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FW-15-1294 Permit nr©. FW-6-1 54 294 `yuoR s Y't Miami Shores Village Permtf'TYpa Fence/Wall 10050 N.E.2nd Avenue NE work asssr> at+on 11II"Ire F0ll Miami Shores,FL 3313&0000 er Pormit Phone: (305)795 2204 E Issue ft'o15 Expiration: 11130/2015 Project Address _ Parcel Number Applicant 11300 NE 2 Avenue Number: Health & Sport 1121360010160-23 Miami Shores, FL 33138-0000 Block: Lot: BARRY UNIVERSITY INC Owner Information Address Phone Cell BARRY UNIVERSITY INC 11300 Nv E 2 Aenue � MIAMI SHORES FL 33161-6628 11300 NE 2 Avenue MIAMI SHORES FL 33161-6628 Contractor(s) Phone Cell Phone # Valuation: $ 5,400.00 ROYAL FENCE AND EQUIPMENT COF (305)477-7191 (305)758-6975 Total Sq Feet: 70 Approved: Available Inspections: Comments: InspectioLType: j Date Approved: : FinalDate Denied: FoundatioType of Construction:Wire Fence Additional Info: INSTALL FENCE SCREEN PROTECT Review PlaClassification:Commercial Scanning:3 Review Bu CANCELLED Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.60 Invoice# FW-5-15-55760 DBPR Fee $2.00 DCA Fee $2.00 05/29/2015 Credit Card $ 50.00 $72.60 Education Surcharge $1.20 06/03/2015 Credit Card $72.60 $0.00 Permit Fee-Wire&Wood $100.00 Scanning Fee $9.00 Technology Fee $4.80 Total: $122.60 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,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I rtify that all the foregoi/nq information is accurate and that all work will be done in compliance with all applicable laws regulating construction and thermore, I au ize t e ove-named contractor to do the work stated. C nil June 03 2015 Authorized Signature:Own Contractor / Agent Date Building Department Copy June 03,2015 1 r � Miami Shores Village APR 3 0 20% Building Department By: 90050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2264 Fax: (305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 20 BUILDING Permit No. PERMIT APPLICATION Master Permit No. )w / f� Permit Type: BUILDING ROOFING JOB ADDRESS: Bang University - HSC - Modular Fence - City: _Miami Shore __ County: Miami Dade Zip: Folio/Parcel#: — Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): Barry University Phone#: 305.899.3995 Address: 11300 NE 2nd Ave City: Miami Shores state: FL zip:33161 Tenant/Lessee Name: Phone#:_ Email: 031 • - CONTRACTOR:Company Name: C' q Address: 500 City: i`- -�1-1<: .'V' kk Stale: �L C7-LCC _-ate zip. Qualifier Name: `Jl cA iz,,D \ :.1 t`L-1 t' Phone#t:E�D - State Certification or Recistrauon;vCertificate of Gump:ieucv#: _0p00 19,577 Contact Phone#: r -7 ' __7J ` Email Address: r�c'k�kc-Q �cc_-� (= A o L ' c_o N DESIGNER:Architect/Engineer: Phone#: Value of Work 'Tb%�for this Permit:T •J� , Square/Linear Footage of Work: \ 47© Type of Work: uAddition OAlteration `l7JNew JRepair/Replace ❑Demolition Description of work: Install fence screen protection at HSC Modt dar trailers Color thru tile: Submittal Fee$ c Permit Fee$ CCF$ ._ CO/CC$ _ 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. 1 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 valdeJexc eding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien lapd'broch a wilj.be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice ofoeommen many t"at be posted at the job site for the first inspection which occurs seven (7) days aper the building permit is isso'd. In t a*nc such posted notice, the inspection will not be approved and a reinspection fee ill be charged. P PP P .f g Signature Signature Owner or AgentContractor The foregoing instrument was acknowledged before me this The foregoing in me was acknowledged before eme this day of�.20 a,by �'� �t� I Q�J day of �.P 1 L 201 4,by-:! .AQ-1 ps z who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identificatt a o did take an oath. NOTARUBLIC: Y Sign: Sign: le,°us is o lorida Print: Print:: lal `` eoF tv0 Expires 0,018/2015 My Commission Expires: y 1 4Y COMMISSION#EE36829 My Co '?a,A MIRES:N-arbor 12,2014 lAW3•NOTARY Fl.Notary Doomat An=Co APPROVED BY I Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) ROYAL-1 OP ID: YL �ACORO" DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 104/17/2014 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(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 endorsement(s). PRODUCER CONTACT iSure Insurance Brokers NAME: Javier A. Fernandez J 8700 W.Flagler St.,Suite 270 A/CO,NN,Ext):305 223-2533 AA ,No): 305-220-0765 IB Miami,FL 33174 E-MAIL Javier@iSureBrokers.com Javier A.Fernandez ADDRESS_ _ _ INSURER(S)AFFORDING COVERAGE _ _ NAI_C_# INSURER A:Security National Insurance Co �. INSURED Royal Fence&Equipment Corp.-- INSURER B:Associated Industries 5500 NW 74 Ave _ - - - -- - . Miami, FL 33166 INSURER c:Progressive Ins. Co. 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 ADDL SUBR LTR TYPE OF INSURANCE -- - _-- - -- '-POLICY EFF POLICY EXP LIMITS POLICY NUMBER MM/DDlYYYY MMIDD/YYYY GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 -_-- -DAMAGE-TO-RENTED A X COMMERCIAL GENERAL LIABILITY x,1923 04/20/2014 04/20/2015 PREMISES(Ea occurrence) $ 100,000 CLAIMS-MADE X OCCUR I MED EXP(Any one person) i S excluded PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/CP AGG S 2,000,000 POLICY PRO- LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident)_. S C ANY AUTO 08468281-2 03/07/2014 03/07/2015 BODILY INJURY(Per person) S ALL OWNED SCHEDULEDI - - - - - - BODILY INJURY(Per accident) S AUTOS X AUTOS X , X NON-OWNED PROPERTY DAMAGE- $ HIRED AUTOS ,. AUTOS ,.(PER ACCIDENT) IS UMBRELLA LIAB OCCUR EACH OCCURRENCE___ S — __--------.._ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTION S S WORKERS COMPENSATION WC STATU- I OTH-I AND EMPLOYERS'LIABILITY 'STORY LIMITS!--ER_ - -. -__-- B ANY PROPRIETOR/PARTNERIEXECUTIVE Y/" AWC1022137 06/26/2013 06/26/2014 E L.EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E L DISEASE EA EMPLOYEE S 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) FENCE ERECTION CONTRACTORS CERTIFICATE HOLDER CANCELLATION CITYMI1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS. Building &Zoning 10050 NE 2 Ave AUTHORIZED REPRESENTATIVE Miami, FL 33138 ©11988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD �SNic193, � Miami shores Village .... �, .....� Building Department 10050 N.E.2nd Avenue �RNp Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHAIN LINK FENCE DESIGN DETAIL (ACCORDING TO THE F.B.C. SECTION R4408.11) TABLE R4408.11 CHAIN LINK FENCE MINIMUM REQUEREMENTS Fence Terminal Post Line Post Dimensions Terminal Post Line Post Concrete Height (ft) Dimensions (in inches) Concrete Foundation Size (in inches) (o.d.X wall thickness) Foundation Size (diameter X depth) (o.d.X wall thickness) (diameter X depth) (in inches) _ _ (in inches U t -- --23-/8 x0.042 1518x0.047 10x24 8x24 Over 4to5 23/8x0.042 1718x0.055 10x24 8x24 For SI:1 inch=25.4 mm. NOTES: 1. This table is applicable only to fences with unrestricted airflow. 2. Fabric:12%gauge minimum. 3. Tension bands:Use one less than the height of the fence in feet evenly spaced. 4. Fabric Ties:Must minimum the same gauge of the fabric. 5. Fabric Tie Spacing on the Top Rail:Five ties between posts evenly spaced. 6. Fabric Tie Spacing on Line Posts:One less than height of the fence in feet,evenly spaced. 7. Either top rail or top tension wire shall be used. 8. Braces must be used at Terminal Posts if top tension wire is used instead of Top Rail. 9. Post Spacing:10 foot(3m)on center maximum. 10. Post shall be embedded to within 6 inches(152 mm)from bottom of the foundation. 11. In order to follow the contour of the land,the bottom of the fence may clear the contour of the ground by up to 5 inch (127 mm)without increasing table values to the next higher limit. NOTICE TO PROPERTIES WITH POOLS: If the fence is to meet the criteria as a pool barrier,the fence shall not be climbable and all rails must be placed facing the inside of the property.Pedestrian gates shall have self-closing and latching devices installed at the minimum of 54" above ground.For further details see Section R4401.7.1 of FBC. CONCURRED Created on 512212009 MLDV Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-235692 Permit Number: FW-5-15-1294 Scheduled Inspection Date: October 20, 2015 Permit Type: Fence/Wall Inspector: Rodriguez,Jorge Inspection Type: Final Owner: , BARRY UNIVERSITY Work Classification: Wire Fence Job Address: 11300 NE 2 Avenue Health &Sports Miami Shores, FL 33138-0000 Phone Number Parcel Number 1121360010160-23 Project: BARRY UNIVERSITY Contractor: ROYAL FENCE AND EQUIPMENT CORP. Phone: (305)477-7191 Building Department Comments INSTALL FENCE SCREEN PROTECTION AT HSC Infractio Passed Comments MODULAR TRAILERS INSPECTOR COMMENTS False RENEWAL OF EXPIRED PERMIT FW14-870 Inspector Comments Passed f�t_ Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 19,2015 For Inspections please call: (305)762-4949 Page 9 of 42 C-TVFD �0 Miami Shores Villa ge MAY T9 2015 �;► Building Department BY: 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 2046 BUILDING Master Permit No.f �i�! e .129,v-1 PERMIT APPLICATION Sub Permit No.FW 14-870 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION QRENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS [:] CHANGE OF [:] CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 11300 NE 2nd Ave. HSC Building, City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:_ Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Barry University Phone#:305-899-3785 Address: 11300 NE 2 Avenue city: Miami Shores state: FL Zip: 33161 Tenant/Lessee Name: NSA Phone#: Email: CONTRACTOR:Company Name: Royal Fence and Equipment Corp. Phone#: 305-477-7191 Address: 5500 NW 74 Avenue City: Miami State: FL Zip: 33166 Qualifier Name: Isidro F Suarez Phone#: 305-785-6975 State Certification or Registration#: Certificate of Competency M 000019577 DESIGNER:Architect/Engineer: N/A Phone#: Address: 11300 NE 2nd Avenue city. Miami Shores state: FL. Zip: 33161 . Value of Work for this Permit.$5400 Square/Linear Footage of Work. 70 Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: INSTALL FENCE SCREEN PROTECTION AT HSC MODULAR TRAILERS z=e2 arc,.1a e o` cleeiz / Gam Specify color of color thru tile: Submittal Fee Permit Fee$ '� _ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 2 (Revised02/24/2014) Bonding Company's Name(if applicable) N/A Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) N/A 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 broc will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commegeemynt m be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In e a sen such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT //CO�14AACTOR The /foregoing instrumentt was acknowledged before me this The foregoing instr ment as acknowledged before me this L1��w day of P�1�r 20 1J by day of " � ,20 1 �" by KWOLOOM G„L who is e�rsonally known to � j � �1ZQ Z who is personally known to m�e or who has produced as me or who has produce as identification and who did take an oath. identification a did to an oath. NOTARY PUBL C: e., NOTARY B Sign:_ Si n: Print: Print: c1 Floddat Seal: Hoary Punic Sat•or Fwride #►FF 2217 Jeffry J Yao al: wOMw.Expires Apr 18,2019 My Commission FF 168461 NoonW Notary Assrl. ��1►� Expires 11112/2018 APPROVED BY C I Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) -� ROYAL-1 OP ID: MARZ CERTIFICATE OF LIABILITY INSURANCE DATE05/29/2015 05/29/2015 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). PRODUCER CONTACT Javier A. Fernandez iSure Insurance Brokers NAME: 8700 W.Flagler St.,Suite 270 P"CC,o Ext:305-223-2533 FAX No):305-220-0765 Miami,FL 33174 E-MAIL Javier A.Fernandez ADDRESS:Certificates@iSureBrokers.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:American Empire Surplus Lines 35351 INSURED Royal Fence&Equipment,Corp. INSURER B:Associated Industries 5500 NW 74 Avenue Miami, FL 33166 INSURER c:Progressive Ins.Co. 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 rypE OF INSURANCE DDL UBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM DD MM DD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE OCCUR 14EP0186161 08/01/2014 08/01/2015 PREMISES Ea occurrence $ 100,00 MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,00 POLICY❑ PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 2,00000 OTHER: I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 000,00 Ea accident r C ANY AUTO 08468281-3 03/07/2015 03/07/2016 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS XX NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/" B ANY PROP RIETOR/PARTNER/EXECUTIVE AWC1033634 06/26/2014 06/26/2015 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? El (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under 1 000 00 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) License # 000019577 CERTIFICATE HOLDER CANCELLATION VILLAMS li SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Fax:305-756-8972 10050 NE 2 Ave. AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 @ 11988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Yamil Kuri, P.L. Civi/Strwtural-Florida Reg..4 44726 /d° /o X 10 RAGS Po 6715 /5f8"00 `� U v� .o�� 4d OA y' � m IV01-77x!6 log d 1-7-4RNdI-X 4 a77 z W,A 4V N li i/ ll � TrP/c�G F ooTitir 6 s/aE .s. 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