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MC-14-1025Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-212669 Permit Number: MC -5-14-1025 Scheduled Inspection Date: October 01, 2014 Permit Type: Mechanical - Residential Inspector: Perez. JanPierre Owner: WHITFIELD, KAREN Job Address: 750 NE 97 Street Miami Shores, FL 33138- Project: <NONE> Contractor: NO SWEAT AIC CONDITIONING CONTRACTOR Building Department Comments Inspection Type: Final Work Classification: A/C Replacement I0TOTM,11 fi1167M Parcel Number 1132060142220 Phone: (954)423-9696 4 TON A/C CHANGE OUT WITH 9KW HEAT EQUIPMENT Infractio Passed Comments IN SAME LOCATION INSPECTOR COMMENTS False Inspector Comments Passed h Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. September 30, 2014 For Inspections please call: (305)762-4949 Page 7 of 41 Miami Shores Village Building Department MAY 19 2014 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 113 Y' Tel: (305) 795-2204 Fax: (305) 756-8972 - INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 BUILDING Master Permit No. me PERMIT APPLICATION Sub Permit No. r-JBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ORENEWAL ❑PLUMBING "MECHANICAL ❑PUBLICWORKS [:]CHANGE CONTRACTOR ❑ CANCELLATION ❑ SHOP DRAWINGS JOB ADDRESS: 7� NC 37 7 City: Miami Shores County: Miami Dade Zip: 4Elio/Parcel#: %� -JoZ®� ®/�} 2-20 Is the Building Historically Designated: Yes OccupancyType: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): /`'f'4ew ��� i�`�f c e—'d Phone#: 3&*J 7 Address: 7SV 17 Si City: 114 f Owe/ S 843 State: Zip: Tenant/Lessee Name: Email: 3:�/3t CONTRACTOR: Company Name: -f' ��'%*� �`/�1 %` i.�TE /-VL Phone#: _0e Address: &-l/ City: .0 �//t State: Ap:.a�3���' Qualifier Name: 0`�tlyfl ��' 116twi4v-- I��� Phone#: State Certification or Registration #: e4e- O Z4 *-,/-o Certificate of Competency #: DESIGNER: Architect/Engineer: Address: City: State: ®!a Value of Work for this Permit: $ !� ® Square/linear Footage of Work: _ Type of Work: ❑ Addition ❑ Alteration Wpg i1a=--ffi&place Description of Work: I Specify color of color thru tile: Submittal Fee $ -0(-) Permit Fee $ Scanning Fee $ Notary $ Radon Fee $ Training/Education Fee $ Double Fee $ Structural Review $ Zip: ❑ Demolition r r _ CCF $ CO/CC $ DBPR $ Bond $. Technology Fee $ TOTAL FEE NOW DUE N Bonding Company's Name (if applicable) 7 4 p 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 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 charged. e , Signature Owner or Agent The foreg ing instrument was acknowledged before me this day of 0 20 %, by i who isECMv rs ally known to me or who has produced r _ ,i 6 As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My C mTision Expires: IV t 917-01 1( Signature P Contractor The foregoing instrument was acknowledged before me this day of c' 20 by _k± /'S L0,62vV- who is personally known to me or who has producedlAc-65'-e 7c30,5 -A! 13-6 s identification and who did take an oath. SAM 80iDIRi NMI Pow - swe of W fiat. IOU Apr f COWNSWO APPROVED BYlqj_JtansExaminer Structural Review Clerk NOTARY PUBLIC: e pTMNo�ry public State of Florida a� v'; Joanna M Feliciano Myr ommission FF 082753 �1��®111�1'd01 Zoning Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) JI f 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): ;�P A& ? 7 -If- City: Miami Shores Village County: Miami Dade Zip Code: 3 31340' 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 ❑ NOJf� ARHI Sheet Attached: YES ] NO ❑ Contract Attached: YES UNIT BEING REPLACED DATA NEW UNIT AIIZ-,tom MANUFACTURER j_ Hr PKG. UNIT MODEL # &b rA-7V/,/-& OF I'le/� COND. UNIT MODEL # —,q V 7 KW HEAT 011 "1" NOM TONS fe /-0 AHU S? CU.�:iPKG 1 M.C.A AHU.® CU -70 PKG AHU def CU ye PKG 2 M.O.P AHU6® CU y� PKG AHLVC CU -IOPKG 3 VOLTS AHU" CU a?® PKG PKG UNIT / / PKG UNIT Z, EERISEER YES NO REPLACING DUCTS YES YES NO REPLACING THERMOSTAT &EV NO YES NO NEW 4"CONCRETE SLAB YES do YES NO NEW ROOF STAND YES YES NO NEW RETURN PLENUM BOX YES eAqcp Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: Al® -fwcW '"plc 1,Vc-Phone: State Certificate or Registration N. Certificate of Competency N. Signature - Date: aliflees signature only) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION :,:CONSTRUCTION INDUSTRY LICENSING ' 1940 f;'NOR H MONROE STREET BOARD (850) 487-195 i18``� TALLAH1siSSEE FL 32399-0783 KRAMER, REGIS KENNETH JR NO SWEAT A/C REFRIG & HTG INC 511 SUMTER AVE DAVIE FL 33325 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. l. Everyday we. work,to Improve the way we do business in order to serve you better. For;information about our services; please log onto www.myfloridalicense.com. 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. i ,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' our new license! STATE OF FLORIDA AC# 6 20 L .2 [ DEPARTMENT OF.BUSINESS-AND PROFESSIONAL, REGULATION CACO26410 ' p7;Ylll1,2 120025682 CERTIFIED? A3 x GOND:,:, CONTR KRAMER, JR NO SWEAT IS CERTIFIED under the provisions of Ch.489 FS Expiration Hate: AUG 31, 2014 L12071300704 AC#16 2 O 12 7 Q STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SEQ# L1207I300704 n: LICENSE NBR 0 /13/2012.1120025.682 ICACO26410 The'CLASS A AIR CONDITIONING CONTRACTOR Named,below IS CERTIFIED Under the provisions of Chapter. 489 FS. Expiration date: AUG 31, 2014 KRAMER,. REGIS KENNETH JR NO SWEAT A/C REFRIG & HTG INC 511 SUMTER AVE DAVIE FL 33325 RICK SCOTT KEN LAWSON: GOVERNOR _ _ _ SECRETkR.Y: �.° ACC R'4'® CERTIFICATE OF LIABILITY INSURANCE 5i6/2oi' 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. n SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policy may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Jackson Insurance Agency 2075 West 76th St Hialeah FL 33016 ° Maria Benitez P . (305)824-3464 FAX (305)822-8335 .mbeaitez@jacksoaageaay.aam INSURERS)ADURESS AFFORDING COVERAGE NAIL e ERA,American Empire Surplus Lines 35351 INSURED No Sweat Air Conditioning, Refrigeration, And Heating Inc. 511 Sumter Ave. Davie, FL 33325 INSUREli B INSURER C: INSURER D: INSURER E P. COVERAGES CERTIFICATE NIIM8ERZ014-2015 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. ILTR NSR TYPE OF INSURANCE DOLSUBR Village of Miami Shores POLICY NUMBER ago& LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR Ed Jackson/FANNIE 05202014 5/20/2014 5/20/2015 EACH OCCURRENCE $ 300,000 DAMAGE TO FEWFEu- p $ 100,000 MEO EX, Anyoneperem) $ 1,000 PERSONAL s ADV INJURY $ 300,000 GENERAL AGGREGATE $ 600,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRS LOC PRODUCTS - C OMP/OP AGG $ 600,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL AUTOS OWNED SCHEDULED HIRED AUTOS NON -OWNED AUTOS INGLE LIMIT REWEV BODILY INJURY (Per person) $ BODILY INJURY (Peracddern) $ PROPERTY D E $ er $ UMBRELLA LWBOCCUR EXCESS LIAR HCLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ O $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETORIPARTNER/EXECUTTVE OFFICERIMEMBER EXCLUDED? wendiaory in I" I dasrnbe under DESCRIPTION OF OPERATIONS below N/A � STA TH ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOY $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additions! Remarks Schedule, B more space Is require* This certificate is solely for the use as " Evidence of Insurance" License # CACO26410 CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010" INIRM5 onimsi n+ ®1 988-2010 ACORD CORPORATION. All rights reserved. The AT_AQr1 name and Innn are rerrl*tereA mark* of Ar!f%CM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Village of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS. 10050 HE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 Ed Jackson/FANNIE ACORD 25 (2010" INIRM5 onimsi n+ ®1 988-2010 ACORD CORPORATION. All rights reserved. The AT_AQr1 name and Innn are rerrl*tereA mark* of Ar!f%CM 8/8/13 Report Viewer tte N JEFF AW ATER �xOp vi o� CHEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION *' CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 9/16/2013 EXPIRATION DATE: 9/16/2015 PERSON: KRAMER REGIS K JR FEIN: 592331027 r ; BUSINESS NAME AND ADDRESS: g NO SWEAT AIR CONDITIONING REFRIGERATION AND HEATING INC 511 SUMTER AVE DAVIE FL 33325 SCOPES OF BUSINESS OR TRADE: HEATING, VENTILATION, AIR-COND Parsaand to Chapter 440.06(14), F.S., an officer of a copordon who elects exemption from fids not recover be s its o cwmpe1300n WKsr fids chapter. Pwvwd to Chapter 440.05(12), F.S., ( ofthe 1 isitess or trade listed on the notice of election to be exempt. Pora of to Chmter 440.E slactionto be exempt stall be stdyeat tormcedol it, ffi anytime after fire ming ofitrerxdceo cetiftcete rx, lord meets the retpdremerda ottids section to iasza �e cotidcffie. Tia dap personr�nedanthecenn to meet the requirements ofthissecfion. DFS-F2-DVVG252 CERTIFlCATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413-1609 https:!/apps8.fldfs.com/crreportviewerlreportViewer.aspx?data=kdvpginc9D7Q3gH6TER6ePi KMZ%2fSz5bXKYfBxkrekeESoPVy I v4NPOPN42XeirDRGX V W... 1/2 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014 DBA: NO SWEAT A/C REFRIG & HEATING INC Receipt #:HEATINAIRCONDITION Business Name: G% Business Type: (A/C CONTR) Owner Name: K KRAMER JR REGIS Business Location: 511 SUMTER AVE DAVIE Business Phone: 423-9696 Business Opened:o5/18/1995 State/County/Cert/Reg: CAC 0 2 6 410 Exemption Code: Rooms Seats Employees Machines Professionals 1 Number of Mar_hinpc• For Vending Business Only Tax Amount -- Transfer Fee -- NSF Fee Penalty venaing i ype: Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 1 0.00 27.00 THIS RECEIPT 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: K KRAMER JR REGIS 511 SUMTER AVE DAVIE, FL 33325 2013 -2014 Receipt #OIC -12-00012471 Paid 08/12/2013 27.00 "NO SWEAT" AIR CONDITIONING, REFRIGERATION & HEATING INC. 954-423-9696. 305-623-1500 511 Sumter Ave - Davie FL 33325 Serving South Florida since 1983 - CACO26410 State Licensed and Insured Date L5 �Ylfl Home #139f -'f' ® �� Cell # Customer Name �f`41'111,7X1e4d Address 7j'o Alf7 Sr City, State A4 1&1;1-P1W/ e `� Legal Description Zip 33/-fJ, We hereby submit estimate for: ��� � �� ,* System SEER Rating 16-4' Condenser Model # Vlie)( ® & IV 7 Air Handler Model # 9 eP AP Electric Heater 9 KW Model # 9 -- PRICE INCLUDES: Sales Tax - Installation Labor - Digital Thermostat - Flood Switch - Connect to Existing Copper and Electrical Lines - Liquid Line Filter Drier - Condensing Unit Tie Down - Flush Drain Line - Removal of Old Equipment WARRANTIES: /10 Year Warranty on Entire System with Registration at "No Sweat" will provide 1 Year Labor Warranty Cost of System Change Out: ADDITIONAL SERVICES W Germicidal Light Replace Top Of Return Air Plenum With Plywood Condensate Pump Replace Slab (Size) Aluminum Air Handler Stand Replace Service Disconnect (Size) Total Cost of Installation Florida Power 8a. Light Rebate Final Cost To Customer Accepted by Purchaser "No Sweat" A/C Inc: 4 c?¢-,-,,, d;) -W f A,6--; ") o ds W 9177, 6'0 $ $f $ Y119 l � ' AHRI Certified Reference Number: 3869174 Date: 5/16/2014 Product: Split System: Air -Cooled Condensing Unit, Coll with Blower Outdoor Unit Model Number:14ACX-047-230* Indoor Unit Model Number: CBX27UH4048-230*+TDR Manufacturer: LENNOX INDUSTRIES, INC. Trade/Brand name: 14ACX SERIES Series name: Manufacturer responsible for the rating of this system combination Is LENNOX INDUSTRIES, INC. Rated as follows In accordance with AHRI Standard 210/240-2006 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 Capacity (Btuh): 46500 EER Rating (Cooling): 13.00 SEER Rating (Cooling): 16.00 IEI RA Rating (Cooling): FootWe 11 - The AHRI 210/240 certified EER ratings are calculated under the same methodology as the EER ratings at Ti conditions of ISO 5151:2010 and ISO 132532011. * 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 disclalms 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 u✓ vw.a h rid I vectory. 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; dissemirnated; entered Into a computer database; or otherwise utilized, In any torn or manner or by any means, except for the user's individual, personal and confidential reference. AIR-CONDITIONING, HEATING, CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE The Information forthe model cited on this certificate can beverified at or .®rg,clickon`VerifyCertificate"link wemalm life bettez- 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.: 13oa47�5�3s�azaa43 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. (SEAL) Type of Identification Contractor Print Name: y4+%&�' V t Signature: d�� e State of Florida ) County of Miami -Dade ) Sworn to and subscribed be fo day of By _CO: (SEAL) Type of Identification nrofiud ����lmnnn Owner Print Name: f{ EA Signature:i°CL�(.l f� - State of Florida) `��.�` County of Miami -Dade) ,�` , ' - 6 `�O� . Sworn to beforeeis� ano day of subscribed `( o .2(i By ..... �,. (SEAL) Type of Identification Contractor Print Name: y4+%&�' V t Signature: d�� e State of Florida ) County of Miami -Dade ) Sworn to and subscribed be fo day of By _CO: (SEAL) Type of Identification nrofiud ����lmnnn