MC-13-1581 Inspection Worksheet
Miami Shores Village 1
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-195271 Permit Number: MC-7-13-1581
Scheduled Inspection Date: September 16,2013 Permit Type: Mechanical- Residential
Inspector: Perez,JanPierre
Inspection Type: Final
Owner: TURKEL, DOUGLAS Work Classification: New A/C System
Job Address:220 GRAND CONCOURSE
Miami Shores, FL 33138- Phone Number
Parcel Number 1132060133520
Project: <NONE>
Contractor: REEVE AIR CONDITIONING CONTRACTOR Phone: (954)764-4481
Building Department Comments
INSTALL NEW MITSUBISHI SPLIT ROOM AC Infractio Passed Comments
INSPECTOR COMMENTS False
Jam..
� Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
September 13,2013 For Inspections please call: (305)762-4949 Page 13 of 38
Certificate of Product Ratin s
AHRI Certified Reference Number: 4217791 Date: 7/16/2013
Product:Variable Speed Mini-Split Air-Conditioner,with Remote Outdoor Unit-Air-Source, Free Delivery
Outdoor Unit Model Number: MUY-GE24NA
Indoor Unit Model Number: MSY-GE24NA
Manufacturer: MITSUBISHI ELECTRIC AND ELECTRONICS USA,INC.
Trade/Brand name: MR.SLIM
Manufacturer responsible for the rating of this system combination is MITSUBISHI ELECTRIC AND
ELECTRONICS USA,INC.
Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air-Conditioning and Air-Source
Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, independent,third
party testing:
Cooling Capacity(Btu h): 22400
EER Rating(Cooling): 12.50
SEER Rating{Cooling): 19.00
CERTIFIED RATINGS FOR VARIABLE-SPEED,MINI-AND MULTI-SPLIT SYSTEMS ARE VALID FOR ALL COMBINATIONS OF INDOOR UNITS
(BASED ON COMBINATION TYPES)WITH THE SPECIFIC OUTDOOR UNIT LISTED ABOVE AND IN THE AHRI DIRECTORY OF CERTIFIED
EQUIPMENT.VISIT WWW.AHRIDIRECTORY.ORG TO VERIFY THAT THIS COMBINATION IS AN ACTIVE LISTING AND THE DATA LISTED ON
THIS CERTIFICATE IS ACCURATE.SEARCH ON THE AHRI REFERENCE#TO QUICKLY LOCATE THIS COMBINATION IN THE DIRECTORY.
"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)listed on this Certificate and makes no representations,warranties or guarantees as to,and assumes no responsibility for,
the product(s)listed on this Cardficata.AHRI expressly disclaims all pability for damages of any kind arising out of the use or performance of the product(s),or the
unauthorized alteration of data listed on this Certificate.Certified ratings are valid only for models and configurations listed In the directory at www.ahridirectory.org.
TERMS AND CONDITIONS
This Certificate and its contents are proprietary products of AHRL 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 farthe model cited on this certificate can be verified at www.ahridimctory org, Air-Conditioning,Heating,
click on"Verify Certificate"link and enter the AHRI Certified Reference Number and the date on and Refrigeration Institute
whlctn the certificate was issued,which Is listed above,and the Certificate No.,which Is fisted below.
02013 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 130184546741470644
Z 11 �-
Miami Shores Village
eJ lj Building Department ri t _
JUL -913
�9/r 90050 N.E.2nd Avenue,Miami Shores,Florida 33138 = .
V Tel:(305)795.2204 Fag:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20
]BUILDING Permit No.
PERMIT APPLICATION Master Permit No. mG r':s r 1
Permit Type:MECHANICAL
JOB ADDRESS: 61a 63A4,,yo
City: Miami Shores / County: Miami Dade Zip: ��1�
Folio/Parcel#: ° 32,0 f® 0/3 -5.X00
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): DO -S TUR 1<6L. Phone#: -30.5--33�
Address: 'Z 2® /e(4(/, lcoc"lle-S6
City: M14z;;w -SHO'lees State: -F'& Zip: 33(3
TenandL,essee Name: Phone#:
Email:
CONTRACTOR:Company Name: RE6VE A& 6�61,0,(Tle IV MA57 Phone#: F5Y-9�,Z-
Address• a5-O ( -5, 416k K040
City: p L ie State: -FL
Qualifier Name: �D 06"1 R€EVE Phone#:
State Certification or Registration#: CA C 02-5 Y3 Certificate of Competency#:
Contact Phone#:.9 y-?6 -!Zz e l Email Address: Cayzac f c Aeeye A C . ccA
DESIGNER:Architect/Engineer: Phone#:
value of Work for this Permit:$ 33 6?. S r Square/I.inear Footage of Work: 44/ ET'
Type of Work: DAddress OAlteration ®New - Repair/Replace ODemolition
Description of Work: :C $TALL 616&J 44, d�ji �2.-X 'OO f Q
Submittal Fee$ v"' Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$T
TOTAL FEE NOW DUE$
� ! A
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
IlVIPROVEMENTS 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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and'construction lien lain b;-ochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 15 ,20 - ,by P004 j 1%E!= day of i 20 11,by d
who is personally known to me or who has produced who is personally known to me or who has produced
T40-4-177 1%344s identification and who did take an oath. I as identification and who did take an oath.
NOTARY PUBLI • NOTARY PUBLIC:
Sign: ign; % Ie� qE 6noi
�6�' Z9SNB U IS IW ��,a v
Print' 0®7 Public- Rends rmt• I-/
E
my Comm.Expires Apr 10,2015 BPUoId ic$Ill3-allQnd�� �v
My Commission Expires: " Commission#EE 82552 y Commission Ex s' d100d1i9Y1S 11 111d A" y% +`o,
"nua` Bonded?hmghNall"NOMAm- •`"ry�`',
APPROVED BY -?-mans Examiner Zoning
Structural Review Clerk
Revised 3/1=012)(Revised 07 110/07)(Revised 06/10/2009)(Revised 3/15/09)
Property Search - Deport Page 1 of 2
MIAMI-DADE COUNTY
OFFICE OF THE PROPERTY APPRAISER
PROPERTY SEARCH SUMMARY REPORT
Carlos Lopez-Cantera
Property Appraiser
Property Information: ,\ J,
Folio 11-3206-013-3520
Property Address 220 GRAND CONC
Owner Name(s) DOUGLAS TURKEL&GIG]FONG
a
Mailing Address 220 GRAND CONC
MIAMI SHORES FL
33138 E ✓ ;.
Primary Zone 1300 SGL FAMILY-2801-3000 SQ F
Use Code 0001 RESIDENTIAL-SINGLE y
FAMILY
Beds/Baths/Half 4/3/0
Floors
I ;
Living Units 1
Adj.Sq.Footage 3,176 ;
Lot Size 11,050 SQ FT
Year Built 1956
r`
Full Legal Description MIAMI SHORES SEC 1 AMD PB 10- Aerial Photography 2012
70 N
LOT 7 LESS NELY 35FT&ALL LOT
8 Taxable Value Information:
&NELY 20FT LOT 9 BLK 26
LOT SIZE 85 X 130 Current Previous Previous 2
OR 16786-0398 0595 1
Assessment Information: Year 2013 2012 2011
Exemption/ Exemption/ Exemption/
Current Previous Previous 2 Taxable Taxable Taxable
Year 2013 2012 2011 County $50,000/$227,130 $50,000/$222,498 $50,000/$214,562
Land Value $204,728 $135,051 $135,051 School Board $25,000/$252,130 $25,000/$247,498 $25,000/$239,562
Building Value $245,373 $259,238 $260,838 City $50,000/$227,130 $50,000/$222,498 $50,000/$214,562
Market Value $450,101 $394,289 $395,889
Assessed Value $277,130 $272,498 $264,562 Regional $50,000/$227,130 1 $50,000/$222,498 $50,000/$214,562
Benefits Information:
Sale Information:
Current Previous Previous 2 Date Amount OR Book-Page Qualification Code
Benefit Type 2013 2012 2011 5/1995 $162,000 16786-0398 Sales which are qualified
Save Our Assessment 7/1990 $125,500 14646-0116 Sales which are qualified
Homes Reduction $172,971 $121,791 $131,327 12/1975 $75,000 00000-0000 Sales which are qualified
Homestead Exemption $25,000 $25,000 $25,000
Second Exemption $25,000 $25,000 $25,000
Homestead
Note:not all benefits are applicable to all Taxable Values(ie County,
School Board,City,Regional).
Disclaimer:
The Office of the Property Appraiser and Miami-Dade County are continually editing and updating the tax roll and GIS data to reflect the latest property information
and GIS positional accuracy.No warranties,expressed or implied,are provided for data and the positional or thematic accuracy of the data herein,its use,or its
interpretation.Although this website is periodically updated,this information may not reflect the data currently on file at Miami-Dade County's systems of record.The
Property Appraiser and Miami-Dade County assumes no liability either for any errors,omissions,or inaccuracies in the information provided regardless of the cause
of such or for any decision made,action taken,or action not taken by the user in reliance upon any information provided herein.See Miami-Dade County full
disclaimer and User Agreement at http:/Avww.miamidade.gov/info/disclaimer.asp.
Property information inquiries,comments,and suggestions email:pawebmail @miamidade.gov
GIS inquiries,comments,and suggestions email:gis @miamidade.gov Generated on:Mon Jul 15 2013
http://gisweb.miamidade.gov/PropertySearch/printMap.htm 7/15/2013
REEVE AIR CONDITIONIN , INC
SINCE 1957
E-Mail: ContactgReeveAc.com www.ReeveAc.com State Licensed CACO25438 & Insured
2501 S. Park Rd, Hallandale, FL 33009 Broward 954-764-4481 Fax 954-719-6391 Dade 305-758-4731
NAME- Doug Turkel DATE: 7/ 10/2013
STREET: 220 Grand Concourse LOCATION: Garage
CITY: Miami Shores STATE: FL ZIP: 33138
PRONE: 305-332-9494 305-812-1155 i Gi E-MAIL: D u
g_ o g�a,D ougTurkel.com
We appreciate the opportunity to provide this Proposal for a new High Efficient Split.AIC System with the following.specifications.
1.8 Ton Mitsubishi (Inverter)Straight Cool Condensing Unit REEMUYGE24NA
Fan Coil(s) REEMSYGE24NA w/1__ - R-41 OA Freon 208/230 V. Straight Cool
Cooling Capacity 4400-22000 BTU's @a 19 SEER ARI # 4217791
Including: Materials and Labor to Furnish, Deliver,and Install:
[ X ] New Digital Programmable Multi-Function Wireless Remote Control Thermostat
[ X ) Install New Insulated Copper Refrigeration Lines [ X ] New Cement Slab
[ X ] New White Vinyl Decorative Line Set Cover [ X ] New Hurricane Straps
[ X ] Install New Condensate Sensor Cut off Switch [ X ) Install PVC Condensation Drain Piping
Proposed Mitsubishi (Inverter) Straight Cool System Installed Sale Price $ 3369.57
Manufacturer's Limited Warranty: 1 yr Labor,5 year Mfg. Parts & 7 Years Mfg.Compressor
NOT Included.•
( X J Customer&/or Customer's,Electrician is Responsible for Providing& Connecting (230v) Electric Power,
& All related wiring to all A/C components. Responsibility must include properly fused disconnect switches.
j X J Heat Load Calculation - additional cost is $ •150.00
( X J Any Building Permit Fee, and the costs of obtaining, will become an additional cost over and above the Purchase Price.
Terms: 10% Deposit upon Acceptance of this Proposal, Balance in Full upon Completion/Start-up
if oy u Pay the ENTIRE PURCHASE PRICE by Bank Check, or Cash you will receive an Additional Discount of $ 100.00
All material is guaranteed to be as specified. Any alteration from the above specifications involving extra costs,will be executed only upon written orders,and will become an
extra charge over and above this proposal. Suitable space and access for this installation must be provided by the customer. All agreements contingent upon strikes.accidents or
delays beyond our control. This Proposal subject to acceptance within —3_ days and is void thereafter at the option of the undersigned.
Date: f Z t Signature: Print name: Stephen E Reeve
ACCEPTANCE OF PROPOSAL
The above prices,specifications and conditions are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined
above. It is agreed that title to the above specified equipment and materials,remain titled to seller,until fully paid for. In the event it shall become necessan
to collect the money described herein or any part thereof,I agree to pay any cost thereof,including reasonable attorney's fees. I further acknowledge and
agree that a service charge of 1.5°to er month will be ap p lied to all amounts which are delinquent 30 days past due.
Date: ft' Signature: Print name: :-
iT ati T q-'1
5gOR9
p,..l% 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 IMITH 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
■■��e����e�re��a�or�e���rs�������se���������oa���r�e���������������s��e����a�����r���e�re�
COMPLETE CONTRACTOR'S INFORMATION
BUSINESS NAME: IRGEVE Ali ��t�/����,��,+�� 's 2,dzc.
BUSINESS ADDRESS: 2,601 S P49k P4, CITY
STATE ;FL- ZIP CODE :3300
BUSINESS PHONE:( )_F(y ®2—r-, 2 FAX NUMBER
CELL PHONE�) QUALIFIER'S NAME:
QUALIFIER'S LIC NUMBER: CA-C 02-u-Y 3
E-MAIL ADDRESS OF APPLICABLE):
Created on 3(19109 BY MLDV I RV 3126109 MLDV
Naw of 8mbilm
iOiOo rt.a�i eceipt Receipt No.
REEVE AM CpiiT MOMr, Oct 19 2012 To Sept 309 2013
13-1113308
IS Hemby EASWd in To Bosinw. TO OF PEMBROKE PARK Amowt No.
P'fenion or + rT 113308
A/C+CONit'RA,�G 1"i�R 3154 5, , 52nd A�^�Iaue fee S 78.95
Pembroke Pork,Florida 333 De4 Pity s,
Location . In ym
limit O9� �
2501 S PARK RD ` ' 1\OME: b dw evetd the busiew for wlhkh this
N=o Of ,° mbr I-Park nmipt vms issued domes bands,am r
Ik be bvmsfinvd wilibll3tW tsimb dump orwrip
REEVE A1R CONDMOMUqG }� be0me nuU and vobL ARp nwgiltas4 ftes MW
CYO i 3E REEVE busilims most be paid beftin so&transfer%M be
graAtd.
2501-4,-.PAW RD
PE1110ROKE PARK FL 33009 r
This,Reizipt Must Be Posted In A ConspWim Plaw -J
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT .�
115 S. Andrews Ave., RM. A-100, Ft. Lauderdale, FL 33301-1895 - 954-831-4000
VALID OCTOBER 1,2012 THROUGH SEPTEMBER 30,2013
DBA: Receipt#:H Az c�AZ Cr�:a�r ra0 �
�
Business Name: REEVE AIR CO Type:CONDITIONING INC - Business T
(AIR COND CCNTR)
Owner Name:STEPHEN E REEVE Business Opened:07/16/1993
Business Location: 250, s PARK RIB State/County/CertlReg:CA. CO25438
HALLANDALE Exemption Code: �€
Business Phone;
Rooms .Seats Employees Machines Professionals
10i
For Vending Business Only
Number of Machin_es: Vending Type:
Tax Amount Transfer Fee NSF Fee Penalty Prior Years Co1ection Cost Total maid
0.00 0.00 0.00 0.00 27.00 `
`{ _.__ .ter-� c` _ a. � 5;�. "u,'•wtW�..as: _�=
J STATE OF FLORIDA
DEPARTMENT CONS I1S' #W PRLHEN Q TIC 1
SEQ#L12os24016
08 24 2412 1213053587 CACO25438
The CLASS B AIR CONDITIONING CONTRACTOR
Nramed below I8 CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2014
RE EVE, STEPHEN EDWARD
RES" AIR CONDITIONING INC
2501 S PARR RD
HALLANDALE FL 33009-3813
RICK SCOTT KEN LAW°S'ON
GOVERNOR SECRETARY
r1aCDP AV AC F��f1i IIt�Frl P!Y i 13�
i
ACOP RO CERTIFICATE OF LIABILITY INSURANCE
DATE IMMIDWYYYYI
11/97/2012
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
McTaggan insurance Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS 9900 Stirling Road ALTER THE COVEERRAGE AFFORDED BY THE POLICIES BELOW.
Cooper City,FL 30924
INSURERS AFFORDING COVERAGE NAIC
INSURED INSURERA ZW9Ch
Reeve Air Conditioning Inc. INSURER a EYP.leSt
2501 South Park Rd.. INSURERC
Pembroke Park.F133909 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 BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONSAND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSIR AWL
LTR INSW TYPE OF INSURANCE POLICY NUMBER OA J LIMITS
A GENERAL LIABILITY CFM 90524673 12/14/12 12/14113 EACH OCCURRENCE $ 500.000
f COMMERCIAL GENERAL LIABILITY AG TO RENTED
PREMISES(Ea ocase ) S 300.000
CLAIMS MADE OCCUR MED EXP(Arn/aie P-11 $ 10.000
PERSONAL BADV MAX URY S 500.000
GENFRAI AGG'RFGATE $ 1.000.030
td'LAGGREGATE LIMITAPPLIES PER PRODUCTS-COMPtOPAGG $ 1.000.000
POLICY 7 PROJECT LOC
AUTOMOBILE LIABILITY COMBINED N SWULE LIMIT $
ALL OWNED AUTOS
BODILYRVJURY $
SCHEDULED AUTOS (Per Persona
HIRF D AUTOS
� BODILY iNJURV $
NON-OWNED AUTOS (Per ac6deM)
PROPERTY acwar DAMAGE $
GARAGE LIABILITY
AUTO ONLY-EAACCIDENT $
ANYAUTO
OTHER THAN EAACC $
AUTO ONLY AGG S
EXCESSMMBRELLALIABILITY EACH OCCURRENCE S
OCCUR CLAIMS MADE AGGREGATE $
$
UEDUCTIBLE $
RFTFNTION $ $
B WORKt SCOMPENSAT30NAND 8288641 12114/12 12/14/13 TORYIttWITS FR
EMPLOYERS'LIABILITY
ANY PROPRI£TOPJPARTNER/EXECUT3VE E L EACH ACCIDENT $ 100.000
OFFtCEWMEMBER EXCLUDED :L EAELIC E_ $ 100.000
If yes esmbe urdes
SPEC(AL PROVISIONS below EL DISEASE-POLICYLIMT $ 5W.000
OTHER
DESCRIPTION OF OPERATIONS I LOCATHM I VERICIES I ExcLusjoNs ADDED ey ENDoRs99ENT I SPECIAL PROMS
CERTIFICATE 14OLDER CANCELLATION
SHOULD ANY OF THEASOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Miami Shores Village Building Department DATE THEREOF,THE WSUING INSURERWRLL ENDEAVOR TO MAUL 30 DAYS WRITTEN
10050 N.E.2 Avenue NOTICE TO THE CERTFICATE HOLDER NAMED TO THE LEFT,BUT FAILUr E TO DO SO SHALL
Miami Shares,FL.33138 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR
REPRESENTATIVES,
AUTHORIZED RE THE J T 1
vL r 114
ACORD 25(2001!08) 0 ACORD CORPORATION 11988