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FW-12-47731, BUIIDING � PERMIT APPLICATION FBC 20 Miami Shores Village Building Department INSPECTION'S N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. RECEIVE., MAR 19 2012 BY: Master Permit No. Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): f}V �.sT Phone #: 7`8& ' 3 (71.% -YI C y Address: S? .3 1 K vii \ 12- A APT 1 09- City: iv\ Fkd+/I ► State: P L Tenant/Lessee Name: 141 A Email: L S'1 P-63`7 E �� N1 t L L C A-1 JOB ADDRESS: 2- - JE, % �T City: Miami Shores County: Folio/Parcel #: H I - 32-062-0 r3-(7/0q/ Is the Building Historically Designated: Yes Zip: .J 17 gl Phone #: 78 -'3 L{ (o- Miami Dade Zip: 3 i '3 S NO _.„) Flood Zone: CONTRACTOR: Company Name: M F i D l i r c �'`� phone #:� j r)5 b J 6:5- 7 C� Address: "35(3,5 C.() q c City: M 1 B M I State: F1. Qualifier Name: L try 2' fA 2-0 M f#i OF} 1) T) Phone #: 7 fit, 51; 9a 3 State Certification or Registration #: Certificate of Competency #: 0 !2/ 85 g 2 2 Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ `9 t‘X1 Square/Linear Footage of Work: 1 &) Type of Work: ❑Addition ❑Alteration ❑New. Repair/Replace ❑Demolition Description of Work: a g Lvoo,4 PE _5. r /1 "f"'/ Zip 3/47 **** **+ xM ******* *** * * ****** * * *** * *** * * ** Fees****, x* *** * ******************* * *** ** *gin ****** Submittal Fee Scanning Fee $ Notary $ Double Fee $ Gyermit Fee $_�� Q a, CCF $ CO /CC $ Radon Fee $ DBPR $ Bond $ ' Technology Fee $ Training/Education Fee $ Structural Review $ TOTAL FEE NOW DUE $ M et ' 9 0 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 FI.RCTRICAL 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 uccuts seven (7) days a iei the building ermii is issimed. !n J abs &ace o f such vsied notice, the � I y f'" ' g F r N' inspection will trot # .;., pp ove andspection fee will be charged. Signature Owner or Agent The foregoing i trument was ackno (edge before me this 1 The foregoing instrument was acknowledged before e thi day of =- , 20 42,-by A.) , day of , 20� y ': 11 II A who is known o me or who has produced who is personally known to me or who has produced As identification and who did take an oath. NOTAR . PUBLIC:1 I Sign: 'IDs Print: (N`\ My Commission Expires: • '"V' t ALEXANDER ARRErA .�+ m 4 MY COMMISSION 4D'Dl B EXPIRES: July 18, 2013 Bonded Thru Notary Public Underwrites as identification and who did take an oath. NOTARY PUB ICS Sign: Print: ALEXANDER A1�TA MY S MIMS EXPIRES: July 18, 2013 Bonded Dm Nay P� Ib My Commission Expires: ********* * **** *** * **> HNC******************** ********** * ****** ********** **** :5ii i * HAS+ k**** *a,>K>H>H*****>k ********* APPROVED BY ✓ Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) MAP OF BOUNDARY SURVEY SCALE 1" = 20' R CEC1Vb'ED MAR 19 612 ASPHALT ",.. (15' ALLEY) ` oc 145.0' / BLOCK CORNER • 5 00' f°ao' W/F ON LINE W (50.00') PROPOSED W/F (ON LINE) LOT 15 BLOCK30 It" z1 11.70' 15.9' 43.7' ONE STORY CBS o RES #225 In 11.70' FIR 1/2" NO ID • 8.2' 137.0' W.1 /2OF LOT 16 to 4.0' lI�R2" (50.00') NO ID LOT 16 BLOCK 30 ❑10 a 8.0 COVERED TILES N. . P, ' , ,w! r:a' ; �� w�wlwl� N (50.00') N ,*s*s3 11.60' FIR 1/2" (50.00') _ NO ID W 75.00' Pv ami ��'csfe: F�II1 APPRO`,'ED 'ONI^.IG DEPT D� DEPT Si iE'�JI_CT 10 CC-NI PUNIC E-11Vi F ALL FEDERAL" p b CONC. a -• ASPHALT PAVEMENT:: NE 96TH STREET 80' R/W sr Pd . f WAS' { 0 O LOT 17 BLOCS 311 .PLAT IMAGE NOT TO SCALE PROPERTY ADDRESS; 225 NE 96TH STREET, MIAMI SHORES, FL.. I� it " : 1 `2lil 151 18 19I 2"Oi 41 i ?2 e.5 LLI I1 ,- a • y 5' [.- i E; I-: 0 11 . p I� l; 8 7 b j y Ara 2.1 4I+ f1 ` I l IjQI 1/ 11 11 .��.. { 1 1 1 . I 111 1811H i et) 1z1 122 2!N IV'i nI.3 1.1 15 .. I ._I_. E_,'.]so�st. •' /` 1-3 0 LJ L ?I3 :4I;15 13 � 1 14 rj o ITO.9 10 10 E. V A 9v'r ^ i = '(sor at. * r.,; 3' p 1 ,�, I I At ' I ��n LEGAL DESCRIPTION: LOT 15 AND THE WEST 1/2 OF LOT 16, BLOCK 30, OF MIAMI SHOR THEREOF, AS RECORDED IN PLAT BOOK 10, PAGE 70, OF THE PUB ES SECTION ONE AMENDED, ACCORDING TO THE PLAT UC RECORDS OF MIAMI -DADE COUNTY, FLORIDA. LEGEND & SYMBOLS P A = ARC DISTANCE P A/C = AIR CONDITIONER PAD P BCR =BROWARD COUNTY RECORDS BMM BENCH MARK P BOB = BASIS OF BEARINGS CBS = CONCRETE BLOCK & STUCCO P (C) = CALCULATED P CB = CATCH BASIN C&G = CURB & GUTTER CIF = CHAIN UNK FENCE P COL = COLUMN CONC= CONCRETE DE = DRAINAGE EASEMENT R DME = DRAINAGE & MAINTENANCE (RR EASEMENT x D/W = DRIVE —WAY ENC. = ENCROACHMENT EP = EDGE OF PAVEMENT EW = EDGE OF WATER FDH = FOUND DRILL HOLE FH = FIRE HYDRANT FIP = FOUND IRON PIPE FIR = FOUND IRON ROD FN = FOUND NAIL (NO ID) FND = FOUND NAIL & DISK LP = LIGHT POLE (M) = MEASURED MDCR =MIAMI -DADE COUNTY RECORDS FF = FINISHED FLOOR M =MAN HOLE 0 = OVERHEAD UTIUTY WIRE P) = PLAT B = PLAT BOOK RES. = RESDENCE C = POINT OF CURVATURE SIP = SET IRON PIPE (1/2') CP PERMANENT CONTROL SND = SET NAIL &DISK (PK) G °PAGE SWK = SIDEWALK 1 = POINT OF INTERSECTION (Tf')= TYPICAI. pL = PLANTER UB =UTILITY BOX OB = POINT OF BEGINNING UE = UTILITY EASEMENT POC = POINT OF COMMENCEMENT U = UTILITY POLE RC = POINT OF REVERSE WATER METER CURVATURE = CENTRAL ANGLE RM = PERMANENT REFERENCE = MONUMENT UNE MONUMENT = CENTER UNE PT = POINT OF TANGENCY (00')= ORIGINAL LOT DISTANCE = RADIUS DISTANCE X = CHAIN UNK FENCE R) = RECORD -O--D- = WOOD FENCE M = RIGHT OF WAY —9—e- 0 IRON FENCE 0.00 = ELEVATION SURVEYOR'S NOTES: 1. ELEVATIONS WHEN SHOWN REFER TO 1929 NATIONAL GEODETIC VERTICAL DATUM (NGVD 1929). 2. NO ATTEMPT WAS MADE TO LOCATE FOOTINGS/FOUNDATIONS UNLESS OTHERWISE NOTED. 3. THE LANDS SHOWN HEREON HAVE NOT BEEN ABSTRACTED IN REGARDS TO MATTERS OF INTEREST BY OTHER PARTIES, SUCH AS EASEMENTS, RIGHTS OF WAYS, RESERVATIONS, ETC. ONLY PLATTED EASEMENTS ARE SHOWN. 4. THIS SURVEY WAS PREPARED FOR AND CERTIFIED TO THE PARTY(IES)INDICATED HEREON AND IS NOT TRANSFERABLE OR ASSIGNABLE 7. ALL BOUNDARY UMIT INDICATORS SET ARE STAMPED LB# 7104. 8. THE BOUNDARY LIMITS STABUSHED ON THIS SURVEY ARE BASED ON THE LEGAL DESCRIPTION PROVIDED BY CLIENT OR ITS REPRESENTATIVE 9. ADDITIONS OR DELETIONS TO SURVEY MAPS OR REPORTS BY OTHER THAN THE SIGNING PARTY OR PARTIES IS PROHIBITED WITHOUT WRITTEN CONSENT OF THE SIGNING PARTY OR PARTIES. 10. BEARINGS WHEN SHOWN ARE TO AN ASSUMED MERIDIAN, THE CENTERUNE OF NE 96TH STREET HAS BEEN ASSIGNED A BEARING OF WEST. SURVEYOR'S CERTIFICATE: 1 HEREBY CERTIFY THAT THIS SURVEY IS TRUE AND CORRECT TO THE BEST OF MY KNO SURVEYED AND DRAWN UNDER MY DIRECTION AND MEETS THE MINIMUM TECHNICAL ST STATE BOARD OF SURVEYORS AND MAPPERS IN CHAPTER 5J-17 FLORIDA ADMINISTRA 472.027 FLORIDA STATUE. SEAL AUTHENTIC COPIES OF THIS SURVEY SHALL BEAR 'THE RAISED SEAL OF THE ATTESTING REGISTERED SURVEYOR AND MAPPER / GE AND B EF AS RECENTLY S SET F%� BY THE FLORIDA CODE PU.7 %ANT TO SECTION ! JUAN SU Z PRO ONAL - R OR AND MAPPER ATE OF' ORI' A h C. # 6220 I I 1 Y i°RJ L -� 11 Fvn ! DATE: 03/15/12 N CO CO CO I'r) 0 nit (V m 0 2 2 L() N Z 70 cV 0 J LL 0 0 0 0'] LI.: L3_ O 1- LJ LLI S (/) Owner's Name: BETTY RICHARDSON Owner's Phone: Job Address: 225 96 Street Total Square Feet: 280 1 Miami Shores, FL 33138 -2715 Total Job Valuation: $ 4,127.00 Planning and Zoning Criteria Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Folio Number:1132060134091 Contractor(s) MACHADO FENCE INC Phone (305)691 -5579 Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 3/21/2012: Yes Comments: d THIS IS NOT A. BILL — DO NOT PAY SUAVE UM-8 LOCATION MACHADO FENCE. INC 3525 NW 98 ST 33147 UNIN DADS 'COUNTY OWNER MACHADO FENCE INC Sec. Type of Business THIS IS dug 6A fag MALTY 7 BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE AMY EXISTING REGULATORY OR ZONING. LAWS OF THE COUNTY OR CITIES. NOR DOES. IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUAUFICA- TIONS. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 10/03/2011 02240024001 000082.50 SEE OTHER SIDE FIRST-CLASS U.S.' POSTAGE g PAID MIAMI, FL PERMIT NO. 231 RENE.WAt RECEIPT 'NO; 050241-0 CC *'; 44BS 0 0822` WORKS INTRAcToR, DO NOT FORWARD MACHADO FENCE INC LAZARO R MACHADO PRES 3525 NW 98 ST MIAMI FL 33147 1a1 16ilimihiullea ele aleieeieielLeilaaleeelllehhiald MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 RECEIPT NO. 2011 MUNICIPAL CONTRACTOR'S 2012 TAX RECEIPT MIAMI -DADE COUNTY - STATE OF FLORIDA PURSUANT TO COUNTY CODE SEC. 10 -24 EXPIRES SEPT. 30, 2012 30- 0502410 THIS IS NOT A BILL - DO NOT PAY CC NO: 04BS00822 BUSINESS NAME / LOCATION MACHADO FENCE INC 3525 NW 98 ST OWNER :MACHADO FENCE INC SEE BACK OF RECEIPT FOR A LIST OF NON—PARTICIPATING MUNICIPALITIES Receipt holder must register in the city where work is to be done. PAYMENT RECEIVED MIAMI�-DAy�y DpECOUNTY TAX 'LL1 Y/ 03 /2011 02240024002 000175.00 FIRST-CLASS U.S. POSTAGE i PAID MIAMI, FL PERMIT NO. 231 RECEIPT HOLDER MAY DO BUSINESS AS A CONTRACTr AS SPECIFIED HEREON. SPECIALTY BUILDING CONTRACTOR DO NOT FORWARD MACHADO FENCE INC LAZARO R MACHADO PRES 3525 NW 98 ST MIAMI FL 33147 ia: Iiaee��eeae�irariiere�ta lal ae�airler�iLa�a:!�a�e�iialal:.l • Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENT 04BS00822 MAC.HADQ FENCE4N? D.B.A.: HADO LAZARO R certified under the provisions of Chapter 10 of Miami Dade Coc11 tt! # TO PC2NTRACTI ate =UN` ILD9 OM 11) 11 -21 -2011 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON: FEIN: 11/21/2011 EXPIRATION DATE: 11/20/2013 MACHADO LAZARO 550852706 BUSINESS NAME AND ADDRESS: MACHADO FENCE INC 3525 NW 98 ST MIAMI FL 33147 SCOPES OF BUSINESS OR TRADE: 1- Fence Erection -Metal 2- REPAIR SERVICE * IMPORTANT: Pursuant to Chapter 440 . 05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05112), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -160f DWC -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: 11/21/2011 EXPIRATION DATE: 11/20/2013 PERSON: LAZARO MACHADO FEIN: 550852708 BUSINESS NAME AND ADDRESS: MACHADO FENCE INC 3525 NW 98 ST MIAMI, FL 33147 SCOPE OF BUSINESS OR TRADE: 1- Fence Erection -Metal 2- REPAIR SERVICE IMPORTANT 0 Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of .election to be exempt.. apply only within the scope of the business or trade listed on the notice of election to be exempt. H E R E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED AN THE JOB SITE AT THE OF FIRST INSPECTION PERMIT No. 113? (0 ( 340VTAAx FOLIO NO. STATE OF FLORIDA:-CU12:-471 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. 111111111111111111 111111111111111111111111111 CFN 201280212107 OR Bk 28047 Ps 1416; (1vs; RECORDED 03/26/2012 11:51:03 HARVEY RUVIN, CLERK OF COURT IMIAIII -DADE COUNTY, FLORIDA LAST PAGE f Space above reserved for use of recording office 1. Legal description of property and street/address: , P6 w (0 -70 LOT-15 LClr 1 is L— 2. Description of improvement 15U t✓O kA/ Cr o p 3. Owner(s) name and address: Interest in property: Name and address of fee simple titleholder. f,J Kk- Pd'h -i (7 t IV 4. Contractor's name, ddress d phone number: 2-4A-1(1,0 (VC O 5. Surety: (Payment bond required by owner from contractor, if any) re, S 3 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 't /L. ( )1 22.s- 11l .9 co serfs/ f /1 4t 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number: G ( «- 9. Expiration date of this Notice of Commencement 9-73 u 1( Arlo$/ (the pu n dd 1 y e fron( a 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 COMMENCEMENTARECONSIDERED 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 THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU NTEND 0 OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR • • • • MM CEMENT • , �� • �j �'i orized Officer/Director/Partner/Manager Y�ifii( %. Prepared By '1 [t Print Name .+ a< / /L LYj Title/Office Signature(s) of Prepared By Print Name Title/Office STATE OF FLORIDA COUNTY OF MIAMI -DADE �y The foregoing instrument was acknowledged before me this ° ° day of � By. L lNE -S`- 4s,lndividuaily, or CI 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 1 have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. uv. 2°12_ ABTA INCOMES: ON/O Mg Signature(s) of Owner(s) or Owner(s)'s Authorized O fficer/Director/Partner/Manager who signed above: STATE OF FLORIDA, COMM °FOAM PEREINCERTIFY MetthisisaYvecopyMho arigha1Sedln this office a►._...._.._day of A.D. 20, :1 114 S R mI INard TANASHIA AMID 1144 Seer. Cita and Duty Courts D.C. ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 03/22/2012 PRODUCER HIALEAH GENERAL INSURANCE 1432 WEST 49 ST HIALEAH FLORIDA 33012 1305)- 821 -2777 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC 0 INSURED MACHADO FENCE 3525 NW 98 ST HIALEAH FLORIDA 33012 INSURER A GRANADA INSURANCE COMPANY INSURE.t B INSURER C. INSURER D INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR AUU L INSRD TYPE OF INSURANCE POLICY NUMBER PO CCY EEFFECTS DAE (MM /DD/YY) F XPIRq I ION I DATE (MM /DO/YY) LIMITS GE IERAL LIABILITY COMMERCIAL GENERAL LIABILITY E CLAIMS MADE ./ OCCUR 018FL00022009 10/08/2011 10/08/2012 EACH OCCURRENCE $ 2.000 000.00 DAMAGE TO RENTED PREMISES (Ea oeeurence) 8 100.000.00 MED EXP (Any one person) 5.000.00 J PERSONAL 8 ADV INJURY $ 1.000.000.00 GENERAL AGGREGATE $ 2.000.000.00 GENT AGGREGATE LIMIT APPLIES PER. 7 POLICY n PROJECT n LOC PRODUCTS - COMP /OP AGG $ 2.000.000.00 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS 7 HIRED AUTOS NON -OWNED AUTOS aa accidentSINGLE LIMIT (Ec $ BODILY INJURY (Per person, $ BODILY INJURY ;Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS /UMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE 7 RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED', It es, describe under SPECIAL PROVISIONS below WC S I A II Ol H- TORY LIMMU- ITS I (ER E.L. EACH ACCIDENT $ 1. DISEASE • EA EMPLOYEE I51. $ E L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHIC_ES 1 EXCLUSIONS ADDED BY ENDUKSEMEN 1 (SPECIAL-PROVISIONS CERTIFICATE HOLDERS IS NOT AN ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE 10050 NE 2 AVE MIAMI SHORES FL 33138 I�= SHOULD ANY OF THE ABOVE DESCRIBED POLICIE DATE THEREOF, THE ISSUING INSURER WILL END NOTICE TO THE CERTIFICATE HOLDER NAMED TO IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIN REPRESENTATIVES. E CANCELLED R TO H LEFT, B PON T,HE'1 �� BEFORE THE EXPIRATION L 30 DAYS WRITTEN FAILURE TO DO SO SHALL URER, ITS AGENTS OR \ AUTHORIZED REPRESENTATIVE - — -- I l --_._...--- ACORD 25 (2001/08) IN THE CIRCUIT COURT OF THE ELEVENTH JUDICIAL CIRCUIT IN AND FOR MIAMI -DADE COUNTY, FLORIDA EVERHOME MORT CO Plaintiff(s) / Petitioner(s) VS. RICHARDSON, BETTY NELL (PR) , et al. Defendant(s) / Respondents(s) 111111111111111111111111111111111111111111111 CFN 2011R06!8493 OR 8k 27844 Ps 1133; (1P9) RECORDED 09/30/2011 09 :34 :17 DEED DOC TAX 1,230.60 HARVEY RUVIN, CLERK OF COURT MIAMI -DADE COUNTY, FLORIDA LAST PAGE GENERAL JURISDICTION DMSION Case No: 09047264CA01 Section: 06 Doc Stamps: $1,230.60 Surtax $0.00 Consideration: $205,100.00 CERTIFICATE OF TITLE The undersigned clerk of the court certifies that a Certificate of Sale was executed and filed in this action on September 15, 2011, for the property described herein and that no objections to the sale have been filed within the time allowed for filing objections. The following property in Miami -Dade County, Florida: :umbers the subject property iwau...s ma . -..— _ -- - Property Address: 225 t�rnrtf, east 46 Street. Miami Shores, FL 33121 30.„ OF_ Legal Description: LOT 15 AND �' ST 1/2 OF LOT1� AMENDED PLAT OJ MIAMI SHORES_ SECTIO BOOK, A CQRJXN t T� PEAT THE�o F1 S ORECORDED ADS COUNTY, FLORIDA: THE PUBLIC RE RD Parcel ID No. , 13M13 was sold to: PAUL WEST P.O.BOX 54166 JACKSONVILLE, FL, 32245 • .a x.10 WITNESS my hand and the seal of this court on September 27, 2011 . 1 Harvey Ruvin, Clerk of Courts Miami -Dade County, Florida Book27844/Page1133 CFN #20110658493 Page 1 of 1