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EL-15-2820
'�c o a Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-254356 Permit Number: EL-11-15-2820 Scheduled Inspection Date: March 11,2016 Permit Type: Electrical- Residential Inspector: Devaney, Michael Inspection Type: Final Owner: DEVELOPEMENT LLC,OORT Work Classification: Alteration or 1011000 Job Address.326 NE 92 Street Miami Shores, FL 33138- Phone Number (305)842-8745 Parcel Number 1132060136470 Project: <NONE> Contractor: AAA ON TIME ELECTRIC INC Phone: (786)2954748 Building Department Comments ELECTRICAL SWITCHES AND OUTLETS FOR KITCHEN Infractlo Passed Comments (2)SWITCHES,(10)OUTLETS INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-253886. CREATED AS REINSPECTION FOR INSP-249997. CREATED AS REINSPECTION FOR INSP-249480. CREATED AS REINSPECTION FOR INSP 249216. CREATED AS REINSPECTION FOR INSP 249137. Cabinets not complete. Failed ❑ Add receptacles to meet minimum spacing. Dedicated circuits need 20 amp. receptacle. 16 dec 15 Correction Remove dry wall from kitchen to expose conductors. No rough inspection Needed and dich washer and disposal in#14 not#12. 23 dec. 15 Remove dry wall to expose cables in kitchen, Small appliance circuits to be#12 not#14 conductors. Re-Inspection a 1 mar 16 Fee No plans or permit on site. Remove surface mounted light fixture from above the bath tub. Add arc fault breakers and 20 amp. receptacle for clothes washer. No Additional Inspections can be scheduled until g mar. 16 re-inspection fee is paid no access at 3:18 p. m. �I�OA1� March 10,2016 For Inspections please call: (305)762.4949 Page 22 of 34 p � Lw i Miami Shores Village 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 r Phone: (305)795-2204 Project Address Parcel Number Applicant 326 NE 92 Street 1132060136470 INTER-TEN LLC Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell INTER-TEN LLC 6187 NW 167 Street (305)842-8745 HIALEAH FL 33015- 6187 NW 167 Street HIALEAH FL 33015- Contractor(s) Phone Cell Phone Valuation: $ 1,500.00 AAA ON TIME ELECTRIC INC (786)295-1748rr g A MM F y Total Sq Feet: 0 Type of Work:ELECTRICAL SWITCHES AND OUTLETS FOR Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# EL-11-15-57673 DBPR Fee $3.38 11/05/2015 Cash $50.00 $193.96 DCA Fee $3.38 Education Surcharge $0.40 12/07/2015 Credit Card $193.96 $0.00 Permit Fee-Additions/Aiterations $225.00 Scanning Fee $8.00 Technology Fee $1.60 Total: $243.96 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 zoning. F rm , authorize the above-named contractor to do the work stated. December 07,2015 Authorized gnature:Owner / Applicant / Contractor / Agent Date Building Department Copy December 07,2015 1 QC « 4�L 15--2j-2-o v r� CERTIFICATE OF LIABILITY INSURANCE DATE(MIWDD1 02/26/201Y 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 poo)must be endorsed.N SUBROGATION 13 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 endoreement(s). PRODUCER CONTACT NAME: PHONE A/CNo Ext): 1.800-277-1620 x4800 FAX A/C No): 72 797-0704 FrankCrum Insurance Agency,Inc. E-MAIL ADDRESS: 100 South Missouri Avenue INSURER(S)AFFORDING COVERAGE NAIL# Clearwater FL 33756 INSURER A Frank Winston Crum Insurance Co. 11600 INSURED INSURER B: INSURER C: FrankCrum UC/F A A A On Time Electric,Inc. INSURERD: 100 South Missouri Avenue INSURER E: Clearwater FL 33756 INSURER F: COVERAGES CERTIFICATE NUMBER: 366669 REVISION NUMBER: 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. am TYPE OF INSURANCE ADDL. BURR POLICY NUMBER POLICY EFF POLICY EXP Lim" LTR UBIRD VAfD (MMMOfYYYY) (MM101)"YY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY T $ CLAIMS-MADE OCCUR MED EXP Wry erne Person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTSCOMKOPAGG $ POLICY PROJECT F—ILOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ment ANY AUTO BODILY INJURY $ ALL DINNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per aodderd) $ HIREDAUTOS NON-OW44M PROPERTY DAMAGE $ AUTOS (Per acdderM UMBRELLA LUIS OCWR EACH OCURRENCE $ EXCESS UAB CLAIMS-AMDE AGGREGATE $ DED RETENTION$ $ WORKERS coMPENSATION AND WC201600000 01/01/2016 01/01/2017 X we sTATuroRY oTH- A EMPIAYERS LIABILITY y ER ANY PROPRMTOWARTNER EXECJJTPM OFFICERJMEM TER EXCLUDED? N/A E.L.EACH ACCIDENT 1000 000 Okada"in NH) Ifyes,desaibeundor EL DISEASE-EA EMPLOYEE $1000000 DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $1.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Addltionai Remarks,Schedule,If more space is requhed) Effective 09/07/2015,coverage Is for 100%of the employees of FrankCrum leased to A A A On Time Electric,Inc.(Client)for whom the client is reporting hours to FrankCrum.Coverage is not extended to statutory employees. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Aventura AUTHORQED REPMSENTATIVE 19200 West Country Club Drive Aventura,FL 33180 ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/06) The ACORD name and logo are registered marks of ACORD Miami Shores VillageFBY: INIT D ^� Building Department 5 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 20 BUILDING (waster Permit No. c (1 SZ-6Z9 PERMIT APPLICATION Sub Permit No. -F L I S- ?q zo ❑BUILDING rKELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING F-I MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP 97, CONT CTOR DRAWINGS JOB ADDRESS: N•� c' City Miami Shores County: Miami Dade Zia: 533 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: 4Flooc}Zone BFE: FFE:-111t a OWNER:Name(Fee Simple Titleholder): ��/ r�'C my, L7 0'o/ Pltorte#: � g -? Address: i�• a�. �C - City: i CC_ State: Zip: 33 1 Tenant/Lessee Name: Phone#: Email: / M CONTRACTOR• ompany Name: AAA `) C— / �� Phone#: -7 -2q 5-1 / Address: City: State: Zip: Qualifier Name: �°��� Phone#: �1® State Certification or Registration#: ZAZ zV4 Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ ,ter,��� . W� Square/Linear Footage of Work: (6 i Type of Work: ❑ Addition//L`_'r Alteration +�❑ New ❑ Repair/Replace ❑ Demolition Description of Work: �lGs/— �/ cJ ���+ � -A ®- � Specify color of color thru We: 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$_( (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 CONDITIP.NERS,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 rAGENT CONTRACTOR The foregoing trument ways acknowledged before me this The foregoing instrument was ackno ledged before me this day of S�.C ,20 JJ by C0 day of S 7' 20 Q'5 ,by who is pIE22nally known to is personally known to me or who has du d as me or who has produced as identification nd who id take an ath. identificat n and who did take an oath. NOTARY PU UC: NOTAPBEi�� Sign• Sign• Print: C' PrintS LIME Seal: � '•• * W1 VM' Seal: Jose Luis Soft EXPIRES:JM 9,2019 '�,� MYtWMINIM a 9uats B=WTiwBadgetN6"S0ft ************************************************************************************************************ APPROVED BY l ?Ao'ep`fa Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) __.._................. RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION . . ELE=CTRICAL CONTRACTORS LICENSING BOARD EC13�2896 The ELECTRICAL CONTRACTOR. Named below IS CERTIFIED Under the provision of Chapter 489 FS. lration date: AUG 31,2016 KATZMAN, ROBERT , AAA-ON TIME ELECTRI041W . 651 N W 100 TERP, MIAMI ISSUED: 06/08/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1406080001745 Lecal Business Tax Recei pt Miami-Dade County, State of Florida -THIS IS NOT A BILL-00 NOT PAY 5188263 BUSINESS NAhWE/LOCATION AAA ON TIME ELECTRIC INC RECEIPT NO. EXPIRES����� MI TE RENEWAL , 2016 MIAMI,,FLL 3315050 SEPTEMBER 30 3629756 ' Must be displayed at place of business Pursuant to County Code Chapter BA-Art.9&10 OWNER AAA ON TIME ELECTRIC INC SEC.TYPE OF BUSINESS C/O JOSE LUIS SALADIN 196 ELECTRICAL PAYMENT RECEIVED CONTRACTOR BY TAX COLLECTOR Worker(s) 1 EC13002896 75.00 09/30/2015 This Local Business Tax Receipt only cannot, Local 0230-15-002247 oennit or a carHRCatbrr of the holder's quelificatioag t do busirressBHaidersmust came Receipt is am a license. 9Mf meatal regulatory laws and regairemants which a ph with any oovenmrer� The RECEIPT WD,above tNlSt be displayed on all Cfl Pph tO the business. MIAM imnarcial vehicles-Miami-D ® Far more information,vlsit Code Sac 8a-Z& L�a.miamidade gpp j��IL��f RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY _ STATE OF FLORIDA DEPARTMENT OF.BUSINESS AND.PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD EC13O02896 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 KATZMAN, ROBERT g Y AAA-ON TIME ELECTR# . 651 N W 100-4L31 ORR. 1� 4 , MIAMI FC ISSUED: 06/08/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1406080001745 Local Business axecei t _ Miami-Dade County, State of Florida -THIS IS NOT A BILL_DO NOT PAY 5188263 BUSINESS NAME/LOCATION AAA ON TIME ELECTRIC INC RECEIPT NO. ���'��� MI I. 100 3150ERR 362975 RENEWAL SEPTEMBER 30, 2016 MIAMI, FL 33150 3629756 ' Must be displayed at place of business Pursuant to County Code Chapter 8A-Art.9&10 OWNER AAA ON TIME ELECTRIC INC SEC.TYPE OF BUSINESS C/O JOSE LUIS SALADIN 196 ELECTRICAL. PAYMENT RECEIVED CONTRACTOR SY TAX COLLECTOR Worker(s) 1 EC 13002896 75.00 09/30/2015 This Local Business Tax Receipt ongr caifimts 0230-15-002247 Permit or a cerRRoatisa nf dte hoidees uai PaYmaot the Local Business Tax.:be Receipt or oongover g iRoations.to do business.Halder is nota mound ranemal regulatory laws and requiremems which a t cmTMPM with etry tWvernmer�! The RECEIPT N0.above displayed PPIY to the business. MIAM 0-9 be dis la ed on all commtrrercial vehicles-Alarm-Dade Code See Re.,276. For more information,visit tsRU.t�t CERTIFICATE OF INSURANCE ISSUE DATE 11/4/2015 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 CONRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUDER,AND THE CERTIFICATE HOLDER IMPORTANT:IF THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED,THE POLICY(IES)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 INSURER(S)AFFORDING COVERAGE Investments Corporation INSURER A. Western World Insurance Company a5a3 sw s St � y Miami,FL 33135 INSURER B: N/A INSURED INSURER C: NIA AAA On Time Electric Inc 651 NW 100th Terrace INSURER D: N/A Miami,FL 33150 INSURER E: N/A COVERAGES 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. INSR TYPE OF POLICY POLICY POLICY LIMITS LTR INSURANCE NUMBER EFFECTIVE DATE EXPIRATION DATE General Aggregate $2,000,000 Products-Com/Op Agg• $1,000,000 A General Liability NPP1419827 9262015 9262016 Personal&Adv.Injury $1,000,000 Each Occurrence $1,000,000 Damage Prem Rented To You $100,000 Med Expense(Any one person) $5,000 Combined Single Limit B Personal Liability Medical Payments To Others Each Occurrence C Excess Liability Aggregate D Building E Property Contents Loss Of Use IS INSURANCE IS ISSUED PURSUANT TO THE FLORIDA SURPLUS LINES LAW.PERSONS INSURED BY SURPLUS LINES CARRIERS DO NOT HAVE THE PROTECTION OF THE FLORIDA GUARANTY ACT TO THE EXTENT OF ANY RIGHT OF RECOVERY FOR THE OBLIGATION OF AN INSOLVENT UNLICENSED INSURER. SURPLUS LINES INSURERS'POLICY RATES AND FORMS ARE NOT APPROVED BY ANY FLORIDA REGULATORY AGENCY. Description of Operations/Specialty Items Electrical Work within buildings Certificate Holder Should arty of the above described policies be cancelled before the expiration date Miami Shores Village tmeof,notice will be deihrered in accordance with the policy provisions. 10050 NE 2nd Ave Autlorhwd Signature Miami Shores,FL 33138 41;r�" CERTIFICATE OF LIABILITY INSURANCE �`�0412016 THIS CERTIFICATE 18 ISSUED AS A(NATTER 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(8t AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IIIORTANT:B the certificate holder Is an ADDITIONAL INSURED,the policy(las)must be endorsed.K SUBROGATION IS WANED,subject to the tens and conditions of the po0ay,certain pow may require an endorsement A stetemem on this cwditate does not confer rights to the certlflcata holler M INu of such endosamerd(s). PRODUCER CONTACT NAME PHONE AIC No : 14K0.2T/--1620 x4600 FAX NO Mn 797.0704 FrankCrum Insurance Agency,Inc. E41LNLADDRESS: 100 South Missouri Avenue INSURERLM AFFORDING COVERAGE NAM Clearwater FL 33756 INSURER A: Frank Whreton Cnan Insurance Co. 11600 INSURED INSURER B: INSURER C FrankCnan LIGF A A A On Time Electric,Inc. INSURER or I W South Missouri Avenue INSURER E: Clearwater FL 33756 INSURER F: COVERAGES CERTIFICATE NUMBER. 327205 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLE OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INIKIRED NAM ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIRBIIIENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOMMIENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DI BES HEREIN B SUBJECT TO ALL THE TERMS,EXCLU AND CONDITIONS OF SUCH POLICIES.LDDTS SHOWN MAY HAVE BEEN REDUCED BY PND CLAM alit AM SIIBR POUCYBFP POUCYEV 6TR TYPB�B RAr�E now VOIDPOUC1fta yyy) U111018 seiWRALU►BBnY ECH OOCURREWXa eAMAeETORMW PREMISED Ea oe errenae a CLANSMAN =OCCUR MW ID W(A W One perew) a PERSONAL a AM NAM a GENMWAs ATE a OEM A«a:EaATEUWTAPPUTSPM CABS a POLICY PROJECT r7um a AUTOKOBM UABBm C NEO MOLE UNIT a Oi ell, ANYAM BOOLYNJURY Par ereen a AMCAAAW SCHEOULM AUTOS AUTOS BOOBY Mw(fteodderm a HMMROS PROPERTY 010064M a AUTOS s UMSREUA UAS OCCUR EACH EfESSUA9 HCLANSMA[z AO TE a IOW I IRMEWM$ $ TA YE c ersATmroutAom VYC201600000 01/012015 01/01/2016 X MITAMORY OT,,. EwrPLO A UAr8>< Y/N LBsra ER OF MNIA E.L.EA H 000 T7(fxlJ�? (Me"ted"W we ayes 11e under E.L.MSEASE{A T> Pnaa OFOPHtAIIONSI AI UWT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Renrerhs,S B more space IS oequhedl Effective 09/07/2015,coverage is for 100%of the employees of FrankCrum leased to A A A On Time Electric,Inc.(Client)for whom the client Is reporting hours to FrankCrum.Coverage is not extended to statutory employees. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCR)BED POUCIES DE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE VMTH THE POLICY PROVISIONS. Miami Shores Ave. A Miami h r2nd Ave. Munni Shores,FL 33138 01NO 2010 ACORD CORPORATIONI.All rights reserved. ACORD 26(20101067 The ACORD name ard logo are regi nmft of ACORD 3 � u ®( NOV 12 2 5 14 NSI 'A C41." fCi) v 'i to V SxISTi -s .. «. 9 STUPE GCI., YD PSMAN i Al D OKE/CARBON MONOXIDE DETECTORS. t.DCAT Y AND ALL CLOTH AND RUBBER ' - " S TE10) D CONDUCTORS TO BE REPLACED. 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