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FW-14-1468Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-220172 Scheduled Inspection Date: September 30, 2014 Inspector: Rodriguez, Jorge Owner: OLIVA, TERESA Job Address: 301 GRAND CONCOURSE Miami Shores, FL 33138 - Project: <NONE> Contractor: MAYABEQUE CONSTRUCTION INC tiunaing uepartment comments Permit Number: FW -7-14-1468 Permit Type: Fence/Wall Inspection Type: Final Work Classification: Wood Fence Phone Number (305)807-1210 Parcel Number 1132060133850 WOOD FENCE BOARD ON BOARD 5FT AROUND THE Infractio Passed Comments HOUSE I INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-219667. CREATED AS REINSPECTION FOR INSP-215554. -Maximum 5' height allowed. -Gates should swing to the outside. -Framing of the wood fence should be to the inside. Failed Not ready Z/1 I---� Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. �4 September 29, 2014 For Inspections please call: (305)762-4949 Page 15 of 31 JUL-10 2014 1-- Z w LU U wo U H U) r Q W Z Z w© U N Z O W F- 10, - WOOD FENCE DESIGN DE N.T.S. (ACCORDING TO THE F.B.C. SECTION 2328) .t W—Membled wood fence panels sold in .hardware stores are cowered by this •Metall. Applicant must obtain .the Notice -of Acceptance Product Approval from the More, submit it for permit and build the fAnCe according to that document. ALL NAILS AND ,,ONNECTIONS SHALL BE GALVANIZED 2"X4" No. 3 WOOD RAILS (3) MINIMUM ATTACHED TO WOOD POST WITH MINIMUM (4) 10D NAILS. 4" X 4" X 8'. P.T. No. 2 Grade or Better WOOD POST Fence Height Post Above Grade Spacing 5.-01. 5'-0" 4'-0" 6'-0" 518" WOOD PICKET MIN; DR£SSE THICKNESS. ATTACH EAG PICKET TO RAILS WITH (2) E GALV. NAIL OR #10 GALV. SCREW 1 Q " DI- TEB CONCRE"T"E OTI O If the fence is to mem barrier, the fence shag not t warn AD raft must be. property. Pedestrian closing and latching demos Iced j minimum of 54" above ground, For fur details see Section 424 of 178C. NOTICE: A MANDATORY FOOTING IN eCT] REQUIRED PRIOR. TO POURING CONCE `E BOUNDARY SURVEY SCALE: 1" = 30' / V. 10V l.P. 3, C. B.S. Wap4W.r. Brick Lm C. B-9. Wall Q W. F. NE 95th 5t. 94th St. GT' J� Pacer o I I.2 9.9/' . Driveway I w 13 y/afk r < d ... . A =ARC DISTANCE u� D = CENTRAL ANGLE A' f l O R = RADIUS �C6 �� ° G = DIAMETE 01 B. • n1h d .:.. emV B.C.. = BLOCK CORREZ • TYP sTYPICAI• • • • • •. O 4 � S.M • SIDEWALK • • o o PL. = PLANTESS • • • a N ` ra\�Q v • C.Cm a %CURB & GUTTER • • • Q V. = VALLEY & G TTER • • • p, d ° �O ha O P�� g.�. = ELECTRIC METER • • • • • • �+� c d ...... 23. .. • 670(a •aSTORY • • • & D• • lf2'lF. 93 2yl'iy O SECT i i ECTIO • • • • • a 13 g.39� . ...... •I10 MANHO 41• • •aaCLEAR . • 1P • a a 8 / .89 i� (M) ` '° FD' d F.F.E. =FINISH � rift ATIONL • ` < a •AC• .. %:AIR CONDITIONED UNITo ° ° ° •W.M. iW...... •• • • • ATER MMR • ? °o ° ° d • F� e UTILITY WEMENT • • • • • • ° " ° a 4 CONCRWE&LOCK STRUCTURE- P.M.P. = PERMANkNT etlM'ROL PO a . • • RAINAG EASEME a • �•g•: •p F•11�It`T. P.O.B. = POINT Of BEGINNING ... . ... ... ... P.O.C. = POINT OF t8*0ENCE M . FD. = FOUND IRON PIPE -. ... O.H.L. =OVERHEAD UTILITIES . C.B. = CHORD BEARING (C) =CALCULATED (R) =RECORD ORDA l ENC. =ENCROACHMENT 99. `1/ 9 4 t h RES. = RESIDENCE SEND. AND ABBREVIATIONS. _ = CENTER LINE 52'Asp*alt ravement P/L =PROPERTY LINE 75' TOTAL R/W MIL =MONUMENT LINE RNV= RIGHT OF WAY C.L.F. = CHAIN LINK FENCE W.F. = WOODEN FENCE = ELEVATION CONC. = CONCRETE SLAB 11 0 S U13JECT TO COMPLIANCE WrrH ALL FEDERAL I OTUE AND CCUi y RUI [=.S` anm 0=,, JOB NUMBER: 1307/ l N-568 ELEV.= 9.G5' OF N.G.V.D. OF 1929 BASED ON THE FLOOD INSURANCE RATE MAP OF THE FEDERAL EMERGENCY AGENCY REVISED ON 9- / / -09 THE HEREIN DESCRIBED PROPERTY IS SITUATED WITHIN: ZONE X BASE FLOOD ELEV. N/q COMMUNITY NUMBER 120652 PANEL NUMBER 0302 SUFFIX L LEGAL NOTES THIS SURVEY DOES NOT REFLECT OR DETERMINE OWNERSHIP. EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IF ANY, AFFECTING THE PROPERTY. THIS SURVEY IS SUBJECT To DEDICATION, LIMITATIONS, RESTRICTIONS, RESERVATIONS OR EASEMENTS OF RECORDS. LEGAL DESCRIPTION PROVIDED BY CLIENT. THE LIABILITY OF THIS SURVEY IS LIMITED TO THE COST OF THE SURVEY. UNDERGROUND ENCROACHMENTS, IF ANY, ARE NOT SHOWN. THIS FIRM HAS NOT ATTEMPTED TO LOCATE FOOTING AND/OR FOUNDATIONS AND/OR UNDERGROUND IMPROVEMENTS OF ANY NATURE. IF SHOWN BEARINGS ARE REFERRED TO AN ASSUMED MERIDIAN. IF SHOWN ELEVATIONS ARE REFERRED TO N.G.V.D. OF 1929. THE CLOSURE IN THE BOUNDARY SURVEY IS ABOVE 1: 10000. THIS SURVEY IS NOT INTENDED FOR NEITHER DESIGN NOR CONSTRUCTION PURPOSES. FOR THOSE PURPOSES A TOPOGRAPHIC SURVEY IS REQUIRED. CERTIFIED TO: Teresa Oliva IRUUM W❑ 40UM9 Professional Land Surveyor & Mapper 14317 S.W. 45th Terrace Miami, Florida 33175 Tel: (305) 552-7504 Fax: (305) 229-8068 DATE OF FIELDWORK: July l 1, 20 / REVISED ON: I hereby certify that the attached Sketch of Survey of the herein described property Is to the best of my knowledge and belief, a true and correct representation, of a field survey performed under my direction. And also meets the Minimum Technical Standards as set forth by the Florida Board of Professional Surveyors and Mappers in chapter 5J-17.050 thru 5J-17.052 F.A.C. pursuant to Section 472.027 F. S. ARTURO R. TOIRAC P.S.M. 3102 Not valid Ahout the signature and the original embosed seal of a Florida Licensed Surveyor and Mapper. Pznter +/,3,0a Pati° LOCATION MAP N.T.S. Q c2 10.6 \ ,o`� W \ PROPERTY ADDRESS: 301 Grand Concourse Miami Gardens, FL. 33 138 —1 y9.6 Q - LEGAL DE5CRIPTION: Lot 25, Block 28, of MIAMI SHORES SECTION 1, according to the plat thereof as recorded In Plat Book 10, at Page 70, of. the Public Records of Miami Dade ►� �.od TWO STORY o Z9P� Q. County, Florida. �Q Res.#30 F Bev.: / 2.06 �0�F Miami Sh®res Vila 801/'ED B,•41-A� JUIr Y®2Oi4 40Y G DEPTBY- �7 Pacer o I I.2 9.9/' . Driveway I w 13 y/afk r < d ... . A =ARC DISTANCE u� D = CENTRAL ANGLE A' f l O R = RADIUS �C6 �� ° G = DIAMETE 01 B. • n1h d .:.. emV B.C.. = BLOCK CORREZ • TYP sTYPICAI• • • • • •. O 4 � S.M • SIDEWALK • • o o PL. = PLANTESS • • • a N ` ra\�Q v • C.Cm a %CURB & GUTTER • • • Q V. = VALLEY & G TTER • • • p, d ° �O ha O P�� g.�. = ELECTRIC METER • • • • • • �+� c d ...... 23. .. • 670(a •aSTORY • • • & D• • lf2'lF. 93 2yl'iy O SECT i i ECTIO • • • • • a 13 g.39� . ...... •I10 MANHO 41• • •aaCLEAR . • 1P • a a 8 / .89 i� (M) ` '° FD' d F.F.E. =FINISH � rift ATIONL • ` < a •AC• .. %:AIR CONDITIONED UNITo ° ° ° •W.M. iW...... •• • • • ATER MMR • ? °o ° ° d • F� e UTILITY WEMENT • • • • • • ° " ° a 4 CONCRWE&LOCK STRUCTURE- P.M.P. = PERMANkNT etlM'ROL PO a . • • RAINAG EASEME a • �•g•: •p F•11�It`T. P.O.B. = POINT Of BEGINNING ... . ... ... ... P.O.C. = POINT OF t8*0ENCE M . FD. = FOUND IRON PIPE -. ... O.H.L. =OVERHEAD UTILITIES . C.B. = CHORD BEARING (C) =CALCULATED (R) =RECORD ORDA l ENC. =ENCROACHMENT 99. `1/ 9 4 t h RES. = RESIDENCE SEND. AND ABBREVIATIONS. _ = CENTER LINE 52'Asp*alt ravement P/L =PROPERTY LINE 75' TOTAL R/W MIL =MONUMENT LINE RNV= RIGHT OF WAY C.L.F. = CHAIN LINK FENCE W.F. = WOODEN FENCE = ELEVATION CONC. = CONCRETE SLAB 11 0 S U13JECT TO COMPLIANCE WrrH ALL FEDERAL I OTUE AND CCUi y RUI [=.S` anm 0=,, JOB NUMBER: 1307/ l N-568 ELEV.= 9.G5' OF N.G.V.D. OF 1929 BASED ON THE FLOOD INSURANCE RATE MAP OF THE FEDERAL EMERGENCY AGENCY REVISED ON 9- / / -09 THE HEREIN DESCRIBED PROPERTY IS SITUATED WITHIN: ZONE X BASE FLOOD ELEV. N/q COMMUNITY NUMBER 120652 PANEL NUMBER 0302 SUFFIX L LEGAL NOTES THIS SURVEY DOES NOT REFLECT OR DETERMINE OWNERSHIP. EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IF ANY, AFFECTING THE PROPERTY. THIS SURVEY IS SUBJECT To DEDICATION, LIMITATIONS, RESTRICTIONS, RESERVATIONS OR EASEMENTS OF RECORDS. LEGAL DESCRIPTION PROVIDED BY CLIENT. THE LIABILITY OF THIS SURVEY IS LIMITED TO THE COST OF THE SURVEY. UNDERGROUND ENCROACHMENTS, IF ANY, ARE NOT SHOWN. THIS FIRM HAS NOT ATTEMPTED TO LOCATE FOOTING AND/OR FOUNDATIONS AND/OR UNDERGROUND IMPROVEMENTS OF ANY NATURE. IF SHOWN BEARINGS ARE REFERRED TO AN ASSUMED MERIDIAN. IF SHOWN ELEVATIONS ARE REFERRED TO N.G.V.D. OF 1929. THE CLOSURE IN THE BOUNDARY SURVEY IS ABOVE 1: 10000. THIS SURVEY IS NOT INTENDED FOR NEITHER DESIGN NOR CONSTRUCTION PURPOSES. FOR THOSE PURPOSES A TOPOGRAPHIC SURVEY IS REQUIRED. CERTIFIED TO: Teresa Oliva IRUUM W❑ 40UM9 Professional Land Surveyor & Mapper 14317 S.W. 45th Terrace Miami, Florida 33175 Tel: (305) 552-7504 Fax: (305) 229-8068 DATE OF FIELDWORK: July l 1, 20 / REVISED ON: I hereby certify that the attached Sketch of Survey of the herein described property Is to the best of my knowledge and belief, a true and correct representation, of a field survey performed under my direction. And also meets the Minimum Technical Standards as set forth by the Florida Board of Professional Surveyors and Mappers in chapter 5J-17.050 thru 5J-17.052 F.A.C. pursuant to Section 472.027 F. S. ARTURO R. TOIRAC P.S.M. 3102 Not valid Ahout the signature and the original embosed seal of a Florida Licensed Surveyor and Mapper. Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 UILDING PERMIT APPLICATION ILDING ❑ ELECTRIC ❑ ROOFING F,1 im; 10 Z014 FBC 20/6) Master Permit No. Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL F-1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: o / �G ifg"IC City: Miami Shores County: Miami Dade Zip: 331 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):'14e-s6, 0r Phone#: Address: 3®l G1- Iitonow-se/ City: vV"(M GWKe_S State: r� Zip:'3 _51-39 Name: Email CONTRACTOR:: Company Name: Wt 7kka 77.Aj Address: 77�5 W 130 CA 7q ?0 City:i1 n (,)A Qualifier Name: State Certification or Registration #: &-N J� W6oj Phone#: �'b -311 zip: Phone#: c�. Certificate of Competency #: C) 6 � )5 ` 0 r 0 DESIGNER: Architect/Engineer: Phone#: State: Zip: Value of Work for this Permit: $ G S o ij Square/Linear Footage of Work: 5 ?_ c) Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: C)� ���CJ�_0C Specify color of color thru tile: ff Submittal Fee $ Permit Fee $ ` CCF $ CO/CC $ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ DBPR $ Notary Double Fee $ Bond $ 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, 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 charge Signature OWNER or AGENT The foregoing instrumMwasknowledged bTfore me this day of 20� by who is personally known to me or who has produced Ias identification and who did take an oath. NOTARY PUBLIC: d. Signature CONTRACTOR The foregoing instrument was acknowledged before me this n� day of 20 �' . by N &6 me is personally known to me or who has produced Zi.5 22 ?�cl ;?YLC-f� identification and who did take an oath. NOTARY PUBLIC: Sign: CY Sign: Print: w Public Stift of Fla dg P Seal: My oo.. ny m�s�sion EE 219173 S I: �pt�►PrrB Notary public State of Florida ora Expires 07/24/2019 :� �; Joanna M Felidano My Commission FF 082753 of Expirss011122018 APPROVED BY Plans Examiner l Zoning Structural Review Clerk (Revised02/24/2014) s Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT B. - Le" COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. C. COPY OF LIABILITY INSURACE* D. --'*' COPY OF WORKERS COMPENSATION INSURANCE* *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. ■■rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr� BUSINESS NAME: biv e W BUSINESS ADDRESS: N U 'kj `) 0 J MZ°'° CITYA� STATE L- ZIP CODE X01 BUSINESS PHONE: FAX NUMBER �) CELL PHONE o:iZ-b l3 r QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore. you may be personally liable for the worker compensation injuries of any person allowed to work under this permit Please check with your insurance carver since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner Print Name: lke-,56L l Signature: AL4,�,_ M"L� State of Florida) �z o@Er\ssioN�9 County of Miami -Dade) _® a,�6� �5, 2®� Fs Sworn to anis bscnbed before me ihis E day of J , 20 /� y �p\.� //1� � fps, �. • fl BY qr,��/�� \a, �i \�Y d�✓�i VIJQ �e J��a1 ,„�ya� J (SEAL) Type of Iden cation produced IF I a ; s 1(.n "A- 0410 -5'5" 55 -TO 9 - Contractor Print Name: ` A Signature State of Florida) d 0 P+,� Notary Public Stabs of Florida County of Miami -Dad }: Joanna M Feliciano Sworn to subset may C�m01/ 212018 082753 day of ByJ�I eye I �-� �►�ip ff - * .:CERIMASEOFELECTIONTOBEFROM tAW" TES' Thls cues thatthe lndivdual VmW below has elate 1e►he emnpt tram RoWa Vbd@aW Compw"Son law. EFFE.`TIVEDATE 61412014 EXPIRf11IONVATE 6P3I2016 PEFSON: MENA ALEM FEIN: 421697622 BLISRMSSNAMEANDADDRESS MAYABEQUE CONSTRUCTION 94C 7785 W307" CT #206 HLALEAH FL 33018 SCOPES OFOUSPIM ORTRAM MASONRYNOC WALLSOARDoMEETRtIC FENCE ENSIALLMM K,DRYMPLL, P AND REPAM- DFS.F2.OWC-152 CERWICAIE OF EdWMON TO BE ESP F"SM %37-42 QUEMKMW (M)M-f 0 ",_ TQ B Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 06BS0051 a MAYABEQUE CONSTRUCTION{ INC D.B.A.: GU REZ ALEXEI M N E A Is certified under the provisions of Chapter 14 of Miami -Dade County VALI-D f C3R CONTRCTI G U TWOW301201 Jul. 7. 2014 8:37AM Sebanda Insurance. Corp. No.9973 P. 1 CERTIFICATE OF LIABILITY INSURANCE DATE(M"D/rM) HI7/20 S CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HO/ODER.ITHIS 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 eert(ffcate 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 do entivrsentent. q statement on this certificate does not confer rights to the CertlflCate holder in lieu of such endorsements . PRODUCER Sebanda Insurance Corp rc TAC Yaim1 Mojena 6337 SW 40 St PHONE E-MAIL .305-665-001 FAx No :305.665.0013 Mfami FL 33155 ADDItEps. Sebandainsuranc yahoo.com 11MEO—K—ONG COVERAGE ASCENDANT COMMERCIAL•INSURANCE INSURES rNSUReRA: NAIC# ' Maynbeque Construction Inc INSURRR B : 7785 W 30 CT # F200 INSURER C: HIALEAH FL 33018 INSURER D :. INSURER E I ' COVERAGES CERTIFICATE NUMBER: INSURE P: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEp BELOW HAVE BEEN ISSUED TO THE INSUREpEVISION NUMaER: NAMEb ABOVE OR THE POLICY PERIOD INDICATED. NQ j'y�1ITHS SUED G ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 1MYH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBES HEREIN IS SUBJECT TO ALL THE TERMS. INSREXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MqY HAVE BEEN REDUCED BY SAID CLAIMS. TYPE OF INSURANCE AD 8 TT COMMERCIAL GENERAL LIABILITY POLICY NUMB R FMID OLIC ErrFPOLI pY EXP GLA4927-0 04/2094 07/04/2015 LIMITS 07/ CLAIMS -MADE 71 OCCUR BACHOCCURRENCE S 1,000,000 A P F . ES $ 100,000 MED EXP ( one Hereon) $5,000 GEN AGGREGATE LIMIT APPLIES PER: PERSONAL S ADV INJURY g 1,000,000 V POLICY ED JecpT ❑ LOG O'ENERALAGGREGATE S1,000,000 rHER: P.RODUCTS.COMPIOPAGG g 1,000,000 AUTOMOBILE LIABILITY $ ANYAUTO E MBINEDSINGLELIMIT ard S ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per parson) S HIRED AUTO9 Z%T 11 AA+lED BODILY INJURY (Per gcddenl) $ PRO PE den DA E S UMBRELLA LIAB S OCCUR EXCESS LIAR CLAIMS -MADE I EACH OCCURRENCE 8 OED ' RETENTIONS AQGREGATE S WrXRKOR3 COMPENSATION AND EMPLOYERS' LIABILITY S ANY PROPRISTORIPARTNER/EX PER E ETH. OFFICERIMEMSER EXCLUDED? ECUTIVE YIN N t A (Mandatory da'k- . NH) E.4 EACH ACCIDENT $ 1/Y e8 deaui� Under OESCrRIPT10N OF PERATIONS below E.L. DISEASE - EA EMPLOYEE 11 E.L. DISEASE. PnI Inv r rwr - DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additional Rargarka Scbedue, rrmy be attached N mory Space Is redUl FENCE INSTALLATION fad) Miami Shores Village 10050 NE 2 Ave Miami, FI3138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. YAIMI MOJENA 07/07/2014 ACORD 25 (2014!01) (c) 1988ALF-14 The ACORD name and logo are registered marks v ACOF(D RD CORPORATION. All rights reserved, Produced using Forms Boge Web :qit am H ww.Formsgoag.com; 7 Im0fesslve Publishing 800-208.1977 Jul, 7, 2014 7:20AM Sebanda Insurance, Corp, No, 9968 P. 1 i`"" ffv-v CERTIFICATE OF LIABILITY INSURANCE FDATE (MMmC/YYYYI 07/07/2014 �� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY'AND CO FERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELO* 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 certificateholder is an ADDITIONAL INSURED, the poliCYQ8S) must be endorsed. If SUBROGATION IS WAIVED, subject t0 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 endorsemen(s)_ PRODUCER. ,.Sebanda Insurance Corp 6337 SW 40 St 1:MiamI FL 33155 INSURED Mayabeque Construction Inc 7786 W 30 CT # P206 HIALEAH FL 33018 3 THIS IS'.TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED ENAM O ABOVE B 0 THE POLICY PERIOD INDICATEQ. 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 Or SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R TYPE OF INSURANCE ADDL UeR PO ppY P 41CY E%P COMa OCCUR COMMERCIAL GENERAL LIABILITY POLICY NUMBER LJMRS GL -44927-p 071041201410710412015 CLAIMS -MADE EACH OCOURRENCE $ 1,000,000 DA 7- A MED SXP [Any one erxn g GEML AGGREGATE LIMIT APPLIES PER; PERSONAL & ADV INJURY g 21 POLICY 1:12§9 ❑ LOC I I I I GENERALAGGREGATE S AUTOMOBILE OTHER: LIABILITY ANY AUTO ALL OWNED SSOHHEESULED AUTOS HIRED AUTOS NN NO1NrJED AUTOS UMBRELLA LIAR OCCUR EXCESS LJAB �....._ _ _. _ _ " I PRODUCTS - COMP/OP AGG S S eM�BI�N; D SINGLE CIMIT $ BODILY INJURY (Perperson) g BODILY INJURY (Per BCrdder,I) $ PPRcOPERTY D E S 8 EACH 01 CURRFNCF c AND RMPLOYERS' LIABILITY NIA E.L. DESCRIPTION OF OPERATIONS / L,CCATIONS! VENICLES (gCORD 707, AadlLlongl Remarks 3ahadulo, may altashed'rf mora space W required) INSTALLATION Miaml Shores Village 10050 NE 2 Ave SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCRLL,Ep BEFORE THE EXPIRATION NOTI Miami, FI3138 ACCORDANCE W THOATA THE POLICY PROVISIONS WILL BE DELIVERED IN AUTHORIZED RRPRESRNTATNE YAIMI MOJENA 07/0712014 ©1888-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORb name and logo are registered marks of ACORD Produced using Forms Bos: Web eot<were. www FomisBa58,com, ? Impressive Publishing sae -20g•1077