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MC-14-1166Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: IN$P- 213648 Permit Number: MC -6 -14 -1166 Scheduled Inspection Date: June 25, 2014 Inspector: Perez, JanPierre Owner: GORDON,!REED Job Address: 1271 NE 97 Street Miami ShOres, FL 33138 -2559 Project: <NONE> Contractor: SUPA AIR AND HEAT INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132050090430 Building Department Cpmments REPLACE AC UNIT 2 AND 3.5 TON Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. June 24, 2014 For Inspections please call: (305)762 -4949 Page 16 of 35 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 i JOB ADDRESS: d 2 -71 !v C� a ` TY P ek JUN 0 5® 2014 BY: Q FBC 20 IP Permit No. Master Permit No. NC -A 4 " ( (0 (0 City: Miami Shores County: Miami Dade Zip: 3 3 13 v Folio/Parcel#: Is the Building Iiistoridally Designated: Yes NO % Flood Zone: OWNER: Name (Fee Simple Titleholder): Red 61),(61nh d ar. .V1 A 3 DC • q e3- ) 3 /p 3 Address: SA, fl - (Z71 Q/) S+reee City: k.i rx�.w 4 ewe 5 State: i- l - Zip: 3 13 V Tenant/Lessee Name: Phone#: 3 'l -Q r 'Q13 63 Email. (QQIL 80 d0 ( (0»4 -. riek n_ kit 9-6 06/1 CONTRACTOR: Company Name: �.�d tT n vt � , , � ' Tar.. Phone#: Address: ��3 AJ“) City: maw/ / ; %> State: Zip: 31; Qualifier Name: 012&-C4 y"111 3 ����,, Phone#: State Certification or Re 'station #: C/- c /15/ /3 Certificate of Competency #: Contact Phone#: 9 // g Email Address: ,-7�044-g. p /4,74d h C041 DESIGNER: Architect/Engineer: Phone#: Value of Work for thislPermit: $ Type of Work: OAddress Description of Work: OAlteration Square/Linear Footage of Work: ONew §:ittepair/Replace ODemolition 2 31 Q carte Submittal Fee 'C9-c/ Permit Fee $ 1—.1 t t S CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ d S'k • {j� 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 I the building permit is issued. In the absence of such po ' notice, the inspection will not be approved and a reinspection fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this At day of / who is i nally known to me or who has produced As identification and who did take an oath. OTARY P ; LIC: # ��tsut t j ttr�4'''i Sign: )r;Ji iamt Print Mai I --y'N WIL `: • vfoste 4'f loinunlittoo My Commission Expires: Contractor The foregoing • ' ent was acknowledged before me this day of �l , 20 VI byC €6, Li I l umre. -.)J who is personally known to me or who has produced 14°1-4 Ciaav411--- as identification and who did take an oath. NOTARY PUBLIC: \\\`\got i l rrrr ��� �� �� , cp Examiner Structural Review Revised 3 /12/2012)(Revised J07 /10/07)Revised 06/10/2009)(Revised 3/15/09) Sign: �� Print _m tF f6��IP go" My Commission Expires: =o ` `,o,31 4 Zoning Clerk 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. j Job Address (where the work is being done): /291 / A n ! �j 7-# Sr i r City: Miami Shores Village County: Miami Dade Zip Code: /jn 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 LIED ARHI Sheet Attached: YES j2NO ❑ Contract Attached: YES Er UNIT B ING REPLACED DATA NEW UNIT f:, - MANUFACTURER j.: % -, firl,&_ LI !:`U I I! - '' AHU or PKG. UNIT MODEL # --!AlcIVIECVAGYti 0 COND. UNIT MODEL # 4Y11:1.. .4, y KW HEAT Z A G NOM TONS f3a AHU CU PKG 1) M.C.A AHU CU PKG AHU CU PKG 2) M.O.P AHU CU PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT I I EER/SEER / YES NO r REPLACING DUCTS YES NO e/ YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4 °CONCRETE SLAB YES g./' NO YES NO _ NEW ROOF STAND YES NO j/ YES NO NEW RETURN PLENUM BOX YES NO ✓ 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): e 3. Voltage of Circuit (208/240/480): 0 4. Size Disconnecting Means: All Al "�, Contractor's Company Name: IPar tll a. n ,O) 1 i I I C Phone: q5Cf '/?i97 W I State Certificate or Registration N. &A4/1(61 ' Certificate of Competency N. 4 Signature er's signature only) Date: 41011 tit 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. / ' � ble. � R� Job Address (where the work is being done): 2./1/ City: Miami Shores Village County: Miami Dade Zip Code: 35/N 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 ❑ NOQ"ARHI Sheet Attached: YES iIO ❑ Contract Attached: YES Er U IT BEING REPLACED DATA NEW UNIT i Certificate AHRI Certified I f Pr This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2013. atin s Reference Number: 6873876 Date: 6/4/2014 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number 4TTR6024B1 Indoor Unit Model Number: GAM5B0A24M21 Manufacturer TRANE Trade/Brand name: XR16 Series name: Manufacturer responsible for the rating of this system combination is TRANE Rated as follows in accordance with AHRi Standard 210/240-2008 for Unitarryy Air- Conditioning and Air - Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI- sponsored, Independent, third party testing: Cooll4 Capacity (Stull): 21600 EER Rating (Cooling): 13.50 SEER Rating (Cooling): 16.25 IEER Rating (Cooling): • Ratings followed by an asterisk (•) indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which Indicates an Mwluntary mate. 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 disdains all liability for damages of any kind arising out of the use or performance of the produc(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. CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified at vamv.ahrlddrectory.org, click on 'Verify Certificate' link and enter the AHRI Certified Reference Number end the date on which the certificate was issued, which is listed above, and the Certificate No., which is listed at bottom right 1 02014 Air•Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: AIR - CONDIT ONING, HEATING, & REFRIGERATION INSTITUTE we make life better' 130483842022577824 I FI wvr.hridiae`ctoly aid This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2013. Certificate of Pro ,u t Ratin s AHRI Certified Reference Number: 6873891 Date: 6/4/2014 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 4TTR6042B1 Indoor Unit Model Number. OAM5B0C42M31 Manufacturer TRANE Trade/Brand name: XR16 Series name: Manufacturer responsible for the rating of this system combination is TRANE 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 (Btuh): 42000 EER Rating (Cooling): 13.50 SEER Rating (Cooling): 16.25 JEER Rating (Cooling): • Ratings fofowed 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 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 AMC 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 re erence. CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified at www.aheldirectory.org, click on 'Verify Certificate' link 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. ©2014 Air-Conditioning, Heating, and Refrigeration institute CERTIFICATE NO.: AIR - CONDITIONING, HEATING, & REFRIGERATION INSTITUTE we make life better' 130483638085378691 Supa and Heat Knuth Rd. Suite 101 SUPA AIR AND.HEAT INC. The Ultimate Comfort Solution 2 Boynton Beach PL 33436 Toll Free 866 - 774 -1247 2830 NW 208 St. • Miami Gardens, FL 33056 /5941 SW 23 Street • West Park, FL 33023 ro osal /Agreement CAC1815413 Customer Name Date % Street Street I j 241 )10 City, State, Zip /146 ; ° /3& City, State, Zip Phone 1� 4045 Phone ment for your home in accordance with the conditions and specifications set forth in this proposal. NEW EQUIPMENT 0 Air Conditioning - Size s% • 6 lo�J Model 0 Air Handier - Size a' /C 1) KW �� Model 0 Package Unit - Size Model KW Seer O Hot Water Recovery Unit 0 High Efficiency Media Filter O Attic Insulation 0 U.V. Air Cleanser Mown e hereby propose: o furnish, install and service under warranty (stated below) SUPA AIR products or related equip- seer /‘139H O U.V. Destroyer O Dynamic Air Filter DUCTWORK/AIR DISTRIBUTION CI New Supply Grille(s) and associated ductwork Cr New Return Grille(s) and associated ductwork O Complete supply air trunk system with all required branch and return ductwork O New duct(s) without cans or grilles PIPING o Opti-sized refrigerant pyres with armaflex insulation o Architectural exterior refrigerant line enclosure )(Condensate drain U Clean existing condensate drain INSTALLATION 114Afl work done in accordance with existing codes AO required permits Removal of existing equipment from premises Vibration isolating shock absorbers Pre -cast concrete slab ELECTRICAL/CO OMercury/magnetic five function cooling thermostat OV OH O Programmable thermostat 0 Hard start kit Cr De humidistat O Digital thermostat O Time Delay 0 Comfort Control O Surge suppressor 0 Honeywell Round GUARANTEES O Air handier O Cond. U Pkg. unit Cl Compressor PARTS 0 one yr CI five yr 0 one yr Ofiveyr 0 one yr 0 five yr 0 one yr O five yr ten n ten yr kenyr "\ten Yr CI VISA 0 MC U AMEX Expiration Date: O Duct sanitizing and refreshing O New Air Handler plenums O Balance air distribution system for uniform temperature. O Leak proof mastic seal application 48 `Refrigerant filter dryer Emergency drain pan and float switch O Brass refrigerant oonnectors O Other O Complete clean up including vacuuming and use of drop cloths for the protection of home furnishings O All work performed in a neat and professional manner by Class 1 Certified Technicians O Rustproof O Other NTROLS Cr Low - voltage control wiring O New all copper insulated electric circuits) with disconnect WO) and weatherproof conduit and connectors at condens- ing O Install new Amp. electric service and panel O Electrical disconnect O A.H.U. 0 Cond. 0 one yr O one yr 0 one yr LABOR two yr 0 five yr 0 ten yr two yr O five yr 0 ten yr two yr 0 five yr O ten yr TOTAL INVESTMEENJTJ (/03.0.; t7LESS CREDITS l't' 1. q3 ` o DOWN PAYMENT BALANCE ON u, - , APProYal Ar Date Agreement ¢ This ^"!. for service is by and between the Customs and the Compeer The s price does not include sales or other tax, If any, or er any unforseen parts or labor, which may be needed after the work begins. Written Customer authorisation will be obtained before beginning any additional or extended work. I authorize the performance of the work, subject to all terms and conditions set forth hereof; plus any taxes on completion. This invoice is due and payable upon reciept. Supa Air and Heat 200 Knuth Rd. Suite 101 Boynton Beach, FL 33436 SUPA AIR AND HEAT INC. The Ultimate Comfort Solution Toll Free 866- 774 -1247 2830 NW 208 St. • Miami Gardens, FL 33056 /5941 SW 23 Street • West Park, FL 33023 Pro • osal /Agreement CAC1815413 Customer Name �. JI 1 • Date Street 2i% sr Street City, State, Zip frlaik111 33/31' City, State, Zip `aka) Phone 3c35 907 3,6.0 Phone We hereby propose: To furnish, install and service under warranty (stated below) SUPA MR ment for your home In accordance with the conditions and specifications set forth in this proposal. NEW cQUIPMENT O Air Conditioning - Size-7M/ t 2 Model O Air Handler - Size 7 2-J KW 6 Model O Package Unit - Size Model KW Seer 0 Hot Water Recovery Unit D High Efficiency Media Filter D Attic Insulation O U.V. Air Cleanser products or related equip- seer D U.V. Destroyer O Dynamic Air Filter DUCTWORK/AIR DISTRIBUTION 0 New Supply Grilles) and associated ductwork O New Return Grille(s) and associated ductwork 0 Complete supply air trunk system with all required branch and return ductwork O New (ucts) without cans si or grilles PIPING O Opti -sized refrigerant lines with armaflex insulation O Architectural exterior refrigerant line enclosure O Condensate drain O Clean existing condensate drain INSTALLATION All work done in accordance with suing codes required permits emoval of existing equipment from premises Vibration isolating shock absorbers re -cast concrete slab 0 Duct sanitizing and refreshing 0 New Air Handler plenums O Balance air distr bution system for uniform temperature. 0 Leak proof mastic seal application Refrigerant filter dryer drain pan and float switch O = rass refrigerant connectors O Other Complete clean up inducting vacuuming and use of drop for the protection of home furnishings w ' I 0II° work performed in a neat and professional manner by `Class 1 Certified Technicians 0 Rustproof O Other ELECTRICAL/CONTROLS 0 Mercury/magnetic iiive function cooling thermostat OV OH 0 Low - voltage control wiring O Programmable thermostat O Hard start kit 0 New all copper insulated electric circult(s) with disconnect box(s) and weatherproof conduit and connectors at candens- 0 De humidistat 0 Digital thermostat frig unit 0 Time Delay O Comfort Control 0 install new Amp. electric service and panel O Surge suppressor 0 Honeywell Round 0 Electrical disconnect 0 A.H.U. 0 Cond. GUARANTEES D Air handler O Cond. O Pkg. unit 0 Compressor D one yr 0 one yr D one yr o one yr PAlRiS 0 five yr 0 five yr o five yr O five yr Wten yr ;(ten yr 0 ten yr itkten yr 0 VISA 0 MC O AMEX Expiration Date: Credit Card #: ApProYal Date c D one yr D one yr D one yr LABOR two yr O five yr two yr 0 five yr Iwo yr O five yr 0 ten yr 0 ten yr 0 ten yr TOTAL INVESTMENT $ r/ dov .0t? Pl LESS CREDITS ( #36,5 ` cx3 DOWN PAYMENT BALANCE ON /�,..r- / /O APProYal Date 79 Agreement for service: This Agreement for Service is by and between the Customer and the Compan. The paIc6 does not include sales or other tax, If any, or cover any unforseen parts or labor, which may be needed after the work begins. Written Customer authorization will be obtained before beginning any additional or extended work. I authorize the performance of the work, subject to all terms and conditions set forth heron; plus any taxes on completion. This invoice is due and payable upon reciept. Level Business Tax Receipt Miami Dade County, State of Florida —THIS 18 NOT A BILL DO NOT PAY 129706 ISINERS NAME/LOCATIONTI PA AIR AND HEAT INC 30 NW 208 ST 4M1 GARDENS FL 33056 FIVER A AIR AND HEAT INC rker(s) RECEIPT NO. RENEWAL 6230388 LBT, EXPIRES SEPTEMBER 30, 2014 Must be diaplayed at plane of bualnees Pursuant to County Coda Chapter HA m Art. ® & 10 SEC. TYPE OP BUSINESS 196 SPEC MECHANICAL CONTRACTOR CAC181841.3 PAYMENT RECEIVED BY TAX COLLECTOR $45.00 07/25/2013 TXHS1 ®1'3®036739 This Local Business Tax Receipt a ty coalIrmaf al Local Business Tax. The R is not a lionnee, permh, or a eertlfIoation of the hoIderIa quellti to do eau. Holder most amply n�i any Cnvarnmentai or nCnyowrnmenml ragulatory laws end requiremente whiedapply to the bulimia The RECEIPT NO. above mum be displayed on all oommerolal vehioles- Adlond.itada Cede Sea 5 g75, For more Information,assImIandokotapatkat 06/04/2014 WED 13:05 FAX IZ�J001 /001 -�1 ACORL1.)' CERTIFICATE OF LIABILITY INSURANCE SUPAAII OP ID: PW I DATE (MNIDDJYYYY) 08104/2014 _ 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 POUCIES 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(Ies) must Ise endorsed. If SUBROGATION 18 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 endorsement(s). PRODUCER Hallandale Branch Rlemar insurance Group PO Box 260 Hallandale FL 33005-0260 Stephen L Rimer INSURED Sups Air and Heat, Inc. INSURER a :Wilshire insurance_cammy 5841 SW 23rd Street West Park, FL 33023 CONTACT NAME: �P�HcON E AD : L/C D INSURER(S) AFFORDING COVERAGE !WREN A : ArnTrust North America Mc S INSURER C : INSURER D I INSURER E : INSURER P COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THAT 'THE POUCIES 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, EXCWSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE_ BEEN REDUCED BY PAID CLAIMS. ADM SUHIr TR INER SWD POLICY NUMBER IM EFF I �SVDD/YY11Y1 LIMITS TYPE OP INSURANCE GENERAL. LIAIUTY B X COMMERCIAL GENERAL, mown' CLAIMS..MADE OCCUR GEML AGGREGATE UNIT APPLIES PER: 7 POLICY I—I 171 LOC AUTOMOBILE LIABILITY ANY AUTO UT08 NED HIRED AUTOS UMBRELLA I.IAO EXCESS LIAR CL00182107 01/19/2014 EACH OCCURRENCE 01/19/2016 PREMISES (Ea aNccunencel MED EXP (Any aaa Poravn) $ PERSONAL & ADV INJURY S l► 1,000,000 50,000 6,000. 1,000,000 GENERAL AGGREGATE a 2,000,000 PRODUCTS • COMP/OP AGO a 1,000.000 SCHEDULED O NOON-OWNED AUTOS H OCCUR CLAIMS.MADS BED I I RETENT ON WORKERS COMPENSATION AND EMPLOYER$' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTNE Y❑ OFFICCR MEMSER EXCLUDED'? Mya�ned,atory In NH) DESCRIPTION 9 OPERATIONSbelm o�tE LIMIT $ a BODILY INJURY (Per person) a BODILY INJURY (Par accident) $ I EACH OCCURRENCE a AGGREGATE $ N/A WC1011629 02/01/2014 WO STATU am JQRY LIMITS I I - FR 02/01/2016 E.L. EACH ACCIDENT . $ OESCRIPnON OF OPERATIONS I LOCATION / VEHICLES (Attach ACORO 107, Additional Remarks Schaade Irmo, ewe l,aquI,ed) Air conditioning Service and Installation - Commercial 6 Residential CERTIFICATE HOLDER E.L. DISEASE • LA EMPLOYEE $ 600,000 500,000 E.L DISEASE -POLICY LIMIT a 500,000 CANCELLATION Miami Shores Village Building Department 10050 N.E. 2nd Avenue Miami Shores, FL 33138 MIAMSHI ACORD 25 (201(1/55) SHOULD ANY OF THE ABOVE CRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE r ' ER = OF, NOTICE WILL BE DEWERED IN ACCORDANCE WITH T, E. • • OA CY P • VISIONS. AUTHORIZED REPELS i A Stephen L = m ®1955- ACORD CORPORATION. All rights served, The ACORD name and logo are registered marks o CORD