EL-11-1889Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 168079 Permit Number: EL -10 -11 -1889
Scheduled Inspection Date: December 22, 2011
Inspector: Devaney, Michael
Owner: AYUSO, AGUSTIN & NORMA
Job Address: 10619 NE 10 Place
Miami Shores, FL 33138 -2103
Project: <NONE>
Contractor: ADVANCE SOLAR & SPA INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Solar
Phone Number () -
Parcel Number 1122320280580
Phone: (954)938 -8507
Building Department Comments
PVC SOLAR SYSTEM 32 SQ FT
Passed
L/
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- 167056. CREATED AS
REINSPECTION FOR INSP- 165455. Need 3 foot clear space in front of
equipment.
Support conduit on roof properley.
December 21, 2011
For Inspections please call: (305)762 -4949
Page 18 of 25
f 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 No. ` //-Ar--1-7
PERMIT APPLICATION Master Permit No.
FBC206 7
Permit Type: Electrical
��� Phone#: 305 V / 7 72
OWNER: Name (Fee Simple Titleholder): �� i �i]r� 1\i' 15c'
Address: 1t611 we /Cro' 1L
City: M I di ch
State: L" Zip: i%
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: /004 A/ E 10 Ill pi
City: Miami Shores Count : Miami Dade Zip: - /j 0
Folio/Parcel #: f � Z Z * / — 0' . — 0 5'
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: Add /aY/(f 4o /iit t e 1 6 fel Phone #: 9°5 I - f Ifs ` 55-(97 d'
Address: qq/o, J�1',,/ " j v d
City: f 4 /dv' Ydk State: I/ Zip: 3509
Qualifier Name: , (AI �}- O/ciA/Yi' Phone#:
State Certification or Registration #: l7� (� 4,�6 11 Certificate of Co petency #: f
Contact Phone#: 6191 ,Z/ --Of 5.6 Email Address: �L vdned .® /.i'i'° #C.�
DESIGNER: Architect/Engineer: Phone #:
--a - -
Value of Work for this Permit: $ l Square/Linear Footage of Work:
Type of Work: DAddress OAlteration ONew ORepair/Replace ODemolition
Description of Work: i7 d / /
/ate- e=fke---ta c ,V 574e407
**************** *** ******•x *******m***** Feesm ***** ********** *+ x** ******** * ***** **********
Submittal Fee $ 5-0 e a Permit Fee $ Are' °''' P CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ ® -C
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 AFN'IJ)AVIT: 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 befo me this 1 -
day of 0 �`}- , 20 I,
` by kb t \� U c
who is personally known to me or who has produced t) L
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: eSS Lek \QccLAo a 4-) core L, v^
My Commission Expires: NOTARY PUBLIC -STATE OF FLORIDA
" "' Jessica Vadeboncoeur
Commission #DD765465
fires: l 16 201
•
Signature ,/- A.+-.
Contractor
The foregoing instrument was acknowledged before me this
day of C ' ,20 IL, by )(1( G�Iatt. r,9
who is personally known to me or who has produced I L°
as identification and who did take an oath.
NOTARY PUBLIC:
APPROVED BY Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Sign:
Print:
(116 0�--
C-) � Ccz \Jc ��limolAcC -L) C
My Commission
Expires:
NOTARY PUBLIC -STATE OF FLORIDA
Jessica Vadeboncoeur
"k„,“*""
Commission #DD765465
Expires: MAY 16, 2012
* * * * * * * ** , ... , f�CO.,INC.
!/ Zoning
Clerk
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. T A X FOLIO NO.1 I - 7 - 7 4 1 " . . . 6174 J °5g0
STATE OF FLORIDA:
COUNTY OF MIAMI -DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real
property, and in accordance with Chapter 713, Florida Statutes, the following information
is provided in this Notice of Commencement.
1. Legal descri
tion of property and street/a• dress:
1 1111111111111111 1111111111 1111111111 1111 1111
CFN 201 1 8068,301 3
OR @ k; 27857 Ps 3348; is i p s
RECORDED 10/13/2011 12 :05 :20
HARVEY RLIVIN, CLERK. OF COURT
MIAlI -DADE COUNTY, FLORIDA
LAST RAGE
Space above reserved for use of recording office
By% 75.
1 , !
4
2. Description of improvement:
t Al
3. Owner(s) name and address:
Interest in property:
Name and address of fee simple titleholder:
4. Contractor's name, address and phone number.
5. Surety: (Payment bond required by owner from contractor, if any)
Name, address and phone number:
Amount of bond $
ATE OF FLORIDA, COUNTY
ST
6. Lender's name and address: HEREBY CE 7 rY t* is a ccv of
7. Persons within the State of Florida designated by owner upon w s or other docuiaterdfs m _ `�d as \a., vided by
Section 713.13(1)(a)7., Florida Statutes, or-9wpm
Name, address and phone number: WNW,
e.�y. - h:3:•- . a.tice d in Section
Y // y
or r
8. In addition to himself, Owners designates the following p
713.13(1)(b), Florida Statutes. 8y
Name, address and phone number:
9. Expiration date of this Notice of Commencement:
(the expiration date is 1 year from the date of recording unless a different date is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK
OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Signature(s) of Owner(s) or Owner s)' Authorized Officer/Director/Partner /Manager
Prepared By (\ p.A.w,e, a
Print Name (?rr e9
Prepared By
Print Name
Title /Office Title /Office
STATE OF FLORIDA
COUNTY OF MIAMI -DADE
The f regoi(ig in*rumpntiwa apknowledged before me this
By 1/V-! IN'r- ( l
Individually, or ❑ as for
❑ Personally known, or ❑ produced the following type of identification:
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.
i3 day of
CSC- -ob-e r
e� U e,e . Ar •e
PUBLIC -STATE OF FLORIDA
" Jessica Vadeboncoeur
Commission #DD765465
`%„ Expires: MAY 16, 2012
BONDED THIN; ATLANTIC BONDING CO., INC.
Signature(s) of Owner(s) or Owner(s)'s Authorized Officer/Director/Partner/Manager who signed above:
By
123.01 -62 PAGE 3 3/10
By
BATCH NUMBER
O v, ,•Nit: z ua 55 1312 6%2'0 0 SD 4 y2 .i COO 54;'
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 -831 -4000
VALID OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012
DBA:
Business Name: ADVANCE SOLAR & SPA INC
Receipt #:189- 243170
Business Type�'L OTHER TYPES CONTRACTO
'(SOLAR CONTRACTOR)
Owner Name: BRIAN J GOLDBERG / QUAL Business Opened :08/16/2011
Business Location: 590 N W 53 STREET State /County /CertlReg :CVC056664
FT LAUDERDALE Exemption Code :NQNEXEMPT
Business Phone: 954- 938. -8507
Rooms
Seats
Number of Machines:
Employees
5
Machines Professionals
For Vending Business Only
Vending Type:
Tax Amount
Transfer Fee
NSF Fee
Penalty
Prior Years
Collection Cost
Total Pald
27.00
0.00
0.00
0.00
0.00
0.00
27.00
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is
non - regulatory in nature. You must meet all County and/or Municipality planning
WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location. This receipt does not indicate that the business is legal or that
it is in compliance with State or local laws and regulations.
Mailing Address:
BRIAN JEFFERY GOLDBERG / QUAL
2431 CRYSTAL LAKE DRIVE
FT MYERS, FL 33097
2011 - 2012
Receipt #01A- 10- 00010203
Paid 08/18/2011 27.00
From: FAXmaker To: MIAMI SHORES VILLAGE BUILDING DEPARTMENT Page: 2/2 Date: 10/21/2011 8:45:58 AM
ACCAREA CERTIFICATE OF LIABILITY INSURANCE
X10/2 011 »
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 policy(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).
PRODUCER
Doug Jones c/o AJG Risk Management Services, Inc.
8800 E. Chaparral Rd, Suite 230
Scottsdale, AZ 85250
CONTALI
PHONE FAX
(A No, Eat): (480) 951 4177 (Arc, No): (480) 951 4266
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC e
INSURER A: Zurich - American Insurance Company
16535
INSURED
Oasis Acquisition, Inc Alt. Emp: ADVANCE SOLAR & SPA, INC
2054 Vista Parkway Suite 300
West Palm Beach, FL 33411
INSURER B
INSURER C -
INSURER D:
$
INSURER E :
$
INSURER F :
COVERAGES
CERTIFICATE NUMBER: 11FL075729052
REVISION NUMBER:
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.
R
INSR
LT
TYPE OF INSURANCE
INSR
S
WVD
POLICY NUMBER
POLICY
(h16WDYYYY)
(MMD
DVYYY1)
LQ.UTS
GENERAL
LIABILITY
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$
PRREE�M PREMISES (Ea occurrence)
$
CLAIMS -MADE
OCCUR
MED EXP (Any one person)
$
PERSONAL &ADVINJURY
$
GENERAL AGGREGATE
$
PRODUCTS - COMPIOP AGG
$
GEM. AGGREGATE LIMIT APPLIES PER:
POLICY PRO- LOG
$
AUTOMOBILE
—
LIABILITY
ANY AUTO
AAUT� ED
HIRED AUTOS
AUTOS LED
NON -OWNED
AUTOS
(CEO eBINEEDtSINGLE LIMIT
$
BODL.Y INJURY (Per person)
$
BODLY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
1
EACH OCCURRENCE
$
AGGREGATE
$
$
DED RETENTION$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORtPARTNER/EXECUTNE Y/N
OFFICER'MEMBEREXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
WC 29-38-687-09
06/01/2011
06/01/2012
X WY TLIM OH-
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
Location Coverage Period:
06/01 /2011
G6/01/2012
Client# 2211 -1
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
ADVANCE SOLAR & SPA, INC INCLUDES QUALIFIERS: JAMES FIELDS & BRIAN GOLDBERG
Coverage is provided for 2431 CRYSTAL DRIVE
only those employees FORT MYERS, FL 33907
leased to but not
subcontractors of:
CERTIFICATE HOLDER
CANCELLATION
MIAMI SHORES VILLAGE BUILDING DEPARTMENT
10050 NE 2 AVENUE
MIAMI SHORES, FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
,�p'ra*g`/d"4
Oo 1988 -2010 ACORD CORPORATION. All rights reserved.
This fax was sent with GFI FAXmaker fax server. For more information, visit: http: //Www.gfi.com
Date: 10/19/2011 Time: 4:03 PM To: 19549386949 He
rndon Carr & Co. Page: 001
`'R °® CERTIFICATE OF LIABILITY INSURANCE
10/19/2011
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 pollcy(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 thls certificate does not confer rights to the
certificate holder In ileu of such endorsement(s).
PRODUCER
Herndon Carr & Company
10501 Six Mile Cypress Pkwy.
Suite 101
Fort Myers FL 33966 -6400
CONTACT Tea= I (CJK 20)
NAME:
PHONE <hn: (239) 939 -1996 FAX No): (239) 275 -0277
ADDRESS: Cecilia @herndoncarr. com
PRODUCER 00019815
CUSTOMER ID N:
INSURER(S) AFFORDING COVERAGE
NAICS
INSURED
Advance Solar & Spa, Inc.
2431 Crystal Dr.
Fort Myers FL 33907
INSURER A :FCCI Commercial Ins. Co.
33472
INSuRER6 National Trust Insurance Co
20141
INSURER C :
11 /8 /2010
INSURER D:
EACH OCCURRENCE
INSURERE:
DAMAGE TO RENTED
PREMISES (Ea occurrence)
INSURERF:
CERTIFICATE NUMBER:Master GL & Auto 2010 -11
REVISION NUMBER:
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
LTR
TYPE OF INSURANCE
AOOL
INSR
SUB
WVD
POLICY NUMBER
(MMMIDDI YYY)
(MMIDDTYYVY)
LIMITS
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL
LIABILITY
X
OCCUR
GL00048885
11 /8 /2010
11/8/2011
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 100,000
CLAIMS - MADE
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT AP� PLIES PER .
—I POLICY X PR I x l LOC
PRODUCTS - COMP/OP AGO
$ 2,000,000
$
B
AUTOMOBILE
X
X
X
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON- OVNEDAUTOS
CA00169811
11/8/2010
11/8/2011
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
Uninsured motorist BI- single
$
PIP -Basic
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORJPARTNERIEXECUTIVE ❑
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N!A
WC STATU- OTH-
TORY LIMITS ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E L DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS 1 LOCATIONS !VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
CANCELLATION
(305) 756 -89 72
Miami Shores Village Building Department
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
10050 NE 2 Ave.
AUTHORIZED REPRESENTATIVE
Miami. Shores, FL
33138
�I
/�
Reed Herndon /CELIA
C --�4/[
�
/
ACORD 25 (2009/09)
INS025 (200909)
O 1988 -2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ate: 10/19/2011 Time: 4:03 PM To: 13057568972
ndon Carr & Co. Page: 001
'`' CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DDfYYYY)
10/19/2011
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 policy(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).
PRODUCER
Herndon Carr & Company
10501 Six Mile Cyp kwy.
Cypress Pkwy.
Suite 101
Fort Myers FL 33966 -6400
CONTACT Team I (CJI( 20)
NAME:
wclNo Ems: (239) 939 -1996 (FAAIC,No): (239)275 -0277
E -MAIL
ADDRESS: oecilia @herndoncarr. corn
PRODUCER 0001981'55
CUSTOMER ID is
INSURER(S) AFFORDING COVERAGE
INSURERA:FCCI Commercial Ins. Co.
NAICE
33472
INSURED
Advance Solar & Spa, Inc.
2431 Crystal Dr.
Fort Myers FL 33907
CAVRRA(2 e -
INsuRERB National Trust Insurance Co
20141
INSURER C :
INSURER D:
INSURERS:
INSURERF:
ster GL & Auto 2010 -11
THIS IS TO THAT THE REVISION NUMBER:
IND CATED.CNOTTWITHSTANDING ANYIREQUIREMEN, TERM OR CONDIWTION HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE
OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO POLICY
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
A
8
TYPE OF INSURANCE
GENERAL LIABILITY
X
ADDL
INSR
SUBR
WVD
POLICY NUMBER
COMMERCIAL GENERAL LABILITY
CLAIMS -MADE X OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY ITC TCT I x LOC
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
X
X
X
UMBRELLA LIAB
EXCESS LIAB
GL00048885
POLICY EFF
(MMIDDIYYYY)
11/8/2010
POLICY EXP
(MM /DDIYYYY)
11/8/2011
LIMITS
EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence) $
100,000
MED EXP (Any one person)
5,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP /OP AGG
$ 2,000,000
CA00169811
11/8/2010
11/8/2011
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
PROPERTY DAMAGE
(Per acddent)
Uninsured motorist BI- single
PIP -Basic
$
OCCUR
CLAIMS-MADE
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Li
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
EACH OCCURRENCE
AGGREGATE
N/A
VAC STATU-
TORY LIMITS
'OTH-
ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
DESC
RIPTION OF OPERATIONS / LOCATIONS / VEHIC
CERTIFICATE HOLDER
E.L. DISEASE - POLICY LIMIT $
ES (Attach
ACORD 101, Addltlonal Remarks Schedule
, If more space I
s required)
CANCELLATION
(305)756 -8972
Miami. Shores Village Building Department
10050 NE 2 Ave.
Miami Shores, FL 33138
ACORD 25 (2009/09)
INS025 (200909)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Reed Herndon /CELIA d/
@ 1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Permit No: 11-
Job Name:
Date:
Miami Shores Viiiage
Building Department
Zoning Critique Sheet
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Page 1 of 1
Plan review is not complete, when all items above are corrected, we will do a complete plan
review.
If any sheets are voided, remove them from the plans and replace with new revised sheets and
include one set of voided sheets in the re- submittal drawings.
David Daquisto
Planning Director
305 - 795 -2207