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MC-12-1403
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 176419 Permit Number: MC -7 -12 -1403 Scheduled Inspection Date: September 05, 2012 Inspector: Perez, JanPierre Owner: Job Address: 166 NW 98 Street Miami Shores, FL Project: <NONE> Contractor: RESIDENTIAL AIR CONDITIONING CORP Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1131010260040 Phone: 305 - 652 -6040 Building Department Comments INSTALLATION OF (1) 3 TON A/C SYSTEM WITH 5KW HTR WITH DUCT WORK Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. September 04, 2012 For Inspections please call: (305)762-4949 Page 14 of 33 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 NU °F ER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 2010 Permit No. ivt C °' 12 -14 Q 3 Master Permit No. Permit Type: MECHANICAL C� JOB ADDRESS: I (o ( NJ W City: Miami Shores County: Miami Dade Zip: 3 31 S CO, Folio/Parcel #: // ",3 / 19 / 42660 ifd Is the Building Historically Designated: Yes NO V Flood Zone: a 4 L ge9,1-6 ic!i ;S LLC. OWNER: Name (Fee Simple Titleholder): Phone#: 306 - 1G' 394 Address: 3 "Q N City: (Y State: L Zip: 3 3 1 7 Tenant/Lessee Name: Phone #:� Email: CONTRACTOR: Company Name: Aj e�" ileerm9 L fl/ 6 ecIt i9 Phone #: -40S- —4 s-t2 -1? OD Yn Address: .42-4-S-#9 h•L- • City:.) tf`vlt t 6fre State: t=2,4 Zip: 3311 Qualifier Name: /. / C /i44.b /h//�' YAWL(' • State Certification or Registration #: C�4- g.011/ Certificate of Competency #: Contact Phone#:d9. = 66 'bt `fie Email Address: DESIGNER: Architect/Engineer: Phone #: Phone #: Value of Work for this Permit: $ 5 ?QCZ Square/Linear Footage of Work: Type of Work: DAddress ❑Alteration blew URepair/Replace ODD- m/o /lition¢,L.� Description of Work: 9N.ST)gL4f -TI®.✓ g g fife. 0-15.„) /i/a G d ******** ****** **********+x****** ** � Fe; *** * *** ****** ** ********** **** ***** Submittal Fee $ SZ2 ° L70 Permit Fee $ $ CO/CC $ Scanning Fee $ p Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 150 ao --A 3v 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 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 ap i roved and a reinspection fee will be charged. Signature Signature vN,Lib1166tl� i� // 0 er or Agent �.�tioNwNCH Conti' or The foregoing instrument was acknowledged before me this ,�9 The foregoing tagOt l ki5pv elged before me this .26 day of i.)1 a , 20 ■ a, by (V ' i C Th 1 I e t el y of . ', / a 20 y e who is p, rsonall ' . o me or who has produced , who is person 4y l wii tot* ° produced A. ° ° O . ), As}den A. h 1,, . , -+ :. 4 who did take an oath., NOTARY l'' As-identification and who did take an oath. NOTARY �PUBLIC: Sign: IQ Print: a®--, t'", My Commission Expires: * * * * * * * * * * * * * * * * * * ** a 1 A. (2 tca -1t� „: RONNi A BLANK MY COMMISSION # EE000573 * *' `I' tticki&` i `'" j'rI 1 ** ndallo Sennce.com APPROVED BY / f I,' I My Commission Expires: ********************** ****** ***** ******* **** * ***** *** Plans Examiner Structural Review Revised 3 /12 /2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Zoning Clerk DesignStar Load Calculation Results are intended for use with Rheem heating and cooling systems only n o r, ati' Location: Latitude, Langitude e' • tiate Fc Name: Email: t6fi 25.7791 °, - 80.1978° BROMLEY 305-6040 RES ID ENTIALAIR@ AO L.CO M Outdoor Coolin Indoor Design temperature difference( °F) 58 Heating Coolin 20 7 15 Ceiling Windo�s Sensible Infiltration Last nhtba&zi System Efficiency Gain Internal =: Sensible People Load SHR Btuh 1073 1704 1864 4457 2550 8.3 15is 621 30810 25732 0.84.:. % of load 31 3.5 56.2...' . . 6.1 Windows Cooling Loads 3 0,810 BTU /hr Sensible People Load Latent People Load 1- Ceiling / Wall Internal Sensible Infiitratior System Efiicienci Latent Infiltration fin ®Loa Floor Windows lnfilhakzi System Efficiency Loss Bah 14;X7 4284 1431 1950 3315 1246 % of load 31.3 142 9.1 Floor Heating Loads 13,703 BTU /hr System Efficiency Loss Ceiling Infiltration Wall Windows klthlininXtrt01-47=4:417744iW d e te, E.x rst 0 AED Graph 0 Sam 9am 10am clam 1pm 2pm 3pm 4pm 5pm 6pm 7pm 8pm — Hourly Loads — Average 'g''VZliZC-Vh'iWikirt4tfVZsriti%Atl Sensible Coding System equipment selection will be made using the fdlcwing Manual S derived values. 90°F 75°F 50°F 25,732 Stub 1-1 r.fit '2012 14(f Sflk4gLE5T:A ifirPLOOR MIAMI, FL 313o 063960 -0 MSS, sEP7 30,•`2(112 UOi E bIEPLA1tEb'At PLACE. OF BUSINESS PUi%SUA 1T.j i C UN`CY coot CHAPt F BA... ART. 9 &.10 THIS IS NOT A BILL - DO NOT PAY sumeaium esIDENTIAt5 AI CONDITIONING, CORP 20250 NE 15 CT 33179 UNIN DADE COUNITY RESIDENTIAL AIR CONDITIONING COR sec196 SPEC MECHANICAL CONTRACTOR THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR omen. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. MIAMI -DADS COU ENTY TAX COLLECTOR: 09010611001 000075.00. SEE OTHER SIDE FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 RENEWAL. STATEqq�� # eerd35484 063960 -0 WORKER /S 10 DO NOT FORWARD RESIDENTIAL AIR CONDITIONING CORP RICHARD M VANNI 20250 NE 15 CT MIAMI FL 33179 DETACH HERE 155 4 €3f ICAI NB.EIV1 1:•.r CERTIFICATE OF LIABILITY INSURANCE RESID -1 OP ID: E0 DATE (MM/DD/YYYY) 05/31/12 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 ''EPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. JIPORTANT: 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 Brown & Brown of Florida, Inc. 1201 W Cypress Creek Rd # 130 P.O. Box 5727 Ft. Lauderdale, FL 33310 -5727 Commercial Lines House 954 - 776 -2222 954 - 776 -4446 CONTACT NAME: PHONE INC, No. Ext): FAX (NC, No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : *FFVA Mutual Insurance Co.+ 10385 INSURED Residential Air Conditioning, Corp 20250 N.E. 15th Court N. Miami Beach, FL 33179 INSURER B :Harleysville Mutual Ins. Co.+ 14168 INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFIC • 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 - ADDL INSR SUBR WVD I'OUCY NUMBER POLICY EFF ( MM/DD/YYYY) POLICY EXP ( MM/DD/YYYY) LIMITS B GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY GL82251 H 11/10/11 11/10/12 EACH OCCURRENCE $ 1,000,000 MAGE TO DA PREMISES (Ea RENTED occurrence) $ 100,000 CLAIMS -MADE 1 X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ • AUTOMOBILE X X LIABILITY ANY AUTO ALL AUT03 ED HIRED AUTOS X A OEDULED NON -OWNED AUTOS BA82252H 11/10/11 11/10/12 COMBINED SINGLE LIMB (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ UMBRELLA UAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under. DESCRIPTION OF OPERATIONS below Y / N N / A WC8400025904201 IA • 03/23/12 03/23/13 y WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space 1s required) Air Conditioning Contractor • CERTIFICATE HOLDER CANCELLATION MIAM Miami Shores Village 10050 NE 2nd 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 ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Uo71Ot U.LL 1•:J:4tJ 3J47I0O0.L0 r-,- lr. UL! UL NMI am IR CERTIFIED t:,:.,�v✓,ahri�iirar,triry,gfg M 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 Ratin • s AHRI Certified Reference Number: 4045880 Date: 8/18/2012 Product: Split System: Air - Cooled Cond sing Unit, Coll with Blower Outdoor Unit Model Number: NXA630131 * Indoor Unit Modal Number: FXM4X36"A *1 Manufacturer: DAY & NIGHT Trade/Brand name: 16 SEER M SERIES 111110A AC Manufacturer responsible for the rating of this system combination Is DAY & NIGHT Rated as foilows3 In accordance with AHRJ Standard 2101240 -2000 for Unitary Alr•Conditioning and Air - Source Heat Pump Equipment and subject to verification of rating accuracy by AHRi- sponsored, independent, third party testing Cooling Capacity (Btuh): EER Rating (Coming) :, SEER Rating (Cooling): 34200 13.00 ' 16.00 Rohn followed by On aetefek (1 ',Idiots it wintery rerste or pteuleu9ly published ante, unless acerompenIed with a WAS, which Indleateet art tnvohmthry ramie, DISCLAIMER ARM does net endese the product(s) listed On this Certificate end makes na igpreseoutlen9, vvarrionles er goonedeas i to, and ass the firedogs) fisted nn this Ceriffic ate, AHRI oniosely disabling 4(a Re n0, rapre u do ,y for, rmsutherien *betatron of data Rend em this Certificates. Certified rirti ve►dSn1ey of arty shin edging flirt Of no or tit rmstm a rtthe wftfldt{s), or ow ego era vcRd only ter models and aanfiguradett3 Rsiesf fn tits dheattrry at www�#hNdfreataryarp• TERMS AND CONDITIONS TThin o n na m n HetarY inciuste of ARK This Certificate shell only be used for hn(NIduAl. perenntd and rW ntial rsllarnrR+q purposm, rs noted; t Artac Into o camp1rter data6agur oatnanMsa utRz t, to any taint or manner or by any means, wont for the uses t v 4 , Inane( and eniingei reference. The tnronsdon ter the modal end on this COrHRcete on be vePlfibd at twvw.shdsRrectory erg ea on ".verify Cert flaate" link end ender the ARM Certified Reference Number end the data on Ak-Gondilkrninq, Healing, which the certificate wee issued, which Is Rind Strove, slid the Certain No., which is listed below. 1l� and Refrigeration Institute • 102012 Air - Conditioning. Heating, end Reffrigeration institute CERTIFICATE NO,: 12E84.5209E441E7293 CERTIFICATE VERIFICATION IFICATION Alletelleentalangeob instelleallewlmnsellielegebeeseser Residential Air Conditioning Corp. 20250 NE 15 Court Miami, Florida 33179 305 -652 -6040 * 954- 764 -0489 * Fax: 305 -651 -4992 State Licensed and Insured CAC035484 Serving South Florida Since 1973 A+ Rating Member BBB June 22, 2012 B & L Realty Holdings, LLC 3900 NW 2nd Avenue Miami, FL 33127 Job address: 166 NW 98 Street Miami Shores, FL 33150 Residential Air Conditioning will fiirnish and install the following: Day and Night manufactured by Carrier 3Ton Super High Efficiency Split Cooling System - 16 SEER Installation includes the following R410 Eco Friendly Equipment listed below. Condenser model NXA636GKAwil1 be installed and secured on a Dade County approved slab. Air handler model FXM4X3600 will be installed in the family room closet on a 3/4 inch plywood platform stand. Fabricate and install'new fiberglass ductwork 7 supplies and 3 returns. Refrigeration lines and drains. Digital thermostat Float switch Heater Start up system and check for proper operations. All labor and materials for a complete and professional installation. One year warranty labor and ten year warranty parts. Price does not include permit fee and fmal permit will be determined by the homeowners, their electricians and Residential Air A41 electrical work by others. Payment terms are 50% deposit and balance upon installation. Total Price $5785.00- $585 FPL Rebate = $5200.00 Respectfully, Richard Vanni Accepted by: Print name an W Title: Cr) C.1/ i C-' b Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 /2-003 Inspection Number: INSP- 177311 Permit Number: EL -7 -12 -1404 Scheduled Inspection Date: August 30, 2012 Inspector: Devaney, Michael Owner: Job Address: 166 NW 98 Street Miami Shores, FL Project: <NONE> Contractor: LS CURTIS INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1131010260040 Phone: 305 - 892 -0115 Building Department Comments NEW 5 KW, 3 TON NC UNIT WIRING. 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-176428. 2 conductors under lug G. F. I. receptacle outside to be T. P. /W. P.. August 29, 2012 For Inspections please call: (305)762 -4949 Page 5 of 18 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 Permit Type: Electrical JOB ADDRESS: I (, Co N W G © S'I- -+ i-; ECEQVE JUL 26I52 eau,. 01.a 0" FBC 2010 Permit No. EL- 12'1404 Master Permit No. N\ C -17- i 403 City: Miami Shores County: Miami Dade Zip: 3 1 S ® Folio/Parcel #: � 310( —G2, -0011 0 Is the Building Historically Designated: Yes NO ✓ Flood Zone: . iect L -k 1-bldi ,ri LA- OWNER: Name (Fee Simple Titleholder): Phone #: ®S - O.. %C1- Address: 39 0 0 r.tw =') eg. City: r- 1 i t ®1— o State: r L_. Zip: 3-3k Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: L. '. Corilr Phone#: 30 S 692- 011S- Address: 4)-()31(1 AV1 Ift MO City: Jjfi/(2A S tate: 1' t Zip: 33i Qa• Qualifier Name: t.P.JX j S ,(P C2.1 14-t j Phone#: State Certification or Registration #: Certificate of Competency #: Contact Phone #: If0 44 /A C9 / Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Q 0 C 3 Square/Linear Footage of Work: Type of Work: DAddress OAlterationlew URepair/Replace ODemolition Description of Work: NUJ S ,,,, ; 3 f1 --t , C/1 I4 Uti 1 P4 ; f . ******+ x***** x: *********** ******+x** ** **** Fees** ** * *** ****:x******* ** ** x **** *** * *****x:***** Submittal Fee $ S0rat) Permit Fee $ /,5i. OP CCF $ CO /CC $ Scanning Fee $O Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 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 ' 'rove' es ' a reinspection fee will be charged. Signature 0 er or Agent The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 2y- day of U 1 , 201- by rni Cie 1 13 1 day of 20` L, by iii L ux�r to me or who has produced wh • 1 Contractor As identification and who did take an oath. NOTARY PUBLIC: Sign: 6 v C Print: , . 6 - My Commission Expir :kN=************8 *** APPROVED BY ;ikv4 ; ROHN! A BLANK i MY COMMISSION# EE000573 tte '"�"','a- EXPIRES October 01, 2014 4073 3B8-013 *"*VocV1211tigreettINV**** 6 -ralL Z�'�� y Plans Examiner or who has produced as identification and who did take an oath. NOTA PUBLIC: Sign: Print: My Commissio MELINDA K. CURTIS • \ 4 '* Notary Public - State of Florida •� _ My Comm. Expires May 13, 2014 Commission # DD 991888 T ro a n • Nota Assn. **ik**** * * * * * * * * * * * ** Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk e CERTIFICATE OF LIABILITY INSURANCE DATE(M4) 11/9 /2011 TYPE CF INSURANCE NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BETWEEN THE ISSUING INSURER(S), AUTHORIZED I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED. the polcy(es) must be endorsed. N SUBROGATION IS WAIVED, subject to the terms and conditions of the policy. certain policies may require an endorsement. A statement a+ this certificate does not corder rights to the certificate holder In lieu of such endorsemantis). PRODUCER INSURANCE INDUSTRIES INC 953 NE 125th St. N Miami, FL 33161 A200717 NEET"CTSTACY PARKS ENE E�dt: (305) 891 -2808 I (,NO):(305) 891 -6367 stacx @3.nsurannceisLdustr3.esinc.com WACO aLSERta) Art=oROaar GOYERA48 R A : M AC:NEILL / SCOTTSDPLE INSURANCE INSURED LS CURTIS INCORPORATED 20341 NORTHEAST 30 AVENUE #108-6 AVENTURA, FL 33180 INSURER B : 10/26/12 INSURER c : $ 1,000,000 $ 100 , 000 INSURER D : MED EXP (Aar one person) INSURER E INSURER F : $ 1,000,000 CERTIFICATE MUMBER• wvarwuco - THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ma LIR TYPE CF INSURANCE AWL a R SUM MO POLICY NUMBER iRIM+D YYI pL�I�EEXXpp lbSMWDmYt'1 LIMITS A + S {ERAL LIABILITY COMMERCIAL GENERAL LIABILITY Y APP148628105 1a/26/11 10/26/12 EACH OCCURRENCE $ 1,000,000 $ 100 , 000 PREMiSE$E 1 (Ea c A) MED EXP (Aar one person) $ 5,000, CLAIMS•MADE X occuR $ 1,000,000 PERSONALSADVINJURY GENERAL AGGREGATE $ 2,000,000 $ 2,000,000 PRODUCTS. COMPIOP AGG GEHL AGGREGATE LIMIT APPLIES �: X POLICY n rim $ AUTOMOBILE . LIABILITY ANYAUTO ALL OWNED AUTOS HIRED AUTOS — ___• SCHEDULED AUTOS ((EOaMI SINGLE LIMIT BODILY INJURY (Per person) $ EODILY INJURY (Per axddeat) $ (PROPERTYDAMAGE $ 5 UMBRELLA LUIS EXCESS LIAB �R (I,A .MADE EACH OCCURRENCE $ AGGREGATE $ $ DED 1 I RETENTIONS WORKERS COMPENSATION AND EMPLOYERS' UABIUTY Wei ANY t�PRRETORIPARP XEC*WVE OFFIGERA*EMBER EXCLUDED? l�ry•�.� r u. N ORATIONS t ow NIA I OCSLAT 'S I IO ER E.L. EACH ACCIDENT $ E.L. DISEASE • EA EMPLOYEE $ E.L. DISEASE • POUCY LIMIT $ DESCRIPTION OF OPERATIONS! LOCATIONS! VEHICLES (Attach ACORD 101, Additional Remarks Schedule U mere space is requited) *ELECTRICAL WORK - WITHIN BUILDINGS GERTIFIGAIt 111./LUCK MIAMI SHORES VILLAGE 10050 NE 2ND AVE MIAMI SHORES, FL 33138 I 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 ` ,a ATIVE 1°_e1441 / —... n Annnn # F% fDATtfAI An Ank►nreearond. ACORD25(2010105) The ACORD name and logo are registered marks of ACORD • ACCORD THIS CERTIFICATEIS 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 CERTIFICATEOF 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 ADDITIONALINSURED, the policy(des) must be endorsed. If SUBROGATION'S 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). CERTIFICATE OF LIABILITY INSURANCE DATE IMMI DD YYYYI 04 -17 -2012 PRODUCER AUTOMATIC DATA PROCESSING INS AGCY 250717 P: {877)287 -1316 F:(888)443 -6112 PO BOX 33015 SAN ANTONIO TX 78265 CONTACT NAME: (A:. No. (877)287- 1316 t•MAII. ADDRESS: PRODUCER CUSTOMER ID a: AC.NeI: (888)443 -6112 INSURERIS) AFFORDING COVERAGE 1 NAIL INSURED L. S. CURTIS INC. 20341 NE 30TH AVE APT 108 AVENTURA FL 33180 INSURERA: Twin City Fire Ins Co INSURER 5 : INSURER C : INSURER D : INSURER E : INSURER F : • ON NUMBER: YV VGR..VGV vr•••.. .�. -...r ..— .....w... THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD I 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. TYPE OF INSURANCE ADW. twee pp�IC�T EF 'NO WA 'LIAR BAR WVa POLICY NUMBER IMMiTIDA {MtidrOTIIYYYY) LIMITS • QENFAAL LIABILITY I ° l I I f • EACH OCCURRENCE 8 1—^ 1 ; COMMERCIAL GENERAL UABIUTY i OAMAGtE TO BENIt0 ' PREMISES 8Ea occurrence) S 1 i CLAIMS•MADE ` -; OCCUR I 14._ 1 I MED EXP (Any one Perooal 8 1 PERSONAL & ADV INJURY i 8 I ! GENERAL AGGREGATE !(I AWL AGGREGATE UMUT AJ S PER . PRODUCTS • COMPiOP AOG 8 POLICY _; JEC _, LOC 8 ,•__ ' AUTOMOBILE UABaUTY • • • 1 ' ' } i COMBINED SINGLE LIMIT IEe accident) 9 '1 .ANY AUTO BODILY INJURY (Per person) 8 —•-4 AU. OWNED AUTOS i BODILY INJURY (Per accident)' 8 I SCHEDULED AUTOS ' PROPERTY DAMAGE 14 1 (Per *coders) HIRED AUTOS I 1 NOMOWNED AUTOS n $ 8 • '''AB OCCUR • • i ! I } EACH OCCURRENCE $ ~ • EXCESS VAS r� CLAIMS•MAOE� AGGREGATE $ DEDUCTIBLE 1 8 1 1 RETENTION $ I i 8 `WORKERS COMPENSATION ANTI EMPLOYERS' MAMMY 1 Y! N I I I I I ! 76 WEG TRR4954 : 05/0:/2012 05/01/2013 y�C STA U :07H I X i TWO'S kl TS 1 1 ER i E.L. EACH ACCIDENT 19 1,000 f 000 ANY PROPR)ETORtPARTNERIEXECUT) A OFFICERrMEMBEREXCLUDED1 IN/A In NIB E.L. DISEASE • EA EMPLOYEE 8 1r 000, 000 {Mandatory ' 11 es. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE •POLICY LIMIT 8 0 0 0 0 00 DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (Attach ACORD 101. Additional Remakes Schedule. it mao space Is roNdred) Those usual to the Insured's Operations. vw••..,vr••r ., w•.r•• Miami Shores Village Building Department 10050 N.B. 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. AUTRORI2 7'__ ESENTATNE'�% ! adL`' _ • ...wn ••■■ti arms+) nneenDATIAN AI .Lahti ranAnrnd_ ACORD 25 (2009109) The ACORD name and Ingo are registered marls of ACORD • SINESS AND PROFESSIONAL YOU 6 ... ., r,.... ''.. i ,. ' t t te . t i and e fite totbarbeeuel end thy ke vaRS TirpsW; ''":STREET • : * " 3239g-0783 850) Melt tt... htt- ti arhtets 101S t Every weft( rove the w For 'MR sy 0 fr Our' ne,ftellion uatJon . kers, from ng. fri t n serve you better . th OWISWCOlit ations.thet wstetters.and 1�m rnore beet the • Wftivitteetsit101.0efttif,tResPlate'Pekty. . . . . . . .oriottittitaty$0*0..0.0myot.14tt ottottimers. ttithatkottloridt fttortidli, intardengtedeideentbrit , ,li ... yOurtieW.: . . .3 2Gt4 ...... t-4.ittutievtootttit, DetrActi HERE • • • , . . . ,,,EeeegtaggeEkSegteteieggeelkget.5Apftg,„MgtattfWJRZgggpeeeiekQgg,tagfkttfrgMlgfd).e,Bttfffgeiggregr#AR.KgatagNINEeARtneeea.eeebgkieko .... . TION ',EECUt L;1208180 0884 MET �0 INC a 'CURTIS 0 000' '10 00 1 3318