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MC-15-1203Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-235087 Scheduled Inspection Date: June 01, 2015 Inspector: Perez, JanPierre Owner: MURRAY, KEVIN Job Address: 117 NW 99 Street Miami Shores, FL Project: <NONE> Contractor: MONROE SERVICE CO Building Department Comments REPLACE A/C UNIT 3 TON Permit Number: MC -5-15-1203 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1131010220390 INSPECTOR COMMENTS False Inspector Comments Passed 111 Failed Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid Phone: (305)295-0333 May 29, 2015 For Inspections please call: (305)7624949 Page 19 of 27 Project Address Parcel Number Applicant 117 NW 99 Street 1131010220390 KEVIN MURRAY Miami Shores, FL Block: Lot: Owner Information Address Phone Cell KEVIN MURRAY 117 NW 99 ST MIAMI SHORES FL 33150-1742 Contractor(s) Phone Cell Phone MONROE SERVICE CO (305)295-0333 3 Info: ion: Residential In Review Date Denied: Scannino: 3 Fees Due Miami Shores Village CCF 10050 N.E. 2nd Avenue NW DBPR Fee Miami Shores, FL 33138-0000 ` Phone: (305)795-2204 Education Surcharge $0.80 Project Address Parcel Number Applicant 117 NW 99 Street 1131010220390 KEVIN MURRAY Miami Shores, FL Block: Lot: Owner Information Address Phone Cell KEVIN MURRAY 117 NW 99 ST MIAMI SHORES FL 33150-1742 Contractor(s) Phone Cell Phone MONROE SERVICE CO (305)295-0333 3 Info: ion: Residential In Review Date Denied: Scannino: 3 Fees Due Amount CCF $2.40 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.80 Permit Fee $133.00 Scannin ee $9.00 TechnoldA Fee $3.20 Total:n $152.40 Date Approved:: In Review Type of Work: Valuation: $ 3,800.00 Total Sq Feet: 00 Pay Date Pay Type Amt Paid Amt Due Invoice # MC -5-15-55640 05/20/2015 Credit Card $ 50.00 $ 102.40 05/27/2015 Credit Card $ 102.40 $ 0.00 Available Inspections: Inspection Type: Final Review Mechanical In consicition of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining reto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting cfts permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required fLECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS$FFIDAVIT: 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. Futhermore, I authorize the abovP��d contractor to bo the work stated. May 27, 2015 "orized Signature: Owner / Applicant / Contractot / Agent nate Builcfng Department Copy May 27, 2015 1 � e Miami Shores Villa g Building Department � g p 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 PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING FBC 20 0 Master Permit No. Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL F-1 PLUMBING MECHANICAL ❑PUBLIC WORKS E] CHANGE OF ❑ CANCELLATION ❑ SHOP f l CONTRACTOR DRAWINGS JOB ADDRESS: % ? City: Miami Shores County: Miami Dade Zip: -33f,,5 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Phone#: Address: / / % tl�f City: M/ 9 /Gi 1 S K a State:- Zip: 3 Tenant/Lessee Name: Email: CONTRACTOR: Company Name: A(ew,'fk ? C ��a^///C ��, Phone#: 3�-S Address: % •S_C2 O V e e'- S -e s City: -�/ State: Zip: Z Qualifier Name: , 2 11' 4) /1 0'J'o 0 -e Phone#: 221 9 %-3�� State Certification or Registration #: (q, Cep Sv .? S X Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: City: State: Zip: Value of Work for this Permit: $ J E' 00 Square/Linear Footage of work: / ;(d 6 Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: Specify coli Submittal Feel Scanning Fee $ 14/A Technology Fee Structural Reviews $ (RevisM02/24/2014) Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ G- 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 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 Signature OWNER or AGENT CONTRACTOR The foregoing instrument t was acknowledged before me this —)I day of l r 1� 20 IS , by �NJ �' itf 1°�.-1 , who is personally known to me or who has produced l.- as identification and who did take an oath. NOTARY PUBLIC: Sign: /I �� grv4a �` f► (Revised02/24/2014) The foregoing instrument was acknowledged before me this © day of ��� , 20 S' , by 1 {° °iy,'Z ° e , who is personally known to me or who has produced �L �Z LT as identification and who did take an oath. p NOEL A BROWN Notary Public - State of Florida flow r�iQlt�xFr't1tk�R���#B �** Commission 4E EE 217142 ar+ Bonded Through National Notary Assn��, Pla�is ar`�iner Zoning Structural Review Clerk 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):_/ / 7 d 4o3 • 57V 5 7 City: Miami Shores Village County: Miami Dade Zip Code: l 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 ❑ NO ❑ ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES ❑ 1. Minimum Circuit Ampacity (Wire Size): 10 2. Maximum Overcurrent Protection (Fuse/Breaker Size): ID 3. Voltage of Circuit (208/240/480): _ -1-- k CD 4. Size Disconnecting Means: , A 3 O Contractor's Company Name: / t/( OWjolU C' S e ey C Q ; Phone: 30J-- '297-3-? State Certificate or Registration Signature signature) (Revised02/24/2014) Certificate of Competency No. : /.s'— /1- UNIT BEING REPLACED DATA NEW UNIT 'Ie- H A S 7^ f MANUFACTURER e ti 5 7 C 9 o a*S D1 AHU or PKG. UNIT MODEL # (-- c o,,, q p 3 C, 4 L- 0 & 3c) COND. UNIT MODEL# iq X 113 K G 4 KW HEAT fq a, J NOM TONS 3 AHU CU PKG 1) M.C.A AHU CU PKG AHU CU PKG 2) M.O.P AHU CU PKG AHU CU PKG 3) VOLTS AHUaao CU0140 PKG PKG UNIT / / PKG UNIT / / EE SEE R_ i1,')v Ll Ir YES NO REPLACING DUCTS YES 0 YES NO REPLACING THERMOSTAT YES O YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES N YES NO NEW RETURN PLENUM BOX YES Q NO 1. Minimum Circuit Ampacity (Wire Size): 10 2. Maximum Overcurrent Protection (Fuse/Breaker Size): ID 3. Voltage of Circuit (208/240/480): _ -1-- k CD 4. Size Disconnecting Means: , A 3 O Contractor's Company Name: / t/( OWjolU C' S e ey C Q ; Phone: 30J-- '297-3-? State Certificate or Registration Signature signature) (Revised02/24/2014) Certificate of Competency No. : /.s'— /1- AHRI Certified Reference Number: 7850608 Date: 5/18/2015 Product: Split System: Air -Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: NXA436GKC* Indoor Unit Model Number: FEM4P36**AL Manufacturer: TEMPSTAR Trade/Brand name: TEMPSTAR Region: Series name: 14 SEER N SERIES R410A AC Manufacturer responsible for the rating of this system combination is TEMPSTAR 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): 33400 EER Rating (Cooling): 11.70 SEER Rating (Cooling): 14.00 IEER Rating (Cooling): 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.ahridlrectory.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; 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 verified at www.ahridirectory.org, click on 'Verity Certificate" link w,v make lire boner and enter the AHRI CerUfled 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 130764396833665487 02014 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: Load Calculator Page 1 of 3 07 d. a TIF S i, lM re? S19/'/a,5rSS 33/J 6) HOUSE INFORMATION What direction of the house has the most glass? Click the corresponding arrow next to the photo. Adjust square footage of window area on this home. Adjust square footage of window area: % Shading EF —65 N 15 S 15 W 74 if 30 HOUSE INFORMATION What is the conditioned square footage of your house?: Square feet: 1449 When was your house built? Before 199011 1990 -2000 After 2000 How do ou want insulation values displayed? R U Winter Electricity Rate 0 1 Summer Electricity Rate 0.1 Natural Gas Rate 1.2 Propane Rate 2,5 Oil Rate 2,3 Summer indoor design 70 temperature HOUSE LOADS Cooling Load: 32,953 Heating Load: 14,326 ADEQUATE EXPOSURE DIVERSITY (AED) 16,000 12,000 8,000 4,000 0 Sam 10am Opm 2pm 4pm Bpm 8pm 9am ttam tpm Spm 5pm 7pm ® Hourly Loads 0 Average LOADS GRAPH 40,000 30.000 20,000 10,000 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec ®HEATING it COOLING M HEATING operating E COOLING operatng Cooling Loads 32.953 btu hr Sensible People Load r Latent People Loi !--� Internal =� System Latent Infiltration Ceiling Wal Sensil http://yourvirtualhvac.comlcontractor/loads/?user hash=59621cd4ce8e8lc4f8fe7b9Ob7l3d... 5/16/2015 Load Calculator Page 2 of 3 Summer outdoor design F957— temperature Winter Indoor design 76 Floo temperature Winter outdoor design 5-6 im a temperature SHR 1-35 Number of Residents F2— a Average Ceiling Height Fg—awi Infiltratic Wall Square Feet MP ......... .... .. F13 7 —0 Ceiling Square Feet 1449 Wall R -Value F9. 5 —0 Floor R -Value F4. 0 —0 13 in Ceiling R -Value 1-4.66 Window U -Value F— a n Single Pane = I Double Pane = .5 Triple Pane = .3 Window SHGF Fo —.8s Clear = 1-.85 Low -E .6-.4 Grains of moisture 58 difference Duct Loss % Fio— a a Duct Gain % Flo— a Cooling Infiltration Rate OF. —6 ij jo (ACH) Heating Infiltration Rate [0—.8 (ACH) Winter Ventilation r—®d Summer Ventilation Fo— a a Heating Loads 14,326 btu hr System Efficiency Loss I Ig Win h4:llyourvimaflivae.comleontractorlloadsl?user—hash=59621ed4ce8e81c4f8fe7b90b713d... 5/16/2015 MONROE SERVICE CO., 954-471-8685 HVAC: Basic air duct cleaning Clean return and supply duct work AHU: Contact vacuuming air handling u includes interior compartments Register Cleaning: Hand washing & brt and return register Plenum: Open connection box/plenium, contact vacuuming inside surface Evaporator Coil: Pressure wash with coil cleaner solution Blower: Cleaning Blower Components Drain Line: Inspect and flush drain line Condenser Unit: Pressure wash with coil cleaner solution and interior vacuur Deodorizer Sanitizing: Sanitizer, Fungicidal, Bacterial Envirocon: Applied for Microbial Control Controls mold, mildew, fungi & bacteria Smoke Odor: For smoke / odor control Duct Seal / Coating / Soot Set Date rY `j Tech 7� �7 CJ ` Name *� �' Address,{ / J Apt. # City ` ' rr *"� State Zip f Tel 5 Cell CAC050394 Email/Fax JOB# Model # Model # supply Serial # Serial # Brand # S l'1- Brand #id � _ ^� / H W D Ton/Seer +! Freon: R22 -1 41" / 134 Duct Repair / Replace Thermostat / Contactor A/C Check-up Breaker / Disconnect Box / Hard Switch Capacitor / Transformer / Relay Float Switch / Condensate Pump ❑ 1 Year ❑ 2 Years ❑ 3 Years ❑ 4 Years ❑ 5 Years Next Service Date: Refrig. Type ❑ R-22 ❑ R410A Amps High Low _ Recovered? ❑ Yes ❑ New Qty Recycled? ❑ Yes ❑ New Qty Reclaimed? ❑ Yes ❑ New Qty Returned to this system? ❑ Yes ❑ New Qty Filter: ❑ Gold ❑ Silver ❑ Flex PAYMENT METHOD Filter Size I hereby authorize Monroe Service Co. air conditioning service to charge the amount $ ❑ Finance Acct# UV Light & Install ❑ Cash Amount Office Authorization Initial Credit Card: ❑ MC ❑ Visa ❑ Amex ❑ Discover UV Light Ozone & Install CC # CVv # Dryer Vent Cleaning: Expiration Date / Authorization Code ry g: ❑ Side ❑ Roof Driver License # D.L. Expiration By signing above, customer authorizes performance of the above services and agrees to the terms & conditions set forth on the reverse side of this agreement with regard tads ese services or any additional services authorized by the customer at the time services are performed. Customer also agrees to pay in full the charges referenced above, including all appli [9,Wes, together �llth any charge for additional services authorized by customer at the services were completed. We are not responsible for any paint chipping when registers are removed. of rAuVh6fizati6riDate 'Paper check will be converted to an electronic payment (ach)' [HAVE VERIFIED THAT A/C UNIT IS IN WORKING CONDITION AND THE WORK HAS BEEN COMPLETED TO MY SATISFACTION. customer: Date. 36109 ❑ Service -Install ❑ Estimate ❑ Recall Regular Labor: HRS @$ Overtime Labor: HRS @$ HR=$ HR=$ TERMS AND CONDITIONS OF AGREEMENT Company's Obligation: Company shall provide the services described on the front of this Agreement consistent with Company's standard practices and in accordance with the terms and conditions set forth below. Promised Results And Hidden Conditions: Customer understands and agrees that these cleaning, installation, repair and restoration services may not totally clean or remove, all contaminants, odors, stains or damages in all areas, even after diligent and reasonable efforts by Company. Customer agrees that no such guarantees, warranties or representations as to results or levels of decontamination, cleanliness or restoration are made by Company except as stated in writing in this Agreement. Customer further acknowledges that there may be hidden or unknown conditions that would affect the cleaning and restoration process used by Company and Customer agrees that Company shall not be responsible for any damage caused by any hidden stains, etc. Customer acknowledges that new materials used in restoration may not precisely match existing texture, type, material or color. Prior to Company's arrival, Customer shall notify Company of any preexisting or damaged conditions and shall remove all valuables and breakable items from the area where services may be performed, and Customer shall be responsible for any loss or damage resulting there from. Warranties and limitation of Damage: Company warrants to Customer (and to no other -person or entity) that all work will be completed in a good and workmanlike manner in accordance with Company's standard practices. In the event of any defect in the services provided by Company, Customer's exclusive remedy shall be (i) correction of same by reserve, retreatment, adjustment or repair, or at Company's option, (i) refund of all sums paid on the portion of the work which is not as warranted. All warranties are void if customer does not keep up with company's maintenance program. THIS IS A LIMITED WARRANTY, AND IS EXCLUSIVE AND IN LIEU OF ALL OTHER WARRANTIES, EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO ANY WARRANTY OF MERCHANTABILITY, HABITABILITY, WORKMANSHIP OR FITNESS FOR A PARTICULAR PURPOSE. ALL OF WHICH ARE HEREBY DENIED BY COMPANY AND WAIVED BY CUSTOMER. IN NO EVENT SHALL COMPANY BE LIABLE TO CUSTOMER UNDER ANY THEORY FOR ANY ANTICIPATED OR LOST PROFITS OR ANY INCIDENTAL OR CONSEQUENTIAL LOSS AND COMPANY'S MAXIMUM LABILITY TO CUSTOMER FOR ANY LOSS OR DAMAGE ARISING FROM THE SERVICES RENDERED BY COMPANY SHALL NOT EXCEED THE AMOUNT OF THE CONTRACT PRICE PAID BY CUSTOMER FOR THE SERVICES RENDERED HEREIN. Use of Chemicals: Customer is advised that a potential health risk may occur as a result of the application of cleaning agents, deodorizer, sanitizers, micro biocides or any other chemical (Referred to as the "Chemicals") used in the services as describe on the front of this agreement. The Customer acknowledges reading a copy of the Material Safety Data Sheets (written by the manufacturers) of Chemicals used in performing the services. Customer further represents that he/she accepts the risks as set forth herein customer hereby releases and forever discharge: Monroe Service Company and its agents, principals, owners, shareholders, directors, managers and employees from any and all claims as to injuries, damages and health problems of any nature, whether known or unknown, suffered as a result of the application of the Chemicals. Monroe Service Co. is a State Certified HVAC Company and is not a Remediation Company. Completion Certificates: Upon completion of the services, or any segment thereof, Customer will on request execute such instrument as Company may reasonably request acknowledging completion of the services. Customer agrees to inspect the services immediately upon completion, and notify Company's crew of any complaints before they leave. To the extent that they may validly do so, the parties agree that the services will be deemed to be fully acceptable if no notice of any defect in materials or workmanship is received by Company in writing within 3 days of completion of services. No Other Agreements or Representations: This Agreement and any attachments hereto constitute the complete and exclusive statement of the agreement between the parties with respect to the subject matter hereof and shall supersede all proposals, prior agreements and representations, oral or written and all communications between the parties relating to the subject matter hereof. No representative of Company has authority to make representations, guarantees, warranties, agreements or other promises other than as are expressly set forth I this Agreement, and this Agreement shall not be varied by any agreement or representation other than an instrument in writing executed by the dully authorized officer of Company and Customer. Cancellations: Invoice orders, permits applications accepted by a customer may not be changed or suspended without Monroe Service Co. Inc. written consent and payment of reasonable and proper cancellation charges will apply as follows: Customer's Costs (Invoice Cancellation 'Costs' and return of product to warehouse) will be 15% restocking fee paid by Customer at time of Cancellation. Customer's costs (the "Costs" for all permitting) these costs incurred prior to cancellation for permitting and filing to the city wiH be paid by Customer in the amount of $350. Payment: Customer hereby acknowledge and agrees that 'All sales are final'. Customer has inspected an accepted verification of A/C unit installation and completion including but not limited to all service work performed as listed on this form. Payments are due upon completion of work to Company's representative. Any payments made thereafter shall be delivered at Company's address as shown on the face of this Agreement. Any amount owing the Company and not paid within 30 days after due date shall bear interest at the lesser of 18% per annum or the highest lawful interest rate until paid. All returned checks are subject to a $35 fee per incident. Dispute Resolution: (Customer agrees to notify Company of all complaints in writing, and allow Company to inspect and/or correct any deficiencies in the services.) Customer and Company agree that all disputes, controversies or claims regarding the inadequacy of services between Customer and Company arising from or relating to this Agreement and/or the services to be provided by Company shall be submitted to nonbinding mediation or arbitration in accordance with applicable Alternative Depute Resolution Procedures. The award of the arbitrator in any such proceeding shall be final and binding upon both parties and either party may apply to an appropriate court to enforce such award, if necessary. Costs: Should Company be required to bring an action to enforce the terms hereof or declare rights hereunder, then Company shall be entitled to recover from Company all costs and reasonable attorney's fees required in asserting its rights under this Agreement in any action, arbitration, trial or appeal. The terms and conditions of this Agreement shall insure to the benefit of and be binding upon the parties hereto, their respective heirs, representatives, successors and assigns. "Paper check will be converted to an electronic payment (ach)' Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. "/OPY OF QUALIFIER'S STATE LICENCES B. V COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) BUSINESS NAME: *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. D BUSINESS ADDRESS: J165 -,O c2Je-P_fe. -, gwk CITY 1 ATE-AL—ZIP -,-? BUSINESS PHONE: (^(r.�) 0 23 032 3 FAX NUMBER (� CELL PHONE (J aj- -7579- 7-333 33 QUALIFIER'S NAME:��,//,) Ai- Ay &O t QUALIFIER'S LIC NUMBER: C c� 6 o j 0-3 9 N to r- 0) 0 0 co RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD mummum CAC050394 'he CLASS BAIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 MONROE, PHILIP MANSFIELD MONROE SERVICE CO PO BOX 5451 KEY WEST FL 33045 .Tilr. Q ISSUED: 08112/2014 DISPLAY AS REQUIRED BY LAW SEQ # 1-1408120001732 cc RTY CDIF IkOcldl- l� VVIE s), 7jc Business TAA Receipt 0) This Document is a business tax receipt U') Holder moat meet all city zoning and use provisions. P.O. Box 2409, Key Weot, Florida 33040 (305) 809-3955 Business Name MONROE'S SERVICE COMPANY (MECH Ct1Nbr:0004047 Locat joL-1 Addr 5580 1ST AVE Lic NBR/Class 15-00013884 CONTRACTOR - CERT AC CLASS A Issue Date: August 04, 2014 Expiration Date -Soptember 30, 2015 License Fee $309.75 II Add. Charges $0,00 Penalty $0.00 Total $309.75 Comments: 41 This document must be prominently- displayed. jl MONRORIS SERVICE COMPANY li MONROE'S SERVICE COMPANY (MECH POB 5451 -(D KEY WEST FL 33040 0 Sel 75 05/18/2015 MON 11:45 FAX 3058722324 Johnsons Insurance ]zoo 1/001 AC(7t2'[7"' I OATS (Muco m►,r�rl CERTIFICATE �F LIABILITY INSURANCE 5/15/2015 THIS CERTIFICATE 18 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. It SUBROGATION 18 WAIVED, subject to that terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certlticate holder In lieu of such endammnent(e). PRODUCER The Johnsons Insurance Agency 30975 Ave A Big Pias may FL 53043 IN*UMD wa troo Ssrvica Company LLC dba Monroe Service FO Box 5451 West SL 33045 Nm UUNIFe,AV.- Susan Cherrybon _ PH E (305)872-2888 �� ",�` (305)971-2324 — .Ya.i.QR)'r. ..._ ... ... L Scharr_y@jOhriapC+n+4inaure.com _ •INSURRR1§1AMR1XNQCOVERAGE —_, NAIC0. . INSUReRA tiiraruda IRSuraAQe CCMany---•. 16870 INSURER{C: _.._...— _........ INSURER D: I THIS 19 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. CERTIFICATE NOTWITHSTANDING ANY REQUIREMENT, MAY BE ISSUED OR MAY PERTAIN, TERM OR CONDITION OF ANY THE INSURANCE AFFORDED BY CONTRACT THE POLICIES OR OTHER DESCRIBED DOCUMENT WITH RESPECT HEREIN IS SUBJECT TO TO WHICH THIS ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH TYP! OF IM WRANr POLICIES, LIMITS SHOWN MAY HAVE BEEN LILY NONBER REDUCED BY PAID CLAIMS. �� MR POLICY 6 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 300,000 A — -A CLAIMS -MADE (X� OCCUR rowmo g) S MR 99201112d _ 140,400 S ---- 0195=008271250 9l13J2014 9/13!2078 MED Ex?(Any mleen) S-- 5,400 6 SOO , 000 - __-• _—___......__._ PERSONAL & ADV INJURY OWRAL AGGREGATE $ _ 1,000,000 eEN'L AGGREGATE LINgT APPLIES PER: PRODUCTS • COMPIOP AGG X POLICY [:] JEeOT L_..� LOC S, • S11000,000 Pr wW aameg"Ingle Uma OM , 4 AUTOMOBILE UADUMeWdeftn COMBINED SiNGLE u )T S BODILY INJURY (PM PIO<orI) S ANY AUTO SODILY INJURY (Per mddmd) Ei�TY — Pet o4- rur AUTOS OS C mpg LED NON-0WNED HIRE AUTOS AUTOS 6 3 S UMBRELLALIAB OCCUR - EACH OCCURRENCE —__ S,•, — _— ONCE" LIAR CLAIMS-MADEAtXaRErt►Te S - - —_ - - - — oeo RETENTIONS _ S WORM0141 COMPENSATIONOTH- AND EMPLOYERS' LIAMIUTY Y / N ANY PROPFUE70PJPARTNERJMOUTIVE OFFICERIMEMSEREXCLUDED? (Mand/ "br NH) NIA TA7 TE ER S ..... ... _ .._ •. E.L. EACH ACC@ENT R,l QI8EA88 • EA EMPLOYE 6' L MCA= - PnLICV LOMY S DMOIUFM OF OMRATIONS I LOCATIONS I VEHICLES (ACORD 101, AddtUoeal NOWAMu 6911odVID, may Aro wft$ tl R nmra apaaa 19 MW" The limits of coverage on this cextifi4ete applies to all jobs and all 1008tiOns— 11fs0ription of operatioau air conditioning contractor CERTIFICATE HOLDER CANCELLATION (305)463-9509 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Mi ami NTL 2nd ill Miami Shore Village E'iI 10060 Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE. WITH THE POLICY PROVISIONS. Miami, rL 33138 AUTHOREO REPRESENTATIVE lErTil00•f4"1 R4 .+V,lrVVillVlt. nnnyuwwav,Tvw. ACORD 25 (9014101) The ACORD name and logo are re®latered marke of AOMD INS085 (2aiaal) Paul Kohler 3055097662 PA CERTIFICATE 4F LIABILITY INSURANCE °A�`"°�°°"�"' 5I19/2Q15 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: H 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. As '11: nt on this certificate does not terrier rights to the certificate holder in Ileu of such endorsement(s). PRODUCER .onstruction Pros Insurance LLC 12054 Curley Street San Antonio FL 33576 CONTACT NAME: PHONE(AIC, No- FXM8QQ 60 0027. ADD EMAIL. ANSI WORDING COVERAGE NJUc o INSURER A I INSURED MONRSER-01 Monroe Service Company LLC DBA Monroe Service Company P O Sox 5451 Key West FL 33045 DNSURERe: (@sm Insurance CompanyQ�-._... INSURER c: -.____..._-....._...._--- INSURER D: -"-- USURER E: INSURER F: MVPDAMPA L:FDTICIf ATN= IMI r AQW12' -4n'7nnwan,c 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 NMICH 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. _ WSR im TYPE OF INSURANCE DL.SUBR glyD, POLICY NUMBER EPP POLIN:YLICY PO umm G"rf t GENERAL LIABRnY EACH OCCURRENCE 5 COMMERCIAL GENERAL LIASIUTY � b—ARVAUE TO 11 PREMISES Meo me 5 _ MED EXP (Arty Orme emon) 6 CLAtMs-MADE ❑ OCCUR PERSONAL&MWINIJURY 1 $_— i GENERALAGGREGATE Is _– PRODUCTS_COMP/0PAGG _S _ GEN'LAGGREGATEUMITAPPLIESPEFc $ POLICY El LOC 8 AUTOMOMLE UABIUTY WPP1210267-00 1013112014 1013112015 derd $500,000 SOMILY INJURY (Par person) S ANY AUTO BODILY INJURY (Per acddsm S ALL OWNED xAUTSCHEDULED HIRED�AUT05 AUTOS pO - �E ! PROPERTY DM?AN S S j tWB GR r t A [IAM HCLM"ADE OCCUR EACH OCCURRENCE S AGGREGATE $ EXCESS LIAR Darn , 1 RETENTNON a S j f A WORKERS COMPENSATION AND EMPLOYERS LIABOXY ANY PROPRIETORIPARTNERlEIfECUTN+E YJN ET IOFFICFANMCER EXCLUDED? F-� (Mandatory B NH) NTA TVVC3436153 9/2014 Oil9!2015 X WC STATIN- E.L.PAM ACCIDENT 5100,000 E.L. DISEASE -EA EMPLOYEE 8100,000 E.L DISEASE - POLICY UktlT $500000 i DIS RIPTIOa OFF { DI=SCR�nON OF OPERATIONS b81ow DI'-ACW PTION OF OPERAMONS I LOCATIONS! VEIUCLES (Attach ACOIW IOS,Adffllonel Rouser** Sdredula, If nl*ro speee lsr"ulrsd) Please review named insured's policies referenced in this document for complete list of all applicable coverage's, limits, endorsements, exclusions, deductibles, and their respective terms and conditions they contain. HVAC Contractor State Ucense # CACO 50394 r_F17TIF1r1A1rC Un1 111C0 rdlUr_FI 1 amnw Q798$-2UIDACORI7(.pliF'tiF1A11VP1. nrrrlSrnsreservv ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA71ON DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Sures village 10050 N E 2nd Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores FL 33138 AUTHOPJ=n REPRESENTATIVE G"rf t Q798$-2UIDACORI7(.pliF'tiF1A11VP1. nrrrlSrnsreservv ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD