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RC-10-2245
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 154457 Permit Number: RC -12 -10 -2245 Scheduled Inspection Date: October 31, 2011 Inspector: Bruhn, Norman Owner: UNIVERSITY, BARRY Job Address: 190 NW 111 Street Miami Shores, FL 33168- Project: <NONE> Contractor: PAUL DAVIS RESTORATION OF GREATER MIAMI INC Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Alteration Phone Number Parcel Number 1121360030480 Phone: (305)260 -0034 Building Department Comments REPAIR AND REPLACE CEILINGS AND KTICHEN REMODEL Passed /�j Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Wiehvil October 31, 2011 For Inspections please call: (305)762 -4949 Page 1 of 18 Miami Shores Village Building Department HOLD HARMLESS, 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 7/ 4 DATE: / PROPERTY LOCATED AT: /90 Ncv /1/ "-Li S7. / Shores, FC.33/C./ As Ge•►•r..' CDA.frot fog_ C in v S77 3'3 license contractor of subject property, Permit number RC - la- /a -•A) YS Issued t o fa ( 'Zell. (ci ; a � I agree to hold Miami Shores Village, its agents and authorized personnel harmless and relieve them from any responsibility or liability for any legal action or damage, cost or expense (including attomey's fee) resulting from missed inspection of the above mention permit. I furthermore assume responsibility for the correction, if required, of work performed under the above permit. Type of inspection missed 'D R ), wietil /ow spee.. h o •J OEN joeyie (Print Name) (Prime actor- qualifier) 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 c day of OCA Notary Public, Sate of Florida at Large CREATED ON 6/22/2009 JAIME VELOCCI NOTARY PUBLIC STATE OF FLORIDA Comm# DD959325 xf?ur s 2/14/2014 Miami Shores Viiiage Building Department RECEIPT PERMIT #: ¢C-10 `' DATE: ❑ Contractor ❑ Owner ❑ Architect 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 )2-01 I n 1 031 `70 Cog- Picked up 2 sets of plans and (other) Address: From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. Acknowledged by: PERMIT CLERK INITIAL: RESUBMITTED DATE: Q PERMIT CLERK INITIAL: _12A,— NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. 6C -I2-'D 2216— TAX FOLIO NO. I f— 2136°-003 -D STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to property, and In accordance with Chapter 713, Florida Statutes, the following is provided in this Notice of Commencement. STATE OF 1 HEREBY CE original fiWhi 111111111111111111111111111111111111111111111 c :Ft41 201 1 R0106®. r06 OR Bk 27589 F's 0919 (fps) RECORDED 02/16/2011 11 :08:30 HARVEY RUV'IN, CLERK OF COURT MIIAMI -LADE COUNTY? FLORIDA LAST PAGE 1. Legal description of property and street/address: CiO 0 L3 111 St 3� .fb . a tail _iazdl!I. 2. Description of improvement: :�' Space above reserved for use of recording office - P6 u3-40 to Ito P.l1 aaO 3. Owner(s) name and address: 44\ 1Z j`l U N i v e gs t ti 11100 NE 2- MC $ - ojZ-ems t 331 71 Interest in property: Name and address of fee simple titleholder. 4. Contractor's name, address and phone number ?Ct�JL ��oA.)► �, 'RP S�cltlicv01' v k ( ekk-c r Y�1.ACthU A99ct l,J> )91-1\ S-( - \ \Aio \Puh lrt 33f�ll.A 3o 5-- ato0 0031.j 5. Surety: (Payment bond required by owner fro contractor, if any) Name, address and phone number. N% 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 receive a 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 INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORN BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of r(s) or OwneOsy Authorized Officer/Director/Partner/Manager Prepared By Cc )N. (Z.2) Prepared By Print Name i,114 DA. M. P€[I?L 1 Print Name Title/Office P oSr Title /Office g A @ 330 %� STATE OF FLORIDA r�l� Q 41 COUNTY OF MIAMI -GAGE a day of �G�' "` b The foregoing strumen s acknowledged before me this B t,ta�t� £k P ON � Individually, orb as P20VI]St for ��,// .Vel- Personally known, or ❑ produced the following type of identifi atl Signature of Notary Public: Print Name: (SEAL) VERIF CATION PURSUANT TO SECTION 92.525. FLORIDA ST Under penalties of perjury, I declare that I have read the foregoin that the facts stated in it are true, to the best of my knowledge an MY COIGASSION #EE36829 1 ES:Novamba12,2014 ABp• FLNelyDl 5a*AanaC0. Signature(s) f Owner(s) or Owner(s)'s Authorized Officer/Director/Partner/Manager who signed above: By 1.7ysJ 123.01-52 PAGE 3 8H0 By Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING OWNER: Name (Fee Simple Titleholder Address: / / 300 e City: ft (Aron► t c'hore5 State: FL. Tenant/Lessee Name: Email: DEC 2 2 1010 BY: .. Master Permit No. flay lV&5, 0e_ Phone #: 30= V 9 / -3 7010 Sao mof@ mwi (. -e-Dv JOB ADDRESS: I C) 'Oii' 0 `i Zip: Phone #: City: Miami Shores ? County: Folio/Parcel #: 1) .2)U) " 00 J ®Li O Is the Building Historically Designated: Yes Miami Dade Zip: NO Flood Zone: CONTRACTOR: Company Name: 0C,a)L \Q‘);(,, fPS c OC\ Qtr Phone #: Address: p1(c) (IC , Y l 3 . * 11/4 City: \k,(a \QcAC State: f L Zip:.3(Ytk.D Qualifier Name: Qom. \\..f 1 1 Certificate of Competency #: State Certification or Registration #: _ Q Contact Phone #: 3 6J ' 72 - 3-7q V Email Address: Phone #: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Type of Work: OAddress Pv...fici Alteration, Description of Work: 4 M r 4� Square/Linear Footage of Work: ONew liRepair/Replace kerhice s Lkc) rem, g6 69 59 A- ODemolition COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: ***************************************F ******** ** *** * ********* **** Submittal Fee $ Permit Fee $ �L(IP d a : Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ Is $ CO /CC $ TOTAL FEE NOW DUE $ 19, .(b Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commensement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In.h e absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent g} The foregoing instrument was acknowledged before me this U 5t - day of , 2010 by U iU0/J Pergls bN who ice- ally kn_y=o me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: IA APPROVED BY Signature Contractor The foregoing instrument was acknowledged before me this (Qt day of b8 - • , 204b , byyP4 1C-41.1 j , who is personall= +o me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commissio3 rxpiresNORMA TORRES •� "v" avc4 Commit DD0825215 •'= Expires 8122!2012 nm"a Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10) CERTIFICATE OF LIABILITY INSURANCE 12 /23/20 0 TYPE OF INSURANCE PRODUCER (305)822 -7800 FAX (305) 558 -4294 Collinsworth, Al ter, Fowl er & French LLC P. 0. Box 9315 Miami Lakes, FL 33014 -9315 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Paul Davis Restoration of Greater Miami, Inc 2699 West 79th St Bay #1 Hialeah, FL 33016 INSURER A: AmTrust North America of FL GENERAL INSURER B: INSURER C: INSURER D: $ INSURER E: DAMAGE TO RENTED PRFMISFR (Fa ncdnancn) 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 POUCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD L RNSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATF fMM/DD/YYI POLICY EXPIRATION DATE (MM/DD/Y13 UNITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PRFMISFR (Fa ncdnancn) $ CLAIMS MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GENT_ AGGREGATE LIMIT APPUES PER: POLICY n JECT r--, LOC PRODUCTS - COMP /OP AGG $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ R AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 7 OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PROPRIETOR/PARTNER/EXECUTIVE EXCLUDED? OFFIC SPECIAL describe under SPECIAL PROVISnIONS below AWC1004690 02/15/2010 02/15/2011 X I TORY LIMITS I 1 ER E.L EACH ACCIDENT $ 500,000 E.L DISEASE - EA EMPLOYEE $ 500,000 EL DISEASE - POUCY UMIT $ 500, 000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS VIGR 1 II- IVMI IG FIVLJJ fl Miami Shore Vi 11 age Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138 ..•••••••• �•- ••••••• SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHOR¢EDREPRESENTATIVE Rafael Palacios /SHEILA ACORD 25 (2001/08) ©ACORD CORPORATION 1 ilfjial9 CERTIFICATE OF LIABILITY INSURANCE OP ID SU DATE(MMIDD/YYYY) 09/14/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poflcy(fes) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Brown & Brown of Florida, Inc. Daytona Beach Office P.O. Box 2412 Daytona Beach FL 32115 -2412 Phone:386- 252 -9601 Fax:386- 239 -5729 NAME �� STEFANIE I. PARKER, AAI PHONE (Am 386- 239 -7298 ilk, No: 386 - 238 -8919 Lo,Ext): ADDRESS: SPARKER @BBDAYTONA. COM PRODUCER CUSTOMER PAULD -1 INSURER(S)AFFORDINGCOVERAGE NAICa INSURED PAUL DAVIS RESTORATION OF GREATER MIAMI, INC. 2699 W. 79TH ST. BAY 1 HIALEAH FL 33016 INSURER A : Southern Owners Ins Co 10190 INSURER B: American Staten Insurance co 19704 INSURERC: Auto Owners Insurance Co. 18988 INSURERD: Travelers Prop & Cas of Amer 25674 INSURER E: UAMA(at I U KtN I tU PREMISES(Eaoccurrence) INSURER F : MED EXP (My one person) V.. ................. - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE • . • INSR :,TUBA WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DDIYYYY) LIMITS A GENERAL LABILITY COMMERCIAL GENERAL LIABILITY OCCUR 7263508510 06/01/10 06/01/11 EACH OCCURRENCE $ 1,000,000 $ 300,000 $ 10,00 0 $ 1,000,000 $2,000,000 UAMA(at I U KtN I tU PREMISES(Eaoccurrence) X MED EXP (My one person) CLAIMS -MADE X PERSONAL & ADV INJURY INCLUDES HNOA GENERAL AGGREGATE X 1,000,000 AGGREGATE LIMIT POLICY n JEC APPLIES PER: PRODUCTS - COMP /OP AGG $ 2 , 0 0 0 , 0 0 0 GEM. $ 7 Loc B AUTOMOBILE LABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 01CH8840123 07/06/10 07/06/11 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ C UMBRELIALAB EXCESS LAB X OCCUR CLAIMS -MADE 4455412600 06/01/10 06/01/11 EACH OCCURRENCE $2,000,000 $ 2,000,000 AGGREGATE T DEDUCTIBLE RETENTION $ 0 $ — X WORKERS AND ANY OFFICER/MEMBER (Mandatory It yes, DESCRIPTION COMPENSATION EMPLOYERS' LABILITY PROPRIETOR/PARTNER/EXECUTIV1 EXCLUDED? In NH) describe under OF OPERATIONS Y / N N I A 1TORY LMITS I I TOER E.L. EACH ACCIDENT $ f l E.L. DISEASE - EA EMPLOYEE $ below E.L. DISEASE - POLICY LIMIT $ D EQUIPMENT FLOATER QT6600023L792TIL10 09/28/10 09/28/11 OWNED 65, 652 LEASED EQ 150,000 DESCRIPTION FAX OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) TO: 305 - 762 -5253 CERTIFICATE HOLDER MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVENUE MIAMI SHORES FL 33138 MIAMSO4 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE v// © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 26 (2009109) The ACORD name and logo are registered marks of ACORD SEE OTHER SIDE DONOTFOWNARD PAUL DAVIS RESTORATION OF GREATER MIAMI INC VANESSA VELOCCI ORES 2699 W 79 ST BAY 01 HIALEAH FL 33016 .„. lidhuddh.hdhhhdl 44N11 Jul-15-2010 12:52 PM Building Code Compliance 3053752558 MIAMI -DADE COUNTY BUILDING CODE COMPLIANCE OPlacE 140 W. FLAGLER ST., SUITE 1602 MIAMI FL, 33130 (305) 375 -2527 STATE CONTRACTOR'S CERTIFICATE OS VOLUNTARY REGISTRATION WITH MIAMI -DADS COUNTY ISSUED JUNE 07, 2002 THIS I6 TO CERTIFY THAT PAUL DAVIS RESTORATION OF GREATER MIAMI INC CONTRACTOR CERTIFICATE NO.; CGC057783 TRADE, BUILDING REGISTRATION EXPIRATION DATE, 08/31/2010 HAVING KIT THE REGISTRATION REQUIREMENTS OF MIAMI -DADE COuNTY, REGISTERED AS A STATE CONTRACTOR IN THE FOLLOWING CATEGORY(8): 0004 GENERAL (STATE) 15 WITH ALL WORK TO BE DONE UNDER THE SUPERVISION, DIRECTION AND CONTROL OF QUALIFYING AGENT 1CILIDDJIAN PETER S.B.N. - -4307 ALTERATION, REPRODUCTION OR TRANSFER OF THIS CERTIFICATE XS PROHIBITED. XERMINIO GONZALEZ, P.E. SECRETARY, CONSTRUCTION TRADES QUALIFYING BOARD PAUL DAMS RESTORATION OF GREATER MIA 2699 W 79 6T BAY #1 HIALEAH FL 33016 111 so© FSC Mixed Sources Pagbajdreztrast Cat muss City of Hialeah Business Tax Receipt Mayor Julio Robaina 2010 -11 CITY OF KEY WEST, FLORIDA Business Tax Receipt This Document is a business tax receipt Holder must meet all City zoning and use provisions. P.O. Box 1409, Key West, Florida 33040 (305) 809 -3955 Business Name Location Addr Lic NBR /Class Issue Date: License Fee Add. Charges Penalty Total Comments: PAUL DAVIS RESTORATION OF GREA Ct1Nbr:0008378 2699 W 79 ST 11- 00015111 CONTRACTOR - CERT GENERAL CONTRACTOR July 23, 2010 Expiration Date:September 30, 2011 $309.75 $0.00 $0.00 $309.75 This document must be prominently displayed. PAUL DAVIS RESTORATION OF GREA; PAUL DAVIS RESTORATION OF GREA 2699 W 79 ST BAY 1 HIALEAH FL 33016 00: re PAUL DAVIS Date: (9- 1(0 - I 1 To: From: Fax: RE: RESTORATION �a9�"tiu sncreS - &i,kl,0-. kkut_ '?,ewGkcfI uktAt6 Caup Claim# : Al0 Number of pages including cover: Comments: c',e c c 6 P c-kscak Reci ,s Cce,C PhD c\.‘) S Cori P\u 2699 West 79 Street Bay #1 Hialeah, FL 33016 (305)260 -0034 - Office (305)260 -0038 - Fax CERTIFICATE OF LIABILITY INSURANCE 02/1x6/2011 TYPE OF INSURANCE 'PRODUCER (305)822 -7800 FAX (305) 558 -4294 Collinsworth, Al ter, Fowl er & French LLC Square B7 vd 8000 Governors S q Suite 301 Miami Lakes, FL 33016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Paul Davis Restoration of Greater Miami, Inc 2699 West 79th St Bay #1 Hialeah, FL 33016 INSURER A: AmTrust North America of FL INSURER B: LIABILITY COMMERCIAL GENERAL LIABILITY INSURER C: INSURER D: EACH OCCURRENCE INSURER E: vv•cflflW u 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADM NSW TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE IIATF (p/Inmmnm) POLICY EXPIRATION fATF (MMmnm) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PRFMIRFS p=a nnf nrwnrn) $ CLAIMS MADE [] OCCUR _ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n j' n LOC PRODUCTS - COMP /OP AGG $ —I AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ —I OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ $ 1 RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLU ED? ECUTNE M yes describe under SPECIAL PROVISIONS below AWC1006254 02/15/2011 02/15/2012 I WC STA11.1- I 10TH- I TORY I MRS 1 1 E.L EACH ACCIDENT $ 500,000 E.L DISEASE - EA EMPLOYEE $ 500,000 E.L DISEASE - POUCY LIMB $ 500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS I., u111riLd is TIULUCI'1 Miami Shore Village Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138 v.+.w...�r.- .....•� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES EXPIRATION DATE THEREOF, THE ISSUING INSURER 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE BE CANCELLED BEFORE THE WILL ENDEAVOR TO MAIL HOLDER NAMED TO THE LEFT, IMPOSE NO OBLIGATION OR LIABILITY OR REPRESENTATIVES. BUT FAILURE TO MAIL SUCH NOTICE SHALL OF ANY KIND UPON THE INSURER, ITS AGENTS AUTHORIZED REPRESENTATIVE Rafael Palacios /SHEILA (ilt 1 0'' -" ACORD 25 (2001/08) 02/02/2011 15:58 9543409456 1t"'e"""' `"` "" "" "' -- A °R° CERTIF ICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MAT ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFF)RMATIVEL': OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURA ICE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND 71 E CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ios) must be endorsed. If SUBROGATION IS WAIVED. subject to the terms and conditions of the policy, oertt•in policies may require an endorsement. A statement on this cert)f)Cdte does not confer rights to the certificate holder In (feu of such ondorseme &Is). OP lb: TG 1 Ewa (MMIDD wr» 02102/11 PRODUCER INNOVATIVE INSURANCE CONSULTANTS, INC. 5461 UNIVERSITY DRIVE, 5103 THOMAS SPRINGS. FRANCO067 CONTACT 954 -340 -9551 ! 954 -340 -9466 A, qae Ai OR ss: CUS�Ee� BIGPL -1 • CUSTOMER Io w INSURER INSURER A : VININGS INSURANCE COMPANY PNSUREO BIG PLUMBING CORPORATU iN 9190 NW 119 STREET BAY 1C HIALEAH, FL 33019 COVERAGES CERTIFIC ATE NUMBER: THIS 13 70 CERTIFY 'MAT THE POLICIES OF 11 SURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIR AAENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERT IN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLIC'EES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LINTS � 1NgR - PDLIGY•NUMOSR IEAAAI ORD YYY111 I, MO TYY) LTp TYPE Or INSURANCE WD EACH OCCURRENCE E DAMAUt ID-RENTED PREMISES (Eo memento) FAX 5) AFFORIXNG COVERAGE INSURERS : INSURER INSURER D : INSURER E : INSURER F : NAM REVISION NUMBER :. GENERAL LIABILITY COMMERCIAL GENERA. LIABILITY , CL #S MADE r-7.3 OCCUR DENT AGGREGATE UM, r APPLIES PER: —] PolICY f 1 °F J loC AUTOMOBILE IJABIUTY ANY AUTO AU. OWNED AUTOS _ SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS A EXCESS LIAR UMBRELLAUAB _ OCCUR _L DEOUCTIRI,E RETENTION $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY Y PPROPRI TNEM Cl O p EXCLUDED, (Mnndetoty In NN) Eyyeese deseera under DESCRIPTION OF OPERATIONS eelew NIA MED EXP (Any ens person) t PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGO 0 $ $ COMBINED SINGLE LIMIT S (EaeedeenO BODILY INJURY (Per perwnl 0 BODILY INJURY (Per ea:Went) $ PROPERTY DAMAGE B (Per occident) ... ..w_. S ,0 WCV0098033-00 FLORIDA OPERATIONS 0 01121111 01121112 EACH OCCURRENCE AGGREGATE 3 $ 0 LOR18(.UIT 12c ER- F. L. EACH ACCIDENT _ _ r000,00 Et. DISEASE • EA EMPLOYEE $ 1,000,00- E.L. DISEASE - POLICY LIMIT 10 DAYS CANC FOR 1,000,00-, NOTICE L NON•PAYMEN i DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (At .ch ACORD 101, Addlliene) Removes Schedule R mere epee le requlrod) CERTIFICATE HOLDER PAUL DAVIS RESTORATION 2699 WEST 79TH STREET BAY 1 HIALEAH, FL 33018 ACORD 25 (2009109) PAULD -7 CANCELLATION SNOW) ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE Ofe 6)1988 -2009 ACORD CORPORATION. All rights reserved. Thr ACORD dame and logo are registered marks of ACORD