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RC-15-2774 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-251372 PermitNumber: RC-10-15-2774 Scheduled Inspection Date:January 22,2016 Permit Type: Residential Construction Inspector: Rodriguez,Jorge Inspection Type: Final Building Owner: PREDRAG STARCEVIC, KAREN BLAIR Work Classification: Alteration Job Address:1225 NE 92 Street Miami Shores, FL 33138-2936 Phone Number (305)751-9333 Project: <NONE> Parcel Number 1132050270300 Contractor: A-B REMODELING INC Phone: (954)667-5242 Building Department Comments REMOVE EXISTING TILE, SHOWER PAN. INSTALL NEW tnfractio Passed Comments DUROCK. INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. January 21,2016 For Inspections please call: (305)762-4949 Page 30 of 40 !? rrlt°k6t� 1045-2774 �e*t4 m rye Miami Shores Village 33 � errilkTjr s Zell o tial Cot Tiiomon 0111 10050 N.E.2nd Avenue NE �t5f"f� SE' adOlit{�iStti Miami Shores,FL 3313&0000 P}° Phone: (305)795-2204 ' ; 1120�� Expiration: 06106/2016 true _�� 3 Project Address Parcel Number Applicant 1225 NE 92 Street 1132050270300 Miami Shores, FL 33138-2936 Block: Lot: KAREN BLAIR PREDRAG START Owner Information Address Phone Cell KAREN BLAIR PREDRAG STARCEVIC 1225 NE 92 Street (305)751-9333 MIAMI SHORES FL 33138-2936 1225 NE 92 Street MIAMI SHORES FL 33138-2936 Contractor(s) Phone Cell Phone Valuation: $ 4,400.00 A-B REMODELING INC (954)667-5242 Total Sq Feet: 140 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Fill Cells Columns Date Denied: Final PE Certification Type of Construction:REMOVE EXISTING TILE,SHOWEF Occupancy:Single Family Window Door Attachment Stories: Exterior: Framing Front Setback: Rear Setback: Insulation Left Setback: Right Setback: Drywall Screw Bedrooms: Bathrooms: Window and Door Buck Plans Submitted:Yes Certificate Status: Review Planning Certificate Date: Additional Info: Review Structural Bond Return:-- Classification:Residential Review MechanicalReview Electrical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Electrical CCF $3.00 Review Electrical DBPR FeeInvoice# RC-10-15-57614 Review Electrical $2.00 12/09/2015 Credit Card $ 103.00 DCA Fee $2.00 $50.00 Review Electrical Education Surcharge $1.00 10/30/2015 Credit Card $50.00 $0.00 Review Building Permit Fee $132.00 Review Building Scanning Fee $9.00 Review Building Technology Fee $4.00 Review Plumbing Total: $153.00 Review Plumbing Review Plumbing 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,ROOFIN and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing info I acc rate an all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the abov na ed cont ctor o e work stated. December 09, 2015 Authorized Signature:Owner / Applicanton r ctor / gent Date Building Department Copy December 09,2015 1 k [U1-5 Miami Shores Village ' \\6 g BuildingDepartment OCT 0 2015 10050 N.E.2nd Avenue, Mim> Shores,Florida 33138 `- e\� Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 - — FBC 201 L� BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL M PUBLIC WORKS ❑ CHANGE OF CANCELLATION SHOP �[J /� CONTRACTOR DRAWINGS 122�JOB ADDRESS: �" q2-M -q "''-- City: Miami Shores County: Fl Miami Dade Zip. Folio/Parcel#: `��[, '®� ''®3®© Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: a� OWNER:Name(Fee Simple Titleholder): T�) S-TAn C e U i C Phone#: 30.S- Address: City: M I A IL4 I 9-10110 State: fiL zip: 3-31 V. Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: ` �7 'i�Y�® � 1 Y � Phone#: C560 613 -5 Address. �U. �GLk-)! ) City: 1N' State: Zip: '?�e1 Qualifier Name: ®1c-Y( C.- Phone#: State Certification or Registration#: I c:;- Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: �6�0.� Type of Work: ❑ Addition ❑ Alteration F-1 New New Repair/Replace 1:1 De molition rDescription of Work: L66---, R- t 4 � *%- a x ���� 4�to Specify color of color thru tile: Submittal Fee$ ® Permit Fee$ ' 0Z!1 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews 5 Bond 5 (03-� 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 AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 2A day of Q GTO 3 a_ ,20 15 ,by ?—(-� _day of C CCO C,�EQ- ,20 1 !�- by &-11\Q V1C who is personally known to L.Q 6. CnON7A�2 .who is personally known to me or who has produced C-�Mol 66104-33Z" me or who has produced C-�62g i52S :130 s identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: 26 Sign: Sign: Print: dive re— — Print: OR Seal: t Y Poe a= Notary Public-State of Florida Seal: ,p0.r Pue Y ° `''� ; , .`c�'; Notary Public-State of Florida e My Comm.Expires Sep 15.2018 ''• =My Comm.Expires Sep 15,2018 'a"+. �;•' Commission#FF 159996 °`.•' Commission#FF 159996 °,F�`•�o °i Bonded through National Notary Assn. '•n •• BondedthroughNationalW�aryAssn. ' +t APPROVED BY Plans Examiner Zoning LAW OFFICE OF GERALD K.SCHWARTZ,P.A. 1691 Michigan Avenue TELEPHONE(305)673-1101 SUITE 320 FACSIMILE (305)673-5505 Miami Beach,Florida 33139 E-MAID annic@geraldklaw.com Via USPS MAJIL July 318`,2013 Ms.Karen Blair and Mr.Predrag Starcevic 1225 NE 92'Street Miami Shores,Florida 33138 Re: PurchaseJrom David and Tract Winn(the"Seiler')property located at 1225 NE 92ad Street, Miaml,Florida 33138(the"Property") Dear Ms.Blair &Mr. Starcevic: Enclosed,please find the following original documents in connection with the above mentioned reference for your records and safekeeping: 1. Original Warranty Deed, dated on January 22d,2013 and recorded on February 5",2013 in Official Records Book 28474,at Page 1002 as Document No.CFN 2013R0092979 of the Public Records of Miami Dade County,Florida; and 2. Original Owner's Title Policy.issued by Old Republic National Title Insurance Company under Policy No.0176-8132553 in the amount of$605,000.00. It was a pleasure to work with you on this transaction and once again thank so much for your business. uld you have any further questions or comments,please contact our offices. Ve y yours, .Diego e to Paralegal E 1 sures CFN 203. ROO'er2 a 9 OR Bk 28474 Fos 1002 - 1003; (2pos RECORDED 02/05/2013 10:42:38 DEED DOC TAX 3:630.00 Prepared by and return to: HARVEY RUVIN► CLERK OF COURT Russell S.Jacobs,Esq. HIA111-DARE COUNTYs FLORIDA Russell S.Jacobs,P.A. 1400 N.E.Miami Gardens Drive Suite 208 North Miami Beach,FL 33179 305-405-4444 rSpace Above This bine For Recording Data] Warranty Deed This Warranty Deed made this day of January,2013,between David Winn and Traci Winn, husband and wife,whose post office address is 3727 NE 168 Street, N. Miami Beach, FL 33160 (DW) and 4000 Towerside Terrace, #TS-6, Miami, FL 33138 (TV), grantor, and Karen Blair and Predrag Starcevic, husband and wife, whose post office address is 1225 NE 92 Street,Miami Shores, FL 33138, grantee: (Whenever used heroin the terms'grantor"and"grantee"include all the parties to this instrument and the heirs,legal representatives, and assigns of individuals,and the successors and assigns of corporations,trusts and trustees) Witnesseth, that said grantor, for and in consideration of the sum of TEN AND NO/100 DOLLARS ($10.00) and other good and valuable considerations to said grantor in hand paid by said grantee, the receipt whereof is hereby acknowledged,has granted,bargained,and sold to the said grantee,and grantee's heirs and assigns forever, the following described land, situate, lying and being in Miami-Dade County, Florida to-wit: Lot 18,less the East 25 feet and the East 50 feet of Lot 19,Block 2,of BAY LURE, according to the Plat thereof, recorded in Plat Book 44, Page 63, of the Public Records of Miami-Dade County,Florida. TOGETHER with all the tenements. Folio No. 11-3205-027-0300 SUBJECT TO: Taxes and assessments for 2013 and subsequent years. Conditions, restrictions, limitations and easements of record, if any without intent of reimposing same. Together with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining. To Have and to Hold,the same in fee simple forever. And the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee simple; that the grantor has good right and lawful authority to sell and convey said land; that the grantor hereby fully warrants the title to said land and will defend the some against the lawful claims of all persons whomsoever;and that said land is free of all encumbrances,except taxes accruing subsetluerrt to December 31,2012. OR BIS 28474 PG 1003 PAST PAGE In Witness Whereof,grantor has hereunto set grantor's hand and seal the day and year first above written. Signed,sealed and delivered in our presence: 1 r (Seal} Witnesame: ` 41 David Winn Witness Name: �. (Seal) Wi Name. V. T Winn Wi ess Name: State of Florida County of Miami-Dade The foregoing instrument was acknowledged before me this ZZI day of January,2013, by David Winn and Traci Winn, who [,d are personally known or[ ]have produced as identification. [Notary Seal] No P Printed My Co missi n Expires: l.JA0088 �If�3dy 18,2014 ®oRdodtlaullo�y wbYo t DEPARTMENT OF BUSINESS AND PROFESSIONAL:REGULATION CONSTRUCTION INDUSTRY LICENSING!BOARD d , - _ f ':. e G�G732W46 TH11 The ROOFING_CONTRACTOR Named below IS CERTIFIED Under-the provisionsChapter 489 FS. Expiration date:-AUG 31 2016 - GONZAI:EZLUIS E • A B REI�IODE�II�G 11�C :bGD.S WEST 12TH COURT HIALEAH -L ': . FL�3S�112 ISSUED: 06MM014 DISPLAY AS REQUIRED BY LAW SEQ# L14060M1225 RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY - STATE OF FLORIDA DEPARTMENT.OF BUSINESS AND PROFESSIONAL:REGULATION CONSTRUCTION INDUSTRY LICENSINGBOARD CFC142@397 _ The PLUMBING CONTRACTOR 'Named below:IS CERTIFIED Uncder the provisions of Chapter 489 FS. Expiration date: AUG 31,2016: GON7JILEZ,_LUIS E ■ A REMODELINGrIAIC - 5r�5�}MEST 1�TH COLI '= - - _ - ■ HIAEEAli FL f33P1'i2 WA ISSUED: 061080114 DISPLAY AS REQUIRED BYLAW SEQ# L1406 WW1264 RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA. - DEPARTMENT OF BUSINESS AND PROFESSIONAL.REGULATION Nrj CONSTRUCTIOAt INDUSTRY LICENSING BOARD 4 s r , The.GENERAL-CONTRACTOR 7 Nah*d below IS CERTIFIED Under the provisions.of Chapter 489 FS. - pWration date: AUG 31,2016 C ❑ ❑ GONZALEZ,.LU1S E �• A ..REMt3DELING-INC • 5006 WEST 12T COURT HIALfAH FL 3313:1 . ISSUED: 06/08/2014 DISPLAY AS REQUIRED BY LAW SEQ# L14NO80001380 ootsas Local Business Tax Receipt 'LBT--*Is Miami-Dade County, State of Florida THIS IS NOTA BILL - DO NOT PAY 6837497 BUSINESS NAMEILOCATION RECEIPT NO. EXPIRES A B REMODELING INC 71113 ,13 SEPTEMBER 302016 5605 W 12 Ci 7111313 HIALEAH FL 33012 Must be displayed at place of business Pursuant to County Code Chapter BA-Art.9&10 OWNER SEC-TYPE OF BUSINESS A B REMODELING INC 196 PLUMBING CONTRACTOR PAYMENT RECEIVED Worker(s) I CFC1428397 BY TAX COLLECTOR $45.00 08/03/2015 CREDITCARD-15-039369 This local Business Tax Receipt only confirms payment of the Local Business Tax.The Re Is is not a license, permit,or a certification of the holder's qu8i ications,to do business.Holder must comply wltb any governmental or nongovernmental regulatory laws and requirements which apply to the boolnaes. The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code See ea-27s. For more information,visit wNw.miamidada.uovammileoter 001982 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOTA BILL - DO NOT PAY 6837489 BUSINESS NAME/LOCATION A B REMODELING INC RECEIPT No. EXPIRES �113 5605 W 12 CT RENEW11l SEPTEMBER 30, 2016 HIALEAH FL 33012 0b Must be displayed at place of business Pursuant to County Code Chapter SA-Art.9&1 o OWNER SEC.TYPE OF BUSINESS A B REMODELING INC 196 SPECIALTY BUILDING CONTRACTOR PAYMENT RECEIVED Worker(s) I CCC1329645 BY TAX COLLECTOR $45.00 08/03/2015 CREDITCARD-15-039369 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit or a certification of the holder's qualHlcations,to do business Holder must comply vvith airy governmental Of nongovernmental regulatory laws and requiremams which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dada Code Sec go-27g. For more information,visit .4�'�Rl�° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) b 11/02/2015 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 NAME: PHONE A/C,No,Ext): 1-800-277-1620 x48OO FAX A/C,No): 727 797-0704 FrankCrum Insurance Agency,Inc. E-MAIL ADDRESS: 100 South Missouri Avenue INSURER(S)AFFORDING COVERAGE NAIC# Clearwater,FL 33756 INSURER A: Frank Winston Crum Insurance Co. 11600 INSURED INSURER B: INSURER C: FrankCrum UC/F A-B Remodeling,Inc. INSURER D: 100 South Missouri Avenue INSURER E: Clearwater FL 33756 INSURER F: COVERAGES CERTIFICATE NUMBER: 319163 REVISION NUMBER: 3 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME 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 ADOL SUBRPOLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSRD WVD (MMIDDIYYYY) (MMIDDIY" GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES Ea occurrence CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ POLICY PROJECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND WC201500000 01/01/2015 01/01/2016 X WC STATUTORY OTH- A EMPLOYERS'LIABILITY Y/N UMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? Q N/A E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) Ifyes,describe under E.L.DISEASE-EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 000 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks,Schedule,K more space Is required) Effective 05/04/2015,coverage is for 100%of the employees of FrankCrum leased to A-B Remodeling,Inc.(Client)for whom the client is reporting hours to FrankCrum.Coverage is not extended to statutory employees. (Client Reference:Plumbing License Number:CFC 1428397) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village Bldg.Dept. AUTHORIZED REPRESENTATIVE 10050 NE 2nd Ave. Miami Shores,FL 33138-2382 ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010106) The ACORD name and logo are registered marks of ACORD A CERTIFICATE OF LIABILITY INSURANCE DATE 11/02/2015 YY) r 11/02/2015 `PHIS 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 NAME: PHONE AIC,No,Ext): 1-800-277-1620 x4800 FAX A/C,No): 727 797-0704 FrankCrum Insurance Agency,Inc. E-MAIL ADDRESS: 100 South Missouri Avenue INSURERS)AFFORDING COVERAGE NAIC# Clearwater,FL 33756 INSURER A: Frank Winston Crum Insurance Co. 11600 INSURED INSURER B: INSURER C: FrankCrum L/C/F A-B Remodeling,Inc. INSURER D: 100 South Missouri Avenue INSURER E: Clearwater FL 33756 INSURER F: COVERAGES CERTIFICATE NUMBER: 319163 REVISION NUMBER: 2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME 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 SUSR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSRD WVD (MM/DO/YYYY) (MMIDD/YYYY( GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGES TO Ea ocanRENTEDence $ PREMISE CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEML AGGREGATE LIMIT APPLES PER: PRODUCTS-COMP/OP AGG $ POLICY PROJECT F7 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per penton) $ AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCURRENCE $ EXCESS DAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ TH- WORKERS COMPENSATION AND WC201500000 01/01/2015 01/01/2016 X STATUTORY OR A EMPLOYERS'LIABILITY Y/N LIMITS ER ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Q N/A E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks,Schedule,ff more space Is requlmd) Effective 05/04/2015,coverage is for 100%of the employees of FrankCrum leased to A-B Remodeling,Inc.(Client)for whom the client is reporting hours to FrankCrum.Coverage is not extended to statutory employees. (Client Ref.: Qualifier: License#: CGC 1514807)Re: General Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village Bldg.Dept. AUTHORIZED REPRESENTATIVE 10050 NE 2nd Ave. Miami Shores,FL 33138-2382 ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Ac" DATE(MWDDNYYY) . 1,®,,,.,.--. CERTIFICATE OF LIABILITY INSURANCE 10/30/15 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((es)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 CONTA NAME:CT MARTA ALONSO Florida Bankers Insurance PHONE (305)266-6493 a No): (305)262-0679 7278 SW 8 Street MAIL marta@floridabankersinsurance.com Miami,FL 33144 INSURER(Si AFFORDING COVERAGE NAIC# Phone (305)266-6493 Fax (305)262-0679 INSURER A: FEDERATED NATIONAL INSURANCE CO. INSURED INSURER B A-B REMODELING INC. INSURER C: 5605 W 12 Ct INSURER D: HIALEAH,FL 33012- (305)613-9881 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 CONTRACTOR 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 ADD UBR POLICY EFF POLICY EXP LTR POLICY NUMBER M D M D LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 © COMMERCIAL GENERAL LIABILITY PRAMAGE TO EM SES(Ea RENTED occurrence) $ 100,000.00 A ❑ ❑ CLAIMS-MADE © OCCUR N N GL-0504012103-01 MED EXP(Any one person $ 5,000.00 ❑ 05/17/2015 05/17/2016 PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000.00 91 POLICY ❑ PRO ❑ LOC $ AUTOMOBILE LIABILITYOMBINED SINGLE LIMIT Ea accident ❑ ANYAUTO BODILY INJURY(Per person) $ ❑ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ❑ AUTOS ( ) F—] HIRED AUTOS ❑ AUTOS NED PROPERTYt DAMAGE $ Per acciden ❑ UMBRELLA UAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATIONW C STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ❑ ❑ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BLDG DEPT THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2nd AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FL 33138 AUTHORIZED REPRESENTATIVE PLUMBING AND GENERAL CONTRACTOR @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)OF The ACORD name and logo are registered marks of ACORD