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MC-14-1747Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-217651 Permit Number: MC -8-14-1747 Scheduled Inspection Date: October 27, 2014 Inspecto ,Oe-ra2oj-,2,1 , R/ � ff e. Owner: PITTS, FREDDIE Job Address: 9145 N MIAMI Avenue Miami Shores, FL 33150 - Project: <NONE> Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132060130060 Contractor: ALL STAR HOME SERVICES Phone: (786)270-1860 Isunamg uepartment comments EXACT AC CHANGE OUT REPLACING 3.5 TON AC Infractio Passed Comments SYSTEM I INSPECTOR COMMENTS False Passed Inspector Comments Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. October 24, 2014 For Inspections please call: (305)762-4949 Page 3 of 20 BUILDING PERMIT APPLICATION 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 BUILDING ❑ ELECTRIC ❑ ROOFING -�7,, AUG 112014 IV FBC 20 Master Permit No. r 1c— 6- 1�It- Sub Permit No. ❑ REVISION ❑ EXTENSION RENEWAL ❑PLUMBINGMECHANICAL E] PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION E]SHOP CONTRACTOR DRAWINGS JOB ADDRESS: N4`5 N00) M i nm i AVC City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: I -NO(z % 82W1l Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder); Aeddl? Phone#: City: State: Tenant/Lessee Name: Email: CONTRACTOR: Company Name: 331-50 Address: Lf /-/(/ (Ila 1//x/C. tTWy City: &OME27uhD State: Zip. 030-S3 0-33 Qualifier Name: il'�f /RW/N Phone#: State Certification or Registration #:0� /01 &3-5 2— Certificate of Competency #: DESIGNER: Architect/Engineer: e#: Address: City: State: Zip: Value of Work for this Permit: $45(V'32-- Square/linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration El New XRepair/Replace r-1Demolition Description of Work: /-��� %�'�• e7�' �/� t ® ® -y0" tON A46 Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Training/Education Fee $ CCF $ DBPR $ CO/CC $ 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 Zi Fl 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 charged. Signature luag� OWNER or AGENT The foregoing instrument was acknowledged before me this -6 day ofd , 20 // , by who is personally known to me or who has produced identification and who did take an oath. TARY PUBLIC: Si Print:��_z _ -- 03 Seal: �m Signature O CONTRACTOR The foregoing instrument was .. acknowledged before me this day of I''lAG , 20 1� . by DAVID � jXWJAt , who is personally known to as me or who has produced identification and who did take PUBLIC: Print:-�•C'.� Seal:i as ffiffi��k***ffi�k�k�k�k�k+k***�k*�k**ffi+kik*�k�kak�leak*�k�Ie*ffi�k*��k�jk�k �k�k�k*+k�k�k*�t�*�k*�kakak�k�k�k�k�k#�k�k+k�k�k�kF*�k�k4�k�kM�k�k�k�k�k*�k�Fffi�k�k�k�k�k*�k*+k�k�k*�k**t��k*�k�k�k APPROVED BY (/ t Plana Examiner Zoning Structural Review Clerk (Revised02/24/2014) 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): � 145 Iy a 110 / � � / i v �- City: Miami Shores Village County: Miami Dade Zip.Code: 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 AHRI DATA SHEET REQUIRED Change disconnecting means: YES ❑ Noll ARHI Sheet Attached: YES NO ❑ Contract Attached: YES 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): zf5- 3. Voltage of Circuit (208/240/480): 7 4. Size Disconnecting Means: Contractor's Company Name:/) Phone: State Certificate or Registratio NO. I 1 �V ��� Certificate of Competency No. Signature Date: 0 Y Ab 1r �- (uatlNer's signature) (Revised02/24/2014) UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER tZ NIUO AHU or PKG. UNIT MODEL# "® COND. UNIT MODEL # l 4_ —0 ck KW HEAT 7.5 i,evj NOM TONS 2. 0 Y, AHU CU PKG 1) M.C.A AHU CU PKG AHU CU PKG 2) M.O.P AHU CU 2 PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT ES NO YES NO NEW 4"CONCRETE SLAB YES YES NO NEW ROOF STAND YES YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): zf5- 3. Voltage of Circuit (208/240/480): 7 4. Size Disconnecting Means: Contractor's Company Name:/) Phone: State Certificate or Registratio NO. I 1 �V ��� Certificate of Competency No. Signature Date: 0 Y Ab 1r �- (uatlNer's signature) (Revised02/24/2014) This combination qualifies for a Federal Energy Efficiency Tax Credit when placed In service between Feb 17, 2009 and Dec 31, 2013., AHRI Certified Reference Number: 3869097 Date: 8/8/2014 Product: Split System: Air -Cooled Condensing Unit, Coll with Blower Outdoor Unit Model Number: 14ACX-041-230* Indoor Unit Model Number: CBX27UH-048-230*+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 210/240-2008 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 Capacity (Btuh): 39000 EER Rating (Cooling): 13.00 SEER Rating (Cooling) 16.00 IEER Rating (Cooling): FootNote 11 The AHRI 210/240 certified EER ratings are calculated under the same methodology as the EER ratings at T1 conditions of ISO 5151:2010 and ISO 13253:2011. * Ratings followed by an asterisk (*) Indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rerete. 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 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.ahridirectory.org. TERMS AND CONDITIONS This Certificate and Its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal andAm- 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. AIR-CONDITIONING, HEATING, CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE The Information for the model cited on this certificate can be verifled at www.ahrldirectory.org, click on °Verify Certificate" link we make life better - 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 130519805098687703 ©2014 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: This combination qualifies for a Federal Energy Efficiency Tax Credit when placed In service between Feb 17, 2009 and Dec 31, 2013. AHRI Certified Reference Number: 3869097 Date: 8/8/2014 Product: Split System: Air -Cooled Condensing Unit, Coll with Blower Outdoor Unit Model Number: 14ACX-041-230* Indoor Unit Model Number: CBX27UH-048-230*+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 210/240-2008 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 Capacity (Btuh): 39000 EER Rating (Cooling): 13.00 SEER Rating (Cooling): 16.00 IEER Rating (Cooling): FootNote 11 - The AHRI 210/240 certified EER ratings are calculated under the same methodology as the EER ratings at T1 conditions of ISO 5151:2010 and ISO 13253:2011. * 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 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 AHRI. This Certificate shall only be used for Individual, personal and -0-ON confidential reference purposes. The contents of this Certificate may not, in whole or in part, be reproduced; copied; disseminated; MAI 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. AIR-CONDITIONING, HEATING, CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE The Information for the model cited on this certificate can be verified at www.ahridirectory.org, click on "Verify Certificate" link we make life better - 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 13051980509868771 02014 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: Property Search Application - Miami -Dade County Page 1 of 7 Address Owner Name Folio SEARCH: 9145 north miami ave Suite �t U PROPERITY INFORMATION Folio: 11-3206-013-0060 Sub -Division: MIAMI SHORES SEC 1 AMD Property Address 9145 N MIAMI AVE Miami Shores, FL 33150-2262 Owner FREDDIE L PITTS &W BETTY J Mailing Address 9145 N MIAMI AVE MIAMI SHORES, FL 33150-2262 Primary Zone 1000 SGL FAMILY - 2101-2300 SQ Primary Land Use 0101 RESIDENTIAL -SINGLE FAMILY: 1 UNIT Beds / Baths / Half 2/2/0 Floors 1 Living Units 1 Actual Area 2,819 Sq.Ft Living Area 2,239 Sq.Ft Adjusted Area 2,361 Sq.Ft http://www.miamidade.gov/propertysearch/ 8/8/2014 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. V COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. V 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. 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. BUSINESS NAME: ftu.. c7TAR ft1". Mla 'fr'ruIAY'S BUSINESS ADDRESS: 2q-7qO V01 DID,( Mid CITY -I- STATE R- ZIP CODE3.V33 BUSINESS PHONE: ()2'®V %9&(2 FAX NUMBER �) CELL PHONE �_) QUALIFIER'S NAME: Ny/d fi-driff tw1r) AA 1 11 QUALIFIER'S LIC NUMBER: (�! ic, Y71(f 332, 0 100193 Local Bijlstness Tax Re*ce t MiamiDade Count+', State. Florida' of THIS 15 NOT A BIL �-DG NOT .PAY 7168524 BUSINESS NAME1LOCAT1ON ALL STAR HOME SERVICES INC 29790 OLD DIXIE HWY HOMESTEAD 'FL 33033 OWNEOt ALL STAR HOME SERVICES INC Worker{s} 10 v RECEIPT NO. EXPIRES NEW SEPTEMBER 30, ;014 7447165 Must be displayed at place of business - Purstr0t.to County Code Chapter 8A - Art 9 & 10 SEC. TYPE OF BUSINESS 396 SPEC MECHANICAL CONTRACTOR PAYMENT C LLECT R CAC1816332 .tiY TAX COLLECTOR '4 $75.00 04/11/2014 FPPU08-14-00551 3 This Local business lax' Receipt, only tonf{rms.paymenf.of the Local Business Tax._ The Receipt is not a license, . per�eiit, or a ter8ilcation of :e holdea's gtlali8catlons, to do �I�us{nesst tl4otder must comply with solagovettl , ental yr fno. governmental regulalary lams and requirements wlhlth;apply to the business. Tho R15CE111T NO. above must tie displayed on .a{1 wmmerdal vehicles . bilam{ Daetie Code Sec X276.. For mom lnfosmadon, visit www.milamidadesov/toxcalledor �: STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 IRWIN, DAVID FRANK ALL STAR HOME SERVICES, INC. 29790 OLD DIXIE HWY HOMESTEAD FL 33033 Congratulationsl 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. 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. 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 licensel DETACH HERE RICK SCOTT, GOVERNOR (850) 487-1395 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL -REGULATION CAC1816332 _ ' ISSUED< ,06/08/2014 CERTIFIED AIR av6�6OQNTR IRWIN, DAVID FRANK- ALL STAR HOMEuk-yippstNC: IS CERTIFIED under the provisions of Ch.489 FS. Expiration date : AUG 31, 2016 L1406060001043 KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CAC1816332 The CLASS AAIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 ISSUED: 06/06/2014 DISPLAY AS REQUIRED BY LAW ❑� 0 SEQ # L1406080001043 A *'" CERTIFICATE OF LIABILITY INSURANCE 08/11/200 4DmYY) 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 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 PAYCHEX INSURANCE AGENCY, INC. 150 SAWGRASS DRIVE ROCHESTER, NY 94620 CONTACT Paychex Insurance Agency Inc PHONE FAX (A/C, NO. EXT): 877-266-6850 (AIC, No): 585-389-7426 E-MAILESS. Certs@paychex.com A OR INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: ILLINOIS NATIONAL INSURANCE COMPANY 23817 Paychex Business Solutions, Inc. All Star Home Services, Inc. INSURER B: INSURER C: 911 PANORAMA TRAIL SOUTH ROCHESTER, NY 14625-0397 INSURER D: INSURER E: INSURER F: 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. INSR TR TYPE OF INSURANCE NDSDL R UBR WVD POLICY NUMBER POLICY EFF (MMIDD POLICY EXP (MMIDDrMII) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADE[=OCCUR DAMAGE TO RENTED $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: POLICY = PROJECT= LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS BrogwNED COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY $ (Per person) BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Par accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LUIB CLAIMS -MADE DED RETENTION $ $ WORIO:RS COMPENSATION AND EMPLOYERS' LIABILITY 011732318 06/01/2014 06/01/2015 X WC STAN- OTH- TORY I IMITS ER E.L. EACH ACCIDENT $ 1,000,000.00 ANY PROPRIETORIPARTNER/EXECUTNE OFFICER(MEMBER EXCLUDED9M E.L. DISEASE - EA EMPLOYEE $ 1,000,000.00 E.L. DISEASE - POLICY LIMIT $ 1,000,000.00 (Mandatory In NH) N N/A If yes, describe under DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Worker's Compensation coverage is provided to only those employees leased to, but not subcontractors of the named Insured. Client Inception Date with PBS is 07/19/2014 MECHANICAL CONTRACTOR LICENSC # CAC1916332 CERTIFICATE HOLDER CANCELLATION VILLAGE OF MIAMI SHORES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 10050 NE 2ND AVE DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY MIAMI SHORES, FL 33138 PROVISIONS, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) @1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ALLST01 OP ID: MA A ", CERTIFICATE OF LIABILITY INSURANCE F�ATE(MM/DDnrnm 08/08/2014 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 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 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 FILER INSURANCE, INC. 9440 S.W. 77 Avenue CONTACT NAME: Wilson PHONE 305-270-2100 aC No):S05-270-2195 A/c No Ext Miami„ FL 33156 Michelle Wilson E -MAL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # AUTHORIZED REPRESENTATIVE INSURER A: Western World Insurance Co. 13196 NPP8212923 INSURED All Star Home Services Inc 29790 Old Dixie Highway Homestead, FL 33033 INSURERB: INSURER C: PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,000 INSURER D: INSURER E: GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY JECT 7 LOC OTHER: INSURER F: PRODUCTS - COMP/OP AGG $ 1,000,00 COVERAGES CERTIFICATE NUMRER- REVISInN NUMRER! 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. 1LTR TYPE OF INSURANCE DL SUBR POLICY NUMBER MMMIDDD OLICY EFF MMMD YYPOLICY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR AUTHORIZED REPRESENTATIVE NPP8212923 07/01/2014 07/01/2015 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY JECT 7 LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 1,000,00 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS L COMBINED SINGLE LIMIT $ Ea acGdent) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident $ UMBRELLA LIABOCCUR EXCESS LIAB CLAIMS -MADE EACH OCCURRENCE $ AGGREGATEH$ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTNEE.L. OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER OTH- STATUTE ER EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached K more space is required) License # CAC1816332/Mechanical Contractor CERTIFICATE HOLDER CANCELLATION VILLA04 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, WILL BE DELIVERED IN Village of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS.E 10050 N. E. 2 Avenue Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Merieile Beraza P184346 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD