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EL-14-2085Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-221500 Permit Number: EL -9-14-2085 Scheduled Inspection Date: October 16, 2014 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: HOLT, JAMES Work Classification: Alarm Job Address: 361 NE 97 Street Miami Shores, FL 33138-0000 Project: <NONE> Contractor: ADT SECURITY SERVICE BuIlaing Department comments ALARM A-14-048 Phone Number Parcel Number 1132060135760 INSPECTOR COMMENTS False Inspector Comments Passed 1:0 LORI 7867384500 PROPERTY MANAGER Failed El /p Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Phone: (954)266-5066 October 15, 2014 For Inspections please call: (305)762-4949 Page 19 of 29 MIR Brian WiEson EF0001131 A. Services 7/3;//V' ADT Security Services 10785 Marks Way Miramar, FL 33025 Tei: 954-266-5066 Direct 954-266-5275 Fax 954-266-5180 miramarpermitdeyt657 adtcom UNIFORM NOTICE OF A LOVA-VOLTAGE ALARM PROJECT PERMIT LABEL # (1F REQUIRED) " - b DATE PROPERTY ADDRESS: AJ 9 S �' CUSTOMER'S NAME: kof. T CUSTOMER'S ADDRESS DITY: _m '/1m to _&-FS STATE FL ZIP CODE: 331 9- TELEPHONE # kZ gj !` V-.2 IS - EMAIL ADDRESS;' 7,OF4 73�- CONTRACTOR: ADT SECURITY SERVICES ADDRESS: 10785 MARKS WAY, MIRAMAR, FL 33025 TELEPHONE # 954-266-5066 FAX# 954-266-5180 EMAIL MIRAMARPERMITDEPT(5�ADT,COM QUALIFIER: BRIAN WILSON STATE LICENSE NUMBER: EF0001131 DATE PROJECT COMPLETED_ It "7-) -I I SCOPE OF WORK Low ✓O L �� NOTICE IS HEREBY GIVEN THAT A LOW -VOLTAGE ALARM SYSTEM PROJECT HAS BEEN COMPLETED AT THE ADDRESS SPECIFIED ABOVE I CERTIFY THAT ALL OF THE FOREGOING INFORMATION IS TRUE AND ACCURATE AND IS IN COMPLIANCE WITH ALL APPLICABLE CODES AND STANDARDS. QU IER'S SIGNATURE T- C FT SEP 2 4 2014 tJi7gb(e '�o rewc�, i A �® CERTIFICATE OF LIABILITY INSURANCE DAT10/009/2019/201DD/YYm 4 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 WANED, 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 Marsh USA Inc. 1560 Sawgrass Corporate Pkwy, Suite 300 Sunrise, FL 33323 Attn:`F"uderdale.Certs@marsh.com CONTACT NSE: PHONE ac No : E-MAIL. ADDRESS: GLO 5095899 02 10/01/2014 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Zurich American Insurance Company 16535 048953-ADT-GAW-14-15 INSURED ADT LLC INSURER B: American Zurich Insurance Company 40142 INSURER C : 10785 Marks Way Miramar, FL 33025 INSURER D INSURER E • B INSURER F • LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COVERAGES CERTIFICATE NUMBER: ATL-00328gg9M3 REVISION NUMBER -4 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. ?LTR TYPE OF INSURANCE ADD SUER POLICY NUMBER PMMfDDD EFF MM(DD EXP LIMITS A GENERAL LIABILITY %( COMMERCIAL GENERAL LIABILITY CLAIMS -MADE M OCCUR GLO 5095899 02 10/01/2014 10/01/2015 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED 1,000,000 PREMISES occurrence $ MED EXP (Arty one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS -COMP/OPAGG $ 4,000,000 $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS BAP 5095900 02 10/01/2014 10/01/2015 COEa acdMBdentINED SINGLE LIMB 11000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE eracddent $ UMBRELLA UAB EXCESS1JAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ $ B A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN OFFICER/MEMBER EXCLUDED? � (Mandatory In NH) If as, describe under DESCRIPTION OF OPERATIONS below NIA WC 5095897 02 (AOS) WC 5095898 02 (MA, WI) 10/0112014 10/01/2014 10/01/2015We 10!01/2015 sTATu- oTH- 2,000,000 EE.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEd$ 2,000,000 E.L. DISEASE - POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space Is required) Re: ADT Security Services Miami Shores Village is included as additional insured (except workers' compensation) where required by written contract CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 2nd Ave. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores, FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashl Mukhedee —3� cr ►�a�st.r . , ,. ra- ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD { , RICK 8007 GOVERNOR KEN LAWSON, G.ECREeTARY DEPARTMENT OF SUSWIE.SS AND PROFESSIONAL REGULATIdfl . 5L,ECTRICAL CONTRACTORS LICENSING 80ARD • ��oott�t +•• . , The ALARM SYSTEM 0ONTRACTOR I �¢ Named below IS•CrRTIFI>=D Under the provisions of Chapter 489 FS... ' Expiration date: AUG 31, 2018 • •�.,, ,�' w�' tlT^� ��, '"� SON, BA F-DWV,A�R r+'`.'t•14R • �c , t _ 'ADT R S•{ SEDLiE .40785 MARKS.iN41(��, ;.: �' `^ ��;��n ;v � '� �';•�: � �`' �' ''`' - "?t, VIRAMAR `°'.FL 35 25 a, �:,;; . i�• w 0 IK � '��, n, '. s.m .. .. .. . ... .........t—,a''� _] ......w"--T.Ur. '�' ✓�'�. r�w,r .•�27.ti:..5ra,..S . .. :. st. �Jk •«:.'.. ... .. .. ! ... .. . ISSUED: 07123/2014 DISPL.AYAS RFQUIRED BY LAW L140230001871 M , N _ ' r -�BRO -- COUN` ]LOCAL OUST SSS T- — 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2014 THROUGH SEPTEMBER 30, 201.5 DBS.: Business Name: ADT SECURITY SERVICES Owner Name: BRIAN EDWARD WILSON Business Location: 10785 MARKS WAY MIRAMAR Business Phone: 954-266-5176 Receipt #:ELB CTRI7CAL/ALA Business Type: (ALARM SYSTEM Business Opened:oB/29/2013 State/County/Cert/Reg:EFO 0 01131 Exemption Code: Rooms Seats Employees Machines Professionals 150 For Vending Business only Number of Machines: vandinn Tuna - Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 150.00 0.00 0.00 0.00 0.00 0.00 150.00 r, THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS E 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 iJ 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: ADT SECURITY SERVICES 10785 MARKS WAY MIRAMAR, FL 33025 2014 -2015 Receipt #30B-13-00003576 Paid 09/19/2014 150.00