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EL-12-1127 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 n , Inspection Number: INSP-174988 Permit Number: EL-6-12-1127 Scheduled Inspection Date: October 08,2013 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: FERNANDEZ, DENISE Work Classification: Addition/Alteration Job Address:1077 NE 96 Street Miami Shores, FL 33138- Phone Number Parcel Number 1132060143680 Project: <NONE> Contractor: ALES GROUP ELECTRICAL CONTRACTORS Phone: (786)244-0004 Building Department Comments RELOCATE AND NEW WORK 07/08/2013-PERMIT EXTENDED PER LAST APPROVED INSP. Inspector Comments Passed Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 07,2013 For Inspections please call: (305)762-4949 Page 1 of 34 J °° A q I Miami Shores Village JUN x 2 11i 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 FBC 20 ,l BUILDING Permit No. PERMIT APPLICATION Master Permit No., Permit Type: Electrical JOB ADDRESS: l U�� 'J 'R G+ ` City: Miami Shores II �County: Miami Dade Zip: `5-3 1_35 b Folio/Parcel#: I '3-0Co "U l`t'.° o l5 Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder):. .) 0 1 J{i L- T f'�4 6��Z Phone#:3�` a- Address: N E 9(e G+ City: H 1 C, mores State: Y Zip: '33 1.3 W Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name:l c'(— (f� 1,� 1 I ( Phone#: Address: SSCO 6,0 -I( AVIc ,City: 4 ckvv\'\ State: �l Zip: ?X31WO Qualifier N�Tatne:. , t26t o tlj ,�V'le.VA e—- ` y Phone#: State Certification or Registration#:_EO f ZA 15 Certificate Hof`Competency#: C rnctZggeEmail Address: Ljks ele& t -+4C_ (! mat � e 60�t i 4 i.i tFl NEYt Arclutec En �teer a as Phone# r !e�i IYP;cud tatea�qty i®� M �� '` TO V Square/Linear Footage of Work: f or k: A dress. p,OA1traicjn ONew ORepair/Replace ODemolition Description..of,Work. �A6� � -z-`. 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$ 9 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 Ito 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 t be approved and a reinspection fee will be charged. Signature e Signature caner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of I ,20 t�,by day of ,20 by lZfAw�aotJ t u- , who is person known to a or who has produc (34 — q�,n%0k who i rsonally kno o me or who has produced idenrifica a1 wk- ioo .•""' '�., JENILEE ECHERRI NOTAR NOTARir �'y Notary public.State o1 Florida MWWv a My Comm.Expbea May 9,2014 C�#Im 989839 Sign: 'rys"" Sign: "'�'`� Noted An Print Print: My Commission Expires: (�� 1 �! My Commission Expires: s". jq ,7,004 APPROVED BY 1,/),R"2- Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) :�• u. � Miami shores Village wilding Department OR 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$30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. y COPY OF QUALIFIER'S STATE LIC CARD B. ✓ COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE(CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. V OF WORKERS COMPENSATION(EITHER CERTIFICATE OR EXEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL.CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE(CERTIFICATE HOLDER MUST BE MIAMI SHORES.VILLAGE BLDG DEPT) 0. COPY OF WORKER COMP INSURANCE(EITHER EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 ■■■r■rr■■■■■■■■r■rrr■■■■■■■■■rrrrrrr■■■■■■■■■iarrraa■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■Y,1�■■■■, COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: -�S terra Lac-{ri`cc, Lty, {rAV BUSINESS ADDRESS: Vi cr" 1gv-e CITY STATE FL ZIP CODE �3 L L4 -( BUSINESS PHONE:( 30!5 ) 3(0!5-- S739 FAX NUMBER GeEJ '2,(07- CELL PHONE(2ft ) 2-2-71 - Ga9 e, QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: F-�'G M O 1 Z Y E-MAIL ADDRESS(IF APPLICABLE): Created an SH9109 BY MLDV 1 RV 8128109 MLDV III 5 9 7 9 5 8.2 TAT oF `oR DA. b$FA>:t OF• 8II5=NE:�S A'D1I3. FR.dF3�SS=t)II�iL• F:�'G-�V•L3+.T=ON CTRICAL CONTRACTORS LYCI3�SI�TC:$CaA�2T3 SEQ#L12023300962 DATE 6ATCH NUMBER I, CENSE N8 - 2 I3 he ELECTRICAL CONT1iACT0R aced below IS CERTxi'I,FFr3 nder the prwvisions of -.Chapter•,:*89 8, :, :;, •;_; 'ou date: AUG 31, 2012 LO,REWTE,. RAMON' ::.:,.,::.- ALES- GROUP 'ELECTRli-A-•L' =CQRTAXCTOR 896 SW 70T11 AVMNUE MIAMI FL 3314 RIM SCOTT _ .. KF�1 LAWS©N GOVERNOR _ ';, SECRETARY _. •. , .. _.__--------••_-•-_ ._ .-..,,..,.,DISPLAYASREQbIREDgY1A.W ' i ' I �I • • # MIAM14DADE COUNTY Mt LOCAL BUSINESS TAX RECEIPT 2012 FIRST-CLASS TAX COLLECTOR MIAMI-DAM COUNTY-STATE OF FLORIDA U.S.POSTAGE 140 W.FLAMER ST. EXPIRES SEPT.80.2012 PAID 1st FLOOR MUST BE DISPLAYED AT PLACE OF BUSINESS MIAMI,FL MIAMI,FL 93130 PURSUANT TO COUNTY CODE CHAPTER SA-ART.9&10 PERMIT NO.231 6 5088-6 THM IS NOT A BILL—DO NOT PAY NEW 722657-4 "uILTO MAWWWOTRICAL CONTRACTORS STATff%5%1288 896 SW 70 AVE 33144 UNIN DADE COUNTY OWMES GROUP INC 8"jW1 ejE&"fftCAL CONTRACTOR W0RiCE /S '/"B IS ONLY A LOCAL SLIMNESS AX REOMPT. OO T PER W 6 IM TO VIOLATE ANY Z VM� a°� TW DO NOT FORWARD court" an ornia T" Houmm,�,,,MY ALES OROUP ELECTRICAL CONTRACTORS ,ems®e°rR DAVID CONZALEZ NOT A CEIMFICA'r N OF 896 SW 70 AVE T4&HHOLDEIM OUALIFICAr MIAMI 'FL 33144 PAYMM RECMY90 tffAMZAMCOWMTAX q 022©/2Q7.2 ' 0226QOIQQDI QQU07 .00 isIII,,Jim J11 1:s Ili 1,4 sle:1s1hi3Isl(ssh11114*jh:huif SEE OTHER 810E _ i I , I �► oc ©® CERTIFICATE OF LIABILITY INSURANCE 6�I§/oil THIS CERTIFICATE 13 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 T14E 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 he endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the potieys certain policies may require an endomement, A statement on this certificate does not OCnfor rights to the certificate holder in Lieu of such endorsemant(s). PRODUCER N AGT-)`eray CampuZeno Fcrtun Insurance, Inc. PHONE , (305)445-3535 P'° (sre)azs-os25 hgb 365 Palermo Ave. E $,mercy.campuzano$fortmm nsurance.com INMJRE1451 ArMDING COVERAGE NAIC S Coral Gables FL 33134-6607 INISURMABrid field Casualty Insurance INSURED INSURERS: Aloe Croup, Ino.,dba Prolook & Safe dba Ales NSURERC: Group Electrical Contractor. INSURER D: 896 SW 70 Aire INSURER E I >~2i.ami FL 33194 1 NSUR F, COVERAGES CERTIFICATE NUMBER:CL1241803901 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTCD BELOW HAVE i3o-N ISSUED TO THU 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 CCRTIFlCATE MAY 13E 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. INER LTR TYPE OF INSURANCE POLICY NUMBER Y 1u�Mtp LIMITS GENERAL LABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY P MI E RE g CLAIMS-MADE 0 OCCUR MED EXP mm pawn) 5 PERSONAL&ADV INJURY S GENERAL AGGREGATE S GERL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP)OP AGG S POLICY F1 RRO LOG S AUTOMOBILE LIARR ITY BIKED IN mL LIMIT ANY AUTO BODILY INJURY(Pergsron) S AUTOSS A�IOSULED BODILY INJURY(Per acdaent) e HIRED AUTOS ALIT'ED PcrcPxiGa C'E a UMBWLLAUAe OCCUR EACH OCCURRENCE S EXC[SS LIAe HGLAJM5-MADe AGGREgATB S QED I I RETENTIONS S A, WORKERS COMPENSAMON VY0 ETA p AND EMPLOYERS'LIABILITY ANY PRDPR;ETORfPARTNERMx9GUf VE YIN EL EACH ACCIDENT S 1,00R,000 OFPiCERlMFJdDER EXCLUDED? ❑ N 1 A (My4nadtory In NH1 196-39 067 !X2/2412 /12/2013 S L DISEASE-EA EMPLOYE S :1,000,000 DESCRIPTION 0 OPERATIONS below E.I.,PmEASE-POLICY LIMIT a 11000,000 dasail. DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHIeLES(Attach ACORD 101,Addlgogal Ramada Schedule.It more spare In mquUetl) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED OF-FORK THE EXPIRATION DATE THEREOF, NOTICE WRL BE DELIVERED IN Miami Shores Village Bldg. Dept. ACCORDANCE WITH THE POLICY PROVISIONS, 10050 NE 2nd Ave I Miami Shore, YL 33138 AUTMORPMOWRESENTAWa Cy Campuzano/JG ACORD 25(2010/05) 01988-2010 ACORD CORPORATION. All rights mserved. IN(s02617fHtm!<,n9 The Arnon ns mp and Innn am rani at^rarl rxorrrc of acylpr1 I CERTIFICATE OF LIABILITY INSURANCE DATE{MMroDlYYYY) 06/19/2012 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 poilcy(les)must he endorsed. If SUBROGATION IS WAIVED,subject to the tens and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the fartif)cate holder In lieu of such endorsement s. PRODUCER NAME NAT WIL 5 ALLWAYS INSURANCE or FLORIDA P"°NE mi,306-944.4868 FAx Nc:306.944�Bt39 _ 2020 NE 183RD ST 0104 EOM Y111 II. NATLLIS LLWAYSINSURANCE.NET NORTH MIAMI BEACH KWRe S AMRDINGCOVERAGE NAIC0 FLORIDA 33182 INSURERA:ATLANTIC CASUALTY INSURANCE COMP. INSUREn INSURER B:INFINITY Ales Group Inc d/b/a Ales Group Electrical Contractor nasuRERD: 896 SW 70TH AVE INSURER D, MIAMI,FL 33144 RI$UMRE: 1NSVRER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS tS 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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. lLT R TYPE OF INSURANCE AWL UVISM LTR CY N MARR DI m EXP UMIT3 I t,ENmRAL LIABILITY EACH OCCURRENCE $1,000,000 �X(OMMERMALGENE�GILITY L160000245 06130111 06/30112 PRE °) $300000 TT CLAIMS.MADE X OCCUR MEQ E)(P acre penlonJ $10,000 ;� �... DED:$250 PERSONAL s.AOV INJURY $1,000,000 _ QENERALAGGREGATE 02,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•comp PAGG s2.000.000 I POLICY F71 PRO LOC $ '..AUTOMOBILE LIABILITY D SINGLE IJ ANY AUTO 609560607381007 7J24112 02/24/13 OILY KI $1,000.000 .. ZtOS FD SCHEDULED BODILY INJURY tPer trelsoll) $ BODILY I W URY(Pet eoddent) $ X HIRED AUTOS X NON OWNEQ PROPER GE AUTOS P $ 8 i I UM8RE1„LA UAB =UR EAOH OCCURRENCE $ -�ExGESS LIAR CLAIMS.MADE AGGREGATE S I DED RFTE S 5 WORKERS COMP00ATIM TATU• OTH- - I!AND EMPLOYERS'UABILrtY ANY PROPRIVT0R(PARTNaMEXECUTIYE YIN E.L.EACH ACCIDFNT $ .OFFICERlMEMSER EXCLUDEC)? F NIA {JJf�nd! N NN) If yaS.deSCIIho Untlar EL CISEASE_EA EMPLOYE $ DESCRIPriON OF OPERATIONS bgow E.L.DISEASE-POLICY LIMIT S I DESCRIPTION OF OPERATIONS I LOCATIONS r vENICLES(A@ach ACORD 101,AddWwksl Remarks Schaduta,n mono zpw III mquked) CERTIFICATE HOLDER CANCELLATION Miami Shores Village Bldg.Dept SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE T14F EXPIRATION DATE THEREOF, NOTICt_ WILL BE USUVERED IN 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shore,FL 33138 AUTKURmED R&RESmTAmm ®1988-2010 ACORP CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORO name and logo are registered marks of ACORD 10/16/2�0Jj12 02:24 3058299109 SAADHOMIES PAGE 02108 -,6#628750 STATE OF FLORIDA i I)BPAR $TCA �D�CTORC �$OARTZON Tai W L12082102576 N8R ( 08/21/203-2. �.a804689s B. Tb.e BLECTRXCAL C01'q 7ACTOR Named below .Ts C� T.Xpx Under the pxav ,aJoas o 1'ek. ter 480 %.FS. LxPiration date: AV9 33.,. 30 4 U66 -BuicTpatim .C+ TRAeTop 896 SW 70TH 1�VFWE ; Mimi YL 33144 SCOTT . ' Via-COT ."' R81�1' LAwSOM SIRCART'ARX 10116/2012 02:24 3058299109 SAADHOMES PAGE 03108 Ae County - Local Business Tax -Payment Process Page 1 of 1 ' MIAMI- JADE COUNTY* -- LOCAL BUSNE� SSS T Sec�rr+� Pay Your Luca[ Business 1-ax Please print this {page for your records. You will receive an a-Mall confirmation containing this payment information within an hour. CONFIRMATION Of PAYMENT Receipt Amount Due: View Number: Details; 722657-4 $82.50 Payment Date: 10/09/2012 Payment Time: 15:40:16 EDT AlnmOunt Paid: $82.50 Authorization Plumber: 282191815 Account Holder Name: Ales Group Inc e-Check Account Numbers xxxxxx4598 Routing Number: 067014822 Confirmation Number: 40488353 j Waln Wags Copyright 2003 Mlaml-Dade County.All rights reserved, PrIv�c NdlECv Y 10/16/2012 02:24 3058299109 SAADHOMES PAGE 04/08 k CERTIFICATE OF LIABILITY INSURANCE 0wVV4MMlQ THIS OERTIFICATIR IS ISSUED AS A,INATTPA OF INFORMATION oN1.Y AkD WNFERS NO RIOWS UPON THE b#ftTwIcATg KO©M TIUS CERTIFICATE DOSS NOT AFFIPMATNELY OR NwA'tIVELY AMEND, E)CCiEND QR ALTER THE CIC+VE?RAGE AFFORt�1:0 8Y THE txOl.IG1E$ BELOW. THIS CISRI'►FICATE OF gEg ?,pN+l„E pp�, NO? CONSTITUTE A CONTRACT BETWEEN THE ISSLgN6 1NkSUR�51, AUTt1oR17:E[s REPRESETATPM OR PROOU , C19%AND THn CERTIFICATE HCHME IMPORTANT,, If th@ cOrWM to holder ie etn AO TIONAL INSU RM tho poliey(Iee}most be eandotsad. !f SfJ ROGATION is WAiVEa,subjracx t MO t6r1>'1s4 9111 W11101orlm of the policy,e®ab poTmim may►squirt art*rwQfBeBfAr* A stiku m a 4A thIg cartiliiuBW daft DO reefer rlghth to the 06141Ncate holder in lieu at such endcrnnLenl{s1. wROOUCr:RGT ZllL KA VELA ALL>aIlAYB INSURANCE OF FLORIDA � 306-944��19 2020 Ne 161RD ST#jc4 sae NORTH MIAMI REACH A L1LEIICAVEt,p L�WaYS1NsLtRANIrE.NET FLORIDA 33162 c rluma: A n"URED A- Alas Group Inc d161E Ales group l;Iactrlcal carrtractar �u►�xe.INFINITY 896 6W 70TH AVE a MIAMI,FL 331" r�VHERE: COVEAAi ES 01MOICATE NUM9Ei2: REVISION NUMBER, THIS is To INDICATED,ONROTWITHSTANDING POIJOI ANY REWIPAMENT TERRA OR CONDITION OF AENYY CONTRACT OR 40THEERR DOCUMENT WITH Rk3PMCT TO VYMC14 PERIOD EXCLUSIO GEATIFIQATE& MAYO t MOOS OR MAY pOUGIE THf:INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SURWSCT TO ALL THE TEI@MS, EXGLUSro_ N5 groo cCNiSITfONS OR suCFt POLICIES.LIMITS SNOVVN MAY HAVE BEEN REDWW BY PAID CLAIMS, �Y?E OF IIV6llNhNC$ �. N ,=NMALUA8IWTr Lvar8 I<�MIBl�7ROIAL GENERAL WtN ITY i30H2 d/13 enc�F 000 A $1 000 000 L15000024l5 . OLAi@ .MAIyg {�=IN 4300 DER:,� MEDEXP IA�yonapeetan s 0 000 —�• P@RSOg%A AM INJURY 1 00 000 J GRAL TE a oao 00 6E�N'L aO�EGATE LIMITS APPLIRS PfiFC vU6(iil LOC -COMPIOPAM ! 00 000 aUT�Mp1111-R 4rr�r,I7y S Sr3riEDUL6� 77-tt M9 eor}ILYf�i�wwarr g1O X t�oILYINIURrSPeraooid+an} S K�RsDAUSos � UhMM ,4%9 =VA s C-MMUAe r [MS.LrA� oGCURRENCE Lit- AGGREGATE GATE g 1NDRN @R544MPP,ryBA71pN @ .. aNG @MPr.OYEPX UABn.ITY RRNEMBEBERR n u0SI VE YIN 14!A Im—laeag rA"H) EACH ACd 9 4`E�OMPPTOKOFa' tY &"15 FAF-NIPL�IE ! -PQ4JCYUaoT S DESCR1PT10N pp¢P@Rq'I101�/LACA7fONS I7rEi@0.E3 I41EacF+ACQItD 7llr AdAlllatsd Remoevs 9+�elrds,if mmc Spam r8 f9Qukf� CERTIFICATE HOLDER CANGS-1ATION Miami Shares ViRalga BhMg.Deist. BNWLOANY OF7WABOVE DESCRIBED poLrAM BE i^AWMjXD JIMRS 10060 NE 2nd Ave TK El(PIMMM DATE THM0t, NOTICE WILL BE DELIVERF13 IN Mistni,FL 33130 A CRDANCB WrfH THE POUCYPROVr910N& AUTHOR=afr9we nAvvii ZULEIM VU A AGORG 25(2014105) TheAC et ORD namaartr11990 Bra rogl and nmrirs oA1OOL4p Rt'QRP�TION, All tights r19�ervea, 10/16/2012 02.24 3058299109 SAADHOMES PAGE 05/08 CERTIFICATE OF LIA13II,.11Y INSURANCE 130 CE 6/19/2012 TF1I51 CERTIFICATE h9 ISSUED AS A MATTER OF IWORMATION QNI,Y AND c*NFEAS No 143GNT9 UPON T4fJa GER77FICATB MOW£li TWIS cERTIFICATB DOES NOT AFFIRMATIVEI.'t OR NEGATIVELY AMID, Err Olt AIXER THE COVERAGE AFFORDED BY THp POLICIES 6EL01N, TH19 CERTIFICATE OF INSURANCE Dog$ NOT GDNSTITU M A CONTRACT DETIAt EN THE ISSUIN3 INWRW:Bg AtITNORMED PRESENTATIVE OR PRODUOM AND THS CERTIFICATE HaLagk I IO IR TA[YT: If the ooas oats bohdor is an ADDITIONAL iNSUPIF.M,f11e polltypas Irlost DB andufted. X SUGROGATIQN IS WAI D=suBjud to 1118 ten116 dntl consllflolls>f of the policy.ftrb&PallciaM BOY Faqulra go endolsamand, A ftftlnent on flare woflcats Saes n8!oa�br�Ights�the Caudal la holder in Item*f such andorr.wn e PIT�UGI3R CONTACT �tZ9�fl lax t11n 2a8>,ia:aiice, rue. wl� {805)445-23as F 965 Palermo Ave. Iseslais-QUA p m9Y`�•C�1�7udIIEi�gQTv�VT�$LlSant�o_Y►� Coral Cables l:'1'. 33134-6607 a»t �CO�°E raw �vsusden a:S,ti'i. �.e�8 eas zT19'4'II�IIClt� iA,7 es Gxv 0 �, xac.,dba lNee.�a� S Spa dlan Ales A. Groin Rlmn'tri-2- Cont+racwv. 896 9W 70 Ave WAMD! M3.at0.lt ILL 33144 s= CAVEFEAGES CERTIFICATE NU MME 803901 F• ak"Iri#4IaN NUMGER• THIS IS O cElttlrr THgT THE 54uc1EG of INSUUMM LISTED B�LQW ts��TO yTl�6 INSURec�n�aatiD Aeovc (NDICATRD. NBTWITHSTANDD ANY Y REQUIR19NIENT,TH TERM Ora GMITION OF ANY CONTWT OR OTHER ROCUMENT WITH RESPTF-CT To vwtCH TT" GteRTIFICATE MAY I3F ISSUED OR MAY rERTgIN,THE INSURANCE AFFORDED BY THE POLICIES DFSCRIAEO HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS DP SUGH POLICIES.UMIT8 SHODUN MAY MAYS BEEN RI°AUGED BY PAm CLAIMS, TR 4YP4dRwsuwAlVcB T%3U r-WdaL UAtQR.rrr urrflf6 CQ1fe ..VA1 GlVE:Ci4i.WAEU,ITY E+iCpl voGURRCN ; CLAM-MAN Q CCCyR 5 hdED exP Alryare percent s FFMWaML IL AW INJLW g "N'L Atd M0ATE L*1T-PL1E3 PERt MPPA1.AGGREGATE: g y Cr —LQ PRQGUCTS-CUMPICPAl'rla 5 ALROMOM UAWEITY $ VILY s E I.IIYp ANrpAyt�fT�O uan ALjQ -0 1 n MMD AUTOS IM1LRIRY(Perm term S rxcsG PAMAGE S UMBREUA LIAR O=UR FJlCE55 WA6 � EACM 00 tgngNM E AGGREGA}E A WGINKEM COMM AND EWWRM LM91UTY TYC STA FRID�eGt7i7V8 YIN �Np NIA 156-31057 >~LEadiACGlt T f 140 AA 1Mya�ntl6tgogpy�yoyN0 /'12/2012 /7zJ2ui9 oESCR�P7T�u OP OPERATWN8 Demo �.L WSFASE.t�v g 6DD A0A EL.MiM uulr S T Dora Oa COCRWFML1PGp0i 710NSILMAT10N81VENCLES~ACOAD141.AddM�al RWt7�sSGl�edu If ►�. 1110/980riM iA:a�,4t� CE 7iFICATH HOLDER A MQELI AT1c7N "USA ANY OF TPM AWV6 0180MBED POUCIB"S eE CAIiIGE1.LEp USPORE THE EO R M7101t DATE Tfi6FiM,iF, Nneig WILL, Be aEI,I D 11I . 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