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MC-14-2388
Inspection Number: INSP-227531 Q_ C i C (0 - Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Scheduled Inspection Date: May 26, 2015 Inspector: Perez, JanPierre Owner: ATASH, KARIM & METIS CORINA Job Address: 1195 NE 100 Street Miami Shores, FL Project: <NONE> Permit Number: MC -10-14-2388 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number (305)790-5551 Parcel Number 1132050190360 Contractor: CUSTOM AIR DESIGNS Phone: (954)785-9128 Building Department Comments INSTALL GEOTHERMAL HEAT PUMP AC SYSTEM 5 TON Infractio Passed UNIT I INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-222553. need unit spec, permit for ductwork, framing completed, and access for a/c unit Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid n F May 22, 2016 For Inspections please call: (305)762-4949 Page 3 of 42 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 FBC 201 BUILDING Master Permit No.., 2«/� PERMIT APPLICATION sub Permit No. jy-09.3etT - ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING M MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1195 NE 100 ST City: Miami Shores County Miami Dade Zig• 33138 Folio/Parcel#: 11 -3205-019-0360 Is the Building Historically Designated: Yes NO Occupancy Type: Primary Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Karim Atash Phone#: (305) 790-5551 Address- 1195 NE 100 Street City: Miami Shores State: Florida 33138 Tenant/Lessee Name: Phone#: Email: Karimatash@gmail.com CONTRACTOR: Company Name: Custom Air Designs Phone#: 9545591793 / (954) 785-9128 Address: 1246 SW 6th Street City: Pompano Beach state: Florida Zip: 33069 Qualifier Name: Samuel Block Phone#: (954) 785-9128 State Certification or Registration M CAC033562 Certificate of Competency #: Type A Mechanical DESIGNER: Architect/Engineer: Phone#: Add Value of Work for this Permit: City: State: 1?— 470W,68 Square/Linear Footage of Work: Zip: Type of Work: ❑ Addition ❑ Alteration �4 New ❑ Repair/Replace ❑ Demolition Description of Work: Install Geothermal Heat Pump AC System - 5 Ton Specify color of color thru the Submittal Fee $ ,, 6 a0 Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) hL CCF $ CO/CC $ DBPR $ 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 Zip 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 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 OWNER or AGENT The foregoing instrument was acknowledged before me this .1919 day of 20 by KA490 k . who is personally known to me or who has produced L V -e42 )-rc-At'LS C as identification and who did take an oath. NOTARY PUBLIC: SI Signatur CONTRACTOR The foregoing instrument was acknowledged before me this day of ®'1_ �.20/ , by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign Print: Seal: 'e::S. Ili WRTINEZ Seal: * MY COMMISSION i EE 224401 p EXPIRES: September 8, 2016 ''Fosro11O d%8od0 yS mim APPROVED BY/lla Examiner a Structural Review (Revised02/24/2014) JASMINE RHONDIA HIGHTOWER MYCOMMISSION #FF10019/ EXPIRES March 10, 2018 Zoning 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): 1195 N E 100 Street City: Miami Shores Village County: Miami Dade Zip Code: 33138 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 01 NO ❑ ARHI Sheet Attached: YES M NO ❑ Contract Attached: YES 0 1. Minimum Circuit Ampacity (Wire Size): 36 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 60 3. Voltage of Circuit (208/240/480): 240 4. Size Disconnecting Means: t�3D �3 "�St / d_0u4A/e P_,T— Contractoes Company Name: Custom Air Designs Phone: 954 559 1793 /954 785 9128 State Certificate or Registration Signatu (Qualifiers signature) (Revised02/24/2014) of Competency No. Type A Mechanical Date: �4 UNIT BEING REPLACED DATA NEW UNIT RHEEM MANUFACTURER DUAL AIR AHU or PKG. UNIT MODEL # CFX-M 6® �- COND. UNIT MODEL # N/A i D KW HEAT 500M BTU NOM TONS 5 TONS 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 AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER 27 EER YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): 36 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 60 3. Voltage of Circuit (208/240/480): 240 4. Size Disconnecting Means: t�3D �3 "�St / d_0u4A/e P_,T— Contractoes Company Name: Custom Air Designs Phone: 954 559 1793 /954 785 9128 State Certificate or Registration Signatu (Qualifiers signature) (Revised02/24/2014) of Competency No. Type A Mechanical Date: �4 AHRI Certified Reference Number: 4547269 Date: 1/24/2013 tStatus: Active Product: WaterBrine to Air Heat Pump Packaged Unit Model Number: CFX048 Manufacturer: COLDFLO INC. Trade/Brand name: DUAL AIR Rated as follows in accordance with ANSVAHRVASHRAEASO Standard 13256-1 for Water -to -Air and Brine -To -Air Hest Pumps and subject to verification of rating accuracy by AHRk!:�ponsored, independent, third party testing: Cooling Air Flow Rate: 1600.0 Heating Air Flow Rate: 1600.0 WLHP (Water -Loop Heat Pumps) Full Load Cooling Capacity(Btuh) 51000 Cooling EER Rating(Btuh/watt) Cooling Fluid Flow Rate(gpm) 18.00 12.00 Heating Capacity(Btuh) 58000 Heating COP(wattilwatt) 5.00 Heating Fluid Flow Rate(gpm) 12.00 GWHP(Ground-Water Heat Pumps) Cooling Capacfty(Btuh) 57000 Cooling EER Rating(Btuh/watt) Cooling Fluid Flow late(gpm) 27.00 12.00 Heating Capacity(Btuh) 50000 Heating COP(watVwatt) 4.30 Heating Fluid Flow Rate(gpm) 12.00 GLHP (Ground -Loop Heat Pumps) CoolinCooling LEER 53000 Rating(Bt)uhANatt) 20.00 Cooling Fluid Flow Rate(gpm) 12.00 Heating Capacity(Btuh) 39000 Heating COP(watt/watt) 3.60 Heating Fluid Flow Rate(gpm) 12.00 t Models with an'Active' status are those that are currently in production. Models with a 'Disk wdnued' smtus are those that the manufacturer has elected to stop producing, yet stock Is still available. Models with an'Obsolete'status are those that the manufacturer is required to stop manufacturing due to an AHRI certification program test failure. ' Ratings followed by an asterisk (*) Indicate a voluntary rerate. of previously published data, unless accomparded with a WAS, which Indicates an involuntary rerate. DISCLAIMER AHRI caves not endorse the product(s) Rated on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) Iced on this Certificate. AHW expressly dischims all liability for damages of any kind arising out of the we or perfom erne of the product(s), or the unauthorized situation of data listed on this Certificate. Certified ratings are valid only for models and configurations listed N the dhectory atwwwahrbdirectory org. TERMS AND CONDITIONS This Certificate and Its coMerhls are proprietary products of AHRI. This Certificate shall only be used forindlvlsuaL personal arW confidential reference purposes. The contents of this Certificate may not In whole or in part, be reproduced; copled; disseminated; entered Into a computer database; or otherwise utilized, in any form or manner or by any mom, except fw the user's indbvkdual, iressonai and confidential ref once. CERTIFICATE VERIFICATION The Information for the model cued on tis cerlifkcate can bre verified at www.ahrbdirectoryorg, V � A] Conditioning, Heating, eikk on " Nerifp Certificate" link and enter the AHRd Ceditd Reference Nwnber and the `late on and Refrigeration Institute which the certificate was issued, which Is listed above, and the Certificate No,, Is Rated ad below. 02012 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 131h M195w5los31 KARIM ATASH 1195 Northeast 100th Street Miami Shores, FL 33138 305.790.5551 Description of the work to be performed: • SunAir will install one 5 Ton Ultra Efficient Heat Pump Systems a. Dual Air- 57,000 BTU Ton R410A - 27.00 EER (32.4__SEEIB) • Includes one (1) digital programmable thermostat. • Two (2) well (supply & return water), Installation 1. hp irrigation pump. • All work will be done per Florida Code- In conjunction with C.A.D. CAC033562 Permits Fees Included. for City Wells & State Wells • SunAir will perform comnlete start un. laser review of existing ducts and system cheer. no Jim Theckston 954-456-2274 Jim@SLInAirGS.com Terms and conditions: (Client Signature) (Management Signature) Final Payme' nt ' M=s due upon Ygrene Funding, For credit card payments there will be a fee charged of 3.6% Only includes what is described and specified above. Proposal is valid for 10 days from date stated above. SunAir Cooling/Custom Air Designs CAC033562 is not responsible for any existing electrical, ceiling or wall repairs. SunAir Cooling/American Service Air Conditioning is not responsible for any existing violations. Any electrical upgrades can be performed at an extra charge. t SYSTEM & INSTALLATION: - ,_ : , • 1 r y 1, 1, PROJECT�t FEDERAL REBATE:AC System. R11 TOTALPRICE a 30% REBATES: MR. no Jim Theckston 954-456-2274 Jim@SLInAirGS.com Terms and conditions: (Client Signature) (Management Signature) Final Payme' nt ' M=s due upon Ygrene Funding, For credit card payments there will be a fee charged of 3.6% Only includes what is described and specified above. Proposal is valid for 10 days from date stated above. SunAir Cooling/Custom Air Designs CAC033562 is not responsible for any existing electrical, ceiling or wall repairs. SunAir Cooling/American Service Air Conditioning is not responsible for any existing violations. Any electrical upgrades can be performed at an extra charge. t UNIT SPECIFICATION DATA SHEET UNIT MODEL - CFX048 V AS -N-4 High Efflclency Indoor Water -Source Heat Pump Unit FEATURE INFORMATION CONFIGURATION CABINET DRAIN PAN CONTROL & SAFETY BLOWERIS REF. CIRCUIT/$ COND. COIL EVAP. COIL REFRIGERANT CERTIFIED- : CIP®lig! C-us Vertical Unit - Stainless Steel, Insulated Evap Section, Access Panels Stainless Steel, Insulated. Overload Protection, Intelligent Automatic Reset Solid State Lockout Circuit -HPS, LIPS, Condensate Switch, LPS By -Pass Timer Freeastat in A Geo -Thermo Unit, HI/Lo Voltage Protection, Anti Short Cycle, Random Start Delay Centrifugal Galvanized Wheel/s, X13 ECM Motor Thermal Expansion Valve/s, Filter Drier/s, Sight Glass/es, Coaxial Cupronickel Heat Exchanger - & Steel Jacket, Copper tubes, Aluminum Fins R-41 0A UNIT PERFORMANCE EVAP. COOLING CAPACITY. BhuIHr EER HEATING CAP. - BWHr (HEAT PUMP MODE) C.O.P (HEAT -PUMP MODE) ENTERING WATER TEMP. Cooling/Heating. F WATER FLOW - GPM AIR VOLUME - CFM COIL FACE VELOCITY - FPM COIL ENT. AIR TEMP. - OF BLOWERIS SIZE & QTY EVAP. FAN MOTOR - HP & QTY NO. OF CIRCUITS I CAPACITY STEPS COMPRESSORIS TYPE & QTY VOLTAGE RATING MIN AMP. / MAX FUSE- AMPS DIMENSIONS L"xW zH" Water Loop Ground Water Ground Loop' 51,000 57,000 53,000 18.0 27.0 20.0 58,000 50,000 39,000 5.0 4.3 3.6 86/68 59/50 77/32 12.0 12.0 12.0 1,600 288 Cooling DB/WB: 80.60F/66.20F Heating: 68°F 10'x10' x 1 3/4 x 1 FLA(EA)= 6.0 Scroll x 1 208-230/1/60 36/60 26x24x43 Notes: 1. Unit Is subject to change without notice. 2. Unit is available in various configurations. & Performance ratings are based on ARUISO standard conditions 4. For ratings with conditions other than standard consult Coldfio Inc. & Ground Water and Ground Loop units have to be defined as such when order is placed. With antifreeze RLA(EA)= 24.3 LRA(EA)= 117.0 OFFICE 0F THE PROPERTY APPRAISth Summary Report Property Information Folio: 11-3205-019-0360 Property Address: Owner Mailing Address Primary Zone 1195 NE 100 ST KARIM ATASH METIS CORINA ATASH 1195 NE 100 ST MIAMI SHORES, FL 33138 1400 SGL FAMILY - 3001-3250 SQ 0101 RESIDENTIAL -SINGLE FAMILY: 1 UNIT Primary Land Use Beds / Baths / Half 3/2/0 Floors 1 Living Units 1 Actual Area 2,220 Sq.Ft Living Area 2,220 Sq.Ft Adjusted Area 2,220 Sq.Ft Lot Size 11,513.26 Sq.Ft Year Built 1953 Assessment Information Year Land Value Building Value XF Value Market Value Assessed Value 2014 2013 2012 $311,105 $209,902 $200,156 $153,025 $154,279 $177,613 $0 $0 $0 $464,130 $364,181 $377,769 $400,599 $364,181 $217,545 Benefits Information Previous Benefit Type 2014 2013 2012 Save Our Homes Cap Assessment Reduction $160,224 Non -Homestead Cap Assessment Reduction $63,531 Homestead Exemption $25,000 Second Homestead Exemption $25,000 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description MIAMI SHORES SEC 8 REV PB 43-67 LOT 15 LESS E5FT BLK 177 LOT SIZE IRREGULAR COC 24706-4099 07 2006 5 Generated On: 10/23/2014 Taxable Value Information Previous OR Book - Sale 20141 20131 2012 County 29279-2352 Qual by exam of deed Corrective, tax or QCD; min 07/18/2013 Exemption Value 1$0 $0 $50,000 Taxable Value 07/012006 $400,599 $364,181 $167,545 School Board Exemption Value $0 $0 $25,000 Taxable Value $464,130 _$364,1811 $192,545 City Exemption Value $0 $0 $50,000 Taxable Value $400,599 $364,181 $167,545 Regional Exemption Value $0 $0 $50,000 Taxable Value $400,5991 $364,181 $167,545 Sales Information Previous OR Book - Sale Price Page Qualification Description 08/202014 $515,000 29279-2352 Qual by exam of deed Corrective, tax or QCD; min 07/18/2013 $100 28737-4350 consideration Qual by exam of deed 07/012006 $0 24706-4099 The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at hftp://www.miamidade.gov/info/disclaimer.asp Version 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. COPY OF QUALIFIER'S STATE LICENCES B. 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 Affidavit) 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 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 Affidavit) *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: CUSTOM AIR DESIGNS BUSINESS ADDRESS: 1246 SW 6TH STREET CITY POMPANO STATE FL zIP33039 BUSINESS PHONE:9( 54 ) `+ss 2274 i ssa �s5 s�2s FAX NUMBER8(7 538 8635 CELL PHONE (-954 ) 55M 193 1 tom) 26"311 QUALIFIER'S NAME: Samuel Block QUALIFIER'S LIC NUMBER: CAC033562 RICK SCOTT, GOVERNOR S"R'f QF. 0,pLOIDA DEPAK!C(Wit mC'�'Ido,N{20AM µ,. The CLASS AAIR COIWDITIONING COId , Named below IS CERTIFIED , Under the.provlsions of Chapter 489 FS Expiration date: AUG 31, 2016 v 1 KEN LAWSON, SECRETARY AL115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2014 THROUGH SEPTEMBER 30, 2015 DBA: Business Name: CUSTOM AIR DESIGNS Owner Name: SAWAL A BLOCK Business Location: 1246 SW 6 ST POMPANO BEACH Business Phone: 954-565-8335 Rooms seats, Number of Machines: Tax Amount Transfer Fee NSF Fee 27.00 0.00 0 Receipt #:�TING%AIRCONDITION CONTRACZ Business Type:(AIRCONDITION CONTRACTR) Business Opened:11/01/2004 State/Cou my/CerUReg : CAC 0 3 3 5 6 2 Exemption Code: Employees 10 Penalty ..0.; Machines Professionals Prior Years I Collection Cost Total Paid 0.00 0.001 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 u 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: SAMUAL A BLOCK Receipt #032-13-00002388 1246 SW 6 ST POMPANO BEACH, FL 33069 Paid 09/24/2014 27.00 2014 -2015 CUST030 I OP ID: CO CRS t!4 -' CERTIFICATE OF LIABILITY INSURANCE1 1 TE (MMIOCIWYY) 1 90/2S12o74 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 B`U THE POUCIESi BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the csrCfiicate holder is an ADDITIONAL INSURED,, the pollcy(les) must be andomed. If SUBROGATION IS W�JVED, subject to the tons and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the eertificatt¢ holder in lieu of such endomement(s)_ ` PRODUDERNAME- SIHLE INSURANCE GROUP, INC, P. 0• BOX 160396 NTACT Ca88 Femandex PHONE LAM, No. mm:407-M-0962 #07-774-0930 5- L DRESr, casoy@ddmpr.com INSURER(8) AFFORDING COMPAGE I NAIC 6 ALTAMONTE SPRINGS, FL 32716 Casey Fernandez INSURERA:111SUMnCe CO. of the West 27847 i INSURED : Custom Air Design 1246 SW 8th St- INSUMMB: I Pompano Seach, Fl- 33069 INs1AiBRc: COMrAERCIALGMERALI(ABILITY CLAIM&AIADE 17 OCCUR INSURER O : INSURER E : I INSURER F , COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 1 THIS I$ TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TAE POLICY PERIOD INDICATED. NOTWlTHSTANDiNG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESP6�T TO.IAMICH 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 $HOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I 1117 TYPE OF INSURANCE I 10060 NE 2nd Avenue POLICY NUMBER M Jay MCP mm UMLIGY MrfS GENERAL LIABILITY i F-ACH OCCURRENCE $ -- COMrAERCIALGMERALI(ABILITY CLAIM&AIADE 17 OCCUR I I =AGE TO RENTE7 PREMISES Ea $ MEDEXP(Anyo1e•per8on) 8 PERSONAL&ADVINJURY E I GENERAL AGGREGATE $ ' GE'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO $ POLICY 7 PRO LOC g I AUTOMOBILE LIA81LITY i COMBINED SINGLE LIMfflaIT derm $ BODILY INIURY (P-1 Jw 1 $ ANY AUTO I AUTOSA"OMED SOS n AD nIREDAtmToS ALMOS ED I I 1 I BODILY INJURY (Paraw1tlonqNON-OVVNffi E $ UMBRELLA LIAROCCUR HCLAIM%-MAK EACH OCCURREN ,CE I $ EXCEN LIAR AGGREGATE II $ DED , RETEN ON 9 $ A WORKERS COMPENSA'fmON AND EMPLOYERS LIABILITY' ANY PjU ROPRIElpRlVAKTNP_RIFJCEDLmveYIN OFPIDEWMEMBEREXCLUDEW F tMafiatery In NHI if yyam�,, tl68Pibe under DEiIPYI OF OPERATION$ below NIA L500601803 04=2014 04407,/4016 XY LIrrB TFi E.L. EACHACCI0w S 1iOr� E.L. DISEASE - EA MPLOYE4S 1,000,0 E.1.,• DISEASE - POLICY LIMIT I $ 4,000, • I DESCRIPTION OF OPEAATICNS I LOCATIONS I VEHici-w (Attach AOORD 11T1, A w1uonW Remarlw 9=I..duls, If mora opwo 1-,.y,ked) For mechineal3, work- . i I • I i • i �G i i 14Y 1 C n"L"Lw / A \I^Ml / A"-- 1 CITOMI6 SHOULD ANY OF TI•IE ABOVE DV$CRIBED POLi01E8130 &ANCELLED E19FOR£ City of Miami Shame THE EXPIRATION DATE THEREOF, . NOT= WILL i8E DELIVEREp IN 10060 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. MFd1T11 Shores, ESL 581$8 AUTHORI!DREPRESENTAMYE I i Cyr 1VUUrZU1I) AGUKV GVKPVKATIUN. ACORD 25 (2010405) The ACORD mme and logo are reg' (stared marks of ACORD All nam reservea. I . At+ORD CERTIFICATE OF LIABILITY INSUR>t NCEDATE(INMIDDIYYYY) OV181204 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTVR OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE API Group HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ►"+ Box 934.125 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, y _ OKSIE PEEPLES #A203142 Margate FL 33093 � INSURERS AFFORDING COVERAGE NAIC # IMURED INSURERA; SECURITY NATIONAL INS CO INSURERS: (GRIDIRON INS S & R MECHANICAL CORP INSURER G: DBA CUSTOM AIR DESICtNS INSURER P: 1246 S W 6TH ST POMPANO BEACH FL 33069 INSURER E: SES110MO f'nVFRAr.FS THE POLICIES OF INSURANCE LISTED 81=LDW 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. DMFdiRANCF POLICY NUMBER ECNALEWRN ATDINSR LIMA A GENERAL LUU3IWTY COMUFRCIALtiEN LIABILITY CLAIMS MADE X OCCUR SES110MO 03/1512014 03115/2015 EACH OCOURPENCE $ 1.000 000 DAMAGE To RENTED $loom MEb EXP mie n $ EXCLUDED PERSONAL & ADV INJURY $1,090,000 i GENERPJ. AQPB GATE $ 2.00,000 1 GENLAGGREGATLIMITAR�IES PER PRODUCTS-cOMP/OPAcG $ 2.61M.000. POLICY X. P O GI LOC ' AUTOMOBILE L"LITY ANYAUTO COMBINED SINGLE LIMIT $ (Ea aCGitlen4) ALL OWNED AUTOS SCHEDULEDAUTOS ODILa INJURY BODILY (PwI HIRED AUTOS NON -OWNED AUTOS BODILY INJURY 8 (Per exideM) w - , I PROPERTY DAMAGE g (Per ac�ideM) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT 5 OTHERTHAN EAACC $ AUTO ONLY: AGO S ANs'AUTO B EXCE8NUMBRELLALIABILITY X OCCUR CLAIMSMADE RX3LWOR00113600 I 03/1812014 03/1612016 EACH OCCURRENCE $ 110001-000 .AGGGREGATE. i,000.000 PRODUCTS/CO $1,000,000 DEDUCTIBLE 4 $ $ RETENTION S E WDR14m C066PENSATIOw AND WC, STATL DTH E.L. EACH ACCIDENT `' i EMPLOYEERW LIABILITY ANY PROPRIE!'ORMARTNERIEXECUTIVE OFFIOERNWBER EXCLUDED? I E.L. DISEASE - FA EMPLOYEE $ E.L. DISEASE - POLICY LIMB $ Oweddambe•u v SP below OTHER' DESCRIPMON OF ©AERATIONS l LOCATIONS l VEHICI-SSI EXCLUSIONS AD= BY ENDORSEMENT f SPECIAL PROVISIONS AIR CONDITIONING CONTRACTOR E HOLDER GANUCLLA I lVf4 SHOULD ANY OF THE ABOVE DESCRIED POLICIES BE CANCIELLED NFORE THE EXPIRATION CITY OF MIAMI SHORES DATE THEREOF, THE MU1NG INSURER WILL ENDEAVOR TO MAIL 30 DAYS wmrr SV 10050 NE 2ND AVENUE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LES=T, BUT FAILURE TO DO SO SHALL IMPOSE NO" DLIGAT19N OR UABILITY OF ANY)*13 UPON THE INSURER, ITS AGENTS OR MIAMI SHORES, FL 33138