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MC-13-1060Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 191496 Permit Number: MC -5 -13 -1060 Scheduled Inspection Date: June 05, 2013 Inspector: Perez, JanPierre Owner: GRIGGS, CLAY Job Address: 9717 NE 1 Avenue Miami Shores, FL Project <NONE> Contractor: PENGUIN AIR CONDITIONING CORP Permit Type: Mechanical - Residential ° Inspection Type: Final Work Classification: A/C Replacement Phone Number (305)989 -1944 Parcel Number 1132060132420 Phone: (305)893 -3055 Building Department Comments EXACT REPLACEMENT OF THE EXSISTING 4 TON RHEEM SPILT SYSTEM Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. June 05, 2013 For Inspections please call: (305)762 -4949 Page 13 of 47 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: (M�� ECHAN� ICAL n JOB ADDRESS: "Y 11 @� a ve. City Miami Shores County: Folio/Parcel #: ' t Wel 033 Is the Building Historicrily Designated: Yes BY. FBC 201V Permit No. /� /� Master Permit No.t C )3- X60 CEI' TEID MAY 15 013 Miami Dade Zip: '3315 NO Flood Zone: OWNER: Name (Fee Simple Titleholder): �'('j 119,9 S Phone#') q St I q Address: c o ti toe J city: is ► cunt S\I OQLs. state: _r4 Tenant/Lessee Name: Phone#: Email: Zip: CONTRACTOR Company P. t 6 mp y Name � U � I 4-1, i r Phone# Address: k E J 41 tti city: 10 • ail C,, Yl ► state: 0. Qualifier Name: State Certification or $egistration #: A : 964 4 gar Certificate of Competency #: Contact Phone0 l �d " ci oc Email Address: Ln1Cei I 1 p19,Litrte ,k-A.e r�( 46-041CO3 °Al J zip: 551 8 t Phone#: DESIGNER Architect/Engineer: Phone#: Value of Work for this Permit: $ ) 4 lb' Square/Linear Footage of Work: 1 8 00 .c " 1`. Type of Work: °Address 1��°Altieration ©New . `lRepair/Replace ©Demolition Description of Work: eS . t� e I G P ,.i')I' - 4 f Ifs, i ,1''8 ` +on R ti dpi f S\k\eik m, *** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** (.3) ********* * * * * * * *** * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ \ k V CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ • anding 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 • Signature or Agent The foregoing instrument was acknowled�geed before 7v2i 1 day of i`�' �� , 2017 , by G. L A l N. j0P1 Signature c,,e,‘ { Contractor The forego' tlg ins kno %0 day of instrument was ac w?ill before me /this . 20 1_3, by F(S-Ck °1, who is personally known to me or who has produced ct.OQ,.1.bVr nwho is personally known to me or who has produced r/� C Snub. L C °4 as identificatit gd rh did take oar itt.iltkv t d(.• NOTARY P L LIC: As identification and who did take an oath. Sign: Print: My Commission Expi e SPRY pU9� a °,o-�►t`c�'�. JAMES HICKEY Notary Public - State of Florida • My Comm. Expires Mar 23, 2015 Commission # EE 76828 +p****** ** * ******* * ****** * *** ***** **** * ***** ********** ********* sir* t4N tM # *** * ** ******** * *** **** ****** APPROVED BY Examiner Structural Review Revised 3/12/2012)(Revised 07n0/07)(Revised 0/d10f2009)(Revised 3/15/09) Zoning Clerk 3 —iD6O 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):C1 111 PUE Lie City: Miami Shores Village County: Miami Dade Zip Code: 331 ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.MA MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ N ARHI Sheet Attached: YES0 ❑ Contract Attached: YES ❑'� UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER ham prn m tAS a 15 AHU or PKG. UNIT MODEL # �I v of -ow s'‘ 1A-2. COND. UNIT MODEL #(ZA C4 l iA' JL.O L'4 n z— 10 KW HEAT I (9 0 LI fl, NOM TONS LA AHU CU PKG 1) M.C.A AHU CU PKG AHU CU PKG 2) M.O.P AHU CU PKG AHUalo CU ;3 03KG 3) VOLTS biA, - 93o AHU , CU 37KG PKG UNIT / / -1.1- 930 PKG UNIT / / i 0 EER/SEER II YES NO REPLACING (DUCTS YES NO )4 YES NO REPLACING THERMOSTAT YES NO › YES NO NEW 4 °CONCRETE SLAB YES)< NO YES NO NEW ROOF STAND YES NO g YES NO NEW RETURN PLENUM BOX YES NO y(; 1. Minimum Circuit Ampaclty (Wire Size): 3 2. Maximum Overcurrent Protection (Fuse/Breaker Size): too 3. Voltage of Circuit (208/240/480): d LID 4. Size Disconnecting Means: b `` Contractor's Company Name &ff ' Lan ,4.I & CO 1d41'I O►lt Y1C Phonicn5J fig) 3 °C 0S-6— State Certificate or Registration N. rf (b.64 Certificate of Competency N. CA -ex an LI 3 Signature o . H (Qualifier's signature only) Date: 511.)) STATE CC #CA- CO25435 COUNTY CC #11051 COOLING - HEATING ENERGY / SPECIALIST Pen9uin Air Conditioning, Inc. firopoOat 84 SAcceptance 1-3 - 060 305 - 893 -9055 14230 West Dixie Highway North Miami, FL 33161 Fax: 305 - 893 -9058 :(IIL• H ER o 11111M CITY,,STTE AND ZIP CODE `57:4 ant, START -UP DATE PHONt WORK PHONE BILLING OR TENANT INFORMATION A- HITECT CELL P( #a3 FAX AIR CONDITIONING AND HEATING EQUIPMENT: ❑ New Installation .y19 Replacement ❑ Repairs EQUIPMENT QTY. TONS SEASONAL S.E.E.R. MAKE MODEL # SERIAL # PACKAGE UNIT CONDENSING UNITS [ �? i 4 �' to ��pp gp/+�Le4c) 'z AIR HANDLER A ,� f' m 'g Dt1 S - Li HEATERS K.W. Installation of equipment Drain System Refrigerant piping 5 minute Time Delay Relay Install ducts outlets and returns Structural supports for equipment Auxiliary drain pan Crane Service Copper coils Other Othe COMMENTS THIS PROPOSAL INCLUDES YES 0 0 'a YES Thermostat wiring ❑ Power wiring from panel to equipment ❑ Thermostat installation ❑ Cool ❑ Heat ❑ Cutting patching holes for pipes, ducts, etc ❑ Duct transition ❑ Connections to existing system ❑ Pitch pans and or roof supports ❑ Start up and balancing equipment ❑ (u S� NI Slab or lintels 1 yr. Guaranty on Parts & Labor Manufacturer's Warra _ on Compressor PAYMENT TO BE MADE AS FOLLOWS: lAji Upon Acceptance $ o 0 2.0 Delivery of Equipment 3.0 Other $ 4:$1 Upon Completion $ 1 6- a 00 All material is guaranteed to be as specified. All work is to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tomado and other necessary insurance. Our workers are fully covered by Worker's Compensation insurance. TOTAL $ 9 416 A co Authorized Signature Date Note: This proposal may be withdrawn by us if not accepted within days. acceptance of PrOpoot - The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature Date of Acceptance: Please sign and return top copy with check. Any changes from above agreement, resulting in additional labor or material, will result in and additional charge agreed upon by both parties. Signature t Performance Data AHRI Standard Conditions - Cooling Performance Data Air RANI. Series Model Numbers 8B°F [26.5 °C] DB/67°F [19.5 °C] WB Indoor Air 95 °F [35 °C] DB Outdoor Air Sound Rating dB Indoor CFM [l/s] Outdoor Unit RANI.- Indoor Coil and/or Air Handler Total Capacity BTU/H [kW] Net Sensible BTU/H [kW] Net Latent BTU/H [kW] EER SEER Rev. 5/17/12 049CAVDAZI JAZ/YAZ RCFL- H *4824(RHWB-08WRX60A) 46,500 [13.6] 32,600 [9.6] 13,900 [4.1] 11.50 13.50 76 1,450 [684] RCFL- H *4824(RHWB- 10WRX60A) 46,000 [13.5] 31,500 [92] 14,500 [4.2] 11.50 14.00 76 1,350 [637] RCFL- H *4824(ROLA- 070E04) 46,000 [13.5] 31,550 [9.2] 14,450 [4.2] 11.00 13.00 76 1,375 [649] RCFL- H *4824(ROLA- 115E05) 46,000 [13.5] 31,700 [9.3] 14,300 [4.2] 11.00 13.00 76 1,400 [661] RBHP- 24(RCHL -48A1) 45,500 [13.3] 31,300 [92] 14,200 [4.2] 11.00 13.00 76 1,600 [755] RCQD- 4821(RGFG- 09?ZCM ?) 46,500 [13.6] 32,700 [9.6] 13,800 [4.0] 11.00 13.50 76 1,400 [661] RCQD- 4821(RGFG- 10?ZCM ?) 46,500 [13.6] 32,700 [9.6] 13,800 [4.0] 11.00 13.00 76 1,400 [661] RCQD- 4821(RGPT 07 ?BRQ ?) 47,500 [13.9] 33,250 [9.7] 14,250 [4.2] 11.50 14.00 76 1,425 [672] RCQD- 4821(RGPT 10?BRM ?) 47,500 [13.9] 33,200 [9.7] 14,300 [4.2] 11.50 14.00 76 1,425 [672] RCQD-4821(RHWB- 04WMX36A) 46,500 [13.6] 32,100 [9.4] 14,400 [4.2] 11.50 13.50 76 1,300 [613] RCQD- 4821(RHWB- 06WMX48A) 46,500 [13.6] 32,300 [9.5] 14,200 [4.2] 11.50 13.50 76 1,325 [625] RCQD- 4821(ROLA- 070E04) 46,500 [13.6] 31,550 [92] 14,950 [4.4] 11.00 13.50 76 1,375 [649] RCQD- 4821A* 47,000 [13.8] 34,250 [10.0] 12,750 [3.7] 11.00 13.00 76 1,600 [755] RCQD- 4821A *(RGFD -12 ?RCM ?) 47,500 [13.9] 35,050 [10.3] 12,450 [3.6] 11.00 13.00 76 1,650 [779] RCQD- 4824(RGFE -09 ?ZCM ?) 47,000 [13.8] 32,650 [9.6] 14,350 [4.2] 11.00 13.50 76 1,400 [661] RCQD- 4824(RGFE- 10?ZCM ?) 47,000 [13.8] 32,850 [9.6] 14,150 [4.1] 11.00 13.50 76 1,425 [672] RCQD- 4824(RGFE -12 ?RCM?) 47,500 [13.9] 33,400 [9.8] 14,100 [4.1] 11.50 14.00 76 1,450 [684] RCQD- 4824(RGFG -09 ?ZCM ?) 46,500 [13.6] 32,650 [9.6] 13,850 [4.1] 11.50 13.50 76 1,400 [661] RCQD- 4824(RGFG- 10?ZCM ?) 46,500 [13.6] 32,650 [9.6] 13,850 [4.1] 11.50 13.50 76 1,400 [661] RCQD- 4824(RGFG -12 ?RCM ?) 47,000 [13.8] 33,400 [9.8] 13,600 [4.0] 11.50 13.50 76 1,450 [684] RCQD- 4824(RGJF- 09?ZCM ?) 47,000 [13.8] 32,600 [9.6] 14,400 [4.2] 11.50 13.50 76 1,400 [661 ] RCQD- 4824(RGJF- 10?ZCM ?) 47,000 [13.8] 32,650 [9.6] 14,350 [4.2] 11.00 13.50 76 1,400 [661] RCQD- 4824(RGJF -12 ?RCM ?) 48,000 [14.1] 34,950 [10.2] 13,050 [3.8] 11.50 13.50 76 1,575 [743] RCQD- 4824(RGPE- 07?BRQ?) 48,000 [14.1] 34,950 [10.2] 13,050 [3.8] 11.50 13.50 76 1,600 [755] RC0D- 4824(RGPE- 10 ?BRM?) 48,000 [14.1] 34,950 [102] 13,050 [3.8] 11.50 13.50 76 1,625 [767] RCQD- 4824(RGPE -12 ?ARM?) 48,000 [14.1] 34,900 [102] 13,100 [3.8] 11.50 13.50 76 1,625 [767] RCQD- 4824(RGPT 07?BRQ ?) 47,500 [13.9] 33,550 [9.8] 13,950 [4.1] 11.50 14.00 76 1,475 [696] RCQD- 4824(RGPT- 10 ?BRM ?) 47,500 [13.9] 33,350 [9.8] 14,150 [4.1] 11.50 14.00 76 1,450 [684] RCQD- 4824(RGPT 12 ?ARM ?) 47,500 [13.9] 33,000 [9.7] 14,500 [4.2] 11.50 14.00 76 1,400 [661 ] RCQD- 4824(RHWB- 08WRX60A) 47,000 [13.8] 33,850 [9.9] 13,150 [3.9] 11.50 14.00 76 1,475 [696] RCQD- 4824(RHWB- 10WRX60A) 47,000 [13.8] 33,550 [9.8} 13,450 [3.9] 11.50 14.00 76 1,425 [672] RCQD- 4824(ROCA- 070E04) 47,000 [13.8] 32,700 [9.6] 14,300 [4.2] 11.00 13.00 76 1,400 [661 ] RCQD- 4824(ROLA- 070E04) 47,000 [13.8] 32,400 [9.5] 14,600 [4.3] 11.50 14.00 76 1,375 [649] RCQD- 4824(ROLA- 115E05) 47,500 [13.9] 33,800 [9.9] 13,700 [4.0] 11.00 13.50 76 1,500 [708] RCQD- 4824A *(RGFD -12 ?RCM ?) 47,500 [13.9] 35,050 [10.3] 12,450 [3.6] 11.00 13.00 76 1,650 [779] RHKL- HM4821(RCSL -H *4821) 47,000 [13.8] 33,650 [9.9] 13,350 [3.9] 11.50 13.50 76 1,575 [743] RHLL- HM4821(RCSL -H *4821) 47,000 [13.8] 33,950 [9.9] 13,050 [3.8] 11.50 13.50 76 1,600 [755] RHSL- HM4821(RCSL -H *4821) 46,500 [13.6] 33,250 [9.7] 13,250 [3.9] 11.00 13.00 76 1,525 [720] RHKL- HM4824(RCSL 4I*4824) 48,500 [142] 36,500 [10.7] 12,000 [3.5] 11.50 14.00 76 1,625 [767] RHLL- HM4824(RCSL -H *4824) 48,500 [142] 36,450 [10.7] 12,050 [3.5] 11.50 14.00 76 1,625 [767] RHSL- HM4824(RCSL -H *4824) 47,500 [13.9] 35,000 [10.3] 12,500 [3.7] 11.00 13.00 76 1,525 [720] 060CAZ/DAZ/ JAZ/YAZ RCFL -H *6024 eD 61,000 [17.9] 42,900 [12.6] 18,100 [5.3] 11.00 13.00 76 1,800 [849] RCFL -A *6024 61,000 [17.9] 42,900 [12.6] 18,100 [5.3] 11.00 13.00 76 1,800 [849] RCFL- H *6024(RHWB- 08WRX60A) 60,000 [17.6] 40,700 [11.9] 19,300 [5.7] 11.00 13.00 76 1,650 [779] RCFL- H *6024(RHWB- 10WRX60A) 60,000 [17.6] 41,300 [12.1] 18,700 [5.5] 11.00 13.00 76 1,700 [802] RBHP- 25(RCHL -60A1) 55,500 [16.3] 36,600 [10.7] 18,900 [5.5] 10.50 13.00 76 1,800 [849] RCQD -6024 58,500 [17.1] 40,250 [11.8] 18,250 [5.3] 10.50 13.00 76 1,800 [849] RHKL- HM6024(RCSL -H *6024) 62,000 [18.2] 43,450 [12.7] 18,550 [5.4] 11.50 13.50 76 1,800 [849] RHLL- HM6024(RCSL -H *6024) 62,000 [18.2] 43,500 [12.7] 18,500 [5.4] 11.50 13.50 76 1,800 [849] t Highest sales volume tested combination required by 0.0 E. test procedures. [ ] Designates Metric Conversions -0 . u iN HOME C01 - 4 Air I Electrical and Physical Data RANL Series Electrical and Physical Data Model Number RANL- ELECTRICAL PHYSICAL Phi Frequency (Hz) Voltage (Volts) Compressor Fan Motor Full Load Amperes (FLA) Minimum Circuit AmPa tti Amperes Fuse or HACK Circuit Breaker Outdoor Coif Refrlg. Per Ckatit Oz. [g] Weight Rated Load Amperes (RLA) Locked Rotor Amperes (LRA) Minimum Amperes Maximum Amperes Face Area Sq. Ft. [m2] No. Rows CFM [Us] Net Lbs. [kg] Shipping Lbs. [kg] Rev. 5/17/12 018JAZ 1 -60- 208/230 9/9 48 0.6 12/12 15/15 20/20 9.07 [0.84] 1 1775 [838] 70 [1984] 130 [59.0] 140 [59] 024JAZ 1- 60- 208/230 12.8/12.8 58.3 0.6 17/17 20/20 25/25 11.00 [1.02] 1 1920 [906] 72 [2041] 140 [63.5] 150 [63.5] 031JAZ 1- 60- 208/230 14.1/14.1 73 0.6 19/19 25/25 30/30 11.06 [1.03] 1 1920 [906] 83 [2353] 143 [64.9] 152.5 [64.9] 037CAZ 3-60- 208/230 13.2/13.2 88 1.2 18/18 25/25 30/30 16.10 [1.50] 1 3200 [1510] 106 [3005] 193 [87.5] 211.5 [87.5] 037DAZ 3- 60-460 6 44 0.6 9 15 15 16.10 [1.50] 1 3200 [1510] 106 [3005] 193 [87.5] 211.5 [87.5] 037JAZ 1- 60- 208/230 17.9/17.9 112 1.2 24/24 30/30 40/40 16.10 [1.50] 1 3200 [1510] 106 [3005] 193 [87.5] 211.5 [87.5] 043CAZ 3- 60- 208/230 13.6/13.6 83.1 1.2 19/19 25/25 30/30 16.10 [1.50] 1 3200 [1510] 115 [3260] 202 [91.6] 210.5 [91.6] 043DAZ 3- 60-460 6.1 41 0.6 9 15 15 16.10 [1.50] 1 3200 [1510] 115 [3260] 202 [91.6] 210.5[91.6] 043JAZ 1- 60- 2081230 19.9/19.9 109 1.2 27/27 35/35 45/45 16.10 [1.50] 1 3200 [1510] 115 [3260] 202 [91.6] 210.5 [91.6] 049CAZ 3- 60- 208/230 13.7/13.7 83.1 1.2 19/19 25125 30/30 20.13 [1.87] 1 3500 [1652] 132 [3742] 214 [97.1] 233.5 [97.1] 049DAZ 3- 60-460 6.2 41 0.6 9 15 15 23.13 [2.15] 1 3500 [1652] 132 [3742] 214 [97.1] 233.5 [97.1] 049JAZ 1- 60- 208/230 21.8/21.8 117 1.2 29/29 35/35 50/50 20.13 [1.87] 1 3500 [1652] 132 [3742] 214 [97.1] 233.5 [97.1] 049YAZ 3- 60-575 4.8 33 0.5 7 15 15 20.13 [1.87] 1 3500 [1652] 132 [3742] 214 [97.1] 233.5 [97.1] 060CAZ 3- 60- 208/230 15.6/15.6 110 1.2 21/21 25/25 35/35 23.01 [2.14] 1 3500 [1652] 180 [5103] 250 [113.4] 260 [113.4] 060DAZ 3- 60-460 7.8 52 0.6 11 15 15 23.01 [2.14] 1 3500 [1652] 180 [5103] 250 [113.4] 260 [113.4] 060JAZ 1- 60- 208/230 26.3/26.3 134 1.2 35/35 45/45 60/60 23.01 [2.14] 1 3500 [1652] 180 [5103] 250 [113.4] 260 [113.4] 060YAZ 3- 60-575 5.8 38.9 0.5 8 15 15 23.01 [2.14] 1 3500 [1652] 180 [5103] 250 [113.4] 260 [113.4] [ ] Designates Metric Conversions Client#: 10606 PE Al 13- 1060' ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MANDD/YYYY) 5/08/13 pg 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 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 Advanced insurance Underwriters, LLC 3250 N. 29th Ave Hollywood, FL 33020 C_ ONTTACT Certificate Department PHONE 954 9634666 FA)C (Arc, No, Ext): (A/C, No): 9549641438 SS, Certi icateofinsurance @advancedins.com INSURER(S) AFFORDING COVERAGE NAIL A INSURERA: Granada insurance Company 16870 INSURED Penguin Air Conditioning Corp. 1973 NE 147 Street North Miami, FL 33181 INSURER B : FL Citrus, Bus. & Industries 0185FL00026976 INSURER C : Travelers Indemnity Company 25658 INSURER D $ 1,000,000 550,000 $1,000 $1,000,000 $2 000,000 INSURER E : INSURER F : CLAIMS -MADE 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO AU. THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR WYD POLICY NUMBER LILY EFF (M�/DDIYYYY) 1a 1�:Yp (MMtDL 171YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 0185FL00026976 06/15/2012 06/15/2013 EACH OCCURRENCE $ 1,000,000 550,000 $1,000 $1,000,000 $2 000,000 PREMI3ES (Ea oNance) CLAIMS -MADE X OCCUR MED EXP (Any one person) X PD Ded:500 PERSONAL & ADV INJURY GENERAL AGGREGATE GENII_ AGGREGATE 7 POLICY LIMIT APPLIES 78r- PER: LOC PRODUCTS - COMP/OP AGG $2,000,000 $ C AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS Drive Oth Car X SCHEDULED AUTOS AUTOS WNED BA3B30735613 02/03/2013 02/03/2014 CO BI 4 SINGLE LIMIT $500,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ ( PROPERTY 8 MDAMAGE $ $ UMBRELLA LAB EXCESS UAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ B 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 N /A 10636517 04/01/2013 04/01/2014 X ORV IIJAMITS °R E.L. EACH ACCIDENT $100,000 E.L. DISEASE - EA EMPLOYEE $100,000 E.L. DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is requlred) CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 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 01888 -2010 AC s RD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S985402/M979636 PKG vd, mviata, : s; AC# 9 3 STATE OF FLORIDA DEPAR CONSTFRUCTIa INDIISTRY "LICRI►iiTa HO -'4410K,7-1:=4,101,141. a TION SEQ#L12060800588 BATCH <N U CACO25435 The CLASS H AIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2014 FISCHER, ELI RICHARD PENGUIN AIR CONDITIONING CORP 1973 NE 147TH ST NORTH MIAMI FL 33181 RICK SCOTT GOVERNOR DISPLAY AS REQUIRED BY LAW 048899 -9 I IS NOT A — DO G OT PAY RENEWAL (MA DITIONING CORP 1973 NE 147 ST 33181 NORTH MIAMI NGUIN AIR CONDITIONING CORP 546,2111 SALES THIS LS ONLY A LOCAL a6SIN S8 TAX RECEIPT. IT DOS ROT PERMIT 773E MOWER TO MOLATE ANY MEMO FTECORATORY OR RONIN LAWS OP THE cowry OR ORES. NOR 11026 ? Ei.4Z.:PT THE HOWER PROM POW OR. IiF1Y REOVE ED BY LAW. 7148 IS NOT A CEFITIMATEIR OP IRE MODEM OUALIFICA. ROME. PAY84'IT RECEI E° ommamm COON Y T48 08/0? 012 60010000065 000045.00 SEE OTHER SIDE KEN LAWSON SECRETARY FIRST -CLASS U.S. POSTAGE ; PAID MIAMI, PL. PERMIT NO. 231 RECEIPT NO. 048899-9 EMPLOo E/S DO NOT FORWARD PENGUIN AIR CONDITIONING CORP 1973 NE 147 ST N MIAMI FL 33181 F1FIIlIfIIFtlIIIhItHIIIh iIIl iIf11IIIFFF11FFi11 II! 11I 457101 -5 ThSVSNOT ARMU. — DO NOTPa Y RENEWAL LOCATION RECEJPTNO. 196902 -2 PENGUIN AIR CONDITIONING CORP STATE* CACO25435 1973 NE 147 ST 33181 NORTH MIAMI FIRST - CLASS U.S. POSTAGE PAID IMAM . FL PERMIT N0.239 PENGUIN AIR CONDITIONING CORP Wit. Ti >v: t +r iilusfre3Pz 196 SPEC MECHANICAL CONTRACTOR a1),AMW r '' :o=nce; -••r. 747,•Y: ;fief vr:7+P.;:; i WA; ;3e�i'.h tl :Y ti:^ fNl LA1^S C)i TUfi WORKER /S DO NOT FORWARD PENGUIN AIR CONDITIONING CORP SCOTT FISCHER PRES