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CC-13-638Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-225222 Scheduled Inspection Date: December 16, 2014 Inspector: Rodriguez, Jorge Owner: , Job Address: 9475 NE 2 Avenue Permit Number: CC -4-13-638 Permit Type: Commercial Construction Inspection Type: Final Building Work Classification: Alteration Miami Shores, FL 33138 - Project: <NONE> Contractor: GOLDEN SANDS CONSTRUCTION MANAGEMENT & MAINTI rswlaing uepartment comments Phone Number Parcel Number 1132060133760 Phone: (305)633-3336 RENOVATION OF TELLER DRIVE THRU CANOPY AND Infractlo Passed Comments REPLACEMENT UNDER CANOPY LIGHTING I INSPECTOR COMMENTS False 12/05/2014 permit renewal as per b.o Inspector Comments Passed Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. December 15, 2014 For Inspections please call: (305)762-4949 Page 51 of 61 BUILDING um --in). Miami Shores Village BuildingDepartment p a Y. 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305)s 7624949 FBc zoo 5C.� Permit No. PERMIT APPLICATION Permit Type:UIIDING JOB ADDRESS: 9499 NE 2nd Avenue Master Permit No. ROOFING City: Miami Shores County: Miami Dade zip: 33138 FoIio/ParceW 11-3206-013-3760 Is the Building Historically Designated: Yes . NO Flood zone: OWNER: Name (Fee Simple Titleholder): Bank Of America phone#. 813-225-8176 Address: 101 N. Tryon Street City: Charlotte State: NC zip. 28246 Tenant(Lessee Name: Patricia.l.ramos@bankofamerica.com Phone#: Email: CONTRACTOR: Company Name: Golden Sands General Contractors Phone#: 305-633-3336 AAA,... 2500 NW 39th Street City: Miami Ste. FL Zip: 33142 Qualifier Name: Mary Maguire Phone#: State Certification or Registration #: CGCO6261-7 Certificate of Competency #: Contact Phone#: Email Address: mary.maguire@goidensandsgc.com DESIGNER: Architect/Engineer: ADC (Ray Feito) Phone#: 678-538-6503 Value of Work for this Permit: $_IZ ijV 0 SauareUnear Footage of Work: J, goo v= Type of Work: DAddition OAlteaation Description of Work: Renovation of Teller Drive Thru Color thru tyle: ONew )iRepair/Replace (Demolition 1now & Reglacernent Under Canopy Lighting Submittal Fee $ Permit Fee $_ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ • w `'.0 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 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 gfter 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�—�� Owner or Agent The foregoing instrument was acknowledged before me this 7 2 day of 7 , . 20 0 , by who is personally known to me or who has produced i� �k, ' 0 NOTARY PUBLIC: Sign: Print: 1 6 o E&Wath. NOTARY PUBLIC Fulton County State of Georgia My Comm. Expires Oct. 24, 2016 My Commission Expires: 10 - 4A - I L,.° Signatur Contractor �w The for oing instrument was acknowledged bef re me this 29 rl day of TQV1VJ&Vq2013 by 4 who is personally known to me or who has produced, APPROVED BY �. L! i� / Plans examiner Sign: Print: I My Commission Ex4s: es: O 1 I S an oath. Notary Public State of Florida Anabel Alifeds My Commission EE065468 Expires 01113/2015 Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07XRevised 06/10/2009)(RvAsed 3/15/09) r, Miami Shores Village __ Building Department DEC 05 2014 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Y. Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 Iz�' BUILDING Master Permit No(�_e-3-6 39 PERMIT APPLICATION Sub Permit No. F-LG13 GS') ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: -- City: Miami Shores Coun : Miami Dade Zig): Folio/Parcel#: I I ^ Z X20 (6 0 13 — 3 6 o Is the Building Historically Designated: Yes N Occupancy Type: Load: Construction Type: Flood Zone: BFE: F E: OWNER: Name (Fee Simple Titleholder):_goy and 4w)p�-.'Cq Phone#:913'25r gf 76 Address: 0 ( Na r fj S k. City: L4a.r Co WC State: N C Zip: 2.92 4 Tenant/Lessee Name: Phone#: n j I Email: _ PCjrc'C la. _ f r (`CCtwt sJ Q RaK6C I -CL CONTRACTOR: Company Name:. K O F1 e c V1( Cct ( AC Phone#: Address: 16 s'y® Sw 37 S { City: fft ami State: FL Zip: 3z / 9 6 Qualifier Name: Vo U<cr Si&k7eew. la Phone#: 786-2fa 'S73 3 State Certification or Registration #: F C 13 O0 42 6 Z{ Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: Value of Work for this Permit: Type of Work: ❑ Addition ❑ Alteration Description of Work: F,c1u: c, ( i l 0 9 Specify color of color thru tile: City: State: Zip: _ Square/Linear Footage of Work: New ❑ Repair/Replace Submittal Fee $ Permit Fee $ _ -'f &Ia® CCF $, Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) DBPR $ ❑ Demolition CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ F 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. 1 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. 1 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 cone 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature e Owner or Agent Contractor The foregoing instrument was ac nowledge before me this day 046ft6a.20T 13 Who' ' personally now ohne or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: `\ Print: iqu Wei My Commission Expires: 4 JOANNE HENRY North Carolina ecklenburg Coun The foregoing instrument was acknowledged before me this= day of cQn, 20 J�, by Lc lis aL,w1 who is personally known to me or who has produced as identification and who did take an oath. Sign: Prirlt� My V Plans Examiner � fy Structural Review (Revised 3/12/2012)(Revised 07/IQWXRevised o6/1012oo4XRevised 311$M) COM1611581011 • EE 832225 ted Tbr uP 1lNWW Nfty Assn. ' Zoning Clerk i @ r o 2I)\�14 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: �UILDING DEC 0 4 2014 M FBC 20 16 Permit No. OC / 3 —631 Master Permit No. ROOFING JOB ADDRESS: 95'7- -C zYFG , �i(e City: Miami Shares County: Miami Dade zip; 33138 Folio/Parcei#: 11-3206-013-3760 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): Sank Of America Phone#, 813-225-8176 Address: 101 N. Tryon Street City: Charlotte State: NC Zip; 28246 Tenant/Lessee Name: Patricia.l.ramos@bankofamerica.com Phone#: Email: CONTRACTOR: Company Name: Golden Sands General Contractors phot; 305-633-3336 Address.. 2500 NW 39th Street City: Miami State: FL - — zip; 33142 Qualifier Name: Mary Maguire Phone#• State Certification or Registration #: CGCO62617 Certificate of Competency #: Contact Phone#: —Email Address; mary.maguire@goldensandsgc.eom DESIGNER: Architect/Engineer: ADC (Ray Feito) Phone#: 678.538-6503 Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: DAddition ©Alteration ONew )dRepair/Replace Wemolition Description of Work: Renovation of Teller Drive Thru Canopy & Replacement Under Canopy Lighting Color thm tile: eesea�ee��+�asweeaa�ee��r�+*e�a��*s�ae�F��eea���eeesexeaxexe��*���eew�cc��+�e��c�eeee� Submittal Fee $ Permit Fee $ CCF!; -C1 _I CO/CC $ Scanning Fee $ Radon Fee $ _ DBPR $ QD• ad $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ y Structural Review $ TOTAL FEE NOW DUE v 90 Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address Zip 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 4a 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 Signature Owner or Agent Contractor The foregoing i strument r ackgowledged be re me this day og20 , by , who is !�t�As o me or who has produced identificationand who did take an oath. NOTARY Sign: Print: Notary Public North Carolina APPROVED BY The foregoing instrument was acknowledged before me this-3— day hisday of Q C. , 20 -a, by A4 tV who i na ly k me or who has produced as identification and who did take an oath. Plans Examiner Structural Review (Revised 3/12/2012XRevised 07/10/07XRevised 06110/2009XRevised 3/15!09) NOTARY PUBLIC: Sign: Print: My C • FF ggalSe Zoning Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 MAGUIRE, MARY FRANCES GOLDEN SANDS GENERAL CONTRACTORS INC 2500 N W 39TH ST MIAMI FL 33142 Congrawlationsl 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 Improvethe way we do business In order to serve you better, For Information about our services please 4 onto www-myfloddallcense4com. There you can find More information about our divisions and the Ziulatlonms that impact you, subscribe learn r to department newsletters a learn ore about the Departments Initiatives. Our mission at the Departmerd Is: License Efficiently, Regulate Fairly. We constantly strive to some you boner so that you can serve your cx►stamers. Thank you for doing business in Florida, and congratulations on your new licensel DETACH HERE OffIV ISSUED. 06/1712014 DISPLAY AS REQUIRED BY LAW SEQ# L1406170001002 GOLDSAN-02 SSIMEON '41 R"r CERTIFICATE OF LIABILITY INSURANCE DATE 1010/20141x7 10/10/2014 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 policypes) 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 Collinsworth, Alter, Fowler & French, LLC 8000 Governors Square Blvd Suite 301 Miami Lakes, FL 33016 CONTACT PHONE FAX c No 305 Ext): ) 822-7800 A/c No): (305) 362-2443 E-MAIL ADDRESS: 21UENOT4514 2/1/2014 INSURER(S) AFFORDING COVERAGE NAIC @ INSURER A: Twin City Fire Insurance Co 29459 PREMISES Ea occurrence $ 300,000 INSURED INSURER B. Hartford Fire Ins CO 19682 INSURER c: North River Insurance Company 21105 Golden Sands General Contractors, Inc. INSURER D: Federal Insurance Company 20281 2500 NW 39th Street Miami, FL 33142 INSURER E. INSURER F: LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS Ix AUTOS 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. ILTR TYPE OF INSURANCEINS& THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. UB POLICY NUMBER POLICY Mu DY EFF POLICY Mu D/ EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERALLIABIUTY CLAIMS MADE � OCCUR 21UENOT4514 2/1/2014 2/1/2015 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- LOC PRODUCTS - COMP/OP AGO $ 2,000,00 $ B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS Ix AUTOS 21 UENOT4515 2/1/2014 2/1/2015 COMBINED SINGLE LIMIT 1,000,000 Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident C X UMBRELLA LIAR EXCESSLIAB X OCCUR CLAIMS -MADE 5811025698 2/1/2014 2/1/2015 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,000 DED I X I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITYTORY ANY PROPRIETOR/PARTNER/EXECUTNEFN— OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 21WBOT4513 2/1/2014 2/1/2015 X I WC STATU-OTH- LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,000 D Crime 82214761 2/1/2014 2/1/2015 Employee Theft 1,500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space Is required) For GC License Numbers CGCO62617 - Mary F. Maguire and CGC(LW62 - Peter P. Fedele CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department 10050 NE 2nd Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NOTICE OF COMMENCEMENT R Bkk� 28470 2695? � A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION RECORDED 02/01/2013 091.45 = 56 HARVEY RUVINr CLERK OF COURT MIAMI-DADE COUNTYP FLORIDA PERMIT NO. TAX FOLIO NO.11.3206-013-37 LAST FADE STATE OF FLORIDA: COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street / address: M W Shares Seel AMD PB 10.70 Lots 13 Thnr i7 Inc B1k 28 Lai ske or22766.0801 10 2004 6 (3) COC 2S9M-46,1007 2 17 6 (3) 9475 NE 2nd AM 2. Description of improvement: Renovation of TeW Drive-lbv Canopy & Replac-terd of Urger Carropy LIONIN 3. Owner(s) name and address: Bank of Amedce — - - 101 Tryon SL Charbtte, NC 28748 0 V USP Interest in property:1A-4 Name and address of fee simple titleholder. c 0V c .�..._.� ,A.D 20 4. Contractor's name and address: laiden sands General Cantractors - MarvMaauk 2M NW 39th Street, WOW, FL 33142 5. Surety: (Payment bond required by owner from contractor, if any) Name and Address: Amount of bond $ 6. Lender's name and address: 7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes. Name and Address: 8. in addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and Address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) Signature of Owner Print Owner's Name �Y,�Cn(_ Prepared by Sworn to and subscribed before me this 22 day of J20 1'3 . ,= Notary Publit:: , Print Notary's Name: My ommimo _t -JAC NOTARY PUBLIC Fulton County State of Georgia My Comm. Expires Oct. 24, 2016 05/09/2013 3:17PN FAX 3056348000 Golden Sands Fax GOLDSAN-02 CERTIFICATE OF LIABILITY INSURANCE 1a0002/0002 SSIMEON DATE (MMfDOIYYYY) 1/30/2013 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 CONTACT Collinsworth, Alter, Fowler & French, LLC PHONE 8000 Governors Square Blvd No : (306) 822-7800 No): (305) 362-2443 Suite 301 Miami Lakes, FL 33016 ADDRESS: INSURED Golden Sands General Contractors, Inc. 2500 NW 39th Street Miami, FL 33142 :Hartford Casualty :North River Insurance 1 :Federal Insurance Com 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. OF INSURANCE YEACH POLICY NUMBER M D MIDD LIMITS L GENERAL LIABILITY ddtl OCCUR ddtl InsdPERSONAL&ADV W X X 1UENQT4514 2/1/2013 2/7/2014 OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 100,000 MED EXP (Arty one person) $ 5,000 INJURY $ 1,000,000 OS GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X SCT LOC PRODUCTS- COMPIOPAGG $ 2,000,000 AUTOMOBILE LIABILITY A X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS X X 1UENQT4515 2/1/2013 2/1/2014 Ea accident GLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ R DAMAGE Per accident $ B X UMBRELLA uA6 EXCESS LJA6 X occI CLAIMS -MADE X X 811012792 2/1/2013 2/1/2014 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X RETENTION$ WORKERS COMPENSATION $ AND EMPLOYERS LIABILITY A OFRCERNENBOERREXCLUDED? UIIVEY� NIA 1WBQT4513 2/1/2013 2/1/2014 (Mandatory dory In and If yes, describe under DESCRIPTION OF OPERATIONS below C Crime 2214761 2/1/2013 2/1/2014 X ToLIMITS oT E.ER L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ Employee Theft 1,000,000 1,000,000 1,000,000 1,500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 N E 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD