Loading...
EL-15-2611 Miami Shores Villages ' 10050 N.E.2nd Avenue NE 'g@" 53 Miami Shores,FL 33138-0000 Phone: (305)795-2204MM X33 ' 33 Expiration: 04/30/2016 Project Address Parcel Number Applicant 1320 NE 103 Street 1132050300030 ALEXANDRA CLARKE Miami Shores, FL Block: Lot: Owner Information Address Phone Cell ALEXANDRA CLARKE 1320 NE 103 ST (305)756-0063 MIAMI SHORES FL 33138-2624 Contractor(s) Phone Cell Phone Valuation: $ 100.00 LS CURTIS INC 305-892-0115 Total Sq Feet: 0 Type of Work:NO ELECTRICAL WORK(PERMIT REQUIRED Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# EL-10-15-57425 DBPR Fee $2.00 10/15/2015 Check#:4855 $50.00 $64.60 DCA Fee $2.00 Education Surcharge $0.20 11/02/2015 Cash $64.60 $0.00 Permit Fee-AdditionstAiterations $100.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $114.60 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: ce that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and onin ermore,I authorize the above-named contractor to do the work stated. November 02,2016 uthorized u er / Applicant Contractor / Agent Date Building D p ment Copy November 02,2015 1 E( I c_­=Z611-� . Inspection Worksheet Miami Shores Village • 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 nspection Number: INSP-253700 Permit Number: EL-10-15-2611 Inspection Date: March 01,2016 Permit Type: Electrical- Residential Inspector: Devaney, Michael Inspection Type: Final Owner: CLARKE,ALEXANDRA Work Classification: Alteration Job Address:1320 NE 103 Street Miami Shores, FL Phone Number (305)756-0063 Parcel Number 1132050300030 Project: <NONE> Contractor: LS CURTIS INC Phone: (305)892-6501 Building Department Comments NO ELECTRICAL WORK(PERMIT REQUIRED) ( Infractio Passed Comments BATHROOM REMODELING) INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid For Inspections please call: (305)762-4949 February 29,2016 Pagel of 1 Miami Shores VillageEBY: ,� ,;-- _ Building Department 15 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 � Tel:(305)795-2204 Fax:(305)756-8972 --� INSPECTION LINE PHONE NUMBER:(305)762-4949 S4,q FBC 2014 BUILDING Master Permit No.2c 1 S"240(c) PERMIT APPLICATION Sub Permit No. E�JL Is- 2k t/ ❑BUILDING [H ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF ❑CANCELLATION ❑ SHOP I �/ CONTRACTOR DRAWINGS JOB ADDRESS: ( f nV I 5t Citv: Miami Shores Countv: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: /► Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): YfX � �I//7� CA& Phone#: OSA 7/11 Address NE E 2 City:--10(hOjj/A I � � State: Zip: 1 3 Tenant/Lessee Name: Phone#: Email: '/' CONTRACTOR:Company Name: _ (!.//f Phone#: Address: ,,?, toyo��e City: ' � State: "A:f/ Zip: Qualifier Name: + �ly Phone#:_ffjK��,�% l State Certification or Registration#: / L ��� �,,� Certificate of Competency M DESIGNER:Architect/Engineer:_®1�,/� Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: D Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: PJ8 G—Lim[��'�I.[:ht ��(2r1,�C �' ?e5 R_tf T iL&Q17 I (L C,D) Specify color of color thru tile: s¢ Submittal Fee$ _-7(J 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$ In • �_ (Remed02/24/2014) s +� Bonding Company's Name(if applicable) IA-- 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. J Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrum t was acknowledged before me this The foregoing instrument was cknowledged before me this day of _'20,- by _!1day of / •C ,20/S' ,by �ilssonally known who,w�41y-Ic me or who has produced as me or who has produced as identification and who did take an oath. identification and who di an oath. NOTARY PUP IC: NOTARY PUBLIC: Sign* Sign: M MMIA :•: �-*:_MYEXPM6J*2S-.M6 COMMMSM#EE 218418 Pri Print Seal: Seal: 1407'30'63 �`o•'• LEXYCM7EY * * WISSIONI�EEOW d EXPIRES: ism? * *** * * s1> * x*wxx*s.x* *six**spar**rr*rrrxxwe**saa*a * axwxss** sx* s * * APPROVED BY Ao7-'40P'-4,7_/J_Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD {850}487-1395 VM 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 CURTIS, LEWIS STEVEN L.S.CURTIS INC 20341 NE 30TH AVE APT 108 AVENTURA FL 33180 Congratulations! \Kith this license you become one of-the nearly one million Floridians licensed by the Department of Susiness and Professional Reguiation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTRl1E T t�F lr3US,I�I SS AND and they keep Florida's economy strong. n ,..-` PROFESSIE L°``E IEGULA'FION Every day we work to improve the way we do business in order to ECO003175 I9SUI OW2912014 serve you better. For information about our services,please log onto www.myfloddolicense.com. There you can find more information CERTIFIED ELECTRICAI..0O3t4ItRAAC CR about our divisions and the regulations that impact you,subscribe CURTIS,LEWIS S�EVEN to department newsletters and learn more about the Department's L.S.CURTIS INS` initiatives. " R< Our mission at the Department is:License Effidiently,Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in FloridaISCERTIFIED under-the provisions 010h.499 FS. , and congratulations on your new license! 1x ,4 Auc a1,lois Lt40Mo=874 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWS.0141,SECRETARY. i STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD ECtl001f7s The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 CURTIS, LEWIS STEVEN L.B.CURTIS IMC — = 20341 NE•30TH AV *1.03 .�; .AVI?_NTURA; =FV33(80 2, - ISSUED: 0*6Q x034 DISPLAY AS REQUIRED BY LAW SEC!# L14052W=874 3 xWS52 Lr x + u, Ma�iwtl Caunfy, Stade zaf Iorrtla CHIS, IS Ntl 13iLL -DCI NOT PAY 5108006 eusulrss tvr>�nrit_ac,� fiatu +cr*rIcs. 1 Cuxis�r�c 3 , 201 2Oa41 ( ,3fl:AVE 108.` 4� t1` Ei taiarittlispigyu3ttpefbusiness AVRA,.FI.331 80'; Pursuauat toauty cods CbsalurltA £. &10 OWNERSEC.TYPE OF 810,411 " PAYN3E1<I� REGEIVEP. LSCUtiT#S-INC X86 EL G"iRICIiL� iCTtyA 6Y TAXGt)t1ECTOR Wo t er't) t CC{)0431Z6 .5,013 07/21/2015 z CREbffCARD-15--037 3 This k4esT$u'sitresis Telt Racotpt only msonliir+ns payment of tk i 8usinoss Tax The Rtli¢elpt.is not a licenso, parmlk*a cartiticatipn althe holiTar s.qualilicatiatms,to do business.Holder must comply utith my ilovernmentai or aoAgovernmental;rugtl{story Idtdiffi bf8 requirements which�ppllr to the business. Tho RECEIPT NO.above must he tllsp yad on all commercial vehicles-Miami-0ado CodeSec 8a-276. for antra HRpmmation,visit 4 i CERTIFICATE OF LIABILITY INSURANCE DATE100/26/14IM14` """' 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(les)must be endorsed. If SUBROGATION IS WANED,subject to the temis 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). CONTACT STACY PARKS PRODUCER tN Insurance Industries PHE , (305)891-2808 AX No• (305)891-6367 953 N.E.125th St. L stacyansuranceindustrissinc com N.Miami,FL 33161 INsu S AFFORDING COVERAGE NAIL# Phone 305)891-2808 Fax (305)891-6367 INSURER A: UNITED STATES LIABILTY INSURANCE CO INSURED INSURER B: LS CURTIS INC. INSURER C: 20341 NE 30 Ave 5108-6 INSURER D: AVENTURA,FL 33180- (305)892-0115 INSURER E: INS RER 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. INSR1TYPE OF INSURANCE ADD BviuPOLICY NUMBER MPOLICY EFF MPS EXP LIMITS GENERAL W161UTY MlD EACH OCCURRENCE $ 1,000,000.00 DAMA•E TO RENTED 1 000 0 COMMERCIAL GENERAL LIABILITY PREMISES Ea ocamerns $ .00 ❑ ❑ CLAIMS-MADE © OCCUR CL 1676233 MED EXP(Any one perm $ 5,000.00 A y 10/262014 10/26/2015 PERSONAL&ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000.00 ❑ POLICY ❑ PRO- ❑ LOC �Epp $ AUTOMOBILE LIABILITY a aBgdent INGLE LIMIT ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident $ ❑ AUTOS ❑ AUTOS P OPER DAMAGE F-1HIREDAUTOS E] AUTONON-OS �� � $ El 0 EACH OCCURRENCE $ F] UMBRELLA LIAR OCCUR ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED El RETENTION s $ WORKERS COMPENSATION WC STATU OTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICEMMEMBER EXCLUDED? N I A (Mandatory In NH) 1-1 E.L.DISEASE-EA EMPLOYE $ It yes describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,ft more space Is required) ELECTRICIAN CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 AVE MIAMI SHORES,FL.33138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105)QF The ACORD name and logo are registered marks of ACORD * 3 F CERTIFICATE OF ABILITY I1 1�t NCE tzo� 5 Ttn CEMWAUU SM ASA MATMOF 0dWMT=,OKY AM COWERS NOW W. MUPWYMCOMWATEROLOWILTH13 CEffN"1MV10fS Wff AFFOWAVMY OR "7WELY AMM,WM OR AL OVMGE AFPORM BY THE POLICES BELOW IM CERTIFM E Cf RA14M I IST COM'T1T M A CKINMCt$ RN' 1RM(S},AWnWREED /OW.P111099MANDIM ruFhC�Ae�7E�w�aa{Xgt„�E pQ� g��� �►y/���y/ � �g�� ff SUBi\V117A7IIVtt�WAWED,8W4M t6WY 10:40"ath o' Las). SIM AUTOMATIC DATA PROCESSING INS AGCY 7%-S* t�ac cox 250717 P F. PO BOX 33015 NOW SAN ANTONIO TX 78265 A:talar. city F Fre ins Co a= mac: L. S. CURTIS INC. OUMN o: 20341 NE 30TH AVE APT 108 tea' AVENTURA FL 33180 ®: Common CERTIIrtCAtE!4U PQM MINIM. . . THS a TO CERTIFY THAT THE POUICIES OF INSURANCE LOTED BEWW HAVE BEEN ISSUED TO THE WSURED WOW AB{Nfr I "TK POU CY PERIOD INDICATED. NOTWITIMANDING ANY REQ UIREIMa.TIS OR CONDMON OF ANY COWRACT OR OTHER SENT iR nH.RESPECT TO WHICH THIS CERTWATE MAY BE WWD OR sil'AY PERTAtK THE ICUMNCE AFFORDED BY THE POLICIES OESCRISED HEREIN IS SWECT 10 ALL.THE 7ERMWCLUsxm AND COMMIONS OF SUCH POLK3ES.LIAPTS SHOWN MAY HAVE BEEN REDUCED 0Y PAED CLAIMS. xsT time ra�tr aAM paucrxr rca .COM4WWAALQ9MWALUA9WY EAC1 OCCURROCE DAMAGE TO REMTED CLAW.W09 r—JOCCUR IE7CP{A�raoiepD B PERSONft6ADV0IA" EsNERAt A6ffACE POLCGY PR!} lDC PRODUCTS-C AGO J6CT OVER: ACiWI t S U46WY O LDMT AWAUTO ALLO AUTOS I AUTOS PROPIOM DAMAGE B 1IlY,CNAiRY IF D WASOAUT4 AUTOS UMBRELLALMB OCCUR EACHOCCURFANCE EINAWLIAS CLAWAS4MOE H04 X 11000,000 8T ANY <xua F-L EACHA r 11 000,000 WA 76 WEG TR4954 CS/01/2^15 05/01/2t;16 E.4D1SSAW-EA DYEE 11000,000 E.L m sE.paLr.rtwT $1, 000,000 oa�c ,arlurzrmsr l61.Aaa�al R ,aws�r bo Rasp�¢o Those usual to the Insured's Operations. 9SOR AYE CA1► EUA>" 1 4 4 .SHOULD ANY OF THE ABOVE DESCRIBED POLV,,1ES BE CANCELLED Miami, Shores Village BEFORE THE EXPIRATMDATE THIEREOF.NOTICE WILLBE Building Department 10050 N.E. 2nd Ave. Miami Shores, FL 33138 AC r reseN"ved. At=25(2014101) The AC0R0 r www and logo we Fegistered nwrks of ACORD '®`� CERTIFICATE OF LIABILITY INSURANCE DATFIO/28DMfYI� 10/28/15 o 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: K the certificate holder is an ADDITIONAL INSURED,the policy([")must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement Astatement on this certificate does not confer rights to the certificate holder In lieu of such endomement(s). PRODUCER STACY PARKS Insurance industries fA.NE (W6)891-2808T305 1-6367 953 N.E.125th St L stacy@insuranceindustdesinc.com N.Miami,FL 33161 INSU AFFORDING COVERAGE NAIL# Phone (305)WI-28M Fax (305)891-6367 INSURER A: MOUNT VERNON FIRE INSURANCE COMPANY INSURED INSURER 8: MERCURY INSURANCE COMPANY LS CURTIS INC. INSURER C: UNITED STATES LIABILITY INSURANCE COMPANY 20341 NE 30 Ave #108-6 INSURE D: AVENTURA,FL 33180- (305)892-0115 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. ADDLSUILT NSR TYPE OF INSURANCE B POLICY NUMBER PO Y EFFim Y EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 AMAGO RENTED 0 COMMERCIAL GENERAL LIABILITY PREMISES(Eq occurrence) $ 100,000.00 A ❑ ❑ CLAIMS-MADE d❑ OCCUR Y Y CL 1676233 10/26/2015 10/26/2016 MED EXP(Anyone person $ 5,000.00 F-1PERSONAL&ADV INJURY $ 1,00,000.00 ❑ GENERAL AGGREGATE $ 2,000 000.00 GENT.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000.00 ❑ POLICY ❑ PRO• ❑ LOC $ AUTOMOBILE LIABILITY 0=1INGLE LIMIT 1,0(}0 000.00 ❑ ANY AUTO BODILY INJURY(Per person) $ B ❑ ALL OWNED © SAUTOSCHEDULEDY Y BA09000WM29 04/2012015 04/20/2016 BODILY INJURY(Per aoddent $ ❑ NON-OWNED rHIRED AUTOS ❑ AUTOS per ent AMAGE $ $ ❑ UMBRELLA UAB 0 OCCUR XSL015WI B EACH OCCURRENCE $ 2,000,000.00 t~ d EXCESS Lola ❑cLAIMs-MADE Y Y 10/26/2015 10/26/2016 AGGREGATE $ 2,000,000.00 El DED 0 RETENTION $ WORKERS COMPENSATION WC STATU- OTH AND EMPLOYERS'LIABILITY Y I NPR ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N I A (Mandatory ands In t der El E.L DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101.Addhlonai Remarks Schedule,H more space Is required) ELECTRICIAN:The certificate holder is an additional insured With regards to general labiity when required by written contract scheduled auto:2008 lexus es350. blanket additional insured. waiver of sutlogation. CERTIFICATE HOLDER CANCELLATION SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2 AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FL.33138 AUTHORIZED REPRESENTATIVE ''ll dam' ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)OF The ACORD name and logo are registered marks of ACORD