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RC-14-1760 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-242566 Permit Number: RC-8-14-1760 Scheduled Inspection Date: September 02, 2015 Permit Type: Residential Construction Inspector: Rodriguez,Jorge Inspection Type: Final Building Owner: MILLION, CHARLES Work Classification: Alteration Job Address:485 NE 94 Street Miami Shores, FL 33138- Phone Number (917)887-5511 Parcel Number 1132060140540 Project: <NONE> Contractor: EPOCA CORP Phone: (305)778-5103 Building Department Comments REMODEL KITCHEN Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 01,2015 For Inspections please call: (305)762-4949 Page 30 of 47 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-228744 Permit Number: RC-8-14-1760 Scheduled Inspection Date: February 27, 2015 Permit Type: Residential Construction Inspector: Rodriguez,Jorge Inspection Type: Window Door Attachment Owner: MILLION, CHARLES Work Classification: Alteration Job Address:485 NE 94 Street Miami Shores, FL 33138- Phone Number (917)887-5511 Parcel Number 1132060140540 Project: <NONE> Contractor: EPOCA CORP Phone: (305)778-5103 Building Department Comments REMODEL KITCHEN Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed I,/� CREATED AS REINSPECTION FOR INSP-217763. INSPECTION FOR A WINDOW ONLY NOT THE GARAGE DOOR Missing letter Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. February 26, 2015 For Inspections please call: (305)762-4949 Page 18 of 28 a Edward A Landers PE 038398 Date February 24, 2015 Miami Shores Village 10050 NE 2nd Avenue Miami Shores, Florida 33138 Attn: Building Official RE: Special Inspection Project: Residence Permit# RC14-1760 485 NE 94th Street Miami Shores, Fl. 33138 Dear Sir; This letter includes the inspection of the installation of the window and door buck inspection. The 46"door header is 3.5"x3.5" (located in the kitchen) and is attached to the masonry opening with 4-5/8"x8" Kwik Bolts (with epoxy grout). The plywood used for the window bucks is pressure treated and screwed into the wood buck with %"x 2.75"Tap cons at 8" on center. ` p A- LA �•�`�PP�c E N S'F�R9 Very truly yo �, %U,1. No 38398 Edwar A. La der E. LU ��'• STATE OF i�Q ••• OQ,•. t1.+�� 11111111111 1O N A� �% 7850 NW 146th Street Suite#509 Miami Lakes, Florida 33014 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-227022 Permit Number: RC-8-14-1760 Scheduled Inspection Date: January 28, 2015 Permit Type: Residential Construction Inspector: Rodriguez,Jorge Inspection Type: Columns Owner: MILLION, CHARLES Work Classification: Alteration Job Address:485 NE 94 Street Miami Shores, FL 33138- Phone Number (917)887-5511 Parcel Number 1132060140540 Project: <NONE> Contractor: EPOCA CORP Phone: (305)778-5103 Building Department Comments REMODEL KITCHEN Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments CREATED AS REINSPECTION FOR INSP-226975. Need to remove cement Passed from bottom of columns or procure letter fromArch/Eng Failed � `E Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. January 27, 2015 For Inspections please call: (305)762-4949 Page 23 of 34 w January 26, 2015 Miami Shores Village Building & Zoning Department 10050 NE 2"d Avenue Miami Shores, Florida Attn: Building Official Re: Residence Permit# 12 G — Fj " 71� 0 485 NE 94th Street Miami, Florida, Dear Sir; This letter is to advise that we inspected and approve the dowels for filled cells into existing foundation with epoxy grout and the rebar for filled cells and columns. The work is in compliance with the approved plans and specifications under the above Permit. All work conforms to the requirements of the 2010 Florida Building Code. Please call if we can provide any additional information. ::ward ryRA. rs, P.E. President 101 � I Miami Shores Village �k'3 ^� ' �� Building Department 3L%�ry%t-TI 04D 10050 N.E.2nd Avenue, Miami Shores Florida 33138 0 1 0 2014 7 6-8972 0( S I7�v 5)762-4949 BY:C— ',n FBC 20 -\0 BUILDING Master Permit No. PE MIT APPLICATION`' „�,� Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP n CONTRACTOR DRAWINGS JOB ADDRESS:_ 485 F On S11 tle,&1 - City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 3aC49 - ()SP C7 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: ,n Flood Zone: BFE: FFE: ��I1 OWNER: Name(Fee Simple Titleholder): (Aw QC.S A y�uu�°in Phone#: Address: 4g5 NE 54-th LreL-f' City: y r, )rriyvh *' State: �l Zip: --93 /a Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: �'V-e?C4 )fzro Phone#: �dJ�' 77 5 —55/03 Address: t dy NE I25/A­&r-eo ,✓ City: State: Zip: 3I I Qualifier Name: ✓zelle- Phone#: State Certification or Registration#: 6 (F0--Certificate of Competency#: DESIGNER:Arch itect/Engineer: Wim/ ,, /,rvwdel5 _Phone#: 306 -$n-3gaF' Address: 7960 IV I-V AV4y,`A 5,j-,-eel -#60'j City: /niter/I/�kSState: Zip: ��q Value of Work for this Permit:$ b6 Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 6 ZG✓rse '400elvm�•+ � �iyN --1�c504*a 3 (C'414 S' pVlylAi-,/ s r)&—V 1 S i A �� �0 P �t�n C -�� i �a✓t G) I }��oQ'!'L�, Specify color of color thru tfle: Submittal Fee$ Permit Fee$ _ " y�) CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ ,\ Double Fee$ Structural Reviews$ 40 - QZ By a) q {^W O Bond$ M I;Lc- ---� .z TOTAL FEE NOW DUE$ ^L ! ' (Revised02/24/2014) l 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 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature i.-J, OWNER or AGENT CONTRACTOR The forregoing instrument was ss acknowledged before me this The foregoing instrument was acknowledged before me this day of �C�T 120 J by day of 06,7 / 20 by /2?iW/rMho is ersonall own to ,who i rsonall own to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: Seal: .°��"""°1,�;, �.. ORESTEINNOCENll Seal: Ow '� ORESTEINNOCENTI Notary Publle-Staid of Flo oda ) ~ Notary public-Slate of Florida ;^.� My Comm.Expires May 16,2015 My Comm.Expbas May 16,2015 , Commission•EE 94543 Commission 0 EE 94543 ############################# ###### ####################################################################### APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 001876 x Mkt Fi �ei�d � �s,x✓''� "'Y2',i.. i 1 C t 3'k z Y�°._� � u1 � yS��#} r L r 5} •t -�' s fi `��..�x,: ✓ tea �,"O� x n �'r -r,;� x- f!.r OWN SEC TYta$ F BU$1NES 196 PLOIAihG CQNTRAC PAYMEN t4ECE1V CFC1421/rAX LECTt $ 5 3 45.00 /03/2014 a== k OiECK2 15-00 ,9 Th Busma ecoipt frons pa ' t of the Local Business Tax The Re is not a certifi f the ho f ificatl s,m do business Hol airy pov r rn Is i lytothy eI�CEIPTsbove played Vial vehi ' . ass " -- aeon, ado t i Date CERTIFICATE OF LIABILITY INSURANCE 1/8/2015 Producer: Plymouth Insurance Agency This certificate is Issued as a matter of information only and confers no 2739 U.S. Highway 19 N. rights upon the CertlFcate Holder. This Certificate does not amend,extend Holiday, FL 34691 orafter the coverage afforded bythe poiidesbelow. (727)938-5562 1 Insurers Affording Coverage NAIC# Insured: South East Personnel Leasing, Inc.&Subsidiaries Insurerk Lion Insurance Company 11075 2739 U.S. Highway 19 N. Insurer e: Holiday, FL 34691 Insurer c: Insurer D: Insurer E: Coverages The policies of Insurance listed below have been issued to the insured named above for the policy period indicated. Notwithstanding any requirement,term or con of any contract or other document with rasped 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. INSR ADDL Type of Insurance Policy Number Policy Effective Policy Expiration Limits LTR INSRD Date Date (MM/DDNY) (MM/DD/YY) GENERAL LIABILITY Each Occurrence T-- mmercial General Liability Damage to rented premises(EAClaims Made 1:1 Occur occurrence) Med Exp -neral aggregate limit applies per: Personal Adv Injury Polity ❑Project ❑ LAC General Aggregate Products-Comp/Op Agg AUTOMOBILE LIABILITY Combined Single Limit Any Auto (EA Accident) 5 All Owned Autos Bodily Injury Scheduled Autos (Per Person) Hired Autos Bodily Injury Non-Owned Autos (Per Accident) Property Damage (Per Accident) EXCESSIUMBRELLA LIABILITY Each occurrence Occur ❑Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2015 01/01/2016 X we statu- OTH- Employers'Liability I tory Limits ER Any proprietor/partner/executive officer/member E.L.Each Accident $1,000,000 excluded? No E.L.Disease-Ea Employee $1,000,000 If Yes,describe under special provisions below. E.L.Disease-Policy Limits 31,000,000 Other Lion Insurance Company Is A.M.Best Company rated A-(Excellent). AMB#12616 Descriptions of Operations/LocationsNehle"IExclusions added by Endorsement/Special Provisions: tient ID: 81-65-788 Coverage only applies to active employee(s)of South East Personnel Leasing,Inc.&Subsidiaries that are leased to the following"Client Company": EPOCA Corp. Coverage only applies to injuries incurred by South East Personnel Leasing,Inc.&Subsidiaries active employee(s),while working in:FL. Coverage does not apply to statutory employee(s)or independent contractor(s)of the Olent Company or any other entity. A list of the active employee(s)teased to the Client Company can be obtained by faxing a request to(727)937-2138 or by calling(727)938-5562. Project Name: ISSUE 07-22-14(TLD)REISSUE"l-14(Mr) Becin Dobe 5/21/2014 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE HALL Should any of the above described policies be cancelled before the expiration data thereof,the issuing insurer will endeavor to mail 30 days written notice tD the certificate holder named to the left,but failure to do so shall impose no obligation or liability of any kind upon the Insurer,its agents or representatives. 10050 NE 2ND AVE MIAMI SHORES. FL 33138 �� ' Miami Shores Village OCT2 1 ilding Department ; 43 ' N.E.2nd Avenue, Miami Shores, Florida 33138 - r el:(305)795-2204 Fax:(305)756-8972 - ( — ION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit No.w.— 0- W- P& PERMIT APPLICATION Sub Permit No. 1:: --i L-A " 1--7 (� I ❑BUILDING 7 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION []RENEWAL [PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP Q� CONTRACTOR DRAWINGS /�(�! Q JOB ADDRESS: V � `v -/4 -K 5�&- City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: A FFE: OWNER:Name(Fee Sim le Title pl�fer): � Yom"' Phone#: 1l7 " $7 Address: 4k- city: ��� I/�, City: State: Zip: 37� Tenant/Lessee Name:_ Phone#: Email: CONTRACTOR:Company Name: Metropolitan Plumbing, Inc. Phone#: 305-888-2720 Address: 1020 E 14th St City: Hialeah State: FI Zip: 33010 Qualifier Name: Miguel Guiardinu Phone#: 305-888-2720 State Certification or Registration#: CFC057152 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 0 0-el Square/Linear Footage of Work: Type of Work: ❑ Addition [//--Alterraation(� ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: doom—Rgg- �. Submittal Fee$ f ' Permit Fee$ CCF$ CO/CC$ Scanning Fee$ 3 CJS Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) � f 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 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 AGENTR CTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of(ZJj!:J her 20�,by 21 day of October 20 2014 by who is personally known to Miguel Guiardinu who i ersonally known o me or who has produced /,Sd 111&13 7_ me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: rint: rids Print: Maria ExpoSito NOW''/Pub is Seal: s°'°"8o M Feliciano 20 MM Joanna F 082753 Sear!C?oB Maria ExpoSito MYCes01112120 8 I. .-- h1MISSiON#EE 117934 'Eoi�` ',,� •�o?c E('iRES:AUG.01,2015 aunt` W tiVW AAROiWTY *************************** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) r . Miami Shores Village i OCT 23 2014 g Department � p RE'� venue,Miami Shores,Florida 33138 95.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 BUILDING Permit No. PERMIT APPLICATION Master Permit No.��'' FBC 20 Permit Type: Electrical OWNER:Name(Fee Simple Titleholder): Phone#: 305-933-0683 Address: 485 NE 94 Street City: Miami Shores State: F1 Zip: 33138 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS. 485 NE 94 Street City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel#: Is the Building Historically Designated:Yes NO X Flood Zone: CONTRACTOR:Company Name: L S Curtis inc Phone#: 786-486-1961 Address: 20341 NE 30 Ave #108 City: Aventura State: FL Zip: 33180 Qualifier Name: Lewis S Curtis Phone#: 786-486-1961 State Certification or Registration#: ECO 0 0 317 5 Certificate of Competency#: Contact Phone#: 786-486-1961 Email Address: aasteve@aol .com _ DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ 4 5 0 0 . 0 0 Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: Kitchen counter top receptacles, lights, switches and appliance Submittal Fee$ Permit Fee CCF$ CO/CC$ Scanning Fee$ . f Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ �Y N) 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 permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. r"�/� 7 SignatureC_...,.... �L Signature Owner or Agent Contractor The foregoing instrument was acknowledged before met i,a The foregoing instrument was acknowledged before me this2 2 day of 0 by day of October 2p 14 by Lewis Curtis who is personally known to me or who has produce who is personally known to me or who has produced — As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PU C: Sign- Print: Print: My CO 1' X §H Public State of Flor da ;a� ' My Co tilt ► EYr�MMISgION#EEQ19418 :� ^ pJoanna UI Feliciano EXPIRES July 25,YQt6 My Commission FF 082753 = i�a1" 9�or nd iores 0111212018 (407)398.0153 F�ridaNOWYSerAoa.00m APPROVED BY 9Z fi(� !i Plans Examiner _ Zoning 1 Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Miami shores Village �S,�oRFSG Building Department 'fell HONNI" 10050 N.E.2nd Avenue Miami Shores, Florida 33138o�d Tel: (305) 795.2204 R' Fax: (305) 756.8972 n - N-1y Permit No: k.C!y-1-7'6 fl Page 1 of 1 Structural Critique Sheet -en, kt..,e- f At �-' t1�2JVJ' C,0v'. Cn('cly:e_ r✓J Lt,o �jG� �60.re Co N kA AO 9 A..'U STOPPED REVIEW Plan review is not complete,when all items above are corrected,we will do a complete plan review. If any sheets are voided,remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re-submittal drawings. Mehdi Asraf 2�t Miami Shores Village �RY ' �- t-k Building Department AUG 12 ?014 v-4 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 20 10 BUILDING Master Permit No.;? cIq— PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP �{ CONTRACTOR DRAWINGS JOB ADDRESS: � G 1 �ST 40 City: Miami Shores County: Miami Dade zip: Folio/Parcel#: <<' 7206 - ��� " d s� Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: M 1 lrl�l d� y OWNER: Name(Fee Simple Titleholder): �'�`�L'�S ' " � Phone#: AddressA gs K& `-410 �r City: M 1$1-M I N- s State: Zip: 3 f 3 Tenant/Lessee Name: f�✓� Phone#: Email: GvY�zS n41�� ► O"y► d � .�! i (�W _ ` tc�3 CONTRACTOR:Company Name: *Cck (t,p- Phone#: Address: ?I0 1'j City: Nor�� wl(x n State: -- Zip: 331l� Qualifier Name: Avid ?.WcJ eu Phone#: e 00 State Certification or Registration C --T\O'C�Oq Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: Submittal Fee$ ��O' Permit Fee$ W co CCF$ (o 6CO/CC$ Scanning Fee$ Radon Fee$ C�•W DBPR$ Notary$ Technology Fee$ �yo ; Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ (35 TOTAL FEE NOW DUE$ (Revised02/24/2014) 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 work II Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no or installation atlon 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 (�` a �i.v-� Signature OWNER or AGENT CONTRACTOR The foregoing instrumg/l�was acknowledged before me this The foregoing instrument was acknowledged before me this day of � )J)NC— 20 /�. by � day of S 120 14 by ��138 Le r L c. r 0 tj w K Csprson�knn to who 4-gr sonally know to me or who has produced 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 n: Sign: Print: C' Print: tACf,A-Lo Seal: Seal: �ot�::;; VINCENZOBRUNO ANGEIA HYDE * * MVV COMMISSION t FF 017169 :•` 14 ;.; W COMMISSION t EE 06M EXPIRES:May 19 2017 EXPIRES:February 2,2015 NOF nmd a Bonded Tlw Budget Nola S APPROVED BY ` �2 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET ``�e«� `• TALLAHASSEE FL 32399-0783 BRADLEY, DAVID SCOTT EPOCA CORP 800 NE 125 STREET MIAMI FL 33161 STATE OF FCOMDA AC# _> 3 S 5 6 7 Congratulations! With this license you become one of the nearly one million DEPARTMENTOF Bt78INESS AND Floridians licensed by the Department of Business and Professional Regulation. gPROFESSIONAL,:REGt7LATION Our professionals and businesses range from architects to yacht brokers,from boxers to barbepue restaurants,and they keep Florida's economy strong. CGC1519V9049/ 12 128076613 Every day we work to improve the way we do business in order to serve you better. For information about our services,please log onto www.myfloridalicanse•com. CERTIFIED ° t fNTRACTOR There you can find more information about our divisions and the regulations that I BRADLEY, impact you,subscribe to department newsletters and learn more about the EPt?CA C0R>4 Department's initiatives. Our mission at the Department is:License Efficiently,Regulate Fairly.We l constantly strive to serve you better so that you can serve your customers. ; Xs Cs1ttTZFxB>D vaQ+r the prrnrteiome or cb:,489 zs i Thank you for doing business in Florida,and congratulations on your new license! sxvs:+assn e.eri xucs 3 i,• 2014 1,12041102162 DETACH HERE �. ___. .�..............__—.-_-._ Y l�lC J� STATE OF FLORIDk DEPART11EXT'-OF BUSINESS AND PROFESSIONAL' REGULATION CONSIRMCTION INDUSTRY" LICENSING BOARD k SEQ#L12o91102162 I LICENS NBR >;. 10911 2012. 12807,66.13 CGC151990 f The= GENERAL. CONTRACTOR ' . Named below.:IB CERTIFIED Under the provisions of Chap'6' a1;�q V8� ExpirationdaEte: AUG 31, 2014 At BRADLEY; DAVID SG.OTT € EPOCA CORP 800 NE 125 'STREET MIAMI FL 33181 , RICK SCOTT KEN LAWSON GOVERNOR SECRETARY i DISPLAY AS REQUIRED BY LAW\ City of North Miami N O RTN M M I A M I 776 N.E.125 Street • North Miami, FL 33161 305-893-6511 Business Tax Receipt/Certificate of Use Issued Date: 10/1/2013 OFFICE:ADMINISTRATIVE OFFICE FOR CONSTRUCTION Expiration Date: 9/30/2014 COMPANY, INCLUDING ELECTRIC&PLUMBING SERVICES. Business Tax Receipt#: BT-003920 Business Name/Address: EPOCA CORP 800 NE 125 ST- --- ----------- EPOCA CORP NORTH MIAMI, FL 33161-5712 800 NE 125 ST NORTH MIAMI, FL 33161-5712 Michael A.Etienne,Esquire,City Clerk NOTICE: BUSINESS� . . OR SOLD. NON-TRANSFERABLE POST INA CONSPICUOUS PLACE • NON-TRANSFERABLE EPOCA-2 OP ID:TOM CERTIFICATE OF LIABILITY INSURANCE D080712ATE 14 osro7i2o1a THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS VPON 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(ies) 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 endorsements). PRODUCER CONTACT M&L Insurance Agency,Inc. PHONE FAX 2855 N.University Dr.Ste.110 c No.Ext): (AIC.No): Coral Springs,FL 33065 E-MAIL Amanda CastorinoADDRESS..._ INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Plaza Insurance Company .30945 INSURED EPOCA CORP INSURER B:Arch S ecialty Insurance Co 21199 800 NE 125TH ST INSURER C:Evanston Insurance Com an 35378 NORTH MIAMI, FL 33161 - 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. /NSR — r.-,.,_.. ..,..,._....._._ U5R TR TYPE OF INSURANCE POLICY NUMBER _ _....._M�ODYYYYY MMIDDN YP -_-. LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 B X COMMERCIAL GENERAL LIABILITY AGL003830-00 08/28/2013 08!28/2014 Ids a Nlkl]noe, $^ 100,00 CLAIMS-MADE Fx]OCCUR MED EXP(Any one person) $ 10,00 PERSONAL&ADV INAI $- - —1,000,0 GENERAL AGGREGATE $ 2,0_00,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,00 POLICY X PROIE_• LOC $ AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT 1,000,00 Ea accident _ �._ ...--- -- A X ANY AUTO PALGM1000539-00 06/2612014 07/15/2015 BODILY INJURY(Per person) $ ` ALL OWNED SCHEDULED AUTOS BODILY INJURY(Per accident) $� X AUTOS X AWNED -V- HIREDDPERTY� GE $ r XAUTOS (PER ACCIDENT) $ UMBRELLA LU18 X OCCUR EACH OCCURRENCE $ 4,000,00 C I X EXCESS w►B LAIMS•MADE XOVA771213 1212012013 08/28/2014 I AGGREGATE 41000,00 I DED RETENTION$ _ _-- S$ WORKERS COMPENSATION WC STATU- I LOTH AND EMPLOYERS'LIABILITY Y/N LQ$Y LiM17S ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F7NIAI E1 EACH ACCIDENT $ j(Mandatory In NH) E DISEASE-EA EMPLOYEE $ 12 yes describe under - '---- -- DESCRIPTION OF OPERATIONS below 1 E.L.DISEASE-POLICY LIMrr $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If mon space Is required) SEE ATTACHED SCHEDULE B GENERAL CONTRACTOR # CGC1519904 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE HALL THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE MIAMI SHORES, FL 33138 AUTHORIZED REPRESENTATIVE Amanda Castorino ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD NOTEPAD EPOCA-2 PAGE 2 INSURER'S NAME EPOCA CORP OP IM TOM Date 08107/2074 SCHEDULE B FOR VEHICLES: 2000 FORD F SERIES SUP DUTY # 1FDWF36S77ED93802 LIMIT: ACV !1999 ISUZU NPR # 4KLB4B1RXJ0022911 LIMIT: ACV 12007 CHEVROLET EXPRESS VAN # lGCGG29U171204533 LIMIT: ACV ;2011 FORD F SERIES SUP DUTY # 1FT7W2AT2BEA58313 LIMT: ACV 11997 GMC SIERRA # 1GTEC14W7VZ533645 LIMIT: ACV 12008 FORD F SERIES SUP DUTY # 1FTWW32RSSZB98037 LIMIT: ACV ;2003 CHEVROLET EXPRESS VAN # 1GCEG15X931222001 LIMIT: ACV :2009 BMW X5 VIN# 5UXFF03539LJ95327 LIMIT: ACV 12007 FORD P150 VIN#lFTPX12V37FB74709 LIMIT: ACV 2008 CHEVY # 1GCHC23648FI94708 LIMIT:ACV i Date CERTIFICATE OF LIABILITY INSURANCE 8/1/2014 Producer: Lion Insurance Company This Certificate is issued as a matter of information only and confers no 2739 U.S. Highway 19 N. rights upon the Certificate Holder. This Certificate does not amend,extend Holiday, FL 34691 or alter the coverage afforded by the policies below. (727)938-5562 1 Insurers Affording Coverage NAIC# Insured: South East Personnel Leasing, Inc. &Subsidiaries Insurer A: Lion Insurance Company 11075 2739 U.S. Highway 19 N. Insurer B: Holiday, FL 34691 Insurer C: Insurer D: Insurer E: Coverages The policies of insurance listed below have been issued to the insured named above for the policy period indicated. Notwithstanding any requirement,tens 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. INSR ADDL Policy Effective Policy Expiration Limits LTR INSRD Type of Insurance Policy Number Date Date (MM/DD/YY) (MM/DD/YY) GENERAL LIABILITY Each Occurrence Commercial General Liability Damage to rented premises(EA Claims Made 11Occur occurrence) Med Exp General aggregate limit applies per: Personal Adv Injury Policy11Project 11Products General Aggregate Products-Comp/Op Agg AUTOMOBILE LIABILITY Combined Single Limit Any Auto (EA Accident) All Owned Autos Bodily Injury Scheduled Autos (Per Person) Hired Autos Bodily Injury Non-Owned Autos (Per Accident) Property Damage (Per Accident) EXCESS/UMBRELLA LIABILITY Each Occurrence Occur ❑Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2014 01/01/2015 x I WC Stat.- OTH- Employers'Liability tory Limits ER Any proprietor/partner/executive officer/member E.L.Each Accident $1,000,000 excluded? NO E.L.Disease-Ea Employee $1,000,000 If Yes,describe under special provisions below. E.L.Disease-Policy Limits $1,000,000 Other Lion Insurance Company is A.M.Best Company rated A-(Excellent). AMB#12616 Descriptions of Operations/Locations/Vehicies/Exclusions added by Endorsement/Special Provisions: Client ID: 81-65-788 Coverage only applies to active employee(s)of South East Personnel Leasing,Inc.&Subsidiaries that are leased to the following"Client Company': EPOCA Corp. Coverage only applies to injuries incurred by South East Personnel Leasing,Inc.&Subsidiaries active empioyee(s),while working in:FL. Coverage does not apply to statutory employee(s)or independent contractor(s)of the Client Company or any other entity. A list of the active employee(s)leased to the Client Company can be obtained by faxing a request to(727)937-2138 or by calling(727)938-5562. Project Name: ISSUE 07-22-14(TLD)REISSUE 8-01-14(MT) Becin Date 5/21/2014 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE HALL Should any of the above described policies be cancelled before the expiration date thereof,the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named to the left,but failure to do so shall impose no obligation or liability of any kind upon the insurer,its agents or representatives. 10050 NE 2ND AVE MIAMI SHORES, FL 33138 To: Page 3 of 6 2014-09-17 13:56:45 EDT 13058517143 From: Epoca Corp_ STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATIO(v CONSTRUCTION INDUSTRY LICENSING 1940 NORTH MONROE STREET BOARD (850);487-139,5 TALLAHASSEE FL 32399-0783 BRADLEY, DAVID SCOTT EPOCA CORP 2055 ALAMANDA DRIVE MIAMI FL 33181 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range -7 7777-77- from architects to yacht brokers,from boxers to barbeque restaurants, STATE OF FLORIDA and they keep Florida's economy strong. . DEPARTMENT OF BUSINESS AND .? PROFESSIONAL) EGULf1TION Every day we work to improve the way we do business in order to CGC1519904 serve you better. For information about our services,please log onto ISSUlQ 0$/27/2014 www.myftoridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe CERTIFIED GENERAL CONTRf1CTgR. to department newsletters and learn more about the Department'sBRADLEY, DAV(D initiatives. EPOCA CORP Our mission at the Department is:License Efficiently,Regulate Fairly. We constantly strive to serve you better so that you can serve yourr k customers. Thank you for doing business in Florida, 1S CERTIFIED under the'provtsions 07 Ch 489 FS and Congratulations on your new license! Expralon date:.AUG 31,2018 :Lt40H270Q03351 .r i.: it- .. :k DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION.INDUSTRY LICENSING BOARD CGC1518904 f �� ' The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS.. r%s Expiration date: AUG 31, 2016 BRADLEY, DAVID SCOTT a EPOCA CORP 800 NE 125 STREET MIAMI FL 33181_....... .. ...... 1ssuEo: 08i27i2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408270003351 To: Page 4 of 6 2014-09-17 13:56:45 EDT 13058517143 From: Epoca Corp_ ACa EPO CA-2 CERTIFICATE 4F LIABILITY INSURANCE 0812$!2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIPICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 1.BY:'THE PCILICtE&:. BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHQRIZER REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION -$IAIAIVED,sut fact tD :I the terms and conditions of the Policy,certain policies may require an endorsement A statement on this certificate does niatconfer rights to the ? certificate holder in lieu of such endorsement(s). PRODUCER CONTACT M&L Insurance Agency,Inc. NAME:_ DAVID VAANDERING 2855 N.University Dr.Ste.110 PHONi< —---- --- — L (A/c,rte,E:U:877-304-2323 PA3r� Coral S�ppringgs,F 33065 E-MAIL —---- Aro Nv:964-840.0320 David Vaandenng ADDRESS__ -- (NSURER(S)AFFORDINGCOVERAGE �, NA1Gff INSURER A:Plaza Insurance Company _ 30945 INSURED EPOCA CORP 800 NE 125TH ST INSURER a:Berkley Assurance Com an NORTH MIAMI,FL 33161 INSURER c:Evanston Insurance COnjpany INSURER D: Ut9URHR E INSURER F: " 77777777 COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 13EEN ISSUED TO THE INSUR DENAMED ABOVEB OR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER pCCUMEN7 WITH RESPECT TO.WHICH TH1D CERTIFICATE MAY 8E ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT RESPECT THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR'—_... _.._ AD-6T'SUBR: �- _ _ ._. T TYPE OF INSURANCE POLICY NUMBERDL1CY EFF POLICY EXP—" "— i MM/DD/YYYY MM/OD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY iI CURENuCrErerc_e S - - 00,010'' EACH 00 T_0 OCCUR UMC0068320 o c�28201b PREMISE_E100 000 ` _ __—.... _k - (Any n M-D EXP An o epersOn) g - EXCLUDE -- -- --"—' I E PERSONAL BA DV INJURY g 1,OOD,OO I GE_IrL AGGREGATE LIMIT APPLIES PER —. I POLICY _..PRO- LOC I I I J ,GENERAL AGGREGATE -_ S _-- 2,000,00 X l...._... C_J JEC7 J I - PRODUCTS-COMF/OPAGG $_ 2,000,00 OTHER' ... �S AUTOMOBILE LIABILITY COMBINED SINGLE LIMI - (Ee ecudenp _ $ 1,000,00 A X I ANY _____ I PALGMI000539-00 06/26/2014!06/26120151 BODILY INJURY(Per person) S ALL UWNEU SCHEUULED ! I AUTOS AUTOS i ff I _. X X AUTOS 1 t i BODILY INJURY(Per au.idenq S _— ,.__�HIRED AUTOS I 111 I PROPERTY DAMAGE—I—` {Ver ecald ft l i UMBRHLLA LIAB XOCCUR ) '$ C X EXCESS LIAR 1 EACH OCCURRENCE _ - CLAIMS-MADE' XOVA771213 —_...... 3 4,000,00 _._..i..___.___.- _..... � ' 08128!2014 j 08128/2015(AGGREGATE --..--_ —DED RETENTIONS __—.-- S 4,000,00 WORKERS COMPENSATION g OP AND EMPLOYERS•LIABILITY PE DTH- ANYPRRrETOR/PARTNER/EXECUnVE YIN i I STATUTE.1 1 ER OFFICER/MEMBER EXCLUDED ndaN!A i E.L.EACH ACCIDENT___ 1/EaSCRs.dIPesTrnbeION OunFderOPERATIONS below E.L.DISEASE-EA EMPLOYE- _ D � i -- - i 1 E.L.DISEASE-POLICY LIMIT S --- -- I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 109,Additional Rom arks Scbedulo,may be attached if more apace Is required) GENERAL CONTRACTOR SEE ATTACHED SCHEDULE B CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE HALL THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2ND AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FL 33138 AUTHORIZED REPRESENTATIVE David Vaandering ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD To: Page 5 of 6 2014-09-17 13:56:45 EDT 13058517143 From: Epoca Corp_ NOTEPADEPOCA-2 pa�E2 {NSURED'S NAME EPOCA CORP OP ID:SM Date D$/ZS(2014 SCHEDULE B FOR VEHICLES: _ 2000 FORD F SERIES SUP DUTY # 1FDWF36S7YED93802 LIMIT: ACV 1999 ISUZU NPR # 4KLR4RlRXJ0022911 LIMIT: ACV 2007 CHEVROLET EXPRESS VAN # 1GCGG29U171204533 LIMIT: ACV 2011 FORD F SERIES SUP DUTY # 1FT7W2AT233F,A58313 LXMT: ACV 1997 GMC SIERRA # 1GTEC14W7VZ533645 LIMIT: ACV 2008 FORD F SERIES SUP DUTY # 1FTWW32R58EB98037 LIMIT: ACV 2003 CHEVROLET EXPRESS VAN # 1GCEGlBX931222001 LIMIT: ACV 2009 BMW X5 VIN# SUXFF03539LJ95327 LIMIT: ACV 2007 FORD F150 VIN#lFTPX12V37FR74709 LIMIT: ACV 2008 CHEVY # 1GCHC2364BF194708 LIMIT:ACV To; Page 6 of 6 2014-09-17 13:56:45 EDT 13058517143 From: Epoca Corp_ Data CERTIFICATE OF LIABILITY INSURANCE 9/16/2014 Producer: Lion Insurance Company This Certificate Is issued as a matter of Information only and confers no 2739 U.S. Highway 19 N- rights upon the Certificate Holder. This Certificate does not amend,extend Holiday, FL 34691 or alter the coverage afforded by the policies below, (727)938-5562 Insurers Affording Coverage NAIC 4 Insured: South East Personnel Leasing, Inc. &Subsidiaries Insurer A: Lion InsuralxeConvany 11075 2739 U.S. Highway 19 N. insurer B: Holiday, FL 34691 Insurer C: Insurer D: Insurer E: Coverages The policies Of Insurance hated below have been issued to the insured named above for the policy"period indicated. Notwithstandtng any requirernent,term of 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. INSR ADDL I Policy Effective Policy Expiration LTR INSRD Type of Insurance Policy Number Date Date Limits (MM/DD/YY) (MM/DD/YY) GENERAL LIABILITY Commercial General Liability Each Occurrence Claims Made Occur' Damage to rented Premises(EA u ncn irrenca) Med Exp eneraI aggregate limit applies per: Personal Adv Injury Policy ❑Project LOC General Aggregate Products•Comp!Op Agg AUTOMOBILE LIABILITY Combined Single Limit Any Auto (EA Aczident) At Owned Autos Bodily Injury Scheduled Autos (Per Person) Hired Autos Bodily Injury Non-Owned Autos (Per,Accident) Property Do nage (Par Accident) EXCESS/UMBRELLA LIABILITY Each Occurrence Occur ❑ClairtD Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2014 01/01/2015 x I WO Slat, OTH- Employers`Liability to Limits ER Any proprietor/partnedexecutive officer/member LE1. h Accident $1,000,000 excluded? NO It Yes,describe under special provisions below. ease-�EmfAoyee 51,000,000 ease- $1,000,000 Other Lion Insurance Company is A.M.Best Company rated A-(Excellent). AMB#12616 Descriptions of Operations/Locations/Vehicles/Exclusions added by Endorsement/Special Provisions: Coverage only applies to active efng�Client Company of South East Personnel Leasing,Inc.&Subsidiaries that are teased to the following Client ill: 81.65-788 Pan Y EPOCA Corp. General Contractor Coverage only applies to injuries incurred by South East Personnel Leasing,Inc.&Subsidiaries active emplOyee(s),while working in:FL. Coverage does not apply to statutory employee(s)or Independent contractor(s)of the Client Company or any other entity. A list of the active employee(s)leased to the Client Company can be obtained by faxing a request to(727)937-2138 or by calling(727)938-5562. Project Nam: ISSUE 07-25-14(TD)y REISSUE 09-16-14(TLD) CERTIFICATE HOLDER CANCELLATION Begin Date 51211;1014 VILLAGE OF MIAMI SHORES Should any of the above described policies be cancelled before the exp iraft date thereof,(he issuing VILLAGE HALL. insurer will endeavorendeavor-mats 30 days written notice to the certificate holder named to the left,but failure to CIO so shall impose no obi IgahOn of liability of any kind upon the insurer,its agents or representatives. 10050 NE 2NDAVENUE MIAMI SHORES, FL 33138 ��