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RF-11-1854Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 165332 Permit Number: RF -10 -11 -1854 Scheduled Inspection Date: November 28, 2011 Inspector: Bruhn, Norman Owner: WILLINGHAM, HOWARD Job Address: 1158 NE 92 Street Miami Shores, FL 33138- Project: <NONE> Contractor: OBENOUR ROOFING SHEET METAL & SUPPLY CO. INC Permit Type: Roof Inspection Type: Final Roof Work Classification: Flat Phone Number Parcel Number 1132050270440 Phone: 305 -757 -2612 Building Department Comments RE -ROOF REAR FLAT GAF 4 PLY MINERAL CAPSHEET OVER 1/2" FT TAMPERED Passed' Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments November 23, 2011 For Inspections please call: (305)762.4949 Page 8 of 23 Miami hores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RE: Permit.# �= lQ °l � DATE: ti INSPECTION AFFIDAVIT iQijY\rS . £II1bt'T) ff P. li censed as a (n) Contractor / Engineer / Architect, (Print name and drde License Type) FS 468 Building Inspector License #: On or about I! I/5/ if 1 7 (Dates time) r 5 Q n Secondary water barrier work at 11 i)E Z S� , I did personally inspect th (Complete Job Site Address) Based upon that examination I have determined the installation was done according to the Hurricane Mitigation Retrofit Manual (Bas - .;, 553.844 F.S) State of Florida County of Dade: • The undersigned, being the first duly swom, deposes and says that he/she is the contractor for the above property • mentioned. Swom to and subscribed before me this ® 3 Notary Public, Sate of Florida at Large day of , ,19V 20 201/ �_..'.t ~.:i J. a z4igissioa Di 67 9 AM. 2013 •Genre/, BuUdirg, Residential, or Roofing Conbractore or any individual certified under 468 F.S. to make such an inspection. Include photographs of each plane of the roof with pemilt# and address # dearly shown marked on the deck for each Inspection !ry, oe aed+... tn4rxinn 1 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION] PERMIT NO TAX FOLIO NO./f 5�� '5 a t7 £ STATE OF FLORIDA: COUNTY OF MIAMI -DADE: 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. 111111111111111111111111111111111111111111111 C F N 2011R0695216 OR 8k 27860 Ps 4384; (113s) RECORDED 10/17 /2011 11 :55 :05 HARVEY IRUVINv CLERK OF COURT MIAMI -LADE COUNTY, FLORIDA LAST PAGE ,ry �t Opeltit2 1. Legal description of property and street/address: //J it /t, g ;t �7 he h ,3/ 2. Description of improvement: ! w 0 3.Owner(s) name and address: O w A pr. of & I f l / r� h !-/ t Interest in property: NC. "- Name and address of fee simple titleholder: 5,4 Sri f 4. Contractor's name, address and phone number: ® 0' /J 9 u , ®may h 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(1)(a)7., Florida Statutes, Name, address and phone number: 8. In addition to himself, Owners designates the following person(s) to recei copy of the Uenor'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 INSPEC N Y. INTEND TO O ? N FINANCING, CONSULT TH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECD', % G YOU `, OTCE OF CO; CEMENT. Signatu Prepared By Print Name Title /Office STATE OF FLORIDA COUNTY OF MIAMI -DADE The foregoing instrument was acknowledged before me this • i () day of L. 20 (� By ❑individually, or ❑ as for Personally known, or ❑ produced the following type of identification: Signature of Notary Public: Print Name: ,1 e '75T (SEAL) 201 • recto lPartner/Manager Prepared By P` Print Name Title/Office '-t (11( , i/1 'alcu_ LE.() gr ?a) VERIFICATION PURSUANT TO ECTION 92,525. FLORIDA STATUTES Under . naltl of perjury, I de that I have read the foregoing and tated in it are , to the best of my knowledge and belief. nec ' Auth • zed Offlcer/Direct•' /Partner /Manager who signed above: By 123.01 -52 PAGE3 3/10 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 BUI DING PERMIT APPLICATION FBC 20 OCT iA 1 ,2011 Permit No I I ! I Master Permit No.__ Permit Type: BUILDING ROOFING FING OWNER: Name (Fee Simple Titleholder): 14 0Cu '4,-J L, f) i h, 2 A . Phone#:0..( 2. 7'1/ t Co Address: //S.- d /U ' a. 5 1 City: /4' Ai-4; •S h 0 )' L ) State: l r Zip: 3 `31 3 2 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: `< -: Ale s City: Miami Shores County: Miami Dade Zip: 5 /3 $ �i 3 2v s 027 o Z44 Is the Building Historically Designated: Yes NO Folio/Parcel #: Flood Zone: CONTRACTOR: Company Name: &1 ,6'Odie— ,o�if/,t/c Phone#: 3 7S7.� /2- Address: s /b--/ it/E 97 7 je4' City: /114)19/ f ` v1(l5 State: rC Qualifier Name: /��'�frii% /9/i94/Or0/4' State Certification or Registration #: C-64- 0 /K3o Certificate of Competency #: Contact Phone#: q 7J'7-)-. / >✓ Email Address: DESIGNER: Architect/Engineer: Phone #: Zip:33j4 Phone#: %rIr2-4/2- Value of Work for this Permit: $ /e 9 P6 Square/Linear Footage of Work: All Type of Work: ❑Addition ❑Alteration New ;Hirep • ' e • lace ❑Demolition Description of W rk: 6 < 1 d ' r— tree ( /S07/7•1V/Z 4/ x*+*********** * * * * ********+x****** * *mmm Fees** *** *** ***+ x********** **+x+x*********+x******** d. Submittal Fee $ Permit Fee $ c,L3 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ sliC) Bonding Company's Name (if applicable) Bonding Company's Address City S Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City S te 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 At'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 that a copy of the notice of commencement and construction lien law brochure will be delivered to the person certified copy of the recorded notice of commencement must be posted at the job site days after the building permit is issued. In absence of such posted notice, the on fee will be charged. �� whose property is subject to attachment. Al for the first inspecti>n which occurs sev;` inspecti y e approved and a re Si sp Signature Owner or Agent f Contractor The foregoing instrument was acknowledged before me this 1 The fore ng instrument was acknowledged before me thiskb day of , 20 JL, by Oi7d t:Q'f(1i ti) t I (! p r,L_Lifh , day of , 20 I( , by.-10.0K O L bc 16-.L- who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign`G;t=(,t (> Print: : i4tiriif larLgg gil L 111. 0t My Commission Exp °tRn° Sandra D. I1rt Commission # DD367399 Expires: APR. 02, 2013 c Emma ca. APPROVED BY L�iG�lK 45--/I'// Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) NOTARY PUBLIC: Sign Print: -51 (r My Commissio (r) • ft a( ) t"i..i: 1.:,Sa /i i OF • SRada D Hart Commission #D a 3.59 Epp :. ti Zoning Clerk IVI larni Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNERS'S AFFIDAVIT OF EXEMPTION ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FOR EXISTING SITE - BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES PERSUANT TO SECTION 553.844 F.S. To: Miami Shores Village Building Department Date: P 3 elf 10050 NE 2nd Ave Miami Shores, Fl 33138 Re: Owner's Name: A 1-- d ..' f `lee) A•{..) Property Address: /161 AI E g S-T Roofing Permit Number. Dear Building Official: I ,/46 (14 A r-4 6-)(111A19 A 4 certify that I am not required to retrofit the roof to wall connections of my building because: he just valuation for the structure for purpose of ad valorem taxation is less than $300,000.00. Please attach proof of ad valorem taxation. ❑ The building was const cted in compliance with the provisions of the Florida Building Code (FBC) or with the provisions edition of th S th Florida Building Code (1994 SFBC) 3 Signature Print Name State of Florida County of Dade The undersigned, being the first duly swom, deposes and says that he /she is the owner for the above property mentioned. Swom to and subscribed before me this day of >) Notary Public, Sate of Florida at Large c • When the just valuation of the structure for purpose of ad valorem taxation is equal to or more than $300,000.00, and the building was not constructed with FBC nor a 1994 SFBC. Then you must provide a building application from a General Contractor for the Roof to Wall connection Hurricane Mitigation. Revised on 5/21/2009 Miami -Dade My Home' My Home riamidade. Show Me: IProperty Information Search By: I Select Item Text only El Property Appraiser Tax Estimator Property Appraiser Tax Comparison Lg Portability S.O.H. Calculator Summary Details: Folio No.: 1205-027 -0440 Property: 1158 NE 92 ST Mailing HOWARD E WILLINGHAM Address: 1 Living Units: 1158 NE 92 ST MIAMI Adj Sq Footage: SHORES FL Lot Size: 33138 -2935 Pro perty Information: Primary Zone: „''_ 1100 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds/Baths: 3/2 Floors: 1 Living Units: 1 Adj Sq Footage: 2,635 Lot Size: 18,750 SO FT Year Built: 1950 $50,000/ $256,715 BAY LURE PB 44-83 Legal LOTS 5 & 6 BLK 3 LOT Description: SIZE IRREGULAR OR 18023 -0660 0298 4 OR $25,000/ $281,715 18023 -0660 0298 01 Assessment Information: Year 2010 2009 Land Value: $225,000 $328,500 Building Value: $236,805 $252,724 Market Value: $461,805 $581,224 Assessed Value: $306,715 $298,652 Exemption Information: ear 2010 2009 =MUM M $25,000 $25 000 Taxing Authority: Exemption/ Taxable Exemption/ Taxable Taxable Value Information: Year 2010 2009 Applied Applied Taxing Authority: Exemption/ Taxable Exemption/ Taxable Value: Value: Regional: $50,000/ $256,715 $50,000/ $248,652 County: $50,000/ $256,715 $50,000/ $248,652 �. $50,000/ $256,715 $50,000/ $248,652 School Board: $25,000/ $281,715 $25,000/ $273,852 Sale Information: le Date: 1998 Sale Amount: 1 Page 1 of 2 ACTIVE TOOL: SELECT u Aerial Photography - 2009 0 116 ft My Home 1 Property Information 1 Property Taxes 1 7Iv Nelahborhood I Property Appraiser ome 1 Usina Our Site 1 Phone DIrectory I Privacy 1 Disclaimer If you experience technical difficulties with the Property Information application, or wish to send us your comments, questions or suggestions please email us at Webmaster. Web Site © 2002 Miami -Dade County. All rights reserved. Legend Property Boundary Selected Property Street Highway Miami -Dade County Water Nf 8 http: / /gisims2. miamidade .gov /myhome /propmap.asp 8/17/2011 CUMULATIVE SUBSTANTIAL IMPROVEMENT VERIFICATION WORK SHEET In accordance with FEMA regulation and Miami Shores Village Flood Damage Prevention Ordinance the costs of all improvements must be monitored. The costs of any improvements in the past 12 months and the costs of any proposed improvements must be shown on the worksheet. The cost of improvements must include demolition, raw and finished materials (include those donated), labor (including volunteer and self - performed), construction supervision and management, and overhead and profit. A list of items the costs of which are to be included as well as those excluded is attached for your reference. (A Copy of the Contract must be attached) CL PROPERTY OWNER: l a ' j /- c/ W / /` e i/ 1)4)L( PERMIT # ADDRESS: //6Z ,V '92- S T I1/14%io rzs / R ,113e' FOLIO NUMBEFil 3205. 0 2! otilU FLOOD ZONE: BASE FLOOD ELEVATION: FREEBOARD: EAST OF FL.CCCL: COST OF PAST IMPROVEMENTS (12 MONTHS): COST OF PROPOSED IMPROVEMENTS: �� 9 ® 0 (ATTACH COPY OF CONTRACT) TOTAL CUMULATIVE COST OF IMPROVEMENTS (past and proposed): VALUE OF PRINCIPAL U RE (attach ap OWNERS SIGNA DATE: PLANREVIEWER: PLAN REVIEWER SIGNATURE: DATE: Created on June 2009 Florida Building Code Edition 2007 kiidh Velocity Hurricane Zone Uniform Permit Application Form Miami Shores{ Vf i%age $ectlon A (General Information) APPROVED BY Mester'Permit No. Process No. ZONING DEPT i; Contractor's Name f9d Ei✓atL ����� �I IR SECT T() COMPLIANCE WITH Job Address //_—d /fig Z jrje e r ROOF CATEGORY ow Slope E Mechanically Fastened Tile fl Mortar /Adhesive Set Tile fl Asphaltic Shingles C Metal PanelShingles fl Wood Shingles/Shakes 0 Prescriptive BUR -RAS 150 STATE AND COUNTY RULES AND 1 DATE L1( LLFEDF EGULAH ROOF TYPE U New Roof e- Roofing U Recovering 0 Repair aU Maintenance ROOF SYSTEM INFORMATION Low Slope Roof Area (SF) Steep Sloped Roof Area (SF) Total (SF) Section B (Roof Plan) Sketch Roof Plan: Illustrate all levels and sections, roof drains, overflow drains. 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Design Pressure, From the Specific NOA System: 52'. 5- Deck: Type: GvooC/ 7446* Gauge/Thickness: 3 /1 Slope: t) /FT Wiz., AA Anchor/Base Sheet & No. of Ply(s):_ 7. A %7 Anchor /Base Sheet Fast ner onding Material: /MM'q v /5 re Insulation Base Layer: _ ®Gt/4ii+JI _/i 4c e Base Insulation Size and Thickness:1" )'1 //21//✓ Base Insulation Faste rBonding Material: -7y/to fir' Top Insulation Layer: /44-- Top Insulation Size and Thickness: Top Insulation Fastener/Bonding Material: . Base SRO/MC/1g ): TTA<41 4/ Base Sheet Fastener/Bonding Material: "-COLE .41-f e5 Ply Sheet(s) & No. of Ply(s):g #bioej/ e Ply Sheet Fastener /Bding Material: ®�� Top Ply: �44/ €, 4 ( S 7t y./ Top Ply FastenerB nding aterial: Surfa S Fastener Spacing for Anchor/Base Sheet Attachment Field: 7 " oc @ Lap, # Rows 1 ® f " oc Perimeter: 6 "oc 0 Lap, # Rowse® G" oc Corner: 4 " oc a Lap, # Rows !C@ G" oc Number of Fasteners sulation Board Field r Comer Illustrate Components Noted and Details as Applicable: Woodblocking, Gutter, Edge Termination, Stripping, Flashing, Continuous Cleat, Cant Strip, Base Flashing, Counter- Flashing, Coping, Etc. Indicate: Mean Roof Height, Parapet Height, Height of Base Flashing, Component Material, Material Thickness, Fastener Type, Fastener Spacing or Submit Manufacturers Details that Comply with RAS 111 and Chapter 16. - s`fdC�o GA /v-W4'T€ c Btr/ -.i 1144-i cA/ fyeer Arnie, A f� Tircom »rgto/V! ‘1,4 FT. 1t Parapet Height ,7ij ey 3l �/ rove, !L " "7/5EQLAire � Co/vr,)ow LA/ /% "W /S /o ose �5<9g ga(tr. re" Wiley /fi~9% FT Mean Roof Height Owner's Notification Form 07 "Delivering Excellence Every Day" SECTION 1524 HIGH VELOCITY HURRICANE ZONES - REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS 1524.1 Scope. As it pertains to this section, it is the responsibility of the roofmg contractor to provide the owner with the required roofmg permit, and to explain to the owner the content of this section. The provisions of Chapter 15 of the Florida Building Code, Building govern the minimum requirements and standards of the industry for roofmg system installations. Additionally, the following items should be addressed as part of the agree t ent between the owner and the contractor. The owner's initial in the designated space indicates that the ite s,'l as been explained. 1. Aesthetics - workmanship: The workmanship provisions of Chapter 15 (High Velocity Hurricane Zone) are for the purpose of providing that the roofmg system meets the wind resistance and water intrusion perfo v_ s ce standards. Aesthetics (appearance) are not a consideration with respect to workmanship provisions. Aes s /lc issues such as color or architectural appearance, that are not part of a zoning code, should be addressed as p of the agreement between the owner and the contractor. 2. Renailing wood decks: When replacing roofing, the existing wood roof deck may have to be renail -a in accordance with the current provisions of Chapter 16 (High Velocity Hurricane Zones) of the Florida Buil s g Code. (The roof deck is usually concealed prior to removing the existing roof system). WA3. Common roofs: Common roofs are those which have no visible delineation between neighboring units ,'1e. townhouses, condominiums, etc.). In buildings with common roofs, the roofmg contractor and/or own r should notify the occupants of adjacent units of roofing work to be performed. tig 4. Exposed ceilings: Exposed, open beam ceilings are where the underside of the roof decking can be viewed , om below. The owner may wish to maintain the architectural appearance; therefore, roofing nail penetr -/ions of the underside of the decking may not be acceptable. The ownerprovides the option of ma: .' +is ing this appearance. 5. Ponding water: The current roof system and/or deck of the building may not drain well and may cause water to pond (accumulate) in low -lying areas of the roof. Ponding can be an indication of structural distres :and may require the review of a professional structural engineer. Ponding may shorten the life Y c P expe and performance of the new roofmg system. Ponding conditions may not be evident until the original �, roo , system is removed. Ponding conditions should be corrected. vial 6. Overflow scuppers (wall outlets): It is required that rainwater flow off so that the roof is not overlo` ed from a build up of water. Perimeter /edge walls or other roof extensions may block this discharge if ove • w scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in accordance requirements of: Chapter 15 and 16 herein and the Florida Building Code, Plumbing. 7. Ventilation: Most roof structures should have some ability to vent natural airflow through the interior of the structural assembly (the building 'tself). The existing amount of attic ventilation shall not be reduced. Exception: Attic spaces, - signed a Florida - licensed engineer or registered architect to eliminate the attic venting, venting s . • not ► e requir Owner's /Agent's Signs ��,�� 2 Date: / Contractor's Signature: Property Address: Permit Number: Ell Mai ®� BUILDING C PRODUCT C NOTIC' GAF ]bate 1361 Alps i Wayne, NJ E�COM PLIANCE OFFICE (BCCO) TROL DIVISION SCOPE: This NOA materials. Code and Pr by the Autho This NOA Control Div reserve the material fail fi and the AFL their jurisdiq County Prod applicable b This produa` Code and the DESc LABELIN and followin herein. RENEWAL been no'chati TE @ B A. change in the endorsement this NOA. F NOA. ADVERTI followed by displayed, tl INSPECTI distributors ACCEPTANCE (NOA) MIAMI -DADE COUNTY, FLORIDA METRO -DADE FLAMER BUILDING 140 WEST FLAGLER STREET, SUITE 1603 MIAMI,' FLORIDA 331304563 (305) 375 -2901 FAX (305) 375 -2908 orporation. ad 470 eing issued under the applicable rules and regulations governing the use of construction documentation submitted has been reviewed by the BCCQ and accepted by the Building uct Review Committee to be used in Miami Dade County and other areas where allowed ity Having Jurisdiction (AHJ). 11 not be valid after the expiration date stated below. The Miami -Dade County Product ion (In Miami Dade County) and/or the AHJ (in areas other than Miami Dade County) t to have this product or material tested for quality assurance purposes. If this product or o perform in the accepted manner, the manufacturer will incur the expense of such testing may immediately revoke, modify, or suspend the use of such product or material within on. BORA reserves the right to revoke this acceptance, if it is determined by Miami -Dade ct Control Division that this product or material fails to meet the requirements of the Iding code. s approved as described herein, and has been designed to comply with the Florida Building igh Velocity Hurricane Zone of the Florida Building Code. GRB''T ON: GAF Conventional Built -Up Roof System for Wood Decks„ This NOA re The subm Each unit, shall bear a permanent label with the manufacturer's name or logo, city, state statement: "Miami -Dade County Product Control Approved unless otherwise noted fthis NOA shall be considered after a renewal application has been filed and there has e in the applicable building code negatively affecting the performance of this product: ON of this NOA will occur after the expiration date or if there has been a revision or aerials, use, and/or manufacture of the product or process. Misuse of this NOA. as an f'any product, for sales, advertising or any other purposes shall automatically terminate lure to comply with any section of this NOA shall be cause for termination and removal of NT: The NOA number preceded by the words Miami - Dade County, Florida, and e expiration date may be displayed in advertising literature. If any portion of the NOA is it shall be done in its entirety. : A copy of this entire NOA shall be provided to the user by the manufacturer or its d shall be available for inspection at the job site at the request of the Building Official. ews and revises NOA No. 03-0501.05 and consists of pages 1 throygh'19. documentation was reviewed by Jorge L. Acebo. APPROVED NOA N. 0?7 1219.U9_ Expiration tote: 1.1/04113 Approval Date: 03/20/08 Page 1 of 19 APPROV Deck Typ Deck Desc System Ty ASSEMBLIES Wood, Insulated 19132" or greater plywood or wood plank A Anchor sheet mechanically fastened, all layers of insulation adhered with approved asphalt. nd System Limitations shall apply. ayers of any of the following insulations. . yer (Table 2) Insulation Fasteners Fastener able: Steel plate only =S, plastic plate only (Table 3) Density /ft2 =P) EuergyGnardrM Composite, EverGuard® ISO,'EnergyGuardTM RA, RA`Composite • hick N /A' N/A N/A All Gene One or mo Insulation (When app Energy,G. EnergyGua Minimum I EnergyGu Minimum W EnergyGua Minirnum 3/ Fiberglas ( Note: All i within the Standard as base;laye substrate. F polyisocyan Eliminator on all isocy Fire Barrier. (optional) Anchor she tion: TM High Density Wood Fiber, EnergyGuardTM Recover Board, Wood Fiber thick N/A M Perlite thick N /A, in. "116 thick) N/A N/A N/A ulation,shall be adhered to the anchor sheet in full mopping of approved hot asphalt range; and at a rate of 20-40 Ibs /100 &. Please refer to Roofing Appllcation S 117 'for insulation , attachment. Insulation listed as base ,layer only shall used only with a second layer of approved top layer insulation installed as the final ^Membrane mposite;insulatlon panels may be used as a top layer:placed with the ate side facing''dow-n. GAF requires either a ply of GAFGLAS® STRATAVENT® Perforated laid dry or slayer of EnergyGuardTM'Perlite or wood" fiber overlay' board urate applications. Fastening t? FireOutTM Fire Barrier Coating, VersaShield ®Non - Asphaltic Fiberglass -Based Underlayment or SecurockTM. GAFGLAS® #80 ULTIMATA( Base Sheet,- ,STRATAVENT® EliminatorTM Nailable, RUBEROID® Modified Base Sheet, RUBEROID® 20, RUBEROID Heat- WeIdTM Smooth or RUBEROID® Heat- WeIdTM 25 base sheet mechanically fastened as described below; tions: GAFGLAS® Ply 4, GAFGLAS® Flex PIyTM 6, GAFGLAS® i175 Base Sheet or any of above Anchor sheets attached to deck with approved annular ring shank nails and tin caps at a fastener spacing of 9" o.c. at the lap staggered and in two rows 12" o.c. in the field. (Maximum Design Pressure —45 psf, See General Limitation #7) APPROVED NOA No.: 07- 1219.09 Expiration Date: 11/04/13 Approval Date: 03/20/08 Page 8 of 19 Fastening ptions: GAFGLAS® Ply 4, GAFGLAS® Flex PIyTM 6, GAFGLAS® #75 Base Sheet or any of above Anchor sheets attached to deck with Drill-Tedrm #12 standard, #14 or # 15 Screws and 3" Drill-Teem steel plate or Drill-Tedrm AccuTrac Plates, 12" o.c. in 3 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 12" o.c. in the field of the sheet. (Maximum Design Pressure —45 psf, See General Limilation #V GAFGLAS' Flex P1yTM 6, GAFCiLAS® #75 Base Sheetor any of above Anchor sheets attached to deck with approved annular; ring shan. k nails and tin caps at a -fastener spacing of 9" o.c. at the 4" lap staggered and m twarows 9_0.c. e • field. (Maximum Design Pressure —52.5 psi; See General Limitation #7)- AF GLAS® #80ULTIMATm, RUBERO1D® 20, RUBERO °Mop Smooth, base sheet attached to deck with approved PA" annular ring shank nails Enid inverted 3" steel plate at a fastener spacing of 9" o.c. at the 4" lap and in two rows • staggered with a fastener spacing of 9" o.c. in the center of the membrane. (Maximum Design Pressure —60 psf, See General Lintitation #7) GAFGLAS® #75 Base. Sheet or any of above Anchor sheets attached to deck with Drill-Tee/1'd #12 standard, #I4 or # 15 Screws and 3" Drill-TecTm steel plate or Drill-Tedrm AccuTrac Plates, 12" o.c. in 4 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 9" o.c. in the field of the sheet (Maximum Design Pressure —60 psf, See General Limitation #7) Any of above Anchor sheets attached to deck approved annular ring shank nails and 3" inverted Drill-TecTm insulation plates at a fastener spacing of 9" o.c. at the 4" lap staggered in two rows 9" in the field. (Maximum Design Pressure —60 psi; See General Limitation #7) BaseSheet:1 GAFGLAS® #75 Base Sheet or any of above Anchor sheets attached to deck with Drill-Team #I2 standard, #14 or # 15 Screws and 3" Dri 11-Tedrm steel plate or Drill-Teem Aeon Tree Plates, 8" o.c. in 4 rows. .One row is in the 2" side lap. The other rows are equally spaced approximately 9" o.c. in the field of the sheet. (Maximum .Design Pressure —75 psf; See General Limitation #7) (Optional) kistill Oneply of GAFGLAS® #75, GAFGLAS® #80 ULTIMATM Base*Sheet, GAFGLAS® STRATAVENT®tlinfmatotrm_Perforated, RUBEROI13® Modified Base Sheet, RUBEROID® Mop Smooth, RUBEROID® 20 .RUBEROID HeatWe1dTM Smooth or RUBEROID® Heat-Weld'm civerthefop layerOthisulation. Adhere With any approved mopping asphalt - applied within the EVT range and at a rate of 20-40 lbs./sq; (see General Limitation #4). Ply Sheet: One or Moreiiliei:GAFGLAS® PLY 4, dA.P9T., ®=Flox,PLYr" 6 sheet, #80 RUBEROBI Mop Smooth 'or RUBEROID 20'adhered in a full Motipingof appreved asphalt aPplied'Withiti the EVT range ataiate of 20-40 -- ,lbs./sq- NOA No.: 07-1219.09 Expiration Date: 11/04/13 Approval' Date: 03/20/08 Page 9 of 19 (Optional) One-PlYof GAFGLASP-Mineral-SUrfaeed Cap Sheet or GAFGLASeEnergyCapTm MineralSm•faced Cap,Sheet adhered in a full Mopping of approvadaSPhaltapplied within the EVT rangeand at a rate of 20-40 lbs./sq. (Optional, required if RUBEROID® MOP Smooth or RUBEROID4' 20 is top membrane) Install .one of the following: 1. Gravel or slag applied at 400 lbs./sq. and 300 lbs./sq, respectively in a flood coat of approved asphalt at 60 lbs./sq. or applied in a flood coat of Leak Buster' MatriTM 103 Cold Process Adhesive applied at a rate of 3 gal /sq. 2. GAFGLAr Mineral Surfaced Cap Sheet, GAFGLAS® Energy Cap Mineral Surfaced C..apsheet adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20-40 lbs./sq. 3. Leak BUSt�TTM MatrixTM 303 Premium Fibered Aluminum Roof Coating, at 1.5 gal./sq. 4. Leak BusterTM MatrixTM 715 Leak Buster"' Matrixim 322, TOPCOAT4 MB+, TOPCOAT® Fireshield Elastomeric Roofing Membrane, applied at 1 to 1.5 gal./sq. 5. Leak BusterTM Matrix"' 602 MB Xtra Elastorneric Roofing Membrane, EnergyCote® roof coating applied at 1 to 1.5 gal./sq. 6. TOPCOAT® Surface Seal, TOPCOAT® Fireshield SB Solvent based Elastomerie Roofing Membrane applied at Ito 1.5 gal./sq 7. Advance Green Technologies Photovoltaic Liuninate solar energy collector auxiliary roof equipment installed in compliance with manufacturer's specifications and applicable Building Codes. See Fastening above. APPPOVEO NOA No.: 07-1219.09 ExPiratIaa Date: 11/04/13 Approval Date: 03/20/08 Page 10 of 19 WOOD DE SYSTEM LIMITATIONS: 1 A slip sheet is required with P[ 4 and Flex Pl TM q Y y 6 when used as a mechanically fastened base or anchor sheet. 2. Minimum Dens DeekTM or '1? Type X gypsum board is acceptable to be installed directly over the wood dec GENERAL L M[ITATIONS 1. Fire classi cation is not part of this acceptance, refer to a current Approved Roofing Materials Directory for fire ra gs of 'this product. 2. Insulation : y be installed in multiple layers. The first layer shall be attached in compliance with Product C o trot Approval guidelines. All other layers shall be adhered in a full mopping of approved asphalt app ied. within the EVT.range and at a rate of 20=40 lbssq., or mechanically attached using the fastening 4 ttern of the top layer 3. All stand ; panel sizes are acceptable for mechanical attachment. When applied in approved asphalt, Panel size s a all be 4' x 4' maximum. 4. An overlay and/or recovery board insulation panel is required on all applications over closed cell foam insulations hen the base ;sheet is fully mopped. If no recovery board is used the base sheet shall be applied usi g spot mopping with approved asphalt, 12" diameter circles, 24" o °c,.; or strip mopped 8" ribbons in ree rows, one at each sidelap and one down the center of the sheet allowing a continuous area of vej °[salon. Encircling of the strips is not acceptable. A 6" break shall be placed every 12' in each;ribbo to allow cross ventilation. Asphalt application of either system shall begat a minimum rate of 121bs. /sq. ote: Spot attached systems shall be limited to a maximum design pressure of-45 psf. 5. Fastener sp : cing for insulation attachment is based on a Minimum Characteristic Force (F') value of 275 lbf., as testa . in compliance; with Testing Application Standard TAS 105. If the fastener value, as field- tested, are b.:low 275 lb£ insulation attachment shall not be acceptable. 6. Fasteners $= ing for mechanical attachment of anchor/base sheet or membrane attachment is based on a minimum f tener resistance value in conjunction with the maximum design value listed within a specific system. She Id the fastener resistance be less than that required, as determined by the Building Official, a revised f ner spacing,, prepared, signed and sealed by a Florida Registered Engineer, Architect, or Registered {,° oof Consultant may be submitted. Said revised fastener spacing shall utilize the withdrawal resistance v= ue taken from Testing Application Standards TAS 105 and calculations in compliance with Roofing AO ; .lication Standard RAS 117 7. Perimeter d corner areas shall comply with the enhanced uplift pressure requirements of these areas. Fastener d ities shall be increased for both insulation and base sheet as calculated in compliance. with Roofing AP lication Standard RAS 117. Calculations prepared, signed and sealed by a Florida registered Professional Engineer, Registered Architect, or Registered Roof Consultant (When this limitation is specifical4'''; referred within this NOA, General Limitation #9 will not be applicable.) 8. All attachn ' t and sizing of perimeter nailers, metal profile, and/or flashing termination, designs shall conform wi Roofing Application Standard RAS 111 and applicable wind load requirements. 9. The maxim' > designed pressure limitation listed shall be applicable to all roof pressure zones, (i.e. field, perimeters,' d corners). Neither rational analysis, nor extrapolation shall be permitted for enhanced fastening at nhanced;pressure zones (i.e. perimeters, extended corners and corners). (When this • limitation, pecifically referred within ;',this NOA, General Limitation #7 will not be applicable ) 10.. All products i isted herein shall have a quality assurance audit in accordance with the Florida Building Code and 110 i 9B' e 9B-72 ?of the Florida Administrative Code. END OF THIS ACCEPTANCE NOA No.: 07- 1219.09 Expiration Date: 11/04/13 Approval Date: 03/20/08 Page 19 of 19 • 1(ir U.K13U6 Or' LINE .i ootmg Systems RTI?F1'CATIONS DIRECTORY Page 1 0148 TGFU "R1306 Roofing Systems Base Bottom See General Inforrnat GAF t4ATERIAL*,r; 1361 ALPS, RD WAYNE, NJ 07470 USDA "Ruberoid 20" or "Rube 'h -in. thick (minimum "DensDeck DuraGuard system is acceptable f Corp. "DensDeck ® Flo butt joints in the roof 51 for Rooflna Systems Multiple plies of "GAF Prime ® Roofboard "' or Roofing Systems R1306 id Modified Base. Sheet" may be utilized as an altemateto TypeG2 base''sheets 1n.any of the following Classifications. ypsum board or 1/4-in. thick (rnin) G -P Gypsum Corp. "DensDeck''® Roofboard, ": "DensDeck Prime® Roofboard" or Roofboard" may be used Inarany existing noncombustible deck Classification When this is done, the! resulting: roofing use ove( combustible (15/32 -In. minimum) roof decks. :However, the butt( joints in?the gypsum board and G -P Gypsum oard," "DensDeck'Prime® Roofboard " "or "DensDeck DuraGuard TM Roofboard" are to offset a rrilnienOM of 6 -in, with the ck. If ipOlystyrene Is part of the roof system, it must be ! placed !below the overiayment board: ® PIy 4" or "Tri-Ply Ply 4" or "Ply. 6" may be adhered to G -P Gypsum Corp. "DensDeck ®:Roofboard," "DensDeck ensDeck DuraGuard TM Roofboard" in hot roofing asphalt. " EnergyGuard Ultra" is • n acceptable alternate to "EnergyGuard" in any applicable Classification. "GAF Stratavent® Elin i ator" Venting Base Sheet (Nailable)" may be mechanically attached or mopped over noncombustible decks and as a - recover over existing r a f systems. "GAFGLAS® Perlite 3n; lation" may be utilized as a cover board over "EverGuard" insulation in any of the following.! systems Unless otherwise - indica Polystyrene reference1 References to glass fibe Type G2 asphalt glass it alternate For Type indicated below. d, the roof insulation is mechanically fastened, adhered with hot mopping asphalt or urethane insulation adhesive. n any of the following Classfications ?include "EnergyGuard EPS Insulation" insulation include "EnergyGuard Fiberglass Insulation ". ASPHALT. FELT SYSTEMS WITH ,HOT ROOFING ASPHALT at base sheet ( "GAFGLAS® #75 Base Sheet" or "Tri -Ply, #75 Base Sheet ", or "GAFGLAS® #80 ULTIMA ") is a suitable phalt glass fiber ply sheet ( "GAFGLAS® PIy 4" or''Tri -Ply Ply 4-,-or "GAFGLAS® Ply 6 ") In the Class A, B or C roof systems The roof deck.may first ae- covered with, one, ply Type. G2 asphalt saturated glass mat base sheet "GAF Stra'tavent® ElimnatoVe nting Base Sheet {Perforated) or'" AF Stratevent ®. El inator'"' Venting ,Base Sheet (Nailable).; lit'u.xljut3 bc) The use of gypsum gypsum board is an a The use of polystyren paper /polystyrene /pe goofing systems Page 2 of 48 11a "EnergyGuard RA" or any of the following. Trumbull "Perma Mop "GAFGLAS® #80 Pre under any of the following:. Class A, B or C systems does not adversely effect the rating. The use of r -in. minimum ptable•alternate for insulation over C -15/32 decks. sulation,b'oardUbetweem minimum V -in. thick periite board and deck with; rosin paper (perlite %rosin e) is a suitable alternate for;; polyisocyanurate board Iii the following Class A, B or C'systems. pered`EnergyGuard RA" or "EnergyGuard Composite RA" may be substituted for any Atlas polyisocyanurateinsulation in sifications. ay be utilized with any of the following "Asphalt Felt Systems with Hot Roofing Asphalt ". m Base Sheet" may be used in any of the following systems. "GAFGLAS® Flex Ply 6" and 'Tri -Ply Ultra - Flexible Ply 6" are suitable altemates to "GAFGLAS® Ply 6". "GAFTEMP Permalite Re over Board" may be used in lieu of anyperlite insulation in any of the following NC Classifications. Unless otherwise indii ft2. "Ruberoid Dual Smooth d, any of the "Asphalt Felt Systems with Hot Roofing Asphalt" may be surfaced with "Fireshleld Ms" at 21 to 3 -gal /100- may be used as an alternate to "Ruberoid Mop Smooth" or "Ruberoid 20" Class A, B and! C Hot roofing; asphalt, fo • se,with organic and'?glassfelts or modified bitumen membranes. "Ruberoid Heat Weld" S i S roofing membrane may be used in lieu of "Ruberoid Mop" SBS products inany applicable Classification. Class A 1. Deck: C -15/32 Insulation (p periite/polyi Ply Sheet: — Surfacing: — Deck: G 15J3 Insulation d perlite /poly Ply Sheet: Cap Sheet: 3. Deck: NC Incline: 3 octal): — One or more layers perlite or wood fiber or glass fiber or potyisocyanurate or urethane or nurate composite or perlite /urethane composite or wood fiber /polyfsocyanurate composite or phenolic, any thickness. ree or more plies Type G1 or "GAFGLAS® Ply 4" or "Tri =Ply PIy 4" or "GAFGLAS® Ply 6" hot mopped. vel. Incline: 2 anal): — One, or more layers perlite or wood fiber or glass fiber or potyisocyanurate or urethane or nurate composite br pertite /urethane composite or woifd fiberfpolylsocyanurate ,corrrposite or phenolk, any thickness. -more, plies -Type GA. or GAFF AS ®°Ply or T�tFfly Ply 4�"'or "GAF LASS® P;iy 6 . e pty Type;G3 AFGLAS� Mineral Surfaced Cap Sheet" or "Tri PIy Mineral` Surfaced Cap Sheet'. Insulation (Oi composite, pe Ply Sheet: —r Cap Sheet: — 4. Deck: C -15/32 Incline: 2 tonal). — One or more layers 'perlite , wood fiber, glass fiber, polyisocyanurate, urethane, perlite /polyisocyanurate /uret ane.corpposite, wood fiberfpotyisocyanurate composite, Lphenolic, 2?in. maximum. o or,more plies Type.#s1 "GAFGLAS®,Ply 4" or "Trl -Ply Ply 4 ", "GAPGLAS@ Ply 6 . e ply Type G3 "GAFGLAS@ Minerat,Surfaced Cap Sheet" or "Tri -Ply Mineral Surfaced Cap Sheet ". Incline: 1 Slip Sheet (O " anal): -- Red rosin paper, nailed to deck. Base Sheet: 1" ne ply Type G2 "GAFGLAS® #75 Base Sheet" or "Tri -Ply #75 Base Sheet" (may, be nailed). Ply Sheet: — e or more plies Type GI "GAFGLAS@ Ply 4" or "Tri -PIy PIy 4" or GAFGLAS® Ply 6 "; Cap Sheet: — e ply Type G3 "GAFGLAS® Mineral Surfaced Cap Sheet" or'Tri -Ply Mineral Surfaced Cap Sheet". 5. Deck: NC Base Sheet: Ply Sheet: Cdr Cap`; Sheet: 9 r" 6. Deck: C- 15/32 Incline: 3 ne ply Type G2 GAFGLA$® #755 Base,Sheet" or "Tri- PIy.' #,75 Base Sheet ":. .or rpore.piiesType;Ga . "GAPGLA$@ ply 4';or'Tri =PIy PIy 4" or "GAFGLASPIy 6 ". e piy Type G3 GA�FGLAS( Mineral Surfaced Cap Sheet"'or'"Tri =PIy Mineral Surfaced Cap Sheet Incline: 2 �1 Insulation: — O e or more layers perlite, glass fiber, poiyisocyanurate, urethane, periite/polyisocyanurate composite, ;;perlite /urethane http : / /database,, /tenip tetLISEYE'/ ::: 11/14/2011 10:38 3057588484 OBENOUR ROOFING PAGE 02 -8 ME 1 LOCATION ROOFING SHEET METAL & CO W MIAMI CT IAMI THIS IS NOT A BILL - D pe of Y6Ai RE BR *LATE TOHY IOF . INAPT ENPT ANY u LAW. TW MON QUALIFY 9/08 ' 9010 • 000 tRIE OTH ROOFING SHEET METAL & ueineee C MECHANICAL CONTRACTOR R E NY E R IS F A• 2011 44001 ,00 R SIDE FIRST -CLASS U.S. POSTAGE . PAID MIAMI, FL PERMIT NO. 231 NOT PAY RENEWA RECEIPT NO. :144113 -8 CC 1/ 000006454 WORKER /S 10 DO NOT FORWARD OBENOUR ROOFING SHEET METAL & SUPPLY CO JAMES 0 OBENOUR PRES 159 NE 97 ST MIAMI SHORES FL 33138 1 „11,,,11,,,,11„11,1,1,,,1, 16110 /OP 3S N 1 ENOU Oi Y 357 1,150 cv ' ENOU of S IA6 SP �11 WN PT 1 O Y R,EB. N ENPT T ANY UCE w. mw CATION UFl 4 UNNTY TAX C ; At /08 2011 010146 01 ° O 007 .00 7 THIS IS NOT A BILL -00 NOT PAY E / LOCATION RECEIPT NO. RENEWAL 26110-7 ROOFING SHEET METAL & STATER CCC014306 W MIAMI CT IAMI FIRST CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 ROOFING SHEET METAL 8 C IALTY BUILDING CONTRACTOR S P 111,2 OTHE SIDE DO NOT OBENOUR ROOFING SUPPLY CO JAMES D OBENOUR 159 NE 97 ST MIAMI SHORES FL I „11 „11,,,,11 „11J „1 „,1,1 WORKER /S 20 ORWARD SHEET METAL 8 PRES 33138 ,11,„11,,,1,1,1,1 1IlI b ,1 11/14/2011 10:38 AC RO Oe THIS CERTIFICA`''" $ CERTIFICATE D + H BELOW, THIS �Fi R�•p1 REPRESENTAT ;!IC Orr', IMPORTANT: If col' the terms and c • ARIDt certificate holder Gl PRODUCER Frank H. Fu at,. 1314 Bast Atll,art. P. 0. Box 19 .7 Pompano Beac INSURED • Obenour Roof litais Sheet: Metal It= 94g 159 N8 97th (trrP Miami Shorten COVERAGES ,.■ -., 3057588484 OBENOUR ROOFING CERTIFICATE OF LIABILITY INSU UED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS t AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE C ►r TE O INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN g, • DUC ' , AND THE CERTIFICATE HOLDER. NCE PAGE 01 DATE (MMIDDNYYY) 9/26/3011 PON THE CERTIFICATE HOLDER. THIS RAGE AFFORDED BY THE POUCIES E ISSUING INSURER(S), AUTHORIZED Gate h der is an ADD 0 AL INSURED, the policy(les) must be endorsed.BROQAT1ON IS WANED. subject to 'of the policy, certain policies may require an endorsement. A statement on tills certificate does not confer rights to the such fndorsement(sj. Inc. 51v4. FL 33061 fly Co ire Fn) 33130 „w• CONTACT Laura Suratt mum �fA NF„• (954) 943 -5050 Fmk 1Bura®umina ' rance. com o 1i .Net. (954)942 -6310 INSURERISI AF COVERAGE A:Starr Incisions„ 6 Liabili INSURERa:Bridgof'ield Epployer,e In Co IN3I. ERC: INSURER D • INSURER 5 t INSLIHER F CERTIFICATE NUMBER:11 -12 GL /Wc NAIC 38 8 10701 N NUMBER THIS IS TO CERTIFY INDICATED. NO CERTIFICATE MAY EXCLUSIONS AND -rIt4 iTHErl' BE EI BON DI P tHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR• DING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER tiNED OR MAY PERTAIN, THE INSURANCE AFFORDED B / THE POLICIES DESCRIBE ICONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEE 4 REDUCED BY PAID CLAIM t • NAMED ABOVE FOR THE POLICY PERIOD 'P • UMENT WITH RESPECT TO WHICH THIS HEREIN 15 SUBJECT TO ALL THE TERMS, IL N fit TYPE 111:411UI11430E 1. ILI1Y OCCUP ADADDL. SUER ,rn • .. MB R EZPOt .001$200 POUCY €FP ,,A.t10I1 4 /1 /203.3. MOW EXP ...dtr.nu, 6/1/2012 LIMITS A GENERAL X LIADIUTII COMMERCIALI EN,LI I CLAIMS-1641311 I, EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (EaO<xWIdMe) $ 50,000 1.4ED gxp ,ram parson) s 5,000 — PERSONALEADVINJURY $ 1,000,000 GENERAL, AGGREGATE $ 2,000,000 GEN'L AGGREGATi: 7 POLICY n LIMI r f AR's ' � iJTM' - _ -. — a P p N.IES PER ri LOC TO5ULED N -0WNED AUTOS PRODUCTS • COMP/OP AGG $ 2,000,000 COMBINED SINGLE UMIT la $ $ AUTOMOBILE _ UA6 ANY AUTO . • AUTOSotED ' HIRED AUTOS BODILY INJURY (Pe. pentoo) 3 BODILY INJURY (Per eopdfnt) $ = •7.' • • GAGE $ - ., ... 5 B uNiBRELLA til.hr m006 UABI .._ OCCUF CLAIMS -MADE EACH OGCURRENOE $ AGGREGATE $ D I I , B1 JARIg.ci Et _'KCL. 51 il,' ,, 044 i $ AND�EMPI.OYSC ANY PROPRIETORnvART CCl RIME�Mro R I y R us de,ctibe un DESCRIPTION OFllvIMR r UTIVI Yf N Ix? • ion below NIA 053036366 10/6/2011 10/6/2012 X I T RY L MIT4 . 1OTM* FR E.L EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 5 S00,000 E,L GREASE • POLICY LIMIT DESCRIPTION OF OPER01!iOpa I • ICCATIONS I VEHICLES (Minh ACORD 101, AddiNOUa) Remarks Stit0Ula, $ more spat) illt nqulrat» CERTIFICATE HO I�4 CELLATION City Of �6i LP • village 4 . Shores S4OULD ANY OF THE ABOVE TIE EXPIRATION DATE ACCORDANCE WtTI4 THE POLI SCRIBED POLICIES BE CANCELLED BEFORE REOF, NOTICE WILL BE DELIVERED IN PROVISIONS. KTVOwweo,MSPRw1u+TATIAT 10050 1.4 2 1st I Ave Miami 011tora i, PL 33153 ��,// Frank Furman, Jr /LB (..' 4.'"' - ,- ..,,-- -.•�+- •... „St-. . ACORD 26 (2010 1N8025 (201005).01 019882010 ACRD CORPORATION. All rights reserved. The ACORD name and logo are rakjLittered marks of ACORD