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ELC-12-1597Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 177769 Permit Number: ELC -8 -12 -1597 Scheduled Inspection Date: October 23, 2012 Inspector: Devaney, Michael Owner: VILLAGE, MIAMI SHORES Job Address: 9390 NE 2 Avenue Miami Shores, FL Project: <NONE> Contractor: BENNETT ELECTRIC SERVICES CO Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060132940 Phone: (305)759 -1665 Building Department Comments INSTALL 4 50 WATT LOW VOLTAGE MR Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments ,774t 7 October 23, 2012 For Inspections please call: (305)762 -4949 Page 8 of 18 • •• ■ s • 1...JI EXISTING MONUMENT NO WORK THIS AREA •l, NO WORK THIS AREA NO WORK THIS AREA EXISTING FLAG POLE LIGHTS TYP. OF (6) 0 0 0 0 0 EXISTING PULL BOX & CONDU • • NEW CONDUIT • t¶ 0 '`"%0 A • b o WALL FLOODS TYP. OF (3) (EXISTING) PIO WORK MKS , -.REA ELECTRIC & PUMP EXIST. ELECTRI PANEL. NEW FLUSH BRONZE LOW VOLT. LTG. LV -42 -50 -WATT MR 16 LAMPS 12 -VOLT (TYPICAL OF 4) AttlitAth tit-MORIAL NEW MEMORIAL 12 -VOLT TRANSFORMER /TIME CLOCK TO MOUNT WEST SIDE OF WALL. VILLAGE OF MIAMI SHORES MEMORIAL PARK NE 2 AVENUE & NE 94 STREET DRAWN BY JACK HIGGINS EC-FL 625 CHECKED JH DATE 08/21/12 APPRO ED TONINril DEPT BLDG DIEPT ECT 10 Cc, P IPI .IANCE Vvf r, i ALL FEDERAL cc �_rp,� r r ,�F�- 12,rJ0 RFGLI AT!O,r,ls ALUMINUM OR COPPER COVER SEALANT " THK, TEMPERED GLASS DETAIL B ALL HARDWARE TO BE SCALE 1 STAINLESS STEEL S-1 " THK, BASE PL. AIN �6 "_f d 0 ..d a . d 0 • " THK, TEMPERED GLASS 03" ADVESIVE / SEALANT FOR 25 PSI MIN. SHEAR. 2— 3 "0x9 "LG. ° a° STAINLESS ° STEEL 'J' BOLT. ° "ox3 "LG. COUNTERSINK STAINLESS STEEL MECHANICAL FASTENER ®4 "O.C. 4° o, • a ° f • 0 ° < • DETAIL ALL HARDWARE TO BE SCALE 1 ' =1' -0" STAINLESS STEEL PLAN NOTES: SCALE: ° =1' -0° 1. N2RIMN" mfeleg. FFLOM BUMPS CCM (FBC), 2010 EDISSON. MEANS 7 FOR *10 LOADS, LATEST' MEbli. 2. 611E fi °6 1RAc aR A6PEFa NT 1288R0lm N 11 O' O0*11118 dD WA120 eY 12 °N6o1 u+o 3. ALL CON=TRIVE WORK B MIMED OR 11E BANS CP 'SIREN= OFSor N ACCORDANCE E1N AO 318, *BUMS CODE 513212110113415 FOR REINFORCED CONCRETE'. ALL COMMIE MC MALL BE COBTRUCTED 84 STRICT ACCORD VIM A0 315. 4. CONNIVE I10B SHALL BE PROPORTIONED N ACCORD MTH A0 .101, "01EOflCM 018 FOR 8110011121E RIC=HE' AND AO 211.11. 'TEO010BNOPD PRACTICE FOR SE1.EC1N0 PROPORT08 FOR NORMAL MOAT CONCRETE' TO PRODUCE 111E FCILOBN@ 6. MAMAS CFMEBT. 5f1•. 0150 AO RECA18 QKII C:73 AIA SECT. 2.2 Elt 1114 6. U(8NO.. CONCRETE SHALL BE BATCHED. 2480 AND TRANSPORTED N ACCORDANCE TAM ACI 301, CHAPTER 7. 7. MOM CONFORM M W AM 7011. CHAPTER a 8. CONFORM TO AO 301, SECTION 8S4. gmenzjiratirem AN 301. CHAFER 4 'A0 REMIND USUAL" (SP -88). OC&'PLACING RE FOR@0 BARB'. CSIR "MANUAL of STA10110 PRACTIC 0M-1} a NA1E78404 GRACE �. ferILIBLENEKL. 810010 PERM ASN 80410ROl01T P MERE NOTED ON PLANS. BE1ar PROPOSED Amor TO 211.. PIM 10 RISE. ADD RIMS 10 111E o0N0ETE: NIX NO P28044118801152801440121114 11E MAME NIB.SRECREN. 004 ORME0 QMAPT9t 3. 80 Ma0-V. Mk 16 1/2 GAUGE OR HEAVER. BLACK 10. Mar11567 1H2JQ BE masa& BARB PARESIS EMBEDDED N CONCRETE 8HN.L NOT BE FEED BENT UPUBS NOTED OR 11. mom D0 NOT *SD BARB MESS NOTED OR MHOS= BY 1HE ENGINEER. NEW AO111RIII•D,, CONFORM TO A10 01.4 12. 5480,. PLACE BARB N ACCORDANCE g7V1 CERBI 'NAM REINFORCING 121021. SUPPORT NO 1E 10 PREVENT 001•IADJFINT. 01 b oo 1' 6" r I L r - -J TEMPERED GLASS STEEL MONUMENT 54 "x54 "x12 "DEEP 3000 PSI CONCRETE PLINTH W/4 - #5 EACH WAY MID DEPTH.(ADD 4 -#5 'Z' BARS 4 SIDES.) 84 "x84 "x16 "DEEP 3000 PSI CONCRETE FOOTING W/5-#5 EACH WAY TOP AND BOTTOM ON TAMPED COMPACTED FILL. a a °Q .• ° ° a • 1 'a • A a 4 • 1: L -111 III= ' - i11-7,11I_III 11 ELEVATION 111 —11111111,�111111 111_,; I� SCALE: r =1' -0- , C7 1 LAWRENCE DeROSE, P.E. LICENSED BOWER NO. 20189 STATE OF FLOIBDA DATE DBRas Dodo Job • DeRose Design Consultants Inc. LAND PLANNING • (IVL • STRUCTURAL ENVRO1•8ENTAL • ELECTRICAL. • MEC HANCAL 470 3.S AVENUE SUITE 209 CALL wNN1s RESERVED POMPANO BEACH, FLORIDA 33089 �MR R 1R: (684) 942 -7703 6R11RCA1E as AU1"OI77WNN 1 170 911 MEMORIAL BEAM MIAMI SHORES VILLAGE HOUSING DETAIL FOR 911 I BEAM DRAY/N. R.W. I DATE. I PROOT NO. 04/24/12 x10( DRWO NO 3-1 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 ckv\ 11 L'�� BUILDING PERMIT APPLICATION Permit Type: Electrical JOB ADDRESS: ,v2,�i„A L RECEIVED AUG 2 2 2D12 FBC20 )scr--4- Permit No. Master Permit No. A e 41.1F o os/eRd. City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder):d>42 //0"12.4r, 5i9s1,eef Phone #: 4J i# Address: ( .17P City .0 igA, # # &J State: Zip: 5. 1 Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: geosWen—e'le e, .cep, Phone#: 44°,7 f Address: 14e, 4 47a t..,A City:,, , // _ State: A-1 Qualifier Name: „_.),e) 4.1, rh,e, State Certification or Registration #: Contact Phone #: 7 9 a a 2 Si , 7r7,1 Email Address: DESIGNER: Architect/Engineer:'�_lpm� Zip: 33,52 Phone #: ® / Certificate of Competency #: 5Z. 42,00 4as- Phone#: X2 9 q V -> V70.7 Value of Work for this Permit: $ /i1; o, Square/Linear Footage of Work: Type of Work: OAddress DAlteration )krew ORepair/Replace ODemolition Description of Work: .1,4_2'5_1: Submittal Fee $ * * * * * * * * * * * * * * * * ** *Fees * * * * * * * *+ *********** ******+x****** * * ***x:*x *** Permit Fee $ 4"` CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education 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 FT.F,CTRICAL 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 b roved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of 4.0-0-4 , 2011. , by 3L0i1 , io is personally kno me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: APPROVED BY _ NOTARY PUBLIC Commission # uf:'•EE113059. '���''qlF OF Flm,RL\N, \\. Plans Examiner Signature actor The foregoing instrument was acknowledged before me this 021 Yr day of 1- , 201A , by.3-c) hA P. t4 W - %.1 who is _ onall kno to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: My Commission Expires: Zoning Structural Review Clerk (Revised 3 /12/2012)(Revised 07 /10107)(Revised 06 /10/2009)(Revised 3/15/09) l,t4Mi =DA COUNTY. 11 I' L°CAL USINESSTAX RECEIPT 21112 COLLECTOR I DADE COUNTY -STATE OF FLORIDA 1X 0 W. LER EXPIREs P 20 MUST DISPLAYED AT PLACE OF BUSINESS MIAMI Fk 33130 PURSUANT TO COUNTY. CODE CHAPTER 8A - ART. 9 & i0 THIS ISNOi A BILL - 00 NOT PAY-7 0229195 �� ,. ' RENEWAL BUSINESS NAME 1 LOCATION ;' RECEIPT NO. BENNETT ELECTRIC SERVICE CO` INC STATE# EC0000625 .' 6900 NE 4 CT 33138 MIAMI BENNETT ELECTRIC SERVICE CO Sec. Type of Business 19' 6 ELECTRICAL CONTRACTOR THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. R DOES �sgNOT PERMIT THE EXISTING REGULATORY OR ZONING LAWS of THE DO NOT FORWARD COUNTY Ori CITIES. DOES IT EXEMPT NON !HOLDER FROM ANY OTHER PERMIT OR UcENSE NOT RED R ATION OF THOEN HOLDEFPE QUAUFICA FIRST-CLASS U.S POSTAGE PAID MIAMI, FL PERMIT NO. 231 22919- PAYMENT RECEIVED .. OX A LC UNTV T COLLECTOR: A 11/10/2011 0901002500. 000051.75 SEE OTHER SIDE BENNETT ELECTRIC SERVICE CO INC JOHN P HIGGINS PRES PO BOX 381946 MIAMI FL 33238 III ttl1i tt fill Tltlttlllillilltttll111t11t1tI111t1111 III) 1111ttt om. r■NAC. Irk• crsl THIS DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTING • LINEMARK° PATENTED PAPER AC# 6.21). 3e 7 a STATE. OF FLORIPA7. • • DEPArentstir • ta6. imb PROFiSSibiktit, _ cf-sitiATION . ELECTRICAL RA,.cTORS SEQ# L12071600878 DATE BATCH NUMBER LICENSE NB b7/ 60U. .2 00Z9057 EC000062 The ELECTEIOAL CONTRACTOR $01-edher-o* IS cltfAeriFrSA tinder the ptovi s ions of 'dhapt: Expiratispn date: AUG 31, ..2014 BENNETV ELL.SERVIeW,CO,i1C . 6900 NE 4MUCT MIAM I FL 33138- KEN LAWSON SECRETARY BENNELE -01 SSIMEON A�,...- R °® CERTIFICATE OF LIABILITY INSURANCE DATE 117/°°"'�"'�' 7/17/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION 15 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 Collinsworth, Alter, Fowler & French, LLC 8000 Governors Square Blvd Suite 301 Miami Lakes, FL 33016 CONTACT NAME: PHONE 305 822 -7800 FAX 305 362 -2443 (NC, No. Ext): ( ) talc, No): ( ) E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Colony Insurance Company LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Bennett Electric Service Company, Inc. dba Bennett Power Group P.O. Box 382042 Miami, FL 33138 -1946 INSURER B : Praetorian Ins Co 37257 INSURER c : Federal Insurance Company 20281 INSURER D : $ 1,000,000 INSURER E : 100,000 $ � INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE INSR SUBR POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X X GL850808 3/12/2012 3/12/2013 EACH OCCURRENCE $ 1,000,000 DAMAGES (REN urD PREMISES (Ea occurrence) 100,000 $ � CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 X Contractual Inc! PERSONAL & ADV INJURY $ 1,000,000 X XCU Included GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE 7 POLICY X UMIT APPLIES jE : PER: Loc PRODUCTS - COMP/OP AGG $ 2,000,000 Pr Projt Capped $ 5,000,000 B AUTOMOBILE X X LIABILI ANY AUTO ALL OS VVNED HIRED AUTOS Y X SCHEDU� NON -OWNED AUTOS PICGA0002707 3/12/2012 3/12/2013 (Ea aBIIN ,Dill INGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' LUU31LnY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) I1 yes, describe under DESCRIPTION OF OPERATIONS below ¥ / N N / A WC STATU- TORY LIMITS OTH- ER EL EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ EL DISEASE - POUCY UMIT $ C Installation Floater 06658344ECE 3/12/2012 3/12/2013 250000. Limit w/Ded 1,000 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule If more space Is required) Number. 10159 Project: MCC 7040 and MCC 7360 Contract CICC -7360 - Miscellanous Construction Contract Miami Dade County Is named as Additional insured regards the General Liability) policy. CERTIFICA HOLDER CANCELLATION 1 Mlaml -Dade County Department of Regulatory and Economic Resource 11805 SW 26th St. Suite 207 Miami, FL 33175 'f SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED W ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE `ltt © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 ( 2010/05 }• - .-- — - "' The ACORD name and logo are registered marks of ACORD 1 ACORL7 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/18/2012 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 Ariskco, Inc. 9016 Philips Hwy. Jacksonville, FL 32256 CONTACT NAME: (aC No. Ext): (A/C, No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Normandy Harbor Insurance Company, Inc. 13012 INSURED Matrix Employer Services 9016 Philips Hwy Jacksonville, FL 32256 INSURER B INSURER C : INSURER D : $ INSURER E : $ INSURER F : CLAIMS -MADE - OCCUR • awn ..... cfl. 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 TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DDIYYYY) POLICY EXP (MM/DD/YYYY) LIMITS GENERAL LABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE - OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER 7 POLICY n 78: n LOC PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE — LIABILITY ANY AUTO AWNED AUTOS HIRED AUTOS - AUTOS ANON-OWNED S CO BNEDdSINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAR EXCESS LIAR _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED 1 1 RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? N (Mandatory In NH) If Yes, describe under DESCRIPTION OF OPERATIONS below N / A NHFL120369 01/01/2012 01/01/2013 X (`NCSTATU I IOTH- TORY LIMITS 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 apace Is required) Coverage is extended only to the insured's employees who are leased to the client company employer: Bennett Electric Service Company Inc. 3111025 DISCLAIMER: Coverage is not extended to any employee of the client company employer who is not leased from the insured or to any leased employee for which the client company employer is not reporting payroll hours to the insured. This certificate remains in effect provided the client company employer's account is in good standing with the insured. Please contact the insured at 866- 453 -2722 for verification of employees leased to the client company employer by the insured.. This certificate only applies to Project: MCC 7040 contract CICC -7360. CANCELLATION Miami -Dade County Department of Regulatory and Economic Resources 1185 SW 26th Street Suite 207 Miami, FL 33175 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) Page 1 of 1 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BENNELE -01 SSIMEON At CCP ,RQ° 4,,.._..- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDM(YY) 8/21/2012 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 POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 Collinsworth, Alter, Fowler & French, LLC 8000 Governors Square Blvd Suite 301 Miami Lakes, FL 33016 CONTACT NAME: PHONE (305) 822 -7800 FAX 305 362 -2443 (A/C, No Ext): ) (Alc, No): ( ) E -MAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURER A :Colony Insurance Company uABILITY COMMERCIAL GENERAL LIABILITY INSURED Bennett Electric Service Company, Inc. P.O. Box 381946 Miami, FL 33138 -1946 INSURER B : Praetorian Ins Co 37257 INSURER C : Federal Insurance Company 20281 INSURER D : $ 1,000,000 INSURER E : $ 100,000 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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 POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER (MM/DDIYYYY) (MM//DCDY/YYYYYY) UNITS A GENERAL X uABILITY COMMERCIAL GENERAL LIABILITY X GL850808 3/12/2012 3/12/2013 EACH OCCURRENCE $ 1,000,000 DAAO R EoNTcuED ence) , $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 X Contractual Inc! PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 X XCU Included PRODUCTS - COMPIOP AGG $ 2,000,000 GEN'L AGGREGATE 7 POLICY X LIMIT APPLIES PECOT- PER: LOC Pr ProJt Capped $ 5,000,000 B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTO H REDSAUTOS X _ SCHEDULED N N -OWNED AUTOS PICGA0002707 3/12/2012 3/12/2013 COMBINED SINGLE LIMIT (Ea accident) 1 000 000 $ > > BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENT ON $ 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 WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY OMIT $ C Installation Floater 06658344ECE 3/12/2012 3/1212013 250000. Limit w/Ded 1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 1 d1, Additional Remarks Schedule V more space Is required) Village of Miami Shores is named as additional insured with respect to general liability CERTIFICATE HOLDER CANCELLATION i Village of Miami Shores 10050 NW 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Ac•Rii° CERTIFICATE OF LIABILITY INSURANCE ‘..►/' DATE(MMIDDIYYYY) 08/21/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the pollcy, 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 Ariskco, Inc. 9016 Philips Hwy. Jacksonville, FL 32256 CONTACT PHONE (A/C No. Ext): FAX No): E -MAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURER A :Normandy Harbor Insurance Company, Inc. 13012 INSURED Matrix Employer Services 9016 Philips Hwy Jacksonville, FL 32256 INSURER B INSURER C : INSURER D : $ INSURER E : $ INSURER F : CLAIMS -MADE EJ OCCUR CERTIFICATE NUMBER:URZN6D7 • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT)MTHSTANDING 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 POLICY NUMBER POLICY EFF (MM/DDIYYYY) POLICY EXP (MMlDD/YYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE EJ OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GENT. AGGREGATE JE APPLIES PER: 1-1 n 7 POLICY PRO CT LOC PRODUCTS - COMP /OP AGG $ AUTOMOBILE — _ LABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ — UMBRELLA LAB EXCESS LAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED 1 1 RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LABILITY Y / N ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A NHFL120369 01/01/2012 01/01/2013 X I WC STATU TORY LIMITS 1OTH- 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, K more space 1s required) Coverage is extended only to the insured's employees who are leased to the client company employer: Bennett Electric Service Company Inc. 3111025 DISCLAIMER: Coverage is not extended to any employee of the client company employer who is not leased from the insured or to any leased employee for which the client company employer is not reporting payroll hours to the insured. This certificate remains in effect provided the client company employer's account is in good standing with the insured. Please contact the insured at 866 -453 -2722 for verification of employees leased to the client company employer by the insured.. CANCELLATION Village of Mlaml Shores 10050 NW 2nd Ave. Miami Shores, FL 33136 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) Page 1 of 1 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD