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WS-11-1915Permit Number: WS -10 -11 -1915 I Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 165592 Inspection Date: October 31, 2011 Inspector: Bruhn, Norman Owner: RILEY, JOHN Job Address: 1104 NE 98 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: ACTSYS DOOR SYSTEMS INC. Permit Type: Windows/Shutters Inspection Type: Final Work Classification: Garage Door Phone Number Parcel Number 1132050180360 Phone: 305 - 229 -4007 Building Department Comments REPLACE OLD GARAGE DOOR WITH NEW HURRICANE GARAGE DOOR Passe /a3-7----‘ / Inspector Comments C( Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until October 31, 2011 For Inspections please call: (305)762 -4949 Page 1 of 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 Permit Typ IN ROOFING Permit No. /(15/17 —/f./5 Master Permit No. OWNER: Name (Fee Simple T'tlehold r)• '4 i i . \ � Phone#: 16S-1-Set v ` Address: kV) ! J ` �+ I ('7 City: �Cil. �ll� ��S State: � `($`(- V� gip: �I` /l Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: 1 lr) k I y e cts *c,,..A City: Miami Shores �} � �j 2 County: Miami Dade Zip: 33 ��� Folio/Parcel #: ` 5 Z©S- -C 2 .63 GO Is the Building Historically Designated: Yes NO Flood Zone: • CONTRACTOR: Company Name: S MY( \ 63,1k5 L Phone#: " 7._Zci - a- Address: wsio Sl,J --sZ--cc +co_Ce City: \l&Mal State: F LO aka- Qualifier ` .. �®szz�i— i Name: � ' � s . ��� .. Phone#: State Certification or Registration # Contact Phone#: SOS -'7-7-q_ 4604 Email Address: • DESIGNER: Architect/Engineer: Certificat of Com etency #: S UCJ cr 11.5,6a Phone#: y �o $ Square/Linear Footage of Work: y Value of Work for this Permit: ONew i wpair/Replace Type of Work: CI Addition Description of Work: 15W S \CCit ODemolition *********** wx�x�x�a��xx� +x+x+� *a�x�x�m�x�x+x+xx��x� ****** Fees * ** * * *�x� ******* ****�x ***** *** * *x�w�****+��.�.� **** a o.� Submittal Fee $ V Permit Fee $ //d Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ i a CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ • 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 com ust be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued the absence such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature. Owner or Agen The foregoing instrument was acknowledged before me this day o f()_tr20 , by who is personally known to me or who as produ As identification and who did take an oath. NOTARY PUBLIC: Si Print: My Commission Exp .•'''.'' p, FRANCIS A REBELLO "? MY COMMISSION # DD798265 EXPIRES June 16, 2012 (407) 398.0153 FbddallotarySarvka.com Signs c fizsItk A -i%. / ir / Iv .- Contractor The fore oing instrument was acknowledged before me thi _ s: dayo 610 (,20U,by who is erso 1y known to m pr who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign Print: My Commission • FRANCIS A REBELLO • MY COMMISSION # DD7'� EXPIRES June 16, 2012 (407) 34-0153 Florida rvlca oom **+ k+ kNk*+ k*******+ k******* *************M**** ****************M ****+ N**& ****** ***********+k **+k** Ask* **************** APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk 5 STRUCTURAL SOLUTIONS, P.A. Project No.: 11 -002 5921 -G West Friendly Avenue Date: 9/28/2011 Greensboro, North Carolina 27410 Garage Door Windload Design Pressures The following Design Pressures have been calculated in accordance with ASCE 7 -05, Section 6.5.12.4.1 for Components & Cladding, based upon the design parameters listed below. Building Address: 1104 NE 98 St Miami Shores, FL 33138 Garage Door Width: 16 ft Garage Door Height: 7.42 ft Basic Wind Speed: 146 mph Exposure: C Mean Roof Height: 11.25 ft Least Overall Horizontal Dimension of Building: 40 ft Distance from left building corner to edge of garage door opening: 42 ft Distance from right building corner to edge of garage door opening: 1.5 ft Roof Slope: any slope Positive Design Pressure = 39.0 psf Negative Design Pressure = -43.6 psf Design Assumptions: The building is considered "Enclosed" as defined in ASCE 7 -05 The Importance Factor and Topographic Factor for the building are both 1.00. The building and garage door measurements shown above were provided to Structural Solutions, P.A. by others. These calculations do not address the structural adequacy of the Jambs or other supporting structure. These calculations merely determine the Design Wind Pressures for the given garage door size and building geometry. Evaluating the structural adequacy of the jambs or other supporting structure is not the responsibility of Structural Solutions, P.A. ThiAhwument is only to be used in conjunction with Amarr Garage Doors © ° Via, o, `Pi sk.'N ' ''''Q.:g:rf,2'1,. No O040579 o ® 'i m - t° Aar ""( ST >T ® .0° m, °d R'lk. Thomas L. Shelmerdine, PE STRUCTURAL SOLUTIONS, P.A. Florida PE# 48579 J:\2011 Projects \11 -002 Amarr 2011 Retrofit Doors \1104 NE 98 St Miami Shores_FL_33138 \Garage Door Pressure Calculator.xls MIAMID COUNTY BUILDING CODE COM PRODUCT CONTROL i'• i<:mi Shores \Tii'age t�PPROVED DV DATE ZONMG DEPT a/6 /fie ?4 / BLDG DEPT gg njectibitittkteoir,E WITH ALL FEDERAL 140 WE Tiifpp NAND COUNTY RtJLFS AND REGULATIONS NOTICE OF ACCEPTANCE (NOA) LI I OCT gcmU 1 7 1011 gy BY: ........... MIAMI -DADE COUNTY, FLORIDA IETRO -DADE FLAGLER BUILDING T FLAGLER STREET, SUITE 1603 MIAMI, FLORIDA 33130 -1563 305) 375 -2901 FAX (305) 372 -6339 www.miamidade.gov/buildingcode Amarr Garage Doors 165 Carriage Court Winston - Salem, NC 27105 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed by Miami -Dade County Product Control Division and accepted by the Board of Rules and Appeals (BORA) to be used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ). This NOA shall not be valid after the expiration date stated below. The Miami -Dade County Product Control Division (In Miami Dade County) and/or the AHJ (in areas other than Miami Dade County) reserve the right to have this product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may immediately revoke, modify, or suspend the use of such product or material within their jurisdiction. BORA reserves the right to revoke this acceptance, if it is determined by Miami -Dade County Product Control Division that this product or material fails to meet the requirements of the applicable building code. This product is approved as described herein, and has been designed to comply with the Florida Building Code, including the High Velocity Hurricane Zone DESCRIPTION: Model 1200 -D WeatherGuard Plus w/ DuraSafe Sectional Garage Door (16' wide) APPROVAL DOCUMENT: Drawing No. SFC- 590 -010, Sheet 1 of 1, titled "Model #1200 -D WeatherGuard Plus w/ DuraSafe Short Panel, Long Panel and Flush Panel ", dated 06/21/01, last revision C 05/15/09, prepared by Amarr Garage Doors, signed and sealed by Thomas L. Shelmerdine, P.E., bearing the Miami -Dade County Product Control revision stamp with the Notice of A F : • r� ,: d iration date by the Miami -Dade County Product Control Division. MISSILE IMPACT RATING: Large and Small Missile Impact Resis LABELING: Each unit shall bear a permanent label with the manufactur t ar o, c state and following statement "Miami -Dade County Product Control Approved ", herein. RENEWAL of this NOA shall be considered after a renewal applicati ,: ; z„ * i been no change in the applicable building code negatively affecting the perfo TERMINATION of this NOA will occur after the expiration date or fi0. "'''vis>< ;;` or change in the materials, use, and/or manufacture of the product or process. Misus :...' a A an en �' ement of any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA revises NOA # 07- 0425.03 and consists of this page 1 and evidence page E -1, as well as approval document mentioned above. The submitted documentation was reviewed by Carlos M. Utrera, P.E. NOA No. 09 -0604.02 Expiration Date: May 16, 2012 Approval Date: July 15, 2009 Page 1 Amarr Garage Doors NOTICE OF ACCEPTANCE: EVIDENCE SUBMITTED A. DRAWINGS 1. Drawing No. SFC -590 -010, Sheet 1 of 1, titled "Model #1200 -D WeatherGuard Plus w/DuraSafe Short Panel, Long Panel and Flush Panel ", dated 06/21/01, last revision C 05/15/09, prepared by Amarr Garage Doors, signed and sealed by Thomas L. Shelmerdine, P.E. B. TESTS "Submitted under NOA # 02- 0115.09" 1. 1. Test report on Large Missile Impact Test, Cyclic Wind Pressure Test and Uniform Static Air Pressure Test for 9' x 7' and 16'x 7' sectional steel garage doors, prepared by American Test Lab of South Florida, report # 0709.01 -01, dated 08/23/01, signed and sealed by W. R. Mehner, P.E. and H. Hattem, P.E. 2. Test report on Evaluation of painted panels per ASTM D1654 & BI17, prepared by Subtropical Testing Service, test # AMR -1, signed and sealed by M. Mosbat, PE. C. CALCULATIONS "Submitted under NOA # 07- 0425.03" 1. Calculations prepared by Structural Solutions, P.A., dated 04/06/07, signed and sealed by Thomas L. Shelmerdine, P.E. D. QUALITY ASSURANCE 1. Miami Dade Building Code Compliance Office (BCCO). E. MATERIAL CERTIFICATIONS "Submitted under NOA # 02- 0115.09" 1. Test report on Tensile Test from 3 Samples ATL 0712.01 -01A, B & C, prepared by Q. C. Metallurgical, Inc., report # 1GM -1038 dated 08/02/01, signed and sealed by F. Grate, P.E. F. STATEMENTS 1. 2007 FBC compliance letter issued by Structural Solutions, P.A., on 04/27/09, signed and sealed by Tomas L. Shelmerdine, P.E. "Submitted under NOA # 02- 0115.09" 2. No financial interest letter issued by Structural Solutions P.A., on 10 /01 /01, signed and sealed by Tomas L. Shelmerdine, P.E. 3. Protocol compliance letter issued by American Test Lab of South Florida on 08/30/01, signed and sealed by W. R. Mehner, P.E. & H. Hattem, P.E. G. OTHERS: 1. Notice of Acceptance No. 07- 0425.03, issued to Amarr Garage Door, for their Model 1200 -D WeatherGuard Plus w/ DuraSafe Sectional Garage Door, approved on 06/14/07 and expiring on 05/16/12. E -1 6 2,0? Carlos . Utrera, P.E. Product Control Examiner NOA No. 09- 0604.02 Expiration Date: May 16, 2012 Approval Date: July 15, 2009 m lq -I rei CO E 9 EBBE! Immo MIES: EINEM 1030®© i1�„© d`r m4 s, CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 02BS00728 ACTSYS DOOR SYSTEMS INC D.B.A.: DAWSON SMITH A III Is certified under the provisions of Chapter 10 of Nang-Dade County VALID FOR CONTRACTING UNTIL 09/3012012 QUALIFYING TRADE(S) 0022 GARAGE & INDUS DOOR ALEX SINK 4�ly STATE F CHIEF FINANCIAL OFFICER DEPARTMENT OF P NANCIIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. 10 -08 -2010 EFFECTIVE DATE: PERSON: FEIN: 10/08/2010 EXPIRATION DATE: 10/07/2012 DAWSON 651150848 BUSINESS NAME AND ADDRESS: ACTSYS DOOR SYSTEMS INC 8370 S W 32 TERRACE MIAMI FL 33155 SCOPES OF BUSINESS OR TRADE: 1- SALES SMITH A 111 2- GARAGE DOOR INSTALLATION ** IMPORTANT: Pursuant to Chapter 440 . 05114), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election ander this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05)12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(131, F.S., Notices of election to be exempt and certificates of election 10 be exempt shall be subject to revocation if, at any time alter Ibe filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meal the requirements of this section. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 QUESTIONS? (850) 413 -1609 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OP FLORIDA DEPARTMENT OP FINANCIAL ERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 10/08/2010 EXPIRATION DATE: PERSON: SMITH A DAWSON III FEIN: 13511508481 BUSINESS NAME AND A'ODRESS: ACTSYS DOOR SYSTEMS INC 8370 S W 32 TERRACE MIAMI, FL 33155 10/07/2012 SCOPE OF BUSINESS OR TRADE: 1- SALES 2 • GARAGE DOOR INSTALLATION IMPORTANT 0 Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be 1.2 exempt.. apply only within the scope of the business or trade listed on the notice of election to be exempt. E Pursuant to Chapter 440.05(13). F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 RI D COLE 140 W RAG ER 1st FLOOR 1IMAMI, FL 33130 588855 -8 BUSINESS NAME / LOCATION ACTSYS DOOR SYSTEMS INC OPERATING IN DADE COUNTY LOCAL -DADE MUST 8E 4IS 1URSUANTTTO CO THIS IS NOT A BILL - DO NOT PAY NTY •- STATE OP FLO IRES:SEPT. 30, 2012'_. YED AT PLACE OF CODE CHAP OW YS DOOR SYSTEMS INC Sec. Type • • Business 213 SERVICE BUSINESS IS T°AXRE LOCK NOT A CONTRACTORS RECEIPT ". OT • ra THE HOLD.- •• TE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR VERIT OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS I8 NOT A CERTIFICATION OF THE HOLDERS OUALIFICA- TIONS. PAYMENT RECEIVED MIMIMADE COMFIT TAX COLLECTOR: 08/25/2011 60010000406 000075.00 SEE OTHER SIDE -ART RENEWAL RECEIPT NO. 614228 -5 FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 EMPLOYEE /S 1 DO NOT FORWARD ACTSYS DOOR SYSTEMS INC SMITH A DAWSON III PRES 8370 SW 32 TER MIAMI FL 33155 ►,Irul,1IIw11lI . 11113wIIl }1IIIVIAJW '°`�°R° CERTIFICATE OF LIABILITY INSURANCE DA11/223/10 PRODUCER Acceptance Insurance Services 6887 S.W. 40th St. Miami, FL 33155 Phone (305)740 -0515 Fax (305)740 -0518 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ALTER THE COVERAGE AFFORDED BY THE POLIC OR ES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED ACTSYS 000R SYSTEMS, INC. 8370 SW 32 TERR MIAMI, FL 33155 INSURER A: American Vehicle Insurance Company 10790 INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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 OF 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 ADD L SR IND TYPE OF INSURANCE POUCY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A • GENERAL LIABILITY D COMMERCIAL GENERAL LIABILITY gi MI CLAIMS MADE M OCCUR il♦ 12/14/10 12/14/11 EACH OCCURRENCE $300,000 DAMAGE TO (Ea occurence) $100,000 MED EXP (Any one person) $5,000 PERSONAL & MW INJURY $300,000 • GENERAL AGGREGATE $600,000 GEN'L AGGREGATE LIMIT APPLIES PER: In POUCY ❑ PROJECT ❑ LOC PRODUCTS - COMP /OP AGG $600,000 II AUTOMOBILE LIABILITY • ANY AUTO COMBINED SINGLE LIMIT (Ea accident) • El • • • • ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) • GARAGE LIABIU Y 1 ANY AUTO • AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG ❑ EXCESS/UMBRELLA LIABILITY • OCCUR 111 CLAIMS MADE IN DEDUCTIBLE • RETENTION $ EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' UABILITY ANY PROPRIETOR /!PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below ❑ WC STATU- • OTH- TORY LIMITS ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY UMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Remodeling contractor Request policy for Complete details on endorsements and exclusions CERTIFICATE HOLDER CANCELLATION Miami Dade County Building Code Compliance 140 W. Flagler ST, Suite 1603 Miami, FL 33130 _____ _- I Fax_ 305 -375 -2558 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE if © ACORD CORPORATION 1988 '4` °RI CERTIFICATE OF LIABILITY INSURANCE DATE (MMI10 PRODUCER Acceptance Insurance Services 6887 S.W. 40th St. Miami, FL 33155 Phone (305)7400515 Fax (305)740 -0518 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ALTER THE COVERAGE AFFORDED BY THE POLIC OR ES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED ACTSYS DOOR SYSTEMS, INC. 8370 SW 32 TERR 'MIAMI, FL 33155 INSURER A: American Vehicle Insurance Company 10790 INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OF 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. 1NSR LTR ADD'L 14SRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POUCY EXPIRATION DATE (MM!DD/YY) LIMITS A II GENERAL LIABILITY n COMMERCIAL GENERAL LIABILITY II In CLAIMS MADE in OCCUR GL- 0521018309 -00 12/14/10 12/14/11 EACH OCCURRENCE $300,000 PREMISES (Ea occurence) $100,000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $300,000 • GENERAL AGGREGATE $600,000 GEN'L AGGREGATE LIMIT APPLIES PER: MI POUCY l PROJECT • LOC PRODUCTS - COMP /OP AGG $600,000 • AUTOMOBILE • • II • • • ❑ 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 • OCCUR • CLAIMS MADE II DEDUCTIBLE • RETENTION $ EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILnY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? It yes, describe under SPECIAL PROVISIONS below • TORY C STATU- • T ER E.L. EACH ACCIDENT EL DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Remodeling contractor Request policy for complete details on endorsements and exclusions CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 NE 2 Ave Miami Shores, FL 33138 1 Fax: 305- 756 -8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ,%.7'..-,.4-- --- ACORD 25 (2001/08) QF O ACORD CORPORATION 1988