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EL-12-2309Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 182553 Permit Number: EL -12 -12 -2309 Scheduled Inspection Date: July 30, 2013 Permit Type: Electrical - Residential Inspector: Devaney, Michael Owner: SFARA, VERONIQUE Job Address: 1080 NE 105 Street Miami Shores, FL 33138- Project: <NONE> Contractor: PARDIME ELECTRIC INC comments Inspection Type. Final Work Classification: Addition /Alteration Phone Number (305)799 -2006 Parcel Number 1122320280090 LOW VOLTAGE FOR INSTALLATION OF 22 SPEAKERS, 8 1 ' --- TELEPHONE LOCATIONS AND 7 CABLE LOCATIONS INSPECTOR COMMENTS False 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. July 29, 2013 For Inspections please call: (305)762 -4949 Page 2 of 34 DEC /10/2012/MON 02:11 PM FAX No, P,001 /001 '4 R PARDIEL OP ID: CF �-- CERTIFICATE OF LIABILITY INSURANCE DATEIBMIDD/YYM 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 ADDI170NAL INSURED, the poUcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of tns policy, certain Policies may require an endorsement. A statement on this certliicato does not confer rights to the certificate holder in lieu of such endet+sgmmrronl. INSUREo Insurance Center Phone: Ave Sulte 208 Fax: Clear Ught Electric 24625 SW 127TH AVE HamasWad, FL 33032 E: PHIS 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 WHCH 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, : TYPE OF INSJRUCE POLICY NUMBER o0 � (rylpf/ppNyYh UAAITS GENERAL UADWY A X COMMERCIAL OENERAL UMLPIY C.�+unns nvtuc O wLUK ACPGLZo5qi5204136 iISH3t2012 otd�13l2018 OCCURRENCE g LUUMUE s MED EXP ErE¢ pmm) $ PERSON L&ADV INJURY $ G@I'LA ECiATEUMITAPPLIESPER; A9_1MRALAGMREQATr. $ PRODi1CT3 - CIOPAGO $ X PAY 71 LOC AUTOMCOLE LIABILITY $ aEddeEt E LIMIT MIN % ALLOWNE D BC sc SOO V INJURY(PePp& con) $ AU HIR6D AUTa$ ZW� elooLy -JURY (pop awmera) S $ UAABRELLA LUIB �OCCUR EXCESS LIAR S EACH OQOURRe CE Aw;EOATE g DED 9EOMWNS aO91lgN3ATION AND LO' YERgUMLI'IY Y/N ANY PROPRIETORMARTNER /MCUT (Mmmi ry n KH EXCLUDED't If yea, da=dbe undar N/A $ A F6,EAOHACCIDENT $ EL DISEASE. t?A QVpLr 1rg x 0ESC1t1PTION OF OPERATIONS I LOCATIONS / vENICLES IAttwh ACORO 101. AMM011pi ReM&U Schedule, If mom is re0ulfam Pax # 305 - 756 -8972 1 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELnmmo IN Miami Shores Village ACCORDANCE WITH T146 POLICY PROVISIONS. 10080 NE 2nd Ave. Miami Shores, FL 33138 AUYHORIMDRWRF.$ENTATjW ®1 OW201 O ACORD CORPORATION. All fights reserved. ACORb 25 (2010/06) The ACORD name and logo are registered marks of ACORD i jq'ft 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 FBC 20 Permit Type: Electrical OWNER: Name (Fee Simple Tenant/Lessee Name: Email: V I Cam.. _, Gnu 0 6 2012 °� r 7. oe o ®omee�emoe ®_a Permit No. El l �? g y- n-- Master Permit No. P /4 -- �� .Sf �-ro� State: F Zip: 22 � AM- JOB ADDRESS: 1®4;ko N E lQ,� S+ City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name i-1 l C� °"'` e— � IC.o °'�' Phone# Addres'.9"a0s, - S; . - � m i :�.n -4 V4, M State: 7— Zip: a - 0 � Qualifier Name: � 4 • f'Y+ Phone #: `-66 `" 4-5 a- 9Q(6 State Certification nooreRegistration #: i3 Certificate of Competency #`:�00 U0 Contact Phone #: C� Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for thin Peranit: $ I N Square/Linear Footage of Work: '9 Type of Work: 'OAddress DAlteration j*ew ORepair/Replace e sa _ . — % 1 don of Work: l Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Notary $ Radon Fee $ DBPR $ Bond $ 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 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 ap roved and a reinspection fee will be charged. .-q Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this day of , 20 �q , by)�t� a l,4 cS-f_NC2%4 , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: / Print: My Commission Expires: APPROVED BY (Revised 07 /10/07)(Revised 06 /1012009)(Revised 3/15/09) The fo oin in me was ackn ed I.,- or &me i s g g day of 2� r , b w o is errss naM-0a; wn o me or who produced" • tificati on and who did take an oath. P � ��i Sign: Print . My Commission a>' = 5 N L�/LPlans Examiner Structural Review CLA001A V CU8 NOtaly 1— .,. _ My Comcn. Expires Sep 23.2015 cammiss +on * EE 12BB1A Bonded Through National Notary Assn. Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ��d�� Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: Electrical OWNER: Name (Fee Simple Address: k 0f� n 0 P City: Q. lam► Tenantaxssee Name: Email: Permit No. JZ L I?—, o� 5 � Master Permit No. t ' `� I `tL pp S f. Lfb. State• F1 Zip: JOB ADDRESS: PbTO 61-1�• INS- IS)— City: Miami iShores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes CONTRACTOR: Company Name: \d�; Ararirn d% ;�' 42 L -� 457� 1 City: NO Flood Zone: ,Ci a Qualifier Name: _ 11 - ®1- Z:> YY2 z Phonek State Certification or Registration #:. Certificate of Competency #: 2 Contacf Phone#: ' " Email Address: DESIGNER: Architect/Engineer: Phonek �� Value of Work for this Permit: $ of �hjQ #ddress N V MM, —Square/Linear Footage of Work: ONew ❑Repair/Replace ODemc D csff�1 ir�l N +rvo Submittal Fee $4:;Pj Permit Fee $ �l' i lw CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ C Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address Zip 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 'sued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signatur Owner or Age Contractor The fore oing instrument was acknowledged before me this I The fore instrument was acknow ed before me thi� day of av , 20 �by f� t�� ✓� `� day o , 20 by ! , who is personally known to me or who has produced �L- (� w�� 's personally own to me or who has produced_ As identification and who did take an oath. Y! ees identification and who did take an oath. NOTARY PUBLIC: / // _.��luuittta / NOTARY PUBLIC W J6— Sign: Print: My Commission Expires: APPROVED BY 4p ' -Z. ` ell s (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Plans Examiner Structural Review Sigi Prin My Zoning Clerk Miami Shores village Building Department OCT 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 0 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20 BUI DING Permit No. < PERMIT APPLICATION Master Permit No. ',"WV2- Permit Type: BUILDING ROOFING JOB ADDRESS: tcpo ts!E� 105 City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): ,L,C (l ii C- ` � �_-:�t(64 0 Phone#• Address: City: MA42116. B SI �-_2- State: -! L,)n Zip: 5: E?, Tenant/I.essee Name: Phone#: Email: CONTRACTOR: Company Name: L- RLAE'yL(L g Lks2L , Phone#: Address: City: Ste: J p j -' Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: DESIGW;,Architect/Engineer: Phone#: eL pp � a1Be of Work far Permit: $ Square/Linear`F $ otage 4 Wor1C: Type orW , Addiion ❑Alteration ❑New = ❑R'pp*/Repla(e ❑Demolition lid 7ESEg1r 3l aC9 �� +� Hescriptia�ork• Q �--�{i Tb -s- FAY `iC'� mllwn any d4'Jgleatt''j,4 Color thru tile: wlw-w low 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 $ �1(4 a- 101 18� 19- W ti k &C.) 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 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 is ed. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature a Owner or Age Contractor The f�ininsft-urnent was ac wledged before ni day o, 20 y who is personally known to me or who has produced The foregoing instrument was acknowledged before me this_ I :p day of 0&4 . , 20 i2, by r= hryN Gay rre--y W%® who is personally known to me or who has produced As identification ke an oath. Gv as i en 'fic ion and who did take an oath. NOTOP � F�'' NOTAR A comet June 28.2015 Sign: = No. EE 11=6 Sign: 117 .0 A., Print: I Q1F�� Print: • My Commis lion Expires: My Commission Expires: do % .' .�' �•� _ OF FI. � ,,%t �rrrtiittt�� APPROVED 13Y / O J--at Plans Examiner Zoning Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 01 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20 J BUILDING Permit No. PERMIT APPLICATION Permit Type: BUILDING Master Permit No. QG( � ^ al 19 Z ROOFING JOB ADDRESS: IO 0 W e t ®,� R C. C" City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes OWNER: Name (Fee Simple Titleholder) City: Tenant/Lessee Name: Email: NO Flood Zone: State Zip: CONTRACTOR: Company Name: Lcz la tc:4-u i Ca ( _ (NQ Phone #: Address: /off Of- City: � ��C,t,i A-L Qualifier Name: tl c� Phone #: State Certification or Registration #: Certificate of Competency #; Contact Phone #: �� . �I> Email Address ��' 7 DESIGNER: Architect/Engineer: ,J Value of Work for this Permit: $ Square/Linear Foo f ork. 7 � Type of Work: ❑Addition ❑Alteration ❑New ❑R ace ❑Demolition Description of Work: I j,�1/l� Ca G1. Z�is� � � 1`l Q Y1 -e— k 1 I lap Colo" thru d1e: Submittal Fee Scanning Fee $ oa Permit Fee $ CCF Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CO /CC $ DBPR $ Bond Technology Fee $ TOTAL FEE NOW DUE $ 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 posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent 1 The foregoing instrument was acknowledged before me this day of �, 20 1�� by V&21�r4kb, l 5CAaA, , who is personally known to me or who has produced C-U 1 D. NOT Sign: Print: My C As identification and who did take an oath. —ml III Signature ��"—`� ®� Contractor The foregoing instrument was acknowledged before me this 1ST day of _ �kn l 2 0 3, by � who ' personalln to or who las produced as identification and who did take an oath. APPROVED BY .�- Plans Examiner Structural Review NOTARY PUBLIC: %MalE TpR ��*,i, .si Sl Print: M My Commission Expires: = 0T c' o'-*';i�OF FLOV a\' : (Revised 5/2/2012)(R"ed 3/12/2012) XRevised 06 /10 /2009XRevised 3 /15 /09)(Revised 7/10/2007) Zoning Clerk :curDate > <ourTime >Work Comp Associates Inc.Elissa A Lucchese 12 -24�� CERTIFICATE OF LIABILITY INSURANCE DATE(MWODNYYY) 03/07/2013 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 policy(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 Ileu of such endorsement(s). PRODUCER z Michael D. Holleman Work Comp Associates, Inc. i ask (561) 863-9581 ino ink (561) 881 -9745 a mailoWorkCompAssoc.com P.O. Box 33297 Palm Beach Gardens, FL 33420 -3297 INSURER(S) AFFORDING COVERAGE NAICV INSURER A: Florida Citrus, Business & Ind. $ INSURED INSURER E: Clear Light Electric, Pardime Electric„ Inc. DBA INSURER C: $ INSURER D: 24625 S.W. 127th Ave Homestead, FL 33032 -4113 INSURER E: PRODUCTS - COMP /OPAGG wA \ /CA � A lbw INSURER P: $ �w V Gnft%m GA CERTIFICATE NUMBER: 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. EACH OCCURRENCE $ GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR , MED EXP (Any one person) $ $ PERSONAL A ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: J PRO POLICY - LOC CT PRODUCTS - COMP /OPAGG $ $ AUTOMOBILE LIABILITY A AUTO ALL LL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS AUTOS N 1 (Ea Sodden $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ $ $ A UMBRELLA UAS EXCESS UAB OCCUR CLAIMS -MADE N/A 10650435 8/31/2012 8 /31/2013 EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN OFFICE(MEM ERREXCLUDED XECUTIVE Y ❑ (Mandatory in under Ii yes, describe under DESCRIPTI ON OF OPERATIONS below X r F. $ E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 r7l I DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) CFRTIFit_ATR WnI neo Miami Shores Village Building Dept. 10050 N E 2nd Avenue Miami Shores Village, FL 33138 -2382 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ,. %)1888 -2010 ACORD CORPORATION. All rights reserved. ACORD 23 (2010103) The ACORD name and logo are registered marks of ACORD