TAX Local Business Tax #:00682541 -9 State /CC #:NA Issued to: MODERN MIDWAYS Type of Business: CARNIVAL - SPONSORED THIS RECEIPT IS ISSUED AS EVIDENCE OF PAYMENT FOR YOUR LOCAL BUSINESS TAX OR PERMIT. YOUR OFFICIAL RECEIPT WILL BE MAILED TO YOU WITHIN 10 DAYS FROM THE VALIDATION DATE ON THIS RECEIPT. Payment Received as Certified Above Miami -Dade County Tax Collector 1/8/2010 1300/229/001ILEV 0015 -0002 Last Seq. #:0003 WI LBT #:00 595330 -3 Local Business Tax $352.50 DO NOT FORWARD SUN POWER ELECTRIC CO INC SILVIO J MEDINA PRES 1363 NE 182 ST N MIAMI BCH FL 33162 141 a -t -.1 1.- ....i -. frt 0 I 3 (D v ..,.; ....• 2 2 22 a', . a Ja• U. ;..., isi a cc z pi .... Q.. fi.. 0 •. .)-, f --- i.- :.... a: -1 , 1.-- r, 1 !-.4 55 ' • a %,.. 1 ... . n.... ia. 0 ., --.-t 1 ■ 0 cl 111 t-i 1 0 0-) 1.-- ,-,1 Ec ..., 11. • 11 10 1-4 C. 1 Cu - ,1 Crs t! •= Z57:4 13 .4 13 , 41, Cr IL 1-1t er. .... a ,.. H ; !AI r 1 ,-- :4 i I ,4.. z.... "7 . iii !... 0 0 1 i 4 el IX t t.3 tii ...'" r. ...,1 ,. ' , 1 i 0 CE: Z 4 2 0 c cl.' y: C. a r 1 -• 13 F . 11 „J t-- ;--- 0 1.--i 1.:,1 1:.) E IX 0... ....t Ci.. W ?.... Lt. ..t rf. f --, 13 CI: I-4 1 1 : 11 CU Lj 1:rt t2 1.11 ,--1 1.1.1 33 1.0 r.,.,) LL1 1. 0 Ill* 2 It. > 1 - 4 .1: IX LLI tX -i E, W w 3.. Eri ci a's ii.,i LU , W fS.: 0 a '..e. 2 :-.4 0 ! in 0 > :7_1 2 0 t.rt -7 .... CU W a: tl 01 • rs• I (s I 0 ill 0-. 2 ( 0 "I " "‘ NO ?.."4 al N , co i-- (33 c r.r.= W ;X . rt (.7) „, cl; ft Li. ILL a ta In .r - .-- ,..1 cr.1 0 1 -.,- ; 0 '. '4 ..1 ill e S ■•• ,. N Crl ...1 C.-4 0 al Payment Received as Certified Above •::1 , ......4 .r. !--4 f.. to at a Miami-Dade County Tax Collector W 11) -.- C.... 1.0 (fi ill , C...1 , ..t. - ....i a 1 (4.1 fl, 0 Ce . : 3 _, f i-- Lo ....3 Lu L-- C.r: ca 7: ,..4 :.7:- uJ td sto du 2. ui III i7.1.. At DJ W ....; ...... 4... , ..i L.) ,_ _ ..F• Cl -4 .a W !"-*** .: 0 Z t.'.; 1:: 11 a - it.) r..c.: M ,, :..3 0 4.3 f.„14 4r. 1±.3 I- ,..1 CC. IL1 ,--4 II C) 1 "" 1. - U .7. 7.,.1 ila IA Cr* Of- ::-c: t•;-4 r: C. f'z' , ..., 1 .: ,-.1 --1 1.3 co , -4 r-7 fp 1.11 0 i - :_t a. 7?., IL. S. f..) eT MIAMI-DADE COUNTY TAX COLLECTOR 140 W. Flagler Street g Miami, Florida 33130 11 Please keep your receipt for future reference, Thank you and have a nice day. 10/13/2009 1300/222/001MDM 0008-0001 1 Last Seq..*:0001 WI LBT#:00 678368-3 Local Business Tax $45.00 CHANCE 1 ------ • • 1., A MIAMI-DADE COUNTY TAX COLLECTOR LOCAL BUSINESS TAX SECTION 140 W. Flagler St. - 1st Floor Miami. Florida 33130 TEMPORARY RECEIPT 2009-2010 LOCAL BUSINESS TAX Local Business Tax#:00678368-3 [ State/CCCEC13002897 Issued to: SUN POWER ELECTRIC CO INC Type Business: 1 ELECTRICAL CONTRACTOR $45.00 YOUR OFFICIAL RECEIPT WILL BE MAILED TO YOU WITHIN 10 DAYS FROM THE VALIDATION DATE ON THIS RECEIPT. $0.00 THIS RECEIPT IS ISSUED AS EVIDENCE Og PAYMENT FOR YOUR LOCAL BUSINESS TAX OR PERMIT. 1 of 2 Wor Kers Comp Home Abut 1J'3 Assessment Rates Benefit DE:Tien Process Centralized erformance System Ch, 44C FL Statutes Contact Us Databases no EDI Frequem Quest!ons firstc:ri Memoranda; Bulletins Related [ Rues Safty Statistic s What's New !.trkel'eavkL,77...- •. ■ FLORIDA riKATeim SE 11V I CES Alex Sink hri‘vr cif 1 lorida FLDFS HOME CONTACT US SEARCH BY SUBJECT HELP EN ESPAROL SEARCH RDFS Exemption Details Return to Query Form GO F Detail Page This Database was Last Updated: 10/12/2009 10:15:23 PM Return to Query Form Name Title Effective Date *Termination Date Exemption Type Employe SILVIO J MEDINA PR May 31 2009 May 31 2011- Construction MEDINA El INC SILVIO J MEDINA MEII PR Jun 1 2007 May 31 2009 Construction INC SILVIO J MEDINA PR Mr:DIN.4 El Jun 1 2005 Jun 1 2007 Construction :NC ! I 1.111.01.19h -.! t.f 10/13/2009 1:24 PM 1 oft From: Annette of API Processing <annette @apiprocessing.com> To: janettsilvio @aol.com Subject Emailing: DBPR - MEDINA, SILVIO J; Doing Business As SUN POWER ELECTRIC CO INC, Electrical Contractor Date: Mon, Oct 12, 2009 2:03 pm -- Annette Mote API Processing 3419 Galt Ocean Drive Suite "A" Fort Lauderdale, FL 33308 954 -56770013x10 Office 954- 567 -3401 Fax of Bus •a a .,, LL j3e App!j; View c t ,Jn St a s Term Glossary Online Help (FAOs) Licensee Information Name: Main Address: County: License Mailing: LicenseLocation : County: License Information License Type: Rank: License Number: Status: Licensure Date: Expires: h - Hoil s 1 - -kelp I `Site Maps MEDINA, SILVIO 3 (Primary Name) SUN POWER ELECTRIC CO INC (DSA Name) 1363 NE 182MD ST NORTH MIAMI : §EACH Florida 33162 DADE 1363 NE 162ND ST NORTH MIAMI REACH FL 33162 DADE Electrical! Contractor Cert Electrical EC13OO26 7 Current, Active 06/23/2 FOS X6/31/2010 - - nr 1 i iutiric 1:59:43 PM 10/12/2009 10/112009 2 :04 PM ALEX SINK SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED ELECTRICAL CONTRACTO DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 10 -15 -2009 CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 10/15/2009 EXPIRATION DATE: 10/15/2011 PERSON: MEDINA SILVIO J FEIN: 943472315 BUSINESS NAME AND ADDRESS: SUN POWER ELECTRIC CO INC 1363 NE 182ND STREET N MIAMI BEACH FL 33162 IMPORTANT: Pursuant to Chapter 440 . 05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of eleclion to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certilicates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? 1850) 413 -1609 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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. UISRADD'Il 1. A A 1.11. .,:, .- GENERIC LIABILITY . ' z 1 13 «.. ,:mar. �urY ' X .L _'i FLR54284 POLICY EFFECTIVE 09/25/2009 POLICY EXPIRATION 09/25/2010 1,000 000 . +.,'' �,� .ra� I �, � �i.��.� , ..,� 100,000 CRAMS MADE OCCUR ED 2 {' �L .I: 6,000 In ,, ,, , I. 1,000,000 GENERAL ,r. • _ : 2.000,000 ' IT MIT S PER , • r - COMP�PAGG 1,000,000 P cffli LOC AU .. • • BILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEVULEDAUTOS HIREDAUTOS NON.OVB EDAUTOS (E SINGLE MET 5 BODILY INJURY (Per Pte) $ BAY INJURY (Pei' t) $ � 5 GARAGE LIABILITY ANY AUTO AUTO ONLY - EAACCIDENT 6 OTHER THAN EAACC 5 AUTO ONLY: AGO 6 EXCESS /UMBRELLA LIABIUTY 1 OCCUR ❑ CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE 5 AGGREGATE $ 5 WORKERSOOMPENSATtON AND EMPLOYERS' LIABILITY ANY PROPRIETORRPARTNERIEOCUTNE r OFRCEI EMEIAEET EXCLUDED? w In NH) l ak es PROVIS below NCSTATU- OTH- R' I EL. EACH ACCIDENT 5 EL DISEASE - EA EMPLOYEE $ EL DISEASE- POUCYUMIT $ OTHER DESORIFTlON OF OPERATIONS /LOCATIONS /VEHICLES t EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS .4C0RO PRODUCER INSURED Allstar Direct Insurance 16123 Biscayne Blvd Aventura (305) 754 -7414 Sun Power Electric Co., Inc 1383 NE 182nd St North Miami Beach CERTIFICATE OF LIABILITY INSURANCE FL 33160 FL 33162- 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 wsuRER AAMERICAN STRATEGIC INSURERR INSURER INSURER 11 INSURER E: DATE (MMIDD1YYYY) 12/22/2009 NAIC # 10872 COVERAG CERTIFICATE HOLDER ACORD 25 (2009/01) MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2 ND AVE MIAMI SHORES CANCELLATION Al MORVDV SHOULD ANY OF THE ABOVE DESCRIBED POLKXES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, TIE ISSUING INSURER WILL ENDEAVOR TO MAIL 0 DATE SHUTTER NOTICE TO THE CERUFIOATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR UABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR FL 33138- AUTHORIZED REPRESENTATIVE a • 'z / 1988-2009 ACORD CORPORATION. Aft rights reserved. The ACORD name and logo are registered marks of ACORD AC# 4643573 DATE BATCH NUMBER 10/01/2009 090163708 EC13002897 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS Expiration date: AUG 31, 2010 MEDINA, SILVIO J SUN POWER ELECTRIC CO INC 1363 NE 182ND ST NORTH MIAMI BEACH FL-33162 CHARLIE CRIST GOVERNOR STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD $EQ# L0910010603 LICENSE NBR PLAYAS REQUIRED BY LAW CHARLES W. DRAGO SECRETARY