SGN-15-2155 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-242070 Permit Number: SGN-8-15-2155
Scheduled Inspection Date: September 18,2015 Permit Type: Sign
Inspector: Rodriguez,Jorge
Inspection Type: Final
Owner: SKLAR,ARI&OSCAR Work Classification: Addition/Alteration
Job Address:9400 NE 2 Avenue 9400
Miami Shores, FL 33138-0000 Phone Number (786)326-2747
Parcel Number 1132060132780-00
Project: <NONE>
Contractor: BOB SCOTT LIGHT, POWER AND SIGN Phone: (954)981-6770
Building Department Comments
RENEWAL OF EXPIRED PERMIT SGN 12-444 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 17,2015 For Inspections please call: (305)762-4949 Page 27 of 37
SPRINT NEW BRAND SIGNAGEMAR � 1 SID FT. 22.2'
Front Elevation _ i
yw4Yr
30'-0" Lease Width
SPRINT _
i
Existing
Description: New Channel Letters and Logo Direct lunted.
it
-/—L Channel Letters:24" Reverse Channel Letters with 3" Returns,
and .090"Aluminum Faces Painted Black.
8'-8 1/2" �9" V-7 5/8"I Letters have %2"Stand-Off from Wall
Channel Logo:24"Thermoformed Acrylic Logo, Pigmented PMS 7405
Yellow with Gray Vinyl Counter Shape, 5" Dark Metallic Silver
2'-0" Aluminum Returns, 1" Metallic Silver Trim Cap with Glossy Finish.
LSPRINT
�� - Illumination: Letters and Logo are Lit with White LED's.
.. _ __.__ __.__..-.__ - .___......._....._..__._.
LANDLORD APPROVAL DESIGN,SPECIFICATIONS AND COLOR APPROVALS CLIENT. Sprint DATE: 10.21.11
Another Day In The undeo
' consents to the installation and maintenance
This drawing is the property of Paradise Signs,Inc. ADDRESS: 9400 NE 2nd Ave.,Miami Shores,FL
Paradise Signs Inc of thisn my perty in accourdance with the All rights to it's use for reproduction are reserved
r e aradise Signs,Inc.and my Tenants) by Paradise Signs,Inc. DESTINATION:
10920 Switzer Ave.#113 and e r ewa s� of r Iifica Ions ere SALESMAN: Jacque Forsher R/01.19.12
Dallas,TX 75238
fax:214.221.7244
.3 DESIGN#:
"' t.: 214.221.7242 DESIGNER: J.C.L. PAGE#: 1 of 5
N�Pa►�c�� art�'S�'11.J
tt` s.;j Gr L1 L,
SPRINT NEW BRAND SIGNAGE SQ FT- 7.5'
Side Elevation
a
xY
-
ill ��i
I�
F
E.
Existing
Description: New Channel Letters and Logo Direct Mounted.
6'-5 1/2" Channel Letters: 14" Reverse Channel Letters with 3" Returns,
and .090"Aluminum Faces. Letters Painted Brushed Aluminum.
5'-1" 5"� 11 1/22" Letters have 1/z" Stand-Off from Wall.
' Channel Logo: 14" Flat Face Logo,Acrylic Pigmented PMS 7405
Yellow with Gray Vinyl Counter Shape, 5" Dark Metallic Silver
1 -2 \ Aluminum Returns, 1" Metallic Silver Trim Cap with Glossy Finish.
Illumination: Letters and Logo are Lit with White LED's.
LANDLORD APPROVAL DESIGN,SPECIFICATIONS AND COLOR APPROVALS CLIENT: Sprint DATE: 10.21.11 i
Another Day In --- ----— --.._.................
The
undersigned consents to the installation and maintenance This drawing is the property of Paradise Signs,Inc. ADDRESS: 9400 NE 2nd Ave.,Miami Shores,FL
Paradise Signs Inc of this si perty in accourdance with the All rights to it's use for reproduction are reserved
agree rit between aradise Signs,Inc.and my Tensnt(s) by Paradise Signs,Inc. DESTINATION:
10920 Switzer Ave.#113 and exten ' e ewals or modifications thereof. SALESMAN: Jacque Forsher R/01.19.12
"5° Dalias,TX 7528
`M fax:214.221.724 DESIGN#:
214.221.7242 Date DESIGNER: J.C.L. PAGE#: 2 of 5
MSI c,
i,C_.
f 5" STUCCO OVER BLOCK
! i
.040 ALUM.RETURNS
FI C\/ATI(lAl• C."...a AND.063BACKS 1/4"x2,5"TapCons
li
j 1,T 1 1/2"SEALED FLEX.CONDUIT
-----
98 SELF TAPING SCREWS
MAX 12"OIC SPACING
18 GA UL LISTED AS PER NEC 600.31
8'-8 1/2" 9 —7 WIRE MAY RUN WITHOUT CONDUIT
--�
ALL WALL PENETRATIONS UL LISTED JUNCTION BOX,AS NEEDED
SEALED WITH SILICONE
Yy 1/2"FLEX AND CONNECTOR,AS NEEDED
2'-0"
LSPRINT
LED LIGHTING UL LISTED TRANSFORMER CAN
color i s BLACK
1!8"ACRYLIC FACE 20 AMP SERVICE DISCONNECT
j LED POWER SUPPLY,1.5 AMPS EACH
i
ELEVATION: Side 20 AMP DISCONNECT DEDICATED SUPPLY BY OTHERS
TIMER OR PHOTO CELL IN LINE
ALL CONDUCTORS TO BE#12 THWN
�,ttrcrrr/� Grounding and bonding
�� � *#12 ground wire,or metallic
•1.E .h'q liqudtite connected to
letters and Transformer can
if 's/O
�,,''NA
Structures International,Inc.
All electrical components are UL listed grounded Total Electrical Load Monzer Faramawi PE 57439
in accordance with NEC 250&600, 3 Power Supplies rated @ 1,5 amps This sign complies with Chapter 16,FBC 7501 Wiles Rd Ste 106b
j TOTAL SQUARE FOOTAGE: U� engineered to 146 mph wind loads dissimilar Total load=4.5 amps 2007 HVHZ 146 mph 3 sec gust Coral Springs,FL 33067
materials treated in accordance with FBC. Panel 1,Breaker 12 dedicated to this sign. ASCE 07-05,Exposure C 954_227-1512
Job Name: Sprint Rep: Josh Date: FEBRUARY 2012 �l
Address: 9400 NE 2nd Ave Scale: NTS Page: 1 a
City, State: Miami Shores, FL Artist: Josh Of: 1 4a;E'er Bch FL 33064
� X$ F I
Miami Shores Village y ,
10050 N.E.2nd Avenue NE
' Iitt,Alte �
Miami Shores,FL 33138-000051-0 jz
3rr ettra T, OV D
^a Phone: (305)795-2204
iaxivf` 3
10 Da 01 Expiration: 2/29/201
Project Address Parcel Number Applicant
9400 NE 2 Avenue Number: 9400 1132060132780-00
Miami Shores, FL 33138-0000 Block: Lot: MSVC LLC
Owner Information Address Phone Cell
MSVC LLC 2310 NE HOLLYWOOD BLVD Street (786)326-2747
HOLLYWOOD BLVD FL 33020-
2310 NE HOLLYWOOD BLVD Street
HOLLYWOOD BLVD FL 33020-
Contractor(s) Phone Cell Phone Valuation: $ 50.00
BOB SCOTT LIGHT,POWER AND SIG (954)981-6770 Total Sq Feet: $
Type of Sign: Available Inspections:
Electrical Sign: Inspection Type:
Height: Final
Width:
Review Planning
Color: Elevation: Review Electrical
Plans Submitted: Additional Info: Review Building
Classification:Commercial Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
DBPR Fee Invoice# SGN-8-15-56828
$2.00 08/24/2015 Check#:1000 $50.00 $64.60
DCA Fee $2.00
Education Surcharge $0.20 09/02/2015 Credit Card $64.60 $0.00
Permit Fee $100.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $114.60
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,RO FING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and t at all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-named contra or to do t e stated.
September 02, 2015
Authorized Signature:Owner / Applicant / Contractor / Agent V Date
Building Department Copy
September 02,2015 1
Miami Shores Village AUG 24 1015
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 /d
BUILDING Master Permit No.<6 I) I-�f. S
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
F-1 PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
/JCONTRACTOR DRAWINGS
JOB ADDRESS: �?®� �'e�City: Miami Shores County: Miami Dade Zia: 3 3i
Folio/Parcel#: & C' /.?z 78e7 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): 5,/r6"P2 Phone#: 711 326 --2?y7
Address: 2-?10 'V,6- ear, 1,.f&k1
City: z ew-1 State: ecr-® °cls Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: �cE'f� 4 Ji/ 0?0,C1 0' Phone#: 9S2L 9*1 d 7-70
Address: 3 J 5 d°° •
City: des¢ State: �d Zip: 3 ® �
Qualifier Name: zr®,�et Xce W Phone#: 73Y
State Certification or Registration#: ��/ ✓�� 9��� Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ s e°"' 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$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Rev1sed02/24/2014)
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
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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will 90WNERorAGENT
d and a reinspection fee will be charged.
Signa ure Signature-
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
.?/ day of A!±g us$" 120 ®X by ;Z/M4 day of eu9..a f ,20 Ir ,by
5ZZA who is personally known to Re,a 5'eef4 ,who is personally known to
me or who has produced fcm.+ c-oik cs7 1<1J'C►�s me or who has producedJobs<L�
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Signi4ms amd, a Sign: .
Print: 'C— Print:
Seal: ci;'• 'b VALUEAt+gVNtfXtF�E Seal: R1YQ6MMI3310NiFF098�15
+1 c1,u )+ MY MUSSIMI i FF OM �6 EXPIRES Jure�.ZO78
EXPIRES:Jun 3o,2018 �l� bww Th- Pu
Bow Tin May puft U w"Ibme Nom bacUrtdenr a
APPROVED BY Plans Examiner Zoning
Clerk
(Revisedo2/24/2014)
Sg�RES 6
�n
' logo un.V" Miami bhores Village
Building Department
R� 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION
IF CONTRACTOR 1S A FLORIDA STATE CERTIFIED CONTRACTOR:
A. X COPY OF QUALIFIER'S STATE LICENCES
B. X COPY OF LOCAL BUSINESS TAX RECEIPT
C. X COPY OF LIABILITY INSURANCE*
D. X COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR'S TAX RECEIPT.
D. COPY OF LIABILITY INSURACE*
E. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
*YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES,FL 33138
Certificate must specify the description of operafions or contractor license number.
BUSINESS NAME: Bob Scott Light, Power and Sign
BUSINESS ADDRESS: 3521 SW 35th Street CrryWest Park STATEFL ZIp33023
BUSINESS PHONE: (954 1981-6770 9FAX NUMBER 9( 54 ) 985-2676
CELL PHONE(754 ) 246-3495 QUALIFIER'S NAME: Robert Scott
QUALIFIER'S LIC NUMBER: EC 13005596
�` 4 STATE OF FLORIDA
DE
pARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
t-
ELECTRICAL CONTRACTORS LICENSING BARD (350) 487-1395
�$
1940 NORTH MONROE STREET
TALLAHASSEE FL 323WO783
SCOTT. ROBERT C
BOB SCOTT LIGHT POWER AND SIG[
3521 SW 35TH AVENUE
ST PARK FL 3323
C ! itla tBais N Ise I�ttie y
Orae enbl6sazn F tay og 13 ani£
Pr®#eore�9 R n. ro�a� d i�ursess r�rag STATE OF FLORIDA
ffra�rn ar yat iarokers.ffr�n taoxers to 13arlsla rest�urancs ®EE�s�RTI�EIdT OF BUSINESS ANIS
and tFaey keel►FlPROFESSIONAL REGULATION
Eatery day we work to wiprove the way we do busmess in order to EC13005696 ISSLIEDr 07/21/2014
rare you befter. For informabon about our services,please 109®nto
www.iayflarMalicense.com. Them you can find rncre inffoimation CERTIFIED ELECTRICAL CONTRACTOR
atm our divisions and die regulations mat impact you.subscribe SCOTT:ROBERT C
toitiatsves.deka nent n learn more a the De t's 8013 SCOTT LIQ SIGN
ira
Our Mission at tlae Department is:Lkanse y.Regulate Fairly.
We constantly strive to serve you totter so that you can serve your
customers Thank you for doing business in Florida. IS CERTIFIED ufidW the peed.alons cat Ch 488 FS
and congratulations on your new lKwtsef GsF'�Y".ar.�Yo Ai�73 i�4 ii.::'2,vs�ia;49g;
DETACH HERE
RICK SCOTT.GOVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL COCTORS LICENSING BOARD
EC4 TT OVAL BUSINESS QUALIFICATIONAM
The ELECTRICAL.CONTRACTOR
Named below IS CERTIFIED
Under the provisions of C ter 489 FS.
Expiration date: AUG 31,2115
1111
SCOTT ROBERT C �
BOB SCOTT LIGHT POWER AND SIGN 1W. -
3521
SW 35TH AVENUE
WEST PARK FL 33023
ISSUED 07,,21/2014 DISPLAY AS REQUIRE® BY LAW SF-Q# L i4®s290001191
SROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S. Andrews Ave., RITZ. A-100, Ft. Lauderdale, FL 33301-1595—954-531-4000
VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,2015
DBA:BOB SCOTT LIGHT POWER AND SIGN ReCelp$#:ELEICTRISCAL%ALARMS/CONTRAgTOR
Business Name: Buslness Type:(ELECTRICAL)
Owner Nance:ROBERT C SCOTT Business Opened:l0/20/2014
Business Location:3140 SW 19 ST 669 Sta$e/County/Cert/Reg:EC13005596
PEMBROKE PARK Exemption Code:
Business Phone:
Roomsseats Employees Machines Professionals
4
For Vending Business Only
Number of Machines: Vending Type:
Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid
27.00 0.00 0.00 0.00 0.00 0.00 27.00
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is
non-regulatory In nature. You must meet all County and/or Municipality planning
WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location.This receipt does not indicate that the business is legal or that
It Is in compliance p with State or tical laws and regulations.
Mailing Address:
BOB SCOTT LIGHT POWER AND SIGN Receipt #04B-14-00000390
3521 SW 35 ST Paid 10/20/2014 27.00
WEST PARK, FL 33023
2014 - 2015
DATE
CERTIFICATE OF LIABILITY INSURANCE ; 2/5/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS ;
CERTIFICATE GOES 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 INSURERS►, NAHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIF CATE HOLDER.
IMPORTANT: 8 the certificate holder is an ADDITIONA_INSURED,the poky(iss)must be enoarsed. if SUBROGATION IS WAIVED,sub.00 to
' the terms and conditions of the policy,certain policies tray raegwm an endorsreneat. A statement on this ceridficate ages ita sWollter rights to Ow
1 ccRfftcate holder In lieu of such endorsements►.
PRODUCER NAME. _ANN C SOLED
INDEPENDENT INSURANCE INC PHONE $59}583-7100 Fvc 954j 584-5100"
6827 Sunset Strip 11UC.Ne,Erlp. 4 (A1CNoi t
� (954)584-5100
Sunrise, FL 33313 VmMew MIUwins ate" 4=9
INSURER A:STARR SURPLUS LINES INS CO j. _.� -- & ENDVSTRY
INSURED BAILEY ELECTRIC CONSTR736TION LLC INSURER B. GE
dba BOB SCOTT LIGHT,PO-NER & SIGN wSURERC."
} 3521 SIS 35 ST �INSURERP:.
HOLLYWOOD, FL 33023 INSURER E
L
954-981-6770 INSURER[
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
i THIS IS TO MRTIFY THAT THE POLICIES OF INSURANCE'LISTED BELOW HAVE SEEN-ISSUED TO THE INSURED NAMED ABOVE FOR THE FOLtCY PE-RICO
INDICATED. NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUE4 OR MAY PERTAIN, THE INSURANCE AFFCRDED BY THE PDLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_LMTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
'gegR" --- - - ' PaOlt^Y F:FF I POLICY EXP
LTR
TYPE OF INSURANCE y,yp POLICY NUMBER ItAttID�/YY I I IMITS
X(COWAERCIAL or,NEM LIABILITY FACII GCCURRtNC $ 1,000,000 :
f DamACETO RENTED
PRLWISt s ca ? c s 100,000
`C(.AlMS,MIACE B OCCUR
SLFG-GI.03115-00 oi/23/aois!01123/2016.MED FJU+;ArtgepersW i 3 5,000
.
A g j PERSONAL s DV INJURY ; 1,000,000
I GENT.AGGREGA'b L MIT APPLIES PER ( NtRAI AGGREGATE s 2,000,000
i P OL=i JR?` !SOC PROaUC i5-CO APhJF AG 3 2,000,000
_ a HER ! } 5
} AUTOMOBILE LIAett.:TY (Ea acccrlead) 3
I AhYAVTO i1i I BODRYKPJRY:Per person; 3
1ltt.OWNED SCIIETLkO i } :SWH.Y INJURY tPer acc4era} 3
ADTCJS °AUTa:i i i PROPERTY DANIA":
NON-OWN,n ; (Per ao-holf)
' Hw..OAUrDS AUTOS
a'
IueIBRELr R Nae IX
OCCUP ao1/23/2015`•01/23/2016,EACH OCCURRENCE s 2,OC O,000 .
`ExcessIWB E$U017101476 AGC4&GATF `.$ 2,0G0,400s
B X :clA rnaDE� i
} DED +RETENTION$ r $
WORKERS COMPENSATION STATUTE EK
AND EMPLOYERS^LIABILITY vrav r
7 'ORPAR(PP'.PoEXEWTIV� F.ACIIACCIUENT -$
ANY PR:A _
'OF I Ia:F.RMC Rffi R EXC..Ia,'EC? .^•IIIA ,
( wy m NHt t f t plSfhbC A E41i't OYET$
if ws c>':sc*e cn3e' 1=I UISLASE-POLICY I IMlI $
DESCRIPTION OI UPE RAI R7NS Akan
F
DESCRIPTION OF OPFRATIONS J LOCATION:;I VEHICLES(ACORD 101,Adam)Rana im SdiedA may be at a 6 snareSP2w rs re4uk"I
'ELECTRICAL CONTRACTOR
CERTIFICATE HOLDER CANtLL,>,TlOfd
MIAMI SHORES VILLAGE BIJ)G DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EX21 ATION DATE THEREOF, NOTICE WILL BE DELWERED IN
10050 NE 2ND AVEb= ACCORDANCE.AgTH THE POLICY PROVISIONS
MIAMI SHORES, FL 33138
AUTHORIZEC REPRESENTATiV
t 198 X14 ACORD CORPORATION. All rights reserved.
ACORD 25(20"4/01) The AC ORD name and logo are registered riarks of ACORD
\sERTIFICATE OF LIABILITY INSURANCE 12J2912014
produce: Plymouth Insurance Agency This Certificate Is Issued as a of hyforntation cody and oils no
2739 U.S. Highway 19 N. rights upon the CertIlIcaft t1older.Thi certmcate does notaman4
Holiday, FL 34691 or alter the coverage afforded b rthe polus bei
(727)938-5562 insurers Affardirig Coverage NKC
Insured: South East Personnel Leasing,Inc.8 Subsidiaries Insurer A: liar ince Campm1io75
2739 U.S. Highway 19 N. ire s'
Holiday, FL 34691 mac:
hmm D.
e
Coverages
ora
uM respect Wvd*hffft 11H t maybea Pe v 9 Iq d r ► m�8a �d �sa�r
itaftstwum may have been ri by paid
T Number Deft Effective
P Date Limits
LTR ROM lips
(MM/DD
GENERAL LIABILITY Each O=we= L
Commercial General Uabfl ty rentedpzm (EA
Clams Mede ® Occur
Mod F-V
Personal Adv
aggreade limit apples per GenamlAgragate
3gg
Potcy ®P'roj� ® Lm
LE L.I BILM C Una
(EA A
Any Alto �
At O Atls (Pa Parswt)
Sdteduted Autos
{-Bred Autos �9
kPY
Hat- Au@as �A )
Property Damw
lP-
EXC LUU31LrTY E�CUMMINS
6e
H 0— 13 assne
Dedudible
A Workers Compensation and WC 71949 01101/2015 01101/2016 X VVC stair- OTHI-
EmpioyeW i.iabifty m t.lr� ER
Any e tUea EL Each $1+�
ODD
excluded? No EL -Ea S1, ,
If Yes,dt ram special t
ELL Dw�e-Parer Elands 8ir,�0o
other (ern bmwance Company Is sated A- AM 1M6
Descriptions of by EndwsenundiSpeclal Provislorw Client We 83-65-M
Coverage o*apples to active mss)of South East Pftsonnal Leastrv,Inc.&SubsiftrIes that are to the following"Chent C=npW-
Florlde Tradespeopki,LLC
Comae only apps tD htp6ies h'tnt'red by Sotdtr Easy Personnel Leasing,Inc&Subsidiaries activee,,while watang in R-
Coverage does not ap*to stattibmy s)or s)of the alent CWWW or arty other entItY.
A 651 of the aWve s)Wased to the Gent Can(arry can be obtdried by fwft a retest to 0127)937-21M or byaft=93845562.
projeft
Coverage D*8PPOSS to activeCOPIOVESSM Of South East Leadng,Im;wo its Subsidum end we based to the faOxwong"ClentCorroW Florida T
LLC florTerrporaryAssignawdTo SAfl.EY ELECTRIC Bao SCOTT UWffpoWER&SIC4L F 2774&954- -M6/ISSUE 07 12(.IG)R 12MO/i2
(SM/REISSUE 013143(TD)
Beta Raft 3
trFJtTIFlCATE HOLDER CANCIE"
VIUTAGE OF MIM SHORES Sid any of Do abs described poBsies be cmueBed tore the wrphffim dam ti n,610 rseearg
h affi endeavor W mO So days vattlen notoa to fire carMcats kidder trend to fhe lett,butMura to
ATTN:VAWE do so don rose no abtigaffon or Ifeb W[y of mW Idruf upon the Inmer,its agents or represerftfives.
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
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