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MC-11-1067Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 160851 Permit Number: MC -6 -11 -1067 Scheduled Inspection Date: July 11, 2011 Inspector: Perez, JanPierre Owner: DEFEDE, JAMES Job Address: 10650 NE 11 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: CUSTOM AIR DESIGNS Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1122320280670 Phone: (954)785 -9128 Building Department Comments REPLACE 3.5 A/C SPLIT SYSTEM Ti2 Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. July 08, 2011 For Inspections please call: (305)762 -4949 Page 12 of 32 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 BUILDING PERMIT APPLICATION FBC 20 Permit No. '4 ' e Master Permit No. Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): J tt ill E 5 06-F-6-0E Phone #: 786 `' V Y% - 9 Ss'' Address: / CC 5-6 me: 11 ih Ave,, City: 01 dgflli a S a ;�-� 5 State: rt... Zip: 3 3/ 3 b' Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: pry CC 50 IV 1111\ five City: Miami Shores County: Miami Dade Zip: 7 Folio/Parcel #: f /A'� 52 P O)y "et 7o Is the Building Historically Designated: Yes NO G/"-- Flood Zone: CONTRACTOR: Company Name: Cu ) Tt7I A 1 R OE" r/ 6- 01/.J Phone #: Address: �I 3 y 6 5 P'' �t fh S i2'r�` r City: I" Q h?) % rVd ( 4c# °L State: I Qualifier Name: 5,9 rn el , ; i l L cC !<` State Certification or Registration #: C C a 3 3 S8 Contact Phone#: Email Address: 51 e is c J r§ aci-ofe- Zip: 3 ,%( c, Phone#: 7 S ti— (" - 63/ Certificate of Competency #: r� JM-rvS o Cc'/) DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 5j ).- Square/Linear Footage of Work: o Type of Work: CI Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition .ro Description of Work: t,) 10 J 5� i O •.i / /6 Sip /, f 5 y K 7 C-- n ******************************** * * * * ** Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Fees* CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ \'\ 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 ELECTRICAL 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 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 hich occurs en (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not b roved and ` reinspection fee will be charged. Signatur Owner or Agent The foregoing ins g ment was acknowledged before me day of , a �/ , 20 J I by .9/1) e,) who is p onally known me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commis * * * * * * * * * * * * * * * * * * * ** APPROVED BY Contractor The foregoing instrument was ackno ged before me this _. day of / e, 20 4/ , by who i ersonally known o me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Co * *SR * * * * ** * *** **** * * ** aminer Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) "0.0 e'a Notary Public - State of Florida .,+ SMy Commission Expires Apr 13, 2012 s;3 ' ir : i f. Commission # DD 741601 s Bonded Through National Nota yAssn. a /I, - • *raym.armvir .wa. +rnnfir..vom•mvon.um,.. mitsr4.7r4111* ** Zoning Clerk Miami Shores village Building Department 10050 N. E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 AIR CONDITIONING REPLACEMENT DATA 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): me 5 0 Nfr;.. ll JI) i9ve City: Miami Shores Village County: Miami Dade Zip Code: a 3 / ';Y 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 RHI Sheet Attached: YES NO ❑ Contract Attached: YES UNIT BEING REPLACED DATA NEW UNIT pLg-G6-fil MANUFACTURER /2 meh i v � 5/-��/ s010 -011 AHU or PKG. UNIT MODEL # tif T' 3601/In W / e, fi- i-z COND. UNIT MODEL # ii 47- 7M'r O 1.2- alive / 0 KW HEAT /f 0 m `2. r NOM TONS 3. AHU CU PKG 1) M.C.A AHU y 5 CU,4 PKG AHU &J CUs'e) PKG 2) M.O.P AHU(6;C CUtc PKG AHU CU PKG "-tit, 3) VOLTS AHU3-WCU 2,) PKG PKG UNIT I / PKG UNIT / I EERISEER YES NO REPLACING DUCTS YES! YES NO REPLACING THERMOSTAT YES' NO YES NO NEW 4 "CONCRETE SLAB CYE NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse /Breaker Size): to 3. Voltage of Circuit (208/240/480): - ci 0 4. Size Disconnecting Means: /� aai ' 1% _ Contractor's Company Name: Cm i tore /T ti. D5 / (9w� Phone: q 5 I5 -7V) _ 7f; r State Certificate or Registration N. 6i,C C 3 3-1-2-- Certificate of Competency N. S-6 Signature Dater %72-0/1 9 (Qualifier's signature only) 06/0912011 21:05 3058932214 JIM DEFEDE PAGE 01/03 customs ir designs PAGE 1 OF 3 DATE: June 9, 2011 Home Comfort Options Custom Designed for: Jim Defade 10650 NE 11th Avenue Miami Shores, Fl. 33138 REVISED PHONE: 786- 489 -4589 Email: jdefedeQCb5.Com Jim, Thank you for the opportunity to earn your trust and your business. Below is the proposal and scope of work for your home located at 5141 NE 27th Ave. Scope: • Removal of existing equipment and proper disposal • Furnish and install new American Standard air handler with variable speed blower motor. • Furnish and install new American. Standard 16 Seer condenser • Connect to existing duct work • Re -use existing copper rcfrieration piping, n and evacuation to 450 microns • Install air handler on a new steel stand • New digital thermostat • New condensate overflow safety switch • New concrete slab for the American Standard condensing unit which will be anchored per, wand -load requirements, York can utilize the existing slab • Permit fees are included. All labor and materials to successfully complete the installation are included Warranty: 10 year Compressor - 10 year Parts - 2 year Labor 1246 Southwest 6th Street • Pompano Beach, Florida 33069 • (954) 785 -91.2$ • Fax: (954) 785 -969$ State of Florida License CAC033562 06109/2011 21:05 3059932214 JIM DEFEDE PAGE 02/03 custom air designs PAGE 2 OF 3 Investment Option #1: 16 SEER 3.5 ton American Standard split system $5,232.00 - $665.00 FPL rebate - $250.00 Mfg. instant rebate = $4,297.00 Custom Air Designs Gua,xantees: ✓ COMFORT: The system installed. will heat and cool your home as we have stated or be replaced at no charge. ✓ $500.00 NO FRUSTRATION: If your comfort system breaks down during the first year, and leaves you without heating or cooling for a 24 hour period, we will pay you $500.00 for the inconvenience to you. ✓ MONEY PACK GUARANTEE: If we don't live up to our promises, and you're dissatisfied with your system, within a 1 year period from the date of installation, we will remove the system and provide 100% of your money back. ✓ PEACE OF MIND: Your installation will be performed by professional technicians who have undergone a national criminal background check & ongoing drug screening program. +/ CODE COMPLIANCE: The installation will comply with or exceed local codes. ✓ NO SURPRISE GUARANTEE: The investment quoted is what you pay. ✓ PROPERTY PROTECTION! All property such as lawns, shrubbery, carpeting, floors, walls, furniture and door frames are protected. Damaged property will be repaired or replaced by a contractor of your choice at Custom Air Designs' expense. 1.246 Southwest 6th, Street • Pompano Beach, Florida 33069 • (954) 785 -9128 • Fax: (954) 785 -9698 State of Florida License CAC033562 06/09/2011 21:05 3058932214 JIM DEFEDE PAGE 03/03 custom air designs Page 3 of 3 PAYMENT: $2,000.00 deposit and balance upon satisfactory completion. Material is guaranteed to be as specified. All work is to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from specifications involving extra costs will be executed only upon written work order, and will become an extra charge over and above the estimate. All agreements are contingent. upon strikes, accidents of delays beyond our control. Owner is to carry fire, tornado and other necessary insurance. Our workers are fully covered by workman compensation insurance. It is agreed. that title to the material and to any addition and /or replacements there, remain in CUSTOM AIR DESIGNS until the same shall have been fully paid for Further, I agree that said material shall remain chattel and personal property until fully paid for. It is agreed that the seller will retain title to any equipment or material furnished unit final and. complete payment is made, and if settlement is not made as agreed, the seller shall have the right to remove same and the seller will be heJ.d harmless for any damages resulting from the removal thereof. 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 delinquent 30 days past due date. All payments payable to: CUSTOM AIR DESIGNS. 1246 SW 6t" Street, Pompano Beach, FL 33069 Authorized signature: Note: This proposal may be withdrawn by us if not accepted within 30 days ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory and hereby accepted. You are authorized to do the work as specified. I understand. that if the payment is not made as described above, that access to the equipment and material installed will be allowed to be removed, with no legal proceedings. Payment will be made as outlined. above. SU5 /ECT TO FLORIDA STATUTE 489.1425 CONSTRUCTION INDUSTRIES RECOVERY FUND. YOU NAVE RIGHTS OF COLLECTION :'F LOSSF.. LIMITED TO $25,000. A COPY OF THIS STATUTE IS AVAILABLE TO YOU FO %YOt ! RE'd EW SIGNATURE: TITLE: DATE OF A 1246 Southwest 6th Street • Pompano $each, Florida. 33069 • (954) 785 -9128 • Fax: (954) 785 -9698 State of Florida License CAC033562 This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2011. Certificate of Product Rat i n g s AHRI Certified Reference Number: 3436385 Date: 6/10/2011 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 4A7A5042E1 Indoor Unit Model Number: 4TEE3C04A1 Manufacturer: AMERICAN STANDARD, INC. Trade /Brand name: ALLEGIANCE 15 Manufacturer responsible for the rating of this system combination is AMERICAN STANDARD, INC. Rated as follows in accordance with AHRI Standard 210/240 -2008 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): 40000 EER Rating (Cooling) :. 13.00 SEER Rating (Cooling): 16.00 ' 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 all 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 wwwahridirectory.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 uwww.ahrldirectory.org, Air-Conditioning, Heating, click on `Verify Certificate" link and enter the AHRI Certified Reference Number and the date on mm a. and Refrigeration Institute which the certificate was issued, which Is listed above, and the Certificate No., which is listed below. ©2011 Air - Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129521809577946200 Apr 04 2011 1:49PM HP Fax ENGINEERING EXPRES ® page 1 February 16, 2010 Work Prepared For Miami Tech, Inc, 3bi1 NW 74tS Miami, FL Re A A/C nit.Tiedown to Concrete Certification valid for one (1) project site only. Valid with raised seal only. Attention: Building Ofacial This once has reviewed the design requirements for the installation of air conditioning units onto concrete slabs t sung, Miami Tech Condensing ll it Aluminum Tiedowns (CUTDA 1).. The t(edown or clip used for the installation shall be fabricated using aluminum alloy 5052 -H32, measvriag.4 °48" tell .x 1" wide x 0.080" minirnun, with layout as described below, and a maximum height of 60" per unit. The lower leg of each clip shall be anchored to the concrete host structure with. (1) 1/4" diameter ITW Builder (or equivalent) carbon. steel Tapcon embedded I- 3/4" Minimum into 3,000 psi concrete with 2 4/2" minimum edge distance. The upper 'leg of each.clip shall utilize a minimum of (2) #10 Galvanized sheet metal screws (SAE Grade 2) anchored through the clip into the minimum 22- gauge (0 :028" minimum) steel housing (ASTM A653, Grade 33 minimum), Maximum wind pressures forme with. thing installation.are as noted below; additional anchors may be utilized to achieve higher pleasures, as shown: Table 1: (1) clip required at each corner of unit or (2) each opposite face tar a total of (4), per unit Maximum Unit Face, Area () (2) SMS (3) SMS (4) SMS 4 +/- .114 PSF +/ -150 PSF +1 -150 PSF 7 +1- 65 PSF +/. 98 PSF +/ -127 PSF 9 +/- 50 PSF +1- 76 PSF . +/- 98 PSF 12 +/- 38 PSF +AK 57 PSF +1- 74 PSF 15 +/- 30 PSF . +1. 45 PSF +/- 59 PSF Note: (1) Tapcon acceptable for both one- arid hole versions of the CUTD. Ta1le.2:, (2) clips required at each comer of unit or (4) each opposite face for a total of (S) per unit Madman lint Face, Area ue) (2) SMS (3) SMS (4) SMS 20 +1- 43 PSF +1- 68 PSF +/- 91 PSF 25 +/- 36 PSF +/- 54 PSF +1- 73 PSF 30 -/- 33 PSF +r 50 PSF +1- 66 PSF 35 +i. 30 PSF +/- 46 PSF +1- 61 PSF l ote: (1)Tepcop.aceeptabie for'tioth one and two- nnohorholeversions of the CL?TD. UP 10 18` A/C UNIT HOUSING (22GA MIDI) 6e 10 SMS O l (LOCATION] s u (1) 1/4 "2_ TAPCON "Q3KSI CONCR.TE -1/2 . MrNrMU The contractor shall be responsible for insulation of dissimilar metals to . prevent electrolysis. All other iitstallatiOn work .shall follow the minimum requirements of the 2007 Florida Building Code with 2009 supplements. Thank you for your attention to this matter. Respectfully, Prank L ENGINEERING &PRE #PE0046549 I Cert. Auth. 9885 09-1477-0001.03 160 SW 12TH AVENUE *106 DEERFIELD BEACH, FL 33442 1110 .954-354-0664 FAX: 954. 354.0443 WWW.EI4GEXP.COM Z2/ miami tech inc. PRODUCT SPECIFICATIONS 1 OF 1 STANDARD CONSTRUCTION MATERIAL 14 GAUGE/G -90 ASTM A -653 COLD - ROLLED GALVANIZED STEEL STANDARD SIZES: TYPE BASE DEPTH WIDTH HEIGHT PACK QTY. CUTD4 1.28" 1" 4" 4 PKG. CUTD4 —B 1.28" 1" 4" BULK CUTD6 1.28" 1" 6" 4 PKG. CUTD6 —B 1.28" 1" 6" BULK CUTD8—B 1.28" 1" 8" BULK CUTD11 —B 1.28" 1" 11" BULK CUTD14 —B 1.28" 1" 14" BULK CUTD18 —B 1.28" 1" 18" BULK EATURES GALVANIZED STEEL PROVIDES EXCELLENT CORROSION RESISTANCE AND LONGEVITY. SLATTED DESIGN PROVIDES A UNIVERSAL MOUNT. AVAILABLE IN PEG BOARD DISPLAY PACKAGES (4 PER PACKAGE) UPTO 6 °. BULK PACKAGING AVAILABLE FOR ALL SIZES. AVAILABLE IN ALUMINUM FOR EVEN GREATER CORROSION RESISTANCE (MODEL CUTDAX) aamENS003 war NOTE: ENGINEERING DATA AND CALCULATIONS AVAILABLE UPON REQUEST. JOB NAME: LOCATION: ARCHITECT: ENGINEER: CONTRACTOR: CONTACT MIAMI TECH INC. FOR ADDITIONAL INFORMATION OR WITH SPECIAL REQUIREMENTS. 3611 NW 74TH ST MIAMI, FL 33147 PHONE: 305 - 693 -7054 FAX: 305 - 693 -6152 WEB: WWW.MIAMITECH.COM EMAIL: SALES @MIAMITECH.COM \ZJi anchor with (1) 1/4 " diameter ITW Buildex (or equivalent) carbon steel Tapcon embedded 1 -3/4 " minimum into 3,000 psi concrete with 2 -1/2 " minimum edge distance. SINGLE HOLE DESIGN Optional cable hole TWO HOLES DESIGN ONLY AVAILABLE IN 4" HEIGHT CUTD CONDENSING UNIT TIE DOWN PRODUCT SPECIFICATIONS NOTE ALL DRAWINGS SUBJECT TO CHANGE WITHOUT PRIOR NOTICE miami tech inc. YAWN AF F06-01-2009 TOT TO SCALE CUTD 131, IV 6 -30 -2010 IG ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMJDDmYY) 06108/2091 + - PRDDUCER API Group ‚.0- Box 934125 ROOKSIE PEEPLES #A203142 Margate FL 33093 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 EY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INsuREO $ & R HOLDINGS LLC & S & R MECHANICAL CORP DBA CUSTOM AIR DESIGN 1246 S W 6TH ST POMPANO BEACH FL 33069 INSURERA NOVA CASUALTY CO r. i INSURERS; GENENAL INSURER C: 09GL008356 INSUR R D: 01109/2099 INSURER E: EACH OCCURRENCE ... v c,v"•,t.v - THE POUCIES OF INSURANCE USTED aELOW 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. ». NSR • DD' + - POUCY NUMBER POUCY EFFECTIVE 6,w.•,u POLICY EXPIRATION .,; n • •.• UAA7 9 r. i GENENAL •ra _ , .. LIABILITY COMMERCIALGENEKALLIA6ILITY 09GL008356 01109/2099 01101/2012 EACH OCCURRENCE $ 1,000 000 DAMAGE • RENTED - 100 000 X ■ _ S 5,000 E.LAIMS M,4DE X OCCUR a . $1,000,000 GENERAL AGGREGATE . $ 2,010,000 GEN'L AGGREGATE LIMIT APPLIES PER: PQLIGY n JECT 1-1 LOC PRODUCTS • $ 2,000,000 AVTOINDSILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTO5 HIRED AUTOS NON -OWNED AUTOS - COMBINED SINGLE MIT (Ea accident) ■ • BODILY INJURY (Per person) BODILY (Per accident) PROPERTY DAMAGE (Per ateltlent) GARAGE LIABILITY ANY AUTO AUTO ON Y. EA A IDENT EA ACC OTHER THAN AUTO ONLY: AGO ExoEssfumBRELLA LIABILITY OCCUR ❑ CLAIMS MADE R ■ DEDUCTIBLE RETENTION $ WORKER? COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EAGLUDEO7 If yyeeaa describe udder PECIAL PROVISIONS below ' ' } 5,L FAC,H ACCIDENT $ E.L. DISEASE - EA EMPLOY $ EL. DISE SE- POLICY UM1T OTHER DESCRIPTION OP OPERATIONS J LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS AIR CONDITIONING CONTRACTOR CANCELLATION ' MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVE MIAMI SHORES FL 33138 SHOULD ARV OF WE ABOVE DESCRIBED POLICIES BE CAIdCRI-I.EP BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TC MAIL 10 DAYS WRITTEN DATE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, EUT PMLURE To DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF AN( KIND UPON THE INSURER, ITS AOENTB OH REPRes• Tees. AMMO'�� R ENT t ACORD 25 (2001108) CSI CURD C13RFORAT1ON 1968