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EL-14-2761 0 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-252486 Permit Number: EL-12-14-2761 Scheduled Inspection Date: February 29,2016 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: D'ALACIO, DIOGENES Work Classification: Alteration Job Address:10816 NW 2 Avenue MIAMI SHORES, FL 33168-4302 Phone Number Parcel Number 1121360020160 Project: <NONE> Contractor: SUNSHINE ELECTRICAL CONTRACTORS CO Phone: (305)268-4958 Building Department Comments GENERAL ELECTRICAL REPAIR, SMOKE DETECTORS, Infractio Passed Comments KITCHEN WORK,1 BATHROOM AND NEW TITAN INSPECTOR COMMENTS False WATER HEATER 7-21-15 Met with Mr.Amegual today. according to mr Amengual he has no knowledge of this project. Property owner and contractor of record will have to schedule a meeting with the ELECTRICAL CONTRACTOR HAS A Rj @r Comments LICENSE WITH MIAMI DADE ESA HE REINSPECTION FOR INSP-251925. Need arc fault breaker Cl2WA"E DOCUMENT A D KE r proof receptacles ,lable panels and breaker blank on outside panel. COMPENSATION ALL PERM HO D Failed XX X� Correction �' �� Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid February 26,2016 For Inspections please call: (305)762-4949 Page 25 of 60 �t tua. EL12= 4-216 1 i,� Miami Shores Village PermitTyp �Ie� Ga -�f3Sid�ti�� n�� 10050 N.E.2nd Avenue NW }/o0legl�8pt Altera�n Miami Shores,FL 33138-0000 �r ��� � It .. Permi:tAP�PRONMI � Phone: (305)795-2204 FCORIS� 1" 3/27120'115 Expiration: 09/2312015 Project Address Parcel Number Applicant 10816 NW 2 Avenue 1121360020160 DIOGENES D'ALACIO MIAMI SHORES, FL 331684302 Block: Lot: Owner Information Address Phone Cell DIOGENES D'ALACIO 10816 NW 2 Avenue a MIAMI SHORES FL 33150- 10816 NW 2 Avenue MIAMI SHORES FL 33150- Contractor(s) Phone Cell Phone Valuation: $ 3,200.00 AMENGUAL ELECTRIC INC Total Sq Feet: 0 Type of Work:GENERAL ELECTRICAL REPAIR,SMOKE DE Available Inspections: Additional Info: Inspection Type: Classification:Residential Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 Invoice# EL-12-14-53950 DBPR Fee $3.38 12/17/2014 Credit Card $50.00 $422.16 DCA Fee $3.38 Education Surcharge $0.80 03/27/2015 Check#:5777 $422.16 $0.00 Permit Fee-Additions/Alterations $225.00 Scanning Fee $9.00 Technology Fee $3.20 Work without Permit Fee $225.00 Total: $472.16 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 AF VlT,., I ce that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction n �ningFut rmore,I authorize the above-named contractor to do the work stated. O�. March 27, 2015 Aut66 ' Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy March 27,2015 1 r ' Miami Shores Village , , . DEC 1 7 2014 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 (C> BUILDING Master Permit No. RC,14— -i`off PERMIT APPLICATION Sub Permit No. ❑BUILDING ECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Id IL �� � 'VR t City: Miami Shores / County: Miami Dade zip: ` Folio/Parcel#: l t Z p1 1� -L ®(b b Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): �' to ra e Phone#:`T� b L' 1,7� Addr ss t�'' ' `I vv City: -Flee-) State: �� Zip: Tenant/Lessee Name: Phone#: Email: /. CONTRACTOR:Company Name: C Phone#: Address: o City: M k 0 Mi State: Zip: 33 l Qualifier Name: b Al VOQ Lj(Z Phone#: State Certification or Registration#: C—I& Certificate of Competency#: cc -cm - b DESIGNER:Architect/Engineer: Phone#: ����`� Address: City: State: Zip: Value of Work for this Permit:$ Square/Unea� Repair/Replace rF,00tage of Work: Type of Work: EJ Addition El Alteration Alteration I] New ElDemolition DescriptionofWork• EoeI•Ue � �(,� �l��� � �o . � Jacr.-4_ � CIO n`-�,v bia419�c � Specify color o((f''``��color thru tile: Submittal Fee$45 'La--) Permit Fee$��g=— CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 420 S b (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 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 CO RACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of � ,20 J by day of L 20 by e who is personally known to I UL N Q U °who is personally known to me Jr who has produced L as me or who has produced n� D� ,5Z-aso—37-as3 W _0 identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PU NUNEZ ,..;Y'P�a�•." p INA CECIBE "? 0� 610N#FF166669 Y tober 7,IN 2018 sign: Sign FI Ida Print: f ° fa 2/l3I r Print• „311 ' t• 3'at........,e�w ;i: MY COMMISSION#EE100114 Seal : �t Seal: EXPIRES:JUN,05,2015 e--n th,o.1, hlststateinsurance APPROVED BY i. p -2' �° aat Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ij Kzwwl; y� F, " T, F, rkiii lo'ki STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD ERDW4M5 The ELECTRICAL CONTRACTOR Named below HAS REGISTERED Under the Provisions of Chapter 489 FS. Expiration dates AUG 31. 2016 (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) AMENGUAL, BERNARD AMENGUAL ELECTRIC, INC. 3851 NW 12TH TERRACE MIAMI FL 33126-2816 MWED: OOMMO14 DISPLAY AS REQUIRED BY LAW SE00 L1408280O03433 ki 4 10 % m c% P 94 A lolii� FA 4: F.4, 9 cy FT FTi� , IF F 'F T 4, cl, Z "rte 'F noTil F� ' 4� IFfit, FT, b TV M M, i . 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Jl `l k s �- . r '€ ' wG"" r 'a,� .7 `oS".+�'�idy,{>r,3q 9 �� �� s .�" y °y °v, sax�» ♦ "f' `L, . '* � Z s� 6 : , �[ F 5 .!' r j " .3 mss"*'e" ■ �` I my Y �' 4 '�� �# ''�" 'il:X ✓<v�'..�� � � � k 4!` r t^`rfwY TO r,'� ZIP w x F $ i{ S lam e �r vs.9�' i, � ;. f -g.ta•a4 i"`' s'7 :?* iari `.'r• '° `f dr"� r . Ri"` } 3l +ayy .{r'€-1s4 t n 4 ;1y& ra d, #fit a m`x > a .fit 'a9 �.€ x� + � f a« L * sv ta' yJ Y x ! t 7? t a"` ps r a . t z«dttadr dad; 'aFr" Xays.y� ✓ �. w� { mt �' Y 1, �.. � "F�F�'w '`� F z�� �''Qd., � a�.' ',, 1lf ''�'� .a> y.. .3t •,,.u,t.4 rr �yd r,-r� 4 1'y rY,4 7w*x "�","w ,"'C�gS#'�?A ' {irk s.� SN0�193 G num Miami shores Village Building Department �IpR`�pA 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. f: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 and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTE Signature: , � Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this 23 day of By %®eT 1 � c i� who is personally known to me or has produ �� ^K� as identification. r•,., .,aa,?' �"' Stato°f FI°"d L public i2nn iota J N1 FeV1C 92753 Notary: a a spis ises SEAL: , 9r* - , '® STATE GENERAL OD"ACronS ELEQTRICALCXgWgtAC RESIDENTW- TQlQ3 *4XMTRW-SERVICES DADE: 03/16/2015 7 a-USa k 786,%"M STATE OF: BEFORE ME THIS DAY PERSONALLY APPERARED : AMENGUAL BERNARDO. THAT HE WILL BE THE ONLY PERSON WORKING ON THE PROJECT LOCATED AT. bf 10816 NW 2 AV MIAMI SHORE FLA.331 SWORN TO AND SUBSCRIBED BEFOR ME THIS DAY 03 /16 2015 PERSONALLLY KNOW ID---- ----------------------- TYPE ID-1-21------------- NOTARY------------ �j A .' ANAIDA FERNANDEZ * • . Commission#FF 170677 Expires February 21,2019 8aidod Tlsu Tay F�Atapeatoe 80039¢TD19 �y .: .. .. f .� k ry. Arlenis Silvera From: Tabb, Cheryl <Cheryl.Tabb@myfloridalicense.com> Sent: Tuesday, November 03, 2015 4:20 PM To: naranjo@miamishoresvillage.com;Arlenis Silvera Subject: 10816 N.W. 2nd Avenue Good afternoon, I am investigating a complaint regarding the above address , the permits are RC14-765 master and sub permit ELM-2761, can you provide information regarding the permits (i.e. copy of any inspections, status of the permits, the change of contractor and date, if applicable) and any pertinent information regarding the permits. Thank you for your assistances. Cheryl Tabb Investigator Region X, Miami 8240 N.W. 52nd Terrace, Suite 304 Miami, Florida 33166 Telephone: (305) 513-3437 S �' Fax: (305) 470-5781 /��C ��5 y itmentraf Busines.4 X ,` i r2 S wI-ri-t Ccwii Avg, sR gu i a i i o n Please note, if applicable: Pursuant to Section 455.225(10), Florida Statutes,the contents of this email may be confidential. If you have received this communication in error, or if you intend to use, disclose,copy, or disseminate its contents, please contact the sender at Cheryl.Tabbomyfloridalicense.com immediately before doing so. 1 '9I25I (q Miami Shores Village 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 ((-) BUILDING Master Permit No. f2c0 765 PERMIT APPLICATION Sub Permit No JG ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: f i '.6 , City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: �L FFE: OWNER: Name(Fee Simple Titleholder): a C I�(�l� Phone#: Addres: �- City: ery State: Zip: Tenant/Lessee Name: Phone#: Email: r CONTRACTOR:Company Name: hon #. Address: ( 0 City: f�'�/ �2 7 State: < Zip: 13 3 J6CsL C� Qualifier Name: 0 /-�—AlC� ^AA IL I 1-14-All Phone#: t6 ')1���� State Certification or Registration#: )e. (V,- 60'�N- 07 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 20100 Square/Linear Fo tag e of Work: Type of Work: ❑ Addition [R-Alteration ❑ NewRepair/Replace El Demolition Description of Work: 1!,(� Ait/� �yy >yC . r/ 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$ ?J (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 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 �k Cl�-� Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of- IJ(akA ,20 by day of L 20 e, by (3who is personally known to G xt-A®G 45 who is personally known to me or who has produced 0S�`�-1me or who has produced ��a as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: DIL�LA Y O 6 i,�, Seal: Seal: ;_ ,`� Notary Public-State of Florida My comm.Expires Sep 9.2015 =,~ `o;: Commission#EE 104159 4ogY PLS Notary public State of Florlda �oF,�„;;°p'�� Bonded Through National Notary Assn. oQ*'xoMY om* rez iia ' 'M�B7 *** ***x�** ** * ** ** ** �x*s**ax*** x�*** ** * �x**t*w*** **x� ** ** Ex fres 09/031201 S OF APPROV 'Plans Examiner Zoning Structural Review Clerk (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 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 G Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this �ellf day of _J Gii,I!Z 20 S by day of '� 20 ', by � �' � ��6who is personally known to eaL who is personally known to me or who has produced '6tu -. � �� a3 me or who has produced._ ��, as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: L Print: OIL-LA Seal: .:�`"°SBI;•. Seal: a°. .o: Notary Public-State of Florida My Comm.Expires Sep 9.2015 :.9r Poc Commission#EE 104159 �pnr°4e Notary Pudic State of Florida "'••F�„;°�� Bonded Through National Notary Assn. a my Com i '( Fab&libp* 14 M p,0' Ex ices 0910312018 APPROV 45 Plans Examiner Zoning i; g Structural Review Clerk (Revised02/24/2014) AUG/18/2015/TUE 10:33 AM FAX No, P. 002/002 CERTIFICATE OF LIABILITY INSURANCEDATE(MMMONYYY) 08/18/15 THIS CERTIFICATE IS ISSUEDAS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER Y14E 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 cortlPlcate holder is an ADDITIONAL INSURED.the p011Cy0e8)mUSt De endorsed. If 3LIBROGATION IS WAVED,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 On certificate holder In Ileu of such endorsement(s). PRODUCER CONTAC Maria L Diaz MS Discovery Entr,Insurance Agency "� ( 718-8919 PNO . NW• (305)718.3584 10733 N.W.58th Street E marflugdlscodorallns.com Miami,FL 33178 INSURERIS)AFFORDING COVEc Phone 3 718-8919 Fax 3 718-3584 INSURER A: ACCIDENT INSURANCE COMPANY INSURED INSURER B: SUNSHINE ELECTRICAL CONTRACTORS,CORP. INSURER C: 1300 S.W.85 COURT INSURER 0: MIAMI,FL 33144 INSURER : INSURER F: COVERAGES CERTIFICATE NUMBER* 84 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 FlCATENWY`BE1SS IED"OF VAY-PERTAIN"TH£9NS~CE-AAFFORDED-SY1`ri POIMETDESCRIBED-HERElN'1S'SL'1BJECPTO-AtL rReTE'RMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTq TYPE OF INRANCE ADD UEHi C B P SULIMITS GENERAL LIABILITY EACH OCCURRENCE d 1,000,000.00 DAMAGE TO© COMMERCIAL IABIL GENERAL LITY REN 0 $ 100,000,00 ❑ ❑ OLAims-MADE © OCCUR CP1361 ►�3126-00 D E%P(Any one Persm) ' 8 5.000.00 A N 04/07/Z016 04/07/3016 PERSONAL&ADV INJURY: s 1,000,000.00 ❑ GENERAL AGGREGATE s 2,000.000.00 GEN'L AGGREGATE LMIT APPLIES PER: PROD TS-COMPIOP AGG s 1,000,000.00 E] POLICY [:] PRO. [:] Loc s AUTOMOBILE LIABILITY COMBNIa D SINGLE LIMIT ❑ ANYAUTO BODILY INJURY(PerMoon) I ALL OWNED SCHEDULED BODLYINJURYIPersowdent i ❑ AUTOS ❑ AUTOS NON-0VJNED OPERTY GE i E3 MIRED AUTOS ED AUTOS axaen ❑ s ❑ UMBRELLA UAB ❑OCCUR EACH PCC RRENCE s ❑ EXCESS LU1B ❑CLAMS-MADE AGGREGATE s ED RETENTIm s 5 WORKERS COMPENSATION WC TATU- OTH- AND EMMpPLOYERS'LIABILITY Y 1 N ONYFF[2MOMEMBE�ARYNEtED� � N/A E.LEACMACCDENT s _ (Mandatory In NH) ❑ E.L.DISEASE-EA EMPLOYE s ryes daactibe under DE RIP ON OF OPERATION below I I E.L.DISEASE-POLICY LIMB' s DESCRIPYION OF OPERATIONS I LOCATIONS I VEHICLES(Act eh ACORD 101,AadniovW Remarks SCIISWW,If mWre SPaea Is required) ELECTRICAL WORK-WITHIN BUILDINGS LICENSE S EC13005807 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BB CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE TNEREOP,NOTICE WILL BE DELIVERED IN BUILDIND DEPARTMENT OF:RER ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE AUTPIORIZWfEPRNTATIVE MIAMI,FL 33138 • FAX#:(305)758-8972 O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)OF he ACORD name and logo are registered marks of ACORD CORPOI.-ICENSE INC. PAGE 01/01 r JEFF A7WATER CHEF FMApg4L OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES CERTIFICATE OF ELECTION M DMION OF WORKERS-COMPENSATION • TO BE EXEMPT FROM FLORIDA WORKERS-00W ENSATION Law� CONSTRUCTION INOUSMy EXEMPTION This certifies that the inditridtr$I list EFFECTIVE DATE; bebw�elected to be eK@mpt from Florida Workers Comps 7/17/2015 EXPIRATION DATE: nsation law. PERSON: SANTIESTEBAN 7/1&2017 FEIN: 657009473 MARIANO J BUSINESS NAME AND ADDRESS: SUNSHINE ELECTRICAL CONTRACTORS CORP 1300 SW 65 COURT MIAMI FL 33144 SCo`ES OF BUSINESS OR TRADE: LICENSED ELECTRICAL. CONTRACTOR PIWl Ifl Ch0tsr 4to.ost,,).t=.s.,er,aid.d_e-�. „..,p "ithn tho�Yer oanema or oompenae0on"der thin chapter t>tn to C �ea,+fhts d,apter by a d scope or the b I*aWer„o.esto2�,F. Ce,tltloatea of ateaion to(apo p Udc sed a, uanese or vada It6ted on tae-9-orettxwm,to be a oe apply only exempt wd cenaicates of election to w er v Oban be ZI64 to rewca#on tF.al�any bme aatRer the fihnp a1 IhB0al,f or ptnetoUces or eteawn to ee the Person names on the 4oft cr trUlt a av longer meets fhe tssuarnw of be wthbwte requrmmtggB of'hie BeCOD11 far b9 , ry� uB11a@ of 8 Cetl .TRe2 OepeAlne,tt:�tl revafte B 0F$-F2•VM252 CERTIFICATE of ITLIRc„a„-rp aG E%'31p-r REVISED a&,2 QUEST IONS?(850013-1648 �,,�--a a�y � J �l a� ���� 001670 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOTA BILL - DO NOT PAY LBT 4860764 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES SUNSHINE ELECTRICAL CONTRACTORS CORP RENEWAL SEPTEMBER 30, 2016 1300 SW 85 Cr 5073093 Must be displayed at place of business MIAMI FL 33144 Pursuant to County Code Chapter SA-Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED SUNSHINE ELECTRICAL CONTRS CORP 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR Worker(s) 1 EC13005807 $75.00 08/11/2015 ECHECK-15-159685 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 squalifications,to da business. Holder must comply with any governmental or nongovernmental regulatory laws end requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sec N-276. For more Information,visit www.miamidade.govhexcellector r 4 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND ? ' PROFESSIONAL REGULATION EC13005807 ISSUED: 08/14/2014 i ' CERTIFIED ELECTRICAL CONTRACTOR SANTIESTEBAN,MARIANO J SUNSHINE ELECTRICAL CONTRACTORS CO IS CERTIFIED under the provisions of Ch.489 FS. Expiretlon date:AUG 31,2016 L1408140002216