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MC-15-2696 e r Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 nspection Number: INSP-246343 Permit Number: MC-10-15-2696 Inspection Date:April 06,2016 Permit Type: Mechanical - Commercial Inspector: Perez,JanPierre Inspection Type: Final Owner: VILLAGE, MIAMI SHORES Work Classification: A/C Replacement Job Address:10021 NE 2 Avenue Miami Shores, FL Phone Number Parcel Number 1132060134650 Project: <NONE> Contractor: C&R AIR CONDITIONING CO Phone: 305-685-6394 Building Department Comments EXACT REPLACEMENT OF 7 1/2 TON SPLIT SYSTEM Infractio Passed Comments INSPECTOR COMMENTS False �V C� Inspector Comments Passed Failed Correction Needed Re-Inspection a Fee No Additional Inspections can be scheduled until re-inspection fee is paid For Inspections please call: (305)762-4949 April 06,2016 Page 1 of 1 SUMMETRIK INC. MISIM ^"^F@M e& MW=W;wllT%e CONTFQ^CTOFq Office Use Only- 980 WEST PROSPECT RD FT.LAUDERDALE FL.33309 Arrival Time: 12:30PM PH:964-358-7696 FAX:954-358-7696 Departure Time. e:W M EMAIL:info@symmetrFk.us Total Hrs: L5 CONTRACTOR LICENSE#EF20000738 SERVICE TICKET Technician:ELTON SERVICE PROCEDURES... Date: MARCH 14,2016 Requested By:MICHELLE B. 0 INSTALL,WIRE,PROGRAM AND TEST DUCT DETEC- TOR INTO EXISTING FIRE ALARM PANEL.. Job Name:BROCKWAY LIBRARY Job Address: 10021 NE SECOND AVENUE City: MIAMI SHORES State: FL Zip: 33138 Phone:(305)758.8107 Appt Time:MIDDAY Description of Service Type: FIRE ALARM SERVICES O Now a Add a Repair p False Alarm- O Bypass/Dis Q Clear p GF O Vandalism O Water Damage O Lightning O Emergency Call O COD Actual Work Performed: UPON ARRIVAL,TECHNICIAN INSTALLED&WIRED THE DUCT a Completed DETECTOR INTO EXISITING FIRE ALARM PANEL ONCE THE INSTALLATION PROCESS 0 Parts Required WAS COMPLETE,THE TECHNICIAN PROGRAMMED&TEST THE DEVICE 0 Return UPON DEPARTURE PANEL CLEAR& IN NORMAL STATUS. Hrs.On-Site:5.5 Travel Time: 1 HR Total Hrs.:6.5 HRS Technician(s): 1 xR Materials Used: OR 0 Materials Needed: QTY DescriDtion: QTY Descriotion: Model#. Labor. Materials: Sub-Total: Total Due: 0 Cash 0 Check Acknowledgement I acknowledge the satisfactory completion of the work as described above and receipt of an exact and completely filled in copy of this work order repair form. Authorized Agent Signature Date: 8 Reg. Normal Business Hrs(Mon thru Fri gam-5pm) After Hours(Holiday&Weekends) Print Name: Time: CHECK REQUEST FORM VENDOR NUMBER DATE: November 25, 2015 MAKE CHECK PAYABLE TO: C&R AIR CONDITIONING CO PLEASE INDICATE MAIL CHECK:YES X NO MAILING ADDRESS: 6073 NW 167 ST#C-4 MIAMI, FL 33015 IF"NO"GIVE CHECK TO: BUILDING DEPT AMOUNT OF CHECK: $50.00 BUDGET ACCOUNT N0: ACOUNT NUMBER AMOUNT 001-24-0400-00-322-000-PERMIT FEE 50.00 REASON FOR PURCHASE: Reimbursement for Miami Shores project MC15- 2696. No permit fee required. CHECK REQUESTED BY: ` 'iZ4,- 11 DEPARTMENT HEAD ISMAEL NARANJO G e Miami Shores Village 10050 N.E.2nd Avenue NE ; .... iy Miami Shores,FL 33138-0000 Phone: (305)795-2204 V a 3 M Expiration:04/27/2016 E Project Address Parcel Number Applicant 10021 NE 2 Avenue 1132060134650 MIAMI SHORES VILLAGE Miami Shores, FL Block: Lot: Owner Information Address Phone Cell MIAMI SHORES VILLAGE Contractor(s) Phone Cell Phone Valuation: $ 8,795.00 VAL SANCHEZ,LLC (305)962-9175 C&R AIR CONDITIONING CO 305-685-6394 T(954)680-4494 Total Sq Feet: 0 Tons:71/2 Available Inspections: Additional Info:EXACT REPLACEMENT OF 71/2 TON SPLI Inspection Type: Classification:Commercial Final Approved:In Review Review Mechanical Comments: Date Approved::In Review Date Denied: Type of Work: Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.00 Invoice# MC-10-15-57522 DBPR Fee $0.00 10/22/2015 Credit Card $50.00 $0.00 DCA Fee $0.00 Education Surcharge $0.00 Permit Fee $50.00 Scanning Fee $0.00 Technology Fee $0.00 Total: $50.00 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,MEC ICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the f i on i te and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I autho' e v -i o t or to do the work stated. October 30,2015 Authorized Signature:Owner / Applicant Contra o / Agent Date Building Department Copy October 30,2015 1 1�l Miami Shores EBY: es VillageBuilding Department za,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 201q BUILDING Master Permit No. ISG 15- 26% PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING [A MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 10021 N E dn. A viC City: Miami Shores Coun : Miami Dade zip: 33 1. Follo/Parcel#: is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction p Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 'V & bri � ALVA-- Phone#: 304''7T9 8107 Address: 1 0 4 �2:� N 6 a A-J,* City: A�i g m I S k 0 Q'r '& State: FF., Zip:X12I j Tenant/Lessee Name: Phone#: 3 0y -?,fal' jfI G-7 Email: CONTRACTOR:Company Name: + 9 l �Q Zr (,o4 .C 0 Phone#:j 0�-6 6 ��a9q Address: 6 0 7.1 N W 161 J'r C - q SQualCity: t M State: F1 Zip:,33 0 I's- Qualifier ifier Name: is 6 e r q C k f 3 -', Phone#: State Certification or Registration#: C A C 0 k b y 14 Certificate of Competency#: 1`4 9 810 2 3 DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: p Value of Work for this Permit:$ O q Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New [ Repair/Re lace �7 p El Demolition Description of Work: / Z. �M 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$ ic. (Rev1sed02/24/2014) 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 i h promise in good fatthat 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 CONTFLYCTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of OU 66UL 20 t!5 by gal day of 20I�,by u h-ef e BYi w n ,who personally know o t yd who i1 ] dersona`ITy know o 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 PUBUC: NOTARY PUBLIC: Sign: Sign* ut"< �r Print: 8 C hr f`J Print ✓1 a E PQ Vl Z Seal: ROBERT J.11::; T hJANET KRANZ r C #FF 088047 Sea I: ;; *� Commission#FF 197298 Expkes May 24,2018 Expires May 9,2019 BondsdThnhgFeadmam1a�09tli918 Mz '� OwdedThuTmyFah kwmroe=6Ma18 ############################################ ############################################################## APPROVED BY �� 1 s Examiner Zoning 16 v 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 CHRYST, ROBERT JAMES C&R AIR CONDITIONING COMPANY 6073 N.W. 167TH ST., C-4 MIAMI FL 33015 Congratulationsl With this license you become one of the nearly y = one million Floridians.licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA s from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFEq$j-' � ",Rf GULATION Every day we work to improve the way we do business in order to CACO26414F a� SUE%!�,ti07/03/2014 serve you better. For Information about our services,please log onto '{ www.myfloridalleense.com. There you can find mors informationIt, CERTIFIED Alk., N `GlDHTR ;; about our divisions and the regulations that impact you,subscribe to department newsletters and learn more about the Departments CHRYST,ROB C&Ft AIR C0 .4.11 i+11IVt3 : a� initiatives. ,• ,�, .v r� `d. ,>..`, Our mission at the Department is:License Efficiently,Regulate Fairly. We constantly strive to serve you better so that you can serve your Customers. Thank you for doing business In Florida, IS CERTLFIEp under,the provisions of Ch.489 FS. and congratulations on your new license! Expkadondeo •AUO 31,2016 L1407030000714 DETACH HERE ...........................................-...._.............._........................................................................................................................................................-..._......................................_._............._..._-..................._.........-..............-.............................. .... RICK SCOTT,GOVERNOR ..-KEN LAW ,4E6RETARY .STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD P CACO26414 The CLASS AAIR CONDITIONING CONTRACTOR-1 ONTRACTOR a. . Named below IS CERTIFIED Under the provisions of Chapter 489 F.S. �> Expiration date: AUG 31,2016 'rr+ ea CHRYST, ROBERT JAME --w b C&RAIR CON pI , ONIN 6073 N.W..167TH T.yr .. � ..* L3. � -F30 . .. .�' .•',� .T49.d5 "' ''PIH 4'� dsy8,, v�t,�, � 4MIAMI • • Y - r .- e - we5Y+ 36s.i�`~ 1.,"F Jq•tl '1.�3{: .yAe,.. �'4LF4 '"B4'.+�1'a .. .. _ v .C . ,. 000290 ` Local Business Tax Receipt Miami—Dade County,;; State , of* .FloridaBT . —THIS IS NOTA BILL — DO NOTPAY e 488023 + ` BUSINESS NAM•I?/LOCATION RECEIPT NO. EXPIRES C&RAIR CONDITIONING CO RENEWAL SEPTEMBER 30, 2016 6073 NW 167 ST C4 488023 Must be displayed at place of business . MIAMI FL 33015 Pursuant to'County Code 4 Chapter 8A—Art.9&10 k OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED C&R AIR CONDITIONING CO 196 SPEC MECHANICAL CONTRACTOR BY TAX COLLECTOR r Worker(s) 10 CACO2641,4 $75.00 07/09/2015 CHECK21-15-085930 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's qualifications,to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles—Miami—Dade Code Sec 8a-276. For more information,visit www.miamidads.nov/tazcollector ACC> CERTIFICATE OF LIABILITY INSURANCE DATE`M '°""" 411 . 1 8/27/2015 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 polls (hes)must be endorsed. If SUBROGATION IS WAIVED,stnwect to the terms and conditions of the policy,certain policies may require an endorsement, A statement on this certificate does net confer rights to the Certificate holder to lieu of such endorse s PRODUCER Mangy Zuniga Gil, Garden, Avetrani Insurance Group HRI &M(30S)630-4777 � � ��aNA}:(305)279-3022 10689 N. Kendall Drive E _anzuniga@ggaig-com Suite 208 INSURE 8 AFFORDINt3 COVBRAtiE NAtC# Miami FL 33176 #NSURERA:FCCI 10178 INSURED INSURER ri C 6 R Air Conditioning Company tNSUREitC: 6073 NW 167th Street INSURERD: Suite C-4 INSURER E: Miami Gardens FL 33015 F: COVERAGES CERTIFICATE NUMSER:CL1:582007341 REVISION NUMBER: THIS is TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED RCO—W HAVE BE>8+i 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, L R TYPE OF INSURA6iF`6s POLICY ADM VUBR awn EXP LIMITS X COMMERCIAL C3ENERt#i.k1AI C ctrl EACH OCCURRENCE s 11000,000 A CLAIMS-MADE Ez'aCGUl2 Mt s 100,000 OL00060658 9/1/2015 9/1/2016 MEDEXPdAtlram ppTson) 3 5,000 PERSONAL.&ADV INJURY 3 1,000,000 GEitiLAGGREGATE UMiTAPPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY El xT F�LOC PRODUCTS-CQMPIC}P AcG S 2,000,000 E OTHER E 'Osrt8fd9 $ AUTOMOBILE LIABILITY COMBINED SINGLELIMIT $ ANY AUTO 8400ILY INJURY'(Per poman) $ ALLOVAED SCHEDULED AUTOS AUIJTOS BODILY INJURY(Parift*) S NO 483WNE 9 HIRED AUTOS' AUTOS IOP RTY I3AMAt,! 4 t $ UMBRELLBALIA0 OCCUR EACH OCCURRENCE S E%CESS k IABgtg __. Ol ABMS'1HADE ....AGGREGATE Qa CEO V IVORKERS COMPENSATION AND EMPLOYERS•LIABILITY x PER ER TH- ANY PiROPRIETORIPARTNSWEXECunvE YIN TU OFFKXPA4EM99R EXCLUDED9 NIA E.L.EACH ACCIDENT $,000 A (UNwah"hI N OOIWC13ASS728 6/31/2015 8/3112016E.L.DISEASE-EA EMPLOYEE S 100 000 NOF E.L DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS 1 LOCAMRS 11tEHICLES(ACORD 101,AddIdaml Remarks Sehequla,Maybe attached 0 more"we is regWred) AC Mechanical Contractor Lice # CA026414 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village eSof Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL 13E DELIVERED IN Ci ty ACCORDANCE VWT14 THE POLICY PROVISIONS. 18050 NE; 2 Avenue Miami Shores, FL 33138 AUTHORIM REPRESENTATIVE Ernie Sariol/PM 01OW2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS026(aln4m) PC- is -- ---- _ Miami Shores Village 'VF1D F1D Building Department OCT 2 2 2815 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 AIR CONDITIONING REPCEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change-out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address(where the work is being done): 10091 NE J A vc /'�:A rh i X�or to F p City: Miami Shores Village County: Miami Dade Zip Code: ;3 3 3 O ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ;ARHI RIDATA SHEET REQUIRED Change disconnecting means:YES❑ NO Sheet Attached:YES ❑ NO ❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER 0®g ® AHU or PKG. UNIT MODEL# O k U AAO& k—q-1 IF I MA btu S 14 0 COND.UNIT MODEL# 3FrAU2A08 10 KW HEAT 10 S NOM TONS 7 -17 AHU CU PKG 1)M.C.A AHU--V-LCU.34,%PKG AHU CU PKG 2)M.O.P AHU140 CUBO PKG AHU CU PKG 3)VOLTS AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER YES NO REPLACING DUCTS YES O YES NO REPLACING THERMOSTAT NO YES NO NEW 4"CONCRETE SLAB YES O YES NO NEW ROOF STAND YES N YES NO I NEW RETURN PLENUM BOX YES N 1. Minimum Circuit Ampacity(Wire Size): # 6 2. Maximum Overcurrent Protection (Fuse/Breakepr•sicei: • +s.0• •• 3. Voltage of Circuit(208/ 40 480): 3.'1 ;•; ;•; ••. 4. Size Disconnecting Means: Contractors Company Name: ' `� ' ... .t..• ,... �� Phone• .3OS-s RJ J�y • `�t f • . . p �y $ State Certific R istr N . /QC t� L{ '.'t�'esficafe.3f CB?n eten No. 4 � 02 � SignatureI I 11-Z Inn Date: 10 • X l ' IS' (Qual s Ignature) • • • • • • • • • • • • • • • • • • •• •• • • • •• •• ••• • • • ••• • • (Revised02/24/2014) Certificate of Product Rafin S 1 22S.. AHRI Certified Reference Number.8047437 Date: 1011212015 tStatus:Active Product Split System:Air-Cooled Condensing Unit,Coil with Blower Model Number:38AUZ(A,B)08A0*(5,6,1)A* Indoor Model Number.40RUAA08A*A(3,6,IW Manufacturer:CARRIER CORPORATION Trade/Brand name:CARRIER CORPORATION Series dame:CARRIER GEMINI Rated as follows in accordance with AHRI Standard 340/360-2007,Commercial and Industry Unitary Air-Conditloning and Had Pump Equipment and subject to verification of rating Bracy by AHRI-sponsored, independent,third party testing: Refrigerant Used: R-410A Hertz: 60 Cooling Capacity(Btuh): 92000192000 EER Raft(CooRM): 11.20111.20 IEER: 11.8/11.6 Heating Capacity at 47F(Btu h): COP at 47F: Heating Capacity at 17F(BW). COP at 17F: Full Load indoor toll Air Quantity: 3000 The AFBi13401=1 cerO w EMm&w In BWM we cabAnedunderft own meOxxMogtr as the EER m*W at T1 emiR iam of i60 5151210 and ISO 13253.2011. •Pefts fallowed by an a (*)hhftete a voter a of Previously pubWmd data,urdess sownVaded rrnh a WAS,wfdcth Waftefts an bwok rdmy berate. DISCLMMER AM does not endorse the product(s)listed on this Certificate and makes no representations,warranties or guarantees as ta,and assumes no respormitift for, Um profto)filed on this CwditabL AM expressly disclaims afi Rablfitp for dams of any kW adsl g out of the on or performance of the product(s),or the unauthorised alteration of date fisted an this Certlflcats.Certified ratings we vold ordystormodals aW crrnfig woons Usted in the directory at www.ahridirectory.org. • • • • • • • • • TERMS AND CONDITIONS • •• • • • • ••. • IN This Cartificate and its mhterts are proprietary products of AHRL Thb=4tsi bn persomd orb confidential retarire n erwe purposes.T of ttft Cerdficate may whole or hn part,be dissernhmted: entered tato a computer database;or otherwise utMed,In any farm or manner or by arty means,except for the asses Individual, A:-IMI-110 persorad and confidenthd retwence. AIR-CONDITIONING,HEATING, CERTIFICATE VERIFICATION • ••• ••• ••• • •.• &REFRIGERATION INSTITUTE The hdormatlan far tim model cited on tits OertlfieaGe can be v at*vrwvr*eanddireotph?y.or*tock atWgrify Certificate*Mk we make lite betters and ester the AHRI Carfilled Relimince Number and the date OR whk*ft •car Rcate an !_ 0— •i i which Is listed above,and the Certificate No.,Which Is haled at boDo�nt• • . - 02014 Air-Conditioning,Heating,and Refrigeration Institute CEIMOICATE NO.: 130 1485441027083 CBRAI-1 OP ID:MY CERTIFICATE OF LIABILITY INSURANCE D 09103/201 W) 09/03/2014 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 holler is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the tenns and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holier in Ilau of such endorssme s PRODUCER Phone:305.364-7800 SEA.cT BROWN&BROWN OF FLORIDA INC Fax:305-714-4401 PHONE FAX 14900 NW 79th Cant Suite#2Q0 arc No Miami Lakes,FL 330165889 ADDRESS:- House Accounts 1 S AFFORDING COVERAGE MAIC s INWRERA:FCCIInsurance Com n 10178 INSURED C&R Air Conditioning Company INSURER 0: 6073 NW 167 Street,C-4 INSURER C: Miami Gardens,FL 33015 INSURERD: INSURER E: INSURER COVERAGES CERTIFICATE NUMIBER: 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. LTR TYPE OF INSURANCE ADDLSU POLICYEFF POLICYEXP POLICYNUMBER ITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00q A X COMMERCIAL GENERAL LIABILITY GL.00060858 09101/2014 09/01/2015 PREMIsEs Ea occurrence $ 100,00 CLAIMS-MADE �OCCUR MED EXP y aye person) $ 5.00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,1111110,00( GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000, X POLICY PRO Loc $ AUTOMOBILE LL48HJTY COMBINE= OOMB mSINGLE UMI $ ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per a=kbwd) $ AUTOS AUTOS HIRED AUTOS NON-OWNED Peraa�de D E $ UMBRELLA LIAS OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WGRKERSCOMPENSATION X I WCSTATU- OTH. AND EMPLOYERS'LIABILITYA ANY PROPRIETOWPARTNER/EXECUnVE YIN TORY LIMUS 001WC73A55728 08131/2014 08/3112015 EL EACH ACCIDENT $ 1.000. OFRCER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOY $ 100100 I yas,describe under OEBCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 100.00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 191.Additional Remarks Schedule,Irrr•re space Is rsqubraM 00• ••• • • • • •• • CERTIFICATE HOLDER •• • . . •• NDAAi BLs xnoN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ••• • ••• ••• CION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Miami Gardens i e i •• «• MICE WITH THE POLICY PROVISIONS. 1515 NW 167 Street • • • • • • • •• Blgd 4 Suite 175 ••• ••• ••• AUnrO ••APRESENTATIVE Miami Gardens,FL -� • • • *00 • • • ®1988.2010 ACORD CORPORATION. AN rights reserved. ACORD 25(2010105) The A • • • • • • • • • • marks of ACORD