SGN-11-998Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
sflr
Inspection Number: INSP - 160464 Permit Number: ELC -6 -11 -999
Scheduled Inspection Date: July 25, 2011
Inspector: Devaney, Michael
Owner: , SHORES SQUARE INVESTMENTS
Job Address: 9017 Biscayne Boulevard
Miami Shores, FL 33138 -0000
Project: <NONE>
Contractor: QUALITY COMMUNICATION POWER & SECURITY
Permit Type: Electrical - Commercial
Inspection Type: Final
Work Classification: Sign
Phone Number
Parcel Number 1132060110070 -17
Phone: (954)584 -4111
Building Department Comments
HOOK UP EXISIING POWER
Passed
v
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
,r6 /
July 22, 2011
For Inspections please call: (305)762 -4949
Page 7 of 28
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 160463 Permit Number: SGN -6 -11 -998
Scheduled Inspection Date: July 26, 2011
Inspector: Bruhn, Norman
Owner: , SHORES SQUARE INVESTMENTS
Job Address: 9017 Biscayne Boulevard
Miami Shores, FL 33138 -0000
Project: <NONE>
Contractor: QUALITY COMMUNICATION POWER & SECURITY
Permit Type: Sign
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060110070 -17
Phone: (954)584 -4111
Building Department Comments
ILLUMINATED CHANNEL LETTERS FOR RADIO SHACK
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
July 25, 2011
For Inspections please call: (305)762 -4949
Page 6 of 24
Protect Address
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
Expiration: 12/07 /2011
Applicant
9017 Biscayne Boulevard
Miami Shores, FL 33138 -0000
1132060110070 -17
Block: Lot:
SHORES SQUARE INVESTMENT
Owner Information
Address
Phone
CeII
SHORES SQUARE INVESTMENTS
3850 BIRD Road
MIAMI FL 33146-
I
Contractor(s) Phone
QUALITY COMMUNICATION POWER t (954)584 -4111
Cell Phone
Type of Sign: Wall Sign
Electrical Sign: Yes
Height: 30"
Width: 18'
Color: RED /BLACK
Plans Submitted: Yes
Classification: Commercial
Elevation:
Additional Info: RADIO SHACK
Scanning: 2
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$2.00
$2.00
$0.20
$100.00
$6.00
$0.80
$111.60
Pay Date Pay Type Amt Paid Amt Due
Invoice # SGN -6 -11 -41084
06/16/2011 Check #: 1904 $ 61.60 $ 50.00
06/01/2011 Check #: 1888 $ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Final
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.
June 16, 2011
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
June 16, 2011 1
1
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
Expiration: 12/07 /2011
Applicant
9017 Biscayne Boulevard
Miami Shores, FL 33138 -0000
1132060110070 -17
Block: Lot:
SHORES SQUARE INVESTMENT
Owner Information
Address
Phone
Cell
SHORES SQUARE INVESTMENTS
3850 BIRD Road
MIAMI FL 33146-
i
Contractor(s) Phone
QUALITY COMMUNICATION POWER i (954)584 -4111
CeII Phone
Valuation:
Total Sq Feet:
$ 300.00
54
Type of Work: HOOK UP TO EXISTING POWER
Additional Info: RADIO SHACK SIGN
Classification: Commercial
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$2.00
$2.00
$0.20
$100.00
$3.00
$0.80
$108.60
Pay Date Pay Type Amt Paid Amt Due
Invoice # ELC -6 -11 -41085
06/01/2011 Check #: 1888 $ 50.00 $ 58.60
06/16/2011 Check #: 1904 $ 58.60 $ 0.00
Available Inspections:
Inspection Type:
Final
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.
June 16, 2011
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
June 16, 2011
1
Miami Shores Village
Building Department loN 0 1
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fait: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No:�1 `1 /—
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: BUILDING
OWNER: Name (Fee Simple Titleholder): pQS6 ref
Address: c7o'7 10�ftr'��re?� 8/t a1. 0
City: 41/4401/ / ,f I .-e f State:
Tenant/Lessee Name: &t c Sh
Email: /"✓,1`"i 0 et/am die r J is. (c)„1.
JOB ADDRESS: CID ®�'f a5re-, `;
Master Permit No.
the -it
e F14
FC. Zip: 3 y i 3
Phone #: /72 -73Y -
(hp.
Phone #:
3(-IS' 779 J0
Ft- 3f,,d
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Budding Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: al. 1 (6 crt-.L� 'k., u,° ,5 tLi 3 ; Phone #: q ,, s 'c t-` 1 s t i d 1
Address: 3 L) . s4 4i
City:vt L,„„c4..„ od'5p State: ---'t V,,,, r
Qualifier Name: Ca- i ',,= 1 (0' C9
State Certification or Registration #: rL - V c,c) 'f Certificate of Competency #:
Contact Phone#. —CIA-5e. --.3&14° – a 7 L Email Address: 4 , c—.1
DESIGNER: Architect/Engineer: R=4 (4- N.!1 7 Phone #: S'e'— '-- `t (I
Zip: 73Z • 2—
Phone#:'a rd 6d
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: Address °Alteratio
Description of Work:
ew °Repair ' e . lace
COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by:
ir9FiexeYie &atie*** aF tNatei ***Jr+ti*iUakak+'t4e** **wiedt* ees*** sk*i4ti*0i+ 4dti4*it +4 ****** ************ * *******i **k
ii
Submittal Fee Permit Fee $' MO CCF $ CO /CC $
Scanning Fee $ `� . Radon Fee $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
TOTAL FEE NOW DUE $ (01'6i)
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 tha copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subje • Ito '' nt. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection s seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will not be a reinspection fee will be charged.
Signature
lir
Nur-
Ow ' or Agent
The foregoing instrument w acknowledged before me this
day of 20 J by 6 E. t.-ca �� q✓� �9 s 2>
who is personally known t� t +r who has produced
As identificatio d who did take an oath.
NOTARY BLIC:
Sign:
Print:
My Commission Expires:
'VOT , PUBLIC,STATE OF FLORIDA
` *..,,„
i.
Vir nr T Fuentes
7.
L, -„ = :�ission #DD667598
zo,,,,,,os Expires. JUNE 15, 2011
BONDED MKT ATLANTIC BONDING CO.,INC.
APPROVED BY
Signature
Contra° r
The foregoing instrument was acknowledged be or me this
day of ✓ 2010 ,by 65 �,� .. ('.fre1`a9
who is personally known to me or who has produced , // -
4 as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commis
* * * ** ,.... ., * * * * * * * * * * * * * * * * * ** * * * * * * * * **
-i7
(Revised 07(10 /07)(Revised 06I10f2009)(Revised 3/15109)(rev6/4/10)
Plans Examiner
Structural Review
RO> PERT O. SAPITIL.LI
1'E MY COMMESSION # DD 739349
* *, al, , t er,P *n2 a0 13011*
{: 3 �.ridaN .cry3ervice.com
Zoning
Clerk
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FRONT ELEVATION
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Miami Shores Village
APPROVED
ZONING DEPT
DY
BLDG DEPT
DATE
SUBJECT TO COMPLIANCE WITH ALL FEDERAL
STATE AND COUNTY RULES AND REGULATIONS
C
CITY
COPY
>j
RadioShack
10-1995
Shut 1 at 5
RADIDSHAO(- 101-8901
9017 -19 BISCAYNE BLVD.
MIAMI SHORES. FL
By. JIM HAGLE
wiper
MRG
9-9-10
Chandler
Signs
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MINNA MIN ha MA4674103
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S412-61344a 51113-100-114$
FINAL ELECTRICAL
CONNECTION
BY CUSTOMER
18 -1 S /8'
8 5/S'
14' -11•
PREFORMED ALUMINUM CHANNEL LOGO
PRE -FIN. RED - PAINT INSIDE WITH SPRAYLAT
STAR -BRITE UGHT ENHANCING PAINT
2283 RED ACRYLIC FACE W/
RED TRIMCAP
RED L.E.D. ILLUMINATION (SLOAN V- SERIES )
6' X 6' EXTRUDED AWMINUM RACEWAY
PTD. TO MATCH SW #6127
2' X 2' GALV. PICK -UP ANGLE
LE.D. POWER SUPPLY LOCATED
INSIDE RACEWAY
0
LETTER DISPLAY
SCALE: 1/2• =T-0'
ON BACKGROUND PLATE N/ RACEWAY
(1) SET REQUIRED
NOTE: VERIFY WALL FASCIA STABLE ENOUGH TO SUPPORT SIGN
r W mum.
MI6. STRAPS
W.ORa TO
SACS OF
RACEWAY
*1/4' DIA. WEEP HOLES IN WW POINTS
OF LOGO AND IN BOTTOM OF RACEWAY
.125' ALUMINUM BACKGROUND PLATE
PTD. SATIN BLACK
WEATHERPROOF DISCONNECT SWITCH
ON LOGO END OF RACEWAY
LOGO SECTION
U.L LABELS WINNER
INSTALL IN ACCORDANCE W/
NATIONAL ELECTRIC CODES
NTS
RACEWAY MOUNTED
Note: Signs to withstand
146 MPH 47 PF5 EXP C ,
3 SEC. GUSTS
as per ASCE 07 -05 requirement
Marlon Sebelen
4611 S. University. Dr. #315
Davie, Florida 33328
TUT? NL
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PREFORMED AWMINUM CHANNEL LOGO
PRE -FIN. BLACK - PAINT INSIDE WITH SPRAYLAT
STAR-MUTE LIGHT ENHANCING PAINT
7328 WHITE ACRYUC LETTER FACES W/
BLACK TRIMCAP
WHITE LE.D. ILLUMINATION (SLOAN V- SERIES )
6' X 6• EXTRUDED ALUMINUM RACEWAY
PTD. TO MATCH SW #6127
2' X r GALV. PICK -UP ANGLE
LE.D. POWER SUPPLY LOCATED
INSIDE RACEWAY
*1/4' DIA. WEEP HOLES IN LOW POINTS
OF LOGO AND IN BOTTOM OF RACEWAY
.125' ALUMINUM BACKGROUND PLATE
PTD. SATIN BLACK
WEATHERPROOF DISCONNECT SWITCH
ON LOGO END OF RACEWAY
LETTER SECTION
2. X WAUW.
MTG. Sn1R
MOAN/ TO
Mat OF
RACWAY
r --
ILL. LAMLE INCINNIN
INSTALL IN ACCORDANCE W/
NATIONAL ELECTRIC CODES
NTS
RACEWAY MOUNTED
RadioShack
10 -1995
Shod 3 d 5
9017-19 BISCAYNE BLVD.
MIAMI SHORES, FL
Boat
lbw JIM HAGLE
DAM' MRG
9 -9 -10
Chandler
Signs
FINAL ELECTRICAL
CONNECTION
BY CUSTOMER
SITE PLAN
NOT TO SCALE
RadioShack
10-1995
Seat 5 of 5
RADIOSHACK- 1018901
9017 -19 BISCAYNE BLVD.
MIAMI SHORES, FL
Account
Le JIM HAGLE
Badpw MRQ
9-9-10
Chandler
Signs
wwr.cbaadlenlin..co
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516611138557
FINAL ELECTRICAL
CONNECTION
BY CUSTOMER
WOO. 1:110119C ISM
Miami Shores Village JUN o 1 r'D
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 7952204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): d A ezfre
Address: , . , • Poi r a e. 47 J�
City: if/Aui
Tenant/Lessee Name: %faA os -4 c k
Permit No. �—[�� I ("' -".0 1 1
Master Permit No.
State: /C6
L� Phone #: -� '' 7 7 ` 2' ,f'Yrr
Email: /2 4 e Id s @ c cepct l J./
JOB ADDRESS: qt )/1 a /q by a a- r f b'L` )
City: Miami Shores
zip: , 3e7k
•?hone #: ?7Z —73 i' — E 53 612,"4 ;
L l'9
i
County: Miami Dade
Zip:
Falio/Parcel #:
Is the Building Historically Designated: Yes
NO Mood Zone:
CONTRACTOR: Company Name: (2c 45 ` U-" }'y ' c ?,([4,%. Puu S Pho ` ( Pi/
Address: 3 63 '4f ,�g
City: � o tom; L, :')id >s` - State: f . - D °`k
Qualifier Name: «,K`.i :,s Fy3 .
State Certification or Registration #: CO '2...'17`7)i- Certificate of Competency #:
Contact Phone#: 9 Vjf — 341 d 1 Email Address: ri Lam , CC y - z a� -1
DESIGNER: Architect/Engineer : .l F " (aC2, h 7' f` °d j Phone #: ce7te " s :y„Q ° il t
zip:' 2--
Phone #: S -- d t
Value of Work for this Permit: $ ?
cc
Square/Linear Footage of Work:
Type of Work: OAddress %%�� ClAlteration 36New CORepair/Replace
Description of Work: Ivor- (I fb
ClDemolition
* **
* * * * * * * * * * * * * * * * * ** * * * * * * *** ** ** bees *** * *** ****** * *+ ***** * * * ** *** **** ** ***w*****
rs
Submittal Fee 111 . � Permit Fee $ / 0 `'° ,Cv i* CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 6' coo
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 AZi'FIDAVIT: 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 t a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is s!�'ect o attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspe is occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will no, be ap S ra,(. and a reinspection fee will be charged.
Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this c2/ The foregoing instrument was acknowledged before me this 9
da y nl of �vedyi 20/1_, by
day of , 20 I Ll, by Biz ,-� C_CAL! Y2., p
has produced who is personally known to me or who has produced f t
who did take an oath. 6 G�`v as identification and who did take an oath.
NOT
who is personally known to me
As identification
NOTAR
Sign:
RIDA
Print: .. •, Victor 1. Fuentes
+,- : Commission #DD667598
My Commission Expires :%,„,..„/ Expires,
BONDED 1T�tU� 15, 2011
nzt�rte BONDING CO, INC.
.il
UBLIC:
Sign:
Prin
NOTARY FUBLI
tri
i ' iw. r
My ss xcpit�es:
`o5 ROBERT D. SANTILL9
MY COMMISSION # DD 739349
** * * *a�>k***** *** ** * * *:r *** a��am a��x****** * ***ax** ***** **** * *>Ka:>k *>F�x� * ** T
(407) 393 -0153
APPROVED BY o /�� ct > i 'sue 1'' Plans Examiner
F I o ri d a N ota ry a e ry i ce. co m
Zoning
Structural Review Clerk
(Revised 07110107)(Revised 0611012009)(Revised 3/15109)
cola .. s.
STATE OF FLORIDA
1.
}4 _
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
n'u; = =�
ELECTRICAL CONTRACTORS LICENSING BOARD
TALLAHASSEEMONROE STREET FL (850) 487 -1395
• 1940 NORTH
• MYERS, GORDON W
UALITY COMMUNICATIONS POWER & SECURITY LLC
3700 SW 30TH AVENUE
FORT LAUDERDALE FL 33312
Congratulations! With this license you become one of the nearly one million
Floridians licensed by the Department of Business and Professional Regulation.
Our professionals and businesses range from architects to yacht brokers, from
boxers to barbeque restaurants, and they keep Florida's economy strong.
Every day we work to improve the way we do business in order to serve you better.
For information about our services, please log onto www.myfloridalicense.com.
There you can find more information about our divisions and the regulations that
impact you, subscribe to department newsletters and leam more about the
Department's initiatives.
Our mission at the Department is: License Efficiently, Regulate Fairly. We
constantly strive to serve you better so that you can serve your customers.
Thank you for doing business in Florida, and congratulations on your new license!
DETACH HERE
DATE ` BATCH NUMBER
TOR 1
.<
01 -� ti11I•f JM7 1•11•t.1.M - -1C ♦M- ;t 1 L111,At.i.-•-M t•-
115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954- 831 -4000
VALID OCTOBER 1, 2010 THROUGH SEPTEMBER 30, 2011
DBA: Receipt #:181-236037
Business Name: QUALITY COMMUNICATIONS POWER & Business Type: ELECTRICAL /ALARMS /CONY•
SECURITY LLC
Owner Name: GORDON MYERS/ QUALIFIER
Business Location: 3700 SW 30 AVE
FT LAUDERDALE
Business Phone:
Rooms
Seats
Employees
30
Business Opened:09 /22/2010
State /County /Cert/Reg:ECO 0 02 3 8 0
Exemption Code:NONEXEMPT
Machines Professionals
For Vending Business Only
Number of Machines:
Vending Type:
Tax Amount
Transfer Fee
NSF Fee
Penalty
Prior Years
Collection Cost
Total Paid
81.00
0.00
0.00
- 0_00
0.00
0.00
81.00
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is
non - regulatory in nature. You must meet all County and/or Municipality planning
WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location. This receipt does not indicate that the business is legal or that
it is in compliance with State or local laws and regulations.
Mailing Address:
GORDON MYERS/ QUALIFIER
3700 SW 30 AVE
FT LAUDERDALE, FL 33312
U.S.A.
2010 - 2011
Receipt #04A- 09- 00017683
Paid 09/22/2010 81.00
R ® CERTIFICATE OF LIABILITY INSURANCE OP ID CG
°A1 /23/ o)
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 IN- SURED, the pollcy(les) must be endorsed. If SUBROGATION I5 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
BROWN & BROWN OF FLORIDA INC
8000 GOVERNORS SQUARE BLVD 400
MIAMI LADS FL 33016 -1588
Phone:305- 364 -7800 Fax:305- 822 -5687
-L.UN I Al. I
NAME:
PHONE IAX
c, No, Ext): (NC, No):
ADDRESS:
CUSTOMER ID 0: QUALIO3
INSURER(S) AFFORDING COVERAGE
NAIC#
INSURED
UQUALITY HOLDING GROUP LLC DBA
ALITY COMMUNICATIONS POWER &
ECURITY LLC, QUALITY
COMMUNICATIONS OF FL UALITY
COMMUNICATIONS FIRE & QUALITY
3700 SW 30 AVE
FT LAUDERDALE FL 33312 -6707
INSURERA: FCCI COMMERCIAL INS CO
33472
INSURERB: NATIONAL TRUST INSURANCE co
20141
INSURER C :
07/22/11
INSURER D:
$ 1,000, 000
INSURERE:
PREEMMISES(Eaooccurrence)
INSURER F :
S
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.
INBR
LTR
TYPE OF
-AUUL
INSR
SOUR
WVO
POLICY NUMBER
POLICY EFF
(MMIDD/YYYY)
POLICY bXP
(MMIDD/YYYY)
LIMITS
A
GENERAL
LIABIUTY
COMMERCIAL GENERAL LIABILITY
OCCUR
CPP00102742
07/22/10
07/22/11
EACH OCCURRENCE
$ 1,000, 000
X
PREEMMISES(Eaooccurrence)
$ 100,000
$ 10 , 000
CLAIMS -MADE
X
MED EXP (Any one person)
PERSONAL&ADVINJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2 000 000
GEN'L
AGGREGATE LIMIT
POLICY n
APPLIES PER:
PRODUCTS - COMPIOP AGG
$ 2,000,000
n
LOC
$
B
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
CA00140182
07/22/10
07/22/11
COMBINED SINGLE LIMIT
(Ea accident)
$ 1 000 000
r r
X
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
X
$
X
$
B
UMBRELLA LIAB
EXCESS UAB
X
OCCUR
CLAIMS -MADE
UMB00092202
07/22/10
07/22/11
EACH OCCURRENCE
$ 2 r 000,000
AGGREGATE
$ 2,000,000
DEDUCTIBLE
RETENTION $
10,000
$
$
X
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVF
(Mandatory In N ER EXCLUDED?
(Mandatory In NH).
If yyes describe under
DESCRIPTION OF OPERATIONS
Y/ N
N / A
001WC10A63224
01/02/10
01/02/11
X 1 WCS ATU- XI ER
E.L EACH ACCIDENT
$ 500,000
1
I I
E.L DISEASE - EA EMPLOYEE
$ 500,000
$ 500 000
below
EL DISEASE - POLICY LIMIT
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space Is required)
VCR I Ir1VM 1 E nJI,J r
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
10050 NE 2ND AVENUE
MIAMI SHORES FL 33138
1
MIAMI SH
- - - --- - -- -
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
j)
r, . .t
... .. �....AT1f11J All dnhio .-.m d
ACORD 25(2009/09)
The ACORD name and logo are registered marks of ACORD
=
_ - •
LICENSE
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40 ul,. 29297157 9 Class _.;
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a 11/18/2009
ISS 4b Exp
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boa 0 1 /1 5/1 9 50
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MYERS
GORDON WILLIAM
8 1202 SUMMIT CREST
SAN ANTONIO TX 78258-0000