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CC-15-1951 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-254090 Permit Number: CC-8-15-1951 Scheduled Inspection Date: March 11,2016 Permit Type: Constnwtioq Inspector: Rodriguez,Jorge Insp tion Type: Final Owner: CLUB VILLAS, HARBOUR Work Classification: Repair Job Address:1530 NE 105 Street Miami Shores, FL 33138- Phone Number Parcel Number PARC2003-22 Project <NONE> Contractor: BEACH CONTRACTING&REMODELING INC Phone: (305)542-2256 Building Department Comments REPAIR SPACED CONCRETE AND BALCONY EDGES Infractlo Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-240529. 3-042016 No one at job site. left inspection rejection notice on the door of the storage container located on the west parking lot. Failed /0 ��D �allv 5.!00 Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid March 10,2016 For Inspections please call: (305)762-4949 Page 15 of 34 ENGINEERING G R O U P March 7, 2016 To: Building Department of City of Miami Shores RE. OPEN PERMIT NUMBER- 15-1951 For Concrete Repairs. To whom it may concern: Sierra Engineering Group (Pedro L. Hallo,P.E.)performed the inspections at 1530 NE 105th Street; Miami Shores, FL 33138 during the placement of the steel reinforcement of the elevated (2"d Floor) concrete slab balconies and first floor column. Our inspection reveals the following: To the best of my knowledge, belief and professional judgment and based on my visual inspections performed at the above mentioned property, I certify that the work completed as per above-mentioned permit, complies with the provisions of the codes and the permitted constructions documents. No remarkable structural anomalies were noted Please do not hesitate to contact me if you should have any questions. Sincerely, Jesus Sierra, P.E. 51132 President Sierra Engineering Group S ATE OF nit � 5825 Sunset Drive, Suite 200, South Miami FL 33143 Ph: 305.665.5445 Fx: 305.665.5469 A �'/ Sierra Engineering > G»Ak PROGRESS FIELD REPORT C R O U P To be sent to Chief Structural Inspector on a weekly or daily basis as required PROJECT INFORMATION Project Name: Harbor Club Villas—Concrete Restoration. Permit#. 15-1951 Address: 846 Lincoln Rd.Miami Beach,FL 33138 Manager.Report Start Date: 02-11-2016 Report End 02-11-2016 1- EXCEPT AS SPECIFICALLY NOTED BELOW,ALL WORK PERFORMED IS IN ACCORDANCE WITH THE PROJECT SPECIFICATIONS,LOCAL ORDINANCE,AND THE FLORIDA BUILDING CODE 2014. AcCOMDIishments 211112016 1. Anticorrosive rebar coating in unit#1612 has been applied. Ready to install formwork and pour concrete. 2. Anticorrosive rebar coating in unit#1560&#1558 has been applied. Ready to install formwork and pour concrete. 3. Anticorrosive rebar coating in unit#1544 has been applied. Ready to install formwork and pour concrete. 4. Anticorrosive rebar coating in unit#1542 has been applied. Ready to install formwork and pour concrete. 5. An overhead chipping of the balcony concrete slab in unit#1510 has been finalized.Not steel reinforcement found.Overhead stucco repair is required(See photo#6 below). 6. Anticorrosive rebar coating in unit#1440 has been applied. Ready to install formwork and pour concrete. 7. Anticorrosive rebar coating in unit#1438 has been applied. Ready to install formwork and pour concrete. 5825 Sunset Drive, Suite 200, South Miami FL 33143 Ph.:305-665-5445 Fx.:305-445-5469 V If you have any questions with regards to this report or its content, please contact the undersigned at your convenience. Prepared by: Pedro L. Fiallo, P.E. Professional Engineer Florida License#76100 Reviewed by: v Jesus Sierra, P.E. Professional Engineer Florida License#51132 .ATE OF . 5825 Sunset Drive, Suite 200, South Miami FL 33143 Ph.:305-665-5445 Fx.:305-445-5469 te CERTIFICATE OF LIABILITY INSURANCE 1/14/2016 producer. Plymouth Insurance Agency This Certificate is issued as a matter of Information only and confers no 2739 U.S. Highway 19 N. rights upon the cerNf(catbe Holder. This certificate does not amend,extend Holiday, FL 34691 or alter the coverage afforded by the policies below. (727)938-5562 Insurers Affording Coverage NAIC# Insured: South East Personnel Leasing, Inc. &Subsidiaries insurer A: Lion Insurance Company 11075 2739 U.S. Highway 19 N. Insurer B: Holiday, FL 34691 Insurer C: Insurer D: Insurer E: Coverages The policies of Insurance listed below have been Issued to the Insured narned above for the policy period Indicated. Notwithstanding any requirement tens 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.Aggregate limits shown may have been reduced by paid claims. INSR ADDL Policy Effective Policy Expiration Limits INSRD Type of Insurance Policy Number Data Data (MM/DD/YY) (MM/DD/YY) GENERAL LIABILITY Each Occurrence T mmercial General Liability Damage to rented premises(EA Claims Made 13 Occur occurrence) $ U IEX Med Exp eneral aggregate limit applies per. General Aggregate Personal Adv Injury Policy 13Project11LOC Products-Comp/OP A99 TOMOBILE LIABILITY Combined Single Limit Any Auto (EA Accident) Al Owned Autos Bodily Injury Scheduled Autos (Per Person) Hired Autos Bodily Injury Non-Owned Autos (Per Accident) erty PropDamage (Per Accident) CESSIUMBRELLA LIABILITY each Occurrence Occur ❑Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2016 01/01/2017 X wC Statu- OTH- Employers'Liability I tory Limits ER Any proprietor/partner/executive officer/member E.L.Each Accident $1,000,000 excluded? NO E.L.Disease-Ea Employee $1,000,000 If Yes,describe under special provisions below. E.L.Disease-Policy Limits $1,000,000 Other Lion Insurance company is A.M.Best Company rated A- (Excellent). AMB*12616 Descriptions of Operations/Locations/Vehicles/Exclusions added by Endorsement/Special Provisions: Client ID: 92-66-600 Coverage only applies to active employee(s)of South East Personnel Leasing,Inc.&Subsidiaries that are leased to the following"Client Company": Beach Coming&Remodeling Inc Coverage only applies to injuries Incurred by South East Personnel Leasing,Inc.&Subsidiaries active employee(s),while working in:FL. Coverage does not apply to statutory employee(s)or independent contractor(s)of the Client Company or any other entity. A list of the active employee(s)leased to tate Client Company can be obtained by faxing a request to(727)937-2138 or by calling(727)938-5562. Project Name: ISSUE 01-14-16(PH) Beata Data 7/8/2014 CERTIFICATE HOLDER CANCELLATION CITY OF MIAMI SHORES Should any of the above described policies be cancelled before the expiration date thereof,the issuing BUILDING&ZONING insurer will endeavor to nail 30 days written notice to the certificate holder named to the left,but failure to do so shall Impose no obligation or liability of any Idnd upon the insurer,its agents or representatives. 10050 NE 2ND AVENUE MIAMI SHORES, FL 33138 /'' Miami Shores Village 10050 N.E.2nd Avenue NES 4 Miami Shores,FL 33138-0000 ` Phone: (305)795-2204 f W ' Expiration: 06/0512016 Project Address Parcel Number Applicant 1530 NE 105 Street PARC2003-22 Miami Shores, FL 33138- Block: Lot: HARBOUR CLUB VILLAS Owner Information Address Phone Cell HARBOUR CLUB VILLAS Contractor(s) Phone Cell Phone Valuation: $ 30,000.00 BEACH CONTRACTING&REMODELII (305)542-2256 Total Sq Feet: 00 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final Date Denied: Review Building Type of Construction:REPAIR SPACED CONCRETE AND Occupancy Load: Review Building Stories: Exterior: Review Building Front Setback: Rear Setback: Review Structural Left Setback: Right Setback: Review Structural Plans Submitted:Yes Certification Status: Review Structural Certification Date: Additional Info: Bond Retum: Classification:Commercial nnin :4 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $18.00 Invoice# CC-8-15-55573 DBPR Fee $13.50 12/08/2015 Check#:1457 $1,297.00 $50.00 DCA Fee $13.50 Education Surcharge $6.00 08/032015 Credit Card $50.00 $0.00 Permit Fee $900.00 Pian Review Fee(Engineer) $120.00 Plan Review Fee(Engineer) $120.00 Plan Review Fee(Engineer) $120.00 Scanning Fee $12.00 Technology Fee $24.00 Total: $1,347.00 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. in accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoni h ore,I,a Aori #�e above-named contractor to do the work stated. � December 08,2015 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy December 08,2015 1 Miami Shores Village AUG 0 s 2015 l `�1 2 Building Department ��: (d10050 N.E.2nd Avenue,Miami Shoes,Florida� �� r FI 33138 . Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20/y' sM. BUILDING Master Permit Nodo PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1,5;3 C) 0 G� City: Miami Shores County: Miami Dade Zip:S3 l 7rg5 Folio/Parcel#: Is the Building Historically Designated:Yes NO_ Occupancy Type: Load: ((Construction Type: C-1'75; / Flood Zone: BFE: FFE: iE� OWNER:Name(Fee Simple Titleholder): V-t zo oo e_ �t_ �( L.,"CT t L-L its Phone#: 30S- 3 3 z-3��7 Address: j:;7?7C' tA (;7 (�'� 5T' City: k l egg I S'{��� State: Zip: 3,3 17 c� Tenant/Lessee Name: �1� Phone#: 100-6 Email: �} CONTRACTOR:Company Name: ��.P e JB1-?z- t � Phone#:3 -542-- Z-Z 57e- Addrepss:3 M R2- C "q e0okw ,,//0 City: k F'i:Fii1 I`�7� -State: 4;,., Zip: 3�t`I Qualifier Name:���<10 Phone#: Q -_ State Certification or Registration#: 6 Certificate of Competency#: ..DESIGNER:Archited./EngiReer: 511=t2yetk �l�llaQ��L,�eC �d�tic�P Phone#: _3�0S COG r�-544:S Address: ZS� �y r-2 Ze>a City: 5�6,j: tukPOa State: Zip: :5-31 Value of Work for this Permit:$­3Q nxx> Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New �pRepair/Replace ❑ Demolition o r L. � 4 �d-An�67 r-1 Cmc ( L�+AfC.6®8..o rj iBE�P����e�119161it9ttD0 �^ •� � vvai- (102 OT 11110 51vapi 0s Submittal Fee$ Permit Fee$ � CCF Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ 120 _ Bond$ TOD TOTAL FEE NOW DUE$ (Revised02/24/2014) Bonding Company's Name(if applicable)ff Bonding Company's Address t4 1 City State kA Zip Mortgage Lender's Name(if applicable)�� n Mortgage Lender's AddressCity W State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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. I th absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or CONTRACTOR The foregoing instrument wjas acknowledged before me this The foregoing instrument was acknowledged before me this day of ��UJ y ,20 J�.by �day of 41-11 ,20 1S,by T eri STS,-2F- .who is p�r<„onaiiy k.,.:wwte— �1lsT�N AS 17 ,who is personally known to mAor who has produced /� as me or who has produced Lei--" 'zoo_rJZI-�,_W0 0 identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUB Q Sign: Sign Print: Print: SONY Pdft-811 d ftift C 1 FF 91818'1 Seal: Notary Public-State of Floft Seal: Aly CwAL iBt"Afr 24.2019 My Comm.EKP Ires Aug4.2017 BOnIMiI fif NfBryA�n 9 %•,Fo�� o�.• Commission#FF 40880 �*�a����*�**���*****wsw*��s��•x�* �*� �*�r*�ax�����***x��wm�xx�*s�s��ix+�*e���x*�s�**�x�+xr��*���x�x�x��xx�**�**���x�x��xs�a����a��x APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 ZISQUIT,JUSTIN ALEXANDER BEACH CONTRACTING&REMODELING INC 3921 ALTON ROAD #111 MIAMI BEACH FL 33140 Congratulations! With this license you become one of the one million Floridians licensed by the Department of Business and x Professional Regulation. Our professionals and businesses range STATE OF FLORIDA- from architects to yacht brokers,from boxers to barbeque restaurants, ; DEPARTS T .,,BUSINESS AND { and they keep Florida's economy strong. PROF�� � � ULATION Every day we work to improve the xray we do business in order to CGC 161'6882 f' 08/07/2014 serve you better. For information about our services,please log onto ., � "k www.myfloridelicerme.com. There you can find more information CERTIFIED about our divisions and the regulations that impact you,subscribe to to department newsletters and team more about the Department's initiatives. "SPA Ct1 � �NG'INC Our mission at the Department is:license Efficiently,Regulate Fairly. We constantly strive to serve you better so that you can serve your r customers. Thank you for doing business in Florida, is,_CERrAFIEn under the-provlsions of ch.480 and congratulations on your new licensel « nua ar ams ��aaoors 6 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY ` STATE OF FLORIDA DEPARTMENT OF'BUSINESS,AND PROFESMONAL REGULATION CONSTRUCTI -INDUSTRYLICENSIN6,1BOARD t16t382 a A t The"GENERAL CONTRACT ?R Named below IS;CERTIFIEfl Under the.p"rcr �p;#of Cliaipter ABS FS... Expiratort d6te AU.4�31,ZO I6 � IN - a ZISQUtT"JU$TIN ALE a w .mk �L- &AW EACONtRCT1 �� CHr 's".�"" "^ `^. a. a,'y t*4"�'r y�. `s "'P "'r • s p c I i OQ7973,Yy >° "�4"' dTW'}" rf, � a46 44 QQ'fiat aA;y�YCEa t�p�I�yC,�o-yh.lu'l d z -'s x rt x to iC4 �'a�i 6 s m e�r`aS��,ta�Ni 89 a " s E nad YvtSi a"f "3�kl t pw MWigy veto 4 �d j Ss " r c2.3M, � a 5 _�•C� 1�i 1t,0 '' ��ypp ��x DRIN �{' a Ri1 �yyi�a�4fi� g,at Sid ' "OWNS d¢ SEC $USI{1 C**, ' PA.VMEN *,vm p1� 4�'` CTING C/O �tl GEUIL��NG �}//���� , a TAX CTOi ;� & IR GCi151 a,�a ffta 1y of yi d�'s7c fyr t r � }a rOU 17/20 EDITCI 1,766 y�� 7a�•# �� �� � �' 'p�4 fiat Y � �, k}R, �. s Ibis �7� �� reps pa of tbutrCal Bombs Tim The Reals arx a i 4\ o► ft leans ti� m the �T ,+" '� TE A te! EP CERTIFICATE OF LIABILITY INSURANCE DA07/1M=115) 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 WANED,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 endomeme s. PRODUCER WE: Hanna Sroda METRO INSURANCE AGENCY PHONE 239-466-8600 FAXNo: 239-275-0865 15200 S TAMIAMI TRL SUITE 117 E-MAIL hanna@metroinsurancefl.com INSURERS)AFFORDING COVERAGE NAIL# FT.MYERS FL 33908 INSURERA: Western World Insurance Company 13196 INSURED INSURER B Beach Contracting 8c Remodeling Inc INSURER C: 1935 West Ave,Suite 207 INSURER D: INSURER E: Miami Beach FL 33139 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. IL SR TYPE OF INSURANCE A L BR POLICY NUMBER POLICY EFF M001 OLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ 1,000,000 CLAIMS-MADE ®OCCUR PREMISES Ea Oce'urrexe $ 100,000 MED EXP(Any one person) $ 5,000 A NPP8212278 05/23/2015 05/23/2016 PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000+000 JECT F LOC PRODUCTS-COMProP AGG $ 1,000,000 POLICY 1:1 OTHER: a eN LM T $ AUTOMOBILE LIABILITY Eaddnt $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED BODILY INJURY(Per accident) $ HIREDAUTOS AOAUTOS UTOS (pRer::d DAMAGE $ UM13RELLA UA13 OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y f N SPTF-ARTUTE ERR ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? FIN I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ ifyyes describe under D06RIPTION OF OPERATIONS below E.L.DISEASE-POUCY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORO 101,Additional Remarks Schedule,rosy be attached If more space is required) Painting exterior building exceeding 3 stories in height Contractor General Contractor-License No.CGC1516882, 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 Avenue Miami Shores FL 33138 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Date CERTIFICATE OF LIABILITY INSURANCE 7/16/2015 Producer: Plymouth Insurance Agency This Certificate is Issued as a matter of information only and confers no 2739 U.S. Highway 19 N. rights upon the Certificate Holder. This Certificate does not amend,extend Holiday, FL 34691 or alter the coverage afforded by the policies below. (727) 938-5562 Insurers Affording Coverage NAIC# Insured: South East Personnel Leasing, Inc. &Subsidiaries Insurer A: Uon Insurance Company 11075 2739 U.S. Highway 19 N. Insurer B: Holiday, FL 34691 Insurer C: Insurer D: Insurer E: Coverages The polides of Insurance listed below have bow Issued to the Insurednamed above for the policy period indicated. Notwithstarding any requirement,term or condition of any contract or other document with reaped to which this certificate may be issued or may pertain,the insurance afforded by the pdides described herein is subject to all the terms,exclusions,and conditions of such policies.Aggregate limits shown may have been reduced by paid daims. INSR ADDL Policy Effective Policy Expiration Limits LTR INSRD Type of insurance Policy Number Date Date (MM/DD/YY) (MM/DD/YY) GENERAL LIABILITY Each Occurrence T-- mmercial General Liability Damage to rented premises(EA Claims Made 13Occuroccurrence> Med Exp Pneral aggregate limit applies per: Personal Adv Injury General Aggregate Policy ❑Project 13LOCProducts-Comp/Op Agg TOMOSILE LIABILITY Combined Single Limit Any Auto (EA Accident) $ Bodily Injury All Owned Autos Sdreduled Autos (Per Person) Hired Autos Bodily Injury -Owned Autos (Per Accident) Property Damage (Per Accident) EXCESSIUMBRELLA LIABILITY Each Occurrence Occur El Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2015 01/01/2016WC Statu- OTH- Employers'Liability X to Umits ER Any proprietor/partner/eaecudve officer/member E.L.Each Accident $1,000,000 excluded? NO E.L.Disease-Ea Employee $1,000,000 If Yes,describe under special provisions below. E.L.Disease-Policy Limits $1,000,000 Other Lion Insurance Company is A.M.Best Company rated A-(Excellent). AMB#12616 Descriptions of Operations/LocaUons/VehicloWExclusions added by EndoraementfSpecial Provisions: Client ID: 92-68.600 Coverage only applies to active employee(s)of South East Personnel Leasing,Inc.&Subsidiaries that are leased to the following"Client Company": Beach Contracting&Remodeling Inc Coverage only applies to Injuries Incurred by South East Personnel Leasing,Inc.&Subsidiaries active employee(s),while working in:FL. Coverage does not apply to statutory employee(s)or independent contractors)of the Client Company or any other entity. A list of the active employee(s)leased to the Client Company can be obtained by faxing a request to(727)937-2138 or by calling(727)938-5562. Project Name: JUSTIN ALEXANDER ZISQUIT,LICENSE NO.CGC1516882 AS QUALIFIER/ISSUE 07-16-15(TD) in Date 7/8/2014 CERTIFICATE HOLDER CANCELLATION VILLAGE OF MIAMI SHORES Should any of the above described policies be cancelled before the expiration date thereof,the issuing BUILDING DEPARTMENT insurer will endeavor to met 30 days written notice to the cerdflcate holder named to the left,but failure to do so shall Impose no obligation or liability of any kind upon the insurer,Its agents or representatives. 10050 NE 2ND AVENUE MIAMI SHORES, FL 33138 / Detail by Entity Name Page 1 of 3 f y Detail by Entity Name Florida Not For Profit Corporation HARBOUR CLUB VILLAS CONDOMINIUM CORPORATION, INC. Filing Information Document Number 716710 FEI/EIN Number 591388694 Date Filed 06/10/1969 State FL Status ACTIVE Last Event REINSTATEMENT Event Date Filed 12/06/2013 Principal Address 1530 NORTHEAST 105TH STREET MIAMI SHORES, FL 33138 Changed: 03/13/2012 Mailing Address 1420 NORTHEAST 105TH STREET MIAMI SHORES, FL 33138 Changed: 03/13/2012 Registered Agent Name &Address ROBERT STOBS 1530 NORTHEAST 105TH STREET MIAMI SHORES, FL 33138 Name Changed: 12/06/2013 Address Changed: 12/06/2013 Officer/Director Detail Name&Address Title D/T MAMULA, LOIS 1513 NE 105TH ST MIAMI SHORES, FL 33138 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 7/23/2015 ° Detail by Entity Name Page 2 of 3 Title D/P STOBS, ROBERT J, II 1420 NE 105 ST MIAMI, FL 33138 Title DNP LEONE, CAROLYN 1617 NE 105TH ST MIAMI, FL 33138 Title DIS GOMEZ, MICHELLE 1560 NE 105TH ST MIAMI, FL 33138 Annual Reports Report Year Filed Date 2012 03/13/2012 2014 03/18/2014 2015 04/22/2015 Document Images 04/22/2015--ANNUAL REPORT F View image in PDF format 03/18/2014--ANNUAL REPORT F View image in PDF format 12/06/2013-- REINSTATEMENT F View image in PDF format 03/13/2012 --ANNUAL REPORT F View image in PDF format 02/17/2011 --ANNUAL REPORT View image in PDF format 02/16/2010--ANNUAL REPORT View image in PDF format 06/02/2009--ANNUAL REPORT View image in PDF format 07/27/2008--ANNUAL REPORT View image in PDF format 04/25/2007--ANNUAL REPORT F View image in PDF format 03/14/2006--ANNUAL REPORT F View image in PDF format 03/01/2005--ANNUAL REPORT F View image in PDF format 02/05/2004--ANNUAL REPORT F View image in PDF format -771 02/06/2003--ANNUAL REPORT View image in PDF format 08/21/2002 -- Reg. Agent Change View image in PDF format 02/11/2002--ANNUAL REPORT F View image in PDF format 07/03/2001 --ANNUAL REPORT F View image in PDF format 02/17/2000--ANNUAL REPORT F777View image in PDF format 03/01/1999--ANNUAL REPORT View image in PDF format 05/1111998--ANNUAL REPORT View image in PDF format http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 7/23/2015 r.r— FD Miami Shores Village Building Department INOV 0 6 21J 81 10060 NE 2"s Ave. Miami Shares FL 33138 306--795-22041 Fax 305-756-0972 NOTICE TO-WAMI.SHORES BUILDING IWARTMENT OF EMPLOYMENT AS SPECIAL INSPBCTCRUM13R TEE:IMORIDA BUILDING CODE. I(We)have been retained by Affil OL 40 k to perform special inspeotor services under the [or[a Building Code P kdltlon(2rM4)and Miami D de Co my Administrative Codeattha project on the belowlisted structure as of , t%T (date).I am a registered architect/professional engineer licensed in the State of orlds i Process Number:4L i Special Inspector for RaIntbreed Matey,Section 2922.4 of the 1713C P Edition(2014) ' _Mlamt Dade County AdmUstrative Code,Article 11 Section 8.22.Special Inspector for `Trusses>36 ft,long or 6 It,high { Steel Fmning and Conneollons welted or bolted _Sol[Compaction _Precast Attachments Rooting Applications,Lt.Walght.InsulConc. &'e e . Nate:Only the marked bores apply. The following individuals)employed by this,firm or me is authorized representative to pert m limp e 3. �- 4. *Speclal inspectors utilizing authorized representatives shall Insure the authorized representative is nualitled by education or licensare to peabm the dudes assign by Special Inspector. The qualiScatlons shall Include lleensure as a professional engineer or architect graduadon$om as engineering education program in civil or structure(engineering; + graduation ii'om an architectural education program;succe&4MI completion oftheNaM Fundamentals Examination; o . , or registration as building inspector or general contractor, I(we)will ns)tI#y the Miami.Shores Buildhrg.Department of any changes regarding authorized personnel ., performing in$pectivn.services, I(we),understand that a Special Inspector inspection log for each building must be displayed in a convenient location on the site for reference by the Miami Shores Building Department Inspector. All mandatory inspections,as required by the Florida Building Code,mustbe performed by the Miami Shores Building Department.Inspections perfoemed by-the Speolai Inspector hired by the owner are in addition to the mandatory inspections pwfc med by the department, Further,upon completion of work under each Building Permit,I will submit to the Building Inspector at the time ofthe final inspection the completed Inspection log form and a sealed ststament.indicating that,to the best of my knowledge,belief and professional judgment those portions afthe project outlined above meetihe intent of the Florida Building Code are in substanrtial accordance with the approval plans. 0000 ... �r� t 0000 .�- 0000 0000 . . Name Slinell and VAMI 0000, EIV A.ddn. 1 e�'ZFj 9r:•f" W- 10-6 00'00 'h.�f,�.u.��''• �•�•;• * 1132 00 00 * 0000 0000 .. . . 0000 00 00 . % % '° S ATE OF `�s �ORI'd��1 0000. . 0000 . r01VAL . 000. .00 00 i . 0000 . . • . � 0000 0000 • . . •• •. i �•:.. . . . 0000. . v �Fti