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PL-12-961Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 SC- [ 2- 10s(4- Inspection Number: INSP - 174125 Permit Number: PL -5 -12 -961 Scheduled Inspection Date: December 05, 2012 Inspector: Hernandez, Rafael Owner: RODRIGUES, MARIANA Job Address: 141 NW 96 Street Miami Shores, FL 33150- Project: <NONE> Contractor: RECO PLUMBING CORP Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1131010250110 Phone: (786)202 -5687 Building Department Comments MOVE SHOWER AND TOILET, CHANGE TILE SINK NEW FAUCET Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comme s December 04, 2012 For Inspections please call: (305)762 -4949 Page 3 of 37 FROM <FRI)SEP 28 2012 18: 26 /ST. 18: 28 /No. 7626088484 P 1 ACORD. CERTIFICATE OF LIABILITY INSURANCE PRODUCER ANCORA INSURANCE AGENCY 605 SE 10TH STREET DEERFIELD BCH, FL 33441 Phone :(954)420 -5998 Fax:(954)420 -5985 INSURED RECO PLUMBING CORP 1830 S OCEAN DRIVE #4706 HALLANDALE BEACH, FL 33009 Phone: (561) 703 -2477 COVERAGE —i 1 DATE (MMIDDNY) 09/25/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: North PQinte Insurance Company INSURER B: INSURER C: INSURER 0: INSURER E: N URAN EL TED L Y : � I - r i H 7 I' 3P V T D 4: 11 T S_ = i L Y PER • D INDICATED. NOTHWITHSTANDING 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR -mot A TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL I.IABIUTY CLAIMS MADE © OCCUR GEN'L AGGREGATE UMIT APPLIES )914 POLICYf PROJECT LOC AUTOMOBILE LIABILITY - ANY AUTO ALL OWNED AUTOS ▪ SCHEDULED AUTOS HIRED AUTOS NON•OWNEDAUTOS GARAGE LIABILITY 1 ANY AUTO POLICY NUMBER POliCY EFFECTIVE DATE (MWDDIYY) POLICY EXPIRATION DATE jMWDD!YY) 8090016809 06/20/2012 06/20/2013 EACH OCCURANCE LIMITS $ 1,000,000 UAAMA4Jk 1 U PHLMISES UMIT(Any One Occurrence) $ 100,000 MED EXP(My one person) $ 5,000 PERSONAL AND ADY INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGO $ 2,000,000 EXCESS LIABILITY ] OCCUR ❑ CLAIMS MADE DEDUCTIBLE RETENTION COMBINED SINGLE LIMIT (a accident) i BODILY INJURY (Pm Person) i BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) $ AUTO ONLY - EA ACCIDENT i ER THAN AUTO ONLY: EA ACC AGG WORKERS COMPENSATION AND EMPLOYERS LIABILITY OTHER EACH OCCURANCE AGGREGATE $ JAC STATUTORY uMITS (1 OTHER E.L. EACH ACCIDENT E.L.DISEASE -EA EMPLOYEE $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDROUSMEN7/SPECIAL PROVISIONS PLUMBING CERTIFICATE HOLDER IADDnlONAL INSURED:INSURED LETTER: E.L.DISEASE - POLICY UMIT $ MIAMI SHORES VILLAGE BUILDING DEPART. 10050 NE 2ND AVE MIAMI SHORES, FL-33138 Mailed to: SILVERAA@MIAMISHORESVILLAGE.COM J 'CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO M ILJ9 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION ON LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE /04 14 1 ACCORD 264 (7197) ACORD CORPORATION 1988 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 FBC 2O 1ermit Type:PLUMBING RFC I / SEP 252012 Permit No. 2 —9( 4 Master Permit NoC a —1 C134' OWNER: Name p Titleholder): C- F�� c ��S Phone#:,,3f? --4 3 �'6 / (Fee Simple Titleholder (i .. _„ Address: •.: � `7 / 7"-4'` ree�' City: A 0.09,14 � r ®� 5 State: r1.- � Tenantlr essee Name: ;,f1- �f n# zip: 3 � hone .. .. P JOB ADDRESS: City: Miami Shores Folio/Parcel #: Is the Buillding Jlisforically Designated Yes NO Flood `Lone: CONTRA TOR: Company Name: - • E , C J , D ' P t - U L A N 1) phone# jj _ s--� F)" _._.0 3 County: Miami Dade Zip: City: -MIA-Ali ti) State: Zip :.. 33 Qualifier Name: 36TPkA) 4 `� Phone #t �(��-3 °��[ i State Certification briteesttationt Cr< 10 14 q Certificate' o� Competency #' Contact Phone#: 3C - ����4 Email Address: I /o 64-1 C.; �# DESIGNER: Archiiect/Engineei: Phone#t Value of Work for this Permit: $ »mod': Square/Linear Footage of Work: Type of Work: Address °Alteration °New ORepair/Replace °Demolition Descripdou of Work:,,:_ jkAS V eL- t A Q , a' C, S A 0 p oiA2 PA -u - ... ,,u t I. ' i �`� ^b ra CO/ AA Yu-64i 15/9tJ 7 AtI i 1> **********#** *¢4 sk #*********0 *****jik*,**F ** *** ky��k** **.**** ** **0 {�**** ** * ** *** ** F **** ** Submittal Fee $ Permit Fee $ % CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ I09• 1 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR 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 approved and a reinspection fee will be charged. Signa Owner or Agent The foregoing instrument was acknowledged befome this day of , 20[ ,,.by V & fizetv-p , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC. Sign: Print: My Commission Expires: 1111 I 11 it /i11 S i S %/�)9��'� 03106120'(6 �• • IIAfl w.. w.w.w . Commission # /Nr * * * * * * * * * * * * * * * * * *** * * *** ** * * *ii t *m woiii * * *** * *** ** ***** Plans Examiner Signature Contractor The foregoing instrument ent was ac • o ledged before me day of ZI LF tr t , 20 who is personally known to me or who has produced .r) as identification and who did take an oath. NOTARY PUBLIC :. APPROVED BY (Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09) Structural Review Sign: ...xDjr °•'�'� • Print: ' 03/96/'1016 My Commission ireT NOTARY PUBLIC . Commission # 1. r* ,� * * *jtdkase=** * * * * * * * * ** !!!lNII ltttttt * * * * * * ** ��i Of F1.1 0``� Zoning Clerk 10 -20 -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: BUSINESS NAME 10/20/2011 EXPIRATION DATE: 10/19/2013 RECO STANLEY C 452183892 AND ADDRESS: RECO PLUMBING CORP -- 1830 S OCEAN DR #4706 HALLANDALE FL 33009 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED PLUMBING CONTRACTOR IMPORTANT: Pursuant to Chapter 440 . 05114), 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 440.05(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. 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 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 10/20/2011 EXPIRATION DATE: 10/19/2013 PERSON: STANLEY C RECO FEIN: 452183892 BUSINESS NAME AND ADDRESS: RECO PLUMBING CORP 1830 S OCEAN DR 84706 HALLANDALE, FL 33009 SCOPE OF BUSINESS OR TRADE: 1- CERTIFIED PLUMBING CONTRACTOR IMPORTANT F 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 H exempt.. apply only within the scope of the business or trade listed on E the notice of election to be exempt. 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 i1. 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013 DBA: Business Name: RECO PLUMBING Owner Name: STANLEY C RECO Business Location: 1830 S . OCEAN HALLANDALE Business Phone: 786- 2202 -5687 Rooms Seats CORP DR #3009 Employees 1 Receipt #:2,1,1V22BING /LWN SPRNKL /CO Business Type: (PLUMBING) Business Opened:o5 /10/2o11 State /County /Cert/Reg: CFC142 84 9 3 Exemption Code: Machines Professionals For Vending Business Only Number of Machines: Vending Tvne: Tax Amount Transfer Fee NSF Fee Penalty _ Prior Years Collection Cost Total Paid 27.00 3.00 0.00 +' ` 0 ,'D0 0 '00 0.00 30.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIDATED Mailing Address: RECO PLUMBING CORP 1830 S. OCEAN DR #3009 HALLANDALE, FL 33009 This tax is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County and /or Municipality planning and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. 2012 - 2013 Receipt #15B -11- 00003501 Paid 08/30/2012 30.00 TOR THIS DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTING • LINEMARKr. PATENTED PAPER ,1' 0 8,13, DISPLAY AS REQUIRED BY LAl/ le3)1G1 -cam iviiami ores illa e Ivr�+� s ►� g tuol :letc-- gvilding Department ept °' AS( 1005 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 oramri (N1 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 (cam Permit Type: PLUMBING IR IEIVED MAY 2 5 MI Permit No. P L- t2.- 9191 Master Permit No. cn-cc ,t„ OWNER: Name (Fee Simple Titleholder): -DAV/LL PR /195 Phone#: 3o5 d''o3 ° ?6 /q Address: Iii/ 4"42/ 96 ste2 T City: r✓ 41 J 5 k®& e S Tenant/Lessee Name: Email: State: JOB ADDRESS: 5,1 /14 City: Miami Shores County: Folio/Parcel #: Zip: 3 3 / 6-0 Phone#: �.e Miami Dade Zip: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: C Q /fL/ l -< Phone Address: cr.? e, us (2) 5 / 9 City: 0 G� ` L � State: Qualifier Name: e)OG �� c20,� State Certification or Registration #: C FC /6/2 3 Contact Phone#: tei6 ges / ° o 3 55 Email Address: 660 DESIGNER: Architecf/Engineer: Zip: 3 3 / gam Phone #: ( 66)28/ 6 3 573 ;ei`tificate tl'Competency #: / / we #: Value of Work for this Permit: $ / Squale}L1n e of Type of Work:'` DAddress u Alteration ONew ORepair/Replace ODemoli ' n Description o f Work: i ll , b V t t C - T C 1 MG- S llJ dC / V e a l * * * * * * * * * * * * * * * * * * * * * * * * * ** ***********Fees******************************************** Submittal Fee $ 50.00 Permit Fee $ Scanning Fee $ ?MP Radon Fee $ DBPR $ Bond $ IrD CCF$ CO /CC$ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding ompany's Name (if applicable) Bong Cvmpany°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 Fl FCTRICAL WORK, PLUMBING, SIGNS, WE.I T.S, 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 approved and a reinspection fee will be charged. Signature O ' er or Agent The foregoing instrument was acknowledged before me this 2 The foregoing in day of M 2 A 1 , 201 , by PA Kt CA— F -t -rp b s , day of ► Signature who is personally known to me or who has produced 'PL.— As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: Contractor ent was acknowledged before me this) , 20 (2.,, by 1401.6611 0 1 Z4 4 ti who is personally known to me or who has produced49 as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: - : �` �' !°— • k ...... - !! /.......... <9 .. .QJ �. ****** ** ******** ***** * ** ***** ** * *** * *+t<x * ** * **** ** ******* **> * ** *+x** ** ** ** * * * *** *** * ** 4** * * ** *alt4 **** 1l0/Utttstt,t10\\ APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: 6c F'('k?7/1(7c //c BUSINESS ADDRESS: _ 26/1660 ' d 775 CITY 4`-1; 11) STATE F6 ZIP CODE BUSINESS PHONE: MO ) dP 55 FAX NUMBER ('�') , 654't3 CELL PHONE ( ) 20/ 7,3,55 QUALIFIER'S NAME: (YOZ86'e /2c-€ QUALIFIER'S LIC NUMBER: C f' /4' c 3 E -MAIL ADDRESS (IF APPLICABLE): 6-00 PitiOvh 7A Created on 3119109 BY MLDV 1 RV 3126109 MLDV L# I11 II'14A 1 G Ur LIADILI 1 T IIV�Ut RI trC 05/23/12 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 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 ADDmONAL INSURED, the policyges) 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 Best Option Insurance Brokers, Inc 3400 Coral way Suite 102 Cora! Gables, FL 33145 Phone (305) 859 -7303 Fax (866) 910 -0983 CONTACT Ludys Perez E,t): (305) 859-7303 I fa Nyy, (866) 910 -0983 ADDRESS: Iudysperez@gmail.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Ascendant Insurance A INSURED ECO 1 PLUMBING LLC 247 SW 8th Street APT.178 MIAMI, FL 33130 - (786) 281 -6355 INSURER e INSURER C: 02/17/2012 INSURER D : EACH OCCURRENCE INSURER E: PREMISES (Ea occurrence) INSURER F : $ 5,000.00 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES 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. ILTR TYPE OF INSURANCE 1NSR. WO_ POLICY NUMBER POLICY EFF jMMIDD/YYYY) POLICY EXP (MMJDDJYYYY) LIMITS A GENERAL LIABILITY n COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE ❑ OCCUR ❑ GL- 36686 -0 02/17/2012 02/17/2013 EACH OCCURRENCE $ 1,000,000.00 $ 1,000,000.00 PREMISES (Ea occurrence) MED EXP (Any one person $ 5,000.00 PERSONAL BADVINJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 1,000,000.00 GEN'L AGGREGATE UMR APPLIES PER ❑ POLICY ❑ JECT ❑ LOC PRODUCTS - COMP /OP AGG $ 100,000.00 DED $ 1,000.00 AUTOMOBILE U ABMY ❑ ANY AUTO ALL AUTOS OWNED ❑ SCHEDULED ❑ NON -OWNED ❑ HIRED AUTOS ❑ AUTOS ❑ ❑ COMBINED accident) MBII E DINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE per accident) $ $ ❑ UMBRELLA UAB ❑ OCCUR ❑ EXCESS L.IAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ II DED ❑ RETENTION $ $ WORKERS COMPENSATION LIABILITY AND EMPLOYERS' Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE N /A ❑ WC S LIMITS ❑ OT TORY E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory NH) n E.L DISEASE - EAEMPLOYE $ yyees under If DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedute, B more apace s required) PLUMBING COMPANY. CERTIFICATE HOLDER CANCELLATION Miami Shores Vllage 10050 NE 2 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 WI'T'H THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (201005) OF ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JEFF ATWATER CHIEF FINANCAAt STATE OF FLORIDA OF RS O SERVICES OF WORKERMPENSAT ON * * 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 02/02/2011 EXPIRATION DATE 02/01/2013 PERSON 02 -02 -2011 BORGEAT NORBERTO F FEIN 274477346 BUSINESS NAME AND ADDRESS: ECO 1 PLUMBING LLC 247 SW STN STREET, APT #178 MIAMI FL 33130 SCOPES OF BUSINESS OR TRADE 1- CERTIFIED PLUMBING CONTRACTOR * IMPORTANT: Pursuant to Chapter 440. 05(14), F.S., an officer of a corporation who elects exemption from this section may net recover beoelits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates by to be certificate . ply on under n the of the business or trade listed on the notice of election to be exempt. Pursuant m.. apply only within the election to be exempt shall be subject to revocation if, at any time after the filing of the notice m0 the issuance of the certificateothe pberson named on theifnotice 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. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTNE 02/02/2011 EXPIRATION DATE: 02/01/2013 PERSON NORBERTO F BORGEAT FEIN 274477348 BUSINESS NAME AND ADDRESS: ECO 1 PLUMBING LLC 247 SW 8TH STREET, APT 4178 MIAMI, FL 33130 QUESTIONS? (850) 413 -11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE SCOPE OF BUSINESS OR TRADE t- CERTIFIED PLUMBING CONTRACTOR IMPORTANT O 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 I- under this section may not recover benefits or compensation under this D chapter. Li Pursuant t0 Chsoter 440.05(12), F.S., Certificates of election to be Rexempt.. apply only within the scope of the business or trade listed on the notice of election *M be exempt. 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. FIRST -CLASS U.S. POSTAGE PAID MiAM!{ FL PERMIT NO. 231 676197 -8 BUSINESS NAME! LOCATION ECO 1 PLUMBING LLC 33130 MIAMI OWNER ECO 1 PLUMBING .LIC Sec. Type of Business 196 PLUMBING CONTRACTOR THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERBBCT' THE • G REGULATORY O ZONING LAWS OF THE COUNTY OR CI77ES. NOR OOP - IT THE FROM OTHER REO RED 8 IAW THISSIES NOT A CERTIFICATION OF , OLDER S CAO A PAYMENTRECEIYED MIAMI-DAOE COUNTY TAX 07618/2011 0.2250002001 -_ 000045.00 THIS IS NOT A BILL— DO NOT PAY RECEIPT C STATE* "GI C Ott ^TYCD CIflO DO NOT FORWARD ECO 1 PLUMBING LLC NORBERTO BORGEAT 247 SW 8 ST 178 MIAMI FL 33130 11311 $111111lilltt11Ii1i1Ftl11i11111 IIi11 1I III III tlI STATE OF FLORIDA DEPARTMENT OF BUSINESS -AND PROFESSIONAL REtULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 BORtEAT, NORBERTO F ECO 1 PLUMBING LLC 247 SW 8T8 STREET #1788 33130 MIAMI FL i, Congratutationsl 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.myyfl�orldalicense 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 stove to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE •