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MC-15-1670 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-238361 Permit Number: MC-7-15-1670 Scheduled Inspection Date: July 08, 2015 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: LONG, KRISTINA Work Classification: A/C Replacement Job Address: 14 NE 108 Street Miami Shores, FL 33161-7036 Phone Number Parcel Number 1121360110070 Project: <NONE> Contractor: CHANIN MECHANICAL Phone: (305)865-1729 Building Department Comments REPLACEMENT OF EXISTING 3 TON SPLIT SYSTEM. Infractio Passed Comments REPLACE EXISTING UNIT WITH RUUD SPLIT SYSTEM INSPECTOR COMMENTS False 3.0 TON WITH 8 KW HEATER Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. July 07, 2015 For Inspections please call: (305)762-4949 Page 39 of 52 Rfs y� Miami Shores Village P01M4 Type M@Cfl8 I Residential ou F 10050 N.E.2nd Avenue NE ,WOl teSSi#eet[?t7. `: wlt1tont - 'Per Miami Shores,FL 33138-0000Mit !T!ltS"SAFMOV' E Phone: (305)795-2204 pNr—VQ Issue Da 1/7124,16 Expiration: 0110312016 Project Address Parcel Number Applicant 14 NE 108 Street 1121360110070 Miami Shores, FL 33161-7036 Block: Lot: KRISTINA LONG Owner is-, rmation Address Phone Cell KRISTINA LONG 14 NE 108 Street MIAMI SHORES FL 33161-7035 NwWV„ , — :d+.'�JY ';i5: '�Ss4k:?4Ya P�1'da�.a'�4�.�i>i...�,B laRR33«fcn`.: -- :mr,—s.,.1 1•Y..c. ,::'l,£X\I, . 14 NE 108 Street MIAMI SHORES Fl_ '3161-7035 Contractor(s) Phone Cell Phone Valuation: $ 3,640.00 CHANIN MECHANICAL (305)865-1729 E Total Sq Feet: 0 Tons.S —Y Available Inspections: Additional Info: REPLACEMENT OF EXISTING 3 TON SPLIT Inspection Type: Classification: Residential Final Approved: In Review Review Mechanical Comments: Date Approves In Review Date Denied: Type of Wc' rk Scanning:3 Fees Due Amount Pay Date Pa fir:= Amt Paid Amt Due r CCF $2.40 MIC Invoice# t��L- �`-56221 DBPR Fee $2.00 07/07/2015 Chc,,k. ^,692 $ 96.80 $50.00 DCA Fee $2.00 Education Surcharge $0.80 07/06/2015 Che,', '585 $ 50.00 $0.00 Permit Fee $127.40 I Scanning Fee $9.00 Technology Fee $3.20 Total: $146.80 In consideration of the issuance to me of this perm t, I agree to perform t" work covered hereunder in comph ince with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the prover authorities of Miami Shores Village. In accepting this permit I assume responsibility for all \,iork done ", "` r agent, servants, or employes I understand that separate permits are requirea for ELECTRICAL, PLUMBING, MECHANICA'_,WINDOWS. DOnRc GOOFING and SWIMMING POOL wor'K. OWNERS AFFIDAVIT: I certify that all the foregoing information is arc,,-rE : id that all work will be done in compliance with all applicable laws regulating construction o ling. Futhermo I authorize the above-named contrac{e `.o do the work stated. July 07, 2015 A th rized Signature:Owner / A plicarit / Contractor ;'gent Date Building Department Copy July 07, 2015 1 s� Miami Shores VillagerFA � ��L"� Building Department JUL 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY._ Tel: (305)795-2204 Fax: (305)756-8972 INSPECTION LINE PHONE NUMBER: (305)762-4949 FBC 20(`1 BUILDING Master Permit No. �� PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS i JOB ADDRESS: f City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: ��' ��.3Co ���'Op�l� Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: 1 OWNER: Name(Fee Simple /Titleholder): K,ei-S'>��,� LcJ/�/ Phone#: �aS '58'8f-93/3 Address: �� /��" fd g �T City: A/A71W/ 2Zf101te-T State: Zip: Tenant/Lessee Name: Phone#: Email: /L/ CONTRACTOR:Company Name: Phone#: 3�5 '� S 72- Address: /9& -71e City: /'%!# l-fI /V2 4 WC'��` State: /�O�C/iS�4 Zir): Qualifier Name: U/i{�ln,l � Phone#: 3,05 965 • /7,2 9 State Certification or Registration#:-Cl- ea Certificate of Competency#: DESIGNER:Architect/Engineer Phone#: Address: K K-� City: State: Zip: Value of Work for this Perit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ Newij- air/Re lace p p ❑ Demolition Description of Work: 'R �f���� iSyir✓G Gl�v i T�-f �uUD sPI f" S'y�T�=r"! Specify color of color thru tile: Submittal Fee$ �O Permit Fee$ j �2--1 I Leo CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ L/ v (Revised02/24/2014) w , Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) i Mortgage Lender's Address 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 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 f inspection will not be approved and a reinspection fee will be charged. , i Signature Sig OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument wa acknowledged before me this day of TUIL, ,20 , by _ day of Jl L 20 by who is personally known to t)r'C•U)L-44a A who is personally known_to me or who has produced Dy'fyQ1 L—t as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sig a.. ZL Print: IVICA✓I b Print: l� Seal: MARIO MARRERO MY COMMISSION#EE169630 Seal: ;� Y MARIO MARRERO •1�� EXPIRES March 24,2018 my COMMISSION#EE169830 EXPIRES March 24,2016 (407)39&0163 Floridallo SerNoe.ot>tn 1 FlwidallotarySsrvfos.00m 4{ APPROVED BY fans Examiner Zoning s 1 Structural Review Clerk (Revised02/24/2014) I ` ,5NoRFs Miami Shores Village y� Building Department sell _ NIMBI 10050 N.E.2nd Avenue L ` Miami Shores, Florida 33138 FLOR 0 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. L _ Job Address(where the work is being done): "Lf l�(S tf 3 City: Miami Shores Village County: Miami Dade Zip Code: x i 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❑ N014 ARHI Sheet Attached:YES ] NO ❑ Contract Attached:YES [� UNIT BEING REPLACED DATA NEW UNIT vv MANUFACTURER -11:7 ION%) r , I AHU or PKG. UNIT MODEL# 3 t­�t5k^v' _Y"' IZ MA -0'S 6 -57Az_ COND. UNIT MODEL# 3(a -5- 1 u- KW HEAT mug NOM TONS AHU O CU 215- PKG 1) M.C.A AHU CU SPKG AHUS;OCLAW PKG1110 2) M.O.P AHU CU Z10 PKG AHU CU PKG 3)VOLTS AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER YES I NO REPLACING DUCTS YES N { YES NO REPLACING THERMOSTAT YES N YES NO NEW 4"CONCRETE SLAB YES NO f YES NO JNEW ROOF STAND YES YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity(Wire Size): TJvor 4* (o ALA) � C7��Q-r� (o /4W (� r � 2. Maximum Overcurrent Protection (Fuse/Breaker Size): S oor oq gcb� ��c ls D 3. Voltage of Circuit (208/240/480): 0 9 L3,0 4. Size Disconnecting Means: T,tJOoC r 3 .) d" r Contractor's Company Name: G°G�f�/�///y /yEL'fff��//�/ Phone: v 9,55172 State Certificate or o. L ac O5- Z Certificate of Competency No. Signat a Date: \ k,.e" Quali i signature) (Revised02/24/2014) ® This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service nu CERTI between Feb 17, 2009 and Dec 31, 2014. C 'f'ca'e of ' ' 4W erti i LPla- tin s AHRI Certified Reference Number: 7942207 Date: 7/6/2015 Product: Split System: Air-Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: RA1636AJ1 Indoor Unit Model Number: RH1T3617STAN Manufacturer: RHEEM SALES COMPANY, INC. Trade/Brand name: RHEEM; RUUD Region: Region Note: Central air conditioners manufactured prior to January 1, 2015, are eligible to be installed in all regions until June 30, 2016. Beginning July 1,2016, central air conditioners can only be installed in region(s)for which they meet the regional efficiency requirement. Series name: Manufacturer responsible for the rating of this system combination is RHEEM SALES COMPANY, 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`testielling Capacity(Btuh): 35400* EER Rating (Cooling): 13.00' SEER Rating (Cooling): 16.00* 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.ahridirectory.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, AM 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 ski,lice tx>tte3'" 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. - - ©2014 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 13080662716005999 i SATE 1.1('rySE13 AND tSS1:REi) PH:305465.1729 CA('�sti6,r•�2 FAX:305444.13M 1%5 71s.STRUT M1A.11 BEACH,FL 33141 TuwAAA&AI LC Air "W A$ CON&VOt.fr i AWALt,Arl0or DATE:Juste 25,201,5 We'the firm of Chanin Mechanical, l...0", ro e mditi'Ming and heating systeta for: Kris Lott to to furnish+install and service the Air Job located at: 14 Ne lel Street- iana��•� _ In accordance with following luridconditions and specifications: EQUIP Hoon #l: Rudd— S lit S `stern - 3.0 \� ¢- Qty 11 j Cord 'using Unit -Model#12A l b36j4,d 1��n —Seer li Air Handier Unit-•Nocfel#RH333b ?S'TA:�7JA With$KW Heater - —" -- elan #2; farrier-- S lit S stertl —3.0 Tont -- i Qry III Cos iensiag Ua�t -M+�lel'N CA16N jO360®G Seer 16 Qh'iti Air Handler Unit.Moder#F1'4CNF003L00 With 8 KW Heater LOCATION OF jEQUIPMENT '-To be iasatalle,d ora exb ing return air box 02-Air Hstodtsr tobe closet installed on a new air handier stand with ducted return Condensing Unit to installed can existing foundation PIPING: Wil!tie to exis i"Freon lines and drain lines WTRING: '� yW�f1"triby � e+to existing high and lvw voltage wiring Qty II I Condensate Overflow Safety Switch DUCTWORK: Will tie to existing duct work with fiberglass hoard Icsitistls: t�� RESPONS1811,ITY: as indicated willmum., the Njowl## asci M Dei;very,uncrating.awmbly;and truing: MOWER!SELLLrtt FAalpetwat Ecmudtation:as d+rwrit*d): I X Duct/Work(as destribtd): �PPIY&Return out" lUdeg Er'icati�r' t: Wiring to Building Panei: E7Kimlg Wiring Existing Dbmaxwet; Bzwag Wiring of Air Co"tja CoatM X S Cutting concrete Nom: N/A Rtecoratti ,Patsting and Mjww Patcbiasg; Piping(as described): X X La"I Perm'"And Lice09ft: Please See dote Last Pages X i'0welNueots:Drain tin" Mis+c+eilarkaus: RoMi Stand t:xls# N/A MiseellOneous; Structural Stets to receive rOOf curbs or roof star& N/A Miseeilaaeous: Duet Smoke Detectors NtA M100'ellstneous:Fire Dampers/Fire Smoke Dampers,wbtre shown on tis. N/AMlrcatlttUCOUs:Tait and $alar"Report MtseeMMeons:Fire Stopping NIA X initittiai: i Our work codes:� �in � rite most tv namaser and in co�uyrhonce wide tos regulations. . l 'mit WARRAN-rV AND SERVICE: I. pts i insUass ARS'our q `lirep ntativ start sad tem fire t rise oft eq eQ�Dtent sad also r 2. AU eq� at,aD,rteri�and labor i wUrraaty oar rlre date of iostai t u,&raisbW by"Main �.4C„wiq bear a ose ys+ar Mnna�tterWs warranties ai is+wurlrrrr��atkl aaeaetiry, �`� ft�ht Pfd.u are limited �1'�er�a►�6 #m rise naf tnrers las ' ""es'W"t Wa4aeat or parts, k stye&'+Nabie to Y and w l be aapp# installation' . C op�yr°t the m�ufneturer's rrfentier 3. We rrili ptwv service a of the' l PON i 'i tbie vwa airwnty service not iaciudae Maj dy during on normal working iNmrs. ► mac# AS filters,Marta or&W re'paemeet. i GMRAL: 1. Drerihrg #lou we w'"t"t aif dasaw to property. premutio.to PrOft t all persons and a►avoid x- to ft"M We V""trot be i�iatiie fer" is tree event of deojftrgLelivery ar iastalitetion dela 3. Tltle to Ito tit�s�qp ,r t �+"t'�aredue with Chas'.Mechanical,L.C.,natii ON arses due to Chaain Mrcigtnicwl L.C.,have been 4, h Y naderaood that thisPMPW44 setsuar entire Mathaateal,L.C.,as ani agreement and is entered into bar Ciaaia '�. 'I`hbr gropo,ral*44 bftame +went party sad not as an agent oftbr maanf achtrera. a reset between Cbanira Mechanical.L.C.,if accepted by You, and then lftr approves[to writing by our dn#y authorized representative 4- The prQVMW WW be Coaskk4vd valid ontil. 7, In the event of defames of say terra or conditions of this con I right to take Immediate iOR Of the equipment. tract,SELLER alrall bare tine ` SELLER w131 retaia# tti ribs It�agreed three the � turd i!'settkse►etet it Dot made as grreed she SELLER shall have tine 6t to remove 1. lueygteat is tre,sde, tbt SELLER wllt be iNdd harmless for any damaromge a same and fru event'fire AM amount of the purchase price s become dere and Payremova!le fO thereof. ith. A acrd sill a nt l�shall be retaiaed by the SELLER as liquidated damages and bsot as Any � Penalty: Initials: ofpumbuvr,, $few,,rowo%&Mo A"wwy"s hu* t A gw^w dwV of 1_112% per swath WV be*pp*d it SAW sbmk 00 6e g" f��rr ons.0006.OM of Ged.or Y w� o �.at ill yr et"t#MM„ SAM �" Ids"a"st torr I ob C"baNc+� + �&"h+e t eft dm stow awwvoi at � �C�w►te+rd At�ta� ._ j LAW Uftso Tow U7w" 'U ate 1�ad !Am*wiN et°'d Mach"heaL+C ACCEPTANCE d,�d�7r.R y t a�q o ppa'd' '� Y b��4DvAL is dby . U#"!` 1 Property Search Application - Miami-Dade County Page 1 of 4 1 4 Address Owner Name Folio SEARCH: 14 ne 108 street Suite Q Print Results EXACT MATCH NOT FOUND FOR SEARCH CRITERIA ENTERED. 1 POSSIBLE MATCH [ES) ARE LISTED BELOW. Click on the Folio number to view property details. FOLIO: 11-2136-011-0070 1 SUB-DIVISION: DUNNINGS MIAMI SHORES EXT NO 7 OWNER: KRISTINA LONG ADDRESS: 14 NE 108 ST MIAMI SHORES 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 http://www.miamidade.gov/info/disclaimer.asp For inquiries and suggestions email us at http://www.miamidade.gov/pa/email/ASP/formNew.asp. Version:2.0.3 EXEMPTIONS B BENEFITS Deployed Military http://www.miamidade.gov/propertysearch/ 7/1/2015 i STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 a�Da� 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 CHANIN, DREW NED CHANIN MECHANICAL LC 6095 NORTH BAY ROAD MIAMI BEACH FL 33140 Congratulations! With this license yoGtiecome one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTNI [ T QF BUSINESS AND and they keep Florida's economy strong. PROfEULATION 0f QR Every day we work to improve the way we do business in order to CAC05629206115/2014 serve you better. For information about our services, please log onto ` k°? www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe CERTIFIED ALIS h ' to department newsletters and learn more about the Department's CHANIN, DR initiatives. CHANIN MECH Our mission at the Department is: License Efficiently, Regulate Fairly. -,v ri We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! Expiration date AUG 31,2016 L1406150000932 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CAC056292 The CLASS AAIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 CHANIN, DREW NED .0 .. . 0 CHANIN MECHANICAL LO 6095 NORTH BAY ROAD, °e MIAMI BEACH FL 33.140. 012610 Local Business Tax Receit Miami-Dade County, State of FloridaLBT —THIS IS NOT A BILL — DO NOT PAY 5894317 4 p BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES CHANIN MECHANICAL LC RENEWAL SEPTEMBER 30, 2015 1965 71 5T 6148373 Must be displayed at place of business MIAMI BEACH FL 33141 Pursuant to County Code Chapter 8A—Art 9&10 SEC.TYPE OF BUSINESS OWNER 196 SPECMECHAN}CAL COl�r RAGTOR PAYMENT RECEIVED CHANIN MECHANICAL LC BY TAX COLLECTOR Worker(s) 9 CAC056292 $45.00 07/1.6/2014 FPPLI11-14-016129 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a certification of the holder's qualifications,to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles—Miami—Dade Code Sec 11a-276. For more information,visit www miamidade oovltaxcollector CERTIFICATE OF LIABILITY INSURANCE DATE(MnyDD/YY Y) 7/6�zo1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. T !S CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POCK ES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORI ED 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 he certificate holder in lieu of such andorsement(s)- PRODUCER NTAC NT Maria )Fisk International Insurance Center, Inc, PHONE 7990 SW 117 Avenue E (305)279-5446 AX E-MAIL No:(305)279-4045 Suite 209 ADDRE maria@i3iI MiFINSU�RED mi' FL 33183 INSURERS AFFORDING COVERAGE NAIC INSURERA WeSCO Insuranca Co 25011 unieal LC INSURERS;Teahnolc insurance Co 42376 3treoCINSURER CINSURER D: FL 33141 INSURER E: COVERAGES +NSU ER P CERTIFICATE NUMBER:2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR DENAMIEOD AI30 BER: THE POLICY PER OD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITVE FORH RESPECT TO WHICH I IIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID HEREIN IS SUBJECT TO ALL THE TER $ L8R TYPEOFINSURANCE R CLAIMS. P LILY NUMBERMY OLICYNUCY YYY X COMMERCIAL GENERAL LIp91LITY LIMITS A CLAIM3_MADE FXJ OCCUR EACH OCCURRENCE S 1,000,000 V 15-2253 ISES Eaoc nce S 100, 00 6/20/2015 6/20/2016 MED EXP Any one person $ 5 00 i GEN'LAGGREGATE LIMIT APPLI55PER: PERSONAL&ADv INJURY $ 1,000, 00 X POLICY 0 JECT 600 GENERAL AGGREGATE 5 2,000, 00 OTHER: PRODUCTS-COMP/OPAGG $ 2,000, 00 AUTOMOSILE LIABILITY S ANY AUTO COME INGLE LIMIWider S 500, 00 ALL ED X SCHEDULED AUTOS 15-225y BODILY INJURY(Par Person) Z X HIRED AUTO$ X NON OWNED 6/20/2015 6/20/2016 BODILY INJURY(Per occident) Z PROPERT DAMAGE Per ecciden S UMBRELLA UAB OCCUR Undetlnsured motodg S 300, 00 EXCESS LIAB CLAIMS_MADE EACH OCCURRENCE $ DED RETENTI N AGGREGATE S WORKERS COMPENSATION AND ElYIPLOYERS'LIp61L1TY $ ANY PROPRIETOR/PARTNFR/EXECUT7VEf Y/N X PTATUTE OTH- OFFICER/MEMBER EXCLUDED? N 7 A R (Mendala In NH) �C1045139 E,L EACH ACODENT Z 1 000 00 If es,de;<rlbg Under 4/25/2015 4/28/2016 DESCRIPTION OF OPERATIONS below E.L.DISEASE-EA EMPLOYE 8 1 009,000 E.L.DISEASE'POLICY LIMIT $ 1 000 00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schepule,may b¢atiaChetl if mospice is fequlrap) License number: CACO 59692 re CERTIFICATE HOLDER CANCELLATION Miami, Shores viljage SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 13EF0 10050 NE 2 Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED ) M1a�ln ShoresVilIzII FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Edward CAbassa/Mp ACORD 25(2014/01) The ACORD name and logo Bra registered marks o ACORD RO CORPORATION. Ali INS02S r2a�ant 1 rights resery d.