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EL-14-1324 �� up Miami Shores Village ?(e-c-� CCA lege Vv,C-C DEC 03 Building Department c -'L&C'L— VQDIC� 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 — Tel:(305)795-2204 Fax: 30 ( 5)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 20 �Q)BUILDING (waster Permit No. 1 °� PERMIT APPLICATION Sub Permit No. t7-�-- - � 2-9 ❑BUILDING tj'ELECTRIC ❑ ROOFING /REVISION ❑EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County Miami Dade Zio Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): � n yp .� (tS (_�,� Phone#: Address: �O C � 5r�4� Q P /( L Add -- -- l�S state: Tenant/Lessee Name- Email: Phone# Email: 9)6(�A a- h Ct Ctil✓�XP sA i-&-, G v�ou�+ CONTRACTOR:Company Name: lv ![10eGY/ G ��C ,�' /� SerVIL'e� 41CZ&Phone#: Address: l5-9C,;- 5w la<-Ce City: le State: F /n�� Qualifier Name: S d Cx0 Phone#: 500 2 ltd+ )7122 State Certification or Registration#: 46R F/3 01 Z- 0 Certificate of Competency#:.1,2,E�Voo ��Z— DESIGNER:Architect/Engineer: Phone#: Address: City State: Zip: — Value of Work for this Permit:$ Square/Linear Footage of Work:- Type ork:Type of Work: ❑ Addition ❑ Alteration ❑ Neyy ❑ Repair/Replace ❑ Demolition Description of Work: t!l P V1.51 'Al , k1 a ke.✓ - <� VLS, 4�1 Specify color of color thru tile: Submittal Fee$ Permit Fee$ ')P'.'r® CCF$ CO/CC$ Scanning Fee$ '� Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$�C7 !la 1 (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 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 commencem nt must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the Bence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this I day of �[;l�� 20 c� by day of 'N/vG 020 by S�L/A1►1�'�who is Danro-rAlly known to C daL4!L- who is personally known to me or who has produced as me or who has produced as identification and who d' a n oat identification and who did tak 0 NOTARY PUBLIC: NOTARY PUBLIC: Si n. Sign. Prin Prin Seal: CARLOS A GUERRERO Seal: ? , C 03 A OUERRERO =•t ''� MY COMMISSION�EE176700 - Lbf++IMI331OP1#EE176700 EXPIRES March 06,2016 EXPIRES A 06.2016 OM 3W-M53 PMM%40Wy8"VW&— APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) • 4 - 6 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 anslE�) Inspection Number: INSP-224906 Permit Number: EL-6-14-1324 Scheduled Inspection Date: December 11,2014 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: , Work Classification: Alteration Job Address:29 NW 110 Street Miami Shores, FL 33168-4318 Phone Number (310)622-3079 Parcel Number 1121360030620 Project: <NONE> Contractor: GLOBAL ELECTRIC SERVICES LLC Phone: (305)218-0752 Building Department Comments LIGHT AND SWITCHES FOR NEW MASTER BATH AND Infractio Passed Comments CLOSET. RECESSED LIGHT IN LIVING. INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-224693. Range and dryer need 4 wire receptacles. All counter receptacles to be G F I protected. Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. December 10,2014 For Inspections please call: (305)762-4949 Page 17 n� l q-- /3zy//Y_/161 ACCPREPDACERTIFICATE OF LIABILITY INSURANCE 9/5/2014' 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(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 �MEAOT Jackie Ortega Fortun Insurance, Inc. PHONE (305)445-3535 FIt 0.(866)415-0825 365 Palermo Ave. E-DDR AESS.jackie.orteg0fortuninsurance.com INSURER(S) AFFORDING COVERAGE NAIC# Coral Gables FL 33134-6607 INSURERAMAPFRE Insurance Co. INSURED INSURER B.RetailFirst Insurcance Company Global Electric Services LLC INSURERC: 15905 SW 105 CT INSURER D: INSURER E: Miami FL 33157 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1482706677 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD MM/DD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY -PREMISES(EaEoccurrence) $ 100,000 A CLAIMS-MADE FxI OCCUR CP0324225 /30/2014 /30/2015 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NO OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ B WORKERS COMPENSATION WC STATURY IMIT ER AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ 1 000 000 ED? OFFICER/MEMBER EXCLUD20-48297 /15/2014 /15/2015 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1 000 000 If Ies,descr be under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space is required) Electrical Work CERTIFICATE HOLDER CANCELLATION (305)756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 Ave Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Hector Forton/IZ ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS02519mnnFi m Tho Ar:r1RI1 nnmo 2nel Innn neo ronicforcri morIrc of Ar:r1Qr1 Miami Shores Village Y_ Building Department I LO(o2-16-19 90050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 "` r ,— INSPECTION'S PHONE NUMBER: (305)762.4949 JUN 2 0 201 FBC 20l y. BUILDING Permit No. O Ll @ 13-2-1-1 PERMIT APPLICATION Master Permit No. Dy—d D4v Permit Type: Electrical JOB ADDRESS:ZY 41 4L) //0 J-7— City: -ICity: Miami Shores County: Miami Dade Zip: T:3 / G Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): 4 C C Phone#: JC 4 C G r) C j Address:!2 !j 6 j C 11Ae V7 5__ 5, City: V-r—k2e-12 6 ;e State: C f} Zip: �Z Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name:61_0-�64 L P4 LCCT T� 1 C SEAT/[GK Pho#: Address: /.5'90 7' (lam F(0 5-C, City: State: P4 Zip: Qualifier Name: (05Ren,n, r za 4cz, Phone#: State Certification or Registration#: R 13,0 I7 go S Certificate of Competency#:�_�� ®®YJ Contact Phone#: 305. —31?-07,5a Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit:$ �, Square/Linear Footage of Work: kuz) N Type of Work: ❑Address '`'` OAlteration ❑New ❑Repair/Replace ODemolition Description of Work: kZ�kh f/k�nQ u _p t��I TLS V-V_W Vena S4e4/- n L cQ S !� (`ice 5a,24CA��S (�L-1 �i �c�, ��x�x�:xx��x�:xxx:xxxxxxxxx��x�xxxxxxx��xxFees��x��yx�*�x:x�xxxx�����x��xx�����xxx�xx���x�x� Submittal Fee$ 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$ II �) ro 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 $250 the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure rill be livered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commence nt m e posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In sen e f such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature 4Le-c J OZ-110-4 -Ld(WDe;�.�Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The Wreggooing instrument was acknowledged before me this'd day ofMAT,20 I� ,by �OLVEI& <AaAJAeV day of f'^ ,20�Y ,by L„a"�f'<t�'e (,�P•`� ,� g who is personally known to me or who has pr who is personally known to me or who has produced �j9-WCA& (-i C• As identificatia P� i ` an oath. as identification and id t n o NOTARY PUBLIC: / NOTARY PUBLIC: 00 �o ` yor'�i,�'9ipf Sign: G�� Nyco losy0ssoi0g9s Sign: c 9 Print i ( �F+�9�ie j'�Oyi9�v rint: eS CoGifo 'y t33 My Commission Expires: 'l'o` 4y�4id o issio xp APPROVED BY �/�l // ,�'Ct��/ Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) /®grKG,3o L1 Bill UNIX Miami shores Village Building Department azo 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A$30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE(CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE(EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: GLOBAL ELECTRIC SERVICES, LLC BUSINESS ADDRESS: 15905 SW 105 CT CITY MIAMI STATE FL ZIP CODE 33157 BUSINESS PHONE: 3( 05 ) 218-0752 FAX NUMBER 3 675-5710 ( 05 ) CELL PHONE305 218-0752 OSMANI GONZALEZ ( ) QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: 12E000422 E-MAIL ADDRESS (IF APPLICABLE): osmanigm@yahoo.com Created on 3119109 BY MLDV 1 RV 3126109 MLDV RICK SCOTT, GOVERNO.: KEN LAWSON, SECRETARY s STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD `S i f g••` ER13014808 The ELECTRICAL CONTR,'CTOR Named below HAS REGISTERED Under the provisions of Ch.'!','iter 489 FS. Expiration date: AUG 31, 16 (INDIVIL .L MUST MEET ALL LOCAL LICENSING REQUIRE..IENTS PRIOR TO CONTRACTING IN ANY AREA) 0�' E GONZALEZ, OSMAF GLOBAL ELECTRIC SERVICES LLC 15905 SW 105TH C., '� MIAMI FL '1157 91,N. ISSUED: c 14 DISPLAY AS REQUIRED BY LAW SEQ# L1406080001817 C Z tbl o g m N S G ; M _iR 111 c y Z Ty D fny o r' ° 0 P" d rn Mg`^, O yj�� �S p m a C CO N n'g a O n Orn' 7= 0 0 C1 all ..4.� Miami shores Village Building Department RIDp 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company. Therefore,you may be personally liable for the worker compensation injuries of any person allowed to work under this permit Please check with your insurance carver since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner Contractor Print Name: e f Print Name: Signature: Signature: Ja� State of Florida) State of Florida) County h ' County of Miami-Dade) Sworn ust� Sworn to and subscribed be£ofe 46. 1 day of n & +T Ft . day o . EXPI 6 ERO (•c9�aP&D Fl SES ay 2 M M EE176700 By (SEAL) 0000 (S 4un t Type of Identifica ' T e of Idents on produced D46081'°," „ r x fit y yti W'r"­ w e v it ii Ia M1rt� Dade C9t � y�o/ wrt � s T killQT' 115i s C'II e 762$8�c 9 Ali epi ��a ir p1( I lids"` sl - BtiSSNR$$-W�1`E/i(7C,h1�N r Ia RECEIRt NO t r1svfcsLLC ETiIB. R 3d 2U14 1560��55ryV1�g1YQj � �fia� I, ,71" qfi Must die d�spl }eyd at pl�te of p�rsirae ., i�lillM{�tFJa1j ,61 4�pa��Irh t`tioptet:8}4-Att 9$110 Ama r � SEC.TYPE OF$USINES3 , �s PAYMENT,RECEIVED GLQ$AL `ELECTRIC SERVICES LLC 196 El,� TRIOAtINTRA�3R 12EOOtl 2�. BY TAx co>4ECTDR, Wor�tet6) 7 ���; $7500 ,07/09/2013 ' IIh,�sou' CREDIT�D-102016 Ilds Local Business Tax Reenfiof10616 1 Business Tax The iaeeipt is not a license, germ or a certHicafian of We h�ltler 1 gnalHicahoag to do business.Holder mull complywleh any governmental or he tr gmmental logulatory laws aiid'tequiremet►tswhich app"the bu$(dess ` Tlie RECEIPT NO.above,musuosAsplayedtgn all corttiAertial veh�rlsS ml sDs ti Code Sec 8a-276., , est.lnor'riitormation"vise www.miamidade govffaxcollector` i ULUBALE OP ID:JQ CERTIFICATE OF LIABILITY INSURANCE D0611812014 611 81 2 01 4Y) 06!18/2014 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(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 Phone:305-221-2400 NAME: Tropical Insurance Agency Inc. -- _— HN 8700 West Flagler St Ste 230 Fax:305-552-5360_r&11-Extl: ,_,_,,__—�. arc 14 —.... Miami,FL 33174 ADDRESS: Connie Lageyr® _ AFFORDING COVERAGE NAIL ......._—_.__ _ INSURER A:Granada insurance Company _... INSUREDGlobal Electric Services LLC INSURERS: � 15905 sw 105 ct Miami,FL 33157 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. iNSk ......_-......_ LTR TYPE OF INSURANCE POLICY NUMBER MM/DDIYYYY MP DCf P LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 500,00 .._...._... A X COMMERCIAL GENERAL MIS LIABILITY 0186FL00038772 08/30/2013 08130/2014 PREMISE (Ea s $ 100,00 CLAIMS-MADE [...^_I OCCUR i MED EXP(Arty one parson) E 5,00 PER80NAL&ADV INJURY $ — 500,00 GENERAL AGGREGATE $ 1,000,00 GENT AGGREGATE LIMIT APPLIES PER' i PRO PRODUCTS-GOMPIOPAGO $ 1,000,©� POLICY 1 LOC AUTOMOBILE LIABILITY CO accident! COMBINED SINGLE LIMIT ANY AUTO ALL OWNED BODILY INJURY(Per person) $ SCHEDULED f - - AUTOS AUTOS BODILY INJURY(Per seciaenq $ — NON OWNED .... HIRED AUTOS L ;AUTOS PeOaEc dentD $ UMBRELLA LIAB OCCUR C__. EACH OCCURRENCE $ I EXCESS LIAR CLAIMS MADE AGGREGATE $ _...._ _.. _, _..— __... DEDRETENTIQN IWORKERS COMPENSATIONWC STATU OTH- AND EMPLOYERS RIAStL1TYYIN TQRY LIMITS R ANY PROPRIETORIPARTNERIEXECUTIVE r-- OFFICERIMEMBER EXCLUDED? N J A E.L.EACH ACCIDENT $ (Mandatory In NH) E E.L.DISEASE-EA EMPLOYEE $ N�yas.describe under -_--_... DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ i DESCRIPTION OF OPERATIONS t LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) :lectrical Work License#12E000422 'ERTIFICATE HOLDER CANCELLATION 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, 10050 NE 2 AVenue A HO ED R RESENTATIVE Miami Shores,FL 33136 C nnie ey 1988-20 0 ACORD CORPORATION. All rights reserved. 1CORD 25(2010108) The ACORD name and logo are registered marks of ACORD