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RF-12-164Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 170276 Permit Number: RF -1 -12 -164 Scheduled Inspection Date: February 29, 2012 Inspector: Bruhn, Norman Owner: FLEUR, EMILE ST Job Address: 800 NE 91 Terrace Miami Shores, FL Project: <NONE> Contractor: MARK AND SON CONSTRUCTION Permit Type: Roof Inspection Type: Final Roof Work Classification: Tile Phone Number Parcel Number 1132060050390 Phone: (561)758 -8499 Building Department Comments REMOVE EXISTING TILES AND REPLACE WITH SAME COLOR TROUGH TILE. Passe /16 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 169395. Remove dumpster. NB February 28, 2012 For Inspections please call: (305)762 -4949 Page 23 of 40 RE: Permit # f tl,Lk M %I /,a,r r(— (Print name and circle License Type) Miami Shores Vipiage Building Department INSPECTION AFFIDAVIT License it C CC 1 3 2 P r3 J- On or about licensed as a FS 468 Building Inspector 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 DATE: 3' e°/2- / Engineer / Architect, 011-11— _ /04 , I did personally inspect the roof deck nailing and (Date & time) Secondary water barrier work at N / T.e't" C Job Site Address) Based upon that examination I have determined the installation was done according to the Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S) Signature State of Florida County of Dade: The undersigned, being the first duly sworn, deposes and says that he /she is the contractor for the above property mentioned. Swom to and subscribed before me this 644^ day of V1� Notary Public, Sate of Florida at Large Atlav ;tip" sy BARBARA A. ESTER g*. . ,*g MY COMMISSION d DD 955300 EXPIRES: March 29, 2014 e`� Public UrularwrRers iR¢�' Bonded Thru Notary „ *General, Building, Residential, or Rooting Contractors or any individual certified under 468 F.S. to make such an Inspection. Include photographs of each plane of the roof with permit # and address # dearly shown marked on the deck for each inspection Revised on 5/21/2009 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 ROOFING Permit No. pie -I6i Master Permit No. Tor- 759--t-if/7 OWNER: Name (Fee Simple Titleholder): 88# i✓ ��} / p' r fie' (4 PZ Phone#: Address: iP®O N E 9 / 'rag? c- City: flh / 4,4 2 Tenant/Lessee Name: Ail"--04 Email: /'''1�- State: Zip: .� 3 % J eF Phone#: JOB ADDRESS: PtX1 N 1( Te r4 c -c City: Miami Shores County: Miami Dade Folio/Parcel #: f/ "' 12-0 ,° e> 0 J•— 0 3 S' 0 zip: 33 / Is the Building Historically Designated: Yes NO Flood Zone: Phone#: j7i r ;'r'')L 0 7 Zip: 33 S/l r/ p Phone#:.�i;1r Iii �r P CONTRACTOR: Company Name: f A /LKf echAff ',ct ° r' O Address: 36s0 P1sc%d1( &ue City: kit / //n J o�n+,P' -' State: C/ Qualifier Name: /'(A'K riiM' STr/� State Certification or Registration #: e C C ! Z.19 3J`� Contact Phone#: Certificate of Competency #: 57/ 7�� �1` �/ Email Address: +t(i £/C j ,/ (o sV t% %tea c, (e "i. DESIGNER: Architect/Engineer: //✓A Phone#: Value of Work for this Permit: $ /G/ oA) 41 Square/Linear Footage of Work: COC) Type of Work: ❑Addition ❑Alteration ❑New ❑Repair/Replace UDemolition Description of Work: R(' M a U C t° k s jTraS 771.e5 4-/4 Ret4e I. %4 ..<igi?- 4 . . Co /e r T 1 + 0 . . , s 1-1 . * * *w+tvx, * *** *aa, ,x*** *** * *x, * *+ro** ** *x° ******F **** ,x *** ** *********** * * **** * * * *** ** ** *** Submittal Fee Permit Fee $ .O d Scanning Fee $ ' Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ . . Bonding Company's Name (if applicable) Bonding Company's Address City State V Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City tate 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 commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature, Owner or Agent The foregoing instrument was acknowledged before me this day of w` , 20 12-, by ri"'i, `e sr f /eb. who is personally known to me or who has produced COQ- As NOTARY PUBLIC: Sign: Print: himik fve-401--" My Commission Expires: �l L111 � Signature Contractor The foregoing instrument was acknowledged before me this 2° day of Sp.0--) , 20 r4by M, t rt. cU ?it who is personally known to me or who has produced {Gl- ( as identification and who did take an oath. C) 00c1 NOTARY PUBLIC: Sign: Print: My Commission Expires: dep �s '•. Sale W ^1 � rrrrrn n n�u�� * * * * * * * * * * * * * * ***�w*** mix****: a************ x�************ a�***** ***,x�• **** *�x ******* * ** ** ***** � way * ***+r �ewx•r��•:.:* *** APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk STATE OF FLORIDA IZFIZ -164 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 MCALLISTER, MARK ALLEN MARK & SON CONSTRUCTION INC 3650 MIDDLEBURG DRIVE WELLINGTON FL 33414 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE (850) 487 -1395 STATE OF FLORIDA DEPARTMENT OF PROFES UPN CCC13289$Y CERTIFIEBNa MCALLIST MARK & ADP 4992405 BUSINESS AND REGULATION AV 090479584 414iRACTOR TION INC IS CERTIFIED under the provisions of Ch.4$9 FS Expiration date: AUG 31, 2012 L10061100675 AC# 4992405 STATE OFF FDLORIIoDA DEPARTMENT STRUCTION BUSINESS AND SEQ# L10061100675 BATCH NUMBER LICENSE NBR. 06/11/2010 090479584 CCC132893` The ROOFING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chaptg` Expiration date: AUG 31, 2012 MCALLISTER, MARK ALLEN MARK & SON CONSTRUCTION INC,N, 3650 MIDDLEBURG DRIVE WELLINGTON . FL 33414 CHARLIE CRIST GOVERNOR DISPLAY AS REQUIRED BY LAW CHARLIE LIEM INTERIM SECRETARY Attached is your 2011/2012 Wellington Local Business Tax Receipt. Please verify the information and display at your place of business in a conspicuous location. This receipt expires on September 30, 2012. Renewal Notices are mailed at the end of July to the last known mailing address. If you do not receive the notice by the middle of August, please contact us at (561) 791 -4000. It is your responsibility to renew your receipt. You may renew your Local Business Tax Receipt online at www.wellinRtonfl.Rov RECEIPT FEE $100.00 PENALTY FEE $0.00 ELLINGTON 12300 FOREST HILL BLVD 2012 LOCAL BUSINESS TAX RECEIPT EXPIRES: September 30, 2012 BUSINESS TAX RECEIPT: 12- 00016026 CLASSIFICATION: ROOFING DBA: MARK AND SON CONSTRUCTION Address: 3650 MIDDLEBURG DR WELLINGTON FL 33414 MISC. FEE 50.00 PLEASE DETACH HERE PLEASE DETACH WALLET CARD TOTAL FEES $100.00 //A ELLINGTON LOCATION ADDRESS: DBA: MARK AND SON CONSTRUCTION APPLICANT: MARK MCALLISTER Address: 3650 MIDDLEBURG DR WELLINGTON FL 33414 CLASSIFICATION: ROOFING MAILING ADDRESS: MARK AND SON CONSTRUCTION 3650 MIDDLEBURG DR WELLINGTON FL 33414 LOCAL BUSINESS TAX RECEIPT 2011 -2012 2012 12300 FOREST HILL BLVD (561) 791 -4000 BUSINESS TAX RECEIPT: 12 -00016026 EXPIRES: September 30, 2012 ORIGINAL ISSUE DATE: August 04, 2011 i'YELLINGTON RECEIPT MUST BE DISPLAYED CONSPICUOUSLY AT ESTABLISHMENT OR PLACE OF BUSINESS JEFF ATWATER CHIEF FINANCIAL OFFICER Ay STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION 04 -26 -2011 * * 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. EFFECTIVE DATE: PERSON: FEIN: 04/26/2011 EXPIRATION DATE: 04/25/2013 MCALLISTER MARK A 208313614 BUSINESS NAME AND ADDRESS: MARK & SON CONSTRUCTION INC 3650 MIDDLEBURG DR WELLINGTON FL 33414 SCOPES OF BUSINESS OR TRADE: 1- CONSTRUCTION 3- CERTIFIED GENERAL CONTRACTOR 2- CERTIFIED ROOFING CONTRACTOR * IMPORTANT: Pursuant to Chapter 440 . 051141, F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under 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 440.051131, 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 tiling 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 OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 04/26/2011 EXPIRATION DATE: 04/25/2013 PERSON: MARK A MCALLISTER FEIN: 208313614 BUSINESS NAME AND ADDRESS: MARK & SON CONSTRUCTION INC 3650 MIDDLEBURG DR WELLINGTON, FL 33414 SCOPE OF BUSINESS OR TRADE: 1- CONSTRUCTION 2- CERTIFIED ROOFING CONTRACTOR 3- CERTIFIED GENERAL CONTRACTOR IMPORTANT Pursuant to Chapter 440.05114), F.S., an officer of a corporation who • O 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. H 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 Rthe notice of election to be exempt E Pursuant to Chapter 440.05(131, 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 01 -11 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME & FIRST INSPECTION • . PERMIT NO.? F- ( 1-1 Z -16 11'AX FOLIO NO.//- 3Z-4 0°'r --03 LO 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, Rorida Statutes, the following information is provided in this Notice of Commencement b 111111111111111111111111111111111111111111111 CFN 3012R0082037 DR Bk 27486 Ps 48301 (1as) RECORDED 02/06/2012 11:105:53 HARVEY RUVIN, CLERK OF COURT IIIAI'II -DARE COUNTY/ FLORIDA LAST PAGE �g Space above reserved for use of recording office 1. Legal description of property and street/address: (J ' ° ,vF 9/ tr/'.¢ -cam Amer �.: !%/ .77 31' 2. Description of Improvement iCe G S 4 1 ' �J• 3. Owner(s) name and address: atoll .5-4/ oar / /P4,t Rod /Peg/ 'i"PrrAte -r Interest in property: O(s.," - Name and address of fee simple titleholder: 4. Contractor's name, address and phone number /l/A 3C YD "MA t b.2rs.. D/t Well,�ir, 1- 75'?.- erFSrr 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(1Xa)7., Florida Statutes, Name, address and phone number. crn.0 /c 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienar's Notice as provided in Section 713.13(1)(b), Rorida Statutes. Name, address and phone number: ZB/2 9. Sgairation date of this Notice of Commencement: (the expiration date is 1 year f om the data of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRAT1ON OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, 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 'ME JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signatures) of Owners rr orized Officer/Director/Partner/Mana9 ) Q f T �fr {v Prepared By XI Prepared By Print Name K P :✓7 `- Print Name IAN 1 t S T Kft1 1 Atte/Office Av ti on C/3 Title/Office & ( STATE OF FLORIDA COUNTY OF MIAMI -DADE The foregoing instrument was acknowledged before me this day ofw�4K� I- CY CY Individually, or ❑ as for _ ❑ Personally known, or %produced the following type of identifi'cati Signature of Notary Public: Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in It are true, to the best of my knowledge and belief. Signature(s) of Owner(s) or Owner(s)'s Authorized Officer /Director/Partner /Manager who signed above: By Pyt144 5 / ) By 123.01-52 PAGES 9/10 rtat 11, L p..k.ohk.TE OF FLORIDA, COUNTY OF DADE I 14EREBY " RT FY that this is a true copy or the original 1' r In hls office on /l & / /5 WIT' SS 1 Y hand ar d2J, HARVEY day of aunty Courts D.C. 3�far Miami S hores Viiiage 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: /../36 "i 10050 NE 2nd Ave Miami Shores, Fl 33138 Re: Owner's Name: Re Az 5/4 f,4"_ r 5-772% Property Address: '4 HF 57( %rrT/,}c/ Roofing Permit Number: Dear Building Official: I'2 e fic certify that I am not required to retrofit the roof to wall connections of my building because: The 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 constructed in compliance with the provisions of the Florida Building Code (FBC) or with the provisions of 1994 edition of the South Florida Building Code (1994 SFBC) Signature Air f vitr_ Print Name State of Florida County of Dade The undersigned, being the first duly sworn, deposes and says that he/she is the owner for the above property mentioned. Swom to and subscribed before me this L---' day of i A-" "' ��- fs_ %_ Notary Public, Sate of Florida at Large uois ,;w ' .\ -'t • When the just valuation of the structure for purpose of ad valorem taxation is equal to or more tt n 5300,036.00J SFBC. Then you must provide a building application from a General Contractor for the Roof to Wot? •ti%� , �,,,,,,.Siii�• ,\\ \\ Revised on 5/21/2009 not constructed with FBC nor a 1994 Miami -Dade My Home My Home mirrtidade=gov Show Me: Property Information Search By: Select Item Text only Property Appraiser Tax Estimator igProperty Appraiser Tax Comparison 11 Portability S.O.H. Calculator Summary Details: Folio No.: 11- 3206 - 005 -0390 Property: 800 NE 91 TER Mailing EMILE SAINT FLEUR & Address: BENS SAINT FLEUR JTRS Living Units: 800 NE 91 TERR MIAMI FL Adj Sq Footage: 33138 -3218 Propert y Information: Primary Zone: 0900 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds /Baths: 3/2 Floors: 1 Living Units: 1 Adj Sq Footage: 1,494 Lot Size: 7,233.80 SQ FT Year Built: 1954 $50,000/ GOLDEN GATE PARK ADDN PB 6 -130 LOT 13 Legal BLK 3 LOT SIZE 51.670 Description: .X 140 OR 21306 -0679 062003 6 COC 25109- $65,266 4979 11 2006 5 OR $50,000/ 25109 - 49791106 01 Assessment Information: Year: 2011 2010 Land Value: $43,318 $62,035 Building Value: $113,170 $113,170 Market Value: $156,488 $175,205 Assessed Value: $116,994 $115,266 Exemption Information: Year: 2011 2010 Homestead: $25,000 $25,000 2nd Homestead: . YES YES Taxable Value Information: Year: 2011 2010 Applied Applied Taxing Authority: Exemption/ Exemption/ Taxable Taxable Value: Value: Regional: $50,000/ $50,000/ $66,994 $65,266 County: $50,000/ $50,000/ $66,994 $65,266 City: $50,000/ $50,000/ $66,994 $65,266 School Board: $25,000/ $91,994 $25,000/ $90,266 Sale Information: 'Sale Date: 111/2006 Page 1 of 2 Aerial Photography - 2009 0 114 ft My Home !Property Information 1 Property Taxes 1 My Neighborhood 1 Property Appraiser Home 1 Using Our Site 1 Phone Directory 1 Privacy! 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. N N Legend Property Boundary Selected Property Street Highway Miami -Dade County Water http: / /gisims2. miamidade .gov /MyHome /propmap.asp 1/30/2012 ROOF ASSEMBLIES AND ROOFTOP STRUCTURES RECEIVED Florida Building Code Edition 2007- JAN 3 ( 2017 High- Velocity Hurricane Zone Uniform Permit Application Form. BY. " '� section A (General Information) :HALL FEiDLORAL Master Permit No. Process No. Contractor's Name ,,/r�� f 10ry (0,41c tru c.`TTd d✓ Job Address PO /v E 9/ Terr4 : - ❑ Low Slope 1e( Mechanically Fastened Tile ❑ Mortar /Adhesive Set Tile ❑ Asphaltic ❑ Metal Panel /Shingles ❑ Wood Shingles /Shakes Shingles ❑ New Roof ❑ Prescriptive BUR -RAS 160 ROOF TYPE *Reroofing ❑ Recovering ❑ Repair ❑ Maintenance ROOF SYSTEM INFORMATION Low Slope Roof Area (SF) Steep Sloped Roof Area (SF) Total (SF) ...1390° 12Jaa Section R (Roof plan) Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Include dimensions of sections and levels, clearly identify dimensions of elevated pressure zones and location of parapets. t 3 ') l FLORIDA BUILDING CODE — BUILDING ROOF ASSEMBLIES AND ROOFTOP STRUCTURES Florida Building Code Edition 007 High-Velocity Hurricane Zone Uniform Permit Application Form. Section D (Steep Sloped Roof Syctem) Roof System Manufacturer: f,v f G5 r'' Notice of Acceptance Number: 1th 7-, 0 / Minimum Design Wind Pressures, If Applicable (From RAS 127 or Calculations): 1: P2: 74.7377-6 P3: 7 -e O Maximum Design Pressure 6 116. O (From the Product Approval Specific System): 5/ 2_ kiwi wf Roof ySlope: : 12 ,Stepp sloped Roof system Description \ Deck Type: \ Type Underlayment: Insulation: Ridge Ventilation? Gf ialp 4 / j r''l. 0)696 ird/r Fire Barrier: Mean Roof Height: l21 Fastener Type & Spacing: Adhesive Type: Type Cap Sheet: Roof Covering: FLORIDA BUILDING CODE — BUILDING Type & Size Drip Edge: `' DV Forty, /V d / / -OizV 'i MIAMI•�►DE COUNTY BUILDING AND NEIGHBORHOOD COMPLIANCE DEPARTMENT (BNC) BOARD AND CODE ADMINISTRATION DIVISION NOTICE OF ACCEPTANCE OA Polyfoam Products, Inc. 11715 Boudreaux Road Tomball, TX 77375 MIAMI -DADE COUNTY PRODUCT CONTROL SECTION 11805 SW 26 Street, Room 208 Miami, Florida 33175 -2474 T (786) 315 -2590 F (786) 315 -2599 www.miamidade.govibuildinz/ SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed and accepted by Miami -Dade County BNC - Product Control Section 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 Section (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. BNC reserves the right to revoke this acceptance, if it is determined by Miami -Dade County Product Control Section 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 of Florida Building Code. DESCRIPTION: Polypro® AH160 LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement "Miami -Dade County Product Control Approved ", unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement 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 renews NOA# 06- 0201.02 and consists of pages 1 through 7. The submitted documentation was reviewed by Alex Tigera. NOA No.: 11-0124.04 Expiration Date: 05/10/12 Approval Date: 04/14/11 Page 1 of 7 • ROOFING COMPONENT APPROVAL: Category: Roofing Sub Category: Roof tile adhesive Materials: Polyurethane SCOPE: This approves Polypro® AH160 as manufactured by Polyfoam Products, Inc. as described in Section 2 of this Notice of Acceptance. For the locations where the design pressure requirements, as determined by applicable building code, does not exceed the design pressure values obtained by calculations in compliance with Roofing Application Standard RAS 127, for use with approved flat, low, and high profile roof tiles system using Polypro® AH 160. Where the attachment calculations are done as a moment based system for single patty placement, and as an uplift based system for double patty systems PRODUCTS MANUFACTURED BY APPLICANT: Product Dimensions Test Specifications Polypro? AH160 N/A TAS 101 Foampro® RTF1000 ProPack® 30 & 100 N/A N/A Product Description Two component polyurethane foam adhesive Dispensing Equipment Dispensing Equipment PRODUCTS MANUFACTURED BY OTHERS: Any Miami -Dade County Product Control Accepted Roof Tile Assembly having a current NOA which list moment resistance values with the use of Polypro AH160 roof tile adhesive. PHYSICAL PROPERTIES: Property, Density Compressive Strength Tensile Strength Water Absorption Moisture Vapor Transmission Dimensional Stability Closed Cell Content It ASTM D 1622 ASTM D 1621 ASTM D 1623 ASTM D 2127 ASTM E 96 ASTM D 2126 ASTM D 2856 Results 1.6 lbsfft 3 18 PS1 Parallel to rise 12 PSI Perpendicular to rise 28 PS1 Parallel to rise 0.08 Lbs./Ft2 3.1 Perm / Inch +0.07% Volume Change ® -40° F., 2 weeks +6.0% Volume Change @158 °F., 100% Humidity, 2 weeks 86% Note: The physical properties listed above are presented as typical average values as determined by accepted ASTM test methods and are subject to normal manufacturing variation. NOA No.: 11-0124.04 Expiration Date: 05/10/12 Approval Date: 04/14/11 Page 2 of 7 EVIDENCE SUBMITTED: Test Aaencv Test Identifier Test Name/Renort Date Center for Applied Engineering #94 -060 TAS 101 04/08/94 257818 -1PA TAS 101 12/16/96 25- 7438 -3 SSTD 11 -93 10/25/95 25- 7438 -4 25- 7438 -7 SSTD 11 -93 11/02/95 25 -7492 SSTD 11 -93 12/12/95 Miles Laboratories NB- 589 -631 ASTM D 1623 02/01/94 Polymers Division Ramtech Laboratories, Inc. 9637 -92 ASTM E 108 04/30/93 Southwest Research Institute 01- 6743 -011 ASTM E 108 11/16/94 01- 6739- 062b[1] ASTM E 84 01/16/95 Trinity Engineering 7050.02.96 -1 TAS 114 03/14/96 Celotex Corp. Testing Services 528454 -2 -1 TAS 101 10/23/98 528454 -9 -1 52845410 -1 520109 -1 TAS 101 12/28/98 520109 -2 520109 -3 520109 -6 520109 -7 520191 -1 TAS 101 03/02/99 520109 -2 -1 LINIITATIONS: 1. Fire classification is not part of this acceptance. Refer to the Prepared Roof Tile Assembly for fire. rating. 2. Polypro® A1-1160 shall solely be used with flat, low, & high tile profiles. 3. Minimum underlayment shall be in compliance with the Roofing Application Standard RAS 120. 4. Roof Tile manufactures acquiring acceptance for the use of Polypro AH160 roof the adhesive with their tile assemblies shall test in accordance with TAS 101. 5. Roof Tile manufactures acquiring acceptance for the use of HANDI -STICK roof tile adhesive with their tile assemblies shall test in accordance with TAS 101 with section 10.4 as modified herein. (--F) _W 2 F'— MS NOA No.: 11-0124.04 Expiration Date: 05/10/12 Approval Date: 04 /14/11 Page 3 of 7 INSTALLATION: 1. Polypro® A11160 may be used with any roof tile assembly having a current NOA that lists uplift resistance values with the use of Polypro® AH160. 2. Polypro® AH160 shall be applied in compliance with the Component Application section and the corresponding Placement Details noted herein. The roof tile assembly's adhesive attachment with the use of Polypro® AH160 shall provide sufficient attachment resistance, expressed as an uplift based system, to meet or exceed the uplift resistance determined in compliance with Miami -Dade County Roofing Application Standards RAS 127. The adhesive attachment data is noted in the roof tile assembly NOA 3. Polypro® AH160 roof tile adhesive and its components shall be installed in accordance' with Roofing Application Standard RAS 120, and Polyfoam Products, Inc. Polypro® AH160 Operating Instruction and Maintenance Booklet. 4. Installation must be by a Factory Trained 'Qualified Applicator' approved and licensed by Polyfoam Products, Inc. Polyfoam Products Inc. shall supply a list of approved applicators to the authority having jurisdiction. 5. Calibration of the Foampro® dispensing equipment is required before application of any adhesive. The mix ratio between the "A" component and the "B" component shall be maintained between 1.0- 1.15 (A): 1.0 (B). The dispense timer shall be set to deliver 0.0175 to 0.15 pounds per tile as determined at calibration. No other settings shall be approved. 6. Polypro® AH160 shall be applied with Foampro RTF1000 or ProPack® 30 & 100 dispensing equipment only. 7. Polypro® AH160 shall not be exposed permanently to sunlight. 8. Tiles must be adhered in freshly applied adhesive. Tile must be set within 2 to 3 minutes after Polypro® AH160 has been dispensed. 9. Polypro® AH160 placement and minimum patty weight shall be in accordance with the Placement Details' herein. Each generic file profile requires the specific placement noted herein. Table 1: Adhesive Placement For Each Generic Tile Profile Tile Profile Placement Detail Single Paddy Weight Min. (grams) Two Paddy Weight per paddy Min. (grams) Flat, Low, High Profiles #1 35 N/A High Profile (2 Piece Barrel) #1 17 /side on cap and 34 /pan N/A Flat, Low, High Profiles #2 24 N/A Flat, Low, High Profiles #3 8 LABELING: All Polyproi.I AH160 containers shall comply with the Standard Conditions listed herein. BUILDING PERMIT REQUIREMENTS: As required by the Building Official or applicable building code in order to properly evaluate the installation of this system. NOA No.: 11- 0124.04 Expiration Date: 05/10/12 Approval Date: 04/14/11 Page 4 of 7 ADHESIVE PLACEMENT DETAIL 1 SINGLE PATTY 1) Place anaigh adhesive to achieve 17to29 op r2xTefor team bloke Inocidadvdlhthepandie \ Mdp14/11eppFca63 2) Tare cowls upside doom. Waco tabula V2la. To 1 in. From oulalds edge of corer tilt Then Install tha We. Neff through piss& cement top piton oftheeon cone sover db. AIM b second Nurse of pan ecee�etula flush et ems Ilea. Ewe cto we Wesphote Facts (mita NOA No.: 11- 0124.04 Expiration Date: 05/10/12 Approval Date: 04/14/11 Page 5 of 7 ADHESIVE PLACEMENT DETAIL 2 SINGLE PATTY NOA No.: 11-0124.04 Expiration Date: 05/10/12 Approval Date: 04/14/11 Page 6 of 7 ADHESIVE PLACEMENT DETAIL 3 DOUBLE PATTY Nag through plastic cement Paddy (between tile) Paddy (under tile) S in x 31n. Single paddy on under laYmen Single paddy under the Single paddy on top of the Course MAT is. medium size paddy ease Fascia course only Nall through plastic cement Underlaymant Single paddy under UN Single paddy between the 2ln. x 71n. medium site paddy eave course only r In.x 3 In. 4 in. Single paddyon under. layment Slagle paddy on top of tile %pEeve Cain Fascia Waephole Eaue closure Drip edge END OF THIS ACCEPTANCE NOA No.: 11-0124.04 Expiration Date: 05/10/12 Approval Date: 04 /14/11 Page 7 of 7 MIAMIOD�ADE COUNTY BUILDING CODE COMPLIANCE OFFICE (BCCO) PRODUCT CONTROL DIVISION NOTICE OF ACCEPTANCE (NOA) Entegra Roof Tile, Inc. 1289 NE 9th Ave Okeechobee, FL. 34972 MIAMI -DADE COUNTY, FLORIDA METRO -DADE FLAGLER BUILDING 140 WEST FLAGLER STREET, SUITE 1603 MIAMI, FLORIDA 33130 -1563 (305) 375 -2901 FAX (305) 375 -2908 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 High Velocity Hurricane Zone of the Florida Building Code. DESCRIPTION: Plantation Roof Tile LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Miami -Dade County Product Control Approved ", unless otherwise noted herein RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement 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 revises NOA No. 10- 0804.15 and consists of pages 1 through 5. The submitted documentation was reviewed by Alex Tigera. NOA No.: 10- 1202.01 Expiration Date: 12/08/15 Approval Date: 12/30/10 Page 1 of 5 0 ROOFING ASSEMBLY APPROVAL Category: Roofing Sub Category: Roofing Tiles Material: Concrete 1. SCOPE: This renews a roofing system using Entegra "Plantation" concrete roof tile, as manufactured for Entegra Roof Tile, Inc. in Okeechobee, FL as described in Section 2 of this Notice of Acceptance. For the locations where the pressure requirements, as determined by applicable Building Code, does not exceed the values listed in section 4 herein. The attachment calculations shall be done as a moment based system. 2. PRODUCT DESCRIPTION: Manufactured by Test Product Applicant Dimensions Specifications Description Plantation Tile Length: 161/2" Flat concrete roof tile for direct deck or Width: 13" TAS 112 batten nail -on. Trim Pieces Length: varies Width: varies Thickness: varies TAS 112 Accessory trim, concrete roof pieces for use at hips, rakes ridges and valley terminations 3. LIMITATIONS: 3.1 Fire classification is not part of this acceptance. 3.2 For mortar or adhesive set tile applications, a static field uplift test in accordance with TAS 106 may required, refer to applicable building code. 3.3 Applicant shall retain the services of a Miami -Dade County Certified Laboratory to perform quarterly test in accordance with TAS 112, appendix `A'. Such testing shall be submitted to the Building Code Compliance Office for review. 3.4 Minimum underlayment shall be in compliance with the applicable Roofing Applications Standards listed section 4.1 herein. 3.5 30/90 hot mopped underlayment applications may be installed perpendicular to the roof slope unless stated otherwise by the underlayment material manufacturers published literature. 3.6 This acceptance is for wood deck applications. Minimum deck requirements shall be in compliance with applicable building code. 4. INSTALLATION: 4.1 Entegra Roof Tile, Inc.'s Plantation Flat Tile and its components shall be installed in strict compliance with Roofing Application Standard RAS 118,119, & 120 4.2 Data For Attachment Calculations NOA No.: 10- 1202.01 Expiration Date: 12/08/15 Approval Date: 12/30/10 Page 2 of 5 Table 1: verage Weight (W) and Dimensions (ix w ) Tile Profi a Weight -W (Ibf) Length -I (ft) Width -w (ft) Plantation Tile 11.6 1.375 1.08 • Table 3: Restoring Moments due to Gravity - Mg (ft-Ibf) Table 2: Aerod namic Multi • liers - ?. ft3 2 ":12" Tile Profile ":12" a, (ft3) Batten A . . Iication a. (ft3) Direct Deck A • lication Plantation Tile 2 -10d Ring Shank Nails 0.267 0.289 5 12" • Table 3: Restoring Moments due to Gravity - Mg (ft-Ibf) Tile 2 ":12" 3 ":12" ":12" ": ": Greater than Profile 2 -10d Ring Shank Nails 30.9 4 5 12" 6 12" 7 ": 12" 9.8 Battens Direct Battens Direct Battens Direct Battens Direct Battens Direct Battens Direct 24.4 1 -10d Smooth or Screw Shank Nail (Field Clip) Deck 24.3 Deck 1 -10d Smooth or Screw Shank Nail (Eave Clip) Deck 19.0 Deck 2 -10d Smooth or Screw Shank Nails (Field Clip) Deck 35.5 Deck Plantation 7.22 7.91 6.85 7.79 6.75 7.67 6.61 7.52 6.44 7.32 6.26 7.04 Tile Table 4: ttachment Resistance For Nall Expressed as a Moment - Mt (ft -Ibf) -On Systems Tile Profile _Fastener Type Direct Deck (Min 15132" plywood) Direct Deck (Min. 19132" plywood) Battens Plantation Tile 2 -10d Ring Shank Nails 30.9 38.1 17.2 1 -10d Smooth or Screw Shank Nail 7.3 9.8 4.9 2 -10d Smooth or Screw Shank Nails 14.0 18.8 7.4 1 #8 Screw 30.8 30.8 18.2 2 #8 Screw 51.7 51.7 24.4 1 -10d Smooth or Screw Shank Nail (Field Clip) 24.3 24.3 24.2 1 -10d Smooth or Screw Shank Nail (Eave Clip) 19.0 19.0 22.1 2 -10d Smooth or Screw Shank Nails (Field Clip) 35.5 35.5 34.8 2 -10d Smooth or Screw Shank Nails (Eave Clip) 31.9 31.9 32.2 2 -10d Ring Shank Nails' 50.3 65.5 48.3 1 Installation with a 4" tile headlap and fasteners are located a minimum of 2W from the head of tile. MANMADE COUNTY APPROVED NOA No.: 10-1202.01 Expiration Date: 12/08/15 Approval Date: 12/30/10 Page 3 of 5 Table 5: Attachment Resistance Expressed as a Moment Mr (ft -Ibf) For Two Pa Adhesive Set S stems Tile Profile Tile Application Minimum Attachment Resistance Plantation Tile Adhesive 31.33 2 See manufactures com . onent a. +royal for installation re • uirements. 3 Flexible Products Company 7ileBond Average weights Poi own Product, Inc. Average weight per patty per patty 13.9 grams. 8 drams. Table 6: Attachment Resistance Expressed as a Moment - Mf (ft -Ibf) For Sin. le Patt Adhesive Set S stems Tile Profile Tile Application Minimum Attachment Resistance Plantation Tile PoIyProTM 118.9 PolyProm 40.46 4 Large paddy placement of 45 grams of PoIyProTM. 5 Medium paddy placement of 24 grams of PolyProTm. Table 7: Attachment Resistance Expressed as a Moment - Mf(ft-Ibf) for Mortar Set Systems Tile Profile Tile Application Attachment Resistance See specific mortar manufacturer's Notice of Acceptance. 5. LABELING 5.1 All tiles shall bear the imprint or identifiable marking of the manufacturer's name or logo as seen below or following statement: "Miami -Dade County Product Control Approved ". 5.2 Entegra Roof Tile, Inc.'s Plantation Roof Tile bears the following markings: USA "E" USA, "E ", Entegra "E ", where the E is a stylized logo. 6. BUILDING PERMIT REQUIREMENTS 6.1 Application for building permit shall be accompanied by copies of the following: 6.1.1 This Notice of Acceptance. 6.1.2 Any other documents required by the Building Official or applicable Building Code in order to properly evaluate the installation of this system. 7. MANUFACTURING LOCATIONS 7.1 Okeechobee, FL NOA No.: 10- 1202.01 Expiration Date: 12/08/15 Approval Date: 12/30/10 Page 4 of 5 • • PROFILE DRAWING PLANTATION FLAT CONCRETE TILE END OF THIS ACCEPTANCE NOA No.: 10- 1202.01 Expiration Date: 12/08/15 Approval Date: 12/30/10 Page 5 of 5 • • • SECTION R4402.13 HIGH VELOCITY HURRICANE ZONES — REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS R4402.13.1 Scope. As it pertains to the section, it is the responsibility of roofing contractor to provide the owner with the required roofing permit, and to explain to the owner the content of the section. The provisions of Section R4402 govem the minimum requirements and standards of the industry for roofing system installations. Additionally, the following items should be addressed as part of the agreement between the owner ant the contractor. The owner's initial in the designated space indicates that the item has been explained. 1. 5 Aesthetics- Workmanship: the workmanship provisions of Section R4402 are for the purpose of providing that the roof system meets the wind resistance and water instruction performance standards. Aesthetics (appearance) are not a consideration with respect to workmanship provisions. Aesthetic issues such as color or architectural appearance, that are not part of a zoning code, should be addressed as part of the agreement between the owner and the contractor. 2. -S it Renailing wood decks: When replacing roofing, the existing wood roof deck may have to be renailed in accordance with the current provisions of Section R4403. (The roof deck is usually concealed prior to removing the existing roof system). 3. S ) P Common roofs: Common roofs are those which have no visible delineation between neighboring units (i.e., townhouses, condominiums, etc.) In buildings with common roofs, the roofing contractor and /or owner should notify the occupants of adjacent units of roofing to be performed. 4. 5 rr Exposed Ceiling: Exposed, open beam ceilings are where the underside of the roof decking can be viewed from below. The owner may wish to maintain the architectural appearance; therefore, roofing nail penetration of the underside of the decking may not be acceptable. This provides the option of maintaining the appearance. 5. 5 f ' 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. Pounding can be an indication of structural distress and may require the review of a professional structural engineer. Pounding may shorten the life expectancy and performance of the new roofing system. Pounding conditions may not be evident until the original roofing system is removed. Pounding conditions should be corrected. 6. 5 Tic- Overflow scuppers (wall outlets): It is required that rainwater flows off so that the roof is not overloaded from a buildup of water. Perimeter /edge wall or other roof extension may block this discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in accordance with the requirements of Sections R4402, R4403 and R4413. 7. ,SrF Ventilation: Most roof structures should have some ability to vent natural airflow through the interior of the structure assembly (the building itself). The existing amount of attic ventilation shall not be reduced. It may be beneficial to consider additional venting which can result in extending the service life of the roof. sr-r_i_26) 4r/Agent's Signature ate Revised on 7/9/2009 LD Contractor Si nature Reit Date ACORDP CERTIFICATE OF LIABILITY INSURANCE DATE 0/1 4/nIYY) 1.e3n/2012 THIS CERTIFICATE 1S 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 po1lcy(Ies) 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). PltOOUcaR Florida Bankers Insurance 7278 SW 8 Street Miami, FL 33144 Pha:lne [305)266 -6493 INSURED Mary & Son Construction INC 3650 aiiddleburg Dr. Wellington, FL 33414 561 - 753 -1531 CO. VERAGES Fax 1308)262-0679 CONTACT MARIA ALCMSO moo g: P(305)266-6493 x_......,-._.(305)262 --0679 A.araL mart +a@floridabankersinsusan.ce.cam IN8URERISSAPFORWMO COVERAGE INS KS A:Kingssray...AmiSo Insurance Company _..._ ................ INSURER a: American Vehicle Insurance Company ......... INSURER C : INSURER D: INSURER E NAIC 0 y • IN i THIS IS TO CERTIFY THAT THE POLICIES of fN&LIRANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIL INDICATED- NOTVYITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSLIRANCE 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. A0111C SUISIt POLa Y EFP POLICY EAts • TYPE ON INSURANCE: � � .,., �r e� P i i _ Y N d R ,i: i;a:..utlAi . '4t !JAW I.IIAITB !% GENERAL LIABILITY X COM CaAL GENERAL UA$I OTV EACH OCCURRENCE DAMI4f$�` ti f J�YGO ...PERM!SES.150.0ecut once}_s MEDEXP (Ally ocepors0F1 , PERSONAL 8 ADV INJURY GENERAL AGGREGATE $ 2,000,000 ............._......_1004. 00100,000 g 5,000 000 $ 1,000000 s 2,000,000 S 2,000,000 s CLAIMS -MADE X OCCUR OL050400S230 -D0 10/19/2011 10/LSb/2012 _ (Spit AGGREGATE. Limn APPLIES PER: . POuCY X '�' ._ hcec PRODUCTS - COMP:CPADD • AUTDMOBILE LIABILITY X._ ANY AUTO ... ALL ammo AUTOS CAS0147S2 10/19/2011. 10/19/2012 SCHEDULED TOS AU X HIREpAUT06 ., X .NOW OWNED AUTOS CONENNECI SINGLE LeAIT (FaI:danll 3 1,000,000 BODILY INJURY Oho person' _._.__.......---...._ _....._......_--- _............. BODILY INJURY IPar eoadahh $ $ $ $ �._.__.._.__. ...._........ PROPERTY DAMAGE (Per acchlenl) Un ir, re mC1Qnst cGmtrue7d • �._v _....._ 30,000 1 0 , 0 0 0 A fi X UIIBRI$LLALIAS X . OCCUR EXCESS LUIS .........__... _____..__ - -- CLAIMS -MADE, DEDUCTIBLE x -'T1 ,: .� I $ 11} 000 , I0100091508 11/19/2011 !11/19/2012 . EACH t CCURRErt? AGGREGATE 5 ........._........... ! 2 r 000, 000 ._ ...................._....__.. 2,000,000 $ s WORKERS COP! ENSATION .... . - AMU EMPLOYERS' LIABILITY Y / N ANY PROPRl$TOR/P,eAvRTNER/EXECUT1VE WC STATU- .O'PN. . TORY LIMI.TS........... ER ._ E.L EACH ACGI�JEw'r 5 $.L DISEASE - EA EMPLOYEE 1 _ E.L DISEASE - POLY u10T 1 ....._._... .BOO 000 _..._.. 500, 9.0g 500 0 + 0 OFFICERMEMBER ExCLUDED? E NIA aandatury i In IRH) 001WC10A59312 2/21/2011 •2/21/2012 D yes. deserioe unser 11 - „ IPT1. N Of .,- RATDONS bellow DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It mere apace N. regmlred) ER`CI IC .•.T OLDER Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, FL 33138 CANCELLA ION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, P401105 WILL BE DELNEJRIED IN ACCORDANCE WITH THE POLICY PROVISIONS. AoliostizeD favnesosTATIve ACORD 25 (2O0at09) INS025 !249905) 1888-2005 ACORD CORPORATION. Ail rights reserved. The ACORD name and Ingo are registered marks of ACORD