MC-11-1328Permit Number: MC -7 -11 -1328 1
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 162397
Inspection Date: August 15, 2011
Inspector: Perez, JanPierre
Owner: EVERETT, HENRY
Job Address: 9600 NE 2 Avenue
Miami Shores, FL 33138-
Project: <NONE>
Contractor: LARRABEE AIR CONDITIONER INC
Permit Type: Mechanical - Commercial
Inspection Type: Final
Work Classification: A/C Replacement
Phone Number (727)461 -4370
Parcel Number 1132060132510
Phone: (305)887 -1573
Building Department Comments
REPLACEMENT OF EXISTING 7 1/2 TON SPLIT SYSTEM.
CR_Hg i I
Passed
Inspector Comments
11111
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
For Inspections please call: (305)762 -4949
August 15, 2011
Page 1 of 1
Jul 21 11 10:53a henry everett
Mr. Norman Larrabee
Lanabee Air Conditioning Company
7171 N. W. 741h Street
Medley,
Florida 33166
7274614370 p.2
MC 1
Glt- 13"1(0
We hereby grant you our power of attorney to act in our behalf as respects any and all matters relating to the
permitting process with the Village of Miami Shores and the installation of a new air conditioning system
At 9600 N. E. 2' Avenue, Miami Shores, Florida.
Inasmuch as this location is an urgent care medical center attending sick patients we are hopeful this can be
expedited on an emergency basis.
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT. TIME OF FIRST INSPECTION
PERMIT -NO.hC 7 )4-- fag TAX FOLIO NO.1` �— 3 aO(, - 61? - aS) 0
STATE OF FLORIDA:
COUNTY OF MIAMI-DACE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real
property, and in accordance with Chapter 713, Florida Statutes, the following information
is provided in this Notice of Commencement.
1 111111111111111111111111111111111111 1111111
C'FN. , 2011R0492791
DR Bk 27768 Pas 3360 - 3361i {2P95)
RECORDED 07/26/2011 11 =42 :10
HARVEY RUVIN, CLERK OF COURT
11IAI1I -DADE COUNTY? FLORIDA
R
Space above reserved for use of recording office
1. Legal description of property and street/address: 9&00 Ph e,
tI'1 I (dm i C Loge) , L 3 3/ 3
2. Description of improvement:
3. s) name d ress:
nt s' f o
e . fr FIR
Name and address of fee simple titleholder
4. Contractor's name, address and phone number:
371,73
5. Surety: (Payment bond required by owner from contractor, if any)
Name, address and phone number.
Amount of bond $
6. Lender's name and address: -
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by -
Section 713.13(1j(a)7., Florida Statutes,
Name, address and phone number:
1174
Pn � L 33/ G
8. In addition to. himself, Owners designates the - following person(s). to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes.
Name, address and phone number: -
9. Expiration date of this Notice of Commencement: -
(the expiration date is 1 year from the date of recording unless a different date Is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER - 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE .BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY - BEFORE- COMMENCING WORK
OR RECORDING YOUR NOTICE OF COMMENCEMENT. -
Signature(s) of Own( s) or Owners)' Authorized Officer /Director/Partner/Manager
Prepared By Prepared By
Print Name .,. - is Print Name -
Title/Office G tzfsj- Title /Office
STATE OF FLORIDA
COUNTY OF MIAMI -DADE
The f • regoing instrument was acknowledged before me this
By ► 6 _ t Pc-P-RA EE'
OECD day of it
Q Individually, or ►�'as �' u C► for. VERe-
Wersonally y:known, or r -1 produced the following type of dentification
Signature of Notary Public:
Print Name:
(SEAL)
VERIFICATION PURSUANT TO SECTION 92.525, FLORIDA STATUTES
Under penalties of perjury, I declare that I have read the foregoing and
that the facts stated in it are true, to the best of my knowledge and belief.
Signature(s) of Owner(s) or Owner(s)'s Authorized Officer/Director/Partner/Manager who signed above:',: --
By By
19lM -SP PA•IFA 11/1)7
..iu121‘ 11 10:51a henry everett
OR BK 277458 PG 3361
LAST PAGE
Mr. Norman Larrabee
Larrabee Air Conditionim Company
7171 N. W. 74th Street
Medley,
Florida 33166
We hereby grant you our power of attorney to act in our behalf as respects any and all mattersrelating to the
permitting process with the 'Village of Miami Shores and the installation of a new air conditioning system
At 9600 N. E. rd Avenue, Miami Shores, Florida.
Inasmuch as this location is an urgent care medical center attending sick patients we are hopeful this can be
expedited on an emergency basis.
STATE OF FLORMA, COUNTY OF DADE
I HEREBY CERTIFY tim,t e PR1* awy Mg
origine Mad in tht ofit-JUL2_61.01t cty, of
, A D
WITNESS ru oamtd
HARVEY VW!, CLERK, of Dr
By
linty Courts
1
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
Applicant
9600 NE 2 Avenue
Miami Shores, FL 33138-
1132060132510
Block: Lot:
HENRY EVERETT
Owner Information
Address
Phone
CeII
HENRY EVERETT
188 DEVON Drive
CLEARWATER BEACH FL 33767-
(727)461 -4370
1
188 DEVON Drive
CLEARWATER BEACH FL 33767-
Contractor(s) Phone CeII Phone
LARRABEE AIR CONDITIONER INC (305)887 -1573
Valuation:
Total Sq Feet:
$ 8,170.00
0
1
Tons: 7.5
Additional Info:
Classification: Commercial
Approved: In Review
Comments:
Date Denied:
Scanning: 1
Date Approved: : In Review
Type of Work:
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$5.40
$3.68
$3.68
$1.80
$245.10
$3.00
$7.20
$269.86
Pay Date Pay Type Amt Paid Amt Due
Invoice # MC -7 -11 -41535
07/22/2011 Check #: 4252 $ 50.00 $ 219.86
07/26/2011 Check #: 4253 $ 219.86 $ 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.
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
July 26, 2011
Date
July 26, 2011 1
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
i! - Z
�� JUL 2 2 2011
BY.
Permit No. M e° 11- l3 28
Master Permit No.
Permit Type: MECHANICAL
OWNER: Name (Fee Simple Titleholder): i V F(� Phone #: (7�� ®� �3
Address:
City: tae .� (• . ,. �, k state: F 1 zip: 3371a7 - 4432
Tenant/Lessee Name: Phone#: (7.17) Y61 — X137 o
Email:
J013 ADDRESS: 96 ®+
City: Miami Shores County: Miami Dade .
Folio/Parcel #: 1 — 3 a® L. QS @
Is the Building Historically Designated: Yes NO Flood Zone:
Zip: 33J3
CONTRACTOR: Company Name: L PRA PIP, e E Al P—. 0,,co h.A n / 1 l!i /'- Phone #: ) '8 7-M7.3
Address: '71 7 I/ IV/4) 77/ ' RRE ET
City:
Qualifier Name:
rn l A *! State: FInd J Zip: , (,
NeRin Alm LA eoz_r 3 ar Phone OS_.) ic£i7 ) S73
State Certification or Registration #: 1 9 Certificate of Competency #:
Contact hone #: (2g I) S ®ao 6 Email Address: tj L A R P A Et e Pei E StmAd o v J
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 7 4 0 6 Square/Linear Footage of Work:
Type of Work: °Address °Alteration
Description of Work:
°New Repair/Replace
°Demolition
****** ****** ******* ********** * * * * ****
**
***** ** **** * * ** * ** ***** *a* * * * * **
Submittal Fee $ 5 0 • o° Permit Fee $ CF $ CO /CC $
Scanning Fee $ p �� fl Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
•
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 FT.FCTRICAL 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature _
Owner /ant 1fr)oRrn h LMaRI 3 E Contractor 0RmPtN >F}(CQ2�$E
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 4d , 20 ! / , by 4/f, ,e. M /l Al /1-2/v48c day of a 17d , 20 /i , by ®e st -/r9- 41 /A- X2.,4/ C
who is personally known to me r who has produced (who is personally known to m_Oor who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expire
eiti MY COMMISSION 8 00 864402
EXPIRES: March 6, 2013
;840V Banded Thru Noxy Public
* * * * * * * * * * * * * * * * * * **
APPROVED BY
NOTARY PUBLIC:
Sign:
Print:
My Commi
n
IRIS L EWOTT
s: My COMMISSION 800 864402
EXPIRES: March 6, 2013
Bonded Thru Notary PubIE Underwriters
***************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
lans Examiner Zoning
Structural Review
(Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09)
Clerk
Jul 21 11 10:51a henry everett
FAX
To: Norman Larrabee, Larrabee Air Conditioning Co.
Fax No: 305- 2791537
Cc: Torn Benton, Village Manager, Village ifMian i Shores
Fax No. 305 - 756 -8972
Please see attached authorization.
Thanks,.
Frances B. Everett
1/24
7274614370
p.1
Jul 21 11 10:51a henry everett
7274614370 p.2
Mr. Norman Lanrabee
Larrabee Air Conditioning Company
7171 N. W. 74th Street
Medley,
Florida 33166
We hereby grant you our power of attorney to act in our behalf as respects any and all matters relating to the
permitting process with the Village of Miami Shores and the installation of a new air conditioning system
At 9600 N. E. rd Avenue, Miami Shores, Florida.
Inasmuch as this location is an urgent care medical center attending sick patients we are hopeful this can be
expedited on an emergency basis.
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): 9600 AFrakft telj‘4,0
City: Miami Shores Village County: Miami Dade Zip Code:
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 ❑ ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES ❑
UNIT BEING REPLACED
pf
j <—
7 f®
AHU CU PKG
C PKG
PKG
G UNIT / /
AHU
DATA
UFACTURER
or PKG. UNIT MODEL #
OND UNIT MODEL #
KW HEAT
NOM TONS
1) M.C.A
M.O.P
3 VOLTS 2ce
NEW UNIT
.9 7
���
7 ®"." •
AHU CU PKG
PKG
PKG
YES
EEEER
REPLACING DUCTS
REPLACING THERMOSTAT
NEW 4 "CONCRETE SLAB
NEW ROOF STAND
NEW RETURN PLENUM BOX
KG UNIT
/o 3
YES
YES
YES
1. Minimum Circuit Ampacity (Wire Size):
2. Maximum Overcurr-nt Protection (Fuse /Breaker Size):
3. Voltage of Cir 40/480):
4. Size Disconnecting Means:
Contractor's Company Name: LA P FI- I . ow -b..) (,, a Phone: OOS 7-1573
ei8 X12
State Certificate or Registration N. C ,13o9 Certificate of Competency N.
Signature Date: 7 47
(Qualifler's signature only)
Larrabee Air Conditioning, Inc.
7171 NW 74 th Street Miami, FL 33166 Phone: 305 -887 -1573: 887 -5184 Fax: 885 -0994
Proposal
Date: July 8, 2011
Proposal submitted to: Henry & Fran Everett
9600 N.E. 2nd Avenue
Miami, Shores, Florida 33138 Suite 209
Phone: 786 - 382 -1695
Job Name: Urgent Care Center
Attn: Henry & Fran
We propose hereby to furnish material and labor in accordance with specifications below, for the sum of:
Eight thousand one hundred and seventy dollars 00 /100 $8,170.00.
Larrabee Air Conditioning, Inc. proposes to furnish labor and material necessary to install a new American Standard
split system at the above location as follows.
1. Demo: Remove the existing equipment and take to salvage yard.
2. Install new American Standard condenser model TTA090D300A back in same location as old equipment.
3. Install new American Standard air handler model TWE090D300A back in same location.
4. Install new 10 KW heater model BAYHTRL310A.
5. Install new digital thermostat in same location as old stat.
6. Reconnect new equipment back to the existing electrical, refrigerant piping, drain system and duct system
as before.
7. Fabricate new auxiliary drain pan with auto float switch, install under new air handler and wire to control
circuit.
8. Check refrigerant piping for leaks. Pull vacuum on system, charge and check system for proper operation.
9. After completion this contractor will do a T &B on air flow to rooms.
10. Warrantee: This contractor will give one -year parts and labor for work performed under this contract
and additional 4 years on compressor only as per manufacturer warrantee.
11. Permit fees and crane are included in this proposal.
12. Price: $8,170.00.
Note: This Proposal may be withdrawn if not accepted within 30 days.
All materials are guaranteed to be as specified All work to be completed in a worlomnlike manner according to standard practices. Any alterations or deviation from specifications above
involving extra cost will be executed only upon written orders and will become an extra charge over and above the estimate. All agreements are contingent upon accidents or delays beyond our
control.
Authorized Signature
Acceptance of Proposal: The above prices, specifications and conditions are satisfactory and are hereby accepted.
You are authorized to do the work as specified Payment will be made as outlined above.
Date of acceptance: 7/a // /
Signature . , Signature
JUL -21 -2011 08:51 From:GEMAIRE MIAMI SALES
null .. CERTIFIED..
wwWikl rill1,,,,,,ry. +irk)
Certificate of Product Ratings
AHRI Certified Reference Number: 3541352 Date: 7/5/2011 j'Status: Active
Product: Spilt System: Air-Cooled Condensing Unit, Coil with Blower
Model Number: TTA090D3"A•
Indoor Model Number: 7WE09003"A'
Manufacturer: AMERICAN STANDARD, INC.
Trade/Brand name: AMERICAN-STANDARD
Rated as follows In accordance with AHRI Standard 3401360.2007, Commercial and Industry Unitary
AIr•CondltIonIng and Heat Pump Equipment and subject to verification of rating accuracy by AHRI- sponsored,
Independent, third party tasting:
Cooling Capacity (Btuh): 92000/92000
MR Rating (Cooling): 11.20/11.20
IEER: 122/12.2
Heating Capacity at 47F (8tuh):
COP at 47F:
Heating Capacity at 17F (Btuh):
COP at 17F;
t Medals oath an Acave stalul are Mose Piet am aerarty In production. Models w4h a'Ohoontlrwed' statue ere /how that the manufacturer hie elected to step produuing, yet elogt
b an available. Modals vat en'OWOiala' Otto are those eat the manufacturer b ratuked to slop manufacturing duo to an AMR/ cadecitiar program Ieal (allure.
• Ratings Waved by en astadrk (') Indicate a voluntary mate of movie sy published data, umbras ecoompanled with a WAB, which Moan en Involuntary rural*.
DISCLAIMER
ANRI does not endorse the productlej Gabel on this Cedillas and males no r seem+ Mlen , wwmmtiea or Ymantes, as to, and aatmmea no reepormlbiltly fon
Via producltsl Mad on ties Certificate. AHRI ttrpta iy disclaims tip MatdU4f km damp= deny kind arising out of the use or performance o►em produd(ej, ortha
wumdrorbed .Naadon of date Mad as dab Ce»Ifbat.. Cattfled ratings as valid only for modem and dondgundlone Hated In ere directory at www.ehddltadtory ag,
TERMS AND CONDITIONS
Train C.NGldate and lia contents are proprietary products DIANRN. Mb Wiliest. shah only in used for imilvidual, persons! and confidential mhos= putlwasa,
The conlaMn of ChM Certificate may rat, In whole or In part, be nave cacti copadi dbaernbneed; errterad Intl a cantputra+databws: or nth rwlon uIIItud. In any
fort or manner or by any mesne, ttfortho user's Individual, p utanml and cunmlantlal reference.
ThalInfo C don VERIFICATION
The irdamredon far ds made eked an Oda cartMFea6s can be var(t� w wrwmwahrldlrettory oag, Air- Conditiot+irtg, Hooting,
click on "Verity Csrdff cite" link and enfertheARAI Certified Rabra ee Hamra,' end Vie date on m Br r and Refrigeration lneliluto
ve teh the cndfIcate on WNW which ti Matted above, middle CudfIoatoe Na, whkih la Gated Irelowc
62011 Alr•Conditloning, Heating, and Refrigeration Institute CERTIFICATE NO.: 1205434287773MMA0
i
SUL /20 /2011 /WED 11:25 AM
FAX No,
P. 001
(0
f fall CERTIFICATE OF LIABILITY INSURANCE OP lb TM
CATECtSWeOhYYY)
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THIS
POLICIES
THIS CERT1'FICATE IS ISSUED AS A MATTER or INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORbED BY THE
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER
IM • • • t e cart( cafe hol . ex s an ADD ONAL INSURED, the po se m = a 611.Ors : • • 1 BR . TION 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 andorsernent(s). '
PRODUCER
BROWN & BROWN OF FLORIDA INC
14900 NW 79th Court suite #200
Miami Lakes Fi. 33016 -5869
Pbone:305- 364 -7800 Frax:305- 822 -5687
%mum.,
NAME
t emu I (A, tm):
ADORERS:
PRODUCER LARRA -1
INSURER(S)ArPORDiNOCOVERAOs
NAics
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Larrabee Air Conditioning In
71.73. D Kar rrabeeMechasuoul
Medley FLL.433166 .
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INSURERAI rCCi Insurance Company
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REVISION NUMBER:
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INDICATED.
CERTIFICATE
EXCLUSIONS
IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICYPERIOD
NOTWITHSTANDING ANY REQUtREMSNT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
MAY BE ISSUED OR MAY PERTAIN. THE NSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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CEBCRl 1UN OF OPERATIONS ) LOCATIONS t VEIUCLE9 Which ACORD 101, Addtibrd Remarks Sohadulo, If my specs 1¢ re4Wred)
CANCELLATION
MIAMI55
Miami Shores Village
10050 NE 2nd Avenue
Miami Shores FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVIS IONS,
AUTHORIZED REPRESENTATIVE
Robert MunChjok
'19118-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
JUL /20 /2011 /WED 08:58 AM
FAX No,
F.001
OP ID: OR
"��' -�`` °- CERTIFICATE OF LIABILITY INSURANCE
DATE 07/20/11 ,
07/20119
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOES NOT AFFIRM ATIVVLY oR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCHES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND 'THE CERTIFICATE HOLDER.
IMPORTANT: it the certificate holder Is an ADDITIONAL- INSURED, the poiicy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the tams and conditions of the policy, certain policies may requlrs an andonaamenL A statement on this certificate dorm not confer rights to the
certificate holder lh gee of such endersement(s).
museums 305- 6664636
Wilson,Washbuyn & Forster ins. 305-662 -7778
Email: Infotewwfine.com
10301 $0, Dixie Hwy, Ste. 300
Plnacrest, FL 33156 -3161
JohniCL-Cupinl___
CONYAWY
FAX
Mom DUCJALErk a x
E-MAIL
ADDRESS:
cumomPRunucrs II fLARRA -1
INSURERS) AFFORDING COVERAGE
RAIDS
590514
INSURED Larrabee A(r Conditioning, Inc
dbe KAR Larrsbee
Mechanical Contractors
7171 NW 74th St
Medley, FL 33166
saunER A : Nationwide Insurance Co of
MEURER 8:
o HrrNT7:u
PAF.N6161t9IEaawwvttenal
INSURER 0
100,000
INSURER 0 : •
1 CLAIMS -MADE X OCCUR
INSURER E •
$
• 0,000
COVERAGES
C
THIS
INDICATED.
CERTIFICATE
EXCLUSIONS
LIRR
IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
MAY HE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OPINSUPANCE
iAR,]M�n
POLICY NUMBER
5905149707
.�; 9i
07101!11
' ' .J -)
07/01/12
LUIETS
EACH OCCURRENCE
"D'7i0A�'t
1,100,000
A
GENERAL
X
UABIUTY
COMMERCIAL GENERAL UASLITY
o HrrNT7:u
PAF.N6161t9IEaawwvttenal
$
$
100,000
1 CLAIMS -MADE X OCCUR
MED EXP (Any ®m peen)
$
• 0,000
PERSONAL B ADVINJURY
s
1,000,000
GENERAL AGGREGATE
.s
2,000,000
OENL AGGREGATE UMIT APPLIES PER:
—I POLICY 150 l .PIECT 1 1 LOC
PRODUCTS - COMP/OP AGO
$
2,000,000
$
A
_,
AUTOMOBILE
X
—
X
XNON
LIABIRY
ANYAUTO
ALLOVMNEDAUTOS
SCHEDULED AUTOS
HIRED AUTOS
- OWNED AUTOS
5905149767
07101111
07101112
COMBINED SINGLE LIMIT
(Es soddenly
$
1,000,000
LY INJURY (Par person)
$
ROMLY INJURY (Per eotfdem)
9
PROPERTY DAMAGE
(Per aedden0
1
S
8
A
X
UMBA!LLA LIAB
masa LLAS
X
UCCUR
CL OS -MADE
5005149767
07101111
•
07/01112 '
EACH OCCURRENCE
$
3,000,000
AGGREGATE
s
3,000,000
OFDUCTIBLE
RETENTION 5
$
$
AN EMPLOYERS' LLi eLMTY
ANY PROPRETOA!PARTNER/EXECUIIVE
OFFICERNEMBER EXCLUDED?
(Mandatory In ND
If yea. Mona wider
DESCRIPTION OF OPERATIONS
YIN
NIA
l io" RY UAA s 1 1 ER
E.L. EACH ACCIDENT
$
E.L. OSEASE • EA EMPLOYEE
$
mow
EL DISEASE - POLICY UNIT
$
A
Employment
Practices Uab.
§9a$149707
07101111
07/01112
Limit
nod
26,1104
SAO
oEscRpRIQR aF OPERATIONS I LocAT1WNS 1 VENN:LES (Attach ACORD 101, Addplcryd Ranafl
Heating Air Conditioning
SelwGda, If more apace le revalued)
CERTIFICATE HOLDER
IVIIASH01
Miami Shores Village
9
Building Department
10050 NE 2nd Ave
Miami Shores, FL 33138
---- - -- - -
- - - -
aHOUNL0 ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPitAT�V DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORLIANCE WON THE POLICY PROVISIONS.
Aunt DREPRES>xrANYE
ACORD 25 (2009109)
1908.2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
MIAMI -DADE COUNTY
TAX COLLECTOR
140 W. FLAGLER ST.
lot 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 BA - ART, 9 & 10
THIS IS NOT A BILL - DO NOT PAY RENEWAL
025797 -2
BUSINESS NAME / LOCATION RECEIPT NO. 025797 -2
LARRABEE AIR. CONDITIONING INC STATE* CACO21309
7171 NW 74 ST
33166 MEDLEY'
FIRST- CLASS
U.S. POSTAGE
PAID
MIAMI, FL
PERMIT NO. 231
OWNER
LARRABEE AIR CONDITIONING INC
Sec, Type of Business
196 SPEC MECHANICAL CONTRACTOR
THIS IS ONLY A LOCAL
BUSINESS TAX. RECEIPT. IT
DOES- NOT PERMIT THE
HOLDER TO VIOLATE ANY
EXISTING REGULATORY OR
ZONING LAWS OF THE
COUNTY OR CfIES. ` NOR
DOES 17 EXEMPT THE
HOLDER FROM ANY OTHER
PERMIT OR - LICENSE
REQUIRED BY LAW. TIES IS
NOT A CERTIFICATION OF
THE HOLDER'S _QUAUFICA-
t.TIONS.
PAYEEENlAECEIVED.
MIAMI-DADE: COUNTY TAX
COLLECTOR:
09/08/2010
09010205001
000045.00
SEE OTHER SIDE
DO NOT FORWARD
LARRABEE AIR CONDITIONING INC
NORMAN L LARRABEE PRES
7171 NW 74 ST
MEDLEY FL 33166
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