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MC-11-1734Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 ■\-lurYk Inspection Number: INSP- 170466 Permit Number: MC -9 -11 -1734 Scheduled Inspection Date: February 29, 2012 Inspector: Perez, JanPierre Owner: GOLDBERG, JONATHAN Job Address: 9901 NE 13 Avenue Miami Shores, FL Project: <NONE> Contractor: ALWAYS DO GOOD MECHANICAL INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132050090480 Phone: (305)591 -3212 Building Department Comments INSTALLATION OF A NEW HVAC SYSTEM. ATTACHED TO EXISTING DUCT AND ELECTRIC \12-e 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 INSP- 164710. February 28, 2012 For Inspections please call: (305)762 -4949 Page 34 of 40 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 IMEII�'I31 SEP232011 EY BY: BUILDING Permit No. VC} 11--A t 1 f PERMIT APPLICATION Master Permit No. FC, )1 163 y FBC 20 Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): ADifItft C . A Phone#: SOS• '9O % Address: ?q ®A vg. City: sfiryl a Smzetot,5 State: Pi— Zip: ? X13 Y Tenant/Lessee Name: doJA4- Email: Phone#: JOB ADDRESS: 9 cjo1 ei--16 ' 3 4 City: Miami Shores County: Miami Dade Zip: 9 2 1 3 8 Folio/Parcel #: // • L >0c4,09 • ®YID Is the Building Historically Designated: Yes NO ✓ Flood Zone: CONTRACTOR: Company Name: A 1iv 4 7 pc; ‘-04 ni CJ 4 i Phone#: Address: % R' O Cl/ 14/ 5 5 4• S`f 6 a 2( "s City: Qualifier Name: State: Zip: - / Phone#: State Certification or Registration #: C, A4- t S) "gr'f 7 9 Certificate of Competency #: Contact Phone#: 130 T70 -7/ 2 7 Email Address: DESIGNER: Architect/Engineer: Phone#: eug ii9 vii . Value of Work for this Permit: $ 42 .<( Type of Work: Address Alteration Description of Work: t1"t wo ( Xlc"ly to Square/Linear Footage of Work: ONew ►" • epair/Replace ODemolition et ) L1 c®4 /°a i r1=1'c - 9 4S ' c r 4 A iare, L C" ** *w** ** *** **m** * ** ** * * *** * *** * ** n: * s************* * * *** * ****** **** **** *** *** * **** Submittal Fee $ Permit Fee $ 9 I t ✓0 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 414' ` 1- Bonding Company's Name (if applicable) A /44- Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Ai& 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 P1 RCTRICAL WOgK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BO>T FRS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AN'F'EDAM: 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. r. "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 th a' absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature //AC/ ` Signature „„,.. ,t er or Agent Contractor The for oing instrument was acknowledged before me this �/ The foregoing instrument was acknowledged before me this day of , 20 if , by , day of , 20 Jt , by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: KARI A DROPPER ..*1 MY COMMISSION # EE032278 EXPIRES October 05, 2014 153 FlorldallotaryServioe.com My Commission Expires: APPROVED BY /05-lg.& NOTARY PL' KARI A DROPPER * MY COMMISSION # EE032278 IRES October 05, 2014 Print: My 'o mission x +i s.../d/ ** .1 *** ******** ******** ******* *********** *** * * * * * * *** * * * * * ****** * ** Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): ci 9 D l AJ City: Miami Shores Village County: Miami Dade Zip Coder 3 "; d ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO 12r RHI Sheet Attached: YES ❑ Contract Attached: YES. UNIT BEING REPLACED DATA NEW UNIT g h MANUFACTURER 4 14.c c/u S4,..c cgcs.,4Q lZ 1 1-4 "2. 1 AHU or PKG. UNIT MODEL # , wa'7/4 0C 42_4 3 9 1Z AL M f COND. UNIT MODEL # i A 7 i4 eo Lig E/ KW HEAT 1 e Co `7a Co NOM TONS 44 riAl t AHU Li +f CU 3,5 -PKG 1) M.C.A AHU PH CU2 PKG AHU g°CU q PKG 2) M.O.P AHU 5-CU +( PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / / EER/SEER / 3 h. 6 YES NO REPLACING DUCTS YES NO )e YES NO REPLACING THERMOSTAT YES X NO YES NO NEW 4 °CONCRETE SLAB YES N0 YES NO NEW ROOF STAND YES x NO YES NO NEW RETURN PLENUM BOX YES x NO 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse /Breaker Size): £ C- 3. Voltage of Circuit (208/240/480): 2- if 0 4. Size Disconnecting Means: Cu" h t 3 I so re s� A (4 S 1-rvp. 1(1e-.-3.110-Or Contractor's Company Name: 4 4 (4-"A-YS )) z- 00A- Phone: 3 ©s- °5` I- 3 21 2.. State Certificate or Registration N. 6 (1 50f`(° Z Certificate of Competency N. G 4L i k l 3 ci 7`1 S> Signature (Qualifier's signature only) Date: Z0 I l R nqn i cfiCruC 0411 This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2011. Certificate of Product [atin s AHRI Certified Reference Number: 4385756 Date: 9/1/2011 Product: Split System: Air -Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 4A7A5049E1 Indoor Unit Model Number: *AM7A0C42H31 Manufacturer: AMERICAN STANDARD, INC. Trade/Brand name: ALLEGIANCE 15 Manufacturer responsible for the rating of this system combination is AMERICAN STANDARD, INC. Rated as follows in accordance with AHRI Standard 210/240 -2008 for Unitary Air- Conditioning and Air- Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI- sponsored, independent, third party testing: Cooling Capacity (Btuh): 46000 EER Rating (Cooling): 13.00 SEER Rating (Cooling): 16.00 * Ratings followed by an asterisk ( *) indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disclahns all liability for damages of any kind arising out of the use or performance of the product(s), or the unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed in the directory at crn^,nr.aisridired:ory.org. TERMS AND CONDr11ONS This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and confidential reference purposes. The contents of this Certificate may not, in whole or In part, be reproduced; copied; disseminated; entered into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's individual, personal and confidential reference. CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified at IrI1nv.ahridirectary.org, click on "Verify Ceril icae" link and enter the AHRI Certified Reference Number and the date on which the certificate was Issued, which Is Ilsied above, and the Certificate No., which is listed below. ©2011 Air- Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129593985978449300 7.7111EA Air- Conditioning,Heating, �® 0/ and Refrigeration Institute Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 7952204 Fax: (305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): cl c2 ( 4/1 1 ii City: Miami Shores Village County: Miami Dade Zip Code: ; 13 ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO,E ARHI Sheet Attached: YES 0 NO ❑ Contract Attached: YES I-" UNIT BEING REPLACED DATA NEW UNIT W li ee t MANUFACTURER 14 (411Arac n rrekni 4 14 leA Z AHU or PKG. UNIT MODEL # Qm7A®C & »44 ( to 74 6, 060 L / V? /+Jet 0 le, c COND. UNIT MODEL # KW HEAT cl , (0 q1, [a 5- NOM TONS 6 AHU hi se-CU PKG 1) M.C.A L/ 0 AHU 6s CU37 PKG AHU (oD CU PKG 2) M.O.P 4) AHU `o(% CU t,O PKG AHU 2hiCU PKG 3) VOLTS AHU2/0 CU 4 oPKG PKG UNIT / / PKG UNIT / / EER/SEER /' / / to YES NO REPLACING DUCTS YES NO x YES NO REPLACING THERMOSTAT YES X NO YES NO NEW 4 "CONCRETE SLAB YES NO x YES NO NEW ROOF STAND YES )( NO YES NO NEW RETURN PLENUM BOX YES 2c NO 1. Minimum Circuit Ampacity (Wire Size): g 2. Maximum Overcurrent Protection (Fuse /Breaker Size): Co 3. Voltage of Circuit (208/240/480): 2 cif 0 4. Size Disconnecting Means: C beSorZ. -l&'"e,ttlev. Co 0 4 (-( ij?,!' a jtei/ (P ° Contractor's Company Name: A LutseKy S A 0 6"0 # ice State Certificate or Registration N. // S ° " 2- Certificate of Signature (Qualifier's signature only) Phone: 305- 591 - 34 r 2 Competency N. a/4-c -1 C c 7 �l Date: `/- Zl-tL9ll -Am. CERTIFIEDT. www.ahridirectory.org of Product Ratings AHRI Certified Reference Number: 4385264 Date: 9/1/2011 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower. Outdoor Unit Model Number: 4A7A6060E1 indoor Unit Model Number: *AM7AOC48H41 Manufacturer: AMERICAN STANDARD, INC. TradelBrand name: ALLEGIANCE 16 Manufacturer responsible for the rating of this system combination is AMERICAN STANDARD, INC. Rated as follows in accordance with AHRI Standard 210/240 -2008 for Unitary Air- Conditioning and Air - Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI - sponsored, independent, third party testing: Cooling Capacity (Btuh): 56500 EER Rating (Cooling): _ . 12,00 SEER Rating (Cooling): 16.00 *Ratings followed by an asterisk (*) indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s) Died on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) fisted on this Certificate. AHRI expressly disdains all liability for damages of any kind arising out of the use or performance of the graduals), orthe unauthorized alteration of data fisted on this Certificate. Certified ratings are valid only for models and configurations listed In the dhoctory at www.ahridireciory.org. TERMS AND CONDITIONS This Certificate and Its contents are proprietary products ofAHRL This Certificate shall only be used for Individual, personal and confidential reference purposes. The contents of this Certificate may not, In whole or In part, be reproduced; copied; disseminated; entered Into a computer database; or otlrerwise idilimd, in any form or manner or by any means, except for the user's Individual, personal and confidential reference. CERTIFICATE VERIFICATION p LikbP The information for the model cited on this certificate can be verified at www.ahridirectory.org, A Air- Conditioning; Heating, click on "Verify Ceraificate" fink and order the AHRI Certified Reference Number and the date on Ar4in ®® and Refrigeration Institute which the certificate was Issued, which is listed above, and the Certificate No., which Is fisted below. 02011 Air- Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129593986807225820 Miami Shores village Building Department 10050 N. E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): 9 1 No (' City: Miami Shores Village County: Miami Dade Zip Code: ( 3 2 ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO HI Sheet Attached: YES NO ❑ Contract Attached: YES UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER Amet4eetcAvz S6 gavel A w, l e4 r) B., a 2 I /4 CA 5 z.1 AHU or PKG. UNIT MODEL # 1 14.4 A c `; ! COND. UNIT MODEL # 114 °-74 --cort., LG 1 KW HEAT "7. 47 NOM TONS 74 AHU £/q CU 2c- PKG 1) M.C.A AHU Lf qCU 19 PKG AHU ¥CCU _2c, PKG 2) M.O.P AHU gi5CU 30 PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT I / PKG UNIT / / EER/SEER YES NO REPLACING DUCTS YES NO )C YES NO REPLACING THERMOSTAT NO YES NO YES NO NEW4 °CONCRETE SLAB YES NO ?C YES NO NEW ROOF STAND YES I< NO YES NO NEW RETURN PLENUM BOX YES ,x._ NO 1. Minimum Circuit Ampacity (Wire Size): 8- 2. Maximum Overcurrent Protection (Fuse /Breaker Size): Ccrn iJ kke. °gyp 13r die f4 /4 ti`D Ar) -af r 3. Voltage of Circuit (208/240/480): 7-- o 4. Size Disconnecting Means: C 1 / 4 o / n $ Q4 e1/" 40 d A1-7411 13ce Contractor's Company Name: A LLAc7 S GiDo C 0 o to Phone: '3°5 57t- 2/ 2, State Certificate or Registration N. Ce 1( Co r` 2_ Certificate of Competency N. C./4C (V-( 3 Q' 7 7 Signature Date: ci -Z( —23( This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2011. Cerlificate (IT rod u ct Ratings AHRI Certified Reference Number: 4385748 Date: 9/1/2011 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 4A7A5036E1 Indoor Unit Model Number: *AM7A0B30H21 Manufacturer: AMERICAN STANDARD, INC. Trade/Brand name: ALLEGIANCE 15 Manufacturer responsible for the rating of this system combination is AMERICAN STANDARD, INC. Rated as follows in accordance with AHRI Standard 210/240 -2008 for Unitary Air- Conditioning and Air - Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI- sponsored, independent, third party testing: Cooling Capacity (Btuh): 34800 EER Rating (Cooling): 13.00 SEER Rating (Cooling): 16.00 . Ratings followed by an asterisk (•) indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the products) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s), or the unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed In the directory at t^ ww.ahridirsctory.org. TERMS AND CONDn7ONS This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and confidential reference purposes. The contents of this Certificate may not, In whole or In part, be reproduced; copied; disseminated; entered into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's individual, personal and confidential reference. CERTIFICATE VERIFICATION ® j� i The information for the model cited on this certificate can be verified at wwmahridirectory.org. Air - Conditioning, Heating, click on "Verity Certificatn" link and enter the AHRl Certified Reference Number and the date on ® and Refrigeration Institute which the certificate was issued, which is listed above, and the Certificate No., which is listed below. ©2011 Air - Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129593985201393185 AX CLTO"TM COLLECTOR 140 W. FLAGLER ST. 14t FLOOR MIAMI,,FC 33130 2011 LOCAL BUSINESS TAX RECEIPT . ' 2012 MIAMI -DADE COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30, :2012 MUST BB DISPLAYED AT PLACE OF BUSINESS PURSUANTTO COUNTY CODE CHAP = ART. 9 & 1 0 THIS IS NOT A BILL - DO NOT PAY RENEWA! RECEIPT NO. 611504-2 STATE* CAC1813979 215 FIRST CLASS U.S. POSTAGE ; PAID MIAMI, FL PERMIT NO. 231 586330 -4 BUSINESS NAME / LOCATION ALWAYS DO GOOD 7950 NW 53 ST 33166 DORAL OWNER ALWAYS DA GOOD MECHANICAL INC Sac. Type of Business Tits 6 12,,6RIC MECHANICAL CONTRACTOR BUSINESS TAX RECEIPT. IT DOES NOT PERMRT THE HOLDER 10 VIOLATE APR' EXISTING REGULATORY OR ZON1NG LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER MAIM LIOENSE REQUIRED BLAME IS '. NOT A CERTIFICATION OF THE HOLIER'S OUAUFCA- PAYMENT RECEIVED SEA1iA.DADE COUNTY TAX COLLECTOR: 09 ✓07/2011 09010008001 000045.00 SEE OTHER SIDE WORKER /S 1 DO NOT FORWARD ALWAYS DO 600D STEPHEN KOPCZYIIISKT PRES 7950 NW 53 ST 215 MIAMI FL 33166 1111711 11.1 111i1111uI1lIti ,i1111111�191111111iIISi11 t! STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 ROPCZYNSKI, STEPHEN DONALD ALWAYS DO GOOD 6TAMNW 73RD AVE MIAMI FL 33166 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 licensel DETACH HERE (850) 487 -1395 CERTIFICATE OF LIABILITY INSURANCE I 90' 0/2 /2011 II I PRODUCER (305)822 -7800 FAX (305) 558 -4294 Collinsworth, Al ter, Fowler & French LLC 8000 Goovernors Square B7 vd Suite 01 Miami Lakes, FL 33016 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 It INSURED Always Do Good Mechanical, Inc DBA: dba Always Do Good 7950 NW 53rd St. Ste. 215 Miami, FL 33166 INSURER A: FCCI Commercial Insurance Co INSURER B: National Trust Insurance Co LIABILITY COMMERCIAL GENERAL LIABILITY INSURER Cl FCCI Insurance Company —DATE 08/18/2011 INSURER D: EACH OCCURRENCE INSURER E: X COVERAGES THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR II I TYPE OF INSURANCE POUCY NUMBER POLICY p EFFECTIVE A1 EtMM/DD LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY GL00090133 —DATE 08/18/2011 08/18/2012 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED IRFR (Fa nnanr a) PAFM ,xg $ 300,000 I CLAIMS MADE I X I OCCUR MED EXP (Any one person) $ 10 , 000 X Blanket Add' 1 Insd PERSONAL & ADV INJURY $ 1,000 000 X Blanket WOS GENERAL AGGREGATE $ 2,000,000 GE■'L AGGREGATE LIMIT APPLIES PER: POLICY DTI JEG n LOC PRODUCTS - COMP/OP AGG $ 2,000,000 n B AUTOMOBILE UABITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CA00141223 08/ 18/ 2011 08/18/2012 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X _ BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ I OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ $ G WORKERS COMPENSATION AND EMPLOYERS' UABI ITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? It yes, describe under SPECIAL PROVISIONS below 001WC10A62352 08/18/2011 08/18/2012 X i C ATU I IOER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L DISEASE - POUCY LIMIT $ 1, 000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS City of Miami Shores Village 150 NE 2nd Avenue Miami Shores Villa 9 , FL 33139 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE _ Justin Failoni /GLADYS `—' ACORD 25 (2001/08) ACORD CORPORATION 1988