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MC-10-1434 Invoice Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Fax: (305)756-8972 For Inspections please call: (305)762-4949 eturn to: Miami Shores Village Invoice Number: MC-8-10-38651 10050 N.E.2nd Avenue Invoice Date: August 10,2010 Miami Shores, FL 33138-0000 Permit Number: MC-8-10-1434 Bond Number: Bill To Comments: I I MIAMI SHORES CHRISTIAN CH INC 10150 NE 2 AVE MIAMI SHORES, FL 33138-2342 %1, woidlwkgmt m RM kmy \ Date Fee Name Fee Type Fee Amount 08/10/2010 Scanning Fee Calculated $3.00 08/10/2010 Permit Fee Percentage $474.00 08/10/2010 Technology Fee Calculated $12.80 08/10/2010 CCF Calculated $9.60 08/10/2010 Education Surcharge Calculated $3.20 Total Fees Due: $502.60 a i Payments Date Pay Type Check Number Amount Paid Change 08/10/2010 Cash $50.00 $0.00 08/11/2010 Check 9624 $452.60 $0.00 Total Paid: $502.60 I Total Due: $0.00 I _ ;s t Wednesday,August 11, 2010 I IBM 1111111111111111111111111111111H11111 OR 8k 27403 Ps 1 n1 P Ups) NOTICE OF COMMENCEMENT RECORDED 0E/30/2010 11=24:13 �.. A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION MIAMI-DOE iii.JilIidr CLERK TY P OF .I::DA 11IAPiI-DAI'aE GD#!i'fTf: FLORIDA LAST PAGE PERMIT NO. DILL-ILI-JB2 TAXFOLIO NO. 11-3266613185'® STATE OF FLORIDA: COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby gives notice that Improvements will be made to certain real property,and In accordance with Chapter 713,Florida Statutes,the following Information is provided In this Notice of Commencement 1.Legal description of property and street/address:/y a(IRS f}j S hes ize S CrR i ST t AM ft c' 10150 WF_ 2 Acv MIAMI `abbey-S F"+ ,3313$ -23'"'I 2. Description of improvement: 3.Owner(s)name and address: ` SF1m Ir Interest in property: Name and address of fee simple titleholder: 4.Contractor's name and address: -rrn f, b i g 1r r L A L z e is 3>e E� 3330 5.Surety: (Payment bond required by owner from contractor,if any) Name and address: Amount of bond$ 6. Lender's name and address: 7: Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida statutes, Name and address: S. In addition to himself,Owners designates the following person(s)to receive a copy of the Lienor's Notice as provided in Section 713A3(1)(b), Florida Statutes. Name and address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a di nt da ecifi Sign a a of Owner y Print Owner's Name W ' I �' CHICI CWtC4repared bypCGd�6 ' Sworn to and INa scribed'before is day of ,20-10 �T, �y dress: (I '� ✓7 fc.'_e Notary Public , ° C �j 1­In /f y�//_ 3�yc Print Notary's a ,b 9 My commission expires: azx�s' coo 123.01-52 PAGE 4 8/02 •g� STATE OF FLORIDA,COIJWrY OF DAME i HERESY CERTIFY that this is y of the ,write c® co vdglnal filed in th on �° AD20 �' y a VWTNESS my hand 8w of Seat. County COWS HARVEY RUVIN,CL C BY D.C. , r Miami Shores Village �IU�` d 02010 g Building Department ......... 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fag:(305)756.8972 INSPECTION'S PRONE NUMBER:(305)762.4949 BUILDING Permit No. (A - MLi PERMIT APPLICATION Master Permit No. FBC ZO Permit Type:MECHANICAL. OWNER:Name(Fee Simple Titleholder):MOM d &KES &ISTI/t AG RL=LPhone#:(S,n5)75 9 m()-2 14 Address:_1615 0 K(L 2m ;p Ave" City: (W Sher F.�5 State: Zip: 3313 8 Tenant/Lessee Name: Phone#: Email: ed&I e, -372, horrnp t . C& r JOB ADDRESS: t; a City: Miami Shores County: Miami Dade Zip: 3313 Folio/Parcel#: -,3a n 6 4) 1 -,31 k 5 Is the Building Historically Designated:Yes NO Flood Zone: CONTRACTOR:Company Name:6D snica yQ ti p e-F!n ce , -I Q O Phone#:6 5 4D.36 -/426.1 Address: 2_9 W. E .r-n a A h i- l 0 1*1 City: Fr L-a ud eP,?A1 e State: FL zip: 30 Qualifier Name:M V C h n P-1 R \6 Q,tk Cz I N ® Phone#(cry )s Li gi -7a-5.5 ° c- State Certification or Regiisstration#:_CHC(11!j q 4!j Certificate of Competency#: Contact Phone#:�� A - A Email Address: b y a C Q Ire a(� AO 1 . O-Q i '-) DESIGNER:Architect/Engineer: Phone#: ° Value of Work for this Permit:$ 15 908 a () Square/Linear Footage of Work: ° Type of Work: DAddress DAlteration ONew d EWepair/Replace ODemolition Description of Work: jy�`MaV e- CL-D l5 In After Il�rt�ffei3p1e2. at a4Un.E&1SA"G L)MOr ' 3r DN4T ,A�� o E _ P� ������.P�1'°B�fai . Sop iai 4- n43SIAd1 MEN' yaw 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$ 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. Si nature g Signature ?Owner or Agent IPA Contractor `\ The foregoing instrument was acknowledged before me this V The for going instrument was acknowledg�ed�®before me this ` (� day of ,20��,by day o ,20 A,by who is personally known to me or who has produced r !/ who is personally known to me or who has produced As identification and who did take an oath. as identification\01w bid take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: - Print: ���� Q'; i t B' @^�'�''•° Print: 106/2012 _ ��} My Commission Expires: _ = My Commission Expire*y PUBLIC I - u, ssion T* )i APPROVED BY w +�\0 plans Examiner Zoning Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) A Uedificate of Product Ratings AHRI Certified Reference Number: 3639192 Date: 8/11/2010 tStatus: Active Product:Split System:Air-Cooled Condensing Unit, Coil with Blower Model Number:38AUZA16A0*(5,6,1)A* Indoor Model Number:40RUAA16A1A(3,5,6,1)A* Manufacturer: CARRIER AIR CONDITIONING -COMMERCIAL Trade/Brand name: GEMINI SPLIT SYSTEM WITH PURON REFRIGERANT Rated as follows in accordance with AHRI Standard 340/360-2004, Commercial and Industry Unitary Air-Conditioning and Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, Independent,third party testing: Cooling Capacity(Btuh): 180000/180000 EER Rating (Cooling): 11.00/11.00 IEER. 112/11.2 Heating Capacity at 47F(Btuh): COPat 47F: I He tlrtg-Capacity at 17F(Btuh) �. COP at 17F: Ratings followed by an asterisk(*}Indicate a voluntary rerate of previously published data,unless accompanied with a WAS,which Indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s)fisted on this Certificate and makes no representations,warranties or guarantees as to,and assumes no responsibility for, the product(s)listed on this Certificate.AHRI expressly disclaims all liability for damages of any kind wising out ofthe use or performance of the product(s),or the unauthorized alteration of data fisted on this Certificate.Certified ratings are valid only for models and configurations listed In the directory at www.ahrklirectoryorg. TERMS AND CONDITIONS This Certificate and Its contents are proprietary products of AHRI.This Certificate shall only be used for individual,personal and confidential reference purposes. The contents of this Certificate may not,in whole or In part,be reproduced;copied;disseminated;entered Into a computer database;or otherwise utilized,in any form or manner or by any means,except for the user's Individual,personal and confidential reference. CERTIFICATE VERIFICATION The Information for the model chad on this certificate can be verified at www.ahridirectotyorg, "IMF, Air-Conditioning,Heating, click on"Verify Certificate"link and enter the AHRI Certified Reference Number and the date on and Refrigeration Institute which the certificate was Issued,which is fisted above,and the Certificate No.,which Is listed below 02010 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 129260303090290568 i V(L P. a Uertificate of Product Ratings AHRI Certified Reference Number: 3639192 Date: 8/11/2010 tStatus:Active Product: Split System:Air-Cooled Condensing Unit, Coil with Blower Model Number: 38AUZA16A0*(5,6,1)A* Indoor Model Number:40RUAA16A1A(3,5,6,1)A* Manufacturer: CARRIER AIR CONDITIONING -COMMERCIAL Trade/Brand name: GEMINI SPLIT SYSTEM WITH PURON REFRIGERANT Rated as follows In accordance with AHRI Standard 340/360-2004, Commercial and Industry Unitary Air-Conditioning and Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, Independent,third party testing: Cooling Capacity(Btuh): 180000/180000 EER Rating (Cooling): 11.00/11.00 IEER _..... Heating Capacity at 47F(Btuh): COP,iat 47F 3 Heating--,Capacity at 17F(Btuh) f COP at 17F: Ratings followed by an asterisk()indicate a voluntary rerate of previously published data,unless accompanied with a WAS,which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the products)listed on this Cerdflcate and makes no representations,warranties or guarantees as to,and assumes no responsibility for, the product(s)listed on this Certificate.AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the products),or the unaufhorhmd alteration of data listed on this Certificate.Certified ratings are valid only for models and configurations listed In the directory at www.ahridimetoryorg. TERMS AND CONDITIONS This Cerdfleate and Its contents are proprietary products ofAHRL This Certificate shall only be used for individual,personal and confidential reference purposes. The contents of this Certificate may not,in whole or in part,be reproduced;copied;disseminated;entered Into a computer database;or otherwise utilized,in any form or manner or by any means,except for the usees individual,personal and confidential reference. CERTIFICATE VERIFICATION The Information for the model cited on this certificate can be verified at www.ahridirectoryorg, As Air-Conditioning,Heating, click on"Verify Certificate"link and enter the AHRI Certified Reference Number and the date on and Refrigeration Institute 0%0 110 IL11 which the certficate was issued,which is listed above,and the Certificate No.,which Is listed below. 02010 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 129260303090290568 MENOMENEEMN 1 OF 1 DATE 7 22-10 HVAC IMAC SALES & SERVICE, INC. HVAC 6275 N. Fed. HM, . Ft. Laud. FI 3 308 * 954-364-4261 * F-954-364-4265 SUBMITTED Miami Shores Christian Church JOB 15 Ton Unit Replacement NALIF M. STREET (04i>-) &e 2 - STREET: Same CITY,STATE, Miami Shores,FI OICE 305-981-8664 CITY STATE Same GENT Eddie/Vern FAX CELL CONTRACT 072210MV Remove one old 15 ton air handler and condensing unit and dispose of unit as per EPA regulations. Supply and install one new 15 ton Carrier R-410A,220 volt 3 phase air handler,condensing unit,thermostat,rubber mounts and freon.New unit to hook-up to existing refrigerant piping(we will install new copper and replace insulation where missing),electrical and duct work.Install one new aux drain pan,new condensate drain trap,add new condensate safety cut-oil switch,new smoke detector if needed and tie in to shut down air handler.Start-up,test and balance new system.Supply permit(no fees)„owner to pay direct cost of any permit fees.Price includes tax and freight. NOTE INCLUDED IN ABOVE SCOPE OF WORK ARE:Engineering,cutting,patching,painting,concrete,high voltage wiring,transformer,fees,permit fees, DESCRIPTION OF WORK SCOPE TYPE OF E UIP. NO.OF UNITS MEXISTING COND.OF UNITS CAPACITY ELECT.SPECS air cord X IR COOLED U 1 NEW X NOM TONS 15 OLTS 220 REFRIG. star Cooled COND. 1 EER/SEER PHASE 3 HEATING P e Unit PACKAGE CRAT/DENT MFG. Carrier YCLE PIPING 5 m PUMP REBUILT E CTR TOWER NOTE:No painting,patching carpentry,plumbing,or work nf an aftr trades DUCTWORK THE FOLL WORK WILL E THE RESPONSIBILITY F: WI SET.OF ECAJIP. DUCT PIPING AIR B. COND.PIPING ELECT. START-UP HVAC X HVAC X HVAC X HVAC HVAC X HVAC HVAC X EXISTING EXISTING X EXISTING X EXI TI G X EXISTING X EXISTING X EXISTING OTHERS OTHERS OTHER S ERS OTHERS OTHERS X OTHERS We Drepoge to fumish material and labor as described for the sum of 15.800.00 PAYMENTS 50%DEPOSIT UPON SIGNING,BALANCE UPON COMPLETION TERMS&CONDITIONS:All mraterials are guaranteed to be as specified. Authorized All work to be completed in a workmanlike manner according to standard Signature: Practices. Any alterations or deviations from the above specifications in- volving extra costs wit!be executed only upon written orders,and will be- come an extra charge over and above the estimate. Owner to carry fire, NOTE:This proposal may be with- tornado,and any other necessary insurances. Our workers are fully covered by drawn by HVAC If not accepted In 15 Days Workmen's Compensation insurance All parts to carry 1 year Factory Warranty and compressor to carry 5 year Factory Warranty unless specified otherwise. HVAC is not responsible for parts,materials or equipment not famished by it,and guarantees on all parts and equipment are limited to the manufad- urers warranties. Labor and material in addition to that herein described required by reason of changes in job conditions,or replacement of worn or defective parts not evidenced by initial inspection shall be Invoiced and paid for separately and in addition to the amounts herein ref- lected. this Iirstrument constitutes the'entire agreement between the parties,and shall not be effective until acceptance by HVAC and may not be modified or altered orally.HVAC shall not be liable for any failure or delay In performance occasioned by strikes,accidents or delays caused by oon- ditions beyond its control. GENERAL:HVAC has the authority to order the work as outlined above. It is agreed that HVAC will retain tide to all equipment and material supplied or famished until final payment is received as stated. N any payment is not made as ageed,the seller(HVAC)shall have the exclusive right to re- move said equipment and material the property of the purchaser promptly,and the seller shall be held hamtless for any damages as a result from this action. In the event the sal (HVAC)shall be required to obtain the services of an attorney to coped monies or deficient sums,the pur- chaser agrees to pay the seller reasorMaWe attomey's fees and court oasts for making the related collection and In addition to legal limit of interest allowed by the law on the unpaid balance. owmtditt a The above pries,specifications and conditions are satisfactory and are hereby accepted, You are authorized to the work specified. Payment will be made as outlined above. BUYERS SIGNATUR TI Stt11R DATE. July 29 h, 2010 Miami Shores Village Attn: Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138 To Whom It May Concern: We have hired HVAC Sales & Service, Inc., to install a brand new, outside 15-ton A/C unit, and its corresponding air handler inside the building. It's our understanding that HVAC Sales & Service, Inc. will be applying to the village for a permit to perform this job. Should you have any questions, feel free to contact me at the telephone number listed below. Warm regards. E ardo Acevedo der/Treasurer Miami Shores Christian Church (305) 668-7505/Office (786) 322-0078/ Cell Cc: HVAC Sales& Services, Inc 10150 NORTHEAST SECOND AVENUE • MIAMI SHORES, FLORIDA 33138 • TELEPHONE: (305) 759-0241 TV n .. . nn � 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 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) 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: El c F crzy 10- a�j CL , BUSINESS ADDRESS:LZ78 W. Femraggl STATE EL , ZIP CODE 3336 8 BUSINESS PHONE: ( ) 3 1.4-4 1 I FAX NUMBER ,4 -4 2 CELL PHONE ) $ 1.17 05 5 QUALIFIER'S NAME: 09 1 P. 0 a 9 R I KI O QUALIFIER'S LIC NUMBER: ,C EI O-w 4 �4 E-MAIL ADDRESS(IF APPLICABLE): hV 1I C CA rn IOc—'—tanL, corn Created on 3119109 BY MLDV 1 RV 3126109 MLDV T*� STATE OF FLORIC Y � -- DEPARTMENT 'OF BUSINESS AND PROFESSIONAL REGULATION 3 a CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET w�oWE TALLAHASSEE FL 32399-0783 VIGARINO, MICHAEL- P RVAC SALES & SERVICES INC 6278 N. FEDERAL HWY, #638 FORT LAUDERDALE FL 33308 STATE of FLORIDA AC# 3 9 0 81 Congratulations! With this license you become one of the nearly one million DEPARTMENT OF' HUSNESS'.''AND Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers,from PROFESSIONAL REGIUhAaON boxers to barbeque restaurants, and they keep Florida's economy strong. CAC014949 . :: 082.2/08. '(,8'0086--19 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.myfloridalleense.com. CERTIFIED 4 AIR COND' CONTR There you can find more information about our divisions and the regulations that ;.•VIGARINO., MI:CRAEL 'P impact you,subscribe to department newsletters and learn more about the :;HfAC:.:SAt;ES & SERVICES INC 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! Is .CZRTZFZIM Hader the provizioa8 of ch.489 8xpizatioa datae AUG 31, 201D °L-08'0812016(15* Zr,, DETACH HERE Ac# .0 8 6.5.2 .-STATE.-OF FLORIDA DEIxAR CAB BUS=9S, STD PROFESSIONAL REGULATION CQl�S.'�RUCTIOIaI' INDUSTRY .LICENSING BOARD SEQ#Lt380 s12.eZ8Ox _ ... ; _ a LICENSE 08°�12J2,0.08 X0,800,8;6.193; ,. CA7C:0.1499. The CT�AS H'::A 21 C.qND Z'I'IOI ING CONTRACTC R: 'C7nder- tZ�:e provisions o.f---:Chapter 489 FS Expiration dates AUG 3T, '2010 :'' .. .. .. ._ ;tit.. t ask- a.�• y� .a„. VIGARINO.,. MICHAEL P HVAC SALES & SERVICES .: 627-8: .N. FEDERAL HWT #6 3 r FORT LAUDERDALE F# :3`3308. CHARL IE. .CR I SAT = CHARLES inT. DRA GO GDVE.RNQR 5 SECRETARY DOPL YAS'REQUIRED IBi'Y LAW'':::.- ! STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 HVAC SALES & SERVICES INC 6278 N. FEDERAL HWY, #638 FORT LAUDERDALE FL 33308 STATE OF FLORIDA Ali# 4 4 6 0 7 9 Congratulations! With this license you become one of the nearly one million DEPARTMENT OF BUSINESS AND Floridians licensed by the Department of Business and Professional Regulation. PROFESSIONAL BUSINESS A Our professionals and businesses range from architects to yacht brokers,from . boxers to barbeque restaurants,and they keep Florida's economy strong. QB58160 07/0.2:/09 09`0006926 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. QUALIFIED BUSINESS ORGANIZATION There you can find more information about our divisions and the regulations that HVAC SALES & SERVICES INC impact you,subscribe to department newsletters and learn more about the Department's initiatives. .(NOT'A LICENSE TO PERFORM WORK. Our mission at the Department is:License Efficiently, Regulate Fairly.We ALLOWS COMPANY TO_ DO BUSINESS IF constantly strive to serve you better so that you can serve your customers. IT HAS A LICENSED QUALIFIER.) Thank you for doing business in Florida,and congratulations on your new license! IS QUALIFIED under the Provisions of Ch.489 Fs Eapiratioa.date. AUG 31, -2011 L09 07 02 01164 DETACH HERE AC# 4460796 STATE OF FLORIDA DEPARTMENT OF BUSINESS- AND--PROF:EBSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SEQ#L090'70203164 - LICENSE NBR 07/02/2009 090006:926 B58160 The BUSINESS ORGAI1ZATION Named below IS QUALIFIED Under the provisions of Chapter 489 FS: Expiration date: AUG 31, 2011 (THIS IS NOT A LICENSE TO PERFORM WORK. THIS ALLOWS THE COMPANY TO DO BUSINESS ONLY IF IT HAS A QUALIFIER. ) ` HVAC SALES & SERVICES INC 6278 N. FEDERAL HWY-, #638 FORT LAUDERDALE FL `33308 CHARLIE CRI�T CHARLES W. DRAGO GOVERNOR ', DISPLAY AS REQUIRED By LAW ` SECRETARY I' �P t� v_;v tt i .�<.,: i 1 'rzw rF uuxm w• V 1 III ti 14� = ffi _ ffi �I t ;n s 4.711 ffi m R x' I e �E zx....2sl: IF BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 - 954=831-4000 VALID OCTOBER 1, 2009 THROUGH SEPTEMBER 30, 2010 DBA: Receipt # 183-0001072 Business Name: HVAC SALES&SERVICE INC Business Type: Owner Name: MICHAEL P VIGARINO A/C CONTR CLASS A Business Location: 10013 SW 5 CT Business Opened: 06/03/88 POMPANO BEACH 33060-0000 Business Phone:, (954)943-2827 State/County/Cert/Reg: CAC014949 Exemption Code: NON EXEMPT Rooms Seats Employees Machines Professionals 2 UNITS For Vending Business Only Number of Machines: - Vendin Type: Tax Amount Transfer Fee NSF Fee Penalty. Prior Yeais Collection Cost Total Paid $ 27.00 $ 27.00 PAID 08/13/09 7709704.0001 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT 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 WHEN VALIDATED 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 Mailing Address: regulations. HVAC SALES & SERVICE INC MICHAEL P VIGARINO 6278 N FEDERAL HWY #638 FORT LAUDERDALE FL- 33308-1916 2009 - 2010 08/03/2010 TUE 15: 35 FAX 1001/001 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 813/2010 PRODUCER Alliance Insurance Solutions LLC. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PO Box 1777 HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR St Petersburg, 33731 �+ ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. III 727-497-1247 www.ina4biz.com 727-497-1280 INSURERS AFFORDING COVERAGE NAIC# INSURED Progressive Employer Services INSURERA:SUNZ Insurance Company 34762 6407 Parkland Drive INSURER B: Sarasota FL 34243 INSURER C: INSURER D: INSURER E: COVERAGES 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' POLICY EFFECTIVE POLICY EXPIRATION POLICY NUMBER y / y LIMITS GENERAL LIABILITY EACH OCCURRENCE $ IE To COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS MADE 7 OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ POLICY PRCO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Peraccident) $ PROPERTY DAMAGE $ (Par accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR LI CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION WCPE0000000605 1/1/2010 1/1/2011 WOCSTATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERtEXECUTIVE El E.L.EACH ACCIDENT $ 1,000,000 OFFICERlMEMSER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 Ifyyes,describe undar SPECIAL PROVISIONS below. E.L..DISEASE-POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS State of FL Coverage Only Coverer Provided for all Leased Employees but not Subcontractors of: HVAC Sales&Service,Inc. fax 305-756-8972-954-364-4265 CERTIFICATE HOLDER CANCELLATION 6549 SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLEDBEFORE THE EXPIRATION Miami Shores Village Building Department DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN 10050 NE 2nd Avenue NOTICE TO THE CERTIFICATE HOLDER NAMED TOTHE LEFT,BUT FAILURE T000SOSHALL Miami Shores FL 33138 IMPOSE NO OBLIGATION OR LIABILITY.OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. "10 Days for Non-Paymanl of Premium AUTHORIZED REPRESENTATIVE Douglas Lilak � ( ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. =DATE IDDIYYYY)CERTIFICATE OF LIABILITY INSURANCE 03/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION W.F Roemer Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE William F. Dowd HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O. Box 190669 ALTER THE COVERAGE AFFORDED BY-THE POLICIES BELOW. Fort Lauderdale FL 33319 Phone: 954-731-5566 Fax:954-731-8438 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: FCCI Insurance Company 10178 INSURER B: HVAC Sales & Service, In INSURER C: 6278 N. Federal Highwa V638 INSURER D: Fort Lauderdale FL 3338-1916 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. EFFECTIVE POLICY EXPIRATION LIMBS LTR NS TYPE OF INSURANCE POLICY NUMBER DUMPY[dI1DD DATE MMIDD GENERAL LIABILITY EACH OCCURRENCE $1,000 OOO A X COMMERCIAL GENERAL LIABILITY CPP00077083 11/14/09 11/14/10 PREMISES Eaorcurence $300,000 CLAIMS MADE �OCCUR MFG EXP(Any one person) $10,000 PERSONAL&ADV INJURY* $1,000,000 GENERAL AGGREGATE $2,000,O00 GEITL AGGREGATE LIMIT APPLIES PEP: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X ECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 A X ANY AUTO CA00096753 11/14/09 11/14/10 (Ea accident) IALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ r OCCUR EI CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WCZ-EA OTH- WORKERS COMPENSATION TOR ER AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTNI E L EACT $ OFFICERIMEMBER EXCLUDED? f E.L.DISEMPLOYE $ (Mandatory in NH) If yes,describe under EL DISECY LIMIT $ ( SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION MIAMI S2 DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL IQ_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Miami Shores Village IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Building Department REPRESENTATIVES. 10050 NE 2 Ave. AUTHORUTM REPRESENTATIVE Miami Shores FL 33138 ACORD 25(2009101) - ©1988 2009 ACORD CORPORATION. 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