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DS-12-39-o Miami Shores Village goon Building Department MI JAN 1 i2 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No.D Master Permit No. BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING OWNER: Name (Fee Simple Titleholder): 541 Ne aS Address: ROOFING £n //tin fia .i« G1 sr Phone #: (?GJ- ) try ° 2l,y City: 4: 4 h^/ % h l Y 1 C State: TL Zip: Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 3e,14^A.^ 4.r 1)10 City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO a.../.-- Flood Zone: CONTRACTOR: Company Name: Address: / 2(0 S LI City: "(ft" 3— Qualifier Name: c�9 I �lll•'/- z,c .sr' hone#: —rah f3'6 - e3 8 d G State Certification or Registration #: Contact Phone #: ' 1 State: F4. es Email Address: Zip: 3 3 /2 Phone#: ( t) 3f` ° d 8' r! L Certificate of Competency #: 44/•04 ® Jo b/4 / crie e • to•-, Phone #: DESIGNER: Architect/Engineer: Value of Work for this Permit: $ 5,000 • 6° Square/Linear Footage of Work: Type of Work: ❑Addition DAlteration DNew Ci pair/Replace Descriptiop of Work: 6 folOfe— EX'3' -�'�° %� `aJ t t.PIV ; „` eA (� . ' ��•6�tsv er•z /,%p t) DDemolition +a+x**x * ***+ ° xx° ***** ********+ x ***x°°x°x*** ** **Fees***+ °x*+ + x***+ x° x** ********* **°x°uu°***°x*:x**°x°x *° *** Submittal Fee $ Permit Fee $ 1.5. CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ tl ° 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. Signature Owner or Agent The f egoing instrument was acknowledged befor me this day o �q %�� 20/1 , b} J/ /tee, c /�G4' who is personally known to me or who has produced As identification and who did take an oath. -t NOTARY PUBLIC: Sign: Print: My Commissio Signature Contractor The for oing instrument was acknowled d before me this 7 day of , 20// , by4 C A4-.64 , who is personally known to me or who has produced as identification and who did take an oath. A NOTARY PUBLIC: Plans Examiner 7' / ®' / ` ® Zoning Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Clerk p.1 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 SADA, ALEXIS JAVIER SFL 9835 SW 76 ST MIAMI FL 33173 Congratulations! With this license you become one of the nearly one million - Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeyue restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For Information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE BATCH NUMBER SOFLA-1 OP ID: KS CERTIFICATE OF LIABILITY INSURANCE I DATEi1�` ;" "'� PRODUCER Ling Risk Management, LLC 2110 Ponce de Leon Blvd, 8601 Coral Gables, FL 33134 Alex Garcia 305 -648 -2445 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # RN,5URED SOFLA Landscaping, Inc. Alex Bade 18550 SW 210 St. Miami, FL 33187 INSURER k. Western World Insurance INSURER B: Associated Industries Inman INSURER C: INSURER D: INSURER E COVERAGES THE POLICIES OF II TRANCE 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 WI111 RESPECT TO WHICH THIS CERTIFICATE MAY ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDmONS OF SUCH POUCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MR AMYL 1 mgonna TVPF nFaecl WAN A POLICYNUMl3ER Gomm MUTT X COMMERCIAL GENERAL LIABILITY `CLAIMS MADE u OCCUR GEN1 AGGREGATE LIMIT APPLIES PER: POLICY I I P 1 1 LOC NPP1296049 POLICY EFIS:TIVE RATE tMSlNWVI 11/17/11 POLICY EXPIRAIXII ItAr tIANIAITINVYVI 11117112 EACH OCCUFdPENO $ PREMISES (Eaoccwence) $ bED EYP (Amy en* person) $ PERSONAL &ADV Ir4JJTY $ $ GENERALAGGr3=GATE PRODUCTS - COMP /OP AGG 1,000,001 100,00t 5,001 1,000,O0C 2,000,00[ 1,000,00t AUTOMOBILELIABMY ANY AUTO _ ALL OWNED AUTOS _ SCFEDIA ®AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) BODILY RIMY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) GARAGE UABMY ANY AUTO AUTO ONLY - EA ACCIDENT EA ACC AGO OTFERTHAN AUTO ONLY: $ EXCESS I UMBRELLA LABMTY OCCUR CLAIMS MADE RDEDUCTIBLE RETENTION $ EACH OCCURRENCE AGGREGATE $ WORKERS COMPENSATION AND ETVLOYEHHS' UABIUW ANY PRC TORIPARTNEP, EOJIIVE OTRCERIMMEER ECCLWED7 (Mandatory In NH) If Yes, describe under SPECIAL PROVISIONS Irslm■ Y® AWC1005845 11/18/11 11 MGM 2 TG LIMITS I I ER E L EACH ACCIDENT 100,001 El. DISEASE - EA EMPLOYEE $ 100,001 OTHER E.L., [�SISEASE - POLICY LIMIT $ 500,00C DESCFMP nON OF OPERATIONS :LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS PAVERSILANDSCAPHNG CERT1F WATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BLDG DEPT 10450 NE 2ND AVE MIAMI SHORES, FL 33138 SHOULD ANY OFTHE ABOVE DESCRIBED mums BECANCEL LEDBETORETHEEXPIRATION DATE THEREOF, THE IS5110 SOURER WILL ENDEAVOR TO 6011E lit_ DAYS WRITTEN NOTICE TO 715 CERTIFICATE HOLDER NAMED TO 71-5 LEFT, BIJTFAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Alex Garcia A APADn RC PSI MNA41 4600 'NMO sermon et1Ob9DATIMUI All el., t.. e..,........a X X X X X X X X It X X X X X X X X X X X MIAMI -DADE COUNTY TAX COLLECTOR 140 W. Flagler Street Miami, Florida 33130 Please keep your receipt for future reference. Thank you and have a nice day. 1/9/2012 1300/229/001ILEV 0024 -0001 Last Seq.# :0001 WI LBT #:0Q 641385 -0 Local Business Tax $93.75 CA $100.00 CHANGE $6.25 MIAMI -DADE COUNTY TAX COLLECTOR LOCAL BUSINESS TAX SECTION 140 W. Flagler St. - 1st Floor Miami, Florida 33130 TEMPORARY RECEIPT 2011 -2012 LOCAL BUSINESS TAX Local Business Ta .State /CCCNA Issued to: SFL Type of Business: SERVICE BUSINESS THIS RECEIPT IS ISSUED AS EVIpENCE OF PAYMENT FOR YOUR LOCAL BUSINESS TAX OR PERMIT. YOUR OFFICIAL RECEIPT WILL BE MAILED TO YOU WITHIN 10 DAYS FROM THE VALIDATION DATE ON THIS RECEIPT. Payment Received as Certified Above Miami -Dade County Tax Collector NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SRE AT TINIE<DF FIRST INSPECTION PERMIT NO. 111111 11111 11111 11111 11111 11111 11111 1111 1111 CIFN 2012R0072924 OR Bk 27982 Ps 2497; (fps) RECORDED 02/01/2012 15 :29:45 HARVEY RUVIN: CLERK OF COURT MIAMII -BADE COUNTY, FLORIDA LAST PAGE STATE OF FLORIDA: - - . 6 ° COUNTY OF MIAMI -DADE: STATE OF FLORi '? r HEREBY CERTIFY THE UNDERSIGNED f ejeby gib notice thatimprovements WIll be ma I,' ' l': property; and•,in- accordance wish Chepter 713,,FloridaStatutes, the following • ;1 w I,7111* is-provided ,in•this Notice of Commencement. 1. Legal description of property a ndstrpet/address: . `j 9 f 3f _ Aehlov 2. Description o improvement: };,e , t. w- �5.��� �J e t✓.*, .3 Owners) narne.and address eo te,« iG Interest 1n pt pe►ty dv ! :Name_and address of fee simple titleholder _4 Contractor's name, address and phone number (S'410-%t 5 Surety (Payment bond required by owner from -co ntractor,'ferny) Name, address and phone number. Amount of bond $ - 6 Lender's name and address: 7 Persons vwit irr the State of Florida designated by Owner upon whom notices or other documents may be :served -as providedaby Section713:1'3(1)(a7., Florida Statute`s, `` " Name, address and pttone`numbe 8. In addition to himself,`' Owners -designates the`=foilowing person(s) to,receive a copy of, the.Uenor'sSNotice -as providedin-Section 710.13(i)'(b) `Florida Statirtesc` -` Name addressandphone "number: 9. -Expiration- date'ofthIS Notice di Cornmencement - - -°(the expiration date Is 1 year fatal _the date of recording unless a different date is specified . WARNING TO OWNER. ANY PAYIVIEM'S MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENTARE CONSIDERED IMPROPER IPAYMENTS =U iDER-CHAPTER 713, •PART I, SECTION- 713.13. FLORIDA ' STATUTES, AND CAN RESULT1N YOUR PAYING-TWICE FOR JMPROVEMENTS -TO YOU PROPERTX, A NOTICE OF COMMENCEMENT MUST BEERECORDED -AND POSTED ON THE JOBS SITE BEFORE THE FIRST` INSPECTION. IF YOU INTEND 70 OBTAIN "FINANCING, C ONSULT WITH YOUR LENDER OR AN ATTORNEY ; BEFORE- COMMENC ING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. - Signat[1r (s- of,: a s ar t; Prepared By _ Print Name Airk _. 211 '11Ue/Offfce (�ituY'" )" Authorized: > Officer /Director/Partner/Manager Prepared By_- Print Name - Title /Office. STATE OF FLORIDA COUNTY OF MIAMI -D The fool Ding nstrurrren w " acknowlec g By cwire_en 1*777 before me this 7 day of ❑ lridividually or Cliati ' la ersonally known, or lI produced the following type of ide o ,;�.± Signature of Notary Public: - "�`;i 1, O ` ►r, ___ Print Name:ili�t i7,sa.ua ao: Under penalties of perjury, i declare thatl have read the foregoing and that the • tfacts- statedin it=are true, to the best of my'knowledge and belief. Signature(s) of Owner(s) or Owner.(s)'s Authorized Officer /Director/Partner/Manager who signed above: By By 123.01 -62 PAGE 3 3/10 Miami Shores Village, Florida BUILDER'S BOND Issued: 02/17/2012 Amount: $ 500.00 Bond #: 2110 Permit #: DS- 1 -12 -39 KNOW ALL MEN BY THESE PRESENTS, that I, ALEXIS BADA of SFL at 18550 210 Street MIAMI FL 33178 - in consideration of the issuance to me by Miami Shores Village, Florida, of a permit or permits to construct or repair a building or buildings at the following address: 561 95 Street Miami Shores FL 33138- do hereby deposit with Miami Shores Village, Florida, the sum of: $500.00 and I agree with Miami Shores Village that, when such construction has been completed by me, within the meaning of the ordinances of Miami Shores Village, I will clear all premises and repair any Village property damaged by me, used for the deposit of material or equipment in the construction or repair and that, if I do not so clear and repair such premises immediately upon the completion of such construction within the meaning of such ordinances, the Village may clear and repair the same and pay the cost of such clearance and repairs out of the aforesaid Builder's Bond, and retum the remainder to me; and that, if I shall clear and repair said property immediately, as aforesaid, then said Builder's Bond shall be retumed to me. WITNESS MY HAND and Seal at Miami Shores Village, Florida this date: 02/17/2012 Signature INSTRUCTIONS TO BUILDER: When the above mentioned construction is completed and the premises are cleared and repaired, take this bond to the Village Building Inspector and obtain his approval, after which Miami Shores Village will refund your money in accordance with the above agreement. VILLAGE BUILDING INSPECTOR'S APPROVAL I hereby certify that the construction contemplated under this Bond, has been completed and that the builder thereof has caused the surrounding premises to be cleared and repaired in as good condition as they were before commencing said construction. WHEN CLEARED AND REPAIRED BY THE VILLAGE: _- _- Amount-of Bond:- -- Cost of clearing and repairs done by Village: Balance due Builder: Cancelled: By: Village Building Inspector, Miami Shores Date Bond refund payable to applicant only. ($10.00 CHARGE IF BOND IS LOST OR DAMAGED) Rick Scott Govemor H. Frank Farmer, Jr., M.D., Ph.D. State Surgeon General February 08, 2012 (Sofia Landscaping) 18550 SW 210 St Miami, FL 33187 RE: Contingency Letter Application Document No: API060575 Centrax Permit Number: 13 -SC- 1391007 OSTDS Number: 561 NE 95 St Miami, FL 33138 Lot:20 21 Block:54 Subdivision: Dear Applicant: This will acknowledge receipt of an application dated 02/02/2012 for a permit to use an existing onsite sewage treatment and disposal system located on the above referenced property. From a review of your completed application, it has been determined that your existing system is adequate for the proposed use (driveway construction). If you have any questions on this matter, please call our office at (305) 623 -3500. Enclosures cc: Sincerely, Jose cialist II Miami -Dade County Health Department 1725 NW 167 St, Opa Locka, FL 33056 Phone: (305) 623 -3500 . Fax: (305) 623 -3645. http: / /www.MyFloridaEH.com FLORIDA DEPARTMENT OF HEALT Rick Scott Governor H. Frank Farmer, Jr., M.D., Ph.D. State Surgeon General February 08, 2012 (Sofia Landscaping) 18550 SW 210 St Miami, FL 33187 RE: Contingency Letter Application Document No: API060575 Centrax Permit Number: 13 -SC- 1391007 OSTDS Number: 561 NE 95 St Miami, FL 33138 Lot:20 21 Block:54 Subdivision: Dear Applicant: This will acknowledge receipt of an application dated 02/02/2012 for a permit to use an existing onsite sewage treatment and disposal system located on the above referenced property. From a review of your completed application, it has been determined that your existing system is adequate for the proposed use (driveway construction). If you have any questions on this matter, please call our office at (305) 623 -3500. Enclosures cc: Sincerely, Josep ecialist II Miami -Dade County Health Department 1725 NW 167 St, Opa Locka, FL 33056 Phone: (305) 623 -3500 . Fax: (305) 623 -3645 . http: / /www.MyFloridaEH.com STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATI N FOR ONSITE SEWAGE. DISPOSAL SYSTEM CONSTRUCTION PERMIT" _ Permit Application Nur'be1� <. ' Pit i -- 'I Yee. l'- (-PARTII- SITEPLAN - - - - Scale: Each block repres nts 10 feet and '1 inch = 40 feet. to Notes: fy ai _,y � p^ �— �� 9 a �� E Gael • Site Plan submitted b Plan Approved By 1 Signature Not Approved P irr r4ellf Date r t) C County Health Department ALL C E MUST BE APPROVED By TH k(1( uNTY HEALTH DEPARTMENT DH 4015, 10/96 (Replaces HRS -H Form 4016 which may used) (Stock Number. 5744 -002- 4015 -6; STATE OF FLORIDA} DEPARTMENT OF HEALTH APPLICAT. N FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Nur ber -�" ,y t ` -- -PART II - SITEPLAN Scale: Each block repress nts 10 feet and 1 inch = 40 feet. MillIMMOMMNIIMMEMEMMEMMEMEMMEMMEMM MEMMEMMEMMEMMEMEMMEMMEMMUMMMERM MMEMMEMMEMMEMORNMEMMEMME MEMEMEMEMMMEMMEMMEMMEMEMEMMEMM MMEMMEMMUMMEMMINIM s NMEMMEMMEMMEM MINIMMEMEMMEMMEMEMMEMEMEMMEMMEM i v, MEMMEMEMMMEMMIMMIIMMEMEMMEMMME Notes: Site Plan submitted by: Plan Approved By Signature Not Approved, Date i w County Health Department ALL CH NGES MUST BE APPROVED By THE-c UNTY HEALTH DEPARTMENT DH 4015, 10/96 (Replaces HRS -H Form 4016 which may be used) (Stock Number: 5744 - 002- 4015 -6 Page 2 of 4 Miami Shores Viivage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT #: Y I DATE: % »/tx,3 4,141 \ Contractor ❑ Owner ❑ Arch' cked up 2 sets of plans and (o her) Address: 1 5-- From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. log) Acknowledged by: Sae PERMIT CLERK INITIAL: RESUBMITTED DATE: PERMIT CLERK INITIAL: www.sunbiz.org - Department of State Page 1 of 1 Home Contact Us E- Filing Services Document Searches Forms Help Previous on List Next on List No Filing History Return to List ictitious Name Detail ictitious Name FL Filing Information Registration Number 609000172634 Status ACTIVE iced Date 11/06/2009 Expiration Date 12/31/2014 Current Owners 1 County MIAMI -DADE Total Pages 1 Events Filed NONE EI /EIN Number NONE ailing Address 8550 SW 210 ST IAMI, FL 33187 wner Information OFLA LANDSCAPING, INC. 8550 SW 210 ST IAMI, FL 33187 EI /EIN Number: 26- 0438906 ocument Number: P07000069211 ocument Images 1 06 2009 -- CANCELLATION ' E- REGISTRATION Note: This is not official record. See documents if question or conflict. Previous on List Next on List Return to List No Filing History I Home ( Contact us I Document Searches I E- Filing Services 1 Forms 1 Help I Copvriaht© and Privacy Policies State of Florida, Department of State Fictitious Name Search Suk Fictitious Name Search http: / / www.sunbiz.org/ scripts /ficidet.exe? action = DETREG &docnum= G09000172634 &rd... 2/10/2012 - """"1) SOFLA -1 OP Kt KS A °� CERTIFICATE OF LIABILITY INSURANCE I PRODDIWYY) a ) PRODUCER Ling Risk Management, LLC 2100 Ponce de Leon BIVd, #601 Coral Gables, FL 33134 Alex Garcia 305-648-2445 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC 0 INS /GOVERAG SOFLA Landscaping, Inc.(SFL) Alex Bade 18550 SW 210 St. Miami, FL 33187 INSURER A: Western World Insurance iNsuRERa: Associated Industries lnsuran INSURER C: INSURER D: INSURER F THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE IN /RED 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 CONDfONS OF SUCH POLICIES. AGGREGATE OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TVPFAPMCI Anne POLICY NUMBER rwavn�n+vnwn lan nw N LIMITS A GENERA. LIABLIT! c'OMU&i ciAL GE um& LIABILITY NPP12e5049 11/17/11 11197/12 EACH OCCURREWM 1,000,00C X DAMAGE FO RENTED PREMISES IEa ocuuenp] $ 100.000 1 CLAIMS MBE X OCCUR MED EXP (Arty one person) $ 5Alt PERSONAL & ADY INJURY $ 1,000,001 GENERAL AGGREGATE $ 2+000,00C GENL AGGREGATE LIMIT APPLIES PER: POLICY' AT IM n LOC PRODUCTS - COMPAOP AGO $ _ 1,000,00C —1 AUTOMOBILE — L1ABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS .. . COMBINED SINGLE LIMIT (Ea accident) $ — — BODILY 'R&M, (Per pew) $ BODILY MIRY (Per accident) $ — — PROPERTY DAMAGE (Per acciderd) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS /UMBRaLAUABIL TY Ell CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ DOCCUR AGGREGATE $ $ $ B WORKERS COMPE SATION AND EMPLOYERS' LIABLRY ANY PROPRELORIPARTNER CURVE YaANNC1005845 OFFIriER/MEMBER aUD ®4 (Mandatory in NH) If yes. describe under SPECIAL PROVISIONS below 11/19/11 11/19112 WC STATU (OTH- I TORY LIMITS 1 1 ER E L. EACH ACCIDENT $ 100,0C1 E.L. DISEASE- EA EMPLOYEE $ 1 (X)+ El. DISEASE - POLICY LIMIT $ 500.E OTHER DESCRPTIONOF OPERATIONS / LOCATIONS /VE ICLES! EXCLUSDONS ADDEDBYEdDORSEMENT !SPECIALPROVISIONS LANDSCAPINGIPAVERS CERTIFICATE HOLDER CANCELLATION Miami Shares Wage 10050 HE 2nd Ave Miami Shores, FL 33138 SHOULDANY OF THE ABOVE DESCRIBED POLICES BECANCS.LED BEFORE/1W EXPIRATION DATE THEREOF, THE ISSUING R WLL ENDEAVOR TO MAL at_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR UABILITY OF ANY KIND UPON THE INSURER, RS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Alex Garcia Amon 7A f7Ntll�nll St IRRIL7MIA Arlan tlRPfRAT(flM All rink *a raaarvarl Pc LE _ or I `.'"1 T4&\31:: 91- 1:-...csd. cY.4 E 4'E- ° Et. • E R __..._ Miami Shores Village APPROVED BY DATE - * 111 2- 7-CNN GIDLE:. • -----1- _____ ...._ CMPLIANCE VVIPH ALL FEDERAL i 1 ,UN 1 ( RULES AND REGULATIONS SUBJECT 1 ' S TATE ANL) 1- t r, t k,Nc CC^,1?./TY F LT> pLt.T 'Lew- Acc.dp, VED MIAMI-DADE COUNTY HEALTH DEPARTMENT 't PERMIT #: fil> 7 5- 9 5 Ti4 /71.13 DATE: c