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MC-12-1352r Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 176156 Permit Number: MC -7 -12 -1352 Scheduled Inspection Date: August 12, 2013 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Inspection Type: Final Owner: LOCKHART SAYDKHUZHIN, TONI Work Classification: A/C Replacement Job Address: 925 NE 98 Street Miami Shores, FL 33138- Phone Number (786)564 -5796 Parcel Number 1132060143430 Project: <NONE> Contractor: EDD HELMS ELECTRIC & A/C INC Phone: 305 -653 -2520 suuarng uepanment Comments REPLACE (1) 4 TON SPLIT SYSTEM OUT OF 2 SYSTEM. PERMIT RENEWED 7/29/13 a� 1 August 12, 2013 For Inspections please call: (305)762 -4949 Page 1 of 41 Inspector Comments Passed Failed Correction Needed ❑ Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid August 12, 2013 For Inspections please call: (305)762 -4949 Page 1 of 41 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: MECHANICAL JOB ADDRESS: City: D Is the Building Historically Designated: Yes Ma JUL 2 9 2013 -;, FBC 20 Permit No. �� �� �►) Master Permit No. County: Miami Dade Zip: 3 , l3 NO Zone: City: Tenant&essee Name: Phone #: Email: CONTRACTOR: Company Name: Address: m,40 0 A�• City: Qualifier Name State Certification or Registration #: 0(.1®4'1 �ZQ Certificate of Competency #: Contact Phone#: Email Address: �� co m DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ S00 Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration -❑New Repair/Replace Description of Work: Submittal Fee $ Permit Fee $ S Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond Technology Fee $ ❑Demolition TOTAL FEE NOW DUE $ lit� Bcnd#ft mpany's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State zip 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 is ection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will t be a roved and a reinspection fee will be charged. Signature Signature„/ �/ t ! / Owner or Agent Contractor The foregoin mstrument was acknowledged before me s The foregoing instrument was acknowledged before me this --� day of "4 , 20�, by 1 E � LO �isl day of � , 20 �, by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take 'an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Si Print: c' q v ?�e'•, INE AUSTERFIELD Prin . ^''fib r " NADINE AWIERRELD *tt # DL? 919633 ' *: �'IS51( i DE 919633 My Commission E EXPiN 5. No ;; �bfr 7 2013 My on 1�xepYrBS: N Vwnf*r 7, 2073 Banded Tin Notary Public Underv+rtters q „' 8 ru fl" tBcltary Public Undittiiers �ks��k $sk��skdsda��k��k #sk�a�sk�$s d+ ak dadifl���fs+�k ��k�se� *1 7PW* APPROVED BY I/ Examiner Zoning Structural Review Clerk Revised 3 /1=012)(Revised (Y7 /10/07)(Revised 06/10/20M)(Revised 3/15/09) `?Pq I2oIZ P0,, rD rO," It-11An t DA -i3iL CI.fcZdoc- c_9' NOTICE OF COMMENCEMENT CFI A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION DA PERMIT NO. TAX FOLIO NO.//JZ©&- 01t/- 1Za1((60 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: /Ir+4 o4 , ;P h o 2. Description of improvement: 20120513873 BOOK 28197 PAGE 4177 ::07/23/2012 09:42:37 AM 'EY RUVIN, CLERK OF COURT, MIA -DADE CTY Space above reserved for use of recording office rvC ? r 737 V / 'P y 3.Owner(s) name and address: 9Zr N - d' 'S IL Interest In property: acv AA9 Name and address of fee simple titleholder _ 4. Contractor's name, address and phone number: �__. �Z d. ,C,lev o.0 j /osv. 4' J7X.Ir 0 ti J- A- e AG',( .33.! 6 Z 5. Surety- (Payment bond required by owner from contractor, if any) Name, address and phone number. 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, address and phone number;__.__ 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.130)(b), Florida Statutes. Name, address and phone number. 9. Expiration date of this Notice of Commencement: expiration date Is 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART (,.SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature (s) of ner(s) r Ow r(s)' Au erred Officer/Director/Partner/Manager er Prepared 13y aC_ Prepared By p1harIQ buicnC Print Name _ � �' „� Print Name c G Title/Office Title /Office .'Y* ia. FC MC, ,�? STATE OF FLORIDA COUNTY OF MIAMI -DADE The �foCegoing instrur��1eQt was acknowledged beforg me this �� day of _ '� c��% 13 1{�t�; 1nC,iC 1'Or� ° c1 k bolt /,;n -- l�lj Individually, or ❑ as for - ❑ Personally known, or produced the following type of identification: ?� 3 — CI4 - 70 i i - p Signature of Notary Publics Print Name: (SEAL) _ VERIFICATION PURSUANT TO SECTION 92525, FLORIDA STATUTES Under pepaides, of perjury, l declare that I have read the foregoing and that the cts stathd in it are true, to the best of my knowledge and belief. of Ofter(s) or Wmner(s)'s Authorized AMM F 0AW * � * IIY(�fi!>SIONiDD�741B Ids: X81, 2M2 ,r who signed above: �- Miami Shores 'pillage m,;,j gf, wcAabBuilding 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 FBC 20 Permit Type: MECHANICAL JUL 2 0 2012 a , -.iv Permit No. MC- 12 - 13 5 2 - Master Permit N Owner's Name (Fee Simple Titleholder) Vob-A,,Y 1e'2110 `2 Sad- JA4uz /&Phone # Owner's Address 9ZS- U/- 9f City._ � �1 r 4o✓ e-s Tenant/Lessee Name Email State leL2 Job Address (where the work is being done) ? Z J- N 1-f �� -",Y- Zip 5.3 / 3 4-2 Phone # city Miami Shores Village County Miami -Dade Zip /3d' FOLIO / PARCEL # `/ — ,320(�s _ ® ( Y - 3 Y3 Is Building Historically Designated YES NO Flood Zone Contractor's Company Name 4U AeL o 4V� 0e,-,.t > ,, o Phone Contractor's Address �'�� ( 7(r-J-0 lJ C j- Wulf City tu/ 141 s State �rL z Zip �'J / & Z Qualifier Name r/ State Certificate or Registration No. lZ Y q & 7 Certificate of Competency No. Contact Phone Lzv ► \ 1 if -/ 3 ° �.(�3 E -mail d C e-<7 Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ j W Square / Linear Footage Of Work: Type of Work: ❑Addition [-]Alteration []New Repair/Replace ❑ Demolition Describe Work: /2 wile -e % / L( (®aj S•, Z % .! i e� � Q,, � iq� 2 � JOC � Submittal Fee $ 5-0, 00 Permit Fee $ � L, ds. a i. � [.� CCF $ CO /CC $ pPtD Notary $ Scanning $ Double Fee Structural Review. $ Training/Education Fee $ Radon $ DPBR Technology Fee $ Bond $ Violation date: r Total Fee Now Due $ ` ° ZLi See Reverse side I Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 pos ed at the job site for the first i ection which occurs seven (7) days after the building permit is issued. In the absence such osted tice, the inspection wit of be pproved and a reinspection fee will be charged. Signature o Signature / L/ Owner or Agent The foregoing instrument was acknowledged before me this cZ. day of L 11/hD -, 20 j�, by �q7 ; 1pC �� , who is p rsonally known to me or who has produceJ Z63 e 06 — "7 0 771 -t% identification and who did take an oath. NOTARY PUBLIC: Contractor The foregoing instrument was acknowledged before me this r�1 day of -1 , 201a , by _ �� Rob�'�s; who i ersonally known to a or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: t Si Print: ~ '' " NADINE AUSTERFIE �DIPIE AUSTERFIEL Print: m } y rnnnnt --yet �— SSI6�I4!fBoelm IRES: November 7, 2013 �t N EXPIRES- November 7, 2013 My COInm }SS1L It Cp u d Thru Notary Public Underwr tern My C0mm�6ST6CAi JUL l 'v 2012 Ell) Miami Shores Village AIR CONDITIONING REPLACEMENT DATA Building Department 10050 N. E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax. (305) 756.8972 &Y: eve PERMIT NUMBER: MC _ 12- 13 s'L 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): IZI— P✓ City: Miami Shores Village County: Miami Dade Zip Code: 33 ` 3� ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO ❑ ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES ❑ UNIT BEING REPLACED DATA NEW UNIT Iv ® g FACTURER IZWCL Jd P ix(j L or PKG. UNIT MODEL # N N h N y Z COND. UNIT MODEL # L 5 14 IF ,TEG KW HEAT NOM TONS AHU (CCU Q0 PKG 1 M.C.A AHU &MU yOPKG AHU x0 CU go PKG 2 M.O.P AHU CCU ® PKG AHU CU PKG 3 VOLTS AHU CU PKG PKG UNIT I l PKG UNIT / I EERISEER YES NO REPLACING DUCTS YES NO K YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4 000NCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO Dt YES NEW RETURN PLENUM BOX YES NO s( 1. Minimum Circuit Z4 I lize), 2. Maximum Overctwi�t 9�tiali: 3. Voltage of 4. Size Disco (jv Size): 71 Contractor's Company Name: &v eo N d.- t i i ®l-i 0 Phone f) 4.13 State Certificate or Regist n N 7 Certificate of Competency N. Signature Date: (QualffWs signature only) This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2011. Uertificate of Fill uduct Ratin, AHRI Certified Reference Number: 3858343 Date: 7/18/2012 �J Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: UASL- 048JEC Indoor Unit Model Number: RHPN- HM4824 +RCSN -H *4824 Manufacturer: RUUD AIR CONDITIONING DIVISION Trade /Brand name: RUUD UASL SERIES Manufacturer responsible for the rating of this system combination Is RUUD AIR CONDITIONING DIVISION Rated as follows in accordance with AHRI Standard 2101240 -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 (Btuh): 48500 EER Rating (Cooling): 13.00 SEER Rating (Cooling): 18.00 * 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 Certificate. AHRI expressly disclaims all Debility 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 ahridlmCtory 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 reproduce!; 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 cited on this certificate can be verified at www.ahridirecimy org, rA Air - Conditioning, Heating, click on "Verify Certificate" link and enter the AHRI Certifled Reference Number and the date on 1113 VkIN and Refrigeration Institute which the certificate was Issued, which is listed above, and the Certificate No., which is listed below. 02012 Air- Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129871137913497859 RUU. DesignStar Load Calculation Results are,intended for use with Ruud heating and cooling systems only b "I ili,i ��i ��,,, ,1 " .�Gusto`merinf.,ormationd��'� - 3, Outdoor Heating Cooling Daily range L Moisture difference 58 Indoor Heating Cooling Design temperature difference(T) 20 15 Area Btuh % of load . , Floor _ 4 0 Windows 4349 23.1 ;i 11fiCds Mi$ <<., is r System Efficiency Loss 1710 9.1 Jill I I' •e o.• Area Btuh % of load VValt� Ceiling 2384 3.5 Sensible Infiltration 4142 6.1 ,i efntl�ii rtrat��in _ _990t) 146 System Efficiency Gain 5599 8.3 Sensible PeTle Load 1380 2 11 `Iate�lt�el�ti$0. Total: 67712 Sensible load 56433 SHR 0.83 Adequate .Exp,QS'ureDiiers.ityl�'' AED Graph 60000 40000 .O m O J 20000 Q -r._._... _....-- r-- - -- - r -�- - -� Sam 9am loam llam 12pm 1pm 2pm 3pm 4pm 5pm 6pm 7pm 8pm — Hourly Loads — Average am DACCA Manual S System equipment selection will be made using the following Manual S derived values. Summer Outdoor 90 °F All calculations are based upon approved hvac industry standards and procedures, and comply with all local, state and federal code requirements. All computed results are Estimates. Product provided by Energy Design Systems and Idea Tree Summer Indoor 75 °F urntne Desficp Greips Winter Outdoor 50T Sensible Coding 56,433 Btuh Required Coding Airflow 2,565 CFM S�nsfblejFipa n 3 r 18 SP6 B6 fi .._ Required Heaing Airflow 244 CFM All calculations are based upon approved hvac industry standards and procedures, and comply with all local, state and federal code requirements. All computed results are Estimates. Product provided by Energy Design Systems and Idea Tree E1111111,Edd Helms Ition qy C"Onerl' _! !_AF .190fic EXISTING ELECTRIC NOTIFICATION The undersigned ( "Customer ") hereby acknowledges that the attached proposal from Edd Helms Air Conditioning and Electric is specifically contingent upon all new air conditioning components being connected to existing adequate electric supply. The determination as to whether existing electric Supply is adequate will be made at the time of installation. If any deficiencies are noted by installation personnel. customer will be immediately notified of the deficiency and the recommended solution. Customer Name 1 0►'1 I Customer Signature AfVU Date 2 l L Edd Helms Represent 17850 NE 5th Avenue o Miarni, FL 33162 b Tel: (305) 653 -2530 0 loll Free: (800) 329 -2530 - Fax: (305) 653 -7933 n www.addhelms.com Property Information Map Page 1 of 2 My Home Miami -Dade County, Florida ) Property Information Map Aerial Photography - 2009 0 ® 116 ft This map was created on 6/2112012 3:44:13 PM for reference purposes only. Web Site © 2002 Miami -Dade County. All rights reserved. Summary Details- Folio No.: 11-3206-014-3430 Property: 925 NE 98 ST Mailing TONI LOCKHART Address: SAYDKHUZHIN Beds/Baths: 925 NE 98 ST MIAMI FL Floors: 33138- Pronerty information- Primary Zone: 1100 SINGLE FAMILY 2010 ES IDENCE CLUC: 0001 RESIDENTIAL - Buildin Value: IN GLE FAMILY Beds/Baths: Market Value: Floors: 1 Living Units: 1 d' Footage: 999 Lot Size: 15 450 SQ FT Year Built: 1946 $338,469 MIAMI SHORES SEC 3 $50,000/ B 10-37 LOTS 16 Legal RU 18 BLK 80 LOT Description: IZE 150.000 X 103 $50,000/ 5R -27025 COC 21737- 194 10 2003 2(2) OR $338469 7621 -4826 091011 Assessment Infnrmatinn- ear: 2011 2010 Land Value: $185,438 $154 96 Buildin Value: $275,739 $243 969 Market Value: $461 177 $398936 ssed Value: $461 177 $388469 Exemotion Infornaflon- nd ear: 2011 2010 Homestead: $Hom IE F25OO st d ES Ta xable Value Infnrmatinn- ear: 2011 2010 Applied Applied Taxing Authority: Exemption/ Exemption/ Taxable Taxable Value: Value: Regional: $50,000/ $50,000/ $411,177 $338,469 County: $50,000/ $50,000/ $411,177 $338469 City, $50,000/ $50,000/ $411 177 $338469 School Board: $25,000/ $25,000/ L_ I $436177 363 469 Sale Infonnation: Sale Date: 9/2010 Sale Amount: L621-4826 Sale O/R: ctive deed, quit deed, or tax deed; bearing Florida http:// gisims2 .miamidad6.govIMyHomelprintmap. asp? mapurl= http:llgisims2.miamidade.g... 6/21/2012 aCC>REP CERTIFICATE OF LIABILITY INSURANCE DATE(MM(DD/YYY11 TYPE OF INSURANCE 6/29/2012 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 poiicy(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 endomemen s . PROWLER NAME: PHONE X No Bateman Gordon and Sands 3050 North Federal Hwy Lighthouse Point FL 33064 E-MAIL ADDRESS EACH OCCURRENCE $1,000,000 PDREM SES Ea occur re INSU S AFFORDING COVERAGE NAIC # INSURERA;Amerisure Insurance Co. 19488 $1,000,000 INSURED EDDHE1 INSURER B;Am risure Mutual Insurance Co. 23396 INSURERC: GEML AGGREGATE LIMIT APPLIES PER POLICY X PRO- LOC JECT —1 Edd Helms Group, Inc.;dba Edd Helms INSURER D: Electric, Edd Helms Electric, LLC: Edd Helms Air Conditioning Inc. 17850 NE 5th Avenue INSURER E: AUTOMOBILEuAai X X INSURER F: Miami FL 33162 -1008 COVERAGES CERTIFICATE NUMBER: 213937280 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iLTR TYPE OF INSURANCE IINSR WVD POLICY NUMBER MM/UDDY EFF MM/UDD EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X XCU /Contractual GL20119261002 /1/2012 11/2013 EACH OCCURRENCE $1,000,000 PDREM SES Ea occur re $100,000 MED EXP (Any one n ) $5,000 PERSONAL& ADV INJURY $1,000,000 X Brad Form PD GENERAL AGGREGATE $2,000,000 GEML AGGREGATE LIMIT APPLIES PER POLICY X PRO- LOC JECT —1 PRODUCTS - COMP /OP AGG $2,000,000 $ B AUTOMOBILEuAai X X ITY ANY AUTO ALLL OWNED SCHEDULED AUTOS NON -OWNED HIRED AUTOS X AUTOS CA20011461102 11/2012 /1/2013 Ea accident $1,000,000 BODILY INJURY (Perperson) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE P. accident $ $ B X UMBRELLA LIAR EXCESS UAB X OCCUR CLAIMS -MADE CU20011491103 /1/2012 /1/2013 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 DED X I RETENTION$0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) re y� desaibe under DESG�RIPTION OF OPERATIONS below NIA WC200250112 /112012 11/2013 X /� STATU X OTH- E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) Lh3 ill IIBLrltlIM Miami Shores Village 10050 NE 2 Avenue. Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD