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MC-13-1026
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-191236 Permit Number: MC-5-13-1026 Scheduled Inspection Date: October 21, 2013 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: POLLEY, RUTH Work Classification: A/C Replacement Job Address:935 NE 95 Street Miami Shores, FL 33138- Phone Number Parcel Number 1132060143110 Project: <NONE> Contractor: BIMINI BREEZE HVAC INC Phone: (305)968-4205 Building Department Comments INSTALL DUCT WORK AND 4.5 TON Infractio Passed Comments INSPECTOR COMMENTS False V� D Inspector Comments Passed �a Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 21,2013 For Inspections please call: (305)762-4949 Page 3 of 29 0 Pb E 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 No. W-1 PERMIT APPLICATION Master Permit Not 0 12.- I fAD FBC 2010 Permit Type: MECHANICAL OWNER:Name(Fee SimpleTitleholder): r,-- 759-3Y7� r � hone#:_3o Address: City: M1 O State: �'�� c� a Zip: Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: 93 City: Miami Shores County: Miami Dade Zip: R, /A 9 Folio/Parcel#• O —" — ;5//0 Is the Building Historically Designated:Yes NO _ Flood Zone: I�O CONTRACTOR:Company Name: 4?kt ' [I*C..,�n CPhone#: S � Address: `70to /� 5 t f t�� f City: State Zip: 3 3 O/T " Qualifier Name: ,� Phone#: State Certification or Registration#: ��L/9163 9- Certificate,of Competency#, Contact Phone#: ��EEmail Address: " DESIGNER:Architect/Engineer: Phone#: . Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ONew ❑Repair/Replace ODemolition Description of Work: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ .z Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) 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 ELECTRICAL WORK,PLUMBING, SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANK,S,and AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is-Accurate and that,all•work will bb 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 p6-mit with an"estrr:ated T ai ue 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 perni.it is issued. In the abs a of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature7lk� G � �i� Signature Owner or Agent Contractor The f oin Inst me t was ac o gedyfo me this The fore i strument was ackno led `before this day of 12� by +''V � day of 20 y V 1 who i r ally known me or who has produced wh is p rso ally kno to me or who has produced " '�s�dentification and who did take an oath. O �• • identification and who did take an oath. NOTA BLIC: • • N TAR LIC: •• Sign: Sign: vk y ci_ nt / f rid Print: Nntar €'ubhc -Stale of Florida Print: / ht CoR,.n E:xpirr�a Sep 2.3,2 5 4ayr,�,irri Expires ep r, Commrssro My Commission Expire EE 128810 My Commissi sJ,r „ Bonded Through flational Notary Assn. GoZss on # Bonded Through National Notary Assn. APPROVED BY " b Plans Examiner Zoning Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) j SHORIC ES D Miami Shores Village "" a111 11" Building Department rue 010050 N.E.2nd Avenue �ORIDp' Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR/ARCHITECT Permit N. — Owner's Name(Fee Simple Title Holder): )Phone#: 05 I`_�p ASLO Owner's Addrpss: �� C City: Y� 1 C� YIn i '(-L)h -Wr='� State : I L__ Zip Code: r Job Address(Of where work is being done): City: Miami Shores State: Florida Zip Code: Contractor's Com any Name. 160'cAC Phone#: 30 Address. D 0 -t_J V City: State: - Zip Code: 33-Ilf— Qualifier's Name : K 5/ Lic. Number: Cf CIS163a-, Architect/Engineer of Record Name: Phone#: Address: City: State: Zip Code: Describe Work: N,6tJ /2 70AC I hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless for all legal involveme Signature �<' a cjc h Signature ownerorAgent o ctororkchitect The foregoing i tru nt was aknoled bef r The foregoin ' str nt s aknowledge bef re me this E day of 20 by this D day-. 2 I v! W�Y ho is rsonall k own to a or who roduoed o i sonally ow tom r who has produced fl �p �s indentitication. t� as indentification. Notary i Notary Pu 1, : G N i uta 3.2D�5 Sign: 015 Sign: nt'W 12 %Ao % -,�r Seal: , \ :nqy EE�2ri81� ary Assn � s.on � Seal: ;,\ � t = COMM Natrona � o �alNotaryAssn. *hrout�h \��.` gondpd ihluU9h Na110' 9 Ee; Bonded F1-7 1 1 ooaie JEFF ATWAJER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA W ORIERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exemptfrom Florida Workers'Compensation law. EFFECTIVE DATE: 8/19/2013 EXPIRATION DATE: 8/19/2015 PERSON: ROMER JUSTIN P FEIN: 371574398 BUSINESS NAME AND ADDRESS: BIMINI BREEZE HVAC INC 7010 NW 169TH STREET HIALEAH FL 33015 SCOPES OF BUSINESS OR TRADE: HEATING,VENTILATION, AIR-GOND Pursued to Chapter 440.05(14),F.S.,an officer d a corporation vto at"eemption from this chapter byll6rg a certificale d electionunder RNs secfim may nut recaer benefits a compensation order this chapter.P rsuant to Chapter 440.05(12),F.S.,Cerdtcates d elecbm to be 6mnip...applyadywithin the scope of the,business a trade listed on the notice of election to be emr pl.Ptrsuant to Chapter 440.05(13),F.S.,Notices d electim to be a)"and certificates d electionto be e)"shell be subject to revocation if,at anytime alter the filing d the rtotice a the tssuanm d the artifloft the person rsmed on the notice or certificate m lager meds the requtremetls of this section for isstence of a certificate.The deperbrat shall re cle a certificate at anytime for failve of the person maned on the certificate to neat the requirements d this secdm DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE E)GEMPT REVISED 07-12 QUESTIONS?(850)413-1609 Sep. 10. 2013 10 : 33AM No. 0990 P. 1 �1 j_�A_TE(MM1DDNY) + R'�° CERTIFICATE OF LIABILITY INSURANCE09/10/13 PRODUCER Annelle Willis Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 4769 N.W. 183rd St. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Miami,FL 33055 __.ALTER THE COVERAGE AFFORDED BY THE-POLICIES BELOW. Phone (305)625-8131 Fax (305)625-3694 INSURERS AFFORDING COVERAGE NAIC# INSURED UIMINI BREEZE HVAC INC. INSURER A: GRANADA 7010 NW 169 St INSURER B: MIAMI, FL 33015 INSURER c: INSURER D: (305)968-4205 - _,.. INSURER E:_ COVERAGES THE POLICIES O> INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANOING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. JNSR ADD'L� -typE OF INSURANCE I POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION JJS _. _.----_,_,•, DATE(MM/DD/YYY_Y_ DATE MMIDDNYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 n COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED � 0185FL00028937 08/26/2013 08/26/2014 PREMISES(Ea occurrence)_•,•_ F311 $50,000 l .3❑ CLAIMS MADE ❑ OCCUR MED EXP(Any one peraQn) _ $5,000 A ❑ ❑ PERSONAL 6 ADV INJURY $1,000,000 ❑ GENER_ALAGGREGATE $2,000.000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 (-] POLICY C�PROJECT n LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT LJ ANYAUTO (Ea acdde_nl) ❑ ALLOWNEDAUTOS BODILY INJURY ❑ ❑ SCHEDULEDAUTOS Perperson) ❑ HIRED AUTOS ❑ NON OWNED AUTOS BODILY INJURY ❑ (Per ooddent) PROPERTY DAMAGE — - __ ..... .. . ...__._ _ __•`- - _ (Per eccidenl)_ _ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ❑ ❑ ANY AUTO OTHER THAN EA ACC 0 AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE � ❑ OCCUR ❑ CLAIMS MADE AGGREGATE ❑ ❑ DEDUCTIBLE — ❑ RETENTION $ — — --- WORKERS COMPENSATION AND ❑ WC$T ❑ H EMPLOYERS'LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E,L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? _ (Mandatory In NH) E.L.DISEASi -EA EMPLOYEE IfyyBs dQscdbe under SPEt~lAL PROVISIONS belOL/ _.,__ �_ E.L.DISEASE-POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS AIR CONDITIONING CONTRACTOR CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL MIAMI SHORES VILLAGE 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 10050 NE 2 AVE THE LEFT,BUT FAILURE TO DO 30 SHALL IMPOSE NO OBLIGATION OR LIABILITY MIAMI FL 33138 —OF ANY KI B"MTHE INSURER,ITS AGENTS OR REPRESENTATIVES. ALIT HORIZATIV _.. �— ... ACORD 25(2009)01)OF 1 8 -2009 ACOR ORPORATION.All rights reserved. T ORD name and logo are registered marks of ACORD RECEIVED �")tr232013 RUTH KETTANEH I]BY: 935 NE 95 Street Miami Shores, FL 33138 ALL-Zone Air Conditioning 10690 NW 123 Street Road Suite 101 Medley, FL 33178 September 11,2013 Please be advised that you have been terminated from the project at the home of Ruth Polley 935 NE 95 Street Miami Shores, FL 33138 your estimate#2654 dated 5/3/2013. I appreciate your help in the past. Sincerely, PC D) Ruth Polley Kettaneh SECTIONCOMPLETE THIS DELIVERY SENDER: COMPLETE THIS SECTION ■ Complete items 1,2,and 3.Also complete A at e ❑Agent item 4 if Restricted Delivery is desired. X ❑Addressee ■ Print your name and address on the reverse so that we can return the card to you. B. Recei byPrint N me) C. Da of De ery ■ Attach this card to the back of the mailpiece, ;' WA or on the front if space permits. I0 Yes D. Is q.ve; 1. Article Addressed to: r 0 No If S,: dx� , �l1 I-Z.06� n kJ � -SER1�2 2013 3. Servi .\�. �4f'a m �' _ erti P it m c11c_u I t_ �3;i -f '. \ ❑Registe ~` B eceipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. ArticleNumber service label) 7012 3050 0001 3241 8926 (Transfer from l) PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 Miami Shores Village MAY 1 2°' 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 No.,rr)C i PERMIT APPLICATIONS ' IasterPermit No. FBC 2011) Y 41 Permit Type: MECHANICAL OWNER:Name(Fee Simple Titleholder):Qu 4ti Ro/Ir y ke/fa A Phone#:_ � J/-- /,,;Z K Address: ,[, 1` 5 ��+ 5.7 c-,'T City: M)AA? State: Tenant/Lessee Name: A.114 Phone#• Email: { JOB ADDRESS: City: Miami Shores County: Miami Dade Zip:a3/3 Folio/Parcel#: // 13 a of Q/y //d Is the Building Historically Designated: Yes 1 O Flood Zone: CONTRACTOR:Company Name:14L 20A)c /7 I'IT Aj C(i 74/ w Phone#t, _ g 2, — 9'33 Address: 6' A), GEJ 3 A t /f � City: e. 4' 'Se / Zip:33/7? Qualifier Name: k / "' Phone#: 7,?, a..5/—,3�j, - .Yy�r State Certification or Registration#: Certificate of Competency#: Contact Phone#: Y A 0-7 e Email Address: �' /f9 DESIGNER:Architect/Engineer: t//9K 1z r' C I t'I, 4 bon e#: 30S—_?,T ' 9 Value of Work for ��this ��Permit:$ �/;5 7� Square/Linear Footage of Work: Type of Work: ' JAddress OAlteration ONew ORepair/Replace ODemolition escri tion of Work: % J tt ct WC-) ti W 1W ************************Fee Submittal Fee$ Permit Fee$ 1 1 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ � .z� Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) 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 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 after the building pennit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. /> ��Signature ..�`'��e�, i �, DSi gnature Owner or Agent Contractor The foregoing instrument was acknowledged before me this/Q_ The foregoing instrument was acknowledged before me this - sd*jbe►40 P rLej day of�,20��by L �> � z9� day of 1"� ,20 �J,by who iserp sonallyknown to me or who has produced who isersonally known t me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: g ` �.`-�( � Sign: Si n: SHELLIE L.FULFORD Print: e �r� Print: • - .•�rar n HAYDEE MIRANDA My Commission Expi JNl o`e My Comm.Expires Feb 28,2017 M Commission �= Commission#EE 849356 y _ Notary Public State of Florida F,�p•'� My Comm.Expires Nov 14,2014 Bonded Through National Notary Assn OFFCommission#EE 41731 APPROVED BY 2-Pl aUxaminer Zoning Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) ' Miami Shores Village �,-- Building Department imp 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel:(305) 795.2204 AIR CONDITIONING REPLACEMENT DATA Fax:(305) 756 8972 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: City: Miami Shores Village County: Miami Dade Zip Code:,3 5 15 e�- 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 ARI(AHRI)DATA SHEET REQUIRED Change Disconnecting means:YES ❑ NO❑ ARHI Sheet Attached:YES❑ NO❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG.UNIT MODEL# COND.UNIT MODEL# KW HEAT NOM TONS AHU CU PKG 1 M.C.A AHU CU PKG AHU CU PKG 2 MAP AHU CU PKG AHU CU PKG 3 VOLTS AHU CU PKG PKG UNIT I / PKG UNIT EER/SEER YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB I YES NO YES NO NEW ROOF STAND I YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity(Wire Size): 2. Maximum Overcurrent Protection(Fuse/Breaker Size): 3. Voltage of Circuit(208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: r ' one: State Certificate or Registration N. '- rtificate of Competency N. Signature Date: ( ualfees signature only) ALLZO-1 OP ID: LS ACORN` DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1 05/01/2013 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). CONTACT PRODUCER Phone:561-392-3300 NAME: Greg Carignan Workers O Box 4Compensation Group Fax:561-361-1132 a$"N E,�;561-392-3300 a/c No 561-361-1132 Boca Raton,FL 33429-0410 E-MAIL routsworkerscom com Workers Compensation Group ADDRESS:cenpg p• INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:RetailFirst Insurance Company 56174 INSURED All Zone Air Conditioning Corp INSURER B: 10690 NW 123rd St,Unit 101 Medley,FL 33178 INSURER C INSURER D: INSURER E: INSURER F: 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. INSR NDDLSUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DDNYYY GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RFNTED-- COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE F7OCCUR MED EXP(Anyone person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1-1 POLICY71 PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOSNON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident L $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X T AC RY TATU OTR AND EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE Y— N/A 520.42398 07/09/2012 07/09/2013 E.L.EACH ACCIDENT $ 100,00 OFFICERIMEMBER EXCLUDED? 100�0 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 5()(l, DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION MIAMIS3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave. Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD DATE(MMIDDNYYY)� AC C>R" CERTIFICATE OF LIABILITY INSURANCE _�.,✓�' _ 05/01!13 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 CONTACT - - -- - NAME: JULIO JIMENEZ Jimenez&Co.,Inc. PHONE 305 264-9900- FAX 305 264-5382 M9L A L 8000 Coral Way Ext ( ) tA/C.Nol._ ADDRESS: 8000 CORAL WAY Miami,FL 33155 I PRODUCER I CUSTOMER — Phone (305)264-9900 Fax (305)264-5382 __INSURER S AFFORDING COVERAGE _ NAIC# wsuReD INSURER A: CYPRESS PROPERTY&,CASUALTY INSURAN ALL ZONE AIR CONDITIONING CORP INSURER-B: 10690 NW 123 RD ST #101 INSURER C: - Miami,FL 33178 1 INSURER D. INSURER E: _ INSURER F 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. INSR TADOLUBR1- POLICY—EFF POLICY EXP — - - ---"--- LTR TYPE OF INSURANCEPOLICY NUMBER (MM/DDIYYYY MMIDD_/YYVY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -- j DAMAGE TO RENTED Fv COMMERCIAL GENERAL LIABILITY 100,000 ❑ ❑ CLAIMS-MADE OCCUR GFL-1019834-01 �PREMISES ny o e per cam___$ - I A � 10!06/2012 10/06/2013 I MED EXP(Any one person) $ 5,000 I PERSONAL&ADV INJURY $ -" - 1,000,000 D, I GENERAL AGGREGATE $ 2,000,000 -- _ I PRODUCTS-COMP/OP AGG�$ 1,000,0001 GEN'L AGGREGATE LIMIT APPLIES PER: i�r; POLICY PRO- I � � �"- - - ---- W-1 ❑ FI LOC $ SECT I _ I ! AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ❑ $ 1 ANY O -- --- F-1 ALL OWNED AUTOS rBDILY INJURY(Per person) $ _ I -I- ❑ SCHEDULED AUTOS i BODILY INJURY(Per accident} $ - - - PROPERTY DAMAGE I $ ❑ HIRED AUTOS (Per accident) -- ❑ NON-OWNED AUTOS j $ `- ❑ $ - - -- _+ _ ❑ UMBRELLA LIAB ❑ OCCUR EACH OCCURRENCE -_$___ ❑' EXCESS LU18 ❑ CLAIMS-MADE I AGGREGATE ! $ ❑ DEDUCTIBLE - - -- I --- $ ----_---- - F RETENTION_$ _ _ ----_---- __ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS.LIABILITY h-❑_T_QBY LIMITS ❑ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N I.NIA A ELEACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? --- - (Mandatory In NH) - ` E_L.. DISEASE-EA EMPLOYEE}$ If Yes,describe under —-- -" D_ESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) **HEATING AND AIR CONDITIONING INSTALLATION,SERVICE OR REPAIR CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIR DATE THEREOF,NOTICE WILL BE DELIVERED IN MIAMI SHORES VILLAGE ACCOR %CE ITH THE POLICY PROVISIONS. 10050 NE 2 AVE _ MIAMI SHORES FL33138 HOREs NTAT RI ©1988- 009 ACORD CO RATION. All rights reserved. ACORD 25(2009/09)CIF The ACORD name and logWe registered marks of ACORD STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING HOARD 1940 NORTH MONt0E STREET (950) 487-1395 TALLAHASSEE FL 32393-0793 i E E PEREZ, IDIALHERTO ANTONIO ALL-ZONE AIR ND 4690 NW 123RDOST EETITIONRDGt7NITP101 MEDLEY FL 33179 DEPARTMENT Congralulationst with this license STATE of a1f Business ,1tRtOA AG# B 1 4 3 g c tion Floridians licensed You�° Drys of the neatly ons million Our professionals and buames�ses rar>entgg from�mfiiand tects to asst brokers,eggtromPROFESSIONALOF BUSINESS AND boxers to barbeque restaurants.and they keel!Florida's economy Strang. REGULATION Every day we work to i CAC 1814 7 3 S improve the way we do business in oder to serve you better_j � /312 000000000 by For re yrnyatios about our services,please log Onio www.myftoridaticense.com. ! CERTI FI gg CO R imp you can find more WOrmation a nd imp you,subscribe to de bast tte divisions a the regulations that PEREZ, Y Department's initiatives, department newststfers and learn more about the ALL-ZONE A IO MING CORP Our mission at the Department is:License Efricientl R constantly strive to serve you better so that yowl cavi serve ynurr Fairlywe s. Thank you for doing business in Florida,and congratulations on your new lieenget r IS C$RTIPIED "d.r tee p,,,.r.,_.or cn.4E9 re E •a�rr.tiso d-c AtM 31, 201{ L12083006663 l i DETACH HERE ;# 6319392 STATE OF FLORIDA DEPARTMENT OF SUSIRRfgS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING HOARD • _ $R SEW L12083000663 081301201 2 00000000fl. CAC18 4734' 11 11 Phe CLASS A AIR CONDITIONIN C ox lamed below Z8 CERTILrIED C" t Jnder the provisions of 3t Cha `ter p iration date: AUG 31, FS' 2014 PEREZ, IDIALB$RTO ANTONIO v; ALL-ZONE AIR CONDITIONING CORP 10690 NW 123 ST RD MEDLEY FL 33178 RICK SCOTT GOVERNOR KEN LAWSON SECRETARY MIAMI-DADE COUNTY 2012; LOCALBUSINESS TAX RECEIPT 2013 FIRST-CLASS TAX,COLLECTOR MIAMI-DADE,COUNTY'-STATE OF FLORIDA U.S.POSTAGE 140 W.FLAGLER ST. EXPIRES SEPT.30,2013 PAID 1st FLOOR MUST BS DISPLAYED AT;PLACE OF BUSINESS MIAMI,FL MIAMI,FL 33430 PURSUANT.TO COUNTY CODE CHAPTER SA-ART.9&10 PERMIT NO. 231 '.i-W.. i`, NO A 1311_!. -_ n(::.r': -5-.. PA., 567156-6 RENEWAL RL-CE.IP1 No. 591563-3 ALL ZONE AIR CONDITIONING CORP STATE# CAC1814735 13348 NW 8 TERR 33182 UNIN DADE COUNTY Atl- ZONE AIR CONDITIONING CORP WORKER/S 196 SPEC MECHANICAL CONTRACTOR 1 ALL ZONE AIR CONDITIONING CORP IDIALBERTO PEREZ PRES 13348 NW 8 TERR MIAMI FL 33182 07/18/2012 60010000482 000075. 00 25