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EL-11-2055Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 168263 Permit Number: EL -11 -11 -2055 Scheduled Inspection Date: December 28, 2011 Inspector: Devaney, Michael Owner: DEL VALLE, ROLANDO Job Address: 717 NE 91 Street 4 -B Project: Miami Shores, FL <NONE> Contractor: AMPSTRONG ELECTRIC INC Permit Type: Electrical - Residential Inspection Type: Rough Work Classification: Alteration Phone Number Parcel Number 1132060440080 Phone: (305)468 -7988 Building Department Comments RELOCATE PANEL 12/22/2011 - REVISION LIVING ROOM BOOKSHELVES LIGHT. TWO LIGHTS PER SHELF. LOW VOLTAGE LIGHTS. Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR REINSPECTION FOR INSP- 167938. ADD SWITCH AND LIGHT IN ATTIC OPEN ALL LIGHTS. MD 12/27/11 INSP- 167967. CREATED AS PLUS SWITCH FOR TRANSFORMER December 28, 2011 For Inspections please call: (305)762 -4949 Page 28 of 28 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 FBC20 RECEIVED DEC 19 011 BY- Permit No. Master Permit No. lC- t b. l 1 Permit Type: ELECTRICAL I Owner's Name (Fee Simple Titleholder) loom AO O c1 \We Owner's Address -In tE. °l S'k 4. Li g City arr i ° 6)r2S State Tenant/Lessee Name Phone # 505 1. ”S Email iZattlOCACe. cut, (-01AI Job Address (where the work is being done) 4 fl 116 City Miami 'Shores Village County Miami -Dade FOLIO / PARCEL # Is Building Historically Designated YES NO Zip 3 31 3 c� Phone # s-} It l-i B Zip '33 13 g Contractor's Company Name 1\m?%:ATCYN c C Jt C � Phone # Contractor's Address (7c1 s I `1 City Iv l` 0; hr1 i State Zip 3 31 % Co Qualifier Name C:)SV Q t C1'O Ca r koza Phone # Flood Zone (3n) H - aX2 State Certificate or Registra tion No. EC- 3 6 0 f-j�l g'/ Certificate of Competency No. _ Contact Phone C`� D S) \\ E-mail �-(6 % - �c($ b 161' 0 GtmvS An • Corn Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 900, O Square / Linear Footage Of Work: Type of Work: dition ['Alteration DNew Q'R air/Re lace ep p 0 Demolition 9 Describe Work: L t K' © ®w wt bev C.� kg! !f t 5,(A.17 (w ® tela lit 'CS .r j * ** * * * * * * * * * * * * ** * * * * *, * * * * * *** * * * * * * ** Fees, * * * * *, * *, *** * * * * * * * * * * * * * * ** * * * * * *** * * * * * ** Submittal Fee $ Permit Fee $ k ;47 CCF $ CO /CC $ Notary $ Scanning $ Double Fee $ Training/Education Fee $ Technology Fee $ Radon $ DPBR $ Bond $ Violation date: Structural Review. $ Total Fee Now Due $ See Reverse side - 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 commencement ust be po ed at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the abs. c of such josted notice, the inspection will not be a roved and a re- inspection fee will be charged. Signature er or Agent Signature The foregoing instrument was acknowledged before me this The fore day of Dew ! i'20 1;1, by ay of who is per me or who has produced who i As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: 0011111111/1//// Artery' % 4.0 cP o e • cD = Sign: per` ' Q • J . s� ec, • • ....... • •' Contractor oing instrument was acknowledged before me this 61P 201 , by Og bOZA- rsonall NOTARY RIP�A APPROVED BY' / (7 Plans Examiner Engineer (Revised 07 /10 /07)(Revised 06/10/2009) P r who has produced tification and who did take an oath. P C, ootttlistrit ki SIND JAykGs®o' Ad401 • s s - N s y Commiss. ►►:.: m: nExp 13�,o'°�: °;gnrsessrdro:° •Q��� Zoning Clerk checked 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..�1 PERMIT APPLICATION Master Permit No. If FBC 20 RE L I if E.!D NOV 0 4 2311 BY: Permit Type: Electrical CO OWNER: Name (Fee Simple Titleholder): eg'O\C1t'� Cc. \,. \ !Y , aqe Phone #: Address: 7-11-+ � � �� E CA\ S p 4 a. City: )� 1iClrvl l � \or+t S State: 'C l-- Zip: 3 3 LS 2 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: -1 \ _ tt E Lit SZ L 5 City: Miami Shores County: Miami Dade Zip: .3 (3 q Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Arn p� -� r10 �C1CG` ri C loc. Phone #: (30 S) G - .I $ t g. Address: 616 5 '31Uo° 43 1 Si City: 0', t 1 State: �" 1-1-- Zip: 3 '3 Qualifier Name: �l SUCK c �'O k Car AC z- CA Phone #: State Certification or Registration #: e C 1-300 Li 1 $4 Certificate of Competency #: Contact Phone #: �J 0 `a Li 6 — `Z TN g Email Address: C C M i l DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 2,00o-00 Square/Linear Footage of Work: Type of Work: ❑Address Description of Work: ❑Alteration UNew G3ifepair/Replace ❑Demolition * *** ********* **** * *************+xa:a::**** Fees**** *********** x: **** **** ************+x **** *** Submittal Fee $ 3 Permit Fee $ / 6 '4-d CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 11 0 '1 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 CONDmONERS, 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement t be posted a the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the abse such, poste notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owne .r Agent The fore oing instrument was acknowledged before me this `` The foregoing instrument was acknowledged before me this � f day of , 20 l , by Ro\ and o P�..i V P-`,leday of Nov , 20 /1 , by (9 v S) c �j�j?S Signature Contractor who is personally known to me or who has produced who i personally known to or who has produced As identification and who did take an oath. as i o entification and who did take an oath . NOTARY PUBLIC: :ss.kA' kk MARIA DEL PILAR ROBLEDO LISA SABRIPd MY COMMISSION # DD814347 NOTARY PUBLIC �s oQ, EXPIRES August 13, 2012 STATE OF FLORIDA Q Sign '�r +��$,y '' 976 Sign: �i J /Ala U P�'fl79153 FloridallotaryService.com Print: S� 2,f �s r�Ites 4/7/2014 �i 7 Print: 0 Vie U C P 1 My C. Sion Expires: / _ . 1 . j My Commission Expires: ACO S l 3( v) 2 APPROVED BY P Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) ame S41ea fellow Made Vefrotittagost 10050 NE 2nd Ave Miami Shores, FI 3313 Phone 305 - 795 -2204; Fax 305 - 762 -5253 www.miamishoresvillage.com CONTRACTOR LICENSING/ REGISTRATION REQUIREMENTS FOR ALL CONTRACTORS TO REGISTER IN THE VILLAGE OF MIAMI SHORES THE FOLLOWING REQUIREMENTS ARE NEEDED: DADE COUNTY CONTRACTORS: A. Certificate of Competency B. Dade Municipal Occupancy C. Dade Occupational Occupancy D. State Registration E. Liability Insurance Certificate F. Workers Compensation Insurance or Exemption STATE CONTRACTORS: A. State License B. '- Occupational License C. x Liability Insurance Certificate D. x Workers Compensation Insurance or Exemption * * * * * * * ** *ALL INSURANCE CERTIFICATES MUST BE MADE OUT TO THE FOLLOWING * * * * * * * * * ** Miami Shores Village 10050 NE 2 AVE Miami Shores, FI 33138 ALL PERMIT APPLICATION REQUIRE THE QUALIFIERS NOTARIZED SIGNATURE ********************************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Business Name: * het QS 1 £ieck c rZ-- Business Address: 6965 /AU) 43 S-6 4 3 :av 1 1FL 3314 Business Telephone: () 4Ct 1 Vii Fax Number: '(3125') AG/ 11 71 Qualifier Name: OVA ci[a carctozek '°'�""' CERTIFICATE OF LIABILITY INSURANCE DATE 04-26 -2011 THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. HOLDER. THIS BY THE POLICIES IMPORTANT: If the certificate holder is an ADDITIONALINSURED, the policy(ies) must be endorsed. If SUBROGATIONIS 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 AUTOMATIC DATA PROCESSING INS AGCY 250717 P: (877)287 -1316 F: (888)443 -6112 PO BOX 33015 SAN ANTONIO TX 78265 CONIACI NAME: PHONE �AmchI0'Ext): (877) 287 -1316 aic,No): (888 ) 443 -6112 ADMDRESS: PRODUCER CUSTOMER ID $: INSURER(S) AFFORDING COVERAGE NAIC # INSURED AMPSTRONG ELECTRIC, INC. 6965 NW 43RD ST UNIT 3 MIAMI FL 33166 _ - ••. ••....im ...._ - rnvCO A'MCC . . INSURER A : Twin City Fire Ins CO LABILITY COMMERCIAL GENERAL LIABILITY INSURER 8 INSURER C: INSURER D : INSURER E : $ INSURER F DAMAGE I O HEN I tU PREMISES (Ea occurrence) • ---- - -- - _" ricinoIVIV lwIVIDCI1: THIS INDICATED. CERTIFICATE EXCLUSIONS INSR IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER (MM DNYYY) (MM/DD ) LIMITS GENERAL LABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE I O HEN I tU PREMISES (Ea occurrence) $ CLAIMS -MADE I I OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY I I PRO- ECT I I LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) 9 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Par accident) $ 9 $ UMBRELLA LAB I IOCCUR EACH OCCURRENCE $ EXCESS LAB I I CLAIMS -MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ A WORKERS AND ANY OF ICER/MEMB (Mandatory If yes, DESCRIPTION COMPENSATION EMPLOYERS' LIABILITY Y/ N R EXCLLUDED7 XECUTIVEI N/ A 76 WEG TS3571 06/16/2011 06/16/2012 WC STATU- OTH- X I TORY LIMITS I I ER E.L. EACH ACCIDENT $100,000 In NH) describe under OF OPERATIONS below E.L. DISEASE - EA EMPLOYEE $ 100, 000 E.L. DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Those usual to the Insured's Operations. e ernes nATr IJ•I nrn Miami Shores Village Building Department 10050 NE 2ND AVE 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. AUTHORIZ RESENTATNE /4Z . �1e_...'' ACORD 25 (2009/09) 88 -2009 ACORD CORPORATION. All rights reserved. . The ACORD name and logo are registered marks of ACORD 1141;60b NUV tad, eon 1- N ; HNIHIY)JH Vddidb P'Hbt; 1/1 Accm IIJ CERTIFICATE OF LIABILITY INSURANCE 11/3/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOGS NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED DY THE POLICIES /Pewee. InW veRtirn.nlc vr INOUIVUaI.c WVCO rev 1.vrv*IIIUIe M l.VN /RI'IV1 DcIUUCeN Ine IOOUINV INOURCRtO), AUlnumiccu REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poiicy(Ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the talmc anti rnnditlnnc of the nnll ty, rartain pnIIrlac may ranidra an anrinrcamant A ctatamant nn thlc nartitirata Mao not rnnfar riahtc to the eereIaeaee holder in Ilea, of oueh endereernank(o). PRODUCER Eastern Insurance Group, Inc. 9570 SW 107 Avenue Suite 104 Miami FL 33176 CONTACT David M. Lopez NAME: p AHH°Nno Ext): (305)595 -3323 1 FA ,No): (305)395 -7135 ADDREEMAIL SS: csr @easterninsuranee.net INSURER(S) AFFORDING COVERAGE NAIC # INSURER Mid- Continent Casualty Company INSURED Amps Lza.mg Bleu (.tic: 1 tut:. coal meg $.:•a atase....t Bay #3 Miami FL 33166 INSURER B : . INSURER C : ' It�JC7KCKU. - INSURER E : $ 1,000,000 INSURER F : COVERAGES CERTIFICATE NUMBER:Master 11 -12 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE INI11f.ATFn NCITWITHSTANIIINCI ANY RFC)IIIRFMFNT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LISTED BELOW HAVE BEEN ISSUED TO TFRM CIR C:fNnITIC1N OF ANY (CINTRA(T THE INSURANCE AFFORDED BY THE POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY THE INSURED NAMED ABOVE FOR THE POLICY PERIOD C1R l)THFR n()C`JIMFNT WITH RFSPFC:T -r-r) WHICH THIS DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR S _ - MID POLICY NUMBER POLICY EFF MIDDIYYYY POLICY EXP • MID, LIMITS GENERAL K LIABILITY CQPAP.4ERCIA1, GEPIERA.L LIABIUTV : /16/2011 6/16/2012 EACH OCCURRENCE $ 1,000,000 EBENNAMMIPIRII ■■ CLAIMS -MADE X OCCUR MED EXP (Any one person) $ Exclude • ■ PERSONAL & ADV INJURY $ 1,000,000 ■ GENERAL AGGREGATE $ 2,000,000 GEN L AGGREGATE LIMIT APPLIES PER: $ POLICY n PRO- n JFCT t I LOC PRODUCTS - COMPIOP AGG $ 2,000,000 A AUTOMOBILE 1011 . $ LIABILITY ANY AU 10 ALL OWNED nuiva HIRED AUTOS . $ SCHEDULED HUI VJ NON -OWNED AUTOS 000: COMBINED SINGLE LIMIT Ea accident 000 000 a • • • I ■ Per occident $ ■ UMBRELLA LIAB ■ EXCESS LIAB ■ ■ OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE ■ DED • RETENTION $ AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Myandatory In NH) DESCRIPTION OF OPERATIONS below N) A MIRA Et. EACH ACCIDENT I1iIWk DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) F.1 ant-pi na1 (:nntrantnr CERTIFICATE HOLDER CANCELLATION (20S)156-111072 Miami Shores Village Building Department 10050 NE 2 Avenue Miami Shores, FL 33138 011GULD ANY or The ADOVC DGZGRIDGD rOLIGIGa be GANGrLLGD DGPORG THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE uavia Lopez /AMAINUA ACORD 25 (2010105) INS025 (201005).01 @ 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 484764 THIS 18 NOT A BILL -DO NOT PAY " RENEWAL ; ```' BUSINESS NAME LOCATION -,.,.. AMPSTRON6 ELECTRIC INI 6965 N1 43 ST 33166 UNIN.OE DA NT' OWNER AMPSTRONG ELECTRIC INC Sec. T of Business 19 •ELECTRICAL CE T ACT0: Baseless 'TIES IS cRECE LOCAL . LT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT FROM OTI A OR LICENSE - 8Y LAW. T THE HOLDER'S GUAIMPI A TIONS. AOOEEC� TAX 07/18/2011 09010278001 000075.00 SEE OTHER SIDE DO NOT FORWARD AMPSTRONG ELECTRIC INC OSVALDO CARDOZA PRES PO BOX 771446 MIAMI FL 33177 �ts��ftti�ftft���ttt��tat��lftt� ]etfn�s�s�t�tt�ttit�iitft��� DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 CARDOZA, OSVALDO ALFREDO AMPSTRONG ELECTRIC INC P 0 BOX 771446 MIAMI FL 33177 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.myflorldalicense.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! ,A ��'+d1 �u•i (850) 487 -1395 DE triel WERE- _ WY' �.it0044bigh 4419 k s 64th, -- 'DATE BATCH PLUMBER 14 r i ct'rsars.Fe; ranch �' R %j `'1_...:.ki*" !. A k'71- �x�m.OrYe a d.!'11!�� 10 :04 NOV 03, 2011 FR: AMANDA #83125 PAGE: 1/1 A� ° CERTIFICATE OF LIABILITY INSURANCE 11 /3/2o 1 Y' 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 this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Eastern Insurance Group, Inc. 9570 SW 107 Avenue Suite 104 Miami FL 33176 NAMNEACT David M. Lopez PHONE . (305) 595 -3323 ac, No): (305)595 -7135 A Ext) csr @easterninsurance.net Arss : INSURER(S) AFFORDING COVERAGE NAIL # INSURER Mid- Continent Casualty CO Y mpany GENERAL _ X INSURED Ampstrong Electric, Inc. 6965 NW 43rd Street Bay #3 Miami FL 33166 INSURER B : $ 1,000,000 INSURER C : $ 100,000 INSURERD: I CLAIMS -MADE X OCCUR INSURER E $ Excluded INSURERF: PERSONAL &ADVINJURY THIS INDICATED. CFRTIFICATF EXCLUSIONS INSR r-. Y1VIV1\ F....m=1 -u IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY RF ISSl1Fn OR MAY PFRTAIN, THF INSl1RANCF AFFORDFC RY THF POI ICIFS nFSCRIRFn HFRFIN IS SIIR.IFCT TO Al I THF TFRMS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER 04 -GL- 000823521 POLICY EFF (MM /DDIYYYY) 6/16/2011 POLICY EXP (MM!DDIYYYYI 6/16/2012 LIMITS A GENERAL _ X LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAO TO RLN 1 ED PREMISES (Ea occurrence) $ 100,000 I CLAIMS -MADE X OCCUR MED EXP Any one person) $ Excluded PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEM. AGGREGATE LIMIT APPLIES X POLICY n FEF ,In LOC PRODUCTS - COMP/OP AGG $ 2,000,000 A AUTOMOBILE x LIABILITY 04 -GL- 000823521 6/16/2011 6/16/2012 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 $ ANY AUTO ALL OWNED AUTOS HIRED AUTOS x — SCHEDULED AUTOS NON -OWNED AUTOS BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED 1 I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y /N r1FCIrFRAARMRFR FX f 11Ir1FT� (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC STATU- OTH- I TORY LIMITS I I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ D03CRIr'TION OF or ORATION* / LOCATIONS / VENICLG3 (Attach ACORD 101, AUUIUUrn0 Rernerhe 3cheuule, it mute apece Is requlreu) Electrical Contractor t"VRTICIt•ATC Lin! nro LATIO N (305) 756-8972 Miami Shores Village Building Department 10050 NE 2 Avenue £s .ami buores , @ "L .331.311 INS025 (201005).01 RHff111 n ANY CIF THE ARfVF RPRf:RIRFf Pff1 IC APR RP r.ANIIPI 1 FILP P PF THE FYDIRATIAN nATF THFRFAF NATIf!F min 1 RF nF11VFDFn 1N ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE David Lopez /AMANDA The ACORD name and logo are registered marks of ACORD