DEMO-14-1144 Miami Shores VillageEY:Building Department 0i
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 -
INSPECTION LINE PHONE NUMBER:(305)762-4949
BUILD NG Master Permit NoDEry-No )'-I 1 l L1'-A
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL E]PUBLICWORKS ❑ CHANGE CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: NL,3
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): 'wut-- 1`3E `/,CCOe-iA Phone#: a0c)iS7- 4,60- 12,
Address: �2 5 nw 1\\ --s-cv- .
City: Stater Zip: 2-15-2-i268
Tenant/Lessee Name: Phone#: - 9
Email: Z*• L.� + ®�is'�1J���a.0.�� . t11;�
CONTRACTOR:Company Name: L� Gl�P I'.,q `��i � �� Phone#: Rk�2-20-Z°"Cf175-
Address: 1 -7 6 2-`0 &V4 Z7
City P State: l—`.. Zip: 3b&W
Qualifier Name: Gijbj5pob Phone#:%!)0!9-z4K-,4q
State Certification or Registration#: 1 Certificate of Competency#:
DESIGNER:Architect/Engineer: Ac-k _ CT.4,n® Phone#: - '9�40 m
Address: 49061 CAyY1P0 ' �C-'. City: State: (:::,—• Zip:3?>1 L140
Value of Work for this Permit:$ 10,QQa6- Square/linear Footage of Work:
Type of Work: El Addition ❑ Alteration ❑N.ew..� �,,,,,:,..;,.,.. ,Q Demolition
e
Description.of Work:. _ � - C-1 L
ei ', ';'�.S .�.'", °-o t°P4ic'a9¢llliFi�®fie 'dviceiass�e ao>
Specify color of color thru tile:
Submittal Fee$ Permit Fee$�00 °0-) CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ 2? 00
Bonding Company's Name(if applicable) 0
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 exceedin $2500, the applicant must
promise in good faith a copy of the notice of commencement and construction lien law ochur it be delivered to the person
whose grope sub' int. Also,a certified copy of the recorded notice of co encemen st be posted at the job site
for the a on which occurs se pen (7) days after the building permit is issued. In the abse ce such posted notice, the
inspect' will of be approved and a re' spection fee will be charged.
s 1
Signature Signature
/ Owner or A t <
d r
The foregoing instrument was acknowle �before this The foregoing Mf rume was ck edged before me �this day of �U20�� by Ic't. 0 4 by
o is personally known o me or who has produced who is personally known to a or who has produced
As identification and who did take an oath. i entification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC: a
Sign: Sign
Print: r2 C Z .••' -og UZ Print:
imp
My Commission Expires: gay Public-State of Florida My Commission Expi
My Comm.Expires Sep 21,2015 M,�0N#
PIRES:MW
• � ��.•`' Commission df EE 132342 � 26,2DFF 17APPROVED BY Plans Examiner Oc Zoning
Structural Review Clerk
(Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012))(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)
CFN: 20140175852 BOOK 29061 PAGE 1527
* DATE:03/10/2014 04:34:32 PM
HARVEY RUVIN,CLERK OF COURT, MIA-DADE CTY
Return Original to:
Levinson,Gritter&DiGiore, LLP
200 S.Andrews Avenue,Suite 903
Ft. Lauderdale, FL 33301
CERTIFICATE OF APPOINTMENT OF SUCCESSOR TRUSTEE
We the undersigned, being all of the beneficiaries under that certain trust known as the JOSE
MARTINEZ, AS TRUSTEE, INC., AS TRUSTEE OF THE 525 LAND TRUST U/AID 1/6/2014 (the "Tnist"),
Owner of Properly legally described on the attached Exhibit "A", by and between the undersigned and JOSE
MARTTNF.7, AS TRUSTFF., [NC., a Florida corporation, as the original Trustee,do hereby certify that we have
this day duly elected, RAUL SANCHEZ DE VARONA, to succeed to the office of TRUSTEE under the Trust,
and to the title of ail the properties of the Trust, with all the powers and subject to all the restrictions upon the
original Trustee, with the same powers, rights and interest regarding the Trust property and subject to the sarne
restrictions and duties as the original Trustee, except as the same shall have been heretofore modified by
amendment.
[signature page follows]
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CFN:20140175852 BOOK 29061 PAGE 1528
IN WITNESS WHEREOF,the said ORIGINAL TRUSTEE has hereunto set his hand and seals thisday of
February,2014.
ORIGINAL TRUSTEE:
JOSE MARTINEZ,AS TRUSTEE, INC.,a
Florida corporation
By, - -
WI Alex Pardo,President -
STATE OF FLORIDA
COUNTY OF MIAMI DADE
Sworn to and subscribed before me this day of February,2014 by Alex R.Pardo,as President of JOSE
MARTINEZ,AS TRUSTEE,INC.,a Florida corporation,as Original Trustee. He is known to me personally or
has produced his Florida driver's license as identification
aor P!Q� Notary Public State of Florida
Joadys Jorge > �--
N�. fav My Contmiemon EE091348 Notary S'gn
Exptres 08/08/2015
IN WITNESS WHEREOF,the said BENEFICIARY has
2014. hereunto set his hand and seals this/�day of February,
BENEFICIARY:
CREATIVE RE-SOLUTIONS,LLC,a
Florida limited liability company
4
j I
:W1Z'TNES� r _ By. t
Ale R. Pardo,Managing Member
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
Sworn to and subscribed before me this d day of February,2014 by Alex R.Pardo,as Managing Member of
CREATIVE RE-SOLUTIONS, LLC,a Florida limited liability company,as Beneficiary. He is known to me t
personally or has produced his Florida driver's license as identification
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�S0"N Notary Public State of Flortdo
toadys Jorge
Na y< My Commieseon E_)i,1348 Notary gn r
"a Ex fres 0510812015
t A
i
CFN: 20140175852 BOOK 29061 PAGE 1529
IN WITNESS WHEREOF the New TRUSTEE aforesaid has hereto set his hand and seal this /3�1 day of
February,2014.
NEW TRUSTEE:
.SS RAYL CHEZ DE VARONA
,geA4e* pot?, 5
WITNESS fJuict
STATE OF FLORIDA
COUNTY OF MIAMI DADE
Sworn to and subscribed before me this dray of February, 2014 by RAUL SANCHEZ DE VARONA. I le is
known to me personator has produced as identification.
r!�C-
�- ry Signat
8AEi8ARA YANIZ BESU
a�2
q. Notary Public-State a1 Florida
My Comm.Expires Jun 22,2015
COm n slon#EE 8 863
Boded Through tiallonal Notary Assn.
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CFN:20140175852 BOOK 29061 PAGE 1530
EXHIBIT «A„
LEGAL DESCRIPTION OF PROPERTY
The land referred to herein below Is situated in the County of MIAMI-
DADE,State of FLORIDA,and is described as follows:
Lot 13, Block 4,of WEST SHORES,according to the Plat thereof, as
recorded in Plat Book 42, Page 18, of the Public Records Mlami-Dade
County, Florida.
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Property Search Application-Miami-Dade County Page 1 of 7
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Address Owner Name Folio
SEARCH:
525 nw 111 st Suite -C�
__ _..._ ._. __ ,_. ..._._ __ .._---__ _...
. _
PROPERTY INFORMATION
Folio: 11-2136-021-0720
Sub-Division:
WEST SHORES
Property Address
525 NW 111 ST
Miami Shores,FL 33168-3331
Owner
;)4ALEX R PARDO TRS
525 LAND TRUST
JOSE MARTINEZ TRUSTEE INC
Mailing Address
13876 SW 56 STREET#173
M 175
Primary Zone
0100 SINGLE FAMILY-GENERAL
Primary Land Use
0101 RESIDENTIAL-SINGLE FAMILY: 1 UNIT
Beds/Baths/Half 3/2/0
Floors 1
Living Units 1
Actual Area
http://www.miamidade.gov/propertysearch/index.html 5/5/2014
GILNICK ENTERPRISES, INC.
Licenses: CBC010630
CCC1328376
ffi-0006440
APR 0 9 2015
April 8,2015
TO WHOM IT MAY CONCERN
Gilnick Enterprises, Inc. is the construction manager in the project located at 525 NW l lla'
Street,and is responsible for the supervision of the construction activities in the above mentioned
project.
The work has been subcontracted to Casa Urbana,Inc.—Mr. Carlos Abaca, being the president
and Casa Urbana,Inc. and Mr.Abaca have the responsibility of completing all of the work to be
p rmed in the subcontract.
Sinc el
Gil ez
e '
State of ®t1AA County of PSC
Subso and swo before me gn 4
(Date)
(Notary ature)
p,F �e��, =CORTEZray r�'t_ �. NotaFlorida4,; My Co3,2015Iq �;:� Co6015
17320 SW 278th Street
Homestead,FL 33031
Telephone:305.245.4939 0 Cell: 786-212-7197
E-mail:gfernandez1214@hotmaiLcom
JEFF ATWATER
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS'COMPENSATION
* CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS!COMPENSATION LAW
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law.
P �
EFFECTIVE DATE: 11/2912013 EXPIRATION DATE: 1112912015
PERSON: FERNANDEZ GILBERTO S
FEIN: 550854028
BUSINESS NAME AND ADDRESS:
GILNICK ENTERPRISES INC
17320 SW 278TH STREET
MIAMI FL 33031
SCOPES OF BUSINESS OR TRADE:
LICENSED BUILDING LICENSED ROOFING
CONTRACTOR CONTRACTOR
Pursuant to Chapter 440.06{14},F.S.,an officer of a corporation who elects exemption from this chapter by Bing a certificate of election under this section may
not recover benefits or compensation under this chapter.Pursuant to Chapter 440.09(12),F.S.,Certificates of election to be exempt...apply only within the scope
of the business or trade listed on the notice of erection to be exempt.Pursuant to Chapter 440.06(13),F.S.,Notices of election to be exempt and certificates of
election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate,the person named on the notice or
certificate no longer meets the requirements of this section for Issuance of a certificate.The department shall revoke a certificate at any time for failure of the
person named on the certificate to meet the requirements of this section.
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609
4A=16 Repan Viewer
JEFF ATWATER
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS'COMPENSATION
"CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW••
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the Individual listed below has elected to be exempt from Florida Workers'Compensation law.
EFFECTIVE DATE: 413!2015 EXPIRATION DATE: 412/2017
PERSON: ASACA CARLOS
FEIN: 043825609
BUSINESS NAME AND ADDRESS:
CASAURBANA INC
637 NE 92 ST#12C
MIAMI FL 33138
SCOPES OF BUSINESS OR TIRADE:
CARPENTRY WALLBOARD,SHEETTROC PAINTING NOC&SHOP
INSTALLATION OF CA K,DRYWALL,P OPERATIONS
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OFSF24)WC-262 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?{850}4931809
taps!/aM8.ttdfs.com/crreporlviewerlrepWiewer.aspx?data=kdvWnc8D7039HBTERftPI MZ%2tSzbbXKYBxkrekeESoP1y1v4NPOPN42XeirDROXVW... 112
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'�- Miami Shores Village
DEC I �. zo14
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 id
BUILDING Master Permit NoD .ffia
PERMIT APPLICATION ub Permit No. /
OUM11-NG ❑ ELECTRIC ❑ ROOFING REVISION EXTENSION ❑RENEWAL
r_1 PLUMBING ❑ MECHANICAL E]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: S.q4
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flo/odd Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): e- Phone#:
Address: � /?4/
City: State: Zip:_3�3/aq
Tenant/Lessee Name: Phone#:_A:X�- 4_36— 12_%S�
Email:
CONTRACTOR:Company Name:I l I3(G4_iF=0_ke f� 1 G Phone#: 4qJ
Address: 0--�)ZD off• Z'72D-A �C
City: State: Zip: -_:5-5
Qualifier Name: 1 16e*Er� 4lez Phone# 2-4,L "
State Certification or Registration I d L 54 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:
v
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ �) CCF$ CO/CC$
Scanning Fee$ �� CC:) 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 co o the notice o commencement and construction lien law brochure will be delivered to the person
P 9 f PY f f
whose property is subject to attachment. Also,a certified copy of the recorded notice of commen ust be posted at the job site
for the first inspecdq occurs seven (7) days after the building permit is issued. In a ab ence f such posted notice, the
inspection w< e prove and a reinspection fee will be charged.
Si att,rfe Signature
OWNER or AGENT ONTRA
The foregoing instrument was acknowledged before me this The foregoing instr' was ac nowledged before me this
day of 201 by I day,of 20 /4 by
Q " -IT, Smeldt? 'he ,who is personally know to 1 ��'✓� s personally known to
® �
me or who has produced as me or who has produced ''// ✓�
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sig VANIZBESU
Sign:
R-APrint: - Pu C- t •o 1&!) print: YD
=;'qr Pa;= Commission#EE 84863 Seal: • �B4P CYCOUMG
Seal: %.,F#F f.,, MY COMMISSION#EE BIiW�
elk, Bonded Through National Notary Assn. * EXPIRES:February 15,2017
wwwqpw ��9jgOF FI�P`O� Bonded ThruaudgBtNo<arYServt�
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APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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STATE OF FLORIDA
DEPARTMENT OF .ISINESS AND PROFESSIONAL R-JULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395
��►,� 1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
FERNANDEZ, GILBERTO S
GILNICK ENTERPRISES, INC.
17320 SW 278TH STREET
HOMESTEAD FL 33031
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 STATE OF FLORIDA
from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND
and they keep Florida's economy strong. <: PROFESSIONAL REGULATION
Every day we work to improve the way we do business in order to CCC1328376 ISSUED: 08/17/2014
serve you better. For information about our services,please log onto
www.myfloridalieense.com. There you can find more information CERTIFIED ROOFING CONTRACTOR
about our divisions and the regulations that impact you,subscribe
FERNANDEZ,GILBERTO S
to department newsletters and learn more about the Department's GILNICK ENTERPRISES,INC.
initiatives.
Our mission at the Department is:License Efficiently, Regulate Fairly.
We constantly strive to serve you better so that you can serve your
customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS.
and congratulations on your new license! Expiretiw date:AUG 31,2016 u4081700=11
DETACH HERE
RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
CCC1328376
The ROOFING CONTRACTOR r
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2016
FERNANDEZ, GILBERTO S
GILNICK ENTERPRISES,'JNd'
17320 SW 278TH STREET
HOMESTEAD FL33031
a~ 1
ISSUED: 08/17/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408170002511
STATE OF FLORID-
DEPARTMENT OF kI rJSINESS AND PROFESSIONAL ItWULATION
F
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
FERNANDEZ, GILBERTO S
GILNICK ENTERPRISES, INC.
17320 SW 278TH STREET
HOMESTEAD FL 33031
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 STATE OF FLORIDA
from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND
and they keep Florida's economy strong. >® PROFESSIONAL REGULATION
Every day we work to improve the way we do business in order to CBC010630 ISSUED: 07/23/2014
serve you better. For information about our services,please log onto
www.myfloridalicense.com. There you can find more information CERTIFIED BUILDING CONTRACTOR
about our divisions and the regulations that impact you,subscribe FERNANDEZ,GILBERTO S
to department newsletters and learn more about the Department's
initiatives. GILNICK ENTERPRISES, INC.
Our mission at the Department is:License Efficiently, Regulate Fairly.
We constantly strive to serve you better so that you can serve your
Customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.488 FS.
and congratulations on your new license! Expiration dte:AUG 31,2016 L1407230001047
DETACH HERE I
RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION -(crE
jS
CONSTRUCTION INDUSTRY LICENSING BOARD F
CBC0low
The BUILDING CONTRACTORi
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS. -
Expiration date: AUG 31,2016
FERNANDEZ, GILBERTO S
GILNICK ENTERPRISES,INC.
17320 SW 278TH STREET •
HOMESTEAD FL 33031
ISSUED: 0723/2014 DISPLAYAS REQUIRED BY LAW SEa# L1407230001047
CIERTI ICAT OF LIABILITY INSU NCE DATE
11/24/2014
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 pollcy(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 05WaecT Jon Rock
The Contractors Choice Agency PHONE (800)918-3584 FAX (877)684-9951
PO Box 13645 .Jon@nginsuranceonline.com
IN S AFFORDING COVERAGE NAIC N
Chandler AZ 85248 INSURER A.-Preferred Contractors Insurance 12497
INSURED INSURERS:
Gilnick Enterprises Inc. INSURER C:
17320 SW 278th Street INSURER D:
INSURER E:
Homestead FL 33031 INSURER F:
COVERAGES CERTIFICATE NUMBER:CL0962304266 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 LTR TYPE OF INSURANCE POLICYUM POLICY EFF CY LIMITS
GENERAL LIABILnY EACH OCCURRENCE $ 1,000,000
VIED—
X COMMERCIAL GENERAL LIABILITY PREMISESc $ 50,000
A CLAIMS-MADE a OCCUR 90806-TR-02 /28/2014 /28/2015 MED EXP(Any one person $ 5,000
PERSONAL 8 ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 1,000,000
X POLICY PROJECT El LOC $
AUTOMOStLE LIASH TY COMGUEBINED 9M
ecx a $
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
HIRED AUTOS koAUTOS
NON-OWNED PROPERTY DAMAGE $
AUTOS er
UMBRELLA IJAB OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DED I I RETENTION$ $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERT LL481UTY Y I N ER
ANY PROPRIETORIPARTNER/EXECUTMENIA EL EACH ACCIDENT $
OFFICERWEMBER EXCLUDED?
(Mandatary In NH) E.L.DISEASE-EA EMPLOYEE $
If yyeess describe under
DESCRIPI ION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more spam Is requlrod)
Gilnick Enterprises, Inc.
CBC010630
CEIRTIFICATE H06OR CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Miami Shores Villae THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
9 ACCORDANCE WITH THE POLICY PROVISIONS.
10050 NE 2nd. Ave
Miami Shores, F I. 33138 AUTHORIZED REPRESENTATIVE
(305)795-2204
Robert Rock/JON
ACORD 25(2010/05) ®1988-2010 ACORD CORPORATION. All rights reserved.
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