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EL-14-2304Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-221876 Scheduled Inspection Date: December 22, 2014 Inspector: Devaney, Michael Owner: AUGUSTE, GABRIEL Job Address: 9555 NW 2 Avenue Miami Shores, FL 33150 - Project: <NONE> Contractor: MASTEC NORTH AMERICA, INC comments LABEL # A-14-064 Permit Number: EL -10-14-2304 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Label Phone Number Parcel Number 1131010240150 INSPECTOR COMMENTS False J Inspector Comments Passed I DANIEL 305-757-5847 Failed _ Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Phone: 305-257-3095 December 19, 2014 For Inspections please call: (305)762-4949 Page 11 of 38 YVE OCT 2 0 2014 UNIFORM NOTICE OF A LOW VOLTAGE -ALARM SYSTEM PROJECT Owner's or Customer's Name:, Daei /Pl zLuqLL& Owner's or Customer's Address: g555 A)W V1C / Vt City: Hicy t;- State: lL Zip Code: -95l-50 Phone Number: 3L)-5" 757 -534_7 E-mail Address: r(en e - Ynaj- , UYn- Contractor's Name: MasTec North America Contractor's Address: 1750 North Florida Mango Rd #106 City: West Palm Beach State: FL Zip Code: 33409 Phone number: 561254-8610 Contractor's License Number: EC0002759 Date Project Completed: 9-2-Z-1-014 Scope of Work: Install Burglar Alarm Label Permit Number: A ` I q -o(o4 Notice is ereby given that a low -voltage alarm system project has been completed at the addreo sfiecifleo above. I certify that all of the forgoing information is true and accurate. of Owner, Tenant, Contractor, or Authorized Representative ACC)RE® CERTIFICATE OF LIABILITY INSURANCE DATE@AM/DD/YYYY) 11/112014 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 MARSH USA, INC. TWO ALLIANCE CENTER 3560 LENOX ROAD, SUITE 2400 ATLANTA, GA 30326 CONTACT NAME: PHONE No Ext : FAXNo): ADDRESS: XSL G27336589 Attn: Atlanta.CertRequest@marsh.com / Fax: 212-948-4321 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: ACE American Insurance Company 22667 605106—Cas-14-15 MAS- INSURED MasTec North America, Inc. 10400 NW 37th Ter Indemnity INSURER S: Ins Co Of North America 43575 INSURER c: Commerce And Industry Ins Co 19410 Doral, FL 33178 INSURER 0: INSURER E: WA NIA $ INSURER F: AuroanoelLE X X X COVERAGES CERTIFICATE NUMBER: ATL -003310746.01 REVISION NUMBER:7 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. LTRR IYYYI TYPE OF INSURANCE ADDL INSR SUBR POLICY NUMBER MEOd/uDCD EFFD EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR X SIR: $250,000 of Marsh USA Inc, XSL G27336589 09/152014 09/152015 EACH OCCURRENCE $ 1,750,000 DAMAGE TO RENTED 250,GOO PREMISES Es occurrence $ MED EXP (Any one person) $ SELF INSURED PERSONAL & ADV INJURY $ 1,750,000 GENERAL AGGREGATE $ 20,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X I POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ 6,000,000 $ A AuroanoelLE X X X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS ISA H08827667 09/152014 09/152015 COMBINED SINGLE LIMIT 5,000,000 arxddent BODILY INJURY (Per penton) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident C X UMBRELLA LIAB EXCESS IJAB X OCCUR CLAIMS -MADE BE 15805711 09/152014 09/152015 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED I I RETENT70N $ $ B A A WORKERS COMPENSATION AND EMPLOYERS' LUIBILnYTORY ANY PROPRIETORIPARTNERIEXECUTNE Y / N OFFICERIMEMBER EXCLUDED? � (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WLR 048017010 (AOS) WLR 048017022 (AZ, CA, MA) WCU 048017046 FL,GA,NC, ( T%� SIR $1.5M for FL,NC,TXI $1 M for GA 09/152014 09/152014 09/152014 09/15/2015 09/152015 09/152015 X we srAru- oTH- LIMITS E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYE $ 2,000,000 E.L. DISEASE - POLICY LIMIT $ 2,000,000 A Workers Compensation SCF C480170M (WI) 09/152014 09/15/2015 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) RE: Qua9fer. Robert Hernandez License # EC -0002759 CERTIFICATE HOLDER CANCELLATION Miami Shores Wlage SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 N.E. 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village, FL 33138 AUTHORED REPRESENTATIVE of Marsh USA Inc, Manashl Mukhedeeu- ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD To: Page 2 of 2 2014-11-12 08:02:31 EST 15614396410 From: Aracelis Tinidad colloCERTIFICATE OF LIABILITY INSURANCE °liliV"�°"""') TYPE OF INSURANCEAff" 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 pollcy(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 MARSH USA. INC. TWO ALLIANCE CENTER 3560 LENOX ROAD, SUITE 2400 E . PHONE n AIC No ADD ATLANTA, GA 30326 AHD: A%nte.CedRequeat@mamh.com I Fax, 212.048-4321 605108–Cas-14-15 A1AS- INSURERS AFFORDING COVERAGE NAIL A INSURER A: ACE American InWrarlCO 00nVORY 22667 INSURED f,SaSTeCNOdh Ametka, Inc. INSURER B i lddeM* IRS Co Of NOdh America 43 576 10400 NW 37th Ter Doral, FL 33179 INSURER C: Contltl M And IDdustgI- Co 19410 INSURER 0: GENERAL AGGREGATE S 20.000,000 INSURER E • NIA N/A ^'�-wwa,ur"'v-arr KCVMIUrl NUMbbil:7 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 1S SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 9M TYPE OF INSURANCEAff" P POLIO EFF 08/15/2014 PO C EXP LIMITS rA oENERAL LIABILITY X COMMERCIAL OENERAL LIABILITY CLAILI9•MADE OCCUR X SIR ��,OOD XSL 027336589 09/15/2016 EACH OCCURRENCE $ 117601000 ..PREMISES We wourrarmal $ 250 LIED EXP (Any onerson S SELF INSURED PERSONAL & ADV INJURY 3 1,760.000 GENERAL AGGREGATE S 20.000,000 A ISA H0027 667 091151201409115/2015 GEN'L AGGREGATE LIMIT APPLIES PER: PRO -LOC :X1 POLICY M AUTOMOBILE LIABILITY X ANY AUTO X V ED AUTOSHIEDULED X "RED AUTOS X AUTOS SEED PRODUCTS-COMP/OP AGO $ 6,000,000 3 COMBINED SINGLE LIMIT 5 r' S BODILYINJURY (Per poison) S BODILY INJURY (Per aedden0 $ PROPERTY pA1.fAOE 1 $ C B A A A X UMBRELLA LIA9 X OCCUR EX -01 S UAB CLAIMS -MADE NIA BE 15605711 WLRC48017010 AOS0 WLR 048017022 (AZ, CA, MA) WCU (:48017046 (FL,GA,NC,TX) SIR:$1.SMlorFL,NC.TX/$1MferGA CF C48017034 (Wo 09/15/2014 4 09110014 09/15/2014 09/15/2014 09/15/2015 9 5 0911512015 09/1512015 09/15!2015 S EACH OCCURRENCE S 5,000,000 AGGREGATE $ 5,006,000 DEC RETENTION WORNERSCOMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRiETORIPARTNEWEXECUTIYE YIN OFFICERIMEMSER OCCLUDED? (Mandatety In Nin ifyes desrribaunder DESLRIPTIONOFOPERATigNsbelow Workers Compenwilon WC TATO- DTH. 3 E.L. EACH ACCIDENT $ 2,000.000 E.L DISEASE - EA EMPLOYE $ 2.000,000 aLDISEASE-POUCYL0RIT $ 2.040,000 DESCRIPTION GF OPERATIONS I LOCATRTNS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it mora apace Is required) RE: QuaSfer: Robert Hemendez license H EC.=2759 CERTIFICOTF F1n) nils Miami Shares Village &dkRng Department 10050 N.E.2nd Ave MISM Shores Vfte, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manosht Mukhodee ©1988.2010 ACORD CORPORATION. All riehts reserveiri ---•--- tom.....•,, .� I no AGURo name and logo are registered marks of ACORD