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FW-11-1197Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 161606 Permit Number: FW -7 -11 -1197 Scheduled Inspection Date: August 01, 2011 Inspector: Bruhn, Norman Owner: HAISCH, CHARLES Job Address: 160 NW 92 Street Miami Shores, FL Project: <NONE> Contractor: UNITED IRON WORK INC Permit Type: Fence/Wall Inspection Type: Final Work Classification: Wire Fence Phone Number 305 - 788 -0416 Parcel Number 1131010000210 Building Department Comments INSTALLATION OF 18' LINEAR FEET OF REGULAR CHAIN LINK FENCE Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CL July 29, 2011 For Inspections please call: (305)7624949 Page 13 of 30 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 JUL 0 6 2011 �. Master Permit No. Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): `� ftigPhone# V5-01ina Address: 100 Mc) qg ,111(24- City: a) /Cairn i I andif State: FC—. Tenant/ Lessee Name: Phone #: Email: JOB ADDRESS: MO Na) 2 City: Miami Shores County: Folio/Parcel #: / / r31®i " 000 07-10 Is the Building Historically Designated: Yes NO Miami Dade Zip: & 15V Flood Zone: CONTRACTOR: Company Name: Ufli'-ety/ (7,11)- n bJZ(k-3 Address: 2*74 1:1C3 LJi --Q fr City: ni a m T _- I te: j PL Zip: ..3i40.314-62. Qualifier Name: /e1 ntt n ti o Phone #: (305-(033-00-80 1 State Certification or Registration #: Certificate of Competency ,, #: �4 /�i� Contact Phone #: � 4.40,-- / Email Address: IN' i 1 e 4 /C d Ki.( ) '' earn kfrk.._ Phone #: . a'ii - 80/ DESIGNER: Architect/Engineer: Value of Work for this Permit: $ 54 Square/Linear Footage of Work: Phone #: /e. Type of Work: ❑Addition Descrip + of Work. ilk iy 4I4 » 1' ❑Alteratio New j ❑Repair/R- 'lace ffir 1 ❑Demolition iJf'il�JIJ�/�" ` `***** * * * ***** * * ** * * * ** * * * * * * * * *** *** Fees * * ** ***** * * * * * * * * * * * * * * * ** : * * * * * * *** * *** * ** �Or oO Submittal Fee $ Scanning Fee $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ Permit Fee $ /96°C1= CCF $ CO /CC $ Radon Fee $ DBPR $ Bond $ TOTAL FEE NOW DUE $ p4 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 which occurs seven (7) days after the building permit is issued In the bsence of such posted notice, the inspection will not j e approved and a reinspection fee will be charged. • Signature Signature latInv° 0 r or Agent • -Contractor The foregoing instrument was acknowledged before me this SO The foregoing instrument was acknowledged before me this .,-� D , day of(vuz- , 20 11 , by I1 Y Mf is v , day of • , 20 1; by ��it 'undo Q who is personally known to me or who has pros deuced U'el SC.... who identification and who did take an oath. NOTARY PUBLIC: Sign: Print: r ?7?1- 6v4.01.: u ,1 PEREZ COMM ON #EE017604 EXPIRES: August 30, 2014 440,00,9- BovialtsuBuSseMstaY &dos My Commission Expires: o me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: /`1" An — My Commissi. .� 4 :, : MY + LIISSiON #EE017604 mil EXPIRES: August 30, 2014 ,g44 �Ae Badedthru Bt Nobly Sakes APPROVED BY :J f l Plans Examiner �I 7/7 Zoning Structural Review Clerk (Revised 07 /10 /07XRevised 06 /10 /2009)(Revised 3/15/09) ODU Roil End 6 Band Tension Band Standard Residential Shop Drawing Top Rail Cap • • • •� • • • • .. • • . • • .• • • • • • • • .• SUBJECT TO COMPUANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS is 4 times the diameter of the post. TERMINAL POST iie LINE POST TOP RAIL Wt. per ft. Size Wt. per f t. Size Wt. per ft. 21" 1 5/8 or 2" 1 3/8" or 1 5 • k Size -Is outside dimension t Weight- Is pounds per linear foot Chain 1.:r.t. Fabric % Gouge 111 2 3/8" Property Information Map My Home Miami -Dade County, Florida Page 1 of 1 Property Information Map W 5380 SST Aerial Photography - 2009 0 This map was created on 6/29/2011 9:50:16 AM for reference purposes only Web Site © 2002 Miami -Dade County. All rights reserved. 117 ft Summary Details: Folio No.: 0800 SINGLE FAMILY RESIDENCE Property: 160 NW 92 ST Mailing CHARLES F HAISCH &W Address: JEAN W YANG Living Units: 160 NW 92 ST MIAMI Adj Sq Footage: SHORES FL Lot Size: 33150 -2229 Property Information: Primary Zone: 0800 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds /Baths: 3/2 Floors: 1 Living Units: 1 Adj Sq Footage: 1,898 Lot Size: 16,900 SQ "FT Year Built: 1961 $50,000/ $231,640 1 53 41 .38 AC N1/2 OF City: E100FT OF W388.6FT $50,000/ $307,876 OF S1/2 OF SW1 /4 OF Legal NW1 /4 OF SE1 /4 LOT Description: SIZE 100.000 X 169 COC 23559 -3160 06 2005 1 OR 23559 -3160 0605 00 Assessment Information: Year: 2010 2009 Land Value: $129,540 $194,311 Building Value: $152,100 $163,565 Market Value: $281,640 $357,876 Assessed Value: $281,640 $357,876 Exemption Information: Year: 2010 2009 $500,000 $25,000 $25,000 Taxing Authority: YES YES Taxable Value Information: Year: 2010 2009 $500,000 Applied Applied Taxing Authority: Exemption/ Taxable Exemption/ Taxable Sales which are qualified Value: Value: Regional: $50,000/ $231,640 $50,000/ $307,876 County: $50,000/ $231,640 $50,000/ $307,876 City: $50,000/ $231,640 $50,000/ $307,876 School Board: $25,000/ $256,640 $25,000/ $332,876 Sale Information: Sale Date: 6/2005 Sale Amount: $500,000 Sale O /R: Sales Qualification Sales which are qualified Description: _ http: / /gisims2.miamidade. gov /myhome /printmap.asp ?mapurl = http: / /gisims2.miamidade. go... 6/29/2011 • • e �. • • • •' OF • • • • • • • • •• • • • •••• •••• • • •••• •• • • • ••• •••• • • • • • • IVoa iN EAST eSyNFNE�f err Z¢ Y4- SEY4- sec• l- 53 -41 OQ WELL-IDENTIFIED FEATURES IN THIS SURVEY AND MF N MEASURED TO AN ESTIMATED HORIZONTAL POSITIONAL ACCURACY OF 0.10 (ft) .S AL .====== 0 'n /tog- c o (P) /fog. 41 (M) t -ro 4 , 4 5 Pia 4s -15 v•OE Go - (-HD AN& b • •• • • • • • • Z- • • •• • • • 0 •• •• 0 • • • •••• 0 • • • • F513r, (02.5 FrNra yeHLJ AN& as[. C•4o T l,) Copyright © 2005 AU Courtly Surveyors, Inc. Inb 2 • • WAL1 dl 4.4.5 ASPHA,I..T DRrvE !02 too 4.70 3o•4.5 2 L •?6 a 41 0 - v 35 r N ",f " { 1,1 CC() (flflY SURVEYORS PROFESSIONAL.. �earovfln"1" 'assr_+ A &in KA11i91010E7 - LEGEND: X X— ABBREVIATIONS: AL -ARC LENGTH - CENTER LINE CF - CALC FROLS Flom MEASURE CR - CALC FROLL RECORD INFO DB - DEED BOOK DBorES FENCE LINE DeaorES Wow Fame LLNE DENOTES ELEvAfron SrrE /fog • 22 CM) /'3 .O0 (Pt) OHC ORB P PC PCC PCP PK FOB POC PRC - MEAsuRED - OVERHEAD POWER CARL - OFF=AL RECORDS Born - PLAT - Pow OF CURVATURE - POCVT OF COtaaouun C' - Pararde Nr CONTROL P, - PARKER KALON NAIL - PROPERTY LNE - POT ING - Pow OF CO FZENCFR'•F - POINT OF REVERSE CUF INVOICE II 05.24157 PROPERTY ADDRESS: 160 NW 92N° STREET, MIAMI SHORES, FL. 33158 LEGAL DESCRIPTION: THE NORTH % OF EAST 100 FEET OF THE WEST 388.6 FEET OF THE SOUTH 'h OF THE SOi1THWEST'h OF THE NORTHWEST'/. OF THE SOUTHEAST % OF SECTION 1, TOWNSHIP 53 SOUTH, RANGE 41 EAST OF DADE COUNTY, FLORIDA FND re /Fe-Owl APE CNC, X4 CERTIFICATIONS CHARLES HAISCH JEAN YANG P. v' ; '1 ATTORNEYS' TITLE INSURANCE FUND, INC. 7„t.11/.. CHEVY CEASE BANK, FAB, ITS SUCCESSORS AND/OR ASSIGNS AS THEIR INTERESTS MAY APPEAR 0 0 0 , 1',o ya" ice.0 nee Coo FLOOD ZONE INFO: COMMUNITY # 120652 LOWEST FINISH FL: N/A PANEL & SUFFDC 0090 J GARAGE EL: N/A FLOOD ZONE X N/A DATE OF FIRM 3/2/94 REVISION SCHEDULE: ES: THIS SURVEY IS BASED UPON RECORDED INFORMATION AS PROVIDED BY CLIENT. NO SPECIFIC SEARCH OF THE PUBLIC RECORD HAS BEEN MADE BY THIS OFFICE. UNDERGROUND IMPROVEMENTS HAVE NOT BEEN LOCATED EXCEPT AS SPECIFICALLY SHOWN. ELEVATIONS ARE BASED UPON NATIONAL GEODETIC VERTICALDATULU 1929 (N.G.'r.D.1929). FENCE TIES ARE NOT CENTERLINE OF FENCE IN SOME CASES, GRAPHIC REPRESENTATIONS HAVE BEEN EXAGGERATED TO MORE CLEARLY ILLUSTRATE MEASURED RELATIONSHIPS-DIMENSIONS SHALL HAVE PRECEDENCE OVER SCALED POSITIONS. ALL DIMENSIONS SHOWN ARE FIELD MEASURED AND CORRESPOND TO RECORD INFORMATION UNLESS SPECIFICALLY NOTED OTFIEA'MSE SURVEYOR'S CERTIFICATION: I HEREBY CERTIFY THAT THIS SURVEY MEETS THE MINIMUM TECHNICAL. STANDARDS FOR SURVEYS, AS SET FORTH BY THE FLORIDA BOARD OF SURVEYORS AND MAPPERS IN CHAPTER 61G17 -6 OF THE FLORIDA ADMINISTRATIVE CODE, PURSUANT TO SECTION 472.027, FLORIDA STATUTES. BOUNDARY ARY 4105- SIGNED: V DATE: Wiliam Michael Carr, Professional Surveyor & Mapper "99 — :7 NE r ... STY E NE �± c.,) MI 1• L 96 97 • 96 �!,'r.1 P_ i--1: r i NE NE Q' WM liAnlin NE E slloaES VAII ` L C' • " M 92 z� NE NE 91 '"r REVISION SCHEDULE: ES: THIS SURVEY IS BASED UPON RECORDED INFORMATION AS PROVIDED BY CLIENT. NO SPECIFIC SEARCH OF THE PUBLIC RECORD HAS BEEN MADE BY THIS OFFICE. UNDERGROUND IMPROVEMENTS HAVE NOT BEEN LOCATED EXCEPT AS SPECIFICALLY SHOWN. ELEVATIONS ARE BASED UPON NATIONAL GEODETIC VERTICALDATULU 1929 (N.G.'r.D.1929). FENCE TIES ARE NOT CENTERLINE OF FENCE IN SOME CASES, GRAPHIC REPRESENTATIONS HAVE BEEN EXAGGERATED TO MORE CLEARLY ILLUSTRATE MEASURED RELATIONSHIPS-DIMENSIONS SHALL HAVE PRECEDENCE OVER SCALED POSITIONS. ALL DIMENSIONS SHOWN ARE FIELD MEASURED AND CORRESPOND TO RECORD INFORMATION UNLESS SPECIFICALLY NOTED OTFIEA'MSE SURVEYOR'S CERTIFICATION: I HEREBY CERTIFY THAT THIS SURVEY MEETS THE MINIMUM TECHNICAL. STANDARDS FOR SURVEYS, AS SET FORTH BY THE FLORIDA BOARD OF SURVEYORS AND MAPPERS IN CHAPTER 61G17 -6 OF THE FLORIDA ADMINISTRATIVE CODE, PURSUANT TO SECTION 472.027, FLORIDA STATUTES. BOUNDARY ARY 4105- SIGNED: V DATE: Wiliam Michael Carr, Professional Surveyor & Mapper x x* x x x x x x x x x x x x x x x x x MIAMI -DADE COUNTY TAX COLLECTOR 140 W. Flagler Street Miami, Florida 33130 Please keep your receipt for future reference. Thank you and have a nice day. 7/19/2011 1300 /227 /OO1IRAR 0010 -0001 Last Seq. #:0001 WI LBT #:30 297429 -4 Local Business Tax $200.00 CK CHANGE $200.00 $0.00 MIAMI -DADE COUNTY TAX COLLECTOR LOCAL BUSINESS TAX SECTION 140 W. Flagler St. - 1st Floor Miami, Florida 33130 TEMPORARY RECEIPT 2010 -2011 MUNICIPAL CONTRACTOR TAX Local Business Taxk:30297429 -4 State /CC #:000019163 Issued to: UNITED IRON WORK Type of Business: SPECIALTY BUILDING, CONTRACTOR SEE BACK OF OFFICIAL RECEIPT FOR NONPARTICIPATING MUNICIPALITIES 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 MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 2010 LOCAL BUSINESS TAX RECEIPT 2011 MIAMI -DADE COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30, 2011 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 THIS IS NOT A BILL - DO NOT PAY RENEWAL RECEIPT NO. 297429-4 CC B 000019160 284186 -5 BUSINESS NAME / LOCATION UNITED IRON WORK 3270 NW 38 ST 33142 UNIN DADE COUNTY FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 OWNER FERNANDO COLOMA Sec. Type of Business WORKER /S THIS Is I� A �6 $CLCIALTY BUILDING CONTRACTOR 4 BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CmES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 10/07/2010 09010056001 000082.50 SEE OTHER SIDE MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 DO NOT FORWARD UNITED IRON WORK FERNANDO COLOMA 3270 NW 38 ST MIAMI FL 33142 11 1111111111111111111111111111111 11 //111111111111111 ir;ill 2010 LOCAL BUSINESS TAX RECEIPT 2011 MIAMI -DADE COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30, 2011 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 THIS IS NOT A BILL - DO NOT PAY 483356 -3 BUSINESS NAME / LOCATION UNITED IRON WORK INC 3270 NW 38 ST 33142 UNIN DADE COUNTY OWNER UNITED IRON WORK INC Sec. Type of Business FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 RENEWAL RECEIPT NO. 504490-4 2Q(� EMPLOYEE /S THIS IS ONLY-A MWRECYCLING /PROCESSING 4 BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CmES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 10/07/2010 09010057001 000082.50 SEE OTHER SIDE DO NOT FORWARD UNITED IRON WORK INC FERNANDO COLOMA 3274 NW 38 ST MIAMI FL 33142 111 11{11111 -1 11111,.11 11111111111111 111111111111111111 1i41d tll CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 000019160 UNITED IRON WORKS INC D.B.A.: C o MA FERNANDO Is certified under the provisions of Chapter 10 of Miami -Dade County VALID FOR CONTRACTING UNTIL0913812OI2 QUALIFYING TRADES) 0018 FENCE 0035 ORNAMENTAL IRON Hemiinio Gonzalez P.E. / Secretary of the Board !Ale � Miami-Dade County retains at property rights herein. M ®� www.miamidade.povfaildinpcode 4 ACCPRD� CERTIFICATE OF LIABILITY INSURANCE D07/05/20111 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 policy(les) must 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 A&A Underwriters, Inc. 8796 SW 8 St - Miami, Fl 33174 CO TACT Pablo M Conde NAME: (a/C N . €asl: 305- 220 -7447 sac, No), 305 - 220 -4821 ADE-MAIDRL ESS: pmc@aaunderwriters.com INSURER(S) AFFORDING COVERAOE NAIC # INSURERA: Mapfre Insurance Co. of Florida INSURER B: Guarantee Insurance Company LIABILITY COMMERCIAL GENERAL LIABILITY INSURED United Iron Work Inc 3 C's Development Group. 3274 NW 38 St Miami FL 33142 INSURER C : CP- 000317292 -1 INSURER o : 02/07/12 INSURER E $ 1,000,000 INSURER F : $ 100,000 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 INSR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYYI POLICY EXP (MMIDD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY CP- 000317292 -1 02/07/11 02/07/12 EACH OCCURRENCE $ 1,000,000 RENTED $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ Included GEN'L AGGREGATE POLICY LIMIT APPLIES PF PRO- T PER: LOC $ AUTOMOBILE LUIBIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON-OWNED TOS D AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? M (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS mow N/A GWIC301004445 -111 01/06/11 01/06/12 WC STATU- TORY LIMITS OTH- ER E.LEACHACCIDENT $ 1,000,000 E.L DISEASE - EA EMPLOYEE $ 1,000,000 E.L DISEASE - POLICY LIMIT $ 1,000,000 A Property CP- 000317292 -0 02/07/1102/07/121 CONTEg $ 0 45 8.00Equipment Breakd $557,537 2.- Building $ 400,000 Equipment Breakd $400,000 DEDUCT $ 1,000 5 %Wind & Hail DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required) CERTIFICATE HOLDER CANCELLATION I MIAMI SHORES VILLAGE 10050 ;ENE 2nd AVE. MIAMI SHORES, FL 33138 Attn: Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZF-D REPRESENTATIVE ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. 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