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PLC-15-2977 k: S �F , Miami Shores Village x` + 10050 N.E.2nd Avenue NE � Miami Shores,FL 33138-0000 , Phone: (305)795-2204 Expiration: 08/31/2016 Project Address Parcel Number Applicant 11300 NE 2 Avenue Number: Wiegand &Anr 1121360010160-09 BARRY UNIVERSITY INC Miami Shores, FL 33138-0000 Block: Lot: Owner Information Address Phone Cell BARRY UNIVERSITY INC 11300 NE 2 Avenue MIAMI SHORES FL 33161-6628 11300 NE 2 Avenue MIAMI SHORES FL 33161-6628 Contractor(s) Phone Cell Phone Valuation: $ 850.00 THE NEW MIAMI SHORES PLUMBING (305)751-2446 (786)553-5424 Total Sq Feet: 0 Type of Work:REMOVE EXISTING SINK AND INSTALL NE Available Inspections: Type of Piping: Inspection Type: Additional Info: Final Classification:Residential Review Plumbing Scanning:1 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.80 Invoice# PLC-11-15-57887 DBPR Fee $2'25 11/25/2015 Credit Card $50.00 $109.10 DCA Fee $2.25 Education Surcharge $0.20 03/04/2016 Credit Card $ 109.10 $0.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $159.10 In consideration of the issuance to me of this permit, I agr a to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,dra gs,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work do by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WIN WS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing i forma i is accurate and that all work will be done in compliance with all applicable laws regulating construction and zona g. Futhermore,I authorize the a ove-na contractor to do the work stated. March 04,2016 Authorized Signature:Owner / Applica / ractor / Agent Date Building Department Copy March 04,2016 1 s R-EC:EIVE : Miami Shores Village M R10 3 2016 Building Department BY: 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 r Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION UNE PHONE NUMBER:(305)762-4949 S� FBC 201` :BUILDING Master Permit No. Cc IG— 2 V PERMIT APPLICATION Sub PermitNL.t _c )S" 2-q--T� ❑BUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL PLUMBING ❑MECHANICAL ❑PUBLIC WORKS X CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 11300 NE 2 Avenue-Weigand Hall City: Miami Shores County: Miami Dade Zia• 1 G j Folio/Parcel#:11-2136-000-0050 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Barry University Phone#:305-899-3785 Address:11300 NE 2 Avenue city: Miami Shores State: FL Zip: 33161 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: The New Miami Shores Plumbing Phone#: 305-751-2446 Address: 900 NW 144 Street City: Miami State: FL Zip: 33168 Qualifier Name: Dennis McLaughlin Phone#: State Certification or Registration M CFC019205 `Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ �7.�(�,~ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration M New ❑ Repair/Replace ❑ Demolition Description of Work: Installation of grease trap and waste piping Specify color of color thru We: 0 Submittal Fee$ Permit Fee$ PSS ._ CCF$ Q - 6b CO/CC$ Scanning Fee$ `l?-' Radon Fee$ < �� DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ . (Revised02/24/2014) 1 BoAg Company's Name(if applicable) r acing Company's Address City State zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant. As a condition to the issuance of a building permit with an estimated value exceeding$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 properly is subject to attachment. Also, a certified copy of the recorded notice of commence ent must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued I sence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. AZSignature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing insLent was acknowledged before me this day of ZY*" ,20 1 L,by SUSAN RS'E'14k.1 day of F2 bru Q ry 20 Jam,by Donn i S M . , who is personally known to me or who has produced who is personally known to me or who has produced F�L— As identification and who did take an oath. tD►_ as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: ``���giuulurtti Sign: Sign: VAMJ" =_ Print: r PumiarAbot1 Print: Van- as 4 My Commission Expires: MY Commb"1P I 1 My Commission Expires: 0V.'oQ wu t:�pxa„H?1�18 11 /2-4111 %-,�99�'' ;;':s�a�••�cg,�. BI/C STA�O�t��\\�� APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 3/1=012)(Revised 07/10/07)(Revised 06/10nm)(Revised 3/15/09) Miami Shores Village Building Department NOV 2 6 NIS 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 2014 BUILDING Master Permit No. R-jcA S " Zcl 1� PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: //J OO NE 2 ua�y� Lllt 64,1A SUtt A1A)6 - City: Miami Shores County: Miami Dade Zip: 3311 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: n pe: Flood Zone: BFE: FFE: L'ure64J.6 t ON4 OWNER:Name(Fee Simple Titleholder): tRu; tlo v"�' _ _CO Phone#:-FQ ��q ©6)- Address:—//.?00 IV ' 2 1td , v e- 'S HOP City: jdd 4 4,.c., to A Zip: 3 3/6 Tenant/Lessee Name: Phone#: t Email: ��Q/', q CONTRACTOR:Company Name: ��, � %!U\T,4 AA hone#: /Y o/ Address: 2.4 '86 W t3�y City: /A A)Q State: Zip: Qualifier Name: dvu��l L-� � Phone#: ���i�s?7.�Z®� State Certification or Registration#: C'c /t/2Y64118 ificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: r City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New rVr VcK Repair/Replace ❑ Demolition Description of Work: Fghdb& IW S•T1 c.!6 S&4 K AN>D Pa FL -i UEw -" f A& t3.17.[n.5 Gr?'2.Ac.0 Specify color of color thru tile: Submittal Fee$ 'J Permit Fee$ l -® CCF$ y W CO/CC$ Scanning Fee$ Radon Fee$.. DBPR$ O a Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ F��7 (X-1/jJEP //Ajy j TOTAL FEE NOW DUE$��� d to (Revised0 4/2014) P-'CD / 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. i62Signature Signature OWNER or AGENT RACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 7 day 20 A by .2� day of t�� 20 /-6-- .by eS�n 3-� 'D�who is personally known to ,�Ga?tlJBL.YrVGr ,who is personally knowffto me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: ����`RSI7 //yNOTARY PUBLIC: \\\ •�••.••.•.Q/�N Sig A,} Sign: Print: _L�ie.C4 �i4-���' 5M A ,„,,___ •*= Print: �+' �✓� Seal: %jVAN, , , •. o; Seal: + LISW=ROMAN N, �rcoi►>�sstoi+ as�a2s�s /f/ppll11111N1�� 14A A A A AA An *�****sa**��,��s�*yaw**�*�•x�****�+x a��x*:�se��s*x�**�**s�sx��****�x*sx�s�x**sa**x�a���*****r*aa����x��,x�a���as�**��*�r*s�x�x*�x**�� APPROVED BY 'Z 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 LIMA,EDWELL IMA PROJECTS&INSTALLATION LLC 2488 WEST 64TH PLACE HIALEAH FL 33016 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 frau 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 CFC1428608 ISSUED: 08/1412014 serve you better. For information about our services,please log onto www.myfioridalicense.com. There you can find more information CERTIFIED PLUMBING CONTRACTOR a:due'F our dmsions and the regulations that impact you,subscribe LIMA,EDWELL toment newslettersand learn more about the Departmenrs IMA PROJECTS&INSTALLATION LLC intr Our mission at the Department is:License Efficiently,Regulate Fairly. We ca►stantiv strive to serve you better so that you can serve your customers. nk you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! Exom ion date AUG 31.2016 L14o6140001639 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD4 CFC142MOS The PLUMBING CONTRACTOR Named below IS CERTIFIED 'tr Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 a..LIMA,EDWELLIMA PROJECTS&INSTALLATION LLC2488 WEST 64TH PLACE HIALEAH FL33016 ISSUED: 08/14/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408140001639 -- ------------ -------------- 003124 ...---.. Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOTA BILL - DO NOT PAY kl-LBTI/ 7005499. BUSINESS NAMBJLOCATION RECEIPT NO. EXPIRES ww PROJECTS&INSTALLATION LLC 8BNEIMAL SEPTEMBER 30, 2016 2488 W 64 PL 7280894 Must be displayed at place of business M EAH FL 33016 Pursuant to County Code Chapter aA-Art,9&10 OWNER SEC.TYPE OR BUSINESS [AAA PRO1ECFS&INSTALLATION LLC 196 PLUMBING CONTRACTOR PAYMENT RECEIVED BY TAX CDUJC M CFC1428608 Worker(s) 1 $45.00 09/02/2015 CREDITCARD-15-043708 Thle Load Bt I Tau R-8100* dare Local Basin=Ta>u Tie Beadpt Is as a Basses, vendtora cardficagas of do lder's to do Roldan aoatphtvWiruY ggwaramesW or 1Ince Which q*todwbashreas. In RECEII+T NIX above oust be dsp eW an an egad veM dies-Wam"ade Cde ase Ba 278. Farceurs(aha.reit MrgAWMWgdLwwbK DATE(MM/DD/YYYY) v: CERTIFICATE OF LIABILITY INSURANCE 9/23/2015 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 Ileu of such endorsement(s). PRODUCER SCAOWCT A&D ALL-LINES INS ASSOC INC PHONEiop on 305 463-6781 1 M.N.J305)387-2916 5600 SW 135 Ave Ste 106E-MAILsamador0J5e1JLsoUth.ne Miami, FL 33183 INSURERS AFFORDING COVERAGE NAIC;M SENECA SPECIALTY INS CO INSURED IMA PROJECT & INSTALLATIONS LLC INSURER B: 2488 WEST 64 PL. INSURER C: HIALEAH, FL 33016 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN C� EFFEXP LTR TYPE OF INSURANCE POLICY LICY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE 10 KEN I ED F r _100,000 CLAIMS-MADE OCCUR MED EXP An oneperson) 5 000 A BAG-1022262 05/31/1505/31/16 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 1,000,000 PRO- $ AUTOMOBILE LIABILITY COM NEDSINGLELIMIT- Eaa�d.', ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED P $ AUTOS P UMBRELLA LIABOCCUR EACH OCCURRENCE HCLAIMS-MADE EXCESS LIAB AGGREGATE $ WORKERS COMPENSATION WCSTATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If describe under 0PERATIONSb,,,, E.L.DISEASE-POLICY LIMIT 19 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Addilonal Remarks Schedule,if more space is required) GENERAL CONTRACTOR MECHANICAL CONTRACTOR & PLUMBING CONTRACTOR MIAMI SHORES VILLAGE BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2ND AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES, FL 33138 FAX: 305-756-8972 AUTHORIZED REPRESENTATIVE ©1988-2010 ACOR I rig ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD JEFF ATOWER CMEF FUIMCUL GFRCER STA7EOFDA DEPARTMENT OF FN04Mt9AL SERIAMS DIVISION OMORKERSCOMPENSATION f f CR�R�Y�fQ�rlE OTryp ION TO BE EKEM"T IN=FLt ifs COWMSMT� nk LAWCONSTRUCTION TRY f f This cortices that ft individual listed below has elected b be e>ampt!nun Rocida Workers'Compensation law. EFFEMMDAIB 5!182014 EXPMATIONDATE: 5!172016 PERSON: LIMA EDWELL FEK- 454257955 BUSINESS NAAEAND ADDRESS: p1ilA PROJECTS&INSTALLATION LLC 2488 W 64 PL H IALEAH• FL 33016 SCOPES OFA OR TRADE: LICENSED GENERAL LICENSED PLUMBING HEATING,VENTILATION, CONTRACTOR COWMACTOR Aft-CONO ws,�emcaao�•saasc+n.F.s.endeoerdao�e�.noomde +dpe.s ey�am+ewmdr�+.�rms .� . �clrmoaUa�ltsaamoareet�wda9sdupa.Arr�vtbCfwpk+4a0.a6I126gF�5p.� ,pg,ddanmmbemert�.�mBieeaoe dd�mmdtp�Ossigaal�eaieaWn�ablaN mdpa0aeatle�oemdr�HF�.�Pd��eed >neaniia6aada e0d�--M' aoeml+Rf9�t61�aN dQ�s triaw�mdee TNedepertroaRelAlra�elea edvy6memrt+RvedlM paeaaua. Iton0ea omrmdtlomqube�alsd0aae�Sd 0FS.F2-0WG-M2 CERIF"IE OF ELECTM TO BE E7EbPT REMSED 07-12 OMST10NS?(850)413.160 Bull nons Miami shores Village %=%Voll Building Department 0 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption ­'� 77777- T 77 _7 Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers'compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption 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 CONTENTS. Signature: Aza Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this-947 day of �J4�20 B AS-;o7.-7�/ ...millilliu, who—is personally known to me or has produced N ..,I, — \BIS TAA 28 !p > i 0 No SEAL: % +11 00", MAN M lima 2488 W W Place, Hialeah, FL 33016 Praia cts& installation, LLC Off: 786.487.3209 - Fax:305.647.2160 Date: 11/24/2015 State of Miami—Dade County of Dade Before me this day personally appeared Edwell Lima who, being duly sworn, deposes and says: That he or she will be the only person working on the projects located at: 11300 NE 2"d Ave, Miami Shores, FL 33161 Sworn to (or affirmed) and subscribed before me this 14th day of November. 20 15_, by Edwell Lima Personal know X OR Produced Identification Type of Identification Produced IdW1 r ROMAN MY C0WWSWN/VU12M F.7�IItffi:Jme 28 2016 Print,Type or Stamp Name of Notary