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DGT-10-370500 NE 102 Street Miami Shores, FL 33138- Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 OS JOHN BUTLER 500 NE 102 Street MIAMI SHORES FL 33138 -2455 Contractor(s) Phone IMBURGIA CONSTRUCTION SERVICE 305/525 -5707 Cell Phone Expiration: 10 /26/2010 Approved: Yes Comments: THE DECK MUST BE LOCATED ON THE SITE PLAN AND THE SITE PLAN AND DECK SCALED M Date Approved: 4/26/2010: Yes Date Denied: 4/19/2010 Type Const: Wood Deck Classification: Residential Additional Info: BUILDING Fees Due CCF Education Surcharge Permit Fee - Deck (wood) Scanning Fee Technology Fee Total: Amount $0.80 $0.20 $150.00 $8.00 $0.80 $157.60 May 10, 2010 Pay Date Pay Type Amt Paid Amt Due Invoice # DGT -3 -10 -37237 05/10/2010 Credit Card $ 157.60 $ 0.00 Valuation: Total Sq Feet: $ 1,000.00 654 Available Inspections: Inspection Type: Final Foundation Framing in Progress MIAMI SHORES VILLA 10050 NE 2ND AVE MIAMI SHORES, FL 3: (305) 795 -2209 Sale 42929800429003 237828 i10 A: 65 XXXXXX1022M Code: 131179 Iriv- Applicant Copy For Inspections, Call (305) 795 -2204. Requests must be received by 3 pm for following day inspections. NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER additional restrictions applicable to this property that may be found in GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT the public records of this county. DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. 2 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795 -2204 500 NE 102 Street Miami Shores, FL 33138- 500 NE 102 Street MIAMI SHORES FL 33138 -2455 Contractor(s) Phone IMBURGIA CONSTRUCTION SERVICE 305/525 -5707 Cell Phone Approved: Yes Comments: THE DECK MUST BE LOCATED ON THE SITE PLAN AND THE SITE PLAN AND DECK SCALED AI Date Approved: 4/26/2010: Yes Date Denied: 4/19/2010 Type Const: Wood Deck Classification: Residential , Additional Info: BUILDING , Fees Due CCF Education Surcharge Permit Fee - Deck (wood) Scanning Fee Technology Fee Total: Amount $0.80 $0.20 $150.00 $8.00 $0.80 $157.60 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. Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy May 10, 2010 Expiration: 10 /26/2010 Pay Date Pay Type Amt Paid Amt Due Invoice # DGT -3 -10 -37237 05/10/2010 Credit Card $ 157.60 $ 0.00 Valuation: Total Sq Feet: $ 1,000.00 654 1 Available Inspections: Inspection Type: Final Foundation Framing in Progress May 10, 2010 ate 1 BUILDING PERMIT APPLICATION FBC 20 e: BUILDING cit 1\-A Shor State Tenant/Lessee Name Email Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit T % ROOFING J o h na etA- %tl'e.2 Owner's Name (Fee Simple Titleholder) L` r &'j r'12.. 1 r 101.1 r, Gl ,Phone # Owner's Address 51)0 N E t oz. > f•• V City Miami Shores Village County Miami -Dade FOLIO / PARCEL # 1 ) - ?J P-0 l6 - 0 1 1 - 1 0.1 D Permit No. D! T O ° (,„;i/l Master Permit No. 1 3 5 Zip S3 13 B Phone # Job Address (where the work is being done) 50 O 1.3e 102. St Is Building Historically Designated YES NO Contractor's Company Name MG W2-.511 CO i\)S'tr u L� Phone # Contractor's Address ) g Nt. 1L/ °r . tot 5+. City N• VIA 1 a V Vl l State a_ Zip OaCTOMM Ia MAR 9 2010 LUJ BY: SOs - ' 1'7e •/ `7 s31 3$ Flood Zone 3 ' .5. 940 .(0 �I a Zip 53181 Phone # ©S' 5 S". Sr? o Qualifier Name Lo S. I liv.bUra i of J. State Certificate or Registration No. C6/ C 0 11 Certificate of Competency No. ✓ Contact Phone K 5a 5 r1 0 E -mail Loci s 9 /i iburyiei,con•s -truc -'ai • car o Architect/Engineer's Name (if applicable) - Phone # a o 07k/ � L Value of Work For this Permit $ Square /Linear Footage Of Work: Type of Work: ['Addition ['Alteration I,New ❑ Repair/Replace ❑ Demolition Describe Work: eon s i rut &(7'a s 6 7 W0DOI (lied V. C9n loci - n 1n o wta * * * ** ** * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************** * * * * * * * * * ***** * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ Aso CCF $ 0 "(00 Notary $ Training/Education Fee $ d "a 0 Scanning $a VI,.) Radon $ DPBR $ CO /CC $ Technology Fee $ . iW Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ ISM (j) See Reverse side -* Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State C•CC (AA6 •NIC 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 jurikdiction. I understand that a separate permit must be secured for ELECTRICAL WORK , PLUM BING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDMONERS, 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 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 s spection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspecti n wil not e appr an_ a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this I R day of VViq itkt, 20 JO, by who • Sign: Print: NOTARY PUBLIC: My Commission Expires: * * * * * * * * * * * * * * * * * * ** APPROVED BY (Revised 07 /10 /07)(Revised 06/10/2009) ho has produced As identification and who did take an oath. 0 z. . � : F t ' .1 9 .,70 fl y . v. /11 11111111111 111 ` Plans Examiner Engineer Signature Contractor The foregoing instrument was acknowledged before me this day of ,20 who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: Clerk checked fanning and Zonin Owner's Name: JOHN BUTLER Job Address: 500 102 Street Miami Shores, FL 33138- Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Criteria Permit NO. DGT -3 -10 -370 Expires: N ot Issued Folio Number:1132060171070 Owner's Phone: Total Square Feet: Total Job Valuation: Contractor(s) Phone IMBURGIA CONSTRUCTION SERVICES, INC. 305/525 -5707 Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: No Date Denied: 4/19/2010 Comments: THE DECK MUST BE LOCATED ON THE SITE PLAN AND THE SITE PLAN AND DECK SCALED AND DIMENTIONED BEFORE IT CAN BE REVIEWED. 4/19/10 PLEASE PROVIDE DIMENTIONS BETWEEN DECK AND SIDE AND REAR LOT LINES. A 5 FOOT LANDSCAPE STRIP MUST BE PROVIDED BETWEEN THE DRIVEWAY AND DECK. PLEASE SHOW ON PLAN cktz_ Ne v00 ∎ 6 n o vn,2 \ oC cue \ \ -(o r\A- c \A0 e- Pte- 1017- D&-10333 o va 6(.e f2.VJC back rNo ton fj \WL OV-Q1‘0 \, moirL •-\\`' ‘0 nn and Z fling Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 roteria Contractor(s) Phone IMBURGIA CONSTRUCTION SERVICES, INC. 305/525 -5707 Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: No Date Denied: 4/16/2010 Comments: THE DECK MUST BE LOCATED ON THE SITE PLAN AND THE SITE PLAN AND DECK SCALED AND DIMENTIONED BEFORE IT CAN BE REVIEWED. Folio Number:1132060171070 Owner's Name: JOHN BUTLER Job Address: 500 102 Street Miami Shores, FL 33138 Owner's Phone: Total Square Feet: 654 Total Job Valuation: $ 1,000.00 RECEIPT PERMIT # T I Q - 31 DATE: 0 1 f ji 1, Os . 61A-feL ❑ Contractor Owner ❑ Architect Picked up 2 sets of plans and (other) Address: 5O 10. From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village uildin epa m is continue permitting process. AO IP V S ' Acknowledged PERMIT CLERK INITIAL: RESUBMITTED DATE: PERMIT CLERK INITIAL: -e-SA) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 7' PARKWAY REVISED: NOT VAUD UNLESS EMBOSSED WITH SURVEYOR'S SEAL 5.20' 5.20' TPAVEMENT 5th AVEN 13.60' 12.30' 10.7' 36.60' 39.20' 6' WIF ox n u 38.50' 37.50' SINCE 1987 BLANGO SURVEYORS ING. Engineers • Land Surveyors • Planners • LB # 0007059 555 NORTH SHORE DRIVE MIAMI BEACH, FL 33141 (305) 865 -1200 Email: blancosurveyorsinc @yahoo.com Fax: (305) 865 -7810 SUFFIX: j DATE: 7/17/95 BASE: N/A COMMUNITY # 120652 i HEREBY CERTIFY That the survey represented thereon meets the minimum technical requirements adopted by the STATE OF FLORIDA Board of Land Surveyors pursuant to Section 472.027 Florida Statutes. There are no encroachments, overlaps, easements appearing on the plat or visible easements other than as shown hereon. ADIS N. NUNEZ REGISTERED LAND SURVEYOR STATE OF FLORIDA #5924 DWN. BY: F. Blanco 115.00'(R &M) Q 1 r- 0 0 • • •• • •• • • •• •• • • • • • • • • • • •• • 0 • • s' ••� O DQ 0 0 • ••• i. � • , ■• . • •••z7.50' L • • ABBREVIATIONS: SWK =S =DEWWLK CBS = CONCRETE BLOCK STRUCTURE, CLF =CHAIN LINK FENCE, PL =PROPERTY LINE, DUE = DRAINAGE UTILITY EASEM EM, IP =IRON PIPE, F =FOUND, A/C =AIR CONDITIONER PAD, PIC= PROPERTY CORNER, D!H =DRILLED HOLE, W/F =WOODEN FENCE, RES=RESIDENCE, CL- CLEAR, RB= REB.AR, UE= UTILITY EASEMENT: CONC = CONCRETE SLAB, RM RIGHT OF WAY, DE =DRAINAGE EASEMENT C/L -CENTER UNE, O=DIAMTER, TYP =TYPIC /1, M=MEASURED, R= RECORDED - N/D=NAIL COMP - COMPUTER, ABH =ASPHALT, N/D -NAIL &DISC, S-SET, FEE =FINISH FLOOR ELEVATION, O /S= OFFSET P/P =POWER POLE, OHP=OVERHEAD POWERLINE, WM =VA TER METER MASONRY I ELEVATION BASED ON LOC. # MASONLL =1 1 1 1 1 1 1 1 I 3100 MAI DRAINAGE EASEMENT= MBD.E :...I:. .i UMW* N-397 ELV. 9.80r TYPE OF SURVEY: BOUNDARY URVEY SURVEYOR'S NOTES: 1) OWNERSHIP SUBJECT TO OPINION OF TITLE. 2) NOT VALID WITHOUT THE SIGNATUR AND RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. 3) THE SURVEY DEPICTED HERE IS NOT COVERED BY PROFESSIONAL LIABILITY INSURANCE. 4) LEGAL DESCRIPTION PROVIDED BY CLIENT. b) UNDERGROUND ENCROACHMENTS NOT LOCATED. 6) ELEVATIONS ARE BASED ON NATIONAL GEODETIC VERTICAL DATUM OF 1929. 7) OWNERSHIP OF FENCES ARE UNKNOWN. 8) THERE MAY BE ADDITIONAL RESTRICTIONS NOT SHOWN ON THIS SURVEY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY. 6) CONTACT THE APPROPRIATE AUTHORITY PRIOR TO ANY DESIGN WORK FOR BUILDING AND ZONING, INFORMATION. 10) EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE.MADE TO DETERMINE RECORDED INSTRUMENTS, IF ANY, AFFECTING THIS PROPERTY. BEARINGS WHEN SHOWN ARE REFERRED TO AN ASSUMED VALUE OF SAID PB PAGE ••• • • • •••• • • • • • • • •• • •••• • • •••• •• • • • • •••• • • CERTIFIED TO: 33138. • • • • • • •• •••• • • •••• • • •• •• • • • • • LOCATION SKETCH SCALE: NTS N.E. 5th AVENUE 1"=20' OFAMENDED P4AT •OF MIAMI SHORES SECTION. NO. 4 JOHN BUTLER, 500 NE 102ND ST., MIAMI SHORES, LE 41• CESCRIPTIO'N: LOT% • 11 AND 12 ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 15 OF THE PUBLIC RECORDS MIAMI —DADE COUNTY, FLORIDA FL. BLOCK 94 SUBDIVISION AT PAGE 14 LDe_u\ ■_ w . -flox HOS-hc C OC 1' 1 1 °' 0. 2" x 7T WwCat • • ••. • • • ••• •• •• • • • • •• • •• • • • • • • •• • 1 • a 6 ! !� • ••••••• r ••.• • •••• • • •. • ••• • plt a MI Planning and Zoning Criteria 4/26/10 NEW PLAN OK Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Issue Date: Not Is Permit NO. DGT -3 -10 -370 sued Permit Type: Decks /Gazebos/Trellises Work Classification: Deck - Wood Expires: Not Issued Folio Number:1132060171070 Miami Shores, FL 33138 - Total Job Valuation: $ 1,000.00 Owner's Name: JOHN BUTLER Job Address: 500 102 Street Owner's Phone: Total Square Feet: 654 Contractor(s) Phone IMBURGIA CONSTRUCTION SERVICES, INC. 305/525 -5707 Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 4/26/2010 : Yes Comments: THE DECK MUST BE LOCATED ON THE SITE PLAN AND THE SITE PLAN AND DECK SCALED AND DIMENTIONED BEFORE IT CAN BE REVIEWED. 4/19/10 PLEASE PROVIDE DIMENTIONS BETWEEN DECK AND SIDE AND REAR LOT LINES. A 5 FOOT LANDSCAPE STRIP MUST BE PROVIDED BETWEEN THE DRIVEWAY AND DECK. PLEASE SHOW ON PLAN Permit No: 10 -370 Job Name: April 14, 2010 Building Critique Sheet 1) HRS approval must include wood deck. Provide plan approved by HRS with approval specifying wood deck or approval letter. Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 2 0•1.. tre...424-wg,.( M iami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Permit No: 10 -370 Job Name: April 14, 2010 Norman Bruhn CBO 305 - 795 -2204 M iami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Building Critique Sheet 1) HRS approval must include wood deck. Provide plan approved by HRS with approval specifying wood deck or approval letter. Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. 02- 09 -'10 12:26 FROM -City Clerk of N.Mia. 3058990497 Issued Date: 10/1/2009 Expiration Date: 9/30/2010 Business Tax Receipt#: BT -001638 IMBURGIA CONSTRUCTION SERVICES. INC 5021 LONDON WALK MIAMI, FL 33138 GENERAL CONTRACTOR NON - TRANSFERABLE • POST IN A CONSPICUOUS PLACE • NON - TRANSFERABLE T -434 P001/001 F -818 NOf�THIMIAMI City of North Miami 776 N.E.125 Street • North Miami, FL 33181 • 305- 893 -8511 Business Tax Receipts Business Name/Address: IMBURGIA CONSTRUCTION SERVICES, INC 1875 NE 149 ST NORTH MIAMI, FL 33181 NOTICE: BUSINESS TAX RECEIPT MUST BE TRANSFERED `JV -IEN BUSINESS IS MOVED OR SOLD. 1 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 POUCIES. AGGREGATE OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSH LTR DM INSRC TYPE OF INSURANCE POUCY NUMBER POLICY EFFECTIVE DATE (MMIDD/YYYY) POLICY EXPIRATION DATE (MM /DD/YYYY) UMITS A GENERAL LIABIUTY COMMERCIAL GENERAL LIABILITY CP31131882 12/05/09 12/05/10 EACH OCCURRENCE $ 1,000,000 X PR MSES(Ea $ 50,000 CLAIMS MADE I X1 OCCUR MED EXP (Any one person) $ 1,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEM. AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 I POLICY PRO- — 1 JECT I LOC AUTOMOBILE LIABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE UMIT (Ea accident) $ N/A BODILY INJURY (Per person) $ N/A BODILY INJURY (Per accident) $N /A PROPERTY DAMAGE (Per accident) $ N/A GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $N /A OTHER THAN EA ACC $ N/A AUTO ONLY: AGG $ N/A $ EXCESS 1 UMBRELLA LIABILITY OCCUR CLAIMS MADE XOVA213809 12/05/09 12/05/10 EACH OCCURRENCE $1,000,000 X AGGREGATE $ 1,000,000 DEDUCTIBLE RETENTION $NONE $ $ X $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIV OFFICER/MEMBER EXCLUDED (Mandatory In NH) If yes, describe under SPECIAL PROVISIONS below WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ N/A E.L. DISEASE - EA EMPLOYEE $ N/A E.L. DISEASE - POUCY UMIT $ N/A OTHER DESCRIPTION OF OPERATIONS / LOCA TIONS / VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Project: 500 NE 102nd Street Miami Shores, FL 33138 RO CERTIFICATE OF LIABILITY INSURANCE OP ID CR I1� PRODUCER Tanenbaum Harber of Florida 2900 SW 149th Avenue Miramar FL 33027 -6605 Phone:954- 883 -2900 Fax:954- 517 -7400 INSURED Imburgia Construction Services Inc 1875 NE 149th Street Miami FL 33181 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 POUCIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: Scottsdale Insurance Company INSURER B: Evanston Insurance Co. INSURER C: INSURER 0: INSURER E: DATE (MM/DDIYYYY) 02/10/10 NAIC # 41297 COVERAGES CERTIFICATE HOLDER ACORD 25 (2009/01) Miami Shores Village 10050 NE 2.'. Avenue Miami Shore.; FL 33138 MIAM138 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR UABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIV AUTHORIZED RE PRE SENTATWE ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered mar'. I .:CORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representati ;-e or producer, and the certificate holder, nor do sit affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009/01) 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 11-E 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. wan LTR NSRO NS TYPE OF INSURANCE POLICY NUMBER DATE((MM�DI "POLICY MM DDS ) LRARS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ur PREMISES (Ee ocxurence) PREMISES (Es occurence) $ a AIMS MADE OCCUR MEO EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER: POLICY I-I P J R CCT 1-11-°C PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY My AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per parson) $ BODILY INJURY per accdent) $ PROPERTY DAMAGE (Per accldent) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ MI-ER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS 1 UMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PP R rR 1� CWIVE I VI i (Mandatory In NH) =r ibs descnba Imdet SPECIALP ISIONSbelow WCV006316400 03/03/10 03/03/11 X I T O RY IIMI U I X I O H. ER E.L. BASIN ACCIDENT $ 1000000 E.L. DISEASE - EA EMPLOYEE $ 1000000 E.L. DISEASE- POL LIMIT $ 1000000 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS JOB ADDRESS IS S00 NE 102nd Street Miami Shores, FL 33138 Miami Shores Village 10050 NE 2nd Miami Shores FL 33138 MIAMSHO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTA From:DARLENE SULLIVAN FaxID:Sihle Insurance Grou Date:5 /5/2010 02:24 PM Page: 2 of 5 R CERTIFICATE OF LIABILITY INSURANCE OP !DURS1 PRODUCER SIHLE INSURANCE GROUP, INC. P. 0. BOX 160398 ALTAMONTE SPRINGS FL 32716 Phone:407 -869 -0962 Fax:407- 774 -0936 INSURED Imbu is Construction Services Inc 1875 NE 149th Street North Miami FL 33181 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 INSIERA Vinings Insurance Company INSURER 8: INSURER C: INSURER 0: INSURER E: DALE (MMIDD/YYYY) 05/05/10 NAIC # 04761 COVERAGES CERTIFICATE HOLDER ACORD 25 (2009/01♦ CANCELLATION The ACORD name and logo are registered marks of ACORD / NriBrilitiOafeBORPORATION. AA rights reserved. From:DARLENE SULLIVAN FaxID :Sihle Insurance Grou Date:5 /5/2010 02:24 PM Page: 3 of 5 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009/01)