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MC-14-540Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 209310 Permit Number: MC -3 -14 -540 Scheduled Inspection Date: March 31, 2014 Inspector: Perez, JanPierre Owner: SOTO, ALBERTO Job Address: 609 NE 105 Street Miami Shores, FL Project: <NONE> Contractor: SERVICE AMERICA NETWORK Isunaing uepartment comments Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number 3051345 -7275 Parcel Number 1122310120060 A/C CHANGE OUT Infractlo Passed Comments INSPECTOR COMMENTS False 3 March 28, 2014 For Inspections please call: (305)762 -4949 Page 11 of 27 Inspector Comments Passed 12 Failed Correction Needed ❑ Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. March 28, 2014 For Inspections please call: (305)762 -4949 Page 11 of 27 Miami Shores Village Building Department l 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 L Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: MECHANICAL JOB ADDRESS: �-ao ck K3+5-" to FBC 20 Permit No. - —40 on Master Permit No. City: Miami Shores County: Miami Dade Zip: J Folio/Parcel #: 1 k QZZk l'7(� 00 f 7 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder):. I bC-C-+O fLo--b> Phone #: Address: ta[) Ci City: III\ 61 s b e�S State: Zip: Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: 4 Address: _-55 A 1 L1) /0'; City: Qualifier Name: --<-CK KL[ � 1�.1 �1}��]1 111 ( Fhone#: State Certification or Registration #: 1 11 Certific4te of Competency#: Contact Phone #: Email Ad Tess: j�� s(- DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Address � OAlteration Description of Work: -AC c, ONew 'Q epair/Replace ODemolition Submittal Fee $�� Permit Fee $�/) CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education .Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ b�� 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 caning. "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 issuanc, of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of comm�.t went and construction lien law broc re will be delivered to the person whose property is subject to attachment. Also, a certied copy recorded notice of com em n u e posted at the job site for the first inspection which occurs seven (7) days after the buildin is issued. In the absence ste otice, the inspection will not be approved and a reinspection fee will be charged. Signature. Owner or Agent The foregoing instrument was acknowledged before me this day of 3 , 20 7 by 19.1 who ' personally known to me or o has produced NOTARY PU IC: —q J,) Sign: Print. My Commission Expires: APPROVED BY and who did take an oath. JESSICA DOTSON MY COMMISSION 0 FF 072984 EXPIRES: November 26, 2017 `—/ Contractor The foregoing instrument was acknowledged before me this-'-b day of ,5 , 20 1 by I -PVl ✓� who is personally known to me or who has produced as identification and who did take an oath. NOTARY My Commission IIns Examiner JESSICA DOTSON- MY COMMISSION # FF 072984 EXPIRES: November 25, 2017 Bonded ihru Notm o,.h,s Zoning Structural Review Clerk Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel. (305) 795.2204 Fax. (305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC 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): LO 0 Q L�I-1 City: Miami Shores Village County: Miami Dade Zip Code: !a3� 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 ICJ NO ❑ Contract Attached: YES ❑ 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractoif s OWpawame: f:�_\i ic:t --V"rM- -0- Phone: State rtifi e orregi\r�'on N. (2iM ill@ L0) Certificate of Competency N. Signature signature Date: UNIT BEING REPLACED DATA NEW UNIT MANUFA_URER LI-e- i A 41 Ai ld AHU d KG NIT MODEL # (60 k4 COND. UNIT MODEL # I ° L) KW HEAT IL NOM TONS AHU CU PKG 1 M.C.A AHU CU PKG 0 AHU CU PKG 2 M.O.P AHU CU PKG D AHU CU PKG a 3 VOLTS .2;G AHU CU PKG 21A) PKG UNIT I I PKG UNIT / I EER/SEER YES REPLACING DUCTS YES YES REPLACING THERMOSTAT YES YES NEW 4 "CONCRETE SLAB YES YES NEW ROOF STAND YES YES 0 NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractoif s OWpawame: f:�_\i ic:t --V"rM- -0- Phone: State rtifi e orregi\r�'on N. (2iM ill@ L0) Certificate of Competency N. Signature signature Date: 03/1912014 10:08 9549773591 SERVICE AMERICA PAGE ASER�VICE„ SAl�E�r n MEit�CA FerttntlaerdgKoGrift."309,'' ACRE MEhli' wwwsatviceAlneriea.c03n s- 888��'41 -5yS9 Al Soto $540294 3/12J2014 Caala:nn N11me Ac+aimt /Cintr+ eta DaM . Matte M 0p:C 6- MM~uAaeia� Oelrerp�mrn . ' S+4aAdminfee: ' 609 NE 105th Street Miami ShareS A. 921W ltaMllAtIOAAdwm11 Clty Zip sweet Type: yprtiip OracllaQe: YES watm•Searpa skWnbtCOOL• Y9:s Neat Pmmp perar. • of SSi11ar 1, CanAe11tarler11etam Graard: 'flee /: Von 01INHe J0. YES A4'N11ndlartovtlar11 Gtaise: ,Arne . ,,,,u�+{{ rAnMOSTAT11M RECll1EECCQCLffM WA met- YES IhlnurYCAMteAgienreinHook -up gewCO11drump tsigtal: YE5 Abffittwter YO saeondepCOnearamtaDratnNe113�w N11i11syb PrvRammDbfe: YES shft AM@}ry 13111111 ran 4x0A fWSI: TOM Na3tm w OmIA pen cawwall r: YFS Aae(aary fide u taty rwtich' Vidr� 9/511: t16tA!{eragtli:o•Cwer• i TAmmostoh 7Vpe: mdnQmareCmppertkmeu She; ' OHeoMAeet ne:C Addsanfat Copper Smion tlne WN SAIOIM 3>att11etm: "Mw st„, 1 10 Getptpet era: . I:ntatianan IrdarmettOAr ' Mlire ' Mahe: Frigldalm Mallet oAr 5 TOV. Tan: Sm is am, SUM UTu: 57.000 stn: Out swiu 30 RWH: nWNi MoOlAtN: PSRF)(KA KIM. Made[AAF modal tamis Maw Shad: tytoadCand: Prim pHp3: Pneer 5VARm invesplrent: hlstaOkit Crone FPL Rebsto Utillly Service America Other Repiacenm,t Cma lgsutallon: curt Cleaning UV Light LOW Adminisusdve Fee (111-- rrmdmdai TOTAL ibIVESTd oq: Dom Payments[ BALANCE DUE: + Type I +' T"/ND vwa $2,85$ $0 SO $100 SO Sa6paro6uawwerr11atnAAt • $350 eSO y.. $0 pmNa,taborgl&mw, C11Memar .. $775 so $n . SAIE Patti @ caber wan11mvs Pta Unit $0 $0 $o M%,s w: M," cnCompressor $0 $0 SO NNg :x W4t"11typNoatdaorCo $0 so $0 tyt 'ew11rr.:+tvonlrateaCOA $0 So' $0 Mrs -,# anantyoa Parta SO SO so Mid of Payment: s0 so so $0 $0 $d Credit Card: Check: $o so $0 Visa Mc $200 $0 s0 Discover weti5 Fargo 2 ••$o credit Cardin SO . $0 Eapirati0n: ' M CODE: $2S $0.11A $0.00 Signature• 3 use Credit Card for insmllattot! Dade; LAddar Rwrylnd for inspection: She or►Adder 01/01 Property Search - Report Property Information: Folio 11 -2231- 012 -0060 MIAMI -DADE COUNTY PROPERTY APPRAISER 609 NE 105 ST Lazaro Solis ALBERTO O SOTO &W JOSEPHINE Mailing Address 1 PROPERTY APPRAISER Property Information: Folio 11 -2231- 012 -0060 Property Address 609 NE 105 ST Owner Name(s) ALBERTO O SOTO &W JOSEPHINE Mailing Address 609 NE 105 ST MIAMI SHORES FL 33138 -2053 Primary Zone 1100 SGL FAMILY - 2301 -2500 SQ Use Code 0101 RESIDENTIAL -SINGLE FAMILY: 1 UNIT Beds /Baths /Half 4/3/0 Floors 2 Living Units 1 Adj. Sq. Footage 3,741 Lot Size 14,600 SQFT Year Built 1946 Full Legal Description GOLF VIEW EST CORR PLAT PB 41 -58 LOT 7 LOT SIZE IRREGULAR OR 18633 -4554 05 1999 1 Assessment Information: Year 2013 2012 Land Value $195,935 $145,137 Building Value $332,542 $363,162 Market Value $528,477 $508,299 Assessed Value $393,947 $387,362 Benefits Information: Benefit Type 2013 2012 Save Our Homes Cap Assessment Reduction $134,530 $120,937 Homestead Exemption $25,000 $25,000 Second Homestead Exemption $25,000 $25,000 Note: not all benefits are applicable to all Taxable Values (le County, School Board, City, Regional). Disclaimer: Page 1 of 1 Aerial Photography 2012 Taxable Value Information: Year 2013 2012 Exemption/ Taxable Exemption/ Taxable County $50,000/$343,947 $50,000/$337,362 School Board $25,000/$368,947 $25,000/$362,362 City $50,000/$343,947 $50,000/$337,362 Regional $50,000/$343,947 $50,000/$337,362 Sale Information: Date Amount OR Book -Page Qualification Code 05/01/1999 $265,000 18633 -4554 2008 and prior year sales; Qual by exam of deed 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: / /www.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: Tue Mar 18 2014 http: / /gisweb. miamidade .gov /PropertySearch/printMap.htm 3/18/2014 [IMMILOMILZ,11 I III=* �1 LTT AHRI Certified Reference Number: 5617709 Date: 3/18/2014 Product: Single- Package Air - Conditioner, Air - Cooled Model Number: P5RF -X60KA Manufacturer: FRIGIDAIRE Trade /Brand name: FRIGIDAIRE Series name: FRIGIDAIRE P5RF SERIES Manufacturer responsible for the rating of this system combination is FRIGIDAIRE 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: " 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 liability 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.ahrldirectory.org. 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. A AIR-CONDITIONING, HEATING, CERTIFICATE VERIFICATION & & REFRIGERATION INSTITUTE The Information for the model cited on this certificate can be verified at www.ahridirectory.org, click on "Verify Certificate" link w we make life better- and enter the AHRI Certified Reference Number and the date on which the certificate was Issued, which Is listed above, and the Certificate No., which is listed at bottom right. 130396250946913: ©2014 Air - Conditioning, Heating, and Refrigeration Institute C CERTIFICATE 1 Project Summa Job: 4 - w' rightSOft® � � Date: Mar Mar 18 18, 2014 Entire House By: JD SERVICE AMERICA 2755 NW 63 CT, FORT LAUDERDALE, FL33309 Phone: 954 -979 -1100 Email: EPERMITSGROUP @SERVICEAMERICA.COM License: CAC014619 For: Notes: AL SOTO 609 NE 105TH STREET, MIAMI SHORES, FL 33138 Weather: Winter Design Conditions Outside db Inside db Design TD 52 OF 70 OF 18 OF Heating Summary Structure 18656 Btuh Ducts 0 Btuh Central vent (0 cfm) 0 Btuh Humidification 0 Btuh Piping 0 Btuh Equipment load 18656 Btuh Infiltration Miami Intl AR FL, US Method Simplified Construction quality Average Fireplaces 0 Heating Equipment Summary Make Trade Model AHRI ref Efficiency Heating input Heating output Temperature rise Actual air flow Air flow factor Static pressure Space thermostat 80 AFUE 0 MBtuh 00 BFtuh 2185 cfm 0.117 cfm/Btuh 0 in H2O Summer Design Conditions Heating Cooling Area(fta 3757 3757 Volume (ft') 34215 34215 Air changes /hour 0.28 0.15 Equiv. AVF (cfm) 160 86 Heating Equipment Summary Make Trade Model AHRI ref Efficiency Heating input Heating output Temperature rise Actual air flow Air flow factor Static pressure Space thermostat 80 AFUE 0 MBtuh 00 BFtuh 2185 cfm 0.117 cfm/Btuh 0 in H2O Summer Design Conditions Outside db Inside db Design TD Daily range Relative humidity Moisture difference 91 75 16 L 50 57 OF OF OF % gr /lb Sensible Cooling Equipment Load Sizing Structure 48020 Btuh Ducts 0 Btuh Cent al vent (0 cfm) 0 Btuh Blower 0 Btuh Use manufacturer's data n Rate/swing multiplier 0.96 Equipment sensible load 45955 Btuh Latent Cooling Equipment Load Sizing Structure 3715 Btuh Ducts 0 Btuh Central vent (0 cfm) 0 Btuh Equipment latent load 3715 Btuh Equipment total load 49671 Btuh Req. total capacity at 0.70 SHR 5.5 ton Cooling Equipment Summary Make FRIGDAIRE Load sensible heat ratio 0.93 Trade Cond P5RFX60KA Coil AHRI ref 5617709 Efficiency 12.0 EER, 15 SEER Sensible cooling 39900 Btuh Latent cooling 17100 Btuh Total cooling 57000 Btuh Actual air flow 2185 cfm Air flow factor 0.046 cfm/Btuh Static pressure 0 in H2O Load sensible heat ratio 0.93 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. 1 Writ 111CSOfi 2014 -Mar- 1813:25:47 g Right -Sufte® Universal 2012 12.1.06 RSU10533 Page 1 AM Project8.rup Cale = MJ8 Front Door faces: N 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. A. COPS' OF QUALIFIER'S STATE LIC CARD B. \,f PY OF,LOCAL BUSINESS TAX RECEIPT C. Y LIABILITY INSURANCE CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. 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: SERVICE AMERICA BUSINESS ADDRESS: 2755 NW 63 COURT CI.yFORT LAUDERDALE STATE FL ZIP CODE 33309 BUSINESS PHONE: 9( 54 ) 979-1100 FAX NUMBER 9( 54 ) 977-3591 CELL PHONE QUALIFIER'S NAME: RICHARD LEVINSON QUALIFIER'S LIC NUMBER. CAC014619 E -MAIL ADDRESS (IF APPLICABLE): EPERMITSGROUP @SERVICEAMERICA.COM Created on 3119109 BY MLDV I RV 3126109 MLDV LEVINSON, RICHARD MARL SERVICE AMERICA ENTERPRISE, INC. 2755 NW 63RD COURT FORT LAUDERDALE FL 33309 Congratulationsl With this license you become one of the nearly one million Floridians licensed by the Department of Busyness and ftfesslohal .Regulatlon. Our professlonals and businesses range t Err[ Orchhectel to yacht brokers, from boxers to'barbeque restaurants,, and they keep,. Florida's economy strong. Every day we work to improve the waywo do business In order to serve you bette For information about our services, please- tog onto www.myftoridatipense.corn. There you can find more Information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the 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! A C$�7 r STATE 4 FLC11Dq ; i SPARS` T i +, 3�±SINES i Pi OFRz � t�U TTO1 f tzar�ICTIi zY I TC<El� sOi> .SE04L1206110004.0.. s £�TGRTFr ''NBa�r 'h® CASS� A A -R Named b 1" IS C$RTIFI I W. R, I Und the provis oxis of :Chap z F ', Expiration date:_AUO 31, 2014 � a , I LEVINS`ON' R�CRARD ,C SERVICE PxtEizCA .ENTRFRISE,r� i 2755 NW 63RD � IOURI FORT LAUDERDALE FL 33 3 09 r .. RICK $C,OTTt ItEN,:LAT+PSON G GOVERNOR C (SPLAI AS RE 3ECRET�iRY` QUIRED I31� 'LAW' 115 S. Andrews Ave., Rm. A -100. Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014 DBA: Receipt # :183 -1417 HEATING /AIRCONDITION Business Name: SERVICE AMERICA ENTERPRISE INC Business Type: (CLASS A A/C CONTR) Owner Name: RICHARD MARC LEVINSON Business Opened:04 /01/1998 Business Location: 2755 NW 63 CT StatelCounty /Cert/Reg:CAC014619 HOLLYWOOD (Exemption Code: Business Phone: 954- 929 -6600 Rooms Seats Employees Machines Professionals 15 For Vending Business Only Numhar of Machines: Vendina TYDe: 'Fax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost I Total Paid 54.00 0.00 0.00 0.00 0.00 0.00 54.00 .T THIS RErCEIPT 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 planning WHEN VALIDATED 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 regulations. Mailing Address: A SERVICE AMERICA ENTERPRISE INC 2755 NW 63 CT FT LAUDERDALE, FL 33309 r . 2013 - ;, Receipt #10A -12- 00001718 Paid 07/12/2013 54.00 ' 03/19/2014 10:56 9549773591 SERVICE AMERICA PAGE 01/01 A� CERTIFICATE OF LIA THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONL` CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITU' REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT. If the certificate holder Is an ADDITIONAL INSURED, the the terms and conditions of the policy, certain policies may require an e certificate holder In itau of such endorsement(s). PaonueER LOCKTON COMPANIES, LLC -1 KANSAS CITY 444 W. 4MI STREI~T, SUITE 900 KANSAS CITY MO 64112 -1906 (816)960.9000 INSURED SERVICE AMERICA ENTERPRISE, INC. I343425 2755 NW 63RD COURT FORT LAUDERDALE FL 33309 BILITY INSURANCE D10/2 /201Y1� 10/25/2014 10/23/2Q 13 'AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES `E A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED poliay()es) must be endorsed. If SUBROGATION IS WAIVED, subject to idomement. A statement on this cartifleate does not confer rights to the CONTACT PHaN o FAX No rl IL 5. INSURER 5 -3 APPORDING COVERAGE NAIC # INSURERA:Zurich Arnerioan T.nsura ce C_0=an 16535 INSURER B s EACI•IOCCURRENCE INSURER C AGGREGATE $ X TORY LIMIT 05-1 INSURER o 1 E.L. EACH ACCIDENT INSURER E s E.L. DISEASE - EA EMPLOYE RER F: DISEASE • POLICY LIMB 1 F 1 _00Q,000 1665 REVISION NUMBER: XxxxCXX 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 aL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS TYPE OF INSURANCE A GENERAL LIABILITY MMMIAL GENE RILITY ( CLAIMS-MAW I X OCCUR OCN'L AGGREGATE LIMIT APPLIES PER: N I N I OW655546744 A ff"I LUIE11 N N NY AUTO LL OWED SCHEDULED UTOS AUTIRED AUTO$ X AUTOS VMRELLA LIAO EXC90a LIAR B I ANe OCCUR NOT APPLICABL$ CLAIM9 -MA4E N 201375 7650856 CUTIVE L_" J NIA 10/25/2013 110/25/2014 10/25/2613 110/25/2014 12/31/2013 110/25/2014 DESCRIPTION OF CPERA'nCNS / LCCAT10N81 VEWICLES (AlMeh ACDRD 907, Add81one1 ReMrka SahodUle, R mam saeco le regrdrod) Evidence of Cov=Se. Richard Levinson CAC014619 11493669 Village of Miami Shores 10050 N.E. 2nd Avenue Miami Shores FL 33138 neme and logo arc LIMITS rA0 O= IRRFUg _S 1-000-000 PRQAISeR° REurrence R 1,900.0 00 ED ane notgo) $10,000 PERSONAL a AOV INJURY S 11000,000 GENERALAGG11E19ATE S PRODU -COMP MEW Eaeadtlen0 BODILY INJURY (Pet pawn) 5 99—CILY aracclaent PROPERTY DAMAGE B EACI•IOCCURRENCE $xxxxxXX s XID=M AGGREGATE $ X TORY LIMIT 05-1 S xxxxxxx E.L. EACH ACCIDENT 9 E.L. DISEASE - EA EMPLOYE 3 1 000 000 DISEASE • POLICY LIMB 1 F 1 _00Q,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.