Loading...
Multiple (2)Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 3313$ Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit No. P01-114 Master Permft No. Re. - /I- //-c2 // 7 Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): /7 tni14"ei '/€7 4,1.185 4 c:1 A Phonet 3 O 7 il-e7P1,,V Address: / 06 34 City: ickT, ;4' 3,1101%-t State: Zip: Tenant/Lessee Name: Phonet Email: JOB ADDRESS: 107r Air eg 54 City: Miami Shores Folio/Parcelt //a/ 36' 001,d 3 5" 0 Is the Building Historically Designated Yes NO NA County: Miami Dade Zip: Flood Zone: CONTRACTOR: Company Name: operioatv se/104-4;13 4.v Phonet jar- 7447av1 Address: /god we /33 Re/ City: ivoiN 11411 State: it• Qualifier Name: pep/163 ,4 //OF' Phone#: 07,400olVi( State Certification or Registration #: RAW° 6 77O Certificate of Competency it: Contact Phone: 301,7q17 7f7c02 Email Address: 5, a 1 seitw-7,4044e,"-ec- DESIGNER: Architect/Enginee-r: Phone#: Zip: 3311/ istissasstmakkAL.,, - ValtWorWork forthis Permit: 0 ;:411:irii D btWorki3 WO, Square/Linear Footage of Work: teration tf-kt ,f.Oftti °Demolition A / / ,1 $ WesAgr /AIL, oz*- 014We /10,1s - SAWA, V4IV$ INS/ 1 ieete, toe-44/ 07- 4411 5 ***************************************Fees******************************************** Submittal Fee $ Permit Fee $ /5 0 1 (n CCF $ CO/CC $ Scanning Fee $ 3-00 Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 153 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 the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a r ' ' ection ee will be charged Signatur Owner or Agent The foregoing instrument was acknowledged before me this day off, / At' 20C 2-7-by 11144,413.0/ ® 62.905444 4 who is onally know )to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print My Commission Exp' * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY Signatui( Contractor The foregoing instrument was acknowledged before me this r day of Live ,206Z,by V 4 '5 tin 0 t who is(6ersonally known)to me or who has produced as identification and who did take an oath. sa tt;s° Bonded Through National Mari Assn. Print: My Commission Expires: ******+x******+><*** ****** as **** non * **** ** see****+ x**** ******* ***************a*+r****** - 30 1— Plans Examiner Structural Review (Revised 07 /10107)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk 106 ST' iM r r9-uu•c �8b - Z4 2-0Z a) cn N O 0 JJ 0 W 0 cc 0 a_ ZONING DEP f BLDG DEPT H ALL FEDERAL SUBJECT CO CCMPIJANCE WI STATE AND U(-UN 1Y RULES AND REGULATIONS C NOV 1 5 2011 gs '2r " 7- Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Permit NO. PL -12 -11 -2289 Permit Type: Plumbing - Residential Work Classification: Addition /Alteration Permit Status: APPROVED Expiration: 06/13/2012 Parcel Number Issue Date: 12/16/2011 Applicant 125 NE 106 Street Miami Shores, FL 33138 -2036 1121360060350 Block: Lot: HUMBERTO QUESADA i Owner Information Address Phone Cell HUMBERTO QUESADA 125 NE 106 Street MIAMI SHORES FL 33138 -2036 Contractor(s) SUPERMAN PLUMBING Phone Cell Phone (305)796 -2042 Type of Work: 2 BATHROOM REMODEL Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $2.40 $2.25 $2.25 $0.80 $150.00 $3.00 $3.20 $163.90 Pay Date Pay Type Amt Paid Amt Due Invoice # PL -12 -11 -42789 12/21/2011 Check #: 1026 $ 163.90 $ 0.00 Available Inspections: Inspection Type: Top Out Final Underground In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. December 21, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date December 21, 2014 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Permit NO. 'EL -12 -11 -2288 Permit Type: Electrical Residential Work Classification: Alteration Permit Status: APPROVED Issue Da 12/16120111 Expiration: 06/13/2012 Parcel Number Applicant 125 NE 106 Street Miami Shores, FL 33138 -2036 1121360060350 Block: Lot: HUMBERTO QUESADA i Owner Information Address Phone Cell HUMBERTO QUESADA 125 NE 106 Street MIAMI SHORES FL 33138 -2036 Contractor(s) JAKE'S ELECTRIC, INC Phone (305)796 -6237 Cell Phone Type of Work: REPLACE HI HATS 2 OUTLETS Additional Info: 1 EXTRACTOR FAN 1FIXTURE LIGTH Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Amount $0.60 $2.25 $2.25 $0.20 $150.00 $3.00 $0.80 Total: $159.10 Pay Date Pay Type Amt Paid Amt Due Invoice # EL -12 -11 -42788 12/21/2011 Check #: 1026 $ 159.10 $ 0.00 Available Inspections: Inspection Type: I In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. December 21, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy December 21, 2011 1 e Miami Shores Village Building Department t0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 RECEI b EL DEC 09 2011 BY: Permit No. Master Permit No. l C -/ 1- // 4117 Permit Type: Plumbing Owner's Name (Fee Simple Titleholder) 1-41'Y1%cied, a &e$484 Phone # Owner's Address as fr e /026 iT City /Yli4mi Sfsol'`ei\,, State /"L Zip 33/7 r.-0743e Tenant/Lessee Name Phone # E -MAIL: Job Address (where the work is being done) S4#4 City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO 2V-V7-101002 Contractor's Company Name SeVe,,:4laiv /9hLi%3/Nf .0V1 Phone # Contractor's Address 4733-r me, /3 Ave ize 4U)6 30j- 7Waorz City /✓Orel, A4)4- State fit Zip 33M/ r� l Qualifier Name fe vi S / *//®/✓ ,mot t 4 Phone # 30Y- 7t � 77re? State Certificate or Registration No. f F n 1019/50 Certificate of Competency No. CG 07,000 o2Y ' E -MAIL: 5P¢ $r .'er leo,0 91/4' . c.ov i Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 36OA Square / Linear Footage Of Work: Type of Work: EAddition ❑Alteration ['New Repair/Replace ❑ Demolition Describe Work: 2 S/YeAv ei aol ve $ Gel (IVG 'r C /D,$t1.S a `at/a 71 ?ri i93 * ** * ** * ** * * *** *, * * *** * * * * ** * * * * **** Fees * * ** ** * * *, * * * *, * * * * ** ** * * * ** ** ** * * * ** **** ** Submittal Fee $ Permit Fee $ CCF $ CO /CG Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ . Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ \, / I. See Reverse side - r 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 the building permit is issued. In the absence of such posted notice, the inspection will not be a .roved and a reins ee will be charged Signature Owner or Agent The foregoing instrument was acknowledged before me this % P/ day of A V , 2011 , by AeLoye who isfrsonally know) to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: ,` Sign Print: My Commis �,.��p.,,,�� MICHAS. J state of d a c <,c, Notary rwmNC • 8m• 01 Ruda SW 1. !1S C • Signature ,ra Yip Contractor The foregoing instrument was acknowledged before me this ft'4 day of A/G 1/ , 20 // , by ,071/x► ,t 4011?) who is personally known)to me or who has produced as identification and who did take an oath. NOTARY Sign. Print: My Commission Expires: Wad ThrOugh Masi Nay kw *** ***** *aY *****x****** * ******* ***** **** *** **** ****** e********* *#rx3aa ****& akaY* xxxxx* ****** ***deie*aYaY****** ****** APPLICATION APPROVED BY: (Revised 02/08/06) Plans Examiner Engineer Zoning MIAMI-DADE COUNTY BUILDING AND NEIGHBORHOOD COMPLIANCE 11805 SW 26TH ST. SUITE 207 MIAMI FL, 33175 (786) 315-2880 CONTRACTOR'S BUSINESS CERTIFICATE OF COMPETENCY ISSUED MARCH 15, 2007 THIS IS TO CERTIFY THAT SUPERMAN PLUMBING INC CONTRACTOR CERTIFICATE NO.: 07P000248 TRADE: PLUMBING CERTIFICATE EXPIRATION DATE: 09/30/2013 HAVING MET THE CODE REQUIREMENTS OF MIAMI-DADE COUNTY, AS AMENDED, IS CERTIFIED AS A CONTRACTOR IN THE FOLLOWING CATEGORY(S): 0001 PLUMBING WITH ALL WORK TO BE DONE UNDER THE SUPERVISION, DIRECTION AND CONTROL OF QUALIFYING AGENT FALLON DENNIS S.S.N. - -2083 ALTERATION, REPRODUCTION OR TRANSFER OF THIS CERTIFICATE IS PROHIBITED. SUPERMAN PLUMBING INC 1400 NE 133RD RD NORTH MIAMI CHARLES DANGER, P.E. SECRETARY, CONSTRUCTION TRADES QUALIFYING BOARD FL 33161 FEE FOR THIS CERTIFICATE WAS PAID ON PROCESS NO. T2011113293 FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 601800 -6 THIS IS NOT A BILL - DO NOT PAY RENEWAL BuVIR1 i� 1/ IFTSIgING INC CC >i EcWWW0248 627864 -2 1400 NE 133 RD 33161,NORTH MIAMI m'ERMAN •PLUMBING INC sec1y ETIG THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE NOLDER FROM ANY OTHER PERMIT OR LICENSE REWIRED BY LAW. THIS Is NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX coLLEc oR07 /25/2011 60000000422 000045.00 SEE OTHER SIDE CONTRACTOR WORKER /S 1 DO NOT FORWARD SUPERMAN PLUMBING INC MICHAEL FABIANO PRES 1400 NE 133 RD NORTH MIAMI FL 33161 1111111111 1 / 11111 1111 11{11111111111111111IIiI1)1i //111 l l'.1 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 FALLON, DENNIS PATRIC SUPERMAN PLUMBING, INC. 1400 NE 133 RD NORTH MIAMI FL 33161 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. t For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that I 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! C". DETACH HERE STATE OF FLORIDA AC# 58 5 7 i DEPARTMENT OF BUSINESS AND. PROFESSIONAL REGULATION RF11067504 10/05/11 117019502 REGISTERED • FLING ;CONTRACTOR FALLON, DENNIS' - PATRIC SUPERMAN PLUMBING, NC (INDIVIDUAL MUST 3EET ALL LOCAL REQUIREMENTS PRIOR TO CONTRACTING.IN ANY AREA) HAS REGISTERED under the provisions of ch.489 Expiration date: AUG 31, 2013 L11100502255 THIS DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTING • LINEMARK' "PATENTED PAPER AC# 5811571 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING. BOARD SEQ#L11100502255 DATE BATCH NUMBER LICENSE NBR 10 05/2011 117019502 RF11067504 PLUMBING CONTRACTOR Named below HAS REGISTERED Under the provisions of Chapter Expiration date: AUG 31, 2013 (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) FALLON, DENNIS PATRIC SUPERMAN PLUMBING, INC. 1400 NE 133 RD NORTH MIAMI FL 33161 RICK SCOTT GOVERNOR DISPLAY AS REQUIRED BYLAW KEN LAWSON SECRETARY • ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDlYYYY) 11/10/11 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(ies) 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 endorsement(s). PRODUCER USI Southwest Inc. Ft Worth /CL 1445 Ross Avenue, Suite 4200 Dallas TX 75202 INSURED Pacesetter Personnel Services Payroll Services Division P. 0. Box 108 Houston TX 77001 NAMEACTusI Southwest PHONE (A/C, No, Eat): 214 -.4,43-310_0 E -MAIL ADDRESS: PRODUCER CUSTOMER ID #: FAX (A/C No):24- 443 -3900 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Ace American Insurance Company t_22667 INSURER B: INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: THIS PERIOD WHICH TO INSR LTR IS TO CERTIFY THAT THE POLICIES OF INDICATED. NOTWITHSTANDING ANY THIS CERTIFICATE MAY BE ISSUED ALL THE TERMS, EXCLUSIONS AND CONDITIONS INSURANCE REQUIREMENT, OR MAY AWL INSR PERTAIN, OF giBR WVD LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED TERM OR CONDITION OF ANY CONTRACT OR OTHER THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED ABOVE FOR THE POLICY DOCUMENT WITH RESPECT TO HEREIN IS SUBJECT BY PAID CLAIMS. _ - - _ - -- - - -� - -- - -- - LIMITS I TYPE OF INSURANCE - - -_ — POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) I GENERAL LIABILITY ,COMMERCIAL GENERAL LIABILITY OCCUR EACH OCCURRENCE $ DAIWA -GE TO-RENTED (Ea occurrence) $ I , CLAIMS -MADE i —i MED EXP (My one person) $ jPERSONAL & ADV INJURY $ GENERAL AGGREGATE $ G EN'L AGGREGATE LIMIT APPLIES PER: j POLICY 1 ; JECT 1 LOC PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE LIABILITY L._.., • ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS ____1 HIRED AUTOS �a NON -OWNED AUTOS 1 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per acc dent) $ $ S L..1 UMBRFI I A UAB I_ I EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE I RETENTION $ ... -- - ----- - - - -.. __ $ A WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS YIN N / A WLRC46477686 3/11/2011 3/11/2012 X J WCSTATU- X OTH- TORYJJMITS ER $1000000 E.L. EACH ACCIDENT below E.L. DISEASE - EA EMPLOYEE $1000000 E.L. DISEASE - POLICY UMIT $1000000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Blanket Waiver of Subrogation on workers Compensation as required by Written contract 30 Days Notice for Non- Renewal and /or Material Change with 10 Days of Cancellation for Nonpayment of premium Certificate of Insurance only applies to Pacesetter Personnel employees doing work for Superman Plumbing, Inc. E CANCELLATION Miami Shores Village Hall 100050 Northeast 2nd Avenue Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/09) ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • ' /'��I�..VRO® CERTIFICATE OF LIABILITY INSURANCE OP ID KT �,�,,,,, ,/ DATE(MMIDDIYYYY) 11/10/11 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. I PO - -ANT: e cert cate older s an ' ' D Ti • INS' R D, e po cy es must ' , en • orse • . l B - OG ON IS AIVE ' , sub ect 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 Newman Insurance Agency, Inc. 5700 Stirling Road Hollywood FL 33021- Phone :954 - 963 - 962 6 I.UN I PA. 1 NAME: PHONE AIC,, to, Ext): FAX No): ADDRESS: CUSTOMER ID tk SUPEPLU INSURER(S) AFFORDING COVERAGE NAIC # INSURED Superman Plumbing Inc Super Plumber, Inc. 14E0 NE 133 Rd. N Miami FL 33161 INSURERA: Lloyd's of London OCCUR INSURER B : INSURER C: 05/23/11 INSURER D : EACH OCCURRENCE INSURER E : X INSURER F : $ 100000 COVERAGES 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. L'TR TYPE OF INSURANCE INUR SW D POLICY NUMBER (MAVNUDDY ) (MMIDD/YYYYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY X OCCUR AMTE009443 05/23/11 05/23/12 EACH OCCURRENCE $ 1000000 X PREMSES(Eatoccurrence) $ 100000 CLAIMS -MADE MED EXP (Any one person) $ 5000 PERSONAL & ADV INJURY $ 10 0 0 0 0 0 GEN'L GENERAL AGGREGATE $ 2000000 AGGREGATE UMIT POLICY JET APPLIES PER: PRODUCTS - COMP/OP AGG $ 1000000 LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE UMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA LIAB EXCESSI.IAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER/EXECUTIVE--I OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N N / A WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ below E.L. DISEASE - POLICY UMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES Attach ACORD 101, Additional Remarks Schedule, H more space Is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village Hall 10050 Northeast 2nd 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. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/09) 1r ggdteh ©1988- 200 ORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD